Sample records for providing statewide systems

  1. Private provider participation in statewide immunization registries

    Directory of Open Access Journals (Sweden)

    Cowan Anne E


    Full Text Available Abstract Background Population-based registries have been promoted as an effective method to improve childhood immunization rates, yet rates of registry participation in the private sector are low. We sought to describe, through a national overview, the perspectives of childhood immunization providers in private practice regarding factors associated with participation or non-participation in immunization registries. Methods Two mailed surveys, one for 264 private practices identified as registry non-participants and the other for 971 identified as registry participants, from 15 of the 31 states with population-based statewide immunization registries. Frequency distributions were calculated separately for non-participants and participants regarding the physician-reported factors that influenced decisions related to registry participation. Pearson chi-square tests of independence were used to assess associations among categorical variables. Results Overall response rate was 62% (N = 756. Among non-participants, easy access to records of vaccines provided at other sites (N = 101, 68% and printable immunization records (N = 82, 55% were most often cited as "very important" potential benefits of a registry, while the most commonly cited barriers to participation were too much cost/staff time (N = 36, 38% and that the practice has its own system for recording and monitoring immunizations (N = 35, 37%. Among registry participants, most reported using the registry to input data on vaccines administered (N = 326, 87% and to review immunization records of individual patients (N = 302, 81%. A minority reported using it to assess their practice's immunization coverage (N = 110, 29% or generate reminder/recall notices (N = 54, 14%. Few participants reported experiencing "significant" problems with the registry; the most often cited was cost/staff time to use the registry (N = 71, 20%. Conclusion Most registry participants report active participation with few

  2. Evaluation of a Statewide Education Management Information System. (United States)

    Bahn, Theodore I.; Maas, John


    This summary of a recent evaluation of the Minnesota Management Information System (MIS) focuses on problems encountered during its evolution and on options available to solve those problems. A delineation between state and district information needs is provided, with an emphasis on statewide standards for reporting educational needs. (MER)

  3. Road weather information system statewide implementation plan. (United States)


    The objective of this project was to develop a plan for deploying a statewide RWIS to support both current NYSDOT operations and future MDSS applications. To develop the plan, various information and data sources were investigated, including the curr...

  4. The 10 Conditions That Increased Vermont's Readiness to Implement Statewide Health System Transformation. (United States)

    Grembowski, David; Marcus-Smith, Miriam


    Following an arduous, 6-year policy-making process, Vermont is the first state implementing a unified, statewide all-payer integrated delivery system with value-based payment, along with aligned medical and social service reforms, for almost all residents and providers in a state. Commercial, Medicare, and Medicaid value-based payment for most Vermonters will be administered through a new statewide accountable care organization in 2018-2022. The purpose of this article is to describe the 10 conditions that increased Vermont's readiness to implement statewide system transformation. The authors reviewed documents, conducted internet searches of public information, interviewed key informants annually in 2014-2016, cross-validated factual and narrative interpretation, and performed content analyses to derive conditions that increased readiness and their implications for policy and practice. Four social conditions (leadership champions; a common vision; collaborative culture; social capital and collective efficacy) and 6 support conditions (money; statewide data; legal infrastructure; federal policy promoting payment reform; delivery system transformation aligned with payment reform; personnel skilled in system reform) increased Vermont's readiness for system transformation. Vermont's experience indicates that increasing statewide readiness for reform is slow, incremental, and exhausting to overcome the sheer inertia of large fee-based systems. The new payments may work because statewide, uniform population-based payment will affect the health care of almost all Vermonters, creating statewide, uniform provider incentives to reduce volume and making the current fee-based system less viable. The conditions for readiness and statewide system transformation may be more likely in states with regulated markets, like Vermont, than in states with highly competitive markets.

  5. The Cornell Cooperative Extension Statewide Data Collection System: An Online Data Collection Tool for Parent Education Programs (United States)

    Kopko, Kimberly; Dunifon, Rachel


    The Statewide Data Collection System for Parent Education Programs is an online tool for collecting statewide data on Cornell Cooperative Extension (CCE) parenting education programs. The process of the development and use of this data collection tool are provided as a guide to Extension systems. Results for data entered between March 2009 and…

  6. 45 CFR 1355.52 - Funding authority for statewide automated child welfare information systems (SACWIS). (United States)


    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Funding authority for statewide automated child welfare information systems (SACWIS). 1355.52 Section 1355.52 Public Welfare Regulations Relating to... welfare information systems (SACWIS). (a) States may receive Federal reimbursement at the 75 percent match...

  7. Integrating a framework for conducting public health systems research into statewide operations-based exercises to improve emergency preparedness. (United States)

    Hunter, Jennifer C; Yang, Jane E; Petrie, Michael; Aragón, Tomás J


    Due to the uncommon nature of large-scale disasters and emergencies, public health practitioners often turn to simulated emergencies, known as "exercises", for preparedness assessment and improvement. Under the right conditions, exercises can also be used to conduct original public health systems research. This paper describes the integration of a research framework into a statewide operations-based exercise program in California as a systems-based approach for studying public health emergency preparedness and response. We developed a research framework based on the premise that operations-based exercises conducted by medical and public health agencies can be described using epidemiologic concepts. Using this framework, we conducted a survey of key local and regional medical and health agencies throughout California following the 2010 Statewide Medical and Health Exercise. The survey evaluated: (1) the emergency preparedness capabilities activated and functions performed in response to the emergency scenario, and (2) the major challenges to inter-organizational communications and information management. Thirty-five local health departments (LHDs), 24 local emergency medical services (EMS) agencies, 121 hospitals, and 5 Regional Disaster Medical and Health Coordinators/Specialists (RDMHC) responded to our survey, representing 57%, 77%, 26% and 83%, respectively, of target agencies in California. We found two sets of response capabilities were activated during the 2010 Statewide Exercise: a set of core capabilities that were common across all agencies, and a set of agency-specific capabilities that were more common among certain agency types. With respect to one response capability in particular, inter-organizational information sharing, we found that the majority of respondents' comments were related to the complete or partial failure of communications equipment or systems. Using the 2010 Statewide Exercise in California as an opportunity to develop our research

  8. Integrating a framework for conducting public health systems research into statewide operations-based exercises to improve emergency preparedness

    Directory of Open Access Journals (Sweden)

    Hunter Jennifer C


    Full Text Available Abstract Background Due to the uncommon nature of large-scale disasters and emergencies, public health practitioners often turn to simulated emergencies, known as “exercises”, for preparedness assessment and improvement. Under the right conditions, exercises can also be used to conduct original public health systems research. This paper describes the integration of a research framework into a statewide operations-based exercise program in California as a systems-based approach for studying public health emergency preparedness and response. Methods We developed a research framework based on the premise that operations-based exercises conducted by medical and public health agencies can be described using epidemiologic concepts. Using this framework, we conducted a survey of key local and regional medical and health agencies throughout California following the 2010 Statewide Medical and Health Exercise. The survey evaluated: (1 the emergency preparedness capabilities activated and functions performed in response to the emergency scenario, and (2 the major challenges to inter-organizational communications and information management. Results Thirty-five local health departments (LHDs, 24 local emergency medical services (EMS agencies, 121 hospitals, and 5 Regional Disaster Medical and Health Coordinators/Specialists (RDMHC responded to our survey, representing 57%, 77%, 26% and 83%, respectively, of target agencies in California. We found two sets of response capabilities were activated during the 2010 Statewide Exercise: a set of core capabilities that were common across all agencies, and a set of agency-specific capabilities that were more common among certain agency types. With respect to one response capability in particular, inter-organizational information sharing, we found that the majority of respondents’ comments were related to the complete or partial failure of communications equipment or systems. Conclusions Using the 2010 Statewide

  9. Statewide Planning for Postsecondary Education: Issues and Design. (United States)

    Glenny, Lyman A., Ed.; Weathersby, George B., Ed.

    The purposes of this publication are twofold: (1) to provide a state-of-the-art discussion of statewide planning for postsecondary education for the wide audience of the higher education community; and (2) to identify major areas amenable to future research and development of improved statewide planning and management systems. The contents of the…

  10. Leveraging a Statewide Clinical Data Warehouse to Expand Boundaries of the Learning Health System. (United States)

    Turley, Christine B; Obeid, Jihad; Larsen, Rick; Fryar, Katrina M; Lenert, Leslie; Bjorn, Arik; Lyons, Genevieve; Moskowitz, Jay; Sanderson, Iain


    Learning Health Systems (LHS) require accessible, usable health data and a culture of collaboration-a challenge for any single system, let alone disparate organizations, with macro- and micro-systems. Recently, the National Science Foundation described this important setting as a cyber-social ecosystem. In 2004, in an effort to create a platform for transforming health in South Carolina, Health Sciences South Carolina (HSSC) was established as a research collaboration of the largest health systems, academic medical centers and research intensive universities in South Carolina. With work beginning in 2010, HSSC unveiled an integrated Clinical Data Warehouse (CDW) in 2013 as a crucial anchor to a statewide LHS. This CDW integrates data from independent health systems in near-real time, and harmonizes the data for aggregation and use in research. With records from over 2.7 million unique patients spanning 9 years, this multi-institutional statewide clinical research repository allows integrated individualized patient-level data to be used for multiple population health and biomedical research purposes. In the first 21 months of operation, more than 2,800 de-identified queries occurred through i2b2, with 116 users. HSSC has developed and implemented solutions to complex issues emphasizing anti-competitiveness and participatory governance, and serves as a recognized model to organizations working to improve healthcare quality by extending the traditional borders of learning health systems.

  11. Building Capacity for Trauma-Informed Care in the Child Welfare System: Initial Results of a Statewide Implementation. (United States)

    Lang, Jason M; Campbell, Kimberly; Shanley, Paul; Crusto, Cindy A; Connell, Christian M


    Exposure to childhood trauma is a major public health concern and is especially prevalent among children in the child welfare system (CWS). State and tribal CWSs are increasingly focusing efforts on identifying and serving children exposed to trauma through the creation of trauma-informed systems. This evaluation of a statewide initiative in Connecticut describes the strategies used to create a trauma-informed CWS, including workforce development, trauma screening, policy change, and improved access to evidence-based trauma-focused treatments during the initial 2-year implementation period. Changes in system readiness and capacity to deliver trauma-informed care were evaluated using stratified random samples of child welfare staff who completed a comprehensive assessment prior to (N = 223) and 2 years following implementation (N = 231). Results indicated significant improvements in trauma-informed knowledge, practice, and collaboration across nearly all child welfare domains assessed, suggesting system-wide improvements in readiness and capacity to provide trauma-informed care. Variability across domains was observed, and frontline staff reported greater improvements than supervisors/managers in some domains. Lessons learned and recommendations for implementation and evaluation of trauma-informed care in child welfare and other child-serving systems are discussed. © The Author(s) 2016.

  12. The Soft Underbelly of System Change: The Role of Leadership and Organizational Climate in Turnover during Statewide Behavioral Health Reform. (United States)

    Aarons, Gregory A; Sommerfeld, David H; Willging, Cathleen E


    This study examined leadership, organizational climate, staff turnover intentions, and voluntary turnover during a large-scale statewide behavioral health system reform. The initial data collection occurred nine months after initiation of the reform with a follow-up round of data collected 18 months later. A self-administered structured assessment was completed by 190 participants (administrators, support staff, providers) employed by 14 agencies. Key variables included leadership, organizational climate, turnover intentions, turnover, and reform-related financial stress ("low" versus "high") experienced by the agencies. Analyses revealed that positive leadership was related to a stronger empowering climate in both high and low stress agencies. However, the association between more positive leadership and lower demoralizing climate was evident only in high stress agencies. For both types of agencies empowering climate was negatively associated with turnover intentions, and demoralizing climate was associated with stronger turnover intentions. Turnover intentions were positively associated with voluntary turnover. Results suggest that strong leadership is particularly important in times of system and organizational change and may reduce poor climate associated with turnover intentions and turnover. Leadership and organizational context should be addressed to retain staff during these periods of systemic change.

  13. The Soft Underbelly of System Change: The Role of Leadership and Organizational Climate in Turnover during Statewide Behavioral Health Reform (United States)

    Aarons, Gregory A.; Sommerfeld, David H.; Willging, Cathleen E.


    This study examined leadership, organizational climate, staff turnover intentions, and voluntary turnover during a large-scale statewide behavioral health system reform. The initial data collection occurred nine months after initiation of the reform with a follow-up round of data collected 18 months later. A self-administered structured assessment was completed by 190 participants (administrators, support staff, providers) employed by 14 agencies. Key variables included leadership, organizational climate, turnover intentions, turnover, and reform-related financial stress (“low” versus “high”) experienced by the agencies. Analyses revealed that positive leadership was related to a stronger empowering climate in both high and low stress agencies. However, the association between more positive leadership and lower demoralizing climate was evident only in high stress agencies. For both types of agencies empowering climate was negatively associated with turnover intentions, and demoralizing climate was associated with stronger turnover intentions. Turnover intentions were positively associated with voluntary turnover. Results suggest that strong leadership is particularly important in times of system and organizational change and may reduce poor climate associated with turnover intentions and turnover. Leadership and organizational context should be addressed to retain staff during these periods of systemic change. PMID:22229021

  14. Emergency Department Visits Prior to Suicide and Homicide: Linking Statewide Surveillance Systems. (United States)

    Cerel, Julie; Singleton, Michael D; Brown, Margaret M; Brown, Sabrina V; Bush, Heather M; Brancado, Candice J


    Emergency departments (EDs) serve a wide range of patients who present at risk of impending suicide and homicide. Two statewide surveillance systems were probabilistically linked to understand who utilizes EDs and then dies violently within 6 weeks. Each identified case was matched with four randomly selected controls on sex, race, date of birth, resident zip code, and date of ED visit vs. date of death. Matched-pair odds ratios were estimated by conditional logistic regression to assess differences between cases and controls on reported diagnoses and expected payment sources. Of 1,599 suicides and 569 homicides in the 3-year study period, 10.7% of decedents who died by suicide (mean = 13.6 days) and 8.3% who died by homicide (mean = 16.3 days) were seen in a state ED within 6 weeks prior to death. ED attendees who died by suicide were more likely to have a diagnosis of injury/ poisoning diagnosis or mental disorder and more likely to have Medicare. Those who died by homicide were more likely to have a diagnosis of injury/poisoning and less likely to have commercial insurance. It is essential for research to further explore risk factors for imminent suicide and homicide in ED patients who present for psychiatric conditions and general injuries.

  15. The Development and Testing of a Statewide Multilevel Curriculum Management System for Georgia Vocational Education Programs. A Model State Level Curriculum Management System. (United States)

    Scott, Paul; And Others

    A project to propose a system for managing curriculum improvement at the state level (1) identified the basic functions necessary for a statewide curriculum management effort, (2) explained the supporting activities required to initiate and maintain its operation, and (3) developed a model system for curriculum management. The five functions…

  16. Colorado statewide historic bridge inventory. (United States)


    The purpose of the Colorado statewide historic bridge inventory was to document and evaluate the National : Register of Historic Places eligibility all on-system highway bridges and grade separation structures built in : Colorado between 1959 and 196...

  17. The Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Adoption Scale: evaluating the diffusion of a tobacco treatment innovation to a statewide prenatal care program and providers. (United States)

    Windsor, Richard; Cleary, Sean; Ramiah, Kalpana; Clark, Jeannie; Abroms, Lorien; Davis, Amanda


    When a new patient education program is being considered for adoption by a public health agency, it is essential to determine provider perceptions of its acceptability for routine use. In 2007, the West Virginia Bureau of Public Health Perinatal Program, Right From The Start (RFTS), decided to adopt the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Program. RFTS is a statewide perinatal home visitation initiative delivered by designated care coordinators (DCCs). The authors developed the SCRIPT Adoption Scale (SAS) in the absence of a valid instrument to assess the perceived attributes of a tobacco treatment innovation among the RFTS DCC population. They evaluated the validity of the five constructs of the Rogers' Diffusion of Innovations model in an organization (relative advantage, compatibility, complexity, observability, and trialability) to predict SCRIPT use. After reviewing the literature and developing draft SAS forms, 2 expert panel reviews established the face and content validity of a 43-item SAS. It was administered to 90% (85/90) of the RFTS DCC population. Psychometric analyses confirmed the validity and reliability of a 28-item scale. All 28 items had factor loadings greater than 0.40 (range = 0.43-0.81). All SAS subscales were strongly correlated, r = 0.51 to 0.97, supporting the convergent validity of a 5-factor SAS. There was a significant association between the DCC SAS score and DCC SCRIPT Program Implementation Index supporting the SAS convergent (construct) validity (r = 0.38). The SAS internal consistencyr = 0.93 and stabilityr = 0.76. Although 2 specific subscales need to be improved, the SAS can be adapted by prenatal care programs to measure the attributes of adoption of new, evidence-based patient education and counseling methods.

  18. Statewide program to promote institutional delivery in Gujarat, India: who participates and the degree of financial subsidy provided by the Chiranjeevi Yojana program. (United States)

    Sidney, Kristi; Iyer, Veena; Vora, Kranti; Mavalankar, Dileep; De Costa, Ayesha


    The Chiranjeevi Yojana (CY) is a large public-private partnership program in Gujarat, India, under which the state pays private sector obstetricians to provide childbirth services to poor and tribal women. The CY was initiated statewide in 2007 because of the limited ability of the public health sector to provide emergency obstetric care and high out-of-pocket expenditures in the private sector (where most qualified obstetricians work), creating financial access barriers for poor women. Despite a million beneficiaries, there have been few reports studying CY, particularly the proportion of vulnerable women being covered, the expenditures they incur in connection with childbirth, and the level of subsidy provided to beneficiaries by the program. Cross-sectional facility based the survey of participants in three districts of Gujarat in 2012-2013. Women were interviewed to elicit sociodemographic characteristics, out-of-pocket expenditures, and CY program details. Descriptive statistics, chi square, and a multivariable logistic regression were performed. Of the 901 women surveyed in 129 facilities, 150 (16 %) were CY beneficiaries; 336 and 415 delivered in government and private facilities, respectively. Only 36 (24 %) of the 150 CY beneficiaries received a completely cashless delivery. Median out-of-pocket for vaginal/cesarean delivery among CY beneficiaries was $7/$71. The median degree of subsidy for women in CY who delivered vaginally/cesarean was 85/71 % compared to out-of-pocket expenditure of $44/$208 for vaginal/cesarean delivery paid by non-program beneficiaries in the private health sector. CY beneficiaries experienced a substantially subsidized childbirth compared to women who delivered in non-accredited private facilities. However, despite the government's efforts at increasing access to delivery services for poor women in the private sector, uptake was low and very few women experienced a cashless delivery. While the long-term focus remains on

  19. Planning Process and Considerations for a Statewide Academic Libraries Information System in Ohio


    Hwa-Wei Lee


    無Academic libraries in Ohio have led in cooperative library automation, with the establishment of OCLC in 1967 as one example. Beyond OCLC, which provides online shared cataloging, interlibrary loan and the world's largest bibliographic database, many have developed or acquired local systems to meet the needs of individual libraries. A 1986 study by the state Board of Regents recommended development of an Ohio Libraries Information System (OLIS) which would permit students and faculty at any ...

  20. Planning Process and Considerations for a Statewide Academic Libraries Information System in Ohio

    Directory of Open Access Journals (Sweden)

    Hwa-Wei Lee


    Full Text Available 無Academic libraries in Ohio have led in cooperative library automation, with the establishment of OCLC in 1967 as one example. Beyond OCLC, which provides online shared cataloging, interlibrary loan and the world's largest bibliographic database, many have developed or acquired local systems to meet the needs of individual libraries. A 1986 study by the state Board of Regents recommended development of an Ohio Libraries Information System (OLIS which would permit students and faculty at any public university to have full access to the resources at any public university in the state. Beyond bibliographic access, the system emphasizes information delivery. This paper describes the planning process and considerations of the system which will go to REP in June 1989.

  1. Do Photovoltaic Energy Systems Effect Residential Selling Prices? Results from a California Statewide Investigation.

    Energy Technology Data Exchange (ETDEWEB)

    Hoen, Ben; Cappers, Pete; Wiser, Ryan; Thayer, Mark


    An increasing number of homes in the U.S. have sold with photovoltaic (PV) energy systems installed at the time of sale, yet relatively little research exists that provides estimates of the marginal impacts of those PV systems on home sale prices. This research analyzes a large dataset of California homes that sold from 2000 through mid-2009 with PV installed. We find strong evidence that homes with PV systems sold for a premium over comparable homes without PV systems during this time frame. Estimates for this premium expressed in dollars per watt of installed PV range, from roughly $4 to $6.4/watt across the full dataset, to approximately $2.3/watt for new homes, to more than $6/watt for existing homes. A number of ideas for further research are suggested.

  2. Challenges and Progress in Building a Comprehensive Statewide System for Fetal Alcohol Spectrum Disorders Prevention in Hawai'i. (United States)

    Onoye, Jane M; Thompson, Mika D


    Introduction Fetal Alcohol Spectrum Disorders (FASD) has been a maternal and child public health concern in Hawai'i for over the past decade. Methods A historical assessment of FASD related activities was conducted to map the challenges and progress made in building a comprehensive statewide system for FASD prevention and intervention in an island state. Results Progress has primarily been reflected in increasing the number of individuals receiving FASD education and training, as well as some initiatives in public awareness. The creation of a State FASD Coordinator position was significant in catalyzing support for FASD initiatives and extending collaborative networks with national experts/teams, community-based organizations, and other local agencies to leverage resources in a time of economic strain. Major challenges and barriers included loss of the FASD Coordinator position, reliance on external resources and lack of local capacity for training and education integration into existing practice systems, and inadequate surveillance infrastructure. Discussion Lack of funding and resources were a common factor overall, and impeded the development of a state strategic plan which was needed to guide overall efforts and policies into a more coordinated system to reduce and prevent FASDs in Hawai'i.

  3. Connecting statewide health information technology strategy to payment reform. (United States)

    Toussaint, John S; Queram, Christopher; Musser, Josephine W


    To develop an effective way to link statewide healthcare information technology strategy to payment reform. Investigation of what Wisconsin did to develop and publicly share provider performance data and then use those data to drive payment reform. We examine 2 statewide organizations (Wisconsin Collaborative for Healthcare Quality and Wisconsin Health Information Organization) and 1 integrated health system (ThedaCare) to evaluate how they pool data and use those data to measure provider performance. When aggregated data regarding health outcomes are shared, a clearer picture emerges of provider performance baselines and improvements with which payment models can be developed. Aggregating commercial and Medicare claims data will help states to better measure provider performance and to compare providers on quality and cost. The ability to compare performance using broad databases is necessary if the current payment system in the United States is to be reformed.

  4. A Statewide Collaboration: Ohio Level III Trauma Centers' Approach to the Development of a Benchmarking System. (United States)

    Lang, Carrie L; Simon, Diane; Kilgore, Jane

    The American College of Surgeons Committee on Trauma revised the Resources for Optimal Care of the Injured Patient to include the criteria for trauma centers to participate in a risk-adjusted benchmarking system. Trauma Quality Improvement Program is currently the risk-adjusted benchmarking program sponsored by the American College of Surgeons, which will be required of all trauma centers to participate in early 2017. Prior to this, there were no risk-adjusted programs for Level III verified trauma centers. The Ohio Society of Trauma Nurse Leaders is a collaborative group made up of trauma program managers, coordinators, and other trauma leaders who meet 6 times a year. Within this group, a Level III Subcommittee was formed initially to provide a place for the Level III centers to discuss issues specific to the Level III centers. When the new requirement regarding risk-adjustment became official, the subcommittee agreed to begin reporting simple data points with the idea to risk adjust in the future.

  5. Does the Institution of a Statewide Trauma System Reduce Preventable Mortality and Yield a Positive Return on Investment for Taxpayers? (United States)

    Maxson, Todd; Mabry, Charles D; Sutherland, Michael J; Robertson, Ronald D; Booker, James O; Collins, Terry; Spencer, Horace J; Rinker, Charles F; Sanddal, Teri L; Sanddal, Nels D


    In July 2009, Arkansas began to annually fund $20 million for a statewide trauma system (TS). We studied injury deaths both pre-TS (2009) and post-TS (2013 to 2014), with attention to causes of preventive mortality, societal cost of those preventable mortality deaths, and benefit to tax payers of the lives saved. A multi-specialty trauma-expert panel met and reviewed records of 672 decedents (290 pre-TS and 382 post-TS) who met standardized inclusion criteria, were judged potentially salvageable, and were selected by a proportional sampling of the roughly 2,500 annual trauma deaths. Deaths were adjudicated into sub-categories of nonpreventable and preventable causes. The value of lives lost was calculated for those lives potentially saved in the post-TS period. Total preventable mortality was reduced from 30% of cases pre-TS to 16% of cases studied post-TS, a reduction of 14%. Extrapolating a 14% reduction of preventable mortality to the post-TS study period, using the same inclusion criteria of the post-TS, we calculate that 79 lives were saved in 2013 to 2014 due to the institution of a TS. Using a minimal standard estimate of $100,000 value for a life-year, a lifetime value of $2,365,000 per person was saved. This equates to an economic impact of the lives saved of almost $186 million annually, representing a 9-fold return on investment from the $20 million of annual state funding invested in the TS. The implementation of a TS in Arkansas during a 5-year period resulted in a reduction of the preventable death rate to 16% post-TS, and a 9-fold return on investment by the tax payer. Additional life-saving gains can be expected with ongoing financial support and additional system performance-improvement efforts. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  6. The trauma ecosystem: The impact and economics of new trauma centers on a mature statewide trauma system. (United States)

    Ciesla, David J; Pracht, Etienne E; Leitz, Pablo T; Spain, David A; Staudenmayer, Kristan L; Tepas, Joseph J


    Florida serves as a model for the study of trauma system performance. Between 2010 and 2104, 5 new trauma centers were opened alongside 20 existing centers. The purpose of this study was to explore the impact of trauma system expansion on system triage performance and trauma center patients' profiles. A statewide data set was queried for all injury-related discharges from adult acute care hospitals using International Classification of Diseases, Ninth Revision (ICD-9) codes for 2010 and 2014. The data set, inclusion criteria, and definitions of high-risk injury were chosen to match those used by the Florida Department of Health in its trauma registry. Hospitals were classified as existing Level I (E1) or Level II (E2) trauma centers and new E2 (N2) centers. Five N2 centers were established 11.6 to 85.3 miles from existing centers. Field and overall trauma system triage of high-risk patients was less accurate with increased overtriage and no change in undertriage. Annual volume at N2 centers increased but did not change at E1 and E2 centers. In 2014, Patients at E1 and E2 centers were slightly older and less severely injured, while those at N2 centers were substantially younger and more severely injured than in 2010. The injured patient-payer mix changed with a decrease in self-pay and commercial patients and an increase in government-sponsored patients at E1 and E2 centers and an increase in self-pay and commercial patients with a decrease in government-sponsored patients at N2 centers. Designation of new trauma centers in a mature system was associated with a change in established trauma center demographics and economics without an improvement in trauma system triage performance. These findings suggest that the health of an entire trauma system network must be considered in the design and implementation of a regional trauma system. Therapeutic/care management study, level IV; epidemiological, level IV.

  7. Statewide shoulders study. (United States)


    With the ultimate purpose of enhancing safety and improving mobility, the Statewide Shoulders Study was initiated to : develop a prioritized list of candidate locations for shoulder improvements. The need for this study stems directly from : ADOTs...

  8. The relationship between processes and outcomes for injured older adults: a study of a statewide trauma system. (United States)

    Saillant, N N; Earl-Royal, E; Pascual, J L; Allen, S R; Kim, P K; Delgado, M K; Carr, B G; Wiebe, D; Holena, D N


    Age is a risk factor for death, adverse outcomes, and health care use following trauma. The American College of Surgeons' Trauma Quality Improvement Program (TQIP) has published "best practices" of geriatric trauma care; adoption of these guidelines is unknown. We sought to determine which evidence-based geriatric protocols, including TQIP guidelines, were correlated with decreased mortality in Pennsylvania's trauma centers. PA's level I and II trauma centers self-reported adoption of geriatric protocols. Survey data were merged with risk-adjusted mortality data for patients ≥65 from a statewide database, the Pennsylvania Trauma Systems Foundation (PTSF), to compare mortality outlier status and processes of care. Exposures of interest were center-specific processes of care; outcome of interest was PTSF mortality outlier status. 26 of 27 eligible trauma centers participated. There was wide variation in care processes. Four trauma centers were low outliers; three centers were high outliers for risk-adjusted mortality rates in adults ≥65. Results remained consistent when accounting for center volume. The only process associated with mortality outlier status was age-specific solid organ injury protocols (p = 0.04). There was no cumulative effect of multiple evidence-based processes on mortality rate (p = 0.50). We did not see a link between adoption of geriatric best-practices trauma guidelines and reduced mortality at PA trauma centers. The increased susceptibility of elderly to adverse consequences of injury, combined with the rapid growth rate of this demographic, emphasizes the importance of identifying interventions tailored to this population. III. Descriptive.

  9. Development of priority based statewide scour monitoring systems in New England (PDF file) (United States)


    A project was funded by the New England Transportation Consortium to research the creation of a scour monitoring system : that would assist in the allocation of resources during potentially destructive flood events in New England. Emphasis was placed...

  10. Michigan Department of Transportation statewide advanced traffic management system (ATMS) procurement evaluation - phase I : software procurement. (United States)


    This project evaluates the process that was followed by MDOT and other stakeholders for the acquisition : of new Advanced Traffic Management System (ATMS) software aiming to integrate and facilitate the : management of various Intelligent Transportat...

  11. Examining Pre-School Classroom Quality in a Statewide Quality Rating and Improvement System (United States)

    Jeon, Lieny; Buettner, Cynthia K.; Hur, Eunhye


    Background: Research has documented the importance of high-quality early childhood experiences in preparing children for school. Quality rating and improvement systems (QRIS) have recently emerged in many states as a way to build quality of child care and to promote better child outcomes. Objective: The goal of this study was to determine if…

  12. Core to College Evaluation: Statewide Networks. Connecting Education Systems and Stakeholders to Support College Readiness (United States)

    Bracco, Kathy Reeves; Klarin, Becca; Broek, Marie; Austin, Kim; Finkelstein, Neal; Bugler, Daniel; Mundry, Susan


    The Core to College initiative aims to facilitate greater coordination between K-12 and postsecondary education systems around implementation of the Common Core State Standards and aligned assessments. Core to College grants have been awarded to teams in Colorado, Florida, Hawaii, Kentucky, Louisiana, Massachusetts, North Carolina, Oregon,…

  13. Development and dissemination of a statewide system to minimize use of Potentially Inappropriate Medications (PIMs). (United States)

    Bachyrycz, Amy; Dodd, Melanie A; Priloutskaya, Galina


    Drug safety and adverse drug reactions in the community are of concern in the geriatric population. To help decrease the number of adverse drug reactions, the New Mexico Prescription Improvement Coalition created a consensus panel, the Potentially Inappropriate Medications (PIMs) Advisory Board. To develop consensus guidelines that would promote decreasing the use of PIMs, as defined by the Beers' criteria, through the promotion of safer alternative therapies and strategies. A consensus panel of clinical pharmacists, geriatricians, nurses, managed care specialists, and consumers evaluated the Beers' criteria and created clinical guidelines addressing the use of PIMs in older adults and disease state alternative treatment recommendations and strategies. The guidelines were distributed and made available electronically to health care providers. In addition, educational sessions were provided to health care providers throughout the state. Since development of the guidelines in 2009, they have been distributed to over 7500 practitioners and 140 pharmacists throughout New Mexico. The PIMs clinical guidelines were endorsed by 27 state-level health care organizations and have been promoted through several managed care organizations. The Web-based version of the guidelines have been viewed an average of 163 times per month and the alternative treatment recommendations and strategies was viewed an average of 407 times per month. Use of a consensus process to develop and promote guidelines that include alternative treatment recommendations and strategies can increase awareness of the use of medications that require caution in the elderly and promote safer prescribing practices.

  14. Design and Implementation of a Centralized Model of Clinical Education Within a Statewide Health System. (United States)

    Elzy, Pamela Smith


    Today's dynamic health care environment is exceedingly complex, and health care facilities across the United States are struggling to respond to changes in technology, health care reimbursement, the Affordable Care Act, and the much-anticipated nursing shortage. Mergers, acquisitions, and integrations are the current health care reality. These are proposed to increase efficiency, efficacy, quality, satisfaction, and safety while effectively reducing cost to the consumer and stabilizing the economy of the health care system. Many of these projects fail to achieve objectives, even years after the formal change in status. Clinical education departments in merged organizations are often operated in the single-facility mindset, or contain an element of the shared services model. They are not truly integrated. Development of skills in complex analysis of current state, identification of desired scope of service and expectations of performance, and articulation of the benefits of the desired future state are all essential to nursing executive practice. This article describes an experience integrating 3 legacy education departments across 21 facilities into a centralized education system. The complexity of integration activities is illustrated and outcome measures of success are discussed. Barriers, facilitators, and risks of the project are identified and evaluated.

  15. Evaluation of a statewide foodborne illness complaint surveillance system in Minnesota, 2000 through 2006. (United States)

    Li, John; Smith, Kirk; Kaehler, Dawn; Everstine, Karen; Rounds, Josh; Hedberg, Craig


    Foodborne outbreaks are detected by recognition of similar illnesses among persons with a common exposure or by identification of case clusters through pathogen-specific surveillance. PulseNet USA has created a national framework for pathogen-specific surveillance, but no comparable effort has been made to improve surveillance of consumer complaints of suspected foodborne illness. The purpose of this study was to characterize the complaint surveillance system in Minnesota and to evaluate its use for detecting outbreaks. Minnesota Department of Health foodborne illness surveillance data from 2000 through 2006 were analyzed for this study. During this period, consumer complaint surveillance led to detection of 79% of confirmed foodborne outbreaks. Most norovirus infection outbreaks were detected through complaints. Complaint surveillance also directly led or contributed to detection of 25% of salmonellosis outbreaks. Eighty-one percent of complainants did not seek medical attention. The number of ill persons in a complainant's party was significantly associated with a complaint ultimately resulting in identification of a foodborne outbreak. Outbreak confirmation was related to a complainant's ability to identify a common exposure and was likely related to the process by which the Minnesota Department of Health chooses complaints to investigate. A significant difference (P foodborne disease surveillance in Minnesota happens through a multitude of mechanisms. The ability to integrate these mechanisms and carry out rapid investigations leads to improved outbreak detection.

  16. Salvia divinorum: exposures reported to a statewide poison control system over 10 years. (United States)

    Vohra, Rais; Seefeld, Andrew; Cantrell, F Lee; Clark, Richard F


    Salvia divinorum, a hallucinogenic herb, has in recent years become popular among teenagers and young adults. Salvia is presently marketed as a "legal" alternative to other drugs of abuse, but little is known about the clinical toxicity of this substance. The purpose of this study is to describe the clinical and demographic features of this emerging substance of recreational abuse using data obtained from the records of a poison control center. We performed retrospective review of exposures to the herbal hallucinogen Salvia divinorum as reported to the California Poison Control System (CPCS) over the last 10 years. Demographic and clinical data were collected and compiled from the computerized records of the CPCS for the search terms "salvia" and "sage." There were 37 exposures to S. divinorum and 96 exposures to non-hallucinogenic Salvia species. Eighteen (49%) of the exposures were to S. divinorum alone. Intentional Salvia exposures resulted in a variety of neurologic, cardiovascular, and gastrointestinal effects. Notably, the use of concomitant substances of abuse was associated with a high rate of complications and psychomotor disturbances. Intentional use of S. divinorum, whether alone or in combination with alcoholic beverages and other drugs, causes neurologic, cardiovascular, and gastrointestinal effects. This poison-center-based review helps to characterize the clinical toxicity of S. divinorum, but more clinical and pharmacologic research is warranted for this rapidly emerging substance of abuse. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. New Jersey’s Historical Development of a Statewide Children’s System of Care, Including the Lessons Learned From Embedding CANS Tools

    Directory of Open Access Journals (Sweden)

    Kenneth McGill


    Full Text Available New Jersey has made significant investments in their creation of a “statewide” reform to better serve the most vulnerable children and their families. Many states can learn from New Jersey’s statewide reform, which now celebrates completion of its first decade. This article details the historic timeline of the implementation processes as well as the structural components of a system of care. The particular role of each system entity is identified as well as their adaptation of the Child and Adolescent Needs and Strengths (CANS assessment tool to best serve the children/youth in a statewide system of care. This article also examines the methods for effectively training and embedding the CANS tools within New Jersey’s Division of Children’s System of Care (DCSOC. As the children’s system of care (SOC celebrates a milestone and its second decade of existence, much data have been accumulated with the next logical step being a series of reviews and systemic update. Result shows the need for planning for transitioning to adulthood especially among a population profile or 16 years and older, which we referred to as “emerging adult” population.

  18. A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass. (United States)

    Asimos, Andrew W; Ward, Shana; Brice, Jane H; Enright, Dianne; Rosamond, Wayne D; Goldstein, Larry B; Studnek, Jonathan


    Our goal was to determine if a statewide Emergency Medical Services (EMSs) Stroke Triage and Destination Plan (STDP), specifying bypass of hospitals unable to routinely treat stroke patients with thrombolytics (community hospitals), changed bypass frequency of those hospitals. Using a statewide EMS database, we identified stroke patients eligible for community hospital bypass and compared bypass frequency 1-year before and after STDP implementation. Symptom onset time was missing for 48% of pre-STDP (n = 2385) and 29% of post-STDP (n = 1612) cases. Of the remaining cases with geocodable scene addresses, 58% (1301) in the pre-STDP group and 61% (2,078) in the post-STDP group were ineligible for bypass, because a community hospital was not the closest hospital to the stroke event location. Because of missing data records for some EMS agencies in 1 or both study periods, we included EMS agencies from only 49 of 100 North Carolina counties in our analysis. Additionally, we found conflicting hospital classifications by different EMS agencies for 35% of all hospitals (n = 38 of 108). Given these limitations, we found similar community hospital bypass rates before and after STDP implementation (64%, n = 332 of 520 vs. 63%, n = 345 of 552; P = .65). Missing symptom duration time and data records in our state's EMS data system, along with conflicting hospital classifications between EMS agencies limit the ability to study statewide stroke routing protocols. Bypass policies may apply to a minority of patients because a community hospital is not the closest hospital to most stroke events. Given these limitations, we found no difference in community hospital bypass rates after implementation of the STDP. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. SMART Plan. Statewide Management of Automated Record Transfer: A Plan To Automate and Transfer Student Records Statewide. (United States)

    Nevada State Dept. of Education, Carson City. Planning, Research and Evaluation Branch.

    As of 1993, Nevada had no systems for statewide automation and transfer of student records. This guide book presents findings of a collaborative study, conducted by the Nevada Department of Education and local school districts, that explored the need for and feasibility of developing a statewide system for automating and transferring student…

  20. 78 FR 64232 - Notice of Adjustment of Statewide Per Capita Impact Indicator (United States)


    ... SECURITY Federal Emergency Management Agency Notice of Adjustment of Statewide Per Capita Impact Indicator... statewide per capita impact indicator under the Public Assistance program for disasters declared on or after... INFORMATION: 44 CFR 206.48 provides that FEMA will adjust the statewide per capita impact indicator under the...

  1. 78 FR 41026 - Request for Proposals for 2013 Statewide Wood Energy Teams (United States)


    ... Forest Service Request for Proposals for 2013 Statewide Wood Energy Teams AGENCY: U.S. Forest Service..., statewide wood energy teams that advance the installation of commercially viable wood energy systems. Public-private statewide teams are invited to seek funding to support the development of geographic or business...

  2. Recommendations and administration of the HPV vaccine to 11- to 12-year-old girls and boys: a statewide survey of Georgia vaccines for children provider practices. (United States)

    Luque, John S; Tarasenko, Yelena N; Dixon, Betty T; Vogel, Robert L; Tedders, Stuart H


    This study explores the prevalence and provider- and practice-related correlates of physician recommendation and administration of the quadrivalent human papillomavirus (HPV) vaccine, Gardasil, to 11- to 12-year-old girls and the intention to recommend the HPV vaccine to 11- to 12-year-old boys in Georgia. The study also describes physician knowledge about and barriers to HPV vaccination. This cross-sectional study was conducted from December 2010 to February 2011. The study sample was drawn using the Georgia Vaccines for Children (VFC) provider list as a sampling frame and probability 1-stage cluster sampling with counties as clusters. The final analytic sample was restricted to 206 provider locations. Weighted percentages and corresponding statistics were calculated accounting for selection probabilities, nonresponse, and the cluster sample design. Among Georgia VFC providers attending to 11- to 12-year-old girls, 46% had always recommended that their patients get the HPV vaccination and 41% had vaccinated their female patients. Among Georgia VFC providers attending to 11- to 12-year-old boys, 20% would always recommend that their male patients get vaccinated.Physicians most frequently endorsed costs of stocking the vaccine (73%), upfront costs (69%), vaccination (68%), and insurance reimbursements (63%) as barriers to their HPV vaccination practices. Despite the Advisory Committee on Immunization Practices' recommendations on HPV vaccination, the prevalence of recommending and administering the HPV vaccine to female and male patients, aged 11 to 12 years, by VFC providers is an ongoing challenge in Georgia.

  3. Development of a statewide transportation data warehousing and mining system under the Louisiana Transportation Information System (LATIS) Program. (United States)


    The objectives of this study are to assess whether introducing a data warehousing/data mining system in Louisiana would be feasible and beneficial. The study sets out to identify the features of the most suitable system for the state as well as to ou...

  4. Evaluation of a Statewide HIV-HCV-STD Online Clinical Education Program by Healthcare Providers - A Comparison of Nursing and Other Disciplines. (United States)

    Wang, Dongwen; Luque, Amneris E


    The New York State HIV-HCV-STD Clinical Education Initiative (CEI) has developed a large repository of online resources and disseminated them to a wide range of healthcare providers. To evaluate the CEI online education program and in particular to compare the self-reported measures by clinicians from different disciplines, we analyzed the data from 1,558 course completions in a study period of three months. The results have shown that the overall evaluations by the clinicians were very positive. Meanwhile, there were significant differences across the clinical disciplines. In particular, physicians and nurse practitioners were the most satisfied. In contrast, pharmacists and case/care managers recorded lower than average responses. Nurses and counselors had mixed results. Nurse practitioners' responses were very similar to physicians on most measures, but significantly different from nurses in many aspects. For more effective knowledge dissemination, online education programs should consider the unique needs by clinicians from specific disciplines.


    Directory of Open Access Journals (Sweden)

    A. V. Rаdkеvich


    Full Text Available Purpose. Development of scientific-methodical bases to the design of rational management of material streams in the field of building providing taking into account intersystem connections with the enterprises of building industry. Methodology. The analysis of last few years of functioning of building industry in Ukraine allows distinguishing a number of problems that negatively influence the steady development of building, as the component of the state economics system. Therefore the research of existent organization methods of the system of building objects providing with material resources is extremely necessary. In connection with this the article justifies the use of method of hierarchies analysis (Saati method for finding the optimal task solution of fixing the enterprises of building industry after building objects. Findings. Results give an opportunity to guidance of building organization to estimate and choose advantageous suppliers - enterprises of building industry, to conduct their rating, estimation taking into account basic descriptions, such as: quality, price, reliability of deliveries, specialization, financial status etc. Originality. On the basis of Saati method the methodologies of organization are improved, planning and managements of the reliable system of providing of building necessary material resources that meet the technological requirements of implementation of building and installation works. Practical value. Contribution to the decisions of many intricate organizational problems that are accompanied by the problems of development of building, provided due to organization of the reliable system of purchase of material resources.

  6. Air Systems Provide Life Support to Miners (United States)


    Through a Space Act Agreement with Johnson Space Center, Paragon Space Development Corporation, of Tucson, Arizona, developed the Commercial Crew Transport-Air Revitalization System, designed to provide clean air for crewmembers on short-duration space flights. The technology is now being used to help save miners' lives in the event of an underground disaster.

  7. Integrating nine prescription opioid analgesics and/or four signal detection systems to summarize statewide prescription drug abuse in the United States in 2007. (United States)

    Schneider, Michael F; Bailey, J Elise; Cicero, Theodore J; Dart, Richard C; Inciardi, James A; Parrino, Mark; Muñoz, Alvaro


    Integrate statewide rankings of abuse across different drugs and/or signal detection systems to summarize prescription drug abuse in each state in 2007. Four signal detection systems (Opioid Treatment Programs, Key Informants, Drug Diversion, and Poison Centers) that covered heterogeneous populations collected data on the abuse of nine opioids: hydrocodone, immediate-release oxycodone, tramadol, extended-release [ER] oxycodone, fentanyl, morphine, methadone, hydromorphone, and buprenorphine). We introduce here linearized maps which integrate nine drugs within each system; four systems for each drug; or all drugs and systems. When rankings were integrated across drugs, Rhode Island, New Hampshire, Maine, West Virginia, and Michigan were in the highest tertile of abuse in three systems. When rankings were integrated across signal detection systems, there was a geographic clustering of states with the highest rates for ER oxycodone (in Tennessee, Mississippi, Kentucky, Ohio, Indiana, Michigan, and in Massachusetts, New Hampshire, Maine, and Vermont) and methadone (Massachusetts, Rhode Island, New Hampshire, Maine, Vermont, Connecticut, and New Jersey). When rankings were integrated across both drugs and signal detection systems, states with 3-digit ZIP codes below 269 (i.e., from Massachusetts to West Virginia): Massachusetts, New Hampshire, Maine, Vermont, Washington DC, Virginia, and West Virginia were in the highest tertile and only Delaware was in the lowest tertile. We have presented methods to integrate data on prescription opioid abuse collected by signal detection systems covering different populations. Linearized maps are effective graphical summaries that depict differences in the level of prescription opioid abuse at the state level.


    Directory of Open Access Journals (Sweden)

    Vladimir N. Shvedenko


    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.

  9. Methods for Improving Consistency between Statewide and Regional Planning Models. (United States)


    Given the difference in scope of statewide and MPO models, inconsistencies between the two levels of modelling are inevitable. There are, however, methods to reduce these inconsistencies. This research provides insight into the current practices of s...

  10. WisDOT statewide customer satisfaction survey : [project brief]. (United States)


    The Wisconsin Department of Transportation (WisDOT) is a major public agency with numerous customers utilizing a variety of services and programs to support the entire statewide multimodal transportation system. The department also houses the Divisio...

  11. Alabama statewide mobility report, 2014. (United States)


    This Alabama Statewide Mobility Report for 2014 is a new way to analyze interstate mobility performance over an entire year. Over half a billion speed records were acquired, stored, and analyzed for this report. These observations capture recurring c...

  12. Automated Cancer Registry Notifications: Validation of a Medical Text Analytics System for Identifying Patients with Cancer from a State-Wide Pathology Repository. (United States)

    Nguyen, Anthony N; Moore, Julie; O'Dwyer, John; Philpot, Shoni


    The paper assesses the utility of Medtex on automating Cancer Registry notifications from narrative histology and cytology reports from the Queensland state-wide pathology information system. A corpus of 45.3 million pathology HL7 messages (including 119,581 histology and cytology reports) from a Queensland pathology repository for the year of 2009 was analysed by Medtex for cancer notification. Reports analysed by Medtex were consolidated at a patient level and compared against patients with notifiable cancers from the Queensland Oncology Repository (QOR). A stratified random sample of 1,000 patients was manually reviewed by a cancer clinical coder to analyse agreements and discrepancies. Sensitivity of 96.5% (95% confidence interval: 94.5-97.8%), specificity of 96.5% (95.3-97.4%) and positive predictive value of 83.7% (79.6-86.8%) were achieved for identifying cancer notifiable patients. Medtex achieved high sensitivity and specificity across the breadth of cancers, report types, pathology laboratories and pathologists throughout the State of Queensland. The high sensitivity also resulted in the identification of cancer patients that were not found in the QOR. High sensitivity was at the expense of positive predictive value; however, these cases may be considered as lower priority to Cancer Registries as they can be quickly reviewed. Error analysis revealed that system errors tended to be tumour stream dependent. Medtex is proving to be a promising medical text analytic system. High value cancer information can be generated through intelligent data classification and extraction on large volumes of unstructured pathology reports.

  13. Providing an efficient intelligent transportation system through ...

    Indian Academy of Sciences (India)

    Syst. 11(4): 917–930. Hou Z 2009 An automated road sign inventory system based on computer vision, Thesis. Kellmeyer D and Zwahlen H 1994 Detection of highway warning signs in natural video images using color image processing and neural networks, IEEE World Congress on Computational Intelligence, Orlando,.

  14. Systems for Providing Aids for Disabled People. (United States)

    World Health Organization, Copenhagen (Denmark). Regional Office for Europe.

    The report summarizes a meeting of the World Health Organization's Working Group on Systems for Provision of Aids for Disabled Persons. The meeting was convened to discuss technical aids and ergonomic measures to bring greater independence to disabled people and the need to systematize services for the disabled in their own environments. Following…

  15. Alcohol policy enforcement and changes in student drinking rates in a statewide public college system: a follow-up study

    Directory of Open Access Journals (Sweden)

    Harris Sion K


    Full Text Available Abstract Background Heavy alcohol use among U.S. college students is a major contributor to young adult morbidity and mortality. The aim of this study was to examine whether college alcohol policy enforcement levels predict changes in student drinking and related behaviors in a state system of public colleges and universities, following a system-wide change to a stricter policy. Methods Students and administrators at 11 Massachusetts public colleges/universities completed surveys in 1999 (N of students = 1252, one year after the policy change, and again in 2001 (N = 1074. We calculated policy enforcement scores for each school based on the reports of deans of students, campus security chiefs, and students, and examined the correlations between perceived enforcement levels and the change in student drinking rates over the subsequent two year period, after weighting the 2001 data to adjust for demographic changes in the student body. Results Overall rates of any past-30-days drinking, heavy episodic drinking, and usual heavy drinking among past-30-days drinkers were all lower in 2001 compared to 1999. School-level analyses (N = 11 found deans' baseline reports of stricter enforcement were strongly correlated with subsequent declines in heavy episodic drinking (Pearson's r = -0.73, p = 0.011. Moreover, consistently high enforcement levels across time, as reported by deans, were associated with greater declines in heavy episodic drinking. Such relationships were not found for students' and security chiefs' reports of enforcement. Marijuana use did not rise during this period of decline in heavy drinking. Conclusions Study findings suggest that stronger enforcement of a stricter alcohol policy may be associated with reductions in student heavy drinking rates over time. An aggressive enforcement stance by deans may be an important element of an effective college alcohol policy.

  16. Statewide mesoscopic simulation for Wyoming. (United States)


    This study developed a mesoscopic simulator which is capable of representing both city-level and statewide roadway : networks. The key feature of such models are the integration of (i) a traffic flow model which is efficient enough to : scale to larg...

  17. The Obesity Prevention Initiative: A Statewide Effort to Improve Child Health in Wisconsin. (United States)

    Adams, Alexandra K; Christens, Brian; Meinen, Amy; Korth, Amy; Remington, Patrick L; Lindberg, Sara; Schoeller, Dale


    Obesity rates have increased dramatically, especially among children and disadvantaged populations. Obesity is a complex issue, creating a compelling need for prevention efforts in communities to move from single isolated programs to comprehensive multisystem interventions. To address these issues, we have established a childhood Obesity Prevention Initiative (Initiative) for Wisconsin. This Initiative seeks to test community change frameworks that can support multisystem interventions and provide data for local action as a means for influencing policies, systems, and environments that support individuals’ healthy eating and physical activity. The Initiative is comprised of three components: (1) infrastructure to support a statewide obesity prevention and health promotion network with state- and local-level public messaging and dissemination of evidence-based solutions (healthTIDE); (2) piloting a local, multisetting community-led intervention study in 2 Wisconsin counties; and (3) developing a geocoded statewide childhood obesity and fitness surveillance system. This Initiative is using a new model that involves both coalition action and community organizing to align resources to achieve health improvement at local and state levels. We expect that it will help lead to the implementation of cohesive and sustainable policy, system, and environment health promotion and obesity prevention strategies in communities statewide, and it has the potential to help Wisconsin become a national model for multisetting community interventions to address obesity. Addressing individual-level health through population-level changes ultimately will result in reductions in the prevalence of childhood obesity, current and future health care costs, and chronic disease mortality.


    The report gives results of a statewide mapping of Florida soil radon potentials. Statewide maps identify Florida Regions with different levels of soil radon potential. The maps provide scientific estimates of regional radon potentials that can serve as a basis for implementing r...


    The report gives results of a statewide mapping of Florida soil radon potentials. Statewide maps identify Florida Regions with different levels of soil radon potential. The maps provide scientific estimates of regional radon potentials that can serve as a basis for implementing r...

  20. Fire Extinguisher Control System Provides Reliable Cold Weather Operation (United States)

    Branum, J. C.


    Fast acting, pneumatically and centrally controlled, fire extinguisher /firex/ system is effective in freezing climates. The easy-to-operate system provides a fail-dry function which is activated by an electrical power failure.

  1. Geodatabase of Wyoming statewide oil and gas drilling activity to 2010 (United States)

    U.S. Geological Survey, Department of the Interior — The Wyoming statewide oil and gas wells feature class was developed to provide a historical perspective of drilling activity for the Wyoming Landscape Conservation...

  2. Statewide Scent Station Survey for South Carolina Furbearers Annual Report 1994 (United States)

    US Fish and Wildlife Service, Department of the Interior — In 1984, a statewide scent station survey was initiated in SC to provide an index to the relative abundance of terrestrial furbearing animals. This report is from...

  3. Electronic consultation system demonstrates educational benefit for primary care providers. (United States)

    Kwok, Jonas; Olayiwola, J Nwando; Knox, Margae; Murphy, Elizabeth J; Tuot, Delphine S


    Background Electronic consultation systems allow primary care providers to receive timely speciality expertise via iterative electronic communication. The use of such systems is expanding across the USA with well-documented high levels of user satisfaction. We characterise the educational impact for primary care providers of a long-standing integrated electronic consultation and referral system. Methods Primary care providers' perceptions of the educational value inherent to electronic consultation system communication and the impact on their ability to manage common speciality clinical conditions and questions were examined by electronic survey using five-point Likert scales. Differences in primary care providers' perceptions were examined overall and by primary care providers' speciality, provider type and years of experience. Results Among 221 primary care provider participants (35% response rate), 83.9% agreed or strongly agreed that the integrated electronic consultation and referral system provided educational value. There were no significant differences in educational value reported by provider type (attending physician, mid-level provider, or trainee physician), primary care providers' speciality, or years of experience. Perceived benefit of the electronic consultation and referral system in clinical management appeared stronger for laboratory-based conditions (i.e. subclinical hypothyroidism) than more diffuse conditions (i.e. abdominal pain). Nurse practitioners/physician assistants and trainee physicians were more likely to report improved abilities to manage specific clinical conditions when using the electronic consultation and/or referral system than were attending physicians, as were primary care providers with ≤10 years experience, versus those with >20 years of experience. Conclusions Primary care providers report overwhelmingly positive perceptions of the educational value of an integrated electronic consultation and referral system. Nurse

  4. Leadership, Innovation Climate, and Attitudes toward Evidence-Based Practice during a Statewide Implementation (United States)

    Aarons, Gregory A.; Sommerfeld, David H.


    Objective Leadership is important in practice change, yet there are few studies addressing this issue in mental health and social services. This study examined the differential roles of transformational (i.e., charismatic) leadership and leader member exchange (i.e., the relationship between a supervisor and their direct service providers) on team innovation climate (i.e., openness to new innovations) and provider attitudes toward adopting evidence-based practice (EBP) during a statewide evidence-based practice implementation (EBPI) of an intervention to reduce child neglect. Methods Participants were 140 case-managers in 30 teams providing home-based services to families in a statewide child-welfare system. Teams were assigned by region to EBPI or services as usual (SAU) conditions. Multiple group path analysis was used to examine associations of transformational leadership and leader member exchange with innovation climate and attitudes toward adoption and use of EBP. Results Transformational leadership predicted higher innovation climate during implementation while leader member exchange predicted higher innovation climate during SAU. Innovation climate was, in turn, associated with more positive attitudes toward EBP for the EBPI group. Conclusions Strategies designed to enhance supervisor transformational leadership have the potential to facilitate implementation efforts by promoting a strong climate for EBPI and positive provider attitudes toward adoption and use of EBP. PMID:22449648

  5. California Statewide PEV Infrastructure Assessment; NREL (National Renewable Energy Laboratory)

    Energy Technology Data Exchange (ETDEWEB)

    Melaina, Marc; Eichman, Joshua


    This presentation discusses how the California Statewide Plug-In Electric Vehicle (PEV) Infrastructure Assessment provides a framework for understanding the potential energy (kWh) and demand (MW) impacts of PEV market growth; how PEV travel simulations can inform the role of public infrastructure in future market growth; and how ongoing assessment updates and Alternative Fuels Data Center outreach can help coordinate stakeholder planning and decision making and reduce uncertainties.

  6. WisDOT statewide customer satisfaction survey. (United States)


    The purpose of this study was to develop and initiate a new customer satisfaction tool that would establish a set of baseline : departmental performance measures and be sustainable for future use. ETC Institute completed a statewide customer : survey...

  7. IMU/GPS System Provides Position and Attitude Data (United States)

    Lin, Ching Fang


    A special navigation system is being developed to provide high-quality information on the position and attitude of a moving platform (an aircraft or spacecraft), for use in pointing and stabilization of a hyperspectral remote-sensing system carried aboard the platform. The system also serves to enable synchronization and interpretation of readouts of all onboard sensors. The heart of the system is a commercially available unit, small enough to be held in one hand, that contains an integral combination of an inertial measurement unit (IMU) of the microelectromechanical systems (MEMS) type, Global Positioning System (GPS) receivers, a differential GPS subsystem, and ancillary data-processing subsystems. The system utilizes GPS carrier-phase measurements to generate time data plus highly accurate and continuous data on the position, attitude, rotation, and acceleration of the platform. Relative to prior navigation systems based on IMU and GPS subsystems, this system is smaller, is less expensive, and performs better. Optionally, the system can easily be connected to a laptop computer for demonstration and evaluation. In addition to airborne and spaceborne remote-sensing applications, there are numerous potential terrestrial sensing, measurement, and navigation applications in diverse endeavors that include forestry, environmental monitoring, agriculture, mining, and robotics.

  8. Employee motivation in Product-Service-System providers

    DEFF Research Database (Denmark)

    Kreye, Melanie


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

  9. Development of a system to provide diagnostics-while-drilling.

    Energy Technology Data Exchange (ETDEWEB)

    Wise, Jack LeRoy; Jacobson, Ronald David; Finger, John Travis; Mansure, Arthur James; Knudsen, Steven Dell


    This report describes development of a system that provides high-speed, real-time downhole data while drilling. Background of the project, its benefits, major technical challenges, test planning, and test results are covered by relatively brief descriptions in the body of the report, with some topics presented in more detail in the attached appendices.

  10. A method for calculating active feedback system to provide vertical ...

    Indian Academy of Sciences (India)

    Home; Journals; Pramana – Journal of Physics; Volume 68; Issue 4. A method for calculating active feedback system to provide vertical position control of plasma in a tokamak. Nizami Gasilov. Research ... Nizami Gasilov1. Faculty of Engineering, Baskent University, Eskisehir Yolu 20. km, Baglica, 06530 Ankara, Turkey ...

  11. Providing Accessible Statewide Inservice Training for Practicing Professionals and Paraprofessionals Working with Infants, Toddlers, and Preschoolers Who Are Deaf or Hard of Hearing and Their Families. SKI-HI Distance Education Project, Final Report. (United States)

    Barringer, Donald; Glover, Barbara; Parlin, Mary Ann; Johnson, Dorothy

    This final report discusses the outcomes of a project that developed, demonstrated, evaluated, and disseminated information about a specialized inservice training model to prepare early interventionists, special education teachers, and related service personnel to provide family-centered programming to infants, toddlers, and preschoolers who are…

  12. A concept of customer–provider relation monitoring system solution

    Directory of Open Access Journals (Sweden)

    Naděžda Chalupová


    Full Text Available The contribution deals with design of customer–provider relationship monitoring system solution with regard to needs of business managers and analytics and to possibilities of contemporaneous information and communication technologies.The attention is followed to targeted modelling, what brings possibilities of acquisition of bigger overview about things taking place in the relation. In consequence it describes the functionality of analytical systems producing these very strategically valuable models – to so-called business intelligence tools. Onward it deals with modern technologies conductive to above mentioned system implementation – with Ajax concept and with some XML applications: PMML for analytical models manipulation, XSLT for XML data transformations to various formats, SVG for representing pictures of statistical graphs etc. and MathML for description of mathematical formulas created in analytical systems.Following these basis it suggests technological solution of some parts of client–provider relationship watching and evaluating system and it discusses its potential advantages and problems, which can occur.

  13. Ductless, multizone split system provides new design options

    Energy Technology Data Exchange (ETDEWEB)

    Esparza, R.


    The introduction of ductless multizone heating and cooling equipment provides new design options. This equipment is similar to a conventional, direct expansion, split system as it features a remote air cooled condensing unit (cooling only) or a remote air source heat pump and indoor fan-coil units. Each indoor unit consists of a housing, an evaporator and drain pan, blower, and filter. Unlike conventional split systems, however, multiple evaporators are supplied from the same condensing unit. This discusses equipment that is designed to handle several evaporators from a single compressor.

  14. Auris System: Providing Vibrotactile Feedback for Hearing Impaired Population

    Directory of Open Access Journals (Sweden)

    Felipe Alves Araujo


    Full Text Available Deafness, an issue that affects millions of people around the globe, is manifested in different intensities and related to many causes. This impairment negatively affects different aspects of the social life of the deaf people, and music-centered situations (concerts, religious events, etc. are obviously not inviting for them. The Auris System was conceived to provide the musical experimentation for people who have some type of hearing loss. This system is able to extract musical information from audio and create a representation for music pieces using different stimuli, a new media format to be interpreted by other senses than the hearing. In addition, the system defines a testing methodology based on a noninvasive brain activity recording using an electroencephalographic (EEG device. The results of the tests are being used to better understand the human musical cognition, in order to improve the accuracy of the Auris musical representation.

  15. Auris System: Providing Vibrotactile Feedback for Hearing Impaired Population. (United States)

    Alves Araujo, Felipe; Lima Brasil, Fabricio; Candido Lima Santos, Allison; de Sousa Batista Junior, Luzenildo; Pereira Fonseca Dutra, Savio; Eduardo Coelho Freire Batista, Carlos


    Deafness, an issue that affects millions of people around the globe, is manifested in different intensities and related to many causes. This impairment negatively affects different aspects of the social life of the deaf people, and music-centered situations (concerts, religious events, etc.) are obviously not inviting for them. The Auris System was conceived to provide the musical experimentation for people who have some type of hearing loss. This system is able to extract musical information from audio and create a representation for music pieces using different stimuli, a new media format to be interpreted by other senses than the hearing. In addition, the system defines a testing methodology based on a noninvasive brain activity recording using an electroencephalographic (EEG) device. The results of the tests are being used to better understand the human musical cognition, in order to improve the accuracy of the Auris musical representation.

  16. Scaling the Pyramid Model across Complex Systems Providing Early Care for Preschoolers: Exploring How Models for Decision Making May Enhance Implementation Science (United States)

    Johnson, LeAnne D.


    Bringing effective practices to scale across large systems requires attending to how information and belief systems come together in decisions to adopt, implement, and sustain those practices. Statewide scaling of the Pyramid Model, a framework for positive behavior intervention and support, across different types of early childhood programs…

  17. Internet-based information system of digital geological data providing (United States)

    Yuon, Egor; Soukhanov, Mikhail; Markov, Kirill


    One of the Russian Federal аgency of mineral resources problems is to provide the geological information which was delivered during the field operation for the means of federal budget. This information should be present in the current, conditional form. Before, the leading way of presenting geological information were paper geological maps, slices, borehole diagrams reports etc. Technologies of database construction, including distributed databases, technologies of construction of distributed information-analytical systems and Internet-technologies are intensively developing nowadays. Most of geological organizations create their own information systems without any possibility of integration into other systems of the same orientation. In 2012, specialists of VNIIgeosystem together with specialists of VSEGEI started the large project - creating the system of providing digital geological materials with using modern and perspective internet-technologies. The system is based on the web-server and the set of special programs, which allows users to efficiently get rasterized and vectorised geological materials. These materials are: geological maps of scale 1:1M, geological maps of scale 1:200 000 and 1:2 500 000, the fragments of seamless geological 1:1M maps, structural zoning maps inside the seamless fragments, the legends for State geological maps 1:200 000 and 1:1 000 000, full author's set of maps and also current materials for international projects «Atlas of geological maps for Circumpolar Arctic scale 1:5 000 000» and «Atlas of Geologic maps of central Asia and adjacent areas scale 1:2 500 000». The most interesting and functional block of the system - is the block of providing structured and well-formalized geological vector materials, based on Gosgeolkart database (NGKIS), managed by Oracle and the Internet-access is supported by web-subsystem NGKIS, which is currently based on MGS-Framework platform, developed by VNIIgeosystem. One of the leading elements

  18. MODIS-aided statewide net groundwater-recharge estimation in Nebraska. (United States)

    Szilagyi, Jozsef; Jozsa, Janos


    Monthly evapotranspiration (ET) rates (2000 to 2009) across Nebraska at about 1-km resolution were obtained by linear transformations of the MODIS (MODerate resolution Imaging Spectroradiometer) daytime surface temperature values with the help of the Priestley-Taylor equation and the complementary relationship of evaporation. For positive values of the mean annual precipitation and ET differences, the mean annual net recharge was found by an additional multiplication of the power-function-transformed groundwater vulnerability DRASTIC-code values. Statewide mean annual net recharge became about 29 mm (i.e., 5% of mean annual precipitation) with the largest recharge rates (in excess of 100 mm/year) found in the eastern Sand Hills and eastern Nebraska. Areas with the largest negative net recharge rates caused by declining groundwater levels due to large-scale irrigation are found in the south-western region of the state. Error bounds of the estimated values are within 10% to 15% of the corresponding precipitation rates and the estimated net recharge rates are sensitive to errors in the precipitation and ET values. This study largely confirms earlier base-flow analysis-based statewide groundwater recharge estimates when considerations are made for differences in the recharge definitions. The current approach not only provides better spatial resolution than available earlier studies for the region but also quantifies negative net recharge rates that become especially important in numerical modeling of shallow groundwater systems. © 2012, The Author(s). Groundwater © 2012, National Ground Water Association.

  19. A statewide collaboration to initiate mental health screening and assess services for detained youths in Indiana. (United States)

    Aalsma, Matthew C; Schwartz, Katherine; Perkins, Anthony J


    We describe a statewide effort to implement detention-based mental health screening and assess follow-up services offered to detained youths in Indiana. A total of 25,265 detention stays (15,461 unique youths) occurred between January 1, 2008, and December 31, 2011, across 16 detention centers participating in the Indiana Juvenile Mental Health Screening Project. We collected screening results and reports of detention-based follow-up mental health services and referrals from justice system records. Approximately 21% of youths screened positive for mental health issues requiring follow-up. A positive screen significantly predicted that youths would receive a follow-up mental health service or referral while detained or upon detention center discharge, compared with youths who did not screen positive (61% vs 39%). Logistic regression models indicated that a positive screen was associated with (1) contact with a mental health clinician within 24 hours of detention center intake and (2) a mental health referral upon discharge. White youths were more likely than minorities to receive both follow-up services. Future statewide efforts to improve the mental health of detained youths should incorporate standards for providing appropriate follow-up services in detention centers.

  20. Sealed Battery Block Provided With A Cooling System (United States)

    Verhoog, Roelof; Barbotin, Jean-Loup


    The present invention relates to a sealed battery block operating at a pressure of at least 1 bar relative, the battery including a container made of a plastics material and made up of a lid and of a case subdivided into wells by at least one partition, said battery being provided with a cooling system including two cheek plates made of a plastics material and co-operating with the outside faces of respective ones of two opposite walls of said case, each cheek plate co-operating with the corresponding wall to define a compartment provided with a plurality of ribs forming baffles for fluid flow purposes, and with an inlet orifice and an outlet orifice for the fluid, said battery being characterized in that each of said ribs extends in a direction that forms an angle relative to the plane of said partition lying in the range to

  1. Using Probablilistic Risk Assessment to Model Medication System Failures in Long-Term Care Facilities

    National Research Council Canada - National Science Library

    Comden, Sharon C; Marx, David; Murphy-Carley, Margaret; Hale, Misti


    Objective: State agencies and Oregon's long-term care providers cosponsored this developmental study to explore the creation of two statewide medication system risk models using sociotechnical probabilistic risk assessment (ST-PRA...

  2. Development of a statewide Landsat digital data base for forest insect damage assessment (United States)

    Williams, D. L.; Dottavio, C. L.; Nelson, R. F.


    A Joint Research Project (JRP) invlving NASA/Goddard Space Flight Center and the Pennsylvania Bureau of Forestry/Division of Forest Pest Management demonstrates the utility of Landsat data for assessing forest insect damage. A major effort within the project has been the creation of map-registered, statewide Landsat digital data base for Pennsylvania. The data base, developed and stored on computers at the Pennsylvania State University Computation Center, contains Landsat imagery, a Landsat-derived forest resource map, and digitized data layers depicting Forest Pest Management District boundaries and county boundaries. A data management front-end system was also developed to provide an interface between the various layers of information within the data base and image analysis software. This front-end system insures than an automated assessment of defoliation damage can be conducted and summarized by geographic area or jurisdiction of interest.

  3. Method and Apparatus Providing Deception and/or Altered Operation in an Information System Operating System (United States)

    Cohen, Fred; Rogers, Deanna T.; Neagoe, Vicentiu


    A method and/or system and/or apparatus providing deception and/or execution alteration in an information system. In specific embodiments, deceptions and/or protections are provided by intercepting and/or modifying operation of one or more system calls of an operating system.

  4. 42 CFR 431.50 - Statewide operation. (United States)


    ... continuously in operation in all local offices or agencies through— (i) Methods for informing staff of State... operations in local offices by regularly assigned State staff who make regular visits; and (iii) Reports, controls, or other methods. (c) Exceptions. (1) “Statewide operation” does not mean, for example, that...

  5. Long-Term Effects of the Implementation of State-Wide Exit Exams: A Multilevel Regression Analysis of Mediation Effects of Teaching Practices on Students' Motivational Orientations (United States)

    Maag Merki, Katharina; Oerke, Britta


    This study extends previous research investigating the effects of state-wide exit exams by studying the change from a class-based to a state-wide exit exam system over 5 years, using multilevel analyses and examining mediating effects of teachers' practices on students' motivational orientations. In this multi-cohort study, we analyzed in…

  6. Assessing the process of designing and implementing electronic health records in a statewide public health system: the case of Colima, Mexico. (United States)

    Hernández-Ávila, Juan Eugenio; Palacio-Mejía, Lina Sofia; Lara-Esqueda, Agustín; Silvestre, Eva; Agudelo-Botero, Marcela; Diana, Mark L; Hotchkiss, David R; Plaza, Beatriz; Sanchez Parbul, Alicia


    The findings of a case study assessing the design and implementation of an electronic health record (EHR) in the public health system of Colima, Mexico, its perceived benefits and limitations, and recommendations for improving the implementation process are presented. In-depth interviews and focus group discussions were used to examine the experience of the actors and stakeholders participating in the design and implementation of EHRs. Results indicate that the main driving force behind the use of EHRs was to improve reporting to the two of the main government health and social development programs. Significant challenges to the success of the EHR include resistance by physicians to use the ICD-10 to code diagnoses, insufficient attention to recurrent resources needed to maintain the system, and pressure from federal programs to establish parallel information systems. Operating funds and more importantly political commitment are required to ensure sustainability of the EHRs in Colimaima.

  7. Providing scalable system software for high-end simulations

    Energy Technology Data Exchange (ETDEWEB)

    Greenberg, D. [Sandia National Labs., Albuquerque, NM (United States)


    Detailed, full-system, complex physics simulations have been shown to be feasible on systems containing thousands of processors. In order to manage these computer systems it has been necessary to create scalable system services. In this talk Sandia`s research on scalable systems will be described. The key concepts of low overhead data movement through portals and of flexible services through multi-partition architectures will be illustrated in detail. The talk will conclude with a discussion of how these techniques can be applied outside of the standard monolithic MPP system.

  8. Subterranean systems provide a suitable overwintering habitat for Salamandra salamandra

    Directory of Open Access Journals (Sweden)

    Monika Balogová


    Full Text Available The fire salamander (Salamandra salamandra has been repeatedly noted to occur in natural and artificial subterranean systems. Despite the obvious connection of this species with underground shelters, their level of dependence and importance to the species is still not fully understood. In this study, we carried out long-term monitoring based on the capture-mark-recapture method in two wintering populations aggregated in extensive underground habitats. Using the POPAN model we found the population size in a natural shelter to be more than twice that of an artificial underground shelter. Survival and recapture probabilities calculated using the Cormack-Jolly-Seber model were very constant over time, with higher survival values in males than in females and juveniles, though in terms of recapture probability, the opposite situation was recorded. In addition, survival probability obtained from Cormack-Jolly-Seber model was higher than survival from POPAN model. The observed bigger population size and the lower recapture rate in the natural cave was probably a reflection of habitat complexity. Our study showed that regular visits are needed to detect the true significance of underground shelters for fire salamanders. The presence of larvae was recorded in both wintering sites, especially in bodies of water near the entrance. On the basis of previous and our observations we incline to the view, that karst areas can induce not only laying in underground shelters but also group wintering in this species. Our study highlights the strong connection of the life cycle of fire salamanders with underground shelters and their essential importance for the persistence of some populations during unfavourable conditions and breeding activity. In addition, the study introduces the POPAN and Cormac-Jolly-Seber models for estimating of population size, survival and recapture probability in wintering populations of the species, which could provide important information

  9. Power system services provided by inverter connected distributed energy resources

    DEFF Research Database (Denmark)

    For the last few years there has been a significant increase of DER units in Denmark, of those units more and more are connected to the power system using inverters. These inverter connected units have the potential to support the electrical power system with various power system services. One...

  10. Providing over-the-horizon awareness to driver support systems

    NARCIS (Netherlands)

    van Eenennaam, Martijn; Heijenk, Geert


    Vehicle-to-vehicle communications is a promising technique for driver support systems to increase traffic safety and efficiency. A proposed system is the Congestion Assistant [1], which aims at supporting drivers when approaching and driving in a traffic jam. Studies have shown great potential for


    Energy Technology Data Exchange (ETDEWEB)

    LaCourt, Donna M.; Miller, Raymond O.; Shonnard, David R.


    A team composed of scientists from Michigan State University (MSU) and Michigan Technological University (MTU) assembled to better understand, document, and improve systems for using forest-based biomass feedstocks in the production of energy products within Michigan. Work was funded by a grant (DE-EE-0000280) from the U.S. Department of Energy (DOE) and was administered by the Michigan Economic Development Corporation (MEDC). The goal of the project was to improve the forest feedstock supply infrastructure to sustainably provide woody biomass for biofuel production in Michigan over the long-term. Work was divided into four broad areas with associated objectives: • TASK A: Develop a Forest-Based Biomass Assessment for Michigan – Define forest-based feedstock inventory, availability, and the potential of forest-based feedstock to support state and federal renewable energy goals while maintaining current uses. • TASK B: Improve Harvesting, Processing and Transportation Systems – Identify and develop cost, energy, and carbon efficient harvesting, processing and transportation systems. • TASK C: Improve Forest Feedstock Productivity and Sustainability – Identify and develop sustainable feedstock production systems through the establishment and monitoring of a statewide network of field trials in forests and energy plantations. • TASK D: Engage Stakeholders – Increase understanding of forest biomass production systems for biofuels by a broad range of stakeholders. The goal and objectives of this research and development project were fulfilled with key model deliverables including: 1) The Forest Biomass Inventory System (Sub-task A1) of feedstock inventory and availability and, 2) The Supply Chain Model (Sub-task B2). Both models are vital to Michigan’s forest biomass industry and support forecasting delivered cost, as well as carbon and energy balance. All of these elements are important to facilitate investor, operational and policy decisions. All

  12. Making an Impact Statewide to Benefit 21st-Century School Leadership (United States)

    Hewitt, Kimberly Kappler; Mullen, Carol A.; Davis, Ann W.; Lashley, Carl


    How can institutions of higher education, local education agencies, and departments of education partner to build capacity for 21st-Century school leadership? The model (IMPACT V) we describe utilizes a systems-wide partnership approach to cultivate shared leadership within influenced middle and high schools statewide to leverage technology as a…

  13. A method for calculating active feedback system to provide vertical ...

    Indian Academy of Sciences (India)

    not difficult to see that ϕ (+∞)=+∞. Therefore, for the equation ϕ (γ)=0to have no positive root, the fulfillment of the following condition is necessary: ϕ (0) = (R−1w, a) − w0 ≥ 0. (12). We will call (12) as the necessary condition of vertical position control by active feedbacks. 5. Problem of selection of active feedback system.


    Directory of Open Access Journals (Sweden)

    Grzegorz KLEKOT


    Full Text Available High capacities of currently available devices for sound registering and processing have generated a need for sound insulated spaces dedicated to exchange of confidential information. In such spaces, preventing propagation of vibroacoustic signals both by the way of air and construction elements entails complete insulation of the room. In order to meet this requirement, proper chemical composition of air and stabilized temperature conditions have to be guaranteed. The paper discusses questions related to the process of solving the task of providing thermal comfort and satisfying air quality in a room for confidential discussions. It presents prototype solutions of installations dedicated to stabilize human-friendly conditions inside a modular chamber provided with acoustic insulation.

  15. Systems Engineering Provides Successful High Temperature Steam Electrolysis Project

    Energy Technology Data Exchange (ETDEWEB)

    Charles V. Park; Emmanuel Ohene Opare, Jr.


    This paper describes two Systems Engineering Studies completed at the Idaho National Laboratory (INL) to support development of the High Temperature Stream Electrolysis (HTSE) process. HTSE produces hydrogen from water using nuclear power and was selected by the Department of Energy (DOE) for integration with the Next Generation Nuclear Plant (NGNP). The first study was a reliability, availability and maintainability (RAM) analysis to identify critical areas for technology development based on available information regarding expected component performance. An HTSE process baseline flowsheet at commercial scale was used as a basis. The NGNP project also established a process and capability to perform future RAM analyses. The analysis identified which components had the greatest impact on HTSE process availability and indicated that the HTSE process could achieve over 90% availability. The second study developed a series of life-cycle cost estimates for the various scale-ups required to demonstrate the HTSE process. Both studies were useful in identifying near- and long-term efforts necessary for successful HTSE process deployment. The size of demonstrations to support scale-up was refined, which is essential to estimate near- and long-term cost and schedule. The life-cycle funding profile, with high-level allocations, was identified as the program transitions from experiment scale R&D to engineering scale demonstration.

  16. On providing the fault-tolerant operation of information systems based on open content management systems (United States)

    Kratov, Sergey


    Modern information systems designed to service a wide range of users, regardless of their subject area, are increasingly based on Web technologies and are available to users via Internet. The article discusses the issues of providing the fault-tolerant operation of such information systems, based on free and open source content management systems. The toolkit available to administrators of similar systems is shown; the scenarios for using these tools are described. Options for organizing backups and restoring the operability of systems after failures are suggested. Application of the proposed methods and approaches allows providing continuous monitoring of the state of systems, timely response to the emergence of possible problems and their prompt solution.

  17. Water Quality Stressor Information from Clean Water Act Statewide Statistical Surveys (United States)

    U.S. Environmental Protection Agency — Stressors assessed by statewide statistical surveys and their state and national attainment categories. Statewide statistical surveys are water quality assessments...

  18. Water Quality attainment Information from Clean Water Act Statewide Statistical Surveys (United States)

    U.S. Environmental Protection Agency — Designated uses assessed by statewide statistical surveys and their state and national attainment categories. Statewide statistical surveys are water quality...

  19. 49 CFR 613.200 - Statewide transportation planning and programming. (United States)


    ... 49 Transportation 7 2010-10-01 2010-10-01 false Statewide transportation planning and programming. 613.200 Section 613.200 Transportation Other Regulations Relating to Transportation (Continued... Transportation Planning and Programming § 613.200 Statewide transportation planning and programming. The...

  20. Projected Statewide Impact of "Opportunity Culture" School Models (United States)

    Holly, Christen; Dean, Stephanie; Hassel, Emily Ayscue; Hassel, Bryan C.


    This brief estimates the impact of a statewide implementation of Opportunity Culture models, using North Carolina as an example. Impacts estimated include student learning outcomes, gross state product, teacher pay, and other career characteristics, and state income tax revenue. Estimates indicate the potential for a statewide transition to…

  1. Statewide and Metropolitan Transportation Planning Processes : a TPCB Peer Exchange (United States)


    This report highlights key recommendations and noteworthy practices identified at Statewide and Metropolitan Transportation Planning Processes Peer Exchange held on September 9-10, 2015 in Shepherdstown, West Virginia. This event was sponsored ...

  2. Data integration for statewide transportation planning : final report (United States)


    The goal of this study was to investigate the data availability, accessibility, and interoperability issues arisen from the statewide : transportation planning activities undertaken at WisDOT and to identify possible approaches for addressing these i...

  3. Statewide Transportation Engineering Warehouse for Archived Regional Data (STEWARD). (United States)


    This report documents Phase III of the development and operation of a prototype for the Statewide Transportation : Engineering Warehouse for Archived Regional Data (STEWARD). It reflects the progress on the development and : operation of STEWARD sinc...

  4. Nebraska Statewide Wind Integration Study: April 2008 - January 2010

    Energy Technology Data Exchange (ETDEWEB)

    EnerNex Corporation, Knoxville, Tennessee; Ventyx, Atlanta, Georgia; Nebraska Power Association, Lincoln, Nebraska


    Wind generation resources in Nebraska will play an increasingly important role in the environmental and energy security solutions for the state and the nation. In this context, the Nebraska Power Association conducted a state-wide wind integration study.

  5. 48 CFR 9.505-1 - Providing systems engineering and technical direction. (United States)


    ... engineering and technical direction. 9.505-1 Section 9.505-1 Federal Acquisition Regulations System FEDERAL... of Interest 9.505-1 Providing systems engineering and technical direction. (a) A contractor that provides systems engineering and technical direction for a system but does not have overall contractual...

  6. System and Method for Providing a Climate Data Analytic Services Application Programming Interface Distribution Package (United States)

    Schnase, John L. (Inventor); Duffy, Daniel Q. (Inventor); Tamkin, Glenn S. (Inventor)


    A system, method and computer-readable storage devices for providing a climate data analytic services application programming interface distribution package. The example system can provide various components. The system provides a climate data analytic services application programming interface library that enables software applications running on a client device to invoke the capabilities of a climate data analytic service. The system provides a command-line interface that provides a means of interacting with a climate data analytic service by issuing commands directly to the system's server interface. The system provides sample programs that call on the capabilities of the application programming interface library and can be used as templates for the construction of new client applications. The system can also provide test utilities, build utilities, service integration utilities, and documentation.

  7. WiFi RFID demonstration for resource tracking in a statewide disaster drill. (United States)

    Cole, Stacey L; Siddiqui, Javeed; Harry, David J; Sandrock, Christian E


    To investigate the capabilities of Radio Frequency Identification (RFID) tracking of patients and medical equipment during a simulated disaster response scenario. RFID infrastructure was deployed at two small rural hospitals, in one large academic medical center and in two vehicles. Several item types from the mutual aid equipment list were selected for tracking during the demonstration. A central database server was installed at the UC Davis Medical Center (UCDMC) that collected RFID information from all constituent sites. The system was tested during a statewide disaster drill. During the drill, volunteers at UCDMC were selected to locate assets using the traditional method of locating resources and then using the RFID system. This study demonstrated the effectiveness of RFID infrastructure in real-time resource identification and tracking. Volunteers at UCDMC were able to locate assets substantially faster using RFID, demonstrating that real-time geolocation can be substantially more efficient and accurate than traditional manual methods. A mobile, Global Positioning System (GPS)-enabled RFID system was installed in a pediatric ambulance and connected to the central RFID database via secure cellular communication. This system is unique in that it provides for seamless region-wide tracking that adaptively uses and seamlessly integrates both outdoor cellular-based mobile tracking and indoor WiFi-based tracking. RFID tracking can provide a real-time picture of the medical situation across medical facilities and other critical locations, leading to a more coordinated deployment of resources. The RFID system deployed during this study demonstrated the potential to improve the ability to locate and track victims, healthcare professionals, and medical equipment during a region-wide disaster.

  8. State-Wide Microcomputer Software for Fiscal and Evaluation Reporting. [and] West Virginia Microcomputer Budget File, 1983: Apple II+ Version. (United States)

    McNeil, Keith; And Others

    A state-wide microcomputer software program and support system for local education agency (LEA) reporting of Chapter 1 fiscal and evaluation information was developed. The microcomputer budget application for West Virginia was developed by the Technical Assistance Center at RMC Corporation. The program is intended for use by the Chapter 1 staff of…

  9. A state-wide obstetric hemorrhage quality improvement initiative. (United States)

    Bingham, Debra; Lyndon, Audrey; Lagrew, David; Main, Elliott K


    The mission of the California Maternal Quality Care Collaborative is to eliminate preventable maternal death and injury and to promote equitable maternity care in California. This article describes California Maternal Quality Care Collaborative's (CMQCC's) statewide multistakeholder quality improvement initiative to improve readiness, recognition, response, and reporting of maternal hemorrhage at birth and details the essential role of nurses in its success. In partnership with the State Department of Maternal, Child, and Adolescent Health, CMQCC identified maternal hemorrhage as a significant quality improvement opportunity. CMQCC organized a multidisciplinary, multistakeholder task force to develop a strategy for addressing obstetric (OB) hemorrhage. The OB Hemorrhage Task Force, co-chaired by nurse and physician team leaders, identified four priorities for action and developed a comprehensive hemorrhage guideline. CMQCC is using a multilevel strategy to disseminate the guideline, including an open access toolkit, a minimal support-mentoring model, a county partnership model, and a 30-hospital learning collaborative. In participating hospitals, nurses have been the primary drivers in developing both general and massive hemorrhage policies and procedures, ensuring the availability of critical supplies, organizing team debriefing after a stage 2 (or greater) hemorrhage, hosting skills stations for measuring blood loss, and running obstetric (OB) hemorrhage drills. Each of these activities requires effort and leadership skill, even in hospitals where clinicians are convinced that these changes are needed. In some hospitals, the burden to convince physicians of the value of these new practices has rested primarily upon nurses. Thus, the statewide initiative in which nurse and physician leaders work together models the value of teamwork and provides a real-time demonstration of the potential for effective interdisciplinary collaboration to make a difference in the

  10. Correspondence of biological condition models of California streams at statewide and regional scales (United States)

    May, Jason T.; Brown, Larry R.; Rehn, Andrew C.; Waite, Ian R.; Ode, Peter R; Mazor, Raphael D; Schiff, Kenneth C


    We used boosted regression trees (BRT) to model stream biological condition as measured by benthic macroinvertebrate taxonomic completeness, the ratio of observed to expected (O/E) taxa. Models were developed with and without exclusion of rare taxa at a site. BRT models are robust, requiring few assumptions compared with traditional modeling techniques such as multiple linear regression. The BRT models were constructed to provide baseline support to stressor delineation by identifying natural physiographic and human land use gradients affecting stream biological condition statewide and for eight ecological regions within the state, as part of the development of numerical biological objectives for California’s wadeable streams. Regions were defined on the basis of ecological, hydrologic, and jurisdictional factors and roughly corresponded with ecoregions. Physiographic and land use variables were derived from geographic information system coverages. The model for the entire state (n = 1,386) identified a composite measure of anthropogenic disturbance (the sum of urban, agricultural, and unmanaged roadside vegetation land cover) within the local watershed as the most important variable, explaining 56 % of the variance in O/E values. Models for individual regions explained between 51 and 84 % of the variance in O/E values. Measures of human disturbance were important in the three coastal regions. In the South Coast and Coastal Chaparral, local watershed measures of urbanization were the most important variables related to biological condition, while in the North Coast the composite measure of human disturbance at the watershed scale was most important. In the two mountain regions, natural gradients were most important, including slope, precipitation, and temperature. The remaining three regions had relatively small sample sizes (n ≤ 75 sites) and had models that gave mixed results. Understanding the spatial scale at which land use and land cover affect

  11. Transitioning from a single-site pilot project to a state-wide regional telehealth service: The experience from the Victorian Stroke Telemedicine programme. (United States)

    Bagot, Kathleen L; Cadilhac, Dominique A; Kim, Joosup; Vu, Michelle; Savage, Mark; Bolitho, Les; Howlett, Glenn; Rabl, Justin; Dewey, Helen M; Hand, Peter J; Denisenko, Sonia; Donnan, Geoffrey A; Bladin, Christopher F


    Scaling of projects from inception to establishment within the healthcare system is rarely formally reported. The Victorian Stroke Telemedicine (VST) programme provided a very useful opportunity to describe how rural hospitals in Victoria were able to access a network of Melbourne-based neurologists via telemedicine. The VST programme was initially piloted at one site in 2010 and has gradually expanded as a state-wide regional service operating with 16 hospitals in 2017. The aim of this paper is to summarise the factors that facilitated the state-wide transition of the VST programme. A naturalistic case-study was used and data were obtained from programme documents, e.g. minutes of governance committees, including the steering committee, the management committee and six working groups; operational and evaluation documentation, interviews and research field-notes taken by project staff. Thematic analysis was undertaken, with results presented in narrative form to provide a summary of the lived experience of developing and scaling the VST programme. The main success factors were attaining funding from various sources, identifying a clinical need and evidence-based solution, engaging stakeholders and facilitating co-design, including embedding the programme within policy, iterative evaluation including performing financial sustainability modelling, and conducting dissemination activities of the interim results, including promotion of early successes.

  12. Influenza vaccination uptake among Victorian healthcare workers: evaluating the success of a statewide program. (United States)

    Johnson, Sandra A; Bennett, Noleen; Bull, Ann L; Richards, Michael J; Worth, Leon J


    Annual influenza vaccination is recommended for all Australian healthcare workers (HCWs). In 2014, a target vaccination uptake of 75% was set for Victorian healthcare facilities. This study aimed to determine the 2014 uptake, describe trends over time and propose an enhanced reporting framework. Annual data submitted to the Victorian Healthcare Associated Infection Surveillance System (VICNISS) regarding HCW influenza were evaluated for 2005-2014. Faculty uptake - the number of vaccinations administered divided by total number of staff employed - was reported as a statewide aggregate and stratified by facility size (number of staff employed). In 2014, 78,885 HCWs were vaccinated across 93 healthcare facilities, corresponding to an overall uptake of 72.2%. During 2005-2014, small facilities (healthcare facility size categories, the highest uptake was observed in 2014. Influenza vaccination uptake in HCWs has successfully been introduced as a performance indicator in Victorian healthcare facilities and a peak uptake was reported in 2014. Varied trends are evident when uptake is stratified by number of employed HCWs, providing a feasible and meaningful method for benchmarking. © 2015 Public Health Association of Australia.

  13. Provider Profiling: A Population Health Improvement Tool for the Southeast Military Health System

    National Research Council Canada - National Science Library

    Pemberton, Phillip


    ...). Profiling with Provider Perspectives, a Primary Care Management Tool, provides the SEMHS with a standardized performance measurement system that offers feedback in a user friendly and non-threatening format...

  14. Algorithm of control systems required accuracy providing under the undetermined external disturbances


    Zbrutskyi, O.; Zagirska, I.; Stetsenko, T.


    New control algorithm and algorithm for providing required quality are defined. It based on comparison the forecast system condition, allowance conditions value, dynamic system properties and undetermined external disturbances compensation.

  15. Systems and methods for providing power to a load based upon a control strategy

    Energy Technology Data Exchange (ETDEWEB)

    Perisic, Milun; Kajouke, Lateef A; Ransom, Ray M


    Systems and methods are provided for an electrical system. The electrical system includes a load, an interface configured to receive a voltage from a voltage source, and a controller configured to receive the voltage from the voltage source through the interface and to provide a voltage and current to the load. Wherein, when the controller is in a constant voltage mode, the controller provides a constant voltage to the load, when the controller is in a constant current mode, the controller provides a constant current to the load, and when the controller is in a constant power mode, the controller provides a constant power to the load.

  16. Systems and methods for providing power to a load based upon a control strategy

    Energy Technology Data Exchange (ETDEWEB)

    Perisic, Milun; Lawrence, Christopher P; Ransom, Ray M; Kajouke, Lateef A


    Systems and methods are provided for an electrical system. The electrical system, for example, includes a first load, an interface configured to receive a voltage from a voltage source, and a controller configured to receive the voltage through the interface and to provide a voltage and current to the first load. The controller may be further configured to, receive information on a second load electrically connected to the voltage source, determine an amount of reactive current to return to the voltage source such that a current drawn by the electrical system and the second load from the voltage source is substantially real, and provide the determined reactive current to the voltage source.

  17. Configurable memory system and method for providing atomic counting operations in a memory device (United States)

    Bellofatto, Ralph E.; Gara, Alan G.; Giampapa, Mark E.; Ohmacht, Martin


    A memory system and method for providing atomic memory-based counter operations to operating systems and applications that make most efficient use of counter-backing memory and virtual and physical address space, while simplifying operating system memory management, and enabling the counter-backing memory to be used for purposes other than counter-backing storage when desired. The encoding and address decoding enabled by the invention provides all this functionality through a combination of software and hardware.

  18. Up Close and Personal: A Statewide Collaborative's Effort to Get Individual Surgeon Quality Improvement Data to the Practitioner. (United States)

    Daley, Brian J; Cecil, William; Cofer, Joseph B; Clarke, P Chris; Guillamondegui, Oscar


    Ranking of surgeons and hospitals focuses on procedure volume and hospitality. The National Surgical Quality Improvement Program provides vetted outcomes of surgical quality and therefore can direct improvement. Our statewide collaborative's analysis creates personalized surgeon data to drive quality improvement. Statewide National Surgical Quality Improvement Program data generated specific measures from 103,656 general/vascular cases and identified individual surgeon's outcome of occurrences and length of procedure. We assumed a normal distribution and called the top 2.5 per cent as exemplars and the bottom 2.5 per cent as outliers. For length of operation, a standard duration was calculated, and identified outliers as longer than the 95th percentile of the upper confidence interval/procedure. Since 2009, sharing best practice reduced statewide mortality rate by 31.5 per cent and postoperative morbidity by 33.3 per cent. For length of surgery, long outliers have more complications (urinary tract infection, organ space/surgical site infection, sepsis, septic shock, prolonged intubation, pneumonia, deep venous thrombosis, deep incisional infection, and wound disruption). No significant trends in surgeon performance were seen over 24 months. A statewide collaborative has resulted in substantial risk-adjusted reductions in surgical morbidity and mortality. These results of the individual surgeon demonstrate best practices are shared, a proven tool for improvement in our collaborative.

  19. Trends in statewide long-range transportation plans : core and emerging topics in 2017 (United States)


    This report synthesizes key findings and trends from the 2017 Statewide Long-Range Transportation Plan (SLRTP) Database, which represents key observations identified through a review of all 52 SLRTPs and Statewide Transportation Improvement Programs ...

  20. A collaborative interdisciplinary approach to electronic fetal monitoring: report of a statewide initiative. (United States)

    Miller, Lisa A; Miller, David A


    Intrapartum electronic fetal monitoring (EFM) is one of the most common procedures in obstetrics. Current consensus statements provide clinicians with a common language for EFM as well as provide a basis for a simplified approach to interpretation and management. This article presents a summary of the content and implementation of a statewide initiative in interdisciplinary EFM education and training designed to give clinicians of all backgrounds a shared mental model in EFM. Challenges to implementation at individual institutions may include physician and nursing engagement as well as time and cost constraints.

  1. Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System. (United States)

    Squitieri, Lee; Chung, Kevin C


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

  2. How Health Systems Make Available Information on Service Providers: Experience in Seven Countries. (United States)

    Cacace, Mirella; Ettelt, Stefanie; Brereton, Laura; Pedersen, Janice S; Nolte, Ellen


    This article provides details on a report that reviews and discusses information systems reporting on the quality or performance of providers of healthcare ("quality information systems") in seven countries: Denmark, England, Germany, Italy, the Netherlands, Sweden and the United States. Data collection involves a review of the published and grey literature and is complemented by information provided by key informants in the selected countries using a detailed questionnaire. Quality information systems typically address a number of audiences, including patients (or respectively the general public before receiving services and becoming patients), commissioners, purchasers and regulators. We observe that as the policy context for quality reporting in countries varies, so also does the nature and scope of quality information systems within and between countries. Systems often pursue multiple aims and objectives, which typically are (a) to support patient choice (b) to influence provider behaviour to enhance the quality of care (c) to strengthen transparency of the provider-commissioner relationship and the healthcare system as a whole and (d) to hold healthcare providers and commissioners to account for the quality of care they provide and the purchasing decisions they make. We emphasise that the main users of information systems are the providers themselves as the publication of information provides an incentive for improving the quality of care. Finally, based on the evidence reviewed, we identify a number of considerations for the design of successful quality information systems, such as the clear definition of objectives, ensuring users' accessibility and stakeholder involvement, as well as the need to provide valid, reliable and consistent data.

  3. A method of providing a barrier in a fracture-containing system

    DEFF Research Database (Denmark)


    The present invention relates to a method of providing a barrier in a fracture-containing system, comprising: i) Providing a treatment fluid comprising: a) a base fluid; b) an elastomeric material, wherein said elastomeric material comprises at least one polymer capable of crosslinking into an el......The present invention relates to a method of providing a barrier in a fracture-containing system, comprising: i) Providing a treatment fluid comprising: a) a base fluid; b) an elastomeric material, wherein said elastomeric material comprises at least one polymer capable of crosslinking...

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

  5. System and Method for Providing Vertical Profile Measurements of Atmospheric Gases (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — A system and method for using an air collection device to collect a continuous air sample as the device descends through the atmosphere are provided. The air...

  6. Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG) (United States)

    U.S. Department of Health & Human Services — A provider level summary of Inpatient Prospective Payment System (IPPS) discharges, average charges and average Medicare payments for the Top 100 Diagnosis-Related...

  7. A comparison of the efficiency of health systems in providing life expectancy

    DEFF Research Database (Denmark)

    Lenart, Adam; Zarulli, Virginia

    The role of the national health systems is to provide health for their citizens but each country achieves it up to a different degree. The health systems are heterogeneous not only in their efficiency but in their funding, organization and management too. As it is difficult to measure their effic......The role of the national health systems is to provide health for their citizens but each country achieves it up to a different degree. The health systems are heterogeneous not only in their efficiency but in their funding, organization and management too. As it is difficult to measure...... their efficiency in absolute terms, the countries can be compared with each other. The relative efficiency of health systems can be measured by the life expectancy that they provide by taking education level and their funding structure into account. Based on data coming from the HMD, GGS, OECD and WHO, data...

  8. Nutrition: Intervention Guidance for Service Providers and Families. Connecticut Birth to Three System, Service Guideline 6. (United States)

    Connecticut Birth to Three System, Hartford.

    This guide was developed to assist families and service providers in Connecticut with nutrition services for infants and toddlers with disabilities. Individual sections provide information about the following topics: laws and regulations related to nutrition services; eligibility for the Connecticut Birth to Three System and nutrition; nutrition…

  9. Solar-energy conversion system provides electrical power and thermal control for life-support systems (United States)

    Davis, B. K.


    System utilizes Freon cycle and includes boiler turbogenerator with heat exchanger, regenerator and thermal-control heat exchangers, low-pressure and boiler-feed pumps, and condenser. Exchanger may be of interest to engineers and scientists investigating new energy sources.

  10. An Enterprise System and a Business Simulation Provide Many Opportunities for Interdisciplinary Teaching (United States)

    Kreie, Jennifer; Shannon, James; Mora-Monge, Carlo A.


    Enterprise systems provide companies with centralized data management, business process support and integrated data flow between functional areas. Thanks to academic alliances offered by companies such as SAP, Oracle, Microsoft and others, universities can also take advantage of the integrated features of enterprise system to give business…

  11. The Issue of Community College Transfers: Peralta and Statewide. (United States)

    Peralta Community Coll. District, Oakland, CA. Office of Research, Planning and Development.

    The transfer rates of students in the Peralta Community College District (PCCD) are examined in the context of statewide and local transfer and enrollment rates. After introductory material citing the low transfer rate of California community college (CCC) students to California State Univeristy or University of California Schools (i.e., 2.6% of…

  12. California Statewide Plug-In Electric Vehicle Infrastructure Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Melaina, Marc; Helwig, Michael


    The California Statewide Plug-In Electric Vehicle Infrastructure Assessment conveys to interested parties the Energy Commission’s conclusions, recommendations, and intentions with respect to plug-in electric vehicle (PEV) infrastructure development. There are several relatively low-risk and high-priority electric vehicle supply equipment (EVSE) deployment options that will encourage PEV sales and

  13. Creating a Minnesota Statewide SNAP-Ed Program Evaluation (United States)

    Gold, Abby; Barno, Trina Adler; Sherman, Shelley; Lovett, Kathleen; Hurtado, G. Ali


    Systematic evaluation is an essential tool for understanding program effectiveness. This article describes the pilot test of a statewide evaluation tool for the Supplemental Nutrition Assistance Program-Education (SNAP-Ed). A computer algorithm helped Community Nutrition Educators (CNEs) build surveys specific to their varied educational settings…

  14. Providing security for automated process control systems at hydropower engineering facilities (United States)

    Vasiliev, Y. S.; Zegzhda, P. D.; Zegzhda, D. P.


    This article suggests the concept of a cyberphysical system to manage computer security of automated process control systems at hydropower engineering facilities. According to the authors, this system consists of a set of information processing tools and computer-controlled physical devices. Examples of cyber attacks on power engineering facilities are provided, and a strategy of improving cybersecurity of hydropower engineering systems is suggested. The architecture of the multilevel protection of the automated process control system (APCS) of power engineering facilities is given, including security systems, control systems, access control, encryption, secure virtual private network of subsystems for monitoring and analysis of security events. The distinctive aspect of the approach is consideration of interrelations and cyber threats, arising when SCADA is integrated with the unified enterprise information system.

  15. Criteria for the evaluation of a cloud-based hospital information system outsourcing provider. (United States)

    Low, Chinyao; Hsueh Chen, Ya


    As cloud computing technology has proliferated rapidly worldwide, there has been a trend toward adopting cloud-based hospital information systems (CHISs). This study examines the critical criteria for selecting the CHISs outsourcing provider. The fuzzy Delphi method (FDM) is used to evaluate the primary indicator collected from 188 useable responses at a working hospital in Taiwan. Moreover, the fuzzy analytic hierarchy process (FAHP) is employed to calculate the weights of these criteria and establish a fuzzy multi-criteria model of CHISs outsourcing provider selection from 42 experts. The results indicate that the five most critical criteria related to CHISs outsourcing provider selection are (1) system function, (2) service quality, (3) integration, (4) professionalism, and (5) economics. This study may contribute to understanding how cloud-based hospital systems can reinforce content design and offer a way to compete in the field by developing more appropriate systems.

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

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


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

  17. Benchmarking statewide trauma mortality using Agency for Healthcare Research and Quality's patient safety indicators. (United States)

    Ang, Darwin; McKenney, Mark; Norwood, Scott; Kurek, Stanley; Kimbrell, Brian; Liu, Huazhi; Ziglar, Michele; Hurst, James


    Improving clinical outcomes of trauma patients is a challenging problem at a statewide level, particularly if data from the state's registry are not publicly available. Promotion of optimal care throughout the state is not possible unless clinical benchmarks are available for comparison. Using publicly available administrative data from the State Department of Health and the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs), we sought to create a statewide method for benchmarking trauma mortality and at the same time also identifying a pattern of unique complications that have an independent influence on mortality. Data for this study were obtained from State of Florida Agency for Health Care Administration. Adult trauma patients were identified as having International Classification of Disease ninth edition codes defined by the state. Multivariate logistic regression was used to create a predictive inpatient expected mortality model. The expected value of PSIs was created using the multivariate model and their beta coefficients provided by the AHRQ. Case-mix adjusted mortality results were reported as observed to expected (O/E) ratios to examine mortality, PSIs, failure to prevent complications, and failure to rescue from death. There were 50,596 trauma patients evaluated during the study period. The overall fit of the expected mortality model was very strong at a c-statistic of 0.93. Twelve of 25 trauma centers had O/E ratios benchmarking method that screens at risk trauma centers in the state for higher than expected mortality. Stratifying mortality based on failure to prevent PSIs may identify areas of needed improvement at a statewide level. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Decision support system of e-book provider selection for library using Simple Additive Weighting (United States)

    Ciptayani, P. I.; Dewi, K. C.


    Each library has its own criteria and differences in the importance of each criterion in choosing an e-book provider for them. The large number of providers and the different importance levels of each criterion make the problem of determining the e-book provider to be complex and take a considerable time in decision making. The aim of this study was to implement Decision support system (DSS) to assist the library in selecting the best e-book provider based on their preferences. The way of DSS works is by comparing the importance of each criterion and the condition of each alternative decision. SAW is one of DSS method that is quite simple, fast and widely used. This study used 9 criteria and 18 provider to demonstrate how SAW work in this study. With the DSS, then the decision-making time can be shortened and the calculation results can be more accurate than manual calculations.

  19. Factors Predicting Oncology Care Providers' Behavioral Intention to Adopt Clinical Decision Support Systems (United States)

    Wolfenden, Andrew


    The purpose of this quantitative correlation study was to examine the predictors of user behavioral intention on the decision of oncology care providers to adopt or reject the clinical decision support system. The Unified Theory of Acceptance and Use of Technology (UTAUT) formed the foundation of the research model and survey instrument. The…

  20. North Carolina Statewide Star Party: 45 Sites Offer Skywatching and Citizen Science the Same Night (United States)

    Sayle, A. E.; Sorrell, M. J.; Frederick, J.; Young, D. L.


    As the kickoff to the 2013 North Carolina Science Festival, 45 sites across the state planned skywatching sessions for the public on April 5, 2013. The Statewide Star Party sites stretched across 500 miles, from the mountains to the Outer Banks, and included large cities as well as rural areas. Hosts included parks, planetariums, museums, nature centers, and universities. Many sites were aided by local amateur astronomers who provided their telescopes and expertise. Because the star party date fell during International Dark Sky Week and a GLOBE at Night citizen-science campaign, each host was encouraged to teach their audiences about light pollution and GLOBE at Night, and was provided with a kit of relevant materials to support them in planning their events and educating the public. Two hosts canceled their events because of poor weather. The 43 star party events that took place attracted 4,926 participants and were held in 31 counties across the state. The North Carolina Statewide Star Party will become an annual event during the North Carolina Science Festival. Other states and regions are encouraged to plan similar star parties to help educate and inspire the public about astronomy and citizen science.

  1. The Pennsylvania Trauma Outcomes Study Risk-Adjusted Mortality Model: Results of a Statewide Benchmarking Program. (United States)

    Wiebe, Douglas J; Holena, Daniel N; Delgado, M Kit; McWilliams, Nathan; Altenburg, Juliet; Carr, Brendan G


    Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n = 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups). Patient demographic variables, physiology, mechanism of injury, transfer status, injury severity, and pre-existing conditions were included as predictor variables. The statistical model had excellent discrimination (area under the curve = 0.94). Funnel plots of observed-to-expected identified five centers with lower than expected mortality and two centers with higher than expected mortality. No centers were outliers for management of penetrating trauma, but five centers had lower and three had higher than expected mortality for blunt trauma. It is feasible to use Trauma Quality Improvement Program methodology to develop risk-adjusted models for statewide trauma systems. Even with smaller numbers of trauma centers that are available in national datasets, it is possible to identify high and low outliers in performance.

  2. Experience in implementing inpatient clinical note capture via a provider order entry system. (United States)

    Rosenbloom, S Trent; Grande, Jonathan; Geissbuhler, Antoine; Miller, Randolph A


    Care providers' adoption of computer-based health-related documentation ("note capture") tools has been limited, even though such tools have the potential to facilitate information gathering and to promote efficiency of clinical charting. The authors have developed and deployed a computerized note-capture tool that has been made available to end users through a care provider order entry (CPOE) system already in wide use at Vanderbilt. Overall note-capture tool usage between January 1, 1999, and December 31, 2001, increased substantially, both in the number of users and in their frequency of use. This case report is provided as an example of how an existing care provider order entry environment can facilitate clinical end-user adoption of a computer-assisted documentation tool-a concept that may seem counterintuitive to some.

  3. Providing the full DDF link protection for bus-connected SIEPON based system architecture (United States)

    Hwang, I.-Shyan; Pakpahan, Andrew Fernando; Liem, Andrew Tanny; Nikoukar, AliAkbar


    Currently a massive amount of traffic per second is delivered through EPON systems, one of the prominent access network technologies for delivering the next generation network. Therefore, it is vital to keep the EPON optical distribution network (ODN) working by providing the necessity protection mechanism in the deployed devices; otherwise, when failures occur it will cause a great loss for both network operators and business customers. In this paper, we propose a bus-connected architecture to protect and recover distribution drop fiber (DDF) link faults or transceiver failures at ONU(s) in SIEPON system. The proposed architecture provides a cost-effective architecture, which delivers the high fault-tolerance in handling multiple DDF faults, while also providing flexibility in choosing the backup ONU assignments. Simulation results show that the proposed architecture provides the reliability and maintains quality of service (QoS) performance in terms of mean packet delay, system throughput, packet loss and EF jitter when DDF link failures occur.

  4. Optimizing the Use of Storage Systems Provided by Cloud Computing Environments (United States)

    Gallagher, J. H.; Potter, N.; Byrne, D. A.; Ogata, J.; Relph, J.


    Cloud computing systems present a set of features that include familiar computing resources (albeit augmented to support dynamic scaling of processing power) bundled with a mix of conventional and unconventional storage systems. The linux base on which many Cloud environments (e.g., Amazon) are based make it tempting to assume that any Unix software will run efficiently in this environment efficiently without change. OPeNDAP and NODC collaborated on a short project to explore how the S3 and Glacier storage systems provided by the Amazon Cloud Computing infrastructure could be used with a data server developed primarily to access data stored in a traditional Unix file system. Our work used the Amazon cloud system, but we strived for designs that could be adapted easily to other systems like OpenStack. Lastly, we evaluated different architectures from a computer security perspective. We found that there are considerable issues associated with treating S3 as if it is a traditional file system, even though doing so is conceptually simple. These issues include performance penalties because using a software tool that emulates a traditional file system to store data in S3 performs poorly when compared to a storing data directly in S3. We also found there are important benefits beyond performance to ensuring that data written to S3 can directly accessed without relying on a specific software tool. To provide a hierarchical organization to the data stored in S3, we wrote 'catalog' files, using XML. These catalog files map discrete files to S3 access keys. Like a traditional file system's directories, the catalogs can also contain references to other catalogs, providing a simple but effective hierarchy overlaid on top of S3's flat storage space. An added benefit to these catalogs is that they can be viewed in a web browser; our storage scheme provides both efficient access for the data server and access via a web browser. We also looked at the Glacier storage system and

  5. Evaluating RITES, a Statewide Math and Science Partnership Program (United States)

    Murray, D. P.; Caulkins, J. L.; Burns, A. L.; de Oliveira, G.; Dooley, H.; Brand, S.; Veeger, A.


    The Rhode Island Technology-Enhanced Science project (RITES) is a NSF-MSP Program that seeks to improve science education by providing professional development to science teachers at the 5th through 12th grade levels. At it's heart, RITES is a complex, multifaceted project that is challenging to evaluate because of the nature of its goal: the development of a large, statewide partnership between higher education and K12 public school districts during a time when science education strategies and leadership are in flux. As a result, these difficulties often require flexibility and creativity regarding evaluation, study design and data collection. In addition, the research agenda of the project often overlaps with the evaluator's agenda, making collaboration and communication a crucial component of the project's success. In it's 5th year, RITES and it's evaluators have developed a large number of instruments, both qualitative and quantitative, to provide direction and feedback on the effectiveness of the project's activities. RITES personnel work closely with evaluators and researchers to obtain a measure of how RITES' 'theory-of-action' affects both student outcomes and teacher practice. Here we discuss measures of teacher and student content gains, student inquiry gains, and teacher implementation surveys. Using content questions based on AAAS and MOSART databases, teachers in the short courses and students in classrooms showed significant normalized learning gains with averages generally above 0.3. Students of RITES-trained teachers also outperformed their non-RITES peers on the inquiry-section of the NECAP test, and The results show, after controlling for race and economic status, a small but statistically significant increase in test scores for RITES students. Technology use in the classroom significantly increased for teachers who were 'expected implementers' where 'expected implementers' are those teachers who implemented RITES as the project was designed. This

  6. [Development of Internet-based system to collect and provide drug information for patients/consumers]. (United States)

    Kurimoto, Fuki; Hori, Satoko; Satoh, Hiroki; Miki, Akiko; Sawada, Yasufumi


    For drug fostering and evolution, it is important to collect information directly from patients on the efficacy and safety of drugs as well as patient needs. At present, however, information gathered by healthcare professionals, pharmaceutical companies, or governments is not sufficient. There is concern that patients may fail to recognize the importance of providing information voluntarily. The present study was conducted to provide drug information to patients/consumers, to enlighten them on the importance of providing drug information by themselves, and to develop an Internet website, called "Minkusu," for collecting drug information from patients. This website is based on a registration system (free of charge). It is designed to provide information on proper drug use, and to collect opinions about drugs. As of May 31, 2012, a total of 1149 people had been registered. The male/female ratio of registered members was approximately 1:1, and patients/consumers accounted for 23%. According to the results of a questionnaire survey, several patient/consumer members appreciated the usefulness of the information service, and they took an opportunity to know of the concepts of drug development and evolution (Ikuyaku, in Japanese) through the information services provided by this site. In conclusion, the developed information system would contribute to the proper use of drugs by patients/consumers and to the promotion of drug development and evolution.

  7. [A web information system for enhancing management and improving special care services provided to dependent persons]. (United States)

    Alvarez-Bermejo, J A; Hernández-Capel, D M; Belmonte-Ureña, L J; Roca-Piera, J


    Ensuring the quality of services provided in centres where dependent persons are seen by specialist services, by improving and enhancing how information -salary, control of tasks, patients' records, etc.- is shared between staff and carers. A web information system has been developed and experimentally deployed to accomplish this. The accuracy of the system was evaluated by assessing how confident the employees were with it rather than relying on statistical data. It was experimentally deployed since January 2009 in Asociación de Personas con Discapacidad "El Saliente" that manages several day centres in Almeria, for dependent persons over 65 years old, particularly those affected by Alzheimer' disease. Incidence data was collected during the experimental period. A total of 84% of the employees thought that the system helped to manage documents, administrative duties, etc., and 92.4% said they could attend to really important tasks because the system was responsible for alerting them of every task, such as medication timetables, checking all patients were present (to prevent an Alzheimer affected person leaving the centre) etc. During this period the incidences reported were reduced by about a 30%, although data is still partially representative. As the life expectancy of the population gets longer, these centres will increase. Providing systems such as the one presented here would be of great help for administrative duties (sensitive data protection...) as well as ensuring high quality care and attention.

  8. Creating a smart application system to provide a beneficial maintenance service for elderly drivers

    Directory of Open Access Journals (Sweden)

    Jung Sebin


    Full Text Available As overall population ages, elderly drivers have become a larger percentage of the driving population. With this trend, a lot of vehicle systems have been improved for elderly’s safety and convenience using different advanced technologies. However, elderly drivers have often paid more money than other drivers in a car-repair shop due to their lack of knowledge about vehicle systems with modern technologies. Given this fact, developing a tool to diminish this disadvantage and to help elderly drivers maintain their cars with confidence and with minimal cost is necessary. Therefore, this research work mainly focuses on suggesting a system concept on user-interface application, which is connected to a smart phone or a tablet to provide beneficial services anywhere. For the research outcome, diverse research activities – surveys, interviews with small focus groups, observations of the focus groups, and discussions – has been conducted to understand the elderly driver’s difficulties and behaviours regarding vehicle maintenance, to investigate what specific problems make them uncomfortable in repair shops, and to demonstrate how new system-concepts could be developed for the elderly. Furthermore, we conclude that adequate system-concepts for the elderly would offer elderly drivers convenient vehicle repair and maintenance and provide them a confident driving experience.

  9. Handgun Legislation and Changes in Statewide Overall Suicide Rates. (United States)

    Anestis, Michael D; Anestis, Joye C; Butterworth, Sarah E


    To examine the extent to which 4 laws regulating handgun ownership were associated with statewide suicide rate changes. To test between-group differences in statewide suicide rate changes between 2013 and 2014 in all 50 states and the District of Columbia with and without specific laws, we ran analyses of covariance. We found significant differences in suicide rate changes from 2013 to 2014 in states with mandatory waiting periods and universal background checks relative to states without such laws. States with both laws differed significantly from those with neither. No significant differences in rate changes were noted for open carry restrictions or gun lock requirements. Some state laws regulating aspects of handgun acquisition may be associated with lower statewide suicide rates. Laws regulating handgun storage and carrying practices may have a smaller effect, highlighting that legislation is likely most useful when its focus is on preventing gun ownership rather than regulating use and storage of guns already acquired. Public Health Implications. The findings add to the increasing evidence in support of a public health approach to the prevention of suicide via firearms, focusing on waiting periods and background checks.

  10. Piloting a Statewide Home Visiting Quality Improvement Learning Collaborative. (United States)

    Goyal, Neera K; Rome, Martha G; Massie, Julie A; Mangeot, Colleen; Ammerman, Robert T; Breckenridge, Jye; Lannon, Carole M


    Objective To pilot test a statewide quality improvement (QI) collaborative learning network of home visiting agencies. Methods Project timeline was June 2014-May 2015. Overall objectives of this 8-month initiative were to assess the use of collaborative QI to engage local home visiting agencies and to test the use of statewide home visiting data for QI. Outcome measures were mean time from referral to first home visit, percentage of families with at least three home visits per month, mean duration of participation, and exit rate among infants home visit was 16.7 days, and 9.4% of families received ≥3 visits per month. Mean participation was 11.7 months, and the exit rate among infants <6 months old was 6.1%. Agencies tested several strategies, including parent commitment agreements, expedited contact after referral, and Facebook forums. No shift in outcome measures was observed, but agencies tracked intermediate process changes using internal site-specific data. Agencies reported positive experiences from participation including more frequent and structured staff meetings. Conclusions for Practice Within a pilot QI learning network, agencies tested and measured changes using statewide and internal data. Potential next steps are to develop and test new metrics with current pilot sites and a larger collaborative.

  11. Avoiding the big bang : membrane nitrogen generation system provides safety and convenience

    Energy Technology Data Exchange (ETDEWEB)

    Ross, E.


    A shortage of liquid nitrogen prompted Lexington Energy Services Inc. to realize the huge market for on-site nitrogen generation. Directive 33 of the Alberta Energy and Utilities Board requires nitrogen to be used in carbon-based atmospheres such as in well testing. In response, the company developed a truck-mounted membrane nitrogen generation system that offers greater purity than other systems. The portable system provides both safety and convenience. The truck-mounted system takes a huge amount of air that is pushed through a membrane or filter, resulting in 44 per cent of the original volume of air produced as pure nitrogen. The nitrogen is put through another compressor and boosted up to the oilfield application pressure. The system produces a waste gas (primarily oxygen) which is vented into the atmosphere. Electricity for the electric system is produced by a diesel engine. The membrane is 5 feet long and 8 inches in diameter. It has an inlet for air and only allows nitrogen to pass through. In designing the system, parameters such as pressure, purity and flow rates were identified. The system is targeted primarily for well servicing applications and is designed to serve approximately 60 per cent of the nitrogen market. It was noted that although membrane systems have limitations and cannot do high rate application such as fracing or coalbed methane, they may be used in underbalanced drilling. In addition to cost savings and convenience, the advantage of a portable nitrogen system over liquid nitrogen is the elimination of venting loss associated with liquid nitrogen transportation. 3 figs.

  12. An analysis of the usability of inpatient insulin ordering in three computerized provider order entry systems. (United States)

    Neinstein, Aaron; Cucina, Russ


    Insulin is a highly scrutinized drug in hospitals since it is both frequently used and high risk. As the insulin ordering process makes a transition from pen and paper to computerized provider order entry (CPOE) systems, the effective design of these systems becomes critical. There are fundamental usability principles in the field of human-computer interaction design, which help make interfaces that are effective, efficient, and satisfying. To our knowledge, there has not been a study that specifically looks at how these principles have been applied in the design of insulin orders in a CPOE system. We analyzed the usability of inpatient insulin ordering in three widely deployed CPOE systems-two commercially marketed systems and the U.S. Department of Veterans Affairs VistA Computerized Patient Record System. We performed a usability analysis using aspects of three different methods. Our first goal was to note each instance where a usability principle was either upheld or not upheld. Our second goal was to discover ways in which CPOE designers could exploit usability principles to make insulin ordering safer and more intuitive in the future. Commonly encountered usability principles included constraints, obviousness/self-evidence, natural mapping, feedback, and affordance. The three systems varied in their adherence to these principles, and each system had varying strengths and weaknesses. Adherence to usability principles is important when building a CPOE system, yet designers observe them to varying degrees. A well-designed CPOE interface allows a clinician to focus more of his or her mental energy on clinical decisions rather than on deciphering the system itself. In the future, intelligent design of CPOE insulin orders can be used to help optimize and modernize management of hyperglycemia in the hospital. © 2011 Diabetes Technology Society.

  13. Child Day Care Centers, This dataset contains the licensed daycare center locations in MD. Addresses were provided by the Department of Labor Licensing and Regulation (DLLR), and geocoded using Maryland Statewide Addressing Initiative Centerline., Published in 2012, 1:2400 (1in=200ft) scale, Towson University. (United States)

    NSGIC Education | GIS Inventory — Child Day Care Centers dataset current as of 2012. This dataset contains the licensed daycare center locations in MD. Addresses were provided by the Department of...

  14. Provider and Health System Factors Associated with Usage of Long-Acting Reversible Contraception in Adolescents. (United States)

    Smith, Anna Jo Bodurtha; Harney, Kathleen F; Singh, Tara; Hurwitz, Anita Gupta


    Long-acting reversible contraception (LARC) is recommended as first-line contraception for adolescents. Surveys of primary care providers suggest that physician and clinic factors might influence LARC counseling, but their effect on usage is unknown. Our objective was to explore provider and clinic characteristics associated with LARC usage in adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional study of 5363 women ages 15-21 years receiving primary care within a large health system in Massachusetts in 2015. We used data abstracted from electronic medical records to characterize rates of LARC usage. We analyzed the association of provider (specialty, degree, gender, resident status, LARC credentialing) and clinic (Title X funding, onsite LARC provision, onsite obstetrician-gynecologist) factors with adolescents' LARC usage using multivariate logistic regression. Overall, 3.4% (95% confidence interval [CI], 2.9-3.9) of adolescents were documented as currently using a LARC method. Older adolescents were significantly more likely to use a LARC method (adjusted odds ratio, 2.41; 95% CI, 1.62-3.58 for women ages 20-21 years compared with ages 15-17 years). Adolescents whose primary care provider was a resident were significantly more likely to use a LARC method (adjusted odds ratio, 1.65; 95% CI, 1.02-2.68). Provider specialty, degree, gender, onsite LARC provision, and onsite obstetrician-gynecologist were not significantly associated with LARC usage in adolescents. Being older and having a primary care provider early in their training increased the odds of LARC usage among adolescents in a large Massachusetts health system. Across primary care specialties, educating providers about the appropriate uses of LARC methods in nulliparous adolescents might facilitate LARC usage. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  15. Computerized provider order entry systems - Research imperatives and organizational challenges facing pathology services. (United States)

    Georgiou, Andrew; Westbrook, Johanna; Braithwaite, Jeffrey


    Information and communication technologies (ICT) are contributing to major changes taking place in pathology and within health services more generally. In this article, we draw on our research experience for over 7 years investigating the implementation and diffusion of computerized provider order entry (CPOE) systems to articulate some of the key informatics challenges confronting pathology laboratories. The implementation of these systems, with their improved information management and decision support structures, provides the potential for enhancing the role that pathology services play in patient care pathways. Beyond eliminating legibility problems, CPOE systems can also contribute to the efficiency and safety of healthcare, reducing the duplication of test orders and diminishing the risk of misidentification of patient samples and orders. However, despite the enthusiasm for CPOE systems, their diffusion across healthcare settings remains variable and is often beset by implementation problems. Information systems like CPOE may have the ability to integrate work, departments and organizations, but unfortunately, health professionals, departments and organizations do not always want to be integrated in ways that information systems allow. A persistent theme that emerges from the research evidence is that one size does not fit all, and system success or otherwise is reliant on the conditions and circumstances in which they are located. These conditions and circumstances are part of what is negotiated in the complex, messy and challenging area of ICT implementation. The solution is not likely to be simple and easy, but current evidence suggests that a combination of concerted efforts, better research designs, more sophisticated theories and hypotheses as well as more skilled, multidisciplinary research teams, tackling this area of study will bring substantial benefits, improving the effectiveness of pathology services, and, as a direct corollary, the quality of

  16. Provider and Site-Level Determinants of Testosterone Prescribing in the Veterans Healthcare System. (United States)

    Jasuja, Guneet K; Bhasin, Shalender; Rose, Adam J; Reisman, Joel I; Hanlon, Joseph T; Miller, Donald R; Morreale, Anthony P; Pogach, Leonard M; Cunningham, Francesca E; Park, Angela; Wiener, Renda S; Gifford, Allen L; Berlowitz, Dan R


    Testosterone prescribing rates have increased substantially in the past decade. However, little is known about the context within which such prescriptions occur. We evaluated provider- and site-level determinants of receipt of testosterone and of guideline-concordant testosterone prescribing. This study was cross-sectional in design. This study was conducted at the Veterans Health Administration (VA). Study participants were a national cohort of male patients who had received at least one outpatient prescription within the VA during fiscal year (FY) 2008 to FY 2012. A total of 38,648 providers and 130 stations were associated with these patients. This study measured receipt of testosterone and guideline-concordant testosterone prescribing. Providers ranging in age from 31 to 60 years, with less experience in the VA [all adjusted odds ratio (AOR), testosterone compared with older providers, providers of longer VA tenure, and primary care providers, respectively. Sites located in the West compared with the Northeast [AOR, 1.75; 95% confidence interval (CI), 1.45-2.11] and care received at a community-based outpatient clinic compared with a medical center (AOR, 1.22; 95% CI, 1.20-1.24) also predicted testosterone use. Although they were more likely to prescribe testosterone, endocrinologists were also more likely to obtain an appropriate workup before prescribing compared with primary care providers (AOR, 2.14; 95% CI, 1.54-2.97). Our results highlight the opportunity to intervene at both the provider and the site levels to improve testosterone prescribing. This study also provides a useful example of how to examine contributions to prescribing variation at different levels of the health care system.

  17. An Intelligent Virtual Human System For Providing Healthcare Information And Support (United States)


    CyberPsychology and Behavior 8, 3 (2005), 187-211. [2] T. Parsons & A.A. Rizzo, Affective Outcomes of Virtual Reality Exposure Therapy for Anxiety...VH System for Providing Healthcare Information and Support508 [4] G. Riva, Virtual Reality in Psychotherapy: Review, CyberPsychology and Behavior 8...3 (2005), 220- 230. [5] F.D. Rose, B.M. Brooks & A.A. Rizzo, Virtual Reality in Brain Damage Rehabilitation: Review, CyberPsychology and Behavior

  18. Reaching out: a strategy to provide primary eye care through the indigenous educational system in Pakistan

    Directory of Open Access Journals (Sweden)

    Muhammad Tanweer Abdullah


    Full Text Available IntroductionIn Pakistan, there is a unique and indigenously established system of education called the madaris . It is the plural of madrassa, which is an Arabic word for a school system. In the context of Pakistan, it refers to an institutional set-up that runs in parallel to the conventional schooling system and is community-based. It is perhaps the oldest and the largest educational system of its kind whereby the students are provided with free religious education. Some institutions offer a combination of religious learning and regular schooling.The facilities and the curricula vary from one madrassa to another. Since a majority of the students studying here belong to the poor and neglected socio-economic level of society, many offer free accommodation and food to the students in hostels, and most of these provide free education. These institutions are mostly funded by philanthropists; the standard of living of the students, however, is not always satisfactory.A few madaris provide basic health care services to their students, but most are neglected both by the government and the voluntary sectors. It is difficult to find data on the health status of these students.This article reports a study on these madaris that was carried out in 2002 in the district of Peshawar, the capital of the North-West Frontier Province (NWFP of Pakistan which has a population of 2.5 million. It aimed to determine the prevalence of blindness and low vision among students in the age group of five to 15 years. It offers an agenda for primary eye care and highlights the importance of integrated health care reforms at the national level for this large non-government community education system that caters to an estimated half a million children throughout Pakistan.

  19. An In-Vehicle Application Providing System Based on Driver’s Biodata

    Directory of Open Access Journals (Sweden)

    Kwang-Ho Seok


    Full Text Available The recent technologies for vehicular networks including wireless communication have allowed vehicles to provide biosensor based various applications to a driver. This paper proposes a system to provide a driver with the application which the driver wants in a vehicle using driver’s biodata. The proposed system is composed of four components including a sensing unit, an inference unit, an application providing unit, and vehicular network unit. In this paper, the experiments were performed for correlation investigation between the number of biodata and the reliability of driver’s characteristics extraction. We found that the number of the data used had a significant influence on improving the driver’s satisfaction level, playing an important role in reflecting driver’s status. Experiments using actual vehicles are conducted to examine the effectiveness of the proposed system, and the results are analyzed and discussed. The results on the investigation of detection of biodata in gasoline and diesel vehicles by the experiments are also given. We confirmed that the proposed sensing method was capable of accurate detection irrespective of vehicle mode and vehicle type.

  20. The development of system components to provide proprioceptive and tactile information to the human for future telepresence systems (United States)

    Wright, Ammon K.


    System components are presented that are being implemented to augment teleoperated systems by providing both force and tactile information to the human operator. The concept proposed is the control of a manipulator to perform tasks; i.e., flight line maintenance and repair of combat aircraft or satellites while under the control of a human operator at a remote location to maintain mission effectiveness in a hostile environment. The human would control the motion of the manipulator via a master system with information from the remote site being fed back by direct stimulation of the humans sensory mechanisms or by graphic interpretation of displays. We are interested in providing the operator feedback of position, force, auditory, vision, and tactile information to aide in the human's cognitive ability to control the manipulator. This sensory information from the remote site would then be presented to the operator in such a manner as to enhance his performance while providing him a sense of being present at the remote location, this is known as telepresence. Also discussed is the research done by the Human Sensory Feedback (HSF) facility at the Armstrong Laboratory to provide tactile and proprioceptive feedback to the operator. The system components of this system includes tactile sensor and stimulators, dexterous robotic hands, and the control of positioning and operating industrial robots with exoskeletal mechanisms.

  1. Neighborhood Stabilization Program Data NSP1 (Statewide) (United States)

    Department of Housing and Urban Development — HUD's Neighborhood Stabilization Program ( provides emergency assistance to state and local governments to acquire and redevelop foreclosed...

  2. Simulation-based Education to Ensure Provider Competency Within the Health Care System. (United States)

    Griswold, Sharon; Fralliccardi, Alise; Boulet, John; Moadel, Tiffany; Franzen, Douglas; Auerbach, Marc; Hart, Danielle; Goswami, Varsha; Hui, Joshua; Gordon, James A


    The acquisition and maintenance of individual competency is a critical component of effective emergency care systems. This article summarizes consensus working group deliberations and recommendations focusing on the topic "Simulation-based education to ensure provider competency within the healthcare system." The authors presented this work for discussion and feedback at the 2017 Academic Emergency Medicine Consensus Conference on "Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcomes," held on May 16, 2017, in Orlando, Florida. Although simulation-based training is a quality and safety imperative in other high-reliability professions such as aviation, nuclear power, and the military, health care professions still lag behind in applying simulation more broadly. This is likely a result of a number of factors, including cost, assessment challenges, and resistance to change. This consensus subgroup focused on identifying current gaps in knowledge and process related to the use of simulation for developing, enhancing, and maintaining individual provider competency. The resulting product is a research agenda informed by expert consensus and literature review. © 2017 by the Society for Academic Emergency Medicine.

  3. Technical architecture of ONC-approved plans for statewide health information exchange. (United States)

    Barrows, Randolph C; Ezzard, John


    ONC-approved state plans for HIE were reviewed for descriptions and depictions of statewide HIE technical architecture. Review was complicated by non-standard organizational elements and technical terminology across state plans. Findings were mapped to industry standard, referenced, and defined HIE architecture descriptions and characteristics. Results are preliminary due to the initial subset of ONC-approved plans available, the rapid pace of new ONC-plan approvals, and continuing advancements in standards and technology of HIE, etc. Review of 28 state plans shows virtually all include a direct messaging component, but for participating entities at state-specific levels of granularity (RHIO, enterprise, organization/provider). About ½ of reviewed plans describe a federated architecture, and ¼ of plans utilize a single-vendor "hybrid-federated" architecture. About 1/3 of states plan to leverage new federal and open exchange technologies (DIRECT, CONNECT, etc.). Only one plan describes a centralized architecture for statewide HIE, but others combine central and federated architectural approaches.

  4. Administrative data provide vital research evidence for maximizing health-system performance and outcomes. (United States)

    Roder, David; Buckley, Elizabeth


    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.

  5. Empowering High School Students in Scientific Careers: Developing Statewide Partnerships (United States)

    Aguilar, C.; Swartz, D.


    Center for Multiscale Modeling of Atmospheric Processes (CMMAP) is a National Science Foundation Science and Technology Center focused on improving the representation of cloud processes in climate models. The Center is divided into three sections including Knowledge Transfer, Research, and Education and Diversity. The Science Education and Diversity mission is to educate and train people with diverse backgrounds in Climate and Earth System Science by enhancing teaching and learning and disseminating science results through multiple media. CMMAP is partnering with two local school districts to host an annual global climate conferences for high school students. The 2008 Colorado Global Climate Conference seeks "To educate students on global and local climate issues and empower them to se their knowledge." The conference is sponsored by CMMAP, The Governor's Energy Office, Poudre School District, Thompson School District, Clif Bar, and Ben and Jerry's Scoop Shop of Fort Collins. The conference seeks to inspire students to pursue future education and careers in science fields. Following an opening welcome from the Governor's Energy Office, Keynote Piers Sellers will discuss his experiences as an atmospheric scientist and NASA astronaut. Students will then attend 3 out of 16 breakout sessions including such sessions as "Hot poems, Cool Paintings, and the treasures of Antiquity of Climate Change", "Mitigation vs Adaptation", "Bigfoot Walks(What Size is our carbon footprint?)" "The Wedges: Reduc ing Carbon Emissions", and "We the People: Climate and Culture of Climate Change" to name a few. Using The Governor's High School Conference on the Environment sponsored by the Wisconsin Center for Environmental Education as a model we are developing statewide partnerships to bring high school students together to look at global climate issues that will impact their future and of which they can be part of the solution through their education and career paths. In addition to

  6. Geodatabase of Wyoming statewide oil and gas drilling activity to 2010 (United States)

    Biewick, Laura


    The U.S. Geological Survey (USGS) compiled a geographic information system (GIS) of Wyoming statewide historical oil and gas drilling activity for the Wyoming Landscape Conservation Initiative (WLCI). The WLCI is representative of the partnerships being formed by the USGS with other Department of the Interior bureaus, State and local agencies, industry, academia, and private landowners that are committed to maintaining healthy landscapes, sustaining wildlife, and preserving recreational and grazing uses as energy resources development progresses in southwestern Wyoming. This product complements the 2009 USGS publication on oil and gas development in southwestern Wyoming by approximating, based on database attributes, the time frame of drilling activity for each well (start and stop dates). This GIS product also adds current oil and gas drilling activity not only in the area encompassing the WLCI, but also statewide. Oil and gas data, documentation, and spatial data processing capabilities are available and can be downloaded from the USGS website. These data originated from the Wyoming Oil and Gas Conservation Commission (WOGCC), represent decades of oil and gas drilling (1900 to 2010), and will facilitate a landscape-level approach to integrated science-based assessments, resource management and land-use decision making.

  7. Benefits to the Europa Clipper Mission Provided by the Space Launch System (United States)

    Creech, Stephen D.; Patel, Keyur


    The National Aeronautics and Space Administration's (NASA's) proposed Europa Clipper mission would provide an unprecedented look at the icy Jovian moon, and investigate its environment to determine the possibility that it hosts life. Focused on exploring the water, chemistry, and energy conditions on the moon, the spacecraft would examine Europa's ocean, ice shell, composition and geology by performing 32 low-altitude flybys of Europa from Jupiter orbit over 2.3 years, allowing detailed investigations of globally distributed regions of Europa. In hopes of expediting the scientific program, mission planners at NASA's Jet Propulsion Laboratory are working with the Space Launch System (SLS) program, managed at Marshall Space Flight Center. Designed to be the most powerful launch vehicle ever flown, SLS is making progress toward delivering a new capability for exploration beyond Earth orbit. The SLS rocket will offer an initial low-Earth-orbit lift capability of 70 metric tons (t) beginning with a first launch in 2017 and will then evolve into a 130 t Block 2 version. While the primary focus of the development of the initial version of SLS is on enabling human exploration missions beyond low Earth orbit using the Orion Multi-Purpose Crew Vehicle, the rocket offers unique benefits to robotic planetary exploration missions, thanks to the high characteristic energy it provides. This paper will provide an overview of both the proposed Europa Clipper mission and the Space Launch System vehicle, and explore options provided to the Europa Clipper mission for a launch within a decade by a 70 t version of SLS with a commercially available 5-meter payload fairing, through comparison with a baseline of current Evolved Expendable Launch Vehicle (EELV) capabilities. Compared to that baseline, a mission to the Jovian system could reduce transit times to less than half, or increase mass to more than double, among other benefits. In addition to these primary benefits, the paper will

  8. Implementation the NASA Planetary Data System PDS4 Providing Access to LADEE Data (United States)

    Beebe, Reta F.; Huber , Lyle; Neakrase, Lynn; Reese, Shannon; Crichton, Daniel; Hardman, Sean; Delory, Gregory; Neese, Carol


    The NASA Planetary Data System (PDS) is responsible for archiving all planetary data acquired by robotic missions, and observational campaigns with ground/space-based observatories. PDS has moved to version 4 of its archive system. PDS4 uses XML to enhance search and retrieval capabilities. Although the efforts are system wide, the Atmospheres Node has acted as the lead node and is presenting a preliminary users interface for retrieval of LADEE data. LADEE provides the first opportunity to test out the end-to-end process of archiving data from an active mission into the new PDS4 architecture. The limited number of instruments, with simple data structures, is an ideal test of PDS4. XML uses schema (analogous to blueprints) to control the structure of the corresponding XML labels. In the case of PDS4, these schemas allow management of the labels and their content by forcing validation dictated by the underlying Information Model (IM). The use of a central IM is a vast improvement over PDS3 because of the uniformity it provides across all nodes. PDS4 has implemented a product-centric approach for archiving data and supplemental documentation. Another major change involves the Central Registry, where all products are registered and accessible to search engines. Under PDS4, documents, data, and other ancillary data are all products that are registered in the system. Together with the XML implementation, the Registry allows the search routines to be more complex and inclusive than they have been in the past. For LADEE, the PDS nodes and LADEE instrument teams worked together to identify data products that LADEE would produce. Documentation describing instruments and data products were produced by the teams and peer reviewed by PDS. XML label templates were developed by the PDS and provided to the instrument teams to integrate into their pipelines. Data from the primary mission (100 days) have been certified and harvested into the registry and are accessible through the

  9. 45 CFR 205.120 - Statewide operation. (United States)


    ... assistance under title I, IV-A, X, XIV, or XVI (AABD) of the Social Security Act must provide that: (1) It...; and (ii) Regular planned examination and evaluation of operations in local offices by regularly assigned State staff, including regular visits by such staff; and through reports, controls, or other...

  10. Using hydropower to complement wind energy: a hybrid system to provide firm power

    Energy Technology Data Exchange (ETDEWEB)

    Jaramillo, O.A.; Borja, M.A.; Huacuz, J.M. [Instituto de Investigaciones Electricas, Morelos (Mexico). Energias No Convencionales


    This paper presents a theoretical study of how wind power can be complemented by hydropower. A conceptual framework is provided for a hybrid power station that produces constant power output without the intermittent fluctuations inherent when using wind power. Two hypothetical facilities are considered as case studies. One of them is a hydropower plant located on the ''Presidente Benito Juarez'' dam in Jalapa del Marques, Oaxaca, Mexico. The other hypothetical facility is a wind farm located near ''La Venta's', an area in Juchitan, Oaxaca, Mexico. The wind-hydro-power system is a combined wind and hydro power plant in a region that is rich in both resources. The model shows that the hybrid plant could provide close to 20 MW of firm power to the electrical distribution system. On a techno-economic basis, we obtain the levelized production cost of the hybrid system. Taking into account two different discount rates of 7% and 10%, figures for levelized production cost are developed. (author)

  11. Lightweight Inflatable Solar Array: Providing a Flexible, Efficient Solution to Space Power Systems for Small Spacecraft (United States)

    Johnson, Len; Fabisinski, Leo; Cunningham, Karen; Justice, Stefanie


    Affordable and convenient access to electrical power is critical to consumers, spacecraft, military and other applications alike. In the aerospace industry, an increased emphasis on small satellite flights and a move toward CubeSat and NanoSat technologies, the need for systems that could package into a small stowage volume while still being able to power robust space missions has become more critical. As a result, the Marshall Space Flight Center's Advanced Concepts Office identified a need for more efficient, affordable, and smaller space power systems to trade in performing design and feasibility studies. The Lightweight Inflatable Solar Array (LISA), a concept designed, prototyped, and tested at the NASA Marshall Space Flight Center (MSFC) in Huntsville, Alabama provides an affordable, lightweight, scalable, and easily manufactured approach for power generation in space or on Earth. This flexible technology has many wide-ranging applications from serving small satellites to soldiers in the field. By using very thin, ultraflexible solar arrays adhered to an inflatable structure, a large area (and thus large amount of power) can be folded and packaged into a relatively small volume (shown in artist rendering in Figure 1 below). The proposed presentation will provide an overview of the progress to date on the LISA project as well as a look at its potential, with continued development, to revolutionize small spacecraft and portable terrestrial power systems.

  12. Hemovigilance in Massachusetts and the adoption of statewide hospital blood bank reporting using the National Healthcare Safety Network. (United States)

    Cumming, Melissa; Osinski, Anthony; O'Hearn, Lynne; Waksmonski, Pamela; Herman, Michele; Gordon, Deborah; Griffiths, Elzbieta; Knox, Kim; McHale, Eileen; Quillen, Karen; Rios, Jorge; Pisciotto, Patricia; Uhl, Lynne; DeMaria, Alfred; Andrzejewski, Chester


    A collaboration that grew over time between local hemovigilance stakeholders and the Massachusetts Department of Public Health (MDPH) resulted in the change from a paper-based method of reporting adverse reactions and monthly transfusion activity for regulatory compliance purposes to statewide adoption of electronic reporting via the National Healthcare Safety Network (NHSN). The NHSN is a web-based surveillance system that offers the capacity to capture transfusion-related adverse events, incidents, and monthly transfusion statistics from participating facilities. Massachusetts' hospital blood banks share the data they enter into NHSN with the MDPH to satisfy reporting requirements. Users of the NHSN Hemovigilance Module adhere to specified data entry guidelines, resulting in data that are comparable and standardized. Keys to successful statewide adoption of this reporting method include the fostering of strong partnerships with local hemovigilance champions and experts, engagement of regulatory and epidemiology divisions at the state health department, the leveraging of existing relationships with hospital NHSN administrators, and the existence of a regulatory deadline for implementation. Although limitations exist, successful implementation of statewide use of the NHSN Hemovigilance Module for hospital blood bank reporting is possible. The result is standardized, actionable data at both the hospital and state level that can facilitate interfacility comparisons, benchmarking, and opportunities for practice improvement. © 2016 AABB.

  13. The Economic Potential of Three Nuclear-Renewable Hybrid Energy Systems Providing Thermal Energy to Industry

    Energy Technology Data Exchange (ETDEWEB)

    Ruth, Mark [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cutler, Dylan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Flores-Espino, Francisco [National Renewable Energy Lab. (NREL), Golden, CO (United States); Stark, Greg [National Renewable Energy Lab. (NREL), Golden, CO (United States); Jenkin, Thomas [National Renewable Energy Lab. (NREL), Golden, CO (United States)


    This report is one of a series of reports that Idaho National Laboratory and National Renewable Energy Laboratory are producing to investigate the technical and economic aspects of nuclear-renewable hybrid energy systems (N-R HESs). Previous reports provided results of an analysis of two N-R HES scenarios. This report builds that analysis with a Texas-synthetic gasoline scenario providing the basis in which the N-R HES sells heat directly to an industrial customer. Subsystems were included that convert electricity to heat, thus allowing the renewable energy subsystem to generate heat and benefit from that revenue stream. Nuclear and renewable energy sources are important to consider in the energy sector's evolution because both are considered to be clean and non-carbon-emitting energy sources.

  14. Architecture of a Conference Management System Providing Advanced Paper Assignment Features

    CERN Document Server

    Kalmukov, Yordan


    This paper proposes an architecture and assignment management model of a conference management system that performs a precise and accurate automatic assignment of reviewers to papers. The system relies on taxonomy of keywords to describe papers and reviewers' competences. The implied hierarchical structure of the taxonomy provides important additional information - the semantic relationships between the separate keywords. It allows similarity measures to take into account not only the number of exactly matching keywords between a paper and a reviewer, but in case of non-matching ones to calculate how semantically close they are. Reviewers are allowed to bid on the papers they would like to (or not like to) review and to explicitly state conflicts of interest (CoI) with papers. An automatic CoI detection is checking for additional conflicts based on institutional affiliation, co-authorship (within the local database) and previous co-authorship in the past (within the major bibliographic indexes and digital lib...

  15. Hospital Consumer Assessment of Healthcare Providers and Systems: An Ethical Leadership Dilemma to Satisfy Patients. (United States)

    Piper, Llewellyn E; Tallman, Erin


    This article examines the parameters and the dynamics of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) that create an ethical leadership dilemma to satisfy patients in the hospital setting while still ensuring appropriate care for quality clinical outcomes. Under the Affordable Care Act, hospitals and health care systems are in a high-stakes struggle of winners and losers based on HCAHPS scores. This high-stakes struggle creates unintended consequences of an ethical dilemma of doing what is right for the patient versus doing whatever it takes to please the patient in order to achieve high scores of satisfaction that are tied to better reimbursements. This article also reports the results of a national survey of 500 chief executive officers by the authors about the attitudes and frustrations of chief executive officers confronting the wild unrest caused by HCAHPS.

  16. Motivation and reward systems in service provision: exploring motivators for people providing engineering services

    DEFF Research Database (Denmark)

    Kreye, Melanie; Nandrup-Bus, Troels


    It is becoming a distinctive feature for manufacturing firms to compete strategically through service provision. In relation to reward systems the aim of this thesis is to investigate what motivates employees of servitized manufacturing firms when providing engineering services and why. Through...... quantitative and qualitative data collection with an international company within the European healthcare sector, the findings show that key motivating factors were to “delight” the customer and being able to take responsibility and accountability for ones work. Service employees were found to feel proud...

  17. Mothers' satisfaction with two systems of providing care to their hospitalized children. (United States)

    Hosseinian, Masoumeh; Mirbagher Ajorpaz, Neda; Esalat Manesh, Soophia


    Despite the paramount importance of the patient's satisfaction, there are limited data on mothers' satisfaction with the nursing care provided to their children in Iranian clinical settings. This study aimed to evaluate mothers' satisfaction with two systems of providing care to their hospitalized children. This research was a two-group quasi-experimental study. Primarily, the basics of the case method and the functional care delivery systems were educated to the practicing nurses of the study setting. Each system was implemented independently. After the implementation of each system, 200 mothers whose children were hospitalized in the pediatric care ward of Shahid Beheshti Hospital, Kashan, Iran, were invited to respond to the 28 -item Pediatric Family Satisfaction Questionnaire. Study data were analyzed by SPSS v. 16.0. Results were indicative of mothers' satisfaction with medical care delivered by case method as 13.2 ± 5.2 and by functional method as 13.17 ± 5.56. Also, no significant difference was seen between two groups (P = 0.4). Mothers' satisfaction with nursing care delivered by case method was 17.7 ± 4.43 and by functional method was 13.33 ± 5.69 and there was a significant difference between two groups (P = 0.004). Mothers' satisfaction with accommodations by case method was 16.78 ± 4.07 and by functional method was 17.9 ± 6.67 with a significant difference between two groups (P = 0.06). Improving the quality of care is associated with higher patient's satisfaction. Accordingly, developing and implementing programs for improving nurses' communication and clinical skills can improve both care quality and patient outcomes.

  18. Use of a Novel Accounting and Grouping Method for Major Trunk Injury-Analysis of Data from a Statewide Trauma Financial Survey. (United States)

    Joubert, Kyla D; Mabry, Charles D; Kalkwarf, Kyle J; Betzold, Richard D; Spencer, Horace J; Spinks, Kara M; Porter, Austin; Karim, Saleema; Robertson, Ronald D; Sutherland, Michael J; Maxson, Robert T


    Major trunk trauma is common and costly, but comparisons of costs between trauma centers (TCs) are rare. Understanding cost is essential to improve quality, manage trauma service lines, and to facilitate institutional commitment for trauma. We have used results of a statewide trauma financial survey of Levels I to IV TC to develop a useful grouping method for costs and clinical characteristics of major trunk trauma. The trauma financial survey collected billing and clinical data on 75 per cent of the state trauma registry patients for fiscal year 2012. Cost was calculated by separately accounting for embedded costs of trauma response and verification, and then adjusting reasonable costs from the Medicare cost report for each TC. The cost-to-charge ratios were then recalculated and used to determine uniform cost estimates for each patient. From the 13,215 patients submitted for the survey, we selected 1,094 patients with major trunk trauma: lengths of stay ≥ 48 hours and a maximum injury of AIS ≥3 for either thorax or abdominal trauma. These patients were then divided into three Injury Severity Score (ISS) groups of 9 to 15, 16 to 24, or 25+ to stratify patients into similar injury groups for analysis of cost and cost drivers. For abdominal injury, average total cost for patients with ISS 9 to 15 was $17,429. Total cost and cost per day increased with severity of injury, with $51,585 being the total cost for those with ISS 25. Similar trends existed for thoracic injury. Use of the Medicare cost report and cost-to-charge ratios to compute uniform costs with an innovative grouping method applied to data collected across a statewide trauma system provides unique information regarding cost and outcomes, which affects quality improvement, trauma service line management, and decisions on TC participation.

  19. DC microgrids with energy storage systems and demand response for providing support to frequency regulation of electrical power systems

    DEFF Research Database (Denmark)

    Basic, Hrvoje; Dragicevic, Tomislav; Pandzic, Hrvoje


    Frequency regulation of electric power systems efficiency depends on response time and on power reserves for frequency regulation. As integration of non-dispatchable renewable generation in the power system results with increased need for power reserves from fast responding power units, the idea...... of using aggregated DC microgrids in frequency regulation is presented. Model proposed in this work is based on using battery energy storage, combined with demand response for achieving efficient usage of battery energy storage. It is shown that large number of DC microgrids can provide sufficient....

  20. A lightweight augmented virtuality system for providing a faithful and spatially manipulable visual hand representation. (United States)

    Pusch, Andreas; Martin, Olivier; Coquillart, Sabine


    This paper introduces the technical foundations of a system designed to embed a lightweight, faithful and spatially manipulable representation of the user's hand into an otherwise virtual world - Augmented Virtuality (AV). A highly intuitive control during pointing-like near space interaction can be provided to the user, as well as a very flexible means to experimenters, in a variety of non-medical and medical contexts. Our approach essentially relies on stereoscopic video see-through Augmented Reality (AR) technology and a generic, extendible framework for managing 3-D visual hand displacements. Research from human-computer interaction, perception and motor control has contributed to the elaboration of our proposal which combines a) acting in co-location, b) avoiding occlusion violations by assuring a correct scene depth ordering and c) providing a convincing visual feedback of the user's hand. We further present two cases in which this system has already successfully been used and then outline some other applications that we think are promising, for instance, in the fields of neuromotor rehabilitation and experimental neuroscience.

  1. Validation of mean glandular dose values provided by a digital breast tomosynthesis system in Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Beraldo O, B.; Paixao, L.; Donato da S, S. [Centro de Desenvolvimento da Tecnologia Nuclear / CNEN, Post-graduation in Sciences and Technology of Radiations Minerals and Materials, Pte. Antonio Carlos 6627, 31270-901 Belo Horizonte (Brazil); Araujo T, M. H. [Dr Maria Helena Araujo Teixeira Clinic, Guajajaras 40, 30180-100 Belo Horizonte (Brazil); Nogueira, M. S., E-mail: [Centro de Desenvolvimento da Tecnologia Nuclear / CNEN, Pte. Antonio Carlos 6627, 31270-901 Belo Horizonte (Brazil)


    Digital breast tomosynthesis (DBT) is an emerging imaging modality that provides quasi-three-dimensional structural information of the breast and has strong promise to improve the differentiation of normal tissue and suspicious masses reducing the tissue overlaps. DBT images are reconstructed from a sequence of low-dose X-ray projections of the breast acquired at a small number of angles over a limited angular range. The Ho logic Selen ia Dimensions system is equipped with an amorphous Selenium (a-Se) detector layer of 250 μm thickness and a 70 μm pixel pitch. Studies are needed to determine the radiation dose of patients that are undergoing this emerging procedure to compare with the results obtained in DBT images. The mean glandular dose (D{sub G}) is the dosimetric quantity used in quality control of the mammographic systems. The aim of this work is to validate D{sub G} values for different breast thicknesses provided by a Ho logic Selen ia Dimensions system using a DBT mode in comparison with the same results obtained by a calibrated 90 X 5-6M-model Radcal ionization chamber. D{sub G} values were derived from the incident air kerma (K{sub i}) measurements and tabulated conversion coefficients that are dependent on the half value layer (HVL) of the X-ray spectrum. Voltage and tube loading values were recorded in irradiations using W/Al anode/filter combination, automatic exposure control mode and polymethyl methacrylate (PMMA) slabs which simulate different breast thicknesses. For K{sub i} measurements, the ionization chamber was positioned at 655 mm from the focus and the same radiographic technique values were selected with the manual mode. D{sub G} values for a complete procedure ranged from 0.9 ± 0.1 to 3.7 ± 0.4 mGy. The results for different breast thicknesses are in accordance with values obtained by DBT images and with acceptable levels established by the Commission of the European Communities (Cec) and the International Atomic Energy Agency (IAEA

  2. The Drupal Environmental Information Management System Provides Standardization, Flexibility and a Platform for Collaboration (United States)

    Gries, C.; Vanderbilt, K.; Reid, D.; Melendez-Colom, E.; San Gil, I.


    Over the last five years several Long-Term Ecological Research (LTER) sites have collaboratively developed a standardized yet flexible approach to ecological information management based on the open source Drupal content management system. These LTER sites adopted a common data model for basic metadata necessary to describe data sets, but also used for site management and web presence. Drupal core functionality provides web forms for easy management of information stored in this data model. Custom Drupal extensions were developed to generate XML files conforming to the Ecological Metadata Language (EML) for contribution to the LTER Network Information System (NIS) and other data archives. Each LTER site then took advantage of the flexibility Drupal provides to develop its unique web presence, choosing different themes and adding additional content to the websites. By nature, information presented is highly interlinked which can easily be modeled in Drupal entities and is further supported by a sophisticated tagging system (Fig. 1). Therefore, it is possible to provide the visitor with many different entry points to the site specific information presented. For example, publications and datasets may be grouped for each scientist, for each research project, for each major research theme at the site, making the information presented more accessible for different visitors. Experience gained during the early years was recently used to launch a complete re-write for upgrading to Drupal 7. LTER sites from multiple academic institutions pooled resources in order to partner with professional Drupal developers. Highlights of the new developments are streamlined data entry, improved EML output and integrity, support of IM workflows, a faceted data set search, a highly configurable data exploration tool with intelligent filtering and data download, and, for the mobile age, a responsive web design theme. Seven custom modules and a specific installation profile were developed

  3. Effects of a Statewide Tobacco Cessation Program Among Individuals Involved With Arkansas Community Correction. (United States)

    Garver-Apgar, Christine; Young, Susan; Howard, Brenda; Udochi, Ben; Morris, Chad


    In response to a critical need for tobacco cessation services among justice-involved populations, Arkansas Community Correction (ACC) partnered with the University of Colorado's Behavioral Health & Wellness Program in 2013 to implement the DIMENSIONS: Tobacco Free Program within all probation, parole, and drug court units. In the first 2 years of this statewide, evidence-based program, more than 1,100 individuals from 33 ACC area office locations attended tobacco-free group sessions and provided data on tobacco use and readiness to quit. Results demonstrated a significant reduction in tobacco use among participants as well as increased knowledge, confidence, and intent to quit. This study provides some of the first evidence that members of this vulnerable population will attend tobacco-free group sessions with regularity and make progress toward tobacco cessation.

  4. Health insurance system and provider payment reform in the Republic of Macedonia

    Directory of Open Access Journals (Sweden)

    Doncho M. Donev


    Full Text Available This article gives an insight to the current health insurance system in the Republic of Macedonia. Special emphasis is given to the specificities and practice of both obligatory and voluntary health insurance, to the scope of the insured persons and their benefits and obligations, the way of calculating and payment of the contributions and the other sources of revenues for health insurance, user participation in health care expenses, payment to the health care providers and some other aspects of realization of health insurance in practice. According to the Health Insurance Law, which was adopted in March 2000, a person can become an insured to the Health Insurance Fund on various modalities. More than 90% of the citizens are eligible to the obligatory health insurance, which provides a broad scope of basic health care benefits. Till end of 2008 payroll contributions were equal to 9.2%, and from January 1st, 2009 are equal to 7.5% of gross earned wages and almost 60% of health sector revenues are derived from them. Within the autonomy and scope of activities of the Health Insurance Fund the structures of the revenues and expenditures are presented. Health financing and reform of the payment to health care providers are of high importance within the ongoing health care reform in Macedonia. It is expected that the newly introduced methods of payments at the primary health care level (capitation and at the hospital sector (global budgeting, DRGs will lead to increased equity, efficiency and quality of health care in hospitals and overall system


    Directory of Open Access Journals (Sweden)

    Yu. A. Rolik


    Full Text Available The problem of providing electric power quality in the electric power systems (EPS that are equipped with sufficiently long air or cable transmission lines is under consideration. This problem proved to be of particular relevance to the EPS in which a source of electrical energy is the generator of wind turbines since the wind itself is an instable primary energy source. Determination of the degree of automation of voltage regulation in the EPS is reduced to the choice of methods and means of regulation of power quality parameters. The concept of a voltage loss and the causes of the latter are explained by the simplest power system that is presented by a single-line diagram. It is suggested to regulate voltage by means of changing parameters of the network with the use of the method of reducing loss of line voltage by reducing its reactance. The latter is achieved by longitudinal capacitive compensation of the inductive reactance of the line. The effect is illustrated by vector diagrams of currents and voltages in the equivalent circuits of transmission lines with and without the use of longitudinal capacitive compensation. The analysis of adduced formulas demonstrated that the use of this method of regulation is useful only in the systems of power supply with a relatively low power factor (cosφ < 0.7 to 0.9. This power factor is typical for the situation of inclusion the wind turbine with asynchronous generator in the network since the speed of wind is instable. The voltage regulation fulfilled with the aid of the proposed method will make it possible to provide the required quality of the consumers’ busbars voltage in this situation. In is turn, it will make possible to create the necessary conditions for the economical transmission of electric power with the lowest outlay of reactive power and the lowest outlay of active power losses.

  6. Characteristics of electronic patient-provider messaging system utilisation in an urban health care organisation

    Directory of Open Access Journals (Sweden)

    Sean Patrick Mikles


    Full Text Available Introduction Research suggests that electronic messaging can improve patient engagement. Studies indicate that a ‘digital divide’ may exist, where certain patient populations may be using electronic messaging less frequently. This study aims to determine which patient characteristics are associated with different levels of usage of an electronic patient-provider messaging system in a diverse urban population.Methods Cross-sectional electronic health record data were extracted for patients 10 years of age or older who live in New York City and who visited a set of clinics between 1 July 2011 and 30 June 2012. Regression analyses determined which participant characteristics were associated with the sending of electronic messages.Results Older, female, English-speaking participants of white race who received more messages, had any diagnoses, more office visits and a provider who sent messages were more likely to send more messages. Non-Millennial, non-white participants who received fewer messages, had more office visits, any diagnoses, a provider who saw fewer patients with patient portal accounts, lived in a low socioeconomic status neighbourhood, and did not have private insurance were more likely to send zero messages.Conclusion This study found significant differences in electronic messaging usage based on demographic, socioeconomic and health-related patient characteristics. Future studies are needed to support these results and determine the causes of observed associations.

  7. The Challenge of Providing Safe Water with an Intermittently Supplied Piped Water Distribution System (United States)

    Kumpel, E.; Nelson, K. L.


    An increasing number of urban residents in low- and middle-income countries have access to piped water; however, this water is often not available continuously. 84% of reporting utilities in low-income countries provide piped water for fewer than 24 hours per day (van den Berg and Danilenko, 2010), while no major city in India has continuous piped water supply. Intermittent water supply leaves pipes vulnerable to contamination and forces households to store water or rely on alternative unsafe sources, posing a health threat to consumers. In these systems, pipes are empty for long periods of time and experience low or negative pressure even when water is being supplied, leaving them susceptible to intrusion from sewage, soil, or groundwater. Households with a non-continuous supply must collect and store water, presenting more opportunities for recontamination. Upgrading to a continuous water supply, while an obvious solution to these challenges, is currently out of reach for many resource-constrained utilities. Despite its widespread prevalence, there are few data on the mechanisms causing contamination in an intermittent supply and the frequency with which it occurs. Understanding the impact of intermittent operation on water quality can lead to strategies to improve access to safe piped water for the millions of people currently served by these systems. We collected over 100 hours of continuous measurements of pressure and physico-chemical water quality indicators and tested over 1,000 grab samples for indicator bacteria over 14 months throughout the distribution system in Hubli-Dharwad, India. This data set is used to explore and explain the mechanisms influencing water quality when piped water is provided for a few hours every 3-5 days. These data indicate that contamination occurs along the distribution system as water travels from the treatment plant to reservoirs and through intermittently supplied pipes to household storage containers, while real

  8. Objectively Optimized Observation Direction System Providing Situational Awareness for a Sensor Web (United States)

    Aulov, O.; Lary, D. J.


    There is great utility in having a flexible and automated objective observation direction system for the decadal survey missions and beyond. Such a system allows us to optimize the observations made by suite of sensors to address specific goals from long term monitoring to rapid response. We have developed such a prototype using a network of communicating software elements to control a heterogeneous network of sensor systems, which can have multiple modes and flexible viewing geometries. Our system makes sensor systems intelligent and situationally aware. Together they form a sensor web of multiple sensors working together and capable of automated target selection, i.e. the sensors “know” where they are, what they are able to observe, what targets and with what priorities they should observe. This system is implemented in three components. The first component is a Sensor Web simulator. The Sensor Web simulator describes the capabilities and locations of each sensor as a function of time, whether they are orbital, sub-orbital, or ground based. The simulator has been implemented using AGIs Satellite Tool Kit (STK). STK makes it easy to analyze and visualize optimal solutions for complex space scenarios, and perform complex analysis of land, sea, air, space assets, and shares results in one integrated solution. The second component is target scheduler that was implemented with STK Scheduler. STK Scheduler is powered by a scheduling engine that finds better solutions in a shorter amount of time than traditional heuristic algorithms. The global search algorithm within this engine is based on neural network technology that is capable of finding solutions to larger and more complex problems and maximizing the value of limited resources. The third component is a modeling and data assimilation system. It provides situational awareness by supplying the time evolution of uncertainty and information content metrics that are used to tell us what we need to observe and the

  9. Antibody SPC-54 provides acute in vivo blockage of the murine protein C system. (United States)

    Burnier, Laurent; Fernández, José A; Griffin, John H


    Multiple protective effects of pharmacological activated protein C (APC) are reported in several organ pathologies. To help evaluate the endogenous murine PC system, we characterized a rat monoclonal anti-mouse PC antibody, SPC-54, which inhibited the amidolytic and anticoagulant activities of murine APC by>95%. SPC-54 blocked active site titration of purified APC using the active site titrant, biotinylated FPR-chloromethylketone, showing that SPC-54 blocks access to APC's active site to inhibit all enzymatic activity. A single injection of SPC-54 (10mg/kg) neutralized circulating PC in mice for at least 7days, and immunoblotting and immuno-precipitation with protein G-agarose confirmed that SPC-54 in vivo was bound to PC in plasma. Pre-infusion of SPC-54 in tissue factor-induced murine acute thromboembolism experiments caused a major decrease in mean survival time compared to controls (7min vs. 42.5min, P=0.0016). SPC-54 decreased lung perfusion in this model by 54% when monitored by vascular perfusion methodologies using infrared fluorescence of Evans blue dye. In LD50 endotoxemia murine models, SPC-54 infused at 7hr after endotoxin administration increased mortality from 42% to 100% (P54 ablates in vitro and in vivo APC protective functions and enzymatic activity. The ability of SPC-54 to block the endogenous PC/APC system provides a powerful tool to understand better the role of the endogenous PC system in murine injury models and in cell bioassays and also to neutralize the enzymatic activities of murine APC in any assay system. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Prescription errors related to the use of computerized provider order-entry system for pediatric patients. (United States)

    Alhanout, Kamel; Bun, Sok-Siya; Retornaz, Karine; Chiche, Laurent; Colombini, Nathalie


    To evaluate the nature and frequency of medication errors resulting from the use of a computerized provider order-entry (CPOE) system in a pediatric department. We conducted a retrospective study to examine errors related to computerized orders using the software Pharma® (Computer Engineering, France) in pediatric department between 31/05/2015 to 01/12/2015. These errors were signaled by pharmacists who examine CPOEs daily. A total of 302 pharmacist interventions (PharmInt) were carried out by clinical pharmacists during the study period. Of the 302 PharmInts, a total of 95 (31.5%) contained no data on the patient's bodyweight, which should have been provided by the prescriber (Table 1). After the PharmInt, information on bodyweight was then provided in 47 of these cases (15.6%). Incomplete information about administration frequency accounted for 19.9% of total PharmInts. Prescribing an excessive dose occurred in 17.6% of PharmInts, inappropriate modifications of prescription unit accounted for 9.9% of PharmInts, and incorrect dosage was prescribed in 8.3% of PharmInts. Of the 302 PharmInts, 255 concerned prescription errors and bodyweight missing not provided after PharmInt. Paracetamol, in its different forms (injectable, solid or liquid oral forms) accounted for 35.7% of total PharmInts. Noted errors for paracetamol included an incorrect dosage form, co-administration of two paracetamol-containing drugs, modification of the prescription unit, incorrect frequency of administrations, and absence of the patient's bodyweight. Inconsistent use of a contradicted or a non-used drug for pediatric patients was noted along with prescriptions for inadequate dosages. Our work revealed several error types in prescribing for pediatric patients, mainly absence of bodyweight, incorrect frequency of administration and excessive doses. Information on bodyweight is crucial in pediatric patients: our study highlights the need to make it mandatory to complete prescriptions via CPOE

  11. Providing therapy to children and families in foster care: a systemic-relational approach. (United States)

    Lewis, Catherine


    Foster care is a system created to protect children from an unsafe home environment yet multiple foster home placements, conflictual or nonexistent relationships between foster parents and birth parents, long, drawn out court battles, and living in an on-going state of not knowing when or if they will be going home are just some of the challenges many children in care are expected to manage. This paper presents a guide for therapists working with families involved in foster care. Utilizing ideas from the postmodern therapies and structural family therapy, suggestions will be provided about who needs to talk to whom about what, when to have these necessary conversations, and how to talk to people in a way that mobilizes adults to take action for the children, with the goal of minimizing postplacement trauma, strengthening and repairing relational bonds, and moving children out of foster care and into permanent homes as quickly as possible.

  12. Human‐Centered Design: Integrating Services & Systems Around People By Providing A Common Ground for Action

    DEFF Research Database (Denmark)

    Junginger, Sabine


    to both professional fields. Yet, how human‐centered design is being practiced and applied depends on the interpretation of the concept, or the “designer’s stance” (Buchanan 2011). In this paper, I trace the shifts in design thinking and the role of people in service engineering and in service design. I...... argue that human-centered design challenges the systems view of service engineers and service designers and requires them to reach out to each other. For this reason, I conclude that for these two disciplines, human-centered design provides a common ground for purposeful action: to arrive at the best......Service engineering and service design, though distinct in their origins, theories, concepts, methods and practices, share that they are both consequential productive arts for people who depend on their outcomes. The ideas, methods and practices of human‐centred design are therefore relevant...

  13. Towards the Use of Unmanned Aerial Systems for Providing Sustainable Services in Smart Cities. (United States)

    Moguel, Enrique; Conejero, José M; Sánchez-Figueroa, Fernando; Hernández, Juan; Preciado, Juan C; Rodríguez-Echeverría, Roberto


    Sustainability is at the heart of many application fields where the use of Unmanned Aerial Systems (UAS) is becoming more and more important (e.g., agriculture, fire detection and prediction, environmental surveillance, mapping, etc.). However, their usage and evolution are highly conditioned by the specific application field they are designed for, and thus, they cannot be easily reused among different application fields. From this point of view, being that they are not multipurpose, we can say that they are not fully sustainable. Bearing this in mind, the objective of this paper is two-fold: on the one hand, to identify the whole set of features that must be provided by a UAS to be considered sustainable and to show that there is no UAS satisfying all these features; on the other hand, to present an open and sustainable UAS architecture that may be used to build UAS on demand to provide the features needed in each application field. Since this architecture is mainly based on software and hardware adaptability, it contributes to the technical sustainability of cities.

  14. Towards the Use of Unmanned Aerial Systems for Providing Sustainable Services in Smart Cities

    Directory of Open Access Journals (Sweden)

    Enrique Moguel


    Full Text Available Sustainability is at the heart of many application fields where the use of Unmanned Aerial Systems (UAS is becoming more and more important (e.g., agriculture, fire detection and prediction, environmental surveillance, mapping, etc.. However, their usage and evolution are highly conditioned by the specific application field they are designed for, and thus, they cannot be easily reused among different application fields. From this point of view, being that they are not multipurpose, we can say that they are not fully sustainable. Bearing this in mind, the objective of this paper is two-fold: on the one hand, to identify the whole set of features that must be provided by a UAS to be considered sustainable and to show that there is no UAS satisfying all these features; on the other hand, to present an open and sustainable UAS architecture that may be used to build UAS on demand to provide the features needed in each application field. Since this architecture is mainly based on software and hardware adaptability, it contributes to the technical sustainability of cities.

  15. Towards the Use of Unmanned Aerial Systems for Providing Sustainable Services in Smart Cities (United States)

    Conejero, José M.; Rodríguez-Echeverría, Roberto


    Sustainability is at the heart of many application fields where the use of Unmanned Aerial Systems (UAS) is becoming more and more important (e.g., agriculture, fire detection and prediction, environmental surveillance, mapping, etc.). However, their usage and evolution are highly conditioned by the specific application field they are designed for, and thus, they cannot be easily reused among different application fields. From this point of view, being that they are not multipurpose, we can say that they are not fully sustainable. Bearing this in mind, the objective of this paper is two-fold: on the one hand, to identify the whole set of features that must be provided by a UAS to be considered sustainable and to show that there is no UAS satisfying all these features; on the other hand, to present an open and sustainable UAS architecture that may be used to build UAS on demand to provide the features needed in each application field. Since this architecture is mainly based on software and hardware adaptability, it contributes to the technical sustainability of cities. PMID:29280984

  16. Efficiency and hospital effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems ratings. (United States)

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


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

  17. An enabling system for echocardiography providing adaptive support through behavioral analysis. (United States)

    Trochim, S; Weidenbach, M; Pieper, S; Wick, C; Berlage, T


    Echocardiography requires the integrated application of a broad spectrum of cognitive and practical skills, e.g. diagnostic knowledge (symbolic), image interpretation (visual perception) and handling of the ultrasound probe (sensorimotor). This complex expertise is acquired through extensive practical training guided by a skilled cardiologist that is often incompatible with clinical reality. Especially for beginners, the most critical point during an echocardiographic examination is the steering of the ultrasound probe to navigate between different cardiological standard planes (sensorimotor skill) without loosing orientation. These transitions or "standard trajectories" can roughly be described by specific movement patterns. We propose an enabling system based on an Augmented Reality simulator for two-dimensional echocardiography imitating this apprenticeship [1]-[3]. During a simulated ultrasound examination the system monitors the activities of the trainee and analyzes the motion pattern of the ultrasound probe. The simulator reacts by mapping the motion patterns onto cognitive orientation demands and providing adaptive feedback in the form of context sensitive help (animations). It partly takes the role of the critical teacher.

  18. Adoption of Telepractice for Speech-Language Services: A Statewide Perspective (United States)

    Lowman, J. Joneen; Kleinert, Harold L.


    Little information exists regarding the statewide adoption of telepractice, the delivery of speech-language services at a distance through telecommunications, for addressing the documented shortage of speech-language pathologists (SLPs) in rural communities. A statewide survey of directors of special education revealed that only two school…

  19. 77 FR 61423 - Notice of Adjustment of Statewide Per Capita Impact Indicator (United States)


    ... SECURITY Federal Emergency Management Agency Notice of Adjustment of Statewide Per Capita Impact Indicator... statewide per capita impact indicator under the Public Assistance program for disasters declared on or after... indicator under the Public Assistance program to reflect changes in the Consumer Price Index for All Urban...

  20. 76 FR 63936 - Notice of Adjustment of Statewide Per Capita Impact Indicator (United States)


    ... SECURITY Federal Emergency Management Agency Notice of Adjustment of Statewide Per Capita Impact Indicator... statewide per capita impact indicator under the Public Assistance program for disasters declared on or after... indicator under the Public Assistance program to reflect changes in the Consumer Price Index for All Urban...

  1. 75 FR 62135 - Notice of Adjustment of Statewide Per Capita Impact Indicator (United States)


    ... SECURITY Federal Emergency Management Agency Notice of Adjustment of Statewide Per Capita Impact Indicator... statewide per capita impact indicator under the Public Assistance program for disasters declared on or after... indicator under the Public Assistance program to reflect changes in the Consumer Price Index for All Urban...

  2. The smoking ban next door: do hospitality businesses in border areas have reduced sales after a statewide smoke-free policy? (United States)

    Klein, Elizabeth G; Hood, Nancy E


    Despite numerous studies demonstrating no significant economic effects on hospitality businesses following a statewide smoke-free (SF) policy, regional concerns suggest that areas near states without SF policies may experience a loss of hospitality sales across the border. The present study evaluated the impact of Ohio's statewide SF policy on taxable restaurant and bar sales in border and non-border areas. Spline regression analysis was used to assess changes in monthly taxable sales at the county level in full-service restaurants and bars in Ohio. Data were analyzed from four years prior to policy implementation to three years post-policy. Change in the differences in the slope of taxable sales for border (n = 21) and non-border (n = 67) counties were evaluated for changes following the statewide SF policy enforcement, adjusted for unemployment rates, general trends in the hospitality sector, and seasonality. After adjusting for covariates, there was no statistically significant change in the difference in slope for taxable sales for either restaurants (β = 0.9, p = 0.09) or bars (β = 0.2, p = 0.07) following the SF policy for border areas compared to non-border areas of Ohio. Border regions in Ohio did not experience a significant change in bar and restaurant sales compared to non-border areas following a statewide SF policy. Results support that Ohio's statewide SF policy did not impact these two areas differently, and provide additional evidence for the continued use of SF policies to provide protection from exposure to secondhand smoke for both workers and the general public. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. VOLTTRON-Based System for Providing Ancillary Services with Residential Building Loads

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Xin


    Ancillary services entail controlled modulation of building equipment to maintain a stable balance of generation and load in the power system. Ancillary services include frequency regulation and contingency reserves, whose acting time ranges from several seconds to several minutes. Many pilot studies have been implemented to use industrial loads to provide ancillary services, and some have explored services from commercial building loads or electric vehicle charging loads. Residential loads, such as space conditioning and water heating, represent a largely untapped resource for providing ancillary services. The residential building sector accounts for a significant fraction of the total electricity use in the United States. Many loads in residential buildings are flexible and could potentially be curtailed or shifted at the request of the grid. However, there are many barriers that prevent residential loads being widely used for ancillary services. One of the major technical barriers is the lack of communication capabilities between end-use devices and the grid. End-use devices need to be able to receive the automatic generation control (AGC) signal from the grid operator and supply certain types of telemetry to verify response. With the advance of consumer electronics, communication-enabled, or 'connected,' residential equipment has emerged to overcome the communication barrier. However, these end-use devices have introduced a new interoperability challenge due to the existence of numerous standards and communication protocols among different end devices. In this paper, we present a VOLTTRON-based system that overcomes these technical challenges and provides ancillary services with residential loads. VOLTTRON is an open-source control and sensing platform for building energy management, facilitating interoperability solutions for end devices. We have developed drivers to communicate and control different types of end devices through standard

  4. Characteristics and Effects of a Statewide STEM Program

    Directory of Open Access Journals (Sweden)

    Jeffrey D. Weld


    Full Text Available A comprehensive statewide STEM (science, technology, engineering, mathematics reform initiative enters its fifth year in the U.S. state of Iowa. A significant proportion of the state’s pre K-12 students and teachers participate in one or more of the twenty programs offered, ranging from classroom curricular innovations to teacher professional development, and from community STEM festivals to career exploration events. An external, inter-university evaluation consortium measures annual progress of the initiative through the Iowa STEM Monitoring Project. Results show citizens to be increasingly aware of and supporting of STEM education; students to be increasingly interested in STEM as well as outperforming nonparticipating peers on state math and science tests; and teachers more confident and knowledgeable in teaching STEM. Iowa’s STEM initiative has garnered national acclaim though challenges remain with regard to expanding the participation of learners of diversity, as well as ensuring the long-term sustainability of the programs and structures that define Iowa’s statewide STEM initiative.

  5. Statewide estimates of stalking among high school students in Kentucky: demographic profile and sex differences. (United States)

    Fisher, Bonnie S; Coker, Ann L; Garcia, Lisandra S; Williams, Corrine M; Clear, Emily R; Cook-Craig, Patricia G


    This large, statewide sample from 26 high schools provided the first population-based estimates of stalking victimization and perpetration among adolescent females and males. Our stalking definition required that pursuing tactics occurred at least 3 times in the past 12 months and included being followed, spied on, or monitored; someone showed up or waited for you when you did not want them to; and receiving unwanted messages. Among 18,013 students, 16.5% disclosed being stalked and 5.3% stalking; 2.8% disclosed both stalking victimization and perpetration. A majority of students reported being most afraid of a former boyfriend or girlfriend as the stalker. © The Author(s) 2014.

  6. Voter comparator switch provides fail safe data communications system - A concept (United States)

    Koczela, L. J.; Wilgus, D. S.


    System indicates status of computers and controls operational modes. Two matrices are used - one relating to permissible system states, the other relating to requested system states. Concept is useful to designers of digital data transmission systems and time shared computer systems.

  7. Contracting private sector providers for public sector health services in Jalisco, Mexico: perspectives of system actors

    Directory of Open Access Journals (Sweden)

    González Luz


    Full Text Available Abstract Introduction Contracting out health services is a strategy that many health systems in the developing world are following, despite the lack of decisive evidence that this is the best way to improve quality, increase efficiency and expand coverage. A large body of literature has appeared in recent years focusing on the results of several contracting strategies, but very few papers have addressed aspects of the managerial process and how this can affect results. Case description This paper describes and analyses the perceptions and opinions of managers and workers about the benefits and challenges of the contracting model that has been in place for almost 10 years in the State of Jalisco, Mexico. Both qualitative and quantitative information was collected. An open-ended questionnaire was used to obtain information from a group of managers, while information provided by a self-selected group of workers was collected via a closed-ended questionnaire. The analysis contrasted the information obtained from each source. Discussion and Evaluation Findings show that perceptions of managers and workers vary for most of the items studied. For managers the model has been a success, as it has allowed for expansion of coverage based on a cost-effective strategy, while for workers the model also possesses positive elements but fails to provide fair labour relationships, which negatively affects their performance. Conclusion Perspectives of the two main groups of actors in Jalisco's contracting model are important in the design and adjustment of an adequate contracting model that includes managerial elements to give incentives to worker performance, a key element necessary to achieve the model's ultimate objectives. Lessons learnt from this study could be relevant for the experience of contracting models in other developing countries.

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

    Directory of Open Access Journals (Sweden)

    Marcelo Cristiano de Azevedo Ramos


    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.

  9. Mediated interruptions of anaesthesia providers using predictions of workload from anaesthesia information management system data. (United States)

    Epstein, R H; Dexter, F


    Perioperative interruptions generated electronically from anaesthesia information management systems (AIMS) can provide useful feedback, but may adversely affect task performance if distractions occur at inopportune moments. Ideally such interruptions would occur only at times when their impact would be minimal. In this study of AIMS data, we evaluated the times of comments, drugs, fluids and periodic assessments (e.g. electrocardiogram diagnosis and train-of-four) to develop recommendations for the timing of interruptions during the intraoperative period. The 39,707 cases studied were divided into intervals between: 1) enter operating room; 2) induction; 3) intubation; 4) surgical incision; and 5) end surgery. Five-minute intervals of no documentation were determined for each case. The offsets from the start of each interval when >50% of ongoing cases had completed initial documentation were calculated (MIN50). The primary endpoint for each interval was the percentage of all cases still ongoing at MIN50. Results were that the intervals from entering the operating room to induction and from induction to intubation were unsuitable for interruptions confirming prior observational studies of anaesthesia workload. At least 13 minutes after surgical incision was the most suitable time for interruptions with 92% of cases still ongoing. Timing was minimally affected by the type of anaesthesia, surgical facility, surgical service, prone positioning or scheduled case duration. The implication of our results is that for mediated interruptions, waiting at least 13 minutes after the start of surgery is appropriate. Although we used AIMS data, operating room information system data is also suitable.

  10. Prolonged Walking with a Wearable System Providing Intelligent Auditory Input in People with Parkinson's Disease. (United States)

    Ginis, Pieter; Heremans, Elke; Ferrari, Alberto; Dockx, Kim; Canning, Colleen G; Nieuwboer, Alice


    Rhythmic auditory cueing is a well-accepted tool for gait rehabilitation in Parkinson's disease (PD), which can now be applied in a performance-adapted fashion due to technological advance. This study investigated the immediate differences on gait during a prolonged, 30 min, walk with performance-adapted (intelligent) auditory cueing and verbal feedback provided by a wearable sensor-based system as alternatives for traditional cueing. Additionally, potential effects on self-perceived fatigue were assessed. Twenty-eight people with PD and 13 age-matched healthy elderly (HE) performed four 30 min walks with a wearable cue and feedback system. In randomized order, participants received: (1) continuous auditory cueing; (2) intelligent cueing (10 metronome beats triggered by a deviating walking rhythm); (3) intelligent feedback (verbal instructions triggered by a deviating walking rhythm); and (4) no external input. Fatigue was self-scored at rest and after walking during each session. The results showed that while HE were able to maintain cadence for 30 min during all conditions, cadence in PD significantly declined without input. With continuous cueing and intelligent feedback people with PD were able to maintain cadence (p = 0.04), although they were more physically fatigued than HE. Furthermore, cadence deviated significantly more in people with PD than in HE without input and particularly with intelligent feedback (both: p = 0.04). In PD, continuous and intelligent cueing induced significantly less deviations of cadence (p = 0.006). Altogether, this suggests that intelligent cueing is a suitable alternative for the continuous mode during prolonged walking in PD, as it induced similar effects on gait without generating levels of fatigue beyond that of HE.

  11. Genome-wide analysis of acetivibrio cellulolyticus provides a blueprint of an elaborate cellulosome system

    Directory of Open Access Journals (Sweden)

    Dassa Bareket


    Full Text Available Abstract Background Microbial degradation of plant cell walls and its conversion to sugars and other byproducts is a key step in the carbon cycle on Earth. In order to process heterogeneous plant-derived biomass, specialized anaerobic bacteria use an elaborate multi-enzyme cellulosome complex to synergistically deconstruct cellulosic substrates. The cellulosome was first discovered in the cellulolytic thermophile, Clostridium thermocellum, and much of our knowledge of this intriguing type of protein composite is based on the cellulosome of this environmentally and biotechnologically important bacterium. The recently sequenced genome of the cellulolytic mesophile, Acetivibrio cellulolyticus, allows detailed comparison of the cellulosomes of these two select cellulosome-producing bacteria. Results Comprehensive analysis of the A. cellulolyticus draft genome sequence revealed a very sophisticated cellulosome system. Compared to C. thermocellum, the cellulosomal architecture of A. cellulolyticus is much more extensive, whereby the genome encodes for twice the number of cohesin- and dockerin-containing proteins. The A. cellulolyticus genome has thus evolved an inflated number of 143 dockerin-containing genes, coding for multimodular proteins with distinctive catalytic and carbohydrate-binding modules that play critical roles in biomass degradation. Additionally, 41 putative cohesin modules distributed in 16 different scaffoldin proteins were identified in the genome, representing a broader diversity and modularity than those of Clostridium thermocellum. Although many of the A. cellulolyticus scaffoldins appear in unconventional modular combinations, elements of the basic structural scaffoldins are maintained in both species. In addition, both species exhibit similarly elaborate cell-anchoring and cellulosome-related gene- regulatory elements. Conclusions This work portrays a particularly intricate, cell-surface cellulosome system in A. cellulolyticus

  12. Military healthcare providers reporting of adverse events following immunizations to the vaccine adverse event reporting system. (United States)

    Li, Rongxia; McNeil, Michael M; Pickering, Susanne; Pemberton, Michael R; Duran, Laurie L; Collins, Limone C; Nelson, Michael R; Engler, Renata J M


    We studied military health care provider (HCP) practices regarding reporting of adverse events following immunization (AEFI). A convenience sample of HCP was surveyed to assess familiarity with Vaccine Adverse Event Reporting System (VAERS), AEFI they were likely to report, methods used and preferred for reporting, and perceived barriers to reporting. We analyzed factors associated with HCP reporting AEFI to VAERS. A total of 547 surveys were distributed with 487 completed and returned for an 89% response rate. The percentage of HCP aware of VAERS (54%) varied by occupation. 47% of respondents identified knowledge of at least one AEFI with only 34% of these indicating that they had ever reported to VAERS. More serious events were more likely to be reported. Factors associated with HCP reporting AEFIs in bivariate analysis included HCP familiarity with filing a paper VAERS report, HCP familiarity with filing an electronic VAERS report, HCP familiarity with VAERS, and time spent on immunization tasks. In a multivariable analysis, only HCP familiarity with filing a paper VAERS report was statistically significant (Odds ratio = 115.3; p reports may improve vaccine safety reporting practices. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  13. Robotics and telecommunication systems to provide better access to ultrasound expertise in the OR. (United States)

    Angelini, L; Papaspyropoulos, V


    Surgery has begun to evolve as a result of the intense use of technological innovations. The result of this is better services for patients and enormous opportunities for the producers of biomedical instruments. The surgeon and the technologist are fast becoming allies in applying the latest developments of robotics, image treatment, simulation, sensors and telecommunications to surgery, in particular to the emerging field of minimally-invasive surgery. Ultrasonography is at present utilised both for diagnostic and therapeutic purposes in various fields. Intraoperative US examination can be of primary importance, especially when dealing with space-occupying lesions. The widening use of minimally-invasive surgery has furthered the development of US for use during this type of surgery. The success of a US examination requires not only a correct execution of the procedure, but also a correct interpretation of the images. We describe two projects that combine robotics and telecommunication systems to provide better access to US expertise in the operating room. The Midstep project has as its object the realisation of two robotic arms, one for the distant control of the US probe during laparoscopic surgery and the second to perform tele-interventional US. The second project, part of the Strategic CNR Project-'Robotics in Surgery', involves the realisation of a common platform for tracking and targeting surgical instruments in video-assisted surgery.

  14. A novel autostereoscopic display system to provide seamless stereoscopic view changes (United States)

    Lee, Hyun; Um, Gi-Mun; Cheong, Won-Sik; Hur, Namho; Lee, Sung Jung; Kim, Changick


    In this paper a new method for the autostereoscopic display, named the Dual Layer Parallax Barrier (DLPB) method, is introduced to overcome the limitation of the fixed viewing zone. Compared with the conventional parallax barrier methods, the proposed DLPB method uses moving parallax barriers to make the stereoscopic view changed according to the movement of viewer. In addition it provides seamless stereoscopic views without abrupt change of 3D depth feeling at any eye position. We implement a prototype of the DLPB system which consists of a switchable dual-layered Twisted Nematic Liquid Crystal Display (TN-LCD) and a head-tracker. The head tracker employs a video camera for capturing images, and is used to calculate the angle between the eye gazing direction and the projected direction onto the display plane. According to the head-tracker's control signal, the dual-layered TN-LCD is able to alternate the direction of viewing zone adaptively by a solid-state analog switch. The experimental results demonstrate that the proposed autostereoscopic display maintains seamless 3D views even when a viewer's head is moving. Moreover, its extended use towards mobile devices such as portable multimedia player (PMP), smartphone, and cellular phone is discussed as well.

  15. Beyond compliance using environmental, health and safety management information systems (EMISs) to provide quantified competitive advantages

    Energy Technology Data Exchange (ETDEWEB)

    Schroeder, J.V.; Mayer, G.


    In the last 20 years, federal, state and local regulations have provided regulatory incentives for industry to better manage environmental, health and safety (EHS) practices. In order for voluntary EHS management practices to move beyond compliance and continue improving, specific, quantifiable benefits must result. That is, companies must achieve some competitive advantage from implementing EHS improvements that are considered voluntary. Recently, many private companies and public agencies have been giving significant consideration toward the implementation of an EHS management information system (EMIS). Currently considered voluntary, the automation of EHS data collection, storage, retrieval and reporting is subject to the same benefit expectations that other EHS improvements are subject to. The benefits resulting from an EMIS typically result from a reduction in either direct or indirect costs. Direct costs, consisting primarily of labor hours, permit fees, disposal costs, etc., are definable and easily to quantify. Indirect costs, which are comprised of reduced risks and liabilities, are less easily quantifiable. In fact, many have abandoned hope of ever quantifying expected benefits from indirect costs, and simply lump all indirect benefits into a qualitative, catch-all category called intangible benefits. However, by statistically analyzing individual risk events over an expected project life, anticipated benefits can be objectively and accurately quantified. Through the use of a case study, this paper will describe the process of quantifying direct and indirect benefits resulting from the implementation of an EMIS. The paper will describe the application of a statistical model to estimate indirect benefits and will demonstrate how the results of the benefit quantification can be used to make sound, business based decisions based on a required rate of return/return on investment.

  16. Effects of Survey Mode on Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey Scores. (United States)

    Parast, Layla; Elliott, Marc N; Hambarsoomian, Katrin; Teno, Joan; Anhang Price, Rebecca


    To examine the effect of mode of survey administration on response rates and response tendencies for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey and develop appropriate adjustments. Survey response data were obtained after sampling and fielding of the CAHPS Hospice Survey in 2015. Sampled caregivers and decedents were randomized to one of three modes: mail only, telephone only, and mixed mode (mail with telephone follow-up). Linear regression analysis was used to examine the effect of mode on individual responses to questions (6 composite measures and 2 global measures that examine hospice quality). U.S. hospice programs (N = 57). Primary caregivers of individuals who died in hospice (N = 7,349). Outcomes were 8 hospice quality measures (6 composite measures, 2 global measures). Analyses were adjusted for differences in case-mix (e.g., decedent age, payer for hospice care, primary diagnosis, length of final episode of hospice care, respondent age, respondent education, relationship of decedent to caregiver, survey language, and language spoken at home) between hospices. Response rates were 42.6% for those randomized to mail only, 37.9%, for those randomized to telephone only, and 52.6% for those randomized to mixed mode (P mode effects (P mode experiments for hospital CAHPS, hospice primary caregivers tend to respond more negatively by telephone than by mail. Valid comparisons of hospice performance require that reported hospice scores be adjusted for survey mode. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

  17. DC microgrids providing frequency regulation in electrical power system - imperfect communication issues

    DEFF Research Database (Denmark)

    Bašić, Hrvoje; Dragicevic, Tomislav; Pandžić, Hrvoje


    This paper presents a model of multiple DC microgrids with battery energy storage systems and demand response capability, taking part in primary frequency regulation of electrical power system. Although DC microgrids can contribute to stability and efficiency of frequency regulation, these complex...... systems may cause serious stability issues due to the imperfect communication. This work presents possible scenarios of unstable primary frequency regulation in a simplified model of electrical power system with DC microgrids, which are controlled through communication network....

  18. Teacher perceptions of a physical education statewide assessment program. (United States)

    Rink, Judith; Jones, Laura; Kirby, Kym; Mitchell, Murray; Doutis, Panayiotis


    A statewide program assessment was established to make positive change in physical education school programs in South Carolina. Reform efforts depend both on balancing accountability for change and teacher support for change (Odden &Anderson, 1986). The purpose of the study was to determine teacher perceptions of the South Carolina Physical Education Assessment Program and its effects across six related themes including: changes in teaching and learning, changes in curriculum and instruction, teacher awareness of the assessment program, teacher support for the program, work place conditions, and the advocacy role of the program. It was also the purpose of this study to determine if the survey responses were in any way related to teacher and school variables. The overall results of the study indicated positive change and support for the assessment program, supporting the viability of the standards, assessment, and accountability reform effort to positively impact physical education programs.

  19. New Mexico statewide geothermal energy program. Final technical report

    Energy Technology Data Exchange (ETDEWEB)

    Icerman, L.; Parker, S.K. (ed.)


    This report summarizes the results of geothermal energy resource assessment work conducted by the New Mexico Statewide Geothermal Energy Program during the period September 7, 1984, through February 29, 1988, under the sponsorship of the US Dept. of Energy and the State of New Mexico Research and Development Institute. The research program was administered by the New Mexico Research and Development Institute and was conducted by professional staff members at New Mexico State University and Lightning Dock Geothermal, Inc. The report is divided into four chapters, which correspond to the principal tasks delineated in the above grant. This work extends the knowledge of the geothermal energy resource base in southern New Mexico with the potential for commercial applications.

  20. From complexity to reality: providing useful frameworks for defining systems of care. (United States)

    Levison-Johnson, Jody; Wenz-Gross, Melodie


    Because systems of care are not uniform across communities, there is a need to better document the process of system development, define the complexity, and describe the development of the structures, processes, and relationships within communities engaged in system transformation. By doing so, we begin to identify the necessary and sufficient components that, at minimum, move us from usual care within a naturally occurring system to a true system of care. Further, by documenting and measuring the degree to which key components are operating, we may be able to identify the most successful strategies in creating system reform. The theory of change and logic model offer a useful framework for communities to begin the adaptive work necessary to effect true transformation. Using the experience of two system of care communities, this new definition and the utility of a theory of change and logic model framework for defining local system transformation efforts will be discussed. Implications for the field, including the need to further examine the natural progression of systems change and to create quantifiable measures of transformation, will be raised as new challenges for the evolving system of care movement.

  1. Real-Time Web-Based Assessment of Total Population Risk of Future Emergency Department Utilization: Statewide Prospective Active Case Finding Study (United States)

    Zhu, Chunqing; Zhao, Yifan; Hao, Shiying; Zheng, Le; Fu, Changlin; Wen, Qiaojun; Ji, Jun; Li, Zhen; Wang, Yong; Zheng, Xiaolin; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank; Sylvester, Karl G; Widen, Eric


    Background An easily accessible real-time Web-based utility to assess patient risks of future emergency department (ED) visits can help the health care provider guide the allocation of resources to better manage higher-risk patient populations and thereby reduce unnecessary use of EDs. Objective Our main objective was to develop a Health Information Exchange-based, next 6-month ED risk surveillance system in the state of Maine. Methods Data on electronic medical record (EMR) encounters integrated by HealthInfoNet (HIN), Maine’s Health Information Exchange, were used to develop the Web-based surveillance system for a population ED future 6-month risk prediction. To model, a retrospective cohort of 829,641 patients with comprehensive clinical histories from January 1 to December 31, 2012 was used for training and then tested with a prospective cohort of 875,979 patients from July 1, 2012, to June 30, 2013. Results The multivariate statistical analysis identified 101 variables predictive of future defined 6-month risk of ED visit: 4 age groups, history of 8 different encounter types, history of 17 primary and 8 secondary diagnoses, 8 specific chronic diseases, 28 laboratory test results, history of 3 radiographic tests, and history of 25 outpatient prescription medications. The c-statistics for the retrospective and prospective cohorts were 0.739 and 0.732 respectively. Integration of our method into the HIN secure statewide data system in real time prospectively validated its performance. Cluster analysis in both the retrospective and prospective analyses revealed discrete subpopulations of high-risk patients, grouped around multiple “anchoring” demographics and chronic conditions. With the Web-based population risk-monitoring enterprise dashboards, the effectiveness of the active case finding algorithm has been validated by clinicians and caregivers in Maine. Conclusions The active case finding model and associated real-time Web-based app were designed to

  2. NASA's Robotic Mining Competition Provides Undergraduates Full Life Cycle Systems Engineering Experience (United States)

    Stecklein, Jonette


    NASA has held an annual robotic mining competition for teams of university/college students since 2010. This competition is yearlong, suitable for a senior university engineering capstone project. It encompasses the full project life cycle from ideation of a robot design, through tele-operation of the robot collecting regolith in simulated Mars conditions, to disposal of the robot systems after the competition. A major required element for this competition is a Systems Engineering Paper in which each team describes the systems engineering approaches used on their project. The score for the Systems Engineering Paper contributes 25% towards the team’s score for the competition’s grand prize. The required use of systems engineering on the project by this competition introduces the students to an intense practical application of systems engineering throughout a full project life cycle.

  3. Valuing the Resilience Provided by Solar and Battery Energy Storage Systems

    Energy Technology Data Exchange (ETDEWEB)

    McLaren, Joyce A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Mullendore, Seth [Clean Energy Group


    This paper explores the impact of valuing resilience on the economics of photovoltaics (PV) and storage systems for commercial buildings. The analysis presented here illustrates that accounting for the cost of grid power outages can change the breakeven point for PV and storage system investment, and increase the size of systems designed to deliver the greatest economic benefit over time. In other words, valuing resilience can make PV and storage systems economical in cases where they would not be otherwise. As storage costs decrease, and outages occur more frequently, PV and storage are likely to play a larger role in building design and management considerations.

  4. Utilizing Provider Feedback to Develop Opioid Risk Mitigation Tools for the Military Health System (United States)


    complex environment of care, treating patients who are often mobile and whose prior prescription history may be difficult to access. Clinical Decision...Support (CDS) tools provide healthcare providers with knowledge and detailed information to enhance decision-making in the clinical workflow and

  5. Provider Payment Trends and Methods in the Massachusetts Health Care System


    Allison Barrett; Timothy Lake


    This report investigates provider payment methods in Massachusetts. Payments include fee-for-service, the predominant model; global payments, which pay providers a single fee for all or most required services during a contract period; and pay-for-performance models, which layer quality incentives onto payments.

  6. General Systems Theory Provides a Conceptual Scheme for the Classification of Variables in Future Research Designs. (United States)

    Smith, Albert B.

    The growth of research in the community college field is reviewed. The need for a general systems approach to classifying and organizing research designs is stressed. A taxonomy is proposed with major categories of input, process, and outcome variables. A community college is considered ideal for "open systems." The practical value of this…

  7. NASA's Robotics Mining Competition Provides Undergraduates Full Life Cycle Systems Engineering Experience (United States)

    Stecklein, Jonette


    NASA has held an annual robotic mining competition for teams of university/college students since 2010. This competition is yearlong, suitable for a senior university engineering capstone project. It encompasses the full project life cycle from ideation of a robot design to actual tele-operation of the robot in simulated Mars conditions mining and collecting simulated regolith. A major required element for this competition is a Systems Engineering Paper in which each team describes the systems engineering approaches used on their project. The score for the Systems Engineering Paper contributes 25% towards the team's score for the competition's grand prize. The required use of systems engineering on the project by this competition introduces the students to an intense practical application of systems engineering throughout a full project life cycle.

  8. Sewer System Management Plan.

    Energy Technology Data Exchange (ETDEWEB)

    Holland, Robert C. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)


    A Sewer System Management Plan (SSMP) is required by the State Water Resources Control Board (SWRCB) Order No. 2006-0003-DWQ Statewide General Waste Discharge Requirements (WDR) for Sanitary Sewer Systems (General Permit). DOE, National Nuclear Security Administration (NNSA), Sandia Field Office has filed a Notice of Intent to be covered under this General Permit. The General Permit requires a proactive approach to reduce the number and frequency of sanitary sewer overflows (SSOs) within the State. SSMPs must include provisions to provide proper and efficient management, operation, and maintenance of sanitary sewer systems and must contain a spill response plan.

  9. Open communication: Recommendations for enhancing communication among primary care and mental health providers, services, and systems. (United States)

    Wong, Shale L; Talmi, Ayelet


    Comments on the article "Please break the silence: Parents' views on communication between pediatric primary care and mental health providers" by Greene et al. (see record 2015-14521-001). The article highlights the need to improve communication between primary care and mental health care providers to better serve children and families. The report reaffirms that parents understand the value and necessity of collaborative care, as evidenced by the identification of gaps in consistency of bidirectional communication between providers in traditional and separate practice settings and the desire for improved care coordination. (c) 2015 APA, all rights reserved).

  10. A Highly Flexible, Automated System Providing Reliable Sample Preparation in Element- and Structure-Specific Measurements. (United States)

    Vorberg, Ellen; Fleischer, Heidi; Junginger, Steffen; Liu, Hui; Stoll, Norbert; Thurow, Kerstin


    Life science areas require specific sample pretreatment to increase the concentration of the analytes and/or to convert the analytes into an appropriate form for the detection and separation systems. Various workstations are commercially available, allowing for automated biological sample pretreatment. Nevertheless, due to the required temperature, pressure, and volume conditions in typical element and structure-specific measurements, automated platforms are not suitable for analytical processes. Thus, the purpose of the presented investigation was the design, realization, and evaluation of an automated system ensuring high-precision sample preparation for a variety of analytical measurements. The developed system has to enable system adaption and high performance flexibility. Furthermore, the system has to be capable of dealing with the wide range of required vessels simultaneously, allowing for less cost and time-consuming process steps. However, the system's functionality has been confirmed in various validation sequences. Using element-specific measurements, the automated system was up to 25% more precise compared to the manual procedure and as precise as the manual procedure using structure-specific measurements. © 2015 Society for Laboratory Automation and Screening.

  11. Metaboli-Net: online groupware system providing counseling guidance for patients with metabolic syndrome. (United States)

    Kuwata, Shigeki; Taniguchi, Shin-ichi; Kato, Atsuko; Inoue, Kazuoki; Yamamoto, Naoya; Ohkura, Tsuyoshi; Teramoto, Kei; Shigemasa, Chiaki; Kondoh, Hiroshi


    This study presented a newly developed online groupware system, Metaboli-Net, to yield counseling guidance on diet and exercise to patients with metabolic syndrome. A distinctive feature adopted in the system to maintain the retention rate of patients was the social network service (SNS) that enables the patients to share their dietary and relevant health information with other participants in the same group on the network. A pilot study was conducted to prove the effectiveness of the system in improving the patient's lifestyle and dietary health awareness. SNS also contributed to the participant's adherence to intervention programs.

  12. Provider responsibility and system redesign: two sides of the same coin. (United States)

    Richardson, William C; Corrigan, Janet M


    Patient safety is a serious problem that health care professionals and hospitals must confront. The health care delivery system must be redesigned. Health care professionals have a moral and ethical responsibility to actively participate in the development and operation of well-designed care processes. Efforts to redesign the delivery system will be most effective if accompanied by changes in the environment that shapes care delivery. Health care leadership must also focus attention on identifying the types of environmental changes needed at different levels, and on the part of specific stakeholders, to allow model twenty-first-century community health systems to develop.

  13. System and Method for Providing Model-Based Alerting of Spatial Disorientation to a Pilot (United States)

    Conner, Kevin J (Inventor); Mathan, Santosh (Inventor); Johnson, Steve (Inventor)


    A system and method monitor aircraft state parameters, for example, aircraft movement and flight parameters, applies those inputs to a spatial disorientation model, and makes a prediction of when pilot may become spatially disoriented. Once the system predicts a potentially disoriented pilot, the sensitivity for alerting the pilot to conditions exceeding a threshold can be increased and allow for an earlier alert to mitigate the possibility of an incorrect control input.


    Directory of Open Access Journals (Sweden)

    O. P. Mintser


    Full Text Available Principles of the new unified informative system of health care (UISHC are considered. In the system unlike existent analogues the complex reflection of all factors influencing on the state of health, including environment, pharmaceutical factors etc are under discussion. Principles of formation of UISHC among which the most important is realization of duality (availability of stationary and mobile - medical electronic passport of a citizen are also defined.

  15. Providing data science support for systems pharmacology and its implications to drug discovery. (United States)

    Hart, Thomas; Xie, Lei


    The conventional one-drug-one-target-one-disease drug discovery process has been less successful in tracking multi-genic, multi-faceted complex diseases. Systems pharmacology has emerged as a new discipline to tackle the current challenges in drug discovery. The goal of systems pharmacology is to transform huge, heterogeneous, and dynamic biological and clinical data into interpretable and actionable mechanistic models for decision making in drug discovery and patient treatment. Thus, big data technology and data science will play an essential role in systems pharmacology. This paper critically reviews the impact of three fundamental concepts of data science on systems pharmacology: similarity inference, overfitting avoidance, and disentangling causality from correlation. The authors then discuss recent advances and future directions in applying the three concepts of data science to drug discovery, with a focus on proteome-wide context-specific quantitative drug target deconvolution and personalized adverse drug reaction prediction. Data science will facilitate reducing the complexity of systems pharmacology modeling, detecting hidden correlations between complex data sets, and distinguishing causation from correlation. The power of data science can only be fully realized when integrated with mechanism-based multi-scale modeling that explicitly takes into account the hierarchical organization of biological systems from nucleic acid to proteins, to molecular interaction networks, to cells, to tissues, to patients, and to populations.

  16. FINDER, A system providing complex decision support for commercial transport replanning operations (United States)

    Bittermann, Vincent; Deker, Guy; Sassus, Pierre; Mielnik, Jean-Christophe; Jud, Jean-Marie


    Decision-aid systems, likely to appear in future aircraft generations, could play a central role in the cockpit thanks to the broad spectrum of functionalities and decision support facilities they will offer to the crew. As part of such systems, the exploratory FINDER mock-up is a knowledge based system (KBS) designed to help crew members continually optimize their flight plan by suggesting solutions considering exhaustive information related to flight context, either on pilot request or upon external information occurrence. The successful evaluation by Air France pilots of that first mock-up dedicated to diversion procedure on pilot request has led to the current development of an enhanced system with nominal enroute operations and real-time capabilities. Nominal enroute operations concern the optimization with respect to an evolutive constraining of favoring environment (due to weather, traffic or regulated areas, and ETOPS constraints). This study paves the way for a future flight assistant system concept which is already under investigation and may take place in SEXTANT Avionique's future development steps.

  17. FRAMES-2.0 Software System: Providing Password Protection and Limited Access to Models and Simulations

    Energy Technology Data Exchange (ETDEWEB)

    Whelan, Gene; Pelton, Mitch A.


    One of the most important concerns for regulatory agencies is the concept of reproducibility (i.e., reproducibility means credibility) of an assessment. One aspect of reproducibility deals with tampering of the assessment. In other words, when multiple groups are engaged in an assessment, it is important to lock down the problem that is to be solved and/or to restrict the models that are to be used to solve the problem. The objective of this effort is to provide the U.S. Nuclear Regulatory Commission (NRC) with a means to limit user access to models and to provide a mechanism to constrain the conceptual site models (CSMs) when appropriate. The purpose is to provide the user (i.e., NRC) with the ability to “lock down” the CSM (i.e., picture containing linked icons), restrict access to certain models, or both.

  18. The MultiCircuit System. 1. Description of a device providing several Mapleson functions. (United States)

    Salkield, I M


    A device which provides for analogues of the Mapleson A, D and E anaesthetic breathing circuits in a compact and reasonably robust form is described. It incorporates a single lever for switching between Mapleson modes and uses a Heidbrink valve in the same way as the familiar CO2 absorbers. The breathing hose attachment points are similar to those on the CIG (BOC) Mark 3 absorber. This allows use with standard breathing tubes for non-coaxial purposes and, with the Mera F attachment, provides a coaxial circuit. Anaesthetic gas scavenging facilities are incorporated.

  19. Cheese rind communities provide tractable systems for in situ and in vitro studies of microbial diversity (United States)

    Wolfe, Benjamin E.; Button, Julie E.; Santarelli, Marcela; Dutton, Rachel J.


    SUMMARY Tractable microbial communities are needed to bridge the gap between observations of patterns of microbial diversity and mechanisms that can explain these patterns. We developed cheese rinds as model microbial communities by characterizing in situ patterns of diversity and by developing an in vitro system for community reconstruction. Sequencing of 137 different rind communities across 10 countries revealed 24 widely distributed and culturable genera of bacteria and fungi as dominant community members. Reproducible community types formed independent of geographic location of production. Intensive temporal sampling demonstrated that assembly of these communities is highly reproducible. Patterns of community composition and succession observed in situ can be recapitulated in a simple in vitro system. Widespread positive and negative interactions were identified between bacterial and fungal community members. Cheese rind microbial communities represent an experimentally tractable system for defining mechanisms that influence microbial community assembly and function. PMID:25036636

  20. Using Botnets to provide security for safety critical embedded systems - a case study focused on UAVs (United States)

    Garcia Muzzi, Fernando Augusto; Rogério de Mello Cardoso, Paulo; Pigatto, Daniel Fernando; Jaquie Castelo Branco, Kalinka Regina Lucas


    The use of unmanned aerial vehicles (UAV s) has been growing not only in military applications, but also in civilian. UAVs have enormous potential for use, which mostly still are unexplored. For the use of UAV s in the airspace, not only Brazilian new studies on methods of analysis and technologies should be incorporated into navigation systems, control among others, promoting security mechanisms for these aircraft. Implement security mechanisms using a platform with operating systems and botnet to simulate such attack Distributed Denial of Service (DDoS) in UAVs is an important task when it is aimed at containment and mitigation of attacks on this type of platform.

  1. JSBML 1.0: providing a smorgasbord of options to encode systems biology models

    DEFF Research Database (Denmark)

    Rodriguez, Nicolas; Thomas, Alex; Watanabe, Leandro


    JSBML, the official pure Java programming library for the Systems Biology Markup Language (SBML) format, has evolved with the advent of different modeling formalisms in systems biology and their ability to be exchanged and represented via extensions of SBML. JSBML has matured into a major, active...... open-source project with contributions from a growing, international team of developers who not only maintain compatibility with SBML, but also drive steady improvements to the Java interface and promote ease-of-use with end users. Source code, binaries and documentation for JSBML can be freely...

  2. Children's Support Services: Providing a System of Care for Urban Preschoolers with Significant Behavioral Challenges (United States)

    Tewhey, Karen


    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…

  3. Changes in Mental Illness Stigma in California During the Statewide Stigma and Discrimination Reduction Initiative


    Collins, Rebecca L.; Wong, Eunice C.; Roth, Elizabeth; Cerully, Jennifer L.; Marks, Joyce


    Presents results of a one-year follow-up to the 2014 California Statewide Survey, which was developed to track attitudes, beliefs, and behaviors related to mental illness. This article focuses on items measuring stigma.

  4. Changes in Mental Illness Stigma in California During the Statewide Stigma and Discrimination Reduction Initiative. (United States)

    Collins, Rebecca L; Wong, Eunice C; Roth, Elizabeth; Cerully, Jennifer L; Marks, Joyce


    Presents results of a one-year follow-up to the 2014 California Statewide Survey, which was developed to track attitudes, beliefs, and behaviors related to mental illness. This article focuses on items measuring stigma.

  5. Modular Biopower System Providing Combined Heat and Power for DoD Installations (United States)


    conventional gasification systems have a significant amount of residual tars that must be destroyed in a separate catalytic reactor or removed by...500,000 Btu/hr (150 kWth) thermal Achieved 83kWe at 5830 ft. elevation, extrap . to 100 kWe at sea level Emissions Quality lbs/MWh of combined

  6. 47 CFR 76.1503 - Carriage of video programming providers on open video systems. (United States)


    ... shall be “Open Video System Notice of Intent” and “Attention: Media Bureau.” This wording shall be... Notice of Intent with the Office of the Secretary and the Bureau Chief, Media Bureau. The Notice of... capacity through a fair, open and non-discriminatory process; the process must be insulated from any bias...

  7. Apparatus, system and method for providing cryptographic key information with physically unclonable function circuitry (United States)

    Areno, Matthew


    Techniques and mechanisms for providing a value from physically unclonable function (PUF) circuitry for a cryptographic operation of a security module. In an embodiment, a cryptographic engine receives a value from PUF circuitry and based on the value, outputs a result of a cryptographic operation to a bus of the security module. The bus couples the cryptographic engine to control logic or interface logic of the security module. In another embodiment, the value is provided to the cryptographic engine from the PUF circuitry via a signal line which is distinct from the bus, where any exchange of the value by either of the cryptographic engine and the PUF circuitry is for communication of the first value independent of the bus.

  8. Progressive taxation as a tool for providing the budget system stability


    Margarita A. Vakhtina


    Objective to consider the alternative additional sources of income of the state budget in the framework of the action plan of the Russian government to provide socioeconomic stability of the country in 2016. Methods comparative and dynamic analysis classification and typology description and measurements including using the tools of institutional Economics the data were interpreted using tables. Results it is shown that due to the lack of financial resources the government has to make...

  9. JSBML 1.0: providing a smorgasbord of options to encode systems biology models. (United States)

    Rodriguez, Nicolas; Thomas, Alex; Watanabe, Leandro; Vazirabad, Ibrahim Y; Kofia, Victor; Gómez, Harold F; Mittag, Florian; Matthes, Jakob; Rudolph, Jan; Wrzodek, Finja; Netz, Eugen; Diamantikos, Alexander; Eichner, Johannes; Keller, Roland; Wrzodek, Clemens; Fröhlich, Sebastian; Lewis, Nathan E; Myers, Chris J; Le Novère, Nicolas; Palsson, Bernhard Ø; Hucka, Michael; Dräger, Andreas


    JSBML, the official pure Java programming library for the Systems Biology Markup Language (SBML) format, has evolved with the advent of different modeling formalisms in systems biology and their ability to be exchanged and represented via extensions of SBML. JSBML has matured into a major, active open-source project with contributions from a growing, international team of developers who not only maintain compatibility with SBML, but also drive steady improvements to the Java interface and promote ease-of-use with end users. Source code, binaries and documentation for JSBML can be freely obtained under the terms of the LGPL 2.1 from the website More information about JSBML can be found in the user guide at or Supplementary data are available at Bioinformatics online. © The Author 2015. Published by Oxford University Press.

  10. A Lightweight AV System for Providing a Faithful and Spatially Manipulable Visual Hand Representation


    Pusch, Andreas; Martin, Olivier; Coquillart, Sabine


    Session: Developing new tools and technologies - Abstracts to be published in a regular issue of the journal Cyberpsychology, Behavior and Social Networking (indexed in MedLine and PsychInfo):; International audience; This paper introduces the technical foundations of a system designed to embed a lightweight, faithful and spatially manipulable representation of the user's hand into an otherwise virtual world (aka Augmented Virtuality, AV). A highly intui...

  11. Organic farming provides improved management of plant parasitic nematodes in maize and bean cropping systems


    Atandi, Janet G.; Haukeland, Solveig; Kariuki, George M.; Coyne, Danny L.; Karanja, Edward N.; Musyoka, Martha W.; Fiaboe, Komi K.M.; Bautze, David; Adamtey, Noah


    Intensification of agriculture, combined with poor agronomic practices have increased the incidence of plant parasitic nematodes (PPN) and other soil pathogens in East Africa, which consequently affects crop productivity in small holder farms. The objective of the study was to assess the effectiveness of farming systems in management of PPN and to recommend the best practice to farmers. Therefore, two field trials were established, one infarmer fieldsandoneon-station,usingmaize (Zeamays L.), inter...

  12. Using Model-Based System Engineering to Provide Artifacts for NASA Project Life-Cycle and Technical Reviews Presentation (United States)

    Parrott, Edith L.; Weiland, Karen J.


    This is the presentation for the AIAA Space conference in September 2017. It highlights key information from Using Model-Based Systems Engineering to Provide Artifacts for NASA Project Life-cycle and Technical Reviews paper.

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


    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.

  14. The adjustable systemic-pulmonary artery shunt provides precise control of flow in vivo. (United States)

    Douglas, William I; Moore, Karabeth B; Resig, Phillip P; Mohiuddin, M Waqar


    The ratio of pulmonary:systemic blood flow (Qp:Qs) remains problematic after single ventricle reconstruction. The adjustable systemic-pulmonary artery shunt (AS) was created as a solution for this problem. Prototype ASs were created using a screw-plunger mechanism as a variable resistor. A stepper motor controls plunger displacement. Six adult dogs underwent placement of a 4-mm AS in the femoral position to test its ability to control flow. Shunts were placed as arteriovenous fistulae to simulate the continuous flow of systemic-pulmonary AS. The 3.5-mm control shunts (CS) were placed on the contralateral side. The stepper motor was rotated from fully open to 3.4 mm of plunger depression for six complete cycles. Flow in the fully open AS was 687.9 +/- 28.7 cc/min* vs. 578.7 +/- 26.8 cc/min in the CS (flow +/- standard error, *p < 0.005 vs. CS). Standard deviation of flow was similar between the AS and CS, implying hysteresis in resistor function did not contribute to flow variability. Peak torque requirement to turn the resistor was 2.4 mNm. The AS offers excellent control of flow in vivo. Control of Qp:Qs may lead to improved outcomes for single ventricle reconstructions.

  15. What the shark immune system can and cannot provide for the expanding design landscape of immunotherapy. (United States)

    Criscitiello, Michael F


    Sharks have successfully lived in marine ecosystems, often atop food chains as apex predators, for nearly one and a half billion years. Throughout this period they have benefitted from an immune system with the same fundamental components found in terrestrial vertebrates like man. Additionally, sharks have some rather extraordinary immune mechanisms which mammals lack. In this review the author briefly orients the reader to sharks, their adaptive immunity, and their important phylogenetic position in comparative immunology. The author also differentiates some of the myths from facts concerning these animals, their cartilage, and cancer. From thereon, the author explores some of the more remarkable capabilities and products of shark lymphocytes. Sharks have an isotype of light chain-less antibodies that are useful tools in molecular biology and are moving towards translational use in the clinic. These special antibodies are just one of the several tricks of shark lymphocyte antigen receptor systems. While shark cartilage has not helped oncology patients, shark immunoglobulins and T cell receptors do offer exciting novel possibilities for immunotherapeutics. Much of the clinical immunology developmental pipeline has turned from traditional vaccines to passively delivered monoclonal antibody-based drugs for targeted depletion, activation, blocking and immunomodulation. The immunogenetic tools of shark lymphocytes, battle-tested since the dawn of our adaptive immune system, are well poised to expand the design landscape for the next generation of immunotherapy products.

  16. Membrane separation system provides low-cost solution for petroleum marketers

    Energy Technology Data Exchange (ETDEWEB)

    Tiberi, T.P.


    Gasoline tanker-truck loading facilities (bulk gasoline terminals) in the United States are required to use vapor recovery or vapor abatement equipment to minimize the impact of gasoline vapor emissions to the atmosphere. These vapors are generated as liquid product is loaded into the bottom of the delivery tankers. Installing semi-permeable membranes upstream of carbon adsorption units would allow carbon adsorption system to achieve higher recovery efficiencies and overcome the challenges posed by streams with high moisture concentrations. Such a membrane unit separates the bulk of the hydrocarbons and all of the water from the vapor stream. A dry, dilute stream is passed to the carbon bed system for final ''polishing,'' enhancing the bed's performance. The moist, hydrocarbon-rich stream that permeates, or diffuses through, the membrane walls is blended with the vapor stream desorbed from the regenerating carbon bed, and both streams subsequently are pressurized and condensed. The creative use of a membrane separator dehydrates and partially recovers hydrocarbons from the gasoline vapor stream. Due to the improved recovery efficiency of this integrated hybrid system, higher terminal throughputs can be realized with lower hydrocarbon emissions.

  17. Progressive taxation as a tool for providing the budget system stability

    Directory of Open Access Journals (Sweden)

    Margarita A. Vakhtina


    Full Text Available Objective to consider the alternative additional sources of income of the state budget in the framework of the action plan of the Russian government to provide socioeconomic stability of the country in 2016. Methods comparative and dynamic analysis classification and typology description and measurements including using the tools of institutional Economics the data were interpreted using tables. Results it is shown that due to the lack of financial resources the government has to make unpopular decisions that reduce the level of social support of the population for the near future. The adopted laws stipulating the principles of address character and needs when providing regional measures of social support increase the risks of poverty and inequality. The analysis has been made of the ranking position of Russia and member countries of the Organization for Economic Cooperation and Development in terms of GDP per capita human development index and quality of life index. The article grounds the need for institutional change to facilitate transition to progressive taxation and redistribution of the tax burden from the poor and middle classes to the super rich. The flat personal income tax rate has not led to the desired results of growing tax revenues in the budget. Russia is still among the top ten states with the largest tax evasion losses. The weak redistributive mechanisms including a flat scale of personal income tax regressive social security contributions and low property taxes lead to stagnation inequality underfunding of education and health. Scientific novelty the article proves the conclusion about need of institutional transformations associated with changing the current tax policy priorities. The transition to a progressive scale of income and wealth taxation promotes the transfer of tax burden from the middle and poor to the rich. These measures can provide a double economic effect. On the one hand the principle of effective taxation

  18. Toward a joint health and disease management program. Toronto hospitals partner to provide system leadership. (United States)

    Macleod, Anne Marie; Gollish, Jeffrey; Kennedy, Deborah; McGlasson, Rhona; Waddell, James


    The Joint Health and Disease Management Program in the Toronto Central Local Health Integration Network (TC LHIN) is envisioned as a comprehensive model of care for patients with hip and knee arthritis. It includes access to assessment services, education, self-management programs and other treatment programs, including specialist care as needed. As the first phase of this program, the hospitals in TC LHIN implemented a Hip and Knee Replacement Program to focus on improving access and quality of care, coordinating services and measuring wait times for patients waiting for hip or knee replacement surgery. The program involves healthcare providers, consumers and constituent hospitals within TC LHIN. The approach used for this program involved a definition of governance structure, broad stakeholder engagement to design program elements and plans for implementation and communication to ensure sustainability. The program and approach were designed to provide a model that is transferrable in its elements or its entirety to other patient populations and programs. Success has been achieved in creating a single wait list, developing technology to support referral management and wait time reporting, contributing to significant reductions in waits for timely assessment and treatment, building human resource capacity and improving patient and referring physician satisfaction with coordination of care.


    Directory of Open Access Journals (Sweden)

    O. Maksymovа


    Full Text Available Currently methods of efficiency analysis are being developed and applied, based on optimization tasks for various types and modes. Usually, the optimization criterion for these objectives is efficiency that can be calculated in various ways, for which there is no concurrent views. The target function based on minimization of given cost that allows comparing options with the same useful effect is used to search for the best indicators of power plants operated within the system. Marginal costs on the amount of difference in the useful effect are introduced to the target function in case of various useful effects. The criterion of selecting the best power plant from an economic point of view is the difference between the reduced costs of the considered and the basic options, but this approach does not allow using the results for long-term projections. Such approach depends on the situation and does not reflect the real costs. The value of the target function to optimize the effectiveness of the technical-economic method is not "marginal" and does not allow assessing the impact of various processes on the overall option efficiency. Therefore, the development of the efficiency criterion that considers the changing needs of the energy system is relevant for analyzing the power plant.

  20. Dolphin genome provides evidence for adaptive evolution of nervous system genes and a molecular rate slowdown (United States)

    McGowen, Michael R.; Grossman, Lawrence I.; Wildman, Derek E.


    Cetaceans (dolphins and whales) have undergone a radical transformation from the original mammalian bodyplan. In addition, some cetaceans have evolved large brains and complex cognitive capacities. We compared approximately 10 000 protein-coding genes culled from the bottlenose dolphin genome with nine other genomes to reveal molecular correlates of the remarkable phenotypic features of these aquatic mammals. Evolutionary analyses demonstrated that the overall synonymous substitution rate in dolphins has slowed compared with other studied mammals, and is within the range of primates and elephants. We also discovered 228 genes potentially under positive selection (dN/dS > 1) in the dolphin lineage. Twenty-seven of these genes are associated with the nervous system, including those related to human intellectual disabilities, synaptic plasticity and sleep. In addition, genes expressed in the mitochondrion have a significantly higher mean dN/dS ratio in the dolphin lineage than others examined, indicating evolution in energy metabolism. We encountered selection in other genes potentially related to cetacean adaptations such as glucose and lipid metabolism, dermal and lung development, and the cardiovascular system. This study underlines the parallel molecular trajectory of cetaceans with other mammalian groups possessing large brains. PMID:22740643

  1. Dolphin genome provides evidence for adaptive evolution of nervous system genes and a molecular rate slowdown. (United States)

    McGowen, Michael R; Grossman, Lawrence I; Wildman, Derek E


    Cetaceans (dolphins and whales) have undergone a radical transformation from the original mammalian bodyplan. In addition, some cetaceans have evolved large brains and complex cognitive capacities. We compared approximately 10,000 protein-coding genes culled from the bottlenose dolphin genome with nine other genomes to reveal molecular correlates of the remarkable phenotypic features of these aquatic mammals. Evolutionary analyses demonstrated that the overall synonymous substitution rate in dolphins has slowed compared with other studied mammals, and is within the range of primates and elephants. We also discovered 228 genes potentially under positive selection (dN/dS > 1) in the dolphin lineage. Twenty-seven of these genes are associated with the nervous system, including those related to human intellectual disabilities, synaptic plasticity and sleep. In addition, genes expressed in the mitochondrion have a significantly higher mean dN/dS ratio in the dolphin lineage than others examined, indicating evolution in energy metabolism. We encountered selection in other genes potentially related to cetacean adaptations such as glucose and lipid metabolism, dermal and lung development, and the cardiovascular system. This study underlines the parallel molecular trajectory of cetaceans with other mammalian groups possessing large brains.

  2. A System to Provide Real-Time Collaborative Situational Awareness by Web Enabling a Distributed Sensor Network (United States)

    Panangadan, Anand; Monacos, Steve; Burleigh, Scott; Joswig, Joseph; James, Mark; Chow, Edward


    In this paper, we describe the architecture of both the PATS and SAP systems and how these two systems interoperate with each other forming a unified capability for deploying intelligence in hostile environments with the objective of providing actionable situational awareness of individuals. The SAP system works in concert with the UICDS information sharing middleware to provide data fusion from multiple sources. UICDS can then publish the sensor data using the OGC's Web Mapping Service, Web Feature Service, and Sensor Observation Service standards. The system described in the paper is able to integrate a spatially distributed sensor system, operating without the benefit of the Web infrastructure, with a remote monitoring and control system that is equipped to take advantage of SWE.

  3. A novel resource management method of providing operating system as a service for mobile transparent computing. (United States)

    Xiong, Yonghua; Huang, Suzhen; Wu, Min; Zhang, Yaoxue; She, Jinhua


    This paper presents a framework for mobile transparent computing. It extends the PC transparent computing to mobile terminals. Since resources contain different kinds of operating systems and user data that are stored in a remote server, how to manage the network resources is essential. In this paper, we apply the technologies of quick emulator (QEMU) virtualization and mobile agent for mobile transparent computing (MTC) to devise a method of managing shared resources and services management (SRSM). It has three layers: a user layer, a manage layer, and a resource layer. A mobile virtual terminal in the user layer and virtual resource management in the manage layer cooperate to maintain the SRSM function accurately according to the user's requirements. An example of SRSM is used to validate this method. Experiment results show that the strategy is effective and stable.

  4. A Novel Resource Management Method of Providing Operating System as a Service for Mobile Transparent Computing

    Directory of Open Access Journals (Sweden)

    Yonghua Xiong


    Full Text Available This paper presents a framework for mobile transparent computing. It extends the PC transparent computing to mobile terminals. Since resources contain different kinds of operating systems and user data that are stored in a remote server, how to manage the network resources is essential. In this paper, we apply the technologies of quick emulator (QEMU virtualization and mobile agent for mobile transparent computing (MTC to devise a method of managing shared resources and services management (SRSM. It has three layers: a user layer, a manage layer, and a resource layer. A mobile virtual terminal in the user layer and virtual resource management in the manage layer cooperate to maintain the SRSM function accurately according to the user’s requirements. An example of SRSM is used to validate this method. Experiment results show that the strategy is effective and stable.

  5. Basic Surgical Skill Retention: Can Patriot Motion Tracking System Provide an Objective Measurement for it? (United States)

    Shaharan, Shazrinizam; Nugent, Emmeline; Ryan, Donncha M; Traynor, Oscar; Neary, Paul; Buckley, Declan


    Knot tying is a fundamental skill that surgical trainees have to learn early on in their training. The aim of this study was to establish the predictive and concurrent validity of the Patriot as an assessment tool and determine the skill retention in first-year surgical trainees after 5 months of training. First-year surgical trainees were recruited in their first month of the training program. Experts were invited to set the proficiency level. The subjects performed hand knot tying on a bench model. The skill was assessed at baseline in the first month of training and at 5 months. The assessment tools were the Patriot electromagnetic tracking system and Objective Structured Assessment of Technical Skills (OSATS). The trainees' scores were compared to the proficiency score. The data were analyzed using paired t-test and Pearson correlation analysis. A total of 14 first-year trainees participated in this study. The time taken to complete the task and the path length (PL) were significantly shorter (p = 0.007 and p = 0.0085, respectively) at 5 months. OSATS scoring showed a significant improvement (p = 0.0004). There was a significant correlation between PL and OSATS at baseline (r = -0.873) and at Month 5 (r = -0.774). In all, 50% of trainees reached the proficiency PL at baseline and at Month 5. Among them, 3 trainees improved their PL to reach proficiency and the other 3 trainees failed to reach proficiency. The parameters from the Patriot motion tracker demonstrated a significant correlation with the classical observational assessment tool and were capable of highlighting the skill retention in surgical trainees. Therefore, the automated scoring system has a significant role in the surgical training curriculum as an adjunct to the available assessment tool. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  6. A Statewide Intervention Improves Appropriate Imaging in Localized Prostate Cancer. (United States)

    Hurley, Patrick; Dhir, Apoorv; Gao, Yuqing; Drabik, Brian; Lim, Kenneth; Curry, Jon; Womble, Paul R; Linsell, Susan M; Brachulis, Andrew; Sexton, Donald W; Ghani, Khurshid R; Denton, Brian T; Miller, David C; Montie, James E


    We implemented a statewide intervention to improve imaging utilization for the staging of patients with newly diagnosed prostate cancer. MUSIC (Michigan Urological Surgery Improvement Collaborative) is a quality improvement collaborative comprising 42 diverse practices representing approximately 85% of the urologists in Michigan. MUSIC has developed imaging appropriateness criteria (prostate specific antigen greater than 20 ng/ml, Gleason score 7 or higher and clinical stage T3 or higher) which minimize unnecessary imaging with bone scan and computerized tomography. After baseline rates of radiographic staging were established in 2012 and 2013, we used multidimensional interventions to deploy these criteria in 2014. Imaging utilization was then remeasured in 2015 to evaluate for changes in practice patterns. A total of 10,554 newly diagnosed patients with prostate cancer were entered into the MUSIC registry from January 1, 2012 through December 31, 2013 and January 1, 2015 through December 31, 2015. Of these patients 7,442 (79%) and 7,312 (78%) met our criteria to avoid bone scan and computerized tomography imaging, respectively. The use of bone scan imaging when not indicated decreased from 11.0% at baseline to 6.5% after interventions (p bone scans and computerized tomography among men at low risk for metastases. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  7. Visualizing the Immune System: Providing Key Insights into HIV/SIV Infections

    Directory of Open Access Journals (Sweden)

    Jacob D. Estes


    Full Text Available Immunological inductive tissues, such as secondary lymphoid organs, are composed of distinct anatomical microenvironments for the generation of immune responses to pathogens and immunogens. These microenvironments are characterized by the compartmentalization of highly specialized immune and stromal cell populations, as well as the presence of a complex network of soluble factors and chemokines that direct the intra-tissue trafficking of naïve and effector cell populations. Imaging platforms have provided critical contextual information regarding the molecular and cellular interactions that orchestrate the spatial microanatomy of relevant cells and the development of immune responses against pathogens. Particularly in HIV/SIV disease, imaging technologies are of great importance in the investigation of the local interplay between the virus and host cells, with respect to understanding viral dynamics and persistence, immune responses (i.e., adaptive and innate inflammatory responses, tissue structure and pathologies, and changes to the surrounding milieu and function of immune cells. Merging imaging platforms with other cutting-edge technologies could lead to novel findings regarding the phenotype, function, and molecular signatures of particular immune cell targets, further promoting the development of new antiviral treatments and vaccination strategies.

  8. Systems analysis of transcriptome data provides new hypotheses about Arabidopsis root response to nitrate treatments

    Directory of Open Access Journals (Sweden)

    Javier eCanales


    Full Text Available Nitrogen (N is an essential macronutrient for plant growth and development. Plants adapt to changes in N availability partly by changes in global gene expression. We integrated publicly available root microarray data under contrasting nitrate conditions to identify new genes and functions important for adaptive nitrate responses in Arabidopsis thaliana roots. Overall, more than two thousand genes exhibited changes in expression in response to nitrate treatments in Arabidopsis thaliana root organs. Global regulation of gene expression by nitrate depends largely on the experimental context. However, despite significant differences from experiment to experiment in the identity of regulated genes, there is a robust nitrate response of specific biological functions. Integrative gene network analysis uncovered relationships between nitrate-responsive genes and eleven highly co-expressed gene clusters (modules. Four of these gene network modules have robust nitrate responsive functions such as transport, signaling and metabolism. Network analysis hypothesized G2-like transcription factors are key regulatory factors controlling transport and signaling functions. Our meta-analysis highlights the role of biological processes not studied before in the context of the nitrate response such as root hair development and provides testable hypothesis to advance our understanding of nitrate responses in plants.

  9. [Quality of service provided to heart surgery patients of the Unified Health System-SUS]. (United States)

    Borges, Juliana Bassalobre Carvalho; Carvalho, Sebastião Marcos Ribeiro de; Silva, Marcos Augusto de Moraes


    To evaluate the service quality provided to heart surgery patients during their hospital stay, identifying the patient's expectations and perceptions. To associate service quality with: gender, age and the use of extracorporeal circulation. We studied 82 elective heart surgery patients (52.4% females and 47.6% males), operated by midsternal thoracotomy, age: 31 to 83 years (60.4 +/- 13.2 years); period: March to September 2006. Service quality was evaluated in two instances: the expectations at pre-operative and the perceptions of the service received on the 6th post-operative; through the application of the modified SERVQUAL scale (SERVQUAL-Card). The result was obtained by the difference of the sum of the scores on perception minus those of the expectations, and through statistical analysis. The SERVQUAL-Card scale was statistically validated, showing adequate level of internal consistency. We found a higher frequency of myocardial revascularization 55 (67.0%); first heart surgery 72 (87.8%) and the use of ECC 69 (84.1%). We noticed high mean values for expectations and perceptions with significant results (PSERVQUAL scale.

  10. The Core Flight System (cFS) Community: Providing Low Cost Solutions for Small Spacecraft (United States)

    McComas, David; Wilmot, Jonathan; Cudmore, Alan


    In February 2015 the NASA Goddard Space Flight Center (GSFC) completed the open source release of the entire Core Flight Software (cFS) suite. After the open source release a multi-NASA center Configuration Control Board (CCB) was established that has managed multiple cFS product releases. The cFS was developed and is being maintained in compliance with the NASA Class B software development process requirements and the open source release includes all Class B artifacts. The cFS is currently running on three operational science spacecraft and is being used on multiple spacecraft and instrument development efforts. While the cFS itself is a viable flight software (FSW) solution, we have discovered that the cFS community is a continuous source of innovation and growth that provides products and tools that serve the entire FSW lifecycle and future mission needs. This paper summarizes the current state of the cFS community, the key FSW technologies being pursued, the development/verification tools and opportunities for the small satellite community to become engaged. The cFS is a proven high quality and cost-effective solution for small satellites with constrained budgets.

  11. Strategies to improve effectiveness of physical activity coaching systems: Development of personas for providing tailored feedback. (United States)

    Achterkamp, Reinoud; Dekker-Van Weering, Marit Gh; Evering, Richard Mh; Tabak, Monique; Timmerman, Josien G; Hermens, Hermie J; Vollenbroek-Hutten, Miriam Mr


    Mobile physical activity interventions can be improved by incorporating behavioural change theories. Relations between self-efficacy, stage of change, and physical activity are investigated, enabling development of feedback strategies that can be used to improve their effectiveness. A total of 325 healthy control participants and 82 patients wore an activity monitor. Participants completed a self-efficacy or stage of change questionnaire. Results show that higher self-efficacy is related to higher activity levels. Patients are less active than healthy controls and show a larger drop in physical activity over the day. Patients in the maintenance stage of change are more active than patients in lower stages of change, but show an equally large drop in level of physical activity. Findings suggest that coaching should at least be tailored to level of self-efficacy, stage of change, and physical activity pattern. Tailored coaching strategies are developed, which suggest that increasing self-efficacy of users is most important. Guidelines are provided. © The Author(s) 2016.

  12. Heart and aortic baroreceptors: operation in providing hemodynamic processes in cardiovascular system

    Directory of Open Access Journals (Sweden)

    Mikhail Y. Rudenko


    Full Text Available Aims Up to the present, ECGs have been classified on the basis of the analysis of the ECG curve shape. But this made impossible to classify many ECG shapes. The most promising methods for the classification must evaluate each of the 10 cardiac cycle phases both by their functions and hemodynamic parameters. The aim hereof is to develop the new classification principles for all possible ECG shape variations. Materials and methods The heart cycle phase analysis method is used to calculate the hemodynamic parameters in each of 10 phases, like the phase-related blood volumes and the level of contraction of the corresponding cardiovascular musculature determining its function dynamics in the cardiac cycle phase structure related to the compensation mechanism for maintaining normal hemodynamics. Results An ECG phase changes periodic table consisting of 10 groups of the actual ECG curves typical for the corresponding pathologies is proposed. Each group contains 4 levels of characteristic phase changes. Conclusion The ECG phase changes periodic table is the first attempt to classify the great variety of the ECG shapes. In this case the proposed system requires further investigations. It has been demonstrated that the theoretical concept of the table is in compliance with practice. Further it is planned to improve characteristics of every group and every level.

  13. Revisiting Peruvian anchovy ( Engraulis ringens) trophodynamics provides a new vision of the Humboldt Current system (United States)

    Espinoza, Pepe; Bertrand, Arnaud


    The Peruvian anchovy or anchoveta ( Engraulis ringens) forages on plankton and is a main prey for marine mammals, seabirds, fish, and fishers, and is therefore a key element of the food web in the Humboldt Current system (HCS). Here, we present results from the analysis of 21,203 anchoveta stomach contents sampled during 23 acoustic surveys over the period 1996-2003. Prey items were identified to the genus level, and the relative dietary importance of different prey was assessed by determination of their carbon content. Variability in stomach fullness was examined relative to the diel cycle, the distance from the coast, sea surface temperature, and latitude, using generalized additive models (GAMs). Whereas phytoplankton largely dominated anchoveta diets in terms of numerical abundance and comprised >99% of ingested prey items, the carbon content of prey items indicated that zooplankton was by far the most important dietary component, with euphausiids contributing 67.5% of dietary carbon followed by copepods (26.3%). Stomach fullness data showed that anchoveta feed mainly during daytime between 07h00 and 18h00, although night-time feeding also made a substantial contribution to total food consumption. Stomach fullness also varied with latitude, distance from the coast, and temperature, but with substantial variability indicating a high degree of plasticity in anchoveta feeding behaviour. The results suggest an ecological role for anchoveta that challenges current understanding of its position in the foodweb, the functioning of the HCS, and trophic models of the HCS.

  14. Multiplex Amplification Refractory Mutation System PCR (ARMS-PCR) provides sequencing independent typing of canine parvovirus. (United States)

    Chander, Vishal; Chakravarti, Soumendu; Gupta, Vikas; Nandi, Sukdeb; Singh, Mithilesh; Badasara, Surendra Kumar; Sharma, Chhavi; Mittal, Mitesh; Dandapat, S; Gupta, V K


    Canine parvovirus-2 antigenic variants (CPV-2a, CPV-2b and CPV-2c) ubiquitously distributed worldwide in canine population causes severe fatal gastroenteritis. Antigenic typing of CPV-2 remains a prime focus of research groups worldwide in understanding the disease epidemiology and virus evolution. The present study was thus envisioned to provide a simple sequencing independent, rapid, robust, specific, user-friendly technique for detecting and typing of presently circulating CPV-2 antigenic variants. ARMS-PCR strategy was employed using specific primers for CPV-2a, CPV-2b and CPV-2c to differentiate these antigenic types. ARMS-PCR was initially optimized with reference positive controls in two steps; where first reaction was used to differentiate CPV-2a from CPV-2b/CPV-2c. The second reaction was carried out with CPV-2c specific primers to confirm the presence of CPV-2c. Initial validation of the ARMS-PCR was carried out with 24 sequenced samples and the results were matched with the sequencing results. ARMS-PCR technique was further used to screen and type 90 suspected clinical samples. Randomly selected 15 suspected clinical samples that were typed with this technique were sequenced. The results of ARMS-PCR and the sequencing matched exactly with each other. The developed technique has a potential to become a sequencing independent method for simultaneous detection and typing of CPV-2 antigenic variants in veterinary disease diagnostic laboratories globally. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Old age and chronic disease: is the emergency medical system the appropriate provider for the elderly? (United States)

    Mochmann, Hans-Christian; Arntz, Hans-Richard; Dincklage, Falk V; Rauch, Ursula; Schultheiss, Heinz P; Bobbert, Peter


    The use of emergency medical services increases with the age of patients. Some care providers hold on to the prejudice that these alarms are unnecessary or of a lower importance. We assessed the relation of age and age-dependent emergency characteristics, taking into consideration the ratings of emergency physicians on whether or not emergency cases were considered truly in need of emergency physician attendance. Emergency physicians dispatched by the Berlin Fire Department evaluated for each case the necessity of emergency physician attendance. Case characteristics such as the day of the week and location of the emergency as well as patient characteristics such as age, sex, prior status, and care dependency were recorded. In addition, whether or not the physician accompanied the patient to the hospital was recorded as a parameter for emergency severity. Analysis was performed using multiple logistic regression modeling. During the 6-month prospective study period, 2702 cases were evaluated. Emergency medical services are used more frequently by older individuals, especially octogenarians. Emergency cases in older individuals were significantly more often rated as in need of emergency physician attendance; however, the rate of patients accompanied by the emergency physician to the hospital did not differ between the age groups. The age of patients, the primary diagnosis, the day and location of the emergency, and the presence of pre-existing dementia showed a significant impact on the necessity of physician-attended emergency missions. Despite common prejudices, emergency cases in elder patients are rated more often as in need of emergency physician attendance compared with those involving younger patients.

  16. Early Peritonitis in a Large Peritoneal Dialysis Provider System in Colombia. (United States)

    Vargas, Edgar; Blake, Peter G; Sanabria, Mauricio; Bunch, Alfonso; López, Patricia; Vesga, Jasmín; Buitrago, Alberto; Astudillo, Kindar; Devia, Martha; Sánchez, Ricardo

    ♦ BACKGROUND: Peritonitis is the most important complication of peritoneal dialysis (PD), and early peritonitis rate is predictive of the subsequent course on PD. Our aim was to calculate the early peritonitis rate and to identify characteristics and predisposing factors in a large nationwide PD provider network in Colombia. ♦ METHODS: This was a historical observational cohort study of all adult patients starting PD between January 1, 2012, and December 31, 2013, in 49 renal facilities in the Renal Therapy Services in Colombia. We studied the peritonitis rate in the first 90 days of treatment, its causative micro-organisms, its predictors and its variation with time on PD and between individual facilities. ♦ RESULTS: A total of 3,525 patients initiated PD, with 176 episodes of peritonitis during 752 patient-years of follow-up for a rate of 0.23 episodes per patient year equivalent to 1 every 52 months. In 41 of 49 units, the rate was better than 1 per 33 months, and in 45, it was better than 1 per 24 months. Peritonitis rates did not differ with age, ethnicity, socioeconomic status, or PD modality. We identified high incidence risk periods at 2 to 5 weeks after initiation of PD and again at 10 to 12 weeks. ♦ CONCLUSION: An excellent peritonitis rate was achieved across a large nationwide network. This occurred in the context of high nationwide PD utilization and despite high rates of socioeconomic deprivation. We propose that a key factor in achieving this was a standardized approach to management of patients. Copyright © 2017 International Society for Peritoneal Dialysis.

  17. Transaction of long-term power purchasing contract by independent power providers in wholesale and retail competitive system

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Hoon [Korea Energy Economics Institute, Euiwang (Korea)


    In general, the restructuring starts with separation and division of power sector from the existing monopolist as the cases of Thailand and Malaysia. When the power provider is separated and divided, it becomes an independent power provider. The existing regional electricity provider carries out the supplying function to end-users buying electricity from several separated and divided providers. Therefore, the existing regional electricity providers give up the power generation business but become a demand monopolist in wholesale market. The competition system capable of applying during the separation period is the Generation Pool. With the Generation Pool, it is able to promote competition of power generation sector effectively and there is no need to have an extra step such as long-term power purchasing contract. In fact, Latin America and Chile have been managed the power market for more than 10 years with the competition system by the Generation Pool. 9 refs.

  18. Type III CRISPR-Cas systems can provide redundancy to counteract viral escape from type I systems (United States)

    Silas, Sukrit; Lucas-Elio, Patricia; Jackson, Simon A; Aroca-Crevillén, Alejandra; Hansen, Loren L; Fineran, Peter C


    CRISPR-Cas-mediated defense utilizes information stored as spacers in CRISPR arrays to defend against genetic invaders. We define the mode of target interference and role in antiviral defense for two CRISPR-Cas systems in Marinomonas mediterranea. One system (type I-F) targets DNA. A second system (type III-B) is broadly capable of acquiring spacers in either orientation from RNA and DNA, and exhibits transcription-dependent DNA interference. Examining resistance to phages isolated from Mediterranean seagrass meadows, we found that the type III-B machinery co-opts type I-F CRISPR-RNAs. Sequencing and infectivity assessments of related bacterial and phage strains suggests an ‘arms race’ in which phage escape from the type I-F system can be overcome through use of type I-F spacers by a horizontally-acquired type III-B system. We propose that the phage-host arms race can drive selection for horizontal uptake and maintenance of promiscuous type III interference modules that supplement existing host type I CRISPR-Cas systems. PMID:28826484

  19. Critical care providers refer to information tools less during communication tasks after a critical care clinical information system introduction. (United States)

    Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel


    Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.

  20. Barriers, facilitators, and potential strategies for increasing HPV vaccination: A statewide assessment to inform action. (United States)

    Cartmell, Kathleen B; Young-Pierce, Jennifer; McGue, Shannon; Alberg, Anthony J; Luque, John S; Zubizarreta, Maria; Brandt, Heather M


    The objective was to investigate how state level strategies in South Carolina could maximize HPV vaccine uptake. An environmental scan identified barriers, facilitators, and strategies for improving HPV vaccination in South Carolina. Interviews were conducted with state leaders from relevant organizations such as public health agencies, medical associations, K-12 schools, universities, insurers, and cancer advocacy organizations. A thematic content analysis design was used. Digital interview files were transcribed, a data dictionary was created and data were coded using the data dictionary. Thirty four interviews were conducted with state leaders. Barriers to HPV vaccination included lack of HPV awareness, lack of provider recommendation, HPV vaccine concerns, lack of access and practice-level barriers. Facilitators included momentum for improving HPV vaccination, school-entry Tdap requirement, pharmacy-based HPV vaccination, state immunization registry, HEDIS measures and HPV vaccine funding. Strategies for improving HPV vaccination fell into three categories: 1) addressing lack of awareness about the importance of HPV vaccination among the public and providers; 2) advocating for policy changes around HPV vaccine coverage, vaccine education, and pharmacy-based vaccination; and 3) coordination of efforts. A statewide environmental scan generated a blueprint for action to be used to improve HPV vaccination in the state. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  1. A Robotics Systems Design Need: A Design Standard to Provide the Systems Focus that is Required for Longterm Exploration Efforts (United States)

    Dischinger, H. Charles., Jr.; Mullins, Jeffrey B.


    The United States is entering a new period of human exploration of the inner Solar System, and robotic human helpers will be partners in that effort. In order to support integration of these new worker robots into existing and new human systems, a new design standard should be developed, to be called the Robot-Systems Integration Standard (RSIS). It will address the requirements for and constraints upon robotic collaborators with humans. These workers are subject to the same functional constraints as humans of work, reach, and visibility/situational awareness envelopes, and they will deal with the same maintenance and communication interfaces. Thus, the RSIS will be created by discipline experts with the same sort of perspective on these and other interface concerns as human engineers.

  2. A Statewide Private Microwave Wide Area Network for Real-time Natural Hazard Monitoring (United States)

    Williams, M. C.; Kent, G.; Smith, K. D.; Plank, G.; Slater, D.; Torrisi, J.; Presser, R.; Straley, K.


    The Nevada Seismological Laboratory (NSL) at the University of Nevada, Reno, operates the Nevada Seismic Network, a collection of ground motion instruments installed throughout Nevada and California, for the purposes of detecting, locating, and notifying the public of earthquakes in the state. To perform these tasks effectively, NSL has designed and built a statewide wireless microwave wide-area network (WAN) in order to receive ground motion data in near real-time. This network consists of radio access points, backhauls, and backbone communication sites transmitting time-series, images, and datalogger diagnostics to our data center servers in Reno. This privately managed communication network greatly reduces the dependence on third-party infrastructure (e.g. commercial cellular networks), and is vital for emergency management response and system uptime. Any individual seismograph or data collection device is networked through a wireless point-to-multipoint connection to a remote access point (AP) using a low-cost radio/routerboard combination. Additional point-to-point connections from AP's to radio backhauls and/or mountaintop backbone sites allow the Data Center in Reno to communicate with and receive data directly from each datalogger. Dataloggers, radios, and routers can be configured using tablets on-site, or via desktop computers at the Data Center. Redundant mountaintop links can be added to the network and facilitate the re-routing of data (similar to a meshed network) in the event of a faulty, failing, or noisy communication site. All routers, radios, and servers, including those at the Data Center, have redundant power and can operate independently in the event of a grid power or public Internet outage. A managed server room at the Data Center processes earthquake data for notifications and acts as a data source for remote users. Consisting of about 500 hosts, and spanning hundreds of miles, this WAN provides network operators access to each router and

  3. Mix of power system flexibility means providing 50 % wind power penetration in the Danish power system in 2030

    DEFF Research Database (Denmark)

    Nørgård, Per; Lund, Henrik; Mathiesen, Brian Vad


    Time series simulations of an example of a realistic modified energy system in Denmark 2030, assuming no internal power transmission bottlenecks, indicates that it is both technical possible and economic feasible to maintain the energy balance on hourly basis, even with a wind power penetration...

  4. Oral-systemic health during pregnancy: exploring prenatal and oral health providers' information, motivation and behavioral skills. (United States)

    Vamos, Cheryl A; Walsh, Margaret L; Thompson, Erika; Daley, Ellen M; Detman, Linda; DeBate, Rita


    Pregnancy is identified as a sensitive period of increased risk for poor oral health among mothers and offspring. Subsequently, both medical and dental associations have re-endorsed consolidated, inter-professional guidelines promoting oral health during pregnancy. The objective was to explore prenatal and oral health providers' information, motivation and practice behaviors related to oral health during pregnancy. Twenty-two in-depth interviews were conducted with prenatal and oral health providers based on the Information-Motivation-Behavioral Skills Model. Data were analyzed using the constant comparative method in NVivo 10. Providers held variable knowledge with regards to identified oral-systemic connections and implications. Most providers were unaware of the guidelines; however, some oral health providers reported avoiding specific treatment behaviors during this period. Motivation to address oral-systemic health during pregnancy included: prevention; healthy pregnancy/birth outcomes; patient's complaint/question as cue to action; comprehensive, patient-centered, and family-centered care; ethical duty; and professional governing body. Oral health providers reported assessing, educating, and communicating with patients about oral health issues; whereas prenatal providers rarely addressed oral health but reported signing approval forms to receive such care. A few oral health providers highlighted lifecourse implications and the need for family-centered care when addressing poor oral health among pregnant patients. Findings suggest gaps in oral health prevention information and behaviors among prenatal and oral health providers. Future efforts should examine effective dissemination and implementation strategies that translate evidence-based guidelines into clinical practice, with the ultimate goal of improve oral-systemic health among women and their offspring across the lifecourse.

  5. Statewide investigation of the role of pyrethroid pesticides in sediment toxicity in California's urban waterways. (United States)

    Holmes, Robert W; Anderson, Brian S; Phillips, Bryn M; Hunt, John W; Crane, Dave B; Mekebri, Abdou; Connor, Valerie


    A statewide investigation of urban creek sediment toxicity was conducted in California in recognition of increased incidences of toxicity linked to pyrethroid pesticides. The goals were to examine the spatial occurrence and magnitude of sediment toxicity in California urban creeks, and to examine the role of pyrethroids in toxic urban creek sediment samples. After a preliminary screening of 90 sites, 30 creeks were sampled in eight geographical regions. Sediment toxicity was assessed using 10 day bioassays with the resident amphipod Hyalella azteca. Bioassays were conducted at two test temperatures of 23 degrees C and at 15 degrees C to provide evidence of the cause of toxicity, and to more accurately reflect ambient environmental temperatures. Twenty-five of 30 samples were toxic when tested at 23 degrees C, and all 30 samples were toxic when tested at 15 degrees C. The magnitude of toxicity increased in samples tested at 15 degrees C suggesting the influence of pyrethroids, which are more toxic at colder temperatures. Pyrethroids were present in all sediment samples and were the only compounds detected at concentrations toxic to H. azteca. Bifenthrin was the pyrethroid of greatest toxicological concern, occurring in all 30 samples at concentrations up to 219 ng/g. Pyrethroid contamination of urban creeks was most severe in the Los Angeles, Central Valley, and San Diego regions, respectively. However, pyrethroids were also linked to urban creek aquatic toxicity in all regions sampled, including the less urbanized areas of the North Coast and Lake Tahoe.


    Directory of Open Access Journals (Sweden)

    Евгений Геннадьевич Панкратов


    Full Text Available This article analyzes the existing methods of e-government systems audit, their shortcomings are examined.  The approaches to improve existing techniques and adapt them to the specific characteristics of e-government systems are suggested. The paper describes the methodology, providing possibilities of integrated assessment of information systems. This methodology uses systems maturity models and can be used in the construction of e-government rankings, as well as in the audit of their implementation process. Maturity models are based on COBIT, COSO methodologies and models of e-government, developed by the relevant committee of the UN. The methodology was tested during the audit of information systems involved in the payment of temporary disability benefits. The audit was carried out during analysis of the outcome of the pilot project for the abolition of the principle of crediting payments for disability benefits.DOI:

  7. Tobacco Smoke Pollution in Hospitality Venues Before and After Passage of Statewide Smoke-Free Legislation. (United States)

    Buettner-Schmidt, Kelly; Boursaw, Blake; Lobo, Marie L; Travers, Mark J


    In 2012, North Dakota enacted a comprehensive statewide law prohibiting smoking in enclosed public places. Disparities in tobacco control exist in rural areas. This study's objective was to determine the extent to which the passage of a comprehensive, statewide, smoke-free law in a predominantly rural state influenced tobacco smoke pollution in rural and nonrural venues. A longitudinal cohort design study comparing the levels of tobacco smoke pollution before and after passage of the statewide smoke-free law was conducted in 64 restaurants and bars statewide in North Dakota. Particulate matter with a median aerodynamic diameter of pollution) was assessed. A significant 83% reduction in tobacco smoke pollution levels occurred after passage of the law. Significant reductions in tobacco smoke pollution levels occurred in each of the rural categories; however, no difference by rurality was noted in the analysis after passage of the law, in contrast to the study before passage. To our knowledge, this was the largest, single, rural postlaw study globally. A comprehensive statewide smoke-free law implemented in North Dakota dramatically decreased the level of tobacco smoke pollution in bars and restaurants. © 2016 The Authors. Public Health Nursing Published by Wiley Periodicals, Inc.

  8. A feedback system in residency to evaluate CanMEDS roles and provide high-quality feedback : Exploring its application

    NARCIS (Netherlands)

    Renting, Nienke; Gans, Rijk O. B.; Borleffs, Jan C. C.; Van Der Wal, Martha A.; Jaarsma, A. Debbie C.; Cohen-Schotanus, Janke

    Introduction: Residents benefit from regular, high quality feedback on all CanMEDS roles during their training. However, feedback mostly concerns Medical Expert, leaving the other roles behind. A feedback system was developed to guide supervisors in providing feedback on CanMEDS roles. We analyzed

  9. Using Model-Based Systems Engineering to Provide Artifacts for NASA Project Life-cycle and Technical Reviews (United States)

    Parrott, Edith L.; Weiland, Karen J.


    This paper is for the AIAA Space Conference. The ability of systems engineers to use model-based systems engineering (MBSE) to generate self-consistent, up-to-date systems engineering products for project life-cycle and technical reviews is an important aspect for the continued and accelerated acceptance of MBSE. Currently, many review products are generated using labor-intensive, error-prone approaches based on documents, spreadsheets, and chart sets; a promised benefit of MBSE is that users will experience reductions in inconsistencies and errors. This work examines features of SysML that can be used to generate systems engineering products. Model elements, relationships, tables, and diagrams are identified for a large number of the typical systems engineering artifacts. A SysML system model can contain and generate most systems engineering products to a significant extent and this paper provides a guide on how to use MBSE to generate products for project life-cycle and technical reviews. The use of MBSE can reduce the schedule impact usually experienced for review preparation, as in many cases the review products can be auto-generated directly from the system model. These approaches are useful to systems engineers, project managers, review board members, and other key project stakeholders.

  10. Using Model-Based Systems Engineering To Provide Artifacts for NASA Project Life-Cycle and Technical Reviews (United States)

    Parrott, Edith L.; Weiland, Karen J.


    The ability of systems engineers to use model-based systems engineering (MBSE) to generate self-consistent, up-to-date systems engineering products for project life-cycle and technical reviews is an important aspect for the continued and accelerated acceptance of MBSE. Currently, many review products are generated using labor-intensive, error-prone approaches based on documents, spreadsheets, and chart sets; a promised benefit of MBSE is that users will experience reductions in inconsistencies and errors. This work examines features of SysML that can be used to generate systems engineering products. Model elements, relationships, tables, and diagrams are identified for a large number of the typical systems engineering artifacts. A SysML system model can contain and generate most systems engineering products to a significant extent and this paper provides a guide on how to use MBSE to generate products for project life-cycle and technical reviews. The use of MBSE can reduce the schedule impact usually experienced for review preparation, as in many cases the review products can be auto-generated directly from the system model. These approaches are useful to systems engineers, project managers, review board members, and other key project stakeholders.

  11. Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory. (United States)

    Rahimi, Bahlol; Timpka, Toomas; Vimarlund, Vivian; Uppugunduri, Srinivas; Svensson, Mikael


    Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods. More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P system not adapted to their specific professional practice (P = system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should

  12. The case for human agency, well-being, and community reintegration for people aging in prison: a statewide case analysis. (United States)

    Maschi, Tina; Morrisey, Mary Beth; Leigey, Margaret


    This study profiled 2,913 adults aged 50 and older sentenced to a statewide correctional system and their parole eligibility status with implications for community reintegration, resettlement, and recovery needs. The research team developed the Correctional Tracking Data Extraction Tool to gather official data and personal and legal characteristics from a state department of corrections website. The majority of older prisoners were men from racial/ethnic minorities between the ages of 50 and 59 with a range of minor to serious offenses. Time served in prison ranged from 1 month to 45 years; more than 40% were eligible for parole within 5 years. These findings underscore the need for an intervention that can address the differing typologies and individual-level and systemic issues that gave rise to the aging prisoner population. Promising practices that address elements of a conceptual model in prison and community reintegration and recovery for older adult prisoners are reviewed.

  13. What Does Success Look Like in the Forensic Mental Health System? Perspectives of Service Users and Service Providers. (United States)

    Livingston, James D


    Outcomes research in forensic mental health (FMH) has concentrated on reoffending as the principal indicator of success. Defining success in one-dimensional, negative terms can create a distorted view of the diverse objectives of the FMH system. This qualitative study examined the complexity of success from the perspectives of people in the FMH system. Interviews were conducted with 18 forensic service users and 10 forensic service providers. Data were analyzed inductively using thematic analysis to identify predominant themes. The participants conceptualized success as a dynamic process materializing across six different domains in the context of the FMH system: (a) normal life, (b) independent life, (c) compliant life, (d) healthy life, (e) meaningful life, and (f) progressing life. The results indicate that people who provide or use FMH services emphasize a broad range of processes and outcomes, apart from public safety, when they think about success.

  14. Physicians' and Nurses' Opinions about the Impact of a Computerized Provider Order Entry System on Their Workflow. (United States)

    Ayatollahi, Haleh; Roozbehi, Masoud; Haghani, Hamid


    In clinical practices, the use of information technology, especially computerized provider order entry (CPOE) systems, has been found to be an effective strategy to improve patient care. This study aimed to compare physicians' and nurses' views about the impact of CPOE on their workflow. This case study was conducted in 2012. The potential participants included all physicians (n = 28) and nurses (n = 145) who worked in a teaching hospital. Data were collected using a five-point Likert-scale questionnaire and were analyzed using SPSS version 18.0. The results showed a significant difference between physicians' and nurses' views about the impact of the system on interorganizational workflow (p = .001) and working relationships between physicians and nurses (p = .017). Interorganizational workflow and working relationships between care providers are important issues that require more attention. Before a CPOE system is designed, it is necessary to identify workflow patterns and hidden structures to avoid compromising quality of care and patient safety.

  15. Use of electronic personal health record systems to encourage HIV screening: an exploratory study of patient and provider perspectives

    Directory of Open Access Journals (Sweden)

    McInnes D Keith


    Full Text Available Abstract Background When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA health care system. Findings We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory. Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising

  16. Use of electronic personal health record systems to encourage HIV screening: an exploratory study of patient and provider perspectives. (United States)

    McInnes, D Keith; Solomon, Jeffrey L; Bokhour, Barbara G; Asch, Steven M; Ross, David; Nazi, Kim M; Gifford, Allen L


    When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs) become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA) health care system. We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory.Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising methods to smooth the flow of patients getting

  17. Implementation of the provider change process via CRM (Customer Relation Management) system; Umsetzung des Lieferantenwechsels mit CRM-System. Masken fuer Vertrieb und Netz durch System strikt getrennt

    Energy Technology Data Exchange (ETDEWEB)

    Liegl, A. [Stadtwerke Muenchen (Germany). Fachbereich Organisation; Percher, G. [Siemens AG, Graz (Austria)


    In October 2001 Stadtwerke Muenchen has set into function the module 'Customer Care' as the first part of a corporate CRM system. The objective oft the project was to gain an overall sight on the customers thus obtaining the necessary basis for customer loyalty programmes and acquisition. The provider change process is up to now marked by a high degree of manual activities. In the future it has to be performed thoroughly and efficiently using CRM functions. Care has to be taken to meet the necessary demands of the provider and the net company with respect to the unbundling requirement. (orig.) [German] Die Stadtwerke Muenchen haben im Oktober 2001 das Modul Kundenkontaktmanagement als erste Stufe eines unternehmensweiten CRM-Systems in Betrieb genommen. Ziel des Projekts war es, eine ganzheitliche Kundensicht zu ermoeglichen und so die Voraussetzungen fuer Kundenbindung und Kundengewinnung zu schaffen. Der bisher durch manuellen Aufwand gepraegte Prozess des Lieferantenwechsels soll nun mit CRM-Funktionen durchgaengig und effizient abgewickelt werden. Dabei wird den Beduerfnissen sowohl des Netzbetreibers als auch des Vertriebs unter Beachtung der Vorschriften des Unbundlings Rechnung getragen. (orig.)

  18. Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory

    Directory of Open Access Journals (Sweden)

    Timpka Toomas


    Full Text Available Abstract Background Computerized provider order entry (CPOE systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. Methods The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0% and 176 from 741 physicians (23.8%. Data were analyzed using descriptive-analytical statistical methods. Results More nurses (56.7% than physicians (31.3% stated that the CPOE system introduction had worked well in their clinical setting (P P = P = 0.041. We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P P Conclusions Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance

  19. Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region. (United States)

    Barbarito, Fulvio; Pinciroli, Francesco; Mason, John; Marceglia, Sara; Mazzola, Luca; Bonacina, Stefano


    Information technologies (ITs) have now entered the everyday workflow in a variety of healthcare providers with a certain degree of independence. This independence may be the cause of difficulty in interoperability between information systems and it can be overcome through the implementation and adoption of standards. Here we present the case of the Lombardy Region, in Italy, that has been able, in the last 10 years, to set up the Regional Social and Healthcare Information System, connecting all the healthcare providers within the region, and providing full access to clinical and health-related documents independently from the healthcare organization that generated the document itself. This goal, in a region with almost 10 millions citizens, was achieved through a twofold approach: first, the political and operative push towards the adoption of the Health Level 7 (HL7) standard within single hospitals and, second, providing a technological infrastructure for data sharing based on interoperability specifications recognized at the regional level for messages transmitted from healthcare providers to the central domain. The adoption of such regional interoperability specifications enabled the communication among heterogeneous systems placed in different hospitals in Lombardy. Integrating the Healthcare Enterprise (IHE) integration profiles which refer to HL7 standards are adopted within hospitals for message exchange and for the definition of integration scenarios. The IHE patient administration management (PAM) profile with its different workflows is adopted for patient management, whereas the Scheduled Workflow (SWF), the Laboratory Testing Workflow (LTW), and the Ambulatory Testing Workflow (ATW) are adopted for order management. At present, the system manages 4,700,000 pharmacological e-prescriptions, and 1,700,000 e-prescriptions for laboratory exams per month. It produces, monthly, 490,000 laboratory medical reports, 180,000 radiology medical reports, 180

  20. Recommendations from primary care providers for integrating mental health in a primary care system in rural Nepal. (United States)

    Acharya, Bibhav; Tenpa, Jasmine; Thapa, Poshan; Gauchan, Bikash; Citrin, David; Ekstrand, Maria


    Globally, access to mental healthcare is often lacking in rural, low-resource settings. Mental healthcare services integration in primary care settings is a key intervention to address this gap. A common strategy includes embedding mental healthcare workers on-site, and receiving consultation from an off-site psychiatrist. Primary care provider perspectives are important for successful program implementation. We conducted three focus groups with all 24 primary care providers at a district-level hospital in rural Nepal. We asked participants about their concerns and recommendations for an integrated mental healthcare delivery program. They were also asked about current practices in seeking referral for patients with mental illness. We collected data using structured notes and analyzed the data by template coding to develop themes around concerns and recommendations for an integrated program. Participants noted that the current referral system included sending patients to the nearest psychiatrist who is 14 h away. Participants did not think this was effective, and stated that integrating mental health into the existing primary care setting would be ideal. Their major concerns about a proposed program included workplace hierarchies between mental healthcare workers and other clinicians, impact of staff turnover on patients, reliability of an off-site consultant psychiatrist, and ability of on-site primary care providers to screen patients and follow recommendations from an off-site psychiatrist. Their suggestions included training a few existing primary care providers as dedicated mental healthcare workers, recruiting both senior and junior mental healthcare workers to ensure retention, recruiting academic psychiatrists for reliability, and training all primary care providers to appropriately screen for mental illness and follow recommendations from the psychiatrist. Primary care providers in rural Nepal reported the failure of the current system of referral, which

  1. Influencing Anesthesia Provider Behavior Using Anesthesia Information Management System Data for Near Real-Time Alerts and Post Hoc Reports. (United States)

    Epstein, Richard H; Dexter, Franklin; Patel, Neil


    In this review article, we address issues related to using data from anesthesia information management systems (AIMS) to deliver near real-time alerts via AIMS workstation popups and/or alphanumeric pagers and post hoc reports via e-mail. We focus on reports and alerts for influencing the behavior of anesthesia providers (i.e., anesthesiologists, anesthesia residents, and nurse anesthetists). Multiple studies have shown that anesthesia clinical decision support (CDS) improves adherence to protocols and increases financial performance through facilitation of billing, regulatory, and compliance documentation; however, improved clinical outcomes have not been demonstrated. We inform developers and users of feedback systems about the multitude of concerns to consider during development and implementation of CDS to increase its effectiveness and to mitigate its potentially disruptive aspects. We discuss the timing and modalities used to deliver messages, implications of outlier-only versus individualized feedback, the need to consider possible unintended consequences of such feedback, regulations, sustainability, and portability among systems. We discuss statistical issues related to the appropriate evaluation of CDS efficacy. We provide a systematic review of the published literature (indexed in PubMed) of anesthesia CDS and offer 2 case studies of CDS interventions using AIMS data from our own institution illustrating the salient points. Because of the considerable expense and complexity of maintaining near real-time CDS systems, as compared with providing individual reports via e-mail after the fact, we suggest that if the same goal can be accomplished via delayed reporting versus immediate feedback, the former approach is preferable. Nevertheless, some processes require near real-time alerts to produce the desired improvement. Post hoc e-mail reporting from enterprise-wide electronic health record systems is straightforward and can be accomplished using system

  2. Challenges and Problems for Research in the Field of Statewide Exams. A Stock Taking of Differing Procedures and Standardization Levels (United States)

    Klein, Esther Dominique; van Ackeren, Isabell


    Statewide exit examinations play an important role in discussions on school effectiveness. Referring to educational governance concepts, this paper presumes a relation between varying organizational structures of statewide examinations across states, and heterogeneous effects on school actors. It is assumed that their ability to affect work in…

  3. Comparability of Semester and Exit Exam Grades: Long-Term Effect of the Implementation of State-Wide Exit Exams (United States)

    Maag Merki, Katharina; Holmeier, Monika


    A goal in many countries is to institute state-wide exams to base student assessment more firmly on norms for all classes. This raises the question as to the extent to which greater standardization of grading practice can be reached by implementing state-wide exit exams. Since there is a lack of longitudinal studies, we analyzed the effect of the…

  4. The Wildland Fire Emissions Information System: Providing information for carbon cycle studies with open source geospatial tools (United States)

    French, N. H.; Erickson, T.; McKenzie, D.


    A major goal of the North American Carbon Program is to resolve uncertainties in understanding and managing the carbon cycle of North America. As carbon modeling tools become more comprehensive and spatially oriented, accurate datasets to spatially quantify carbon emissions from fire are needed, and these data resources need to be accessible to users for decision-making. Under a new NASA Carbon Cycle Science project, Drs. Nancy French and Tyler Erickson, of the Michigan Technological University, Michigan Tech Research Institute (MTRI), are teaming with specialists with the USDA Forest Service Fire and Environmental Research Applications (FERA) team to provide information for mapping fire-derived carbon emissions to users. The project focus includes development of a web-based system to provide spatially resolved fire emissions estimates for North America in a user-friendly environment. The web-based Decision Support System will be based on a variety of open source technologies. The Fuel Characteristic Classification System (FCCS) raster map of fuels and MODIS-derived burned area vector maps will be processed using the Geographic Data Abstraction Library (GDAL) and OGR Simple Features Library. Tabular and spatial project data will be stored in a PostgreSQL/PostGIS, a spatially enabled relational database server. The browser-based user interface will be created using the Django web page framework to allow user input for the decision support system. The OpenLayers mapping framework will be used to provide users with interactive maps within the browser. In addition, the data products will be made available in standard open data formats such as KML, to allow for easy integration into other spatial models and data systems.

  5. Challenges to Providing a Successful Central Configuration Service to Support CERN’s New Controls Diagnostics and Monitoring System

    CERN Document Server

    Makonnen, Z; Zaharieva, Z


    The Controls Diagnostic and Monitoring service (DIAMON) provides monitoring and diagnostics tools to the operators in the CERN Control Centre. A recent reengineering presented the opportunity to restructure its data management and to integrate it with the central Controls Configuration Service (CCS). The CCS provides the Configuration Management for the Controls System for all accelerators at CERN. The new facility had to cater for the configuration management of all agents monitored by DIAMON, (>3000 computers of different types), provide deployment information, relations between metrics, and historical information. In addition, it had to be integrated into the operational CCS, while ensuring stability and data coherency. An important design decision was to largely reuse the existing infrastructure in the CCS and adapt the DIAMON data management to it e.g. by using the device/property model through a Virtual Devices framework to model the DIAMON agents. This article will show how these challenging requiremen...

  6. Time optimal control of an additional food provided predator-prey system with applications to pest management and biological conservation. (United States)

    Srinivasu, P D N; Prasad, B S R V


    Use of additional food has been widely recognized by experimental scientists as one of the important tools for biological control such as species conservation and pest management. The quality and quantity of additional food supplied to the predators is known to play a vital role in the controllability of the system. The present study is continuation of a previous work that highlights the importance of quality and quantity of the additional food in the dynamics of a predator-prey system in the context of biological control. In this article the controllability of the predator-prey system is analyzed by considering inverse of quality of the additional food as the control variable. Control strategies are offered to steer the system from a given initial state to a required terminal state in a minimum time by formulating Mayer problem of optimal control. It is observed that an optimal strategy is a combination of bang-bang controls and could involve multiple switches. Properties of optimal paths are derived using necessary conditions for Mayer problem. In the light of the results evolved in this work it is possible to eradicate the prey from the eco-system in the minimum time by providing the predator with high quality additional food, which is relevant in the pest management. In the perspective of biological conservation this study highlights the possibilities to drive the state to an admissible interior equilibrium (irrespective of its stability nature) of the system in a minimum time.

  7. Preliminary Construction of a Service Provider-Informed Domestic Violence Research Agenda (United States)

    Murray, Christine E.; Welch, Metoka L.


    This article presents the results of a statewide survey of domestic violence (DV) service providers that focused on the needs, background characteristics, and opinions of service providers related to research. The survey included an examination of service providers' motivation for working in the field, research background and training, and…

  8. The applicability of constructivist user studies: how can constructivist inquiry inform service providers and systems designers? Constructivist inquiry, Case study, Systems design, User behaviour

    Directory of Open Access Journals (Sweden)

    Alison Pickard


    Full Text Available This paper has attempted to clarify the ways in which individual, holistic case studies, produced via the process of constructivist inquiry, can be tested for trustworthiness and applied to other, similar situations. Service providers and systems designers need contextual information concerning their users in order to design and provide systems and services that will function effectively and efficiently within those contexts. Abstract models can only provide abstract insight into human behaviour and this is rarely sufficient detail upon which to base the planning and delivery of a service. The methodological issues which surround the applicability of individual, holistic case studies are discussed, explaining the concept of 'contextual applicability.' The relevance and usefulness of in-depth case study research to systems designers and service providers is highlighted.

  9. User-centered development and testing of a monitoring system that provides feedback regarding physical functioning to elderly people

    Directory of Open Access Journals (Sweden)

    Vermeulen J


    Full Text Available Joan Vermeulen,1 Jacques CL Neyens,1 Marieke D Spreeuwenberg,1 Erik van Rossum,1,2 Walther Sipers,3 Herbert Habets,3 David J Hewson,4 Luc P de Witte1,2 1School for Public Health and Primary Care (CAPHRI, Maastricht University, Maastricht, The Netherlands; 2Research Center for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands; 3Expertise Center for Elderly Care, Orbis Medical Center, Sittard, The Netherlands; 4Institute Charles Delaunay, Université de Technologie de Troyes, Troyes, France Purpose: To involve elderly people during the development of a mobile interface of a monitoring system that provides feedback to them regarding changes in physical functioning and to test the system in a pilot study. Methods and participants: The iterative user-centered development process consisted of the following phases: (1 selection of user representatives; (2 analysis of users and their context; (3 identification of user requirements; (4 development of the interface; and (5 evaluation of the interface in the lab. Subsequently, the monitoring and feedback system was tested in a pilot study by five patients who were recruited via a geriatric outpatient clinic. Participants used a bathroom scale to monitor weight and balance, and a mobile phone to monitor physical activity on a daily basis for six weeks. Personalized feedback was provided via the interface of the mobile phone. Usability was evaluated on a scale from 1 to 7 using a modified version of the Post-Study System Usability Questionnaire (PSSUQ; higher scores indicated better usability. Interviews were conducted to gain insight into the experiences of the participants with the system. Results: The developed interface uses colors, emoticons, and written and/or spoken text messages to provide daily feedback regarding (changes in weight, balance, and physical activity. The participants rated the usability of the monitoring and feedback system with a mean score of 5

  10. Porous TiO2-Based Gas Sensors for Cyber Chemical Systems to Provide Security and Medical Diagnosis

    Directory of Open Access Journals (Sweden)

    Vardan Galstyan


    Full Text Available Gas sensors play an important role in our life, providing control and security of technical processes, environment, transportation and healthcare. Consequently, the development of high performance gas sensor devices is the subject of intense research. TiO2, with its excellent physical and chemical properties, is a very attractive material for the fabrication of chemical sensors. Meanwhile, the emerging technologies are focused on the fabrication of more flexible and smart systems for precise monitoring and diagnosis in real-time. The proposed cyber chemical systems in this paper are based on the integration of cyber elements with the chemical sensor devices. These systems may have a crucial effect on the environmental and industrial safety, control of carriage of dangerous goods and medicine. This review highlights the recent developments on fabrication of porous TiO2-based chemical gas sensors for their application in cyber chemical system showing the convenience and feasibility of such a model to provide the security and to perform the diagnostics. The most of reports have demonstrated that the fabrication of doped, mixed and composite structures based on porous TiO2 may drastically improve its sensing performance. In addition, each component has its unique effect on the sensing properties of material.

  11. Porous TiO₂-Based Gas Sensors for Cyber Chemical Systems to Provide Security and Medical Diagnosis. (United States)

    Galstyan, Vardan


    Gas sensors play an important role in our life, providing control and security of technical processes, environment, transportation and healthcare. Consequently, the development of high performance gas sensor devices is the subject of intense research. TiO₂, with its excellent physical and chemical properties, is a very attractive material for the fabrication of chemical sensors. Meanwhile, the emerging technologies are focused on the fabrication of more flexible and smart systems for precise monitoring and diagnosis in real-time. The proposed cyber chemical systems in this paper are based on the integration of cyber elements with the chemical sensor devices. These systems may have a crucial effect on the environmental and industrial safety, control of carriage of dangerous goods and medicine. This review highlights the recent developments on fabrication of porous TiO₂-based chemical gas sensors for their application in cyber chemical system showing the convenience and feasibility of such a model to provide the security and to perform the diagnostics. The most of reports have demonstrated that the fabrication of doped, mixed and composite structures based on porous TiO₂ may drastically improve its sensing performance. In addition, each component has its unique effect on the sensing properties of material.

  12. Porous TiO2-Based Gas Sensors for Cyber Chemical Systems to Provide Security and Medical Diagnosis (United States)


    Gas sensors play an important role in our life, providing control and security of technical processes, environment, transportation and healthcare. Consequently, the development of high performance gas sensor devices is the subject of intense research. TiO2, with its excellent physical and chemical properties, is a very attractive material for the fabrication of chemical sensors. Meanwhile, the emerging technologies are focused on the fabrication of more flexible and smart systems for precise monitoring and diagnosis in real-time. The proposed cyber chemical systems in this paper are based on the integration of cyber elements with the chemical sensor devices. These systems may have a crucial effect on the environmental and industrial safety, control of carriage of dangerous goods and medicine. This review highlights the recent developments on fabrication of porous TiO2-based chemical gas sensors for their application in cyber chemical system showing the convenience and feasibility of such a model to provide the security and to perform the diagnostics. The most of reports have demonstrated that the fabrication of doped, mixed and composite structures based on porous TiO2 may drastically improve its sensing performance. In addition, each component has its unique effect on the sensing properties of material. PMID:29257076

  13. Patient and provider perspectives on quality and health system effectiveness in a transition economy: evidence from Ukraine. (United States)

    Luck, J; Peabody, J W; DeMaria, L M; Alvarado, C S; Menon, R


    Facing a severe population health crisis due to noncommunicable diseases, Ukraine and other former Soviet republics and Eastern European countries have a pressing need for more effective health systems. Policies to enhance health system effectiveness should consider the perspectives of different stakeholder groups, including providers as well as patients. In addition, policies that directly target the quality of clinical care should be based on objective performance measures. In 2009 and 2010 we conducted a coordinated series of household and facility-level surveys to capture the perspectives of Ukrainian household members, outpatient clinic patients, and physicians regarding the country's health system overall, as well as the quality, access, and affordability of health care. We objectively measured the quality of care for heart failure and chronic obstructive pulmonary disease using CPV(®) vignettes. There was broad agreement among household respondents (79%) and physicians (95%) that Ukraine's health system should be reformed. CPV(®) results indicate that the quality of care for common noncommunicable diseases is poor in all regions of the country and in hospitals as well as polyclinics. However, perspectives about the quality of care differ, with household respondents seeing quality as a serious concern, clinic patients having more positive perceptions, and physicians not viewing quality as a reform priority. All stakeholder groups viewed affordability as a problem. These findings have several implications for policies to enhance health system effectiveness. The shared desire for health system reform among all stakeholder groups provides a basis for action in Ukraine. Improving quality, strengthening primary care, and enhancing affordability should be major goals of new health policies. Policies to improve quality directly, such as pay-for-performance, would be mutually reinforcing with purchasing reforms such as transparent payment mechanisms. Such policies

  14. Using hardware-in-the-loop (HWIL) simulation to provide low-cost testing of TMD IR missile systems (United States)

    Buford, James A., Jr.; Paone, Thad


    A greater awareness of and increased interest in the use of modeling and simulation (M&S) has been demonstrated at many levels within the Department of Defense (DoD) and all the Armed Services agencies in recent years. M&S application is regarded as a viable means of lowering the life cycle costs of theater missile defense (TMD) weapon system acquisition beginning with studies of new concepts of warfighting through user training and post-deployment support. The Missile Research, Engineering, and Development Center (MRDEC) of the U.S. Army Aviation and Missile Command (AMCOM) has an extensive history of applying all types of M&S to TMD weapon system development and has been a particularly strong advocate of hardware-in-the-loop (HWIL) simulation for many years. Over the past 10 years MRDEC has developed specific and dedicated HWIL capabilities for TMD applications in both the infrared and radio frequency sensor domains. This paper provides an overview of the infrared-based TMD HWIL missile facility known as the Imaging Infrared System Simulation (I2RSS) which is used to support the Theater High Altitude Air Defense (THAAD) missile system. This facility uses M&S to conduct daily THAAD HWIL missile simulations to support flight tests, missile/system development, independent verification and validation of weapon system embedded software and simulations, and missile/system performance against current and future threat environments. This paper describes the THAAD TMD HWIL role, process, major components, HWIL verification/validation, and daily HWIL support areas in terms of both missile and complete system.

  15. Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives. (United States)

    Whellan, David J; Reed, Shelby D; Liao, Lawrence; Gould, Stuart D; O'connor, Christopher M; Schulman, Kevin A


    Although heart failure disease management (HFDM) programs improve patient outcomes, the implementation of these programs has been limited because of financial barriers. We undertook the present study to understand the economic incentives and disincentives for adoption of disease management strategies from the perspectives of a physician (group), a hospital, an integrated health system, and a third-party payer. Using the combined results of a group of randomized controlled trials and a set of financial assumptions from a single academic medical center, a financial model was developed to compute the expected costs before and after the implementation of a HFDM program by 3 provider types (physicians, hospitals, and health systems), as well as the costs incurred from a payer perspective. The base-case model showed that implementation of HFDM results in a net financial loss to all potential providers of HFDM. Implementation of HFDM as described in our base-case analysis would create a net loss of US dollars 179,549 in the first year for a physician practice, US dollars 464,132 for an integrated health system, and US dollars 652,643 in the first year for a hospital. Third-party payers would be able to save US dollars 713,661 annually for the care of 350 patients with heart failure in a HFDM program. In conclusion, although HFDM programs may provide patients with improved clinical outcomes and decreased hospitalizations that save third-party payers money, limited financial incentives are currently in place for healthcare providers and hospitals to initiate these programs.

  16. Tracking working status of HIV/AIDS-trained service providers by means of a training information monitoring system in Ethiopia

    Directory of Open Access Journals (Sweden)

    Nadew Mesrak


    Full Text Available Abstract Background The Federal Ministry of Health of Ethiopia is implementing an ambitious and rapid scale-up of health care services for the prevention, care and treatment of HIV/AIDS in public facilities. With support from the United States President's Emergency Plan for AIDS Relief, 38 830 service providers were trained, from early 2005 until December 2007, in HIV-related topics. Anecdotal evidence suggested high attrition rates of providers, but reliable quantitative data have been limited. Methods With that funding, Jhpiego supports a Training Information Monitoring System, which stores training information for all HIV/AIDS training events supported by the same funding source. Data forms were developed to capture information on providers' working status and were given to eight partners who collected data during routine site visits on individual providers about working status; if not working at the facility, date of and reason for leaving; and source of information. Results Data were collected on 1744 providers (59% males in 53 hospitals and 45 health centres in 10 regional and administrative states. The project found that 32.6% of the providers were no longer at the site, 57.6% are still working on HIV/AIDS services at the same facility where they were trained and 10.4% are at the facility, but not providing HIV/AIDS services. Of the providers not at the facility, the two largest groups were those who had left for further study (27.6% and those who had gone to another public facility (17.6%. Of all physicians trained, 49.2% had left the facility. Regional and cadre variation was found, for example Gambella had the highest percent of providers no longer at the site (53.7% while Harari had the highest percentage of providers still working on HIV/AIDS (71.6%. Conclusion Overall, the project found that the information in the Training Information Monitoring System can be used to track the working status of trained providers. Data generated from

  17. A Similarity-Ranking Method on Semantic Computing for Providing Information-Services in Station-Concierge System

    Directory of Open Access Journals (Sweden)

    Motoki Yokoyama


    Full Text Available The prevalence of smartphones and wireless broadband networks have been progressing as a new Railway infomration environment. According to the spread of such devices and information technology, various types of information can be obtained from databases connected to the Internet. One scenario of obtaining such a wide variety of information resources is in the phase of user’s transportation. This paper proposes an information provision system, named the Station Concierge System that matches the situation and intention of passengers. The purpose of this system is to estimate the needs of passengers like station staff or hotel concierge and to provide information resources that satisfy user’s expectations dynamically. The most important module of the system is constructed based on a new information ranking method for passenger intention prediction and service recommendation. This method has three main features, which are (1 projecting a user to semantic vector space by using her current context, (2 predicting the intention of a user based on selecting a semantic vector subspace, and (3 ranking the services by a descending order of relevant scores to the user’ intention. By comparing the predicted results of our method with those of two straightforward computation methods, the experimental studies show the effectiveness and efficiency of the proposed method. Using this system, users can obtain transit information and service map that dynamically matches their context.

  18. IEEE 802.15.4 Frame Aggregation Enhancement to Provide High Performance in Life-Critical Patient Monitoring Systems. (United States)

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


    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.

  19. On the assessment of performance and emissions characteristics of a SI engine provided with a laser ignition system (United States)

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


    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.

  20. Making non-discrimination and equal opportunity a reality in Kenya's health provider education system: results of a gender analysis. (United States)

    Newman, Constance; Kimeu, Anastasiah; Shamblin, Leigh; Penders, Christopher; McQuide, Pamela A; Bwonya, Judith


    IntraHealth International's USAID-funded Capacity Kenya project conducted a performance needs assessment of the Kenya health provider education system in 2010. Various stakeholders shared their understandings of the role played by gender and identified opportunities to improve gender equality in health provider education. Findings suggest that occupational segregation, sexual harassment and discrimination based on pregnancy and family responsibilities present problems, especially for female students and faculty. To grow and sustain its workforce over the long term, Kenyan human resource leaders and managers must act to eliminate gender-based obstacles by implementing existing non-discrimination and equal opportunity policies and laws to increase the entry, retention and productivity of students and faculty. Families and communities must support girls' schooling and defer early marriage. All this will result in a fuller pool of students, faculty and matriculated health workers and, ultimately, a more robust health workforce to meet Kenya's health challenges.

  1. Miniature stereoscopic video system provides real-time 3D registration and image fusion for minimally invasive surgery (United States)

    Yaron, Avi; Bar-Zohar, Meir; Horesh, Nadav


    Sophisticated surgeries require the integration of several medical imaging modalities, like MRI and CT, which are three-dimensional. Many efforts are invested in providing the surgeon with this information in an intuitive & easy to use manner. A notable development, made by Visionsense, enables the surgeon to visualize the scene in 3D using a miniature stereoscopic camera. It also provides real-time 3D measurements that allow registration of navigation systems as well as 3D imaging modalities, overlaying these images on the stereoscopic video image in real-time. The real-time MIS 'see through tissue' fusion solutions enable the development of new MIS procedures in various surgical segments, such as spine, abdomen, cardio-thoracic and brain. This paper describes 3D surface reconstruction and registration methods using Visionsense camera, as a step toward fully automated multi-modality 3D registration.

  2. Statewide Physical Fitness Testing: A BIG Waist or a BIG Waste? (United States)

    Morrow, James R., Jr.; Ede, Alison


    Statewide physical fitness testing is gaining popularity in the United States because of increased childhood obesity levels, the relations between physical fitness and academic performance, and the hypothesized relations between adult characteristics and childhood physical activity, physical fitness, and health behaviors. Large-scale physical…

  3. Reduction in Cheating Following a Forensic Investigation on a Statewide Summative Assessment (United States)

    McClintock, Joseph C.


    This study examined indicators of cheating on a statewide summative assessment for grades 3--8 over a 4-year period. Between year 2 and year 3 of this study, the state launched an aggressive, highly publicized investigation into cheating by educators. The basis of the investigation was an erasure analysis. The current study found that the number…

  4. Testing a health research instrument to develop a state-wide survey on maternity care. (United States)

    Todd, Angela L; Aitken, Clare A; Boyd, Jason; Porter, Maree


    Partnerships between researchers and end users are an important strategy for research uptake in policy and practice. This paper describes how collaboration between an academic research organisation (the Kolling Institute) and a government performance reporting agency (the New South Wales [NSW] Bureau of Health Information) contributed to the development of a new state-wide maternity care survey for NSW.

  5. A Multilevel, Statewide Investigation of School District Anti-Bullying Policy Quality and Student Bullying Involvement (United States)

    Gower, Amy L.; Cousin, Molly; Borowsky, Iris W.


    Background: Although nearly all states in the United States require school districts to adopt anti-bullying policies, little research examines the effect of these policies on student bullying and health. Using a statewide sample, we investigated associations between the quality of school district anti-bullying policies and student bullying…

  6. Effects of statewide job losses on adolescent suicide-related behaviors. (United States)

    Gassman-Pines, Anna; Ananat, Elizabeth Oltmans; Gibson-Davis, Christina M


    We investigated the impact of statewide job loss on adolescent suicide-related behaviors. We used 1997 to 2009 data from the Youth Risk Behavior Survey and the Bureau of Labor Statistics to estimate the effects of statewide job loss on adolescents' suicidal ideation, suicide attempts, and suicide plans. Probit regression models controlled for demographic characteristics, state of residence, and year; samples were divided according to gender and race/ethnicity. Statewide job losses during the year preceding the survey increased girls' probability of suicidal ideation and suicide plans and non-Hispanic Black adolescents' probability of suicidal ideation, suicide plans, and suicide attempts. Job losses among 1% of a state's working-age population increased the probability of girls and Blacks reporting suicide-related behaviors by 2 to 3 percentage points. Job losses did not affect the suicide-related behaviors of boys, non-Hispanic Whites, or Hispanics. The results were robust to the inclusion of other state economic characteristics. As are adults, adolescents are affected by economic downturns. Our findings show that statewide job loss increases adolescent girls' and non-Hispanic Blacks' suicide-related behaviors.

  7. The Status of Microcomputers in Oregon Public Schools. A Statewide Survey. (United States)

    Lamon, William E.

    This statewide survey (parelleling a 1983 study) was conducted by the Oregon Department of Education in 1985 to assess the status of microcomputer usage and instructional microcomputing in the public schools of the state. A total of 1,181 principals responded to the mailed questionnaire for a response rate of 96% as opposed to 90% in 1983. The…

  8. The Alabama Career Incentive Program: A Statewide Effort in Teacher Evaluation. (United States)

    Wiersma, William

    This paper summarizes the Alabama Career Incentive Program, a statewide effort to evaluate more than 30,000 teachers including specialists in guidance, speech therapy, and so on. The evaluation was based on 10 classroom competencies and five outside-the-class professional competencies. A low-inference instrument measured competencies by using…

  9. New Jersey Statewide Validation of Career and Vocational Guidance and Counseling Standards Project. Final Report. (United States)

    Bayonne Public Schools, NJ.

    A project was conducted to involve New Jersey business and industry representatives in validating a set of student-based guidance and counseling standards developed by New Jersey counselors for statewide implementation. The Structured Group Interview technique of Task List Verification was selected as the validation method. The project design…

  10. A Statewide Train-the-Trainer Model for Effective Entrepreneurship and Workforce Readiness Programming (United States)

    Fields, Nia Imani; Brown, Mananmi; Piechocinski, Alganesh; Wells, Kendra


    A statewide youth and adult train-the-trainer model that integrates workforce readiness and entrepreneurship can have a profound effect on young people's academic performance, interest in college, and overall youth development. Participants in workforce and entrepreneurship programs develop personal resources that have value in school, in the…

  11. Statewide Dissemination of a Rural, Non-Chain Restaurant Intervention: Adoption, Implementation and Maintenance (United States)

    Nothwehr, F.; Haines, H.; Chrisman, M.; Schultz, U.


    The obesity epidemic calls for greater dissemination of nutrition-related programs, yet there remain few studies of the dissemination process. This study, guided by elements of the RE-AIM model, describes the statewide dissemination of a simple, point-of-purchase restaurant intervention. Conducted in rural counties of the Midwest, United States,…

  12. Extension's Efforts to Help Kids Be SAFE: Evaluation of a Statewide Bullying Prevention Program (United States)

    Duke, Adrienne; Norton, Jessica


    The evaluation reported in this article examined the effectiveness of a statewide bullying prevention program, Be SAFE. Be SAFE involves use of a positive youth development approach to influence peer groups rather than individual bullies or victims. Through the use of pre- and postprogram questionnaires, we found increases in youths' knowledge of…

  13. 2011-2013 Indiana Statewide Imagery and LiDAR Program: Lake Michigan Watershed Counties (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Indiana's Statewide LiDAR data is produced at 1.5-meter average post spacing for all 92 Indiana Counties covering more than 36,420 square miles. New LiDAR data was...

  14. A Cost-Savings Analysis of a Statewide Parenting Education Program in Child Welfare (United States)

    Maher, Erin J.; Corwin, Tyler W.; Hodnett, Rhenda; Faulk, Karen


    Objectives: This article presents a cost-savings analysis of the statewide implementation of an evidence-informed parenting education program. Methods: Between the years 2005 and 2008, the state of Louisiana used the Nurturing Parenting Program (NPP) to impart parenting skills to child welfare-involved families. Following these families' outcomes…

  15. The Polaris Oncology Survivorship Transition (POST) System: A Patient- and Provider-Driven Cancer Survivorship Planning Program. (United States)

    O'Hea, Erin; Wu, Juliet; Dietzen, Laura; Harralson, Tina; Boudreaux, Edwin D


    It is strongly recommended that individuals ending treatment for cancer have a "survivorship plan," and new standards require survivorship planning for accreditation, However, a comprehensive plan is often neglected. To present the development and field test results of a web-based, breast cancer survivorship care planning system. The Polaris Oncology Survivorship Transition (POST) blends input from the electronic health record (EHR), oncology care providers (OCPs), and patients to create a survivorship care plan (SCP). The content of the POST program was created with the assistance of end-user input (patients, oncologists, and primary care providers (PCPs)) and the full program was piloted on women ending treatment for breast cancer. This paper presents the pilot study that field-tested the POST In a clinical setting. Patients were recruited from outpatient care clinics and chemotherapy units in a comprehensive care center. The study included 25 women ending treatment for breast cancer in the past year, 4 OCPs, and PCPs. Patients received the POST computeπzed assessment and a tailored SCP. The POST assists providers in crafting efficient and comprehensive SCPs and was rated highly satisfactory by all end-users. The POST program can be used as a cancer survivorship planning program to assist OCPs in care planning for their patients ending treatment for breast cancer. This study provides support for Incorporating computerized SCP programs into clinical practice. Use of the POST in clinical practice has the potential to improve survivorship planning.


    Directory of Open Access Journals (Sweden)

    Olivera Ecaterina OROS


    Full Text Available Along with the main macroeconomic indicators, the credit risk indicators became an important leverage in monitoring and evaluating the standard of living at a national level and the country’s economic evolution. These two types of indicators show a strong interconnection, and the correct assessment of the credit risk indicators becomes a must. As a consequence, the central banks and the main regulators in the Europe aria provided for a strict monitoring of such indicators and further on, for constant update of the banking supervisory regulations. In October 2013, the European Central bank (ECB issued the Note of Comprehensive Assessment that will be carried out during 2014, on the Euro-zone1 banking system. The outcome of the assessment will impact not only the accounting figures of the banking system, but also might change the macroeconomic overview of Euro-zone and the IASB's Conceptual Framework for Financial Reporting.

  17. Impact of computerised provider order entry system on nursing workflow, patient safety, and medication errors: perspectives from the front line. (United States)

    Alsweed, Fatimah; Alshaikh, Anwar; Ahmed, Anwar; Yunus, Faisel; Househ, Mowafa


    There is a paucity of research on the impact of computerised provider order entry (CPOE) system on the front line staff. We assessed nurses perspectives of the impact of CPOE system implementation on their workflow, patient safety and medication errors in a Saudi Arabian hospital. We conducted a cross-sectional survey involving 112 nurses between April and May 2012. The workflow was easy to manage for nurses who rated CPOE training as of good quality (p = 0.001) and they found that CPOE helped in reducing medication errors (p = 0.001). The nurses who rated CPOE training as of good quality also stated that patient safety was better with CPOE implementation and its use (p workflow, patient safety and medication errors, and is critical in the success of CPOE use and its long-term adoption.

  18. Effects of computer-aided clinical decision support systems in improving antibiotic prescribing by primary care providers: a systematic review. (United States)

    Holstiege, Jakob; Mathes, Tim; Pieper, Dawid


    To assess the effectiveness of computer-aided clinical decision support systems (CDSS) in improving antibiotic prescribing in primary care. A literature search utilizing Medline (via PubMed) and Embase (via Embase) was conducted up to November 2013. Randomized controlled trials (RCTs) and cluster randomized trials (CRTs) that evaluated the effects of CDSS aiming at improving antibiotic prescribing practice in an ambulatory primary care setting were included for review. Two investigators independently extracted data about study design and quality, participant characteristics, interventions, and outcomes. Seven studies (4 CRTs, 3 RCTs) met our inclusion criteria. All studies were performed in the USA. Proportions of eligible patient visits that triggered CDSS use varied substantially between intervention arms of studies (range 2.8-62.8%). Five out of seven trials showed marginal to moderate statistically significant effects of CDSS in improving antibiotic prescribing behavior. CDSS that automatically provided decision support were more likely to improve prescribing practice in contrast to systems that had to be actively initiated by healthcare providers. CDSS show promising effectiveness in improving antibiotic prescribing behavior in primary care. Magnitude of effects compared to no intervention, appeared to be similar to other moderately effective single interventions directed at primary care providers. Additional research is warranted to determine CDSS characteristics crucial to triggering high adoption by providers as a perquisite of clinically relevant improvement of antibiotic prescribing. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.comFor numbered affiliations see end of article.

  19. Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review. (United States)

    Ranji, Sumant R; Rennke, Stephanie; Wachter, Robert M


    Adverse drug events (ADEs) are a major cause of morbidity in hospitalised and ambulatory patients. Computerised provider order entry (CPOE) combined with clinical decision support systems (CDSS) are being widely implemented with the goal of preventing ADEs, but the effectiveness of these systems remains unclear. We searched the specialised database Agency for Healthcare Research and Quality (AHRQ) Patient Safety Net to identify reviews of the effect of CPOE combined with CDSS on ADE rates in inpatient and outpatient settings. We included systematic and narrative reviews published since 2008 and controlled clinical trials published since 2012. We included five systematic reviews, one narrative review and two controlled trials. The existing literature consists mostly of studies of homegrown systems conducted in the inpatient setting. CPOE+CDSS was consistently reported to reduce prescribing errors, but does not appear to prevent clinical ADEs in either the inpatient or outpatient setting. Implementation of CPOE+CDSS profoundly changes staff workflow, and often leads to unintended consequences and new safety issues (such as alert fatigue) which limit the system's safety effects. CPOE+CDSS does not appear to reliably prevent clinical ADEs. Despite more widespread implementation over the past decade, it remains a work in progress. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  20. "Diffusive Gradients in Thin Films" Techniques Provide Representative Time-Weighted Average Measurements of Inorganic Nutrients in Dynamic Freshwater Systems. (United States)

    Huang, Jianyin; Bennett, William W; Welsh, David T; Li, Tianling; Teasdale, Peter R


    Nutrient concentrations in freshwater are highly variable over time, with changes driven by weather events, anthropogenic sources, modifications to catchment hydrology or habitats, and internal biogeochemical processes. Measuring infrequently collected grab samples is unlikely to adequately represent nutrient concentrations in such dynamic systems. In contrast, in situ passive sampling techniques, such as the "diffusive gradients in thin films" (DGT) technique, provide time-weighted average analyte concentrations over the entire deployment time. A pair of recently developed DGT techniques for nitrate (A520E-DGT) and ammonium (PrCH-DGT), as well as the Metsorb-DGT technique for phosphate, were used to monitor inorganic nutrients in different freshwater systems (i.e., streams and wetlands) with a range of environmental values and that were affected by different catchment types. Measurements of grab samples collected frequently (1-2 times daily, 8-10 a.m. and 2-4 p.m.) showed that concentrations of NH4-N and NO3-N changed dramatically in most of the studied freshwater systems over short time scales, while there were only relatively small fluctuations in PO4-P. The DGT measurements were highly representative in comparison with the average nutrient concentrations obtained from daily grab samples over short-term (24 h) and long-term (72 h) deployments. The ratios of DGT-labile concentrations to the average concentrations from grab samples were between 1.00 and 1.12 over the studied deployment periods. The results of this study confirmed that DGT measurements provided a reliable and robust method for monitoring NH4-N, NO3-N, and PO4-P in a diverse range of dynamic freshwater systems.

  1. Developing a tool to assess motivation among health service providers working with public health system in India. (United States)

    Purohit, Bhaskar; Maneskar, Abhishek; Saxena, Deepak


    Addressing the shortage of health service providers (doctors and nurses) in rural health centres remains a huge challenge. The lack of motivation of health service providers to serve in rural areas is one of the major reasons for such shortage. While many studies have aimed at analysing the reasons for low motivation, hardly any studies in India have focused on developing valid and reliable tools to measure motivation among health service providers. Hence, the objective of the study was to test and develop a valid and reliable instrument to assess the motivation of health service providers working with the public health system in India and the extent to which the motivation factors included in the study motivate health service providers to perform better at work. The present study adapted an already developed tool on motivation. The reliability and validity of the tool were established using different methods. The first stage of the tool development involved content development and assessment where, after a detailed literature review, a predeveloped tool with 19 items was adapted. However, in light of the literature review and pilot test, the same tool was modified to suit the local context by adding 7 additional items so that the final modified tool comprised of 26 items. A correlation matrix was applied to check the pattern of relationships among the items. The total sample size for the study was 154 health service providers from one Western state in India. To understand the sampling adequacy, the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's test of sphericity were applied and finally factor analysis was carried out to calculate the eigenvalues and to understand the relative impact of factors affecting motivation. A correlation matrix value of 0.017 was obtained narrating multi-co-linearity among the observations. Based on initial factor analysis, 8 out of 26 study factors were excluded from the study components with a cutoff range of less than

  2. Plant lighting system with five wavelength-band light-emitting diodes providing photon flux density and mixing ratio control

    Directory of Open Access Journals (Sweden)

    Yano Akira


    Full Text Available Abstract Background Plant growth and development depend on the availability of light. Lighting systems therefore play crucial roles in plant studies. Recent advancements of light-emitting diode (LED technologies provide abundant opportunities to study various plant light responses. The LED merits include solidity, longevity, small element volume, radiant flux controllability, and monochromaticity. To apply these merits in plant light response studies, a lighting system must provide precisely controlled light spectra that are useful for inducing various plant responses. Results We have developed a plant lighting system that irradiated a 0.18 m2 area with a highly uniform distribution of photon flux density (PFD. The average photosynthetic PFD (PPFD in the irradiated area was 438 micro-mol m–2 s–1 (coefficient of variation 9.6%, which is appropriate for growing leafy vegetables. The irradiated light includes violet, blue, orange-red, red, and far-red wavelength bands created by LEDs of five types. The PFD and mixing ratio of the five wavelength-band lights are controllable using a computer and drive circuits. The phototropic response of oat coleoptiles was investigated to evaluate plant sensitivity to the light control quality of the lighting system. Oat coleoptiles irradiated for 23 h with a uniformly distributed spectral PFD (SPFD of 1 micro-mol m–2 s–1 nm–1 at every peak wavelength (405, 460, 630, 660, and 735 nm grew almost straight upwards. When they were irradiated with an SPFD gradient of blue light (460 nm peak wavelength, the coleoptiles showed a phototropic curvature in the direction of the greater SPFD of blue light. The greater SPFD gradient induced the greater curvature of coleoptiles. The relation between the phototropic curvature (deg and the blue-light SPFD gradient (micro-mol m–2 s–1 nm–1 m–1 was 2 deg per 1 micro-mol m–2 s–1 nm–1 m–1. Conclusions The plant lighting system, with a computer with a

  3. Seven Novel Probe Systems for Real-Time PCR Provide Absolute Single-Base Discrimination, Higher Signaling, and Generic Components (United States)

    Murray, James L.; Hu, Peixu; Shafer, David A.


    We have developed novel probe systems for real-time PCR that provide higher specificity, greater sensitivity, and lower cost relative to dual-labeled probes. The seven DNA Detection Switch (DDS)-probe systems reported here employ two interacting polynucleotide components: a fluorescently labeled probe and a quencher antiprobe. High-fidelity detection is achieved with three DDS designs: two internal probes (internal DDS and Flip probes) and a primer probe (ZIPR probe), wherein each probe is combined with a carefully engineered, slightly mismatched, error-checking antiprobe. The antiprobe blocks off-target detection over a wide range of temperatures and facilitates multiplexing. Other designs (Universal probe, Half-Universal probe, and MacMan probe) use generic components that enable low-cost detection. Finally, single-molecule G-Force probes employ guanine-mediated fluorescent quenching by forming a hairpin between adjacent C-rich and G-rich sequences. Examples provided show how these probe technologies discriminate drug-resistant Mycobacterium tuberculosis mutants, Escherichia coli O157:H7, oncogenic EGFR deletion mutations, hepatitis B virus, influenza A/B strains, and single-nucleotide polymorphisms in the human VKORC1 gene. PMID:25307756

  4. A Mathematical Model of Metabolism and Regulation Provides a Systems-Level View of How Escherichia coli Responds to Oxygen

    Directory of Open Access Journals (Sweden)

    Michael eEderer


    Full Text Available The efficient redesign of bacteria for biotechnological purposes, such as biofuel production, waste disposal or specific biocatalytic functions, requires a quantitative systems-level understanding of energy supply, carbon and redox metabolism. The measurement of transcript levels, metabolite concentrations and metabolic fluxes per se gives an incomplete picture. An appreciation of the interdependencies between the different measurement values is essential for systems-level understanding. Mathematical modeling has the potential to provide a coherent and quantitative description of the interplay between gene expression, metabolite concentrations and metabolic fluxes. Escherichia coli undergoes major adaptations in central metabolism when the availability of oxygen changes. Thus, an integrated description of the oxygen response provides a benchmark of our understanding of carbon, energy and redox metabolism. We present the first comprehensive model of the central metabolism of E. coli that describes steady-state metabolism at different levels of oxygen availability. Variables of the model are metabolite concentrations, gene expression levels, transcription factor activities, metabolic fluxes and biomass concentration. We analyze the model with respect to the production capabilities of central metabolism of E. coli. In particular, we predict how precursor and biomass concentration are affected by product formation.

  5. A mathematical model of metabolism and regulation provides a systems-level view of how Escherichia coli responds to oxygen. (United States)

    Ederer, Michael; Steinsiek, Sonja; Stagge, Stefan; Rolfe, Matthew D; Ter Beek, Alexander; Knies, David; Teixeira de Mattos, M Joost; Sauter, Thomas; Green, Jeffrey; Poole, Robert K; Bettenbrock, Katja; Sawodny, Oliver


    The efficient redesign of bacteria for biotechnological purposes, such as biofuel production, waste disposal or specific biocatalytic functions, requires a quantitative systems-level understanding of energy supply, carbon, and redox metabolism. The measurement of transcript levels, metabolite concentrations and metabolic fluxes per se gives an incomplete picture. An appreciation of the interdependencies between the different measurement values is essential for systems-level understanding. Mathematical modeling has the potential to provide a coherent and quantitative description of the interplay between gene expression, metabolite concentrations, and metabolic fluxes. Escherichia coli undergoes major adaptations in central metabolism when the availability of oxygen changes. Thus, an integrated description of the oxygen response provides a benchmark of our understanding of carbon, energy, and redox metabolism. We present the first comprehensive model of the central metabolism of E. coli that describes steady-state metabolism at different levels of oxygen availability. Variables of the model are metabolite concentrations, gene expression levels, transcription factor activities, metabolic fluxes, and biomass concentration. We analyze the model with respect to the production capabilities of central metabolism of E. coli. In particular, we predict how precursor and biomass concentration are affected by product formation.

  6. Atypical birdsong and artificial languages provide insights into how communication systems are shaped by learning, use, and transmission. (United States)

    Fehér, Olga


    In this article, I argue that a comparative approach focusing on the cognitive capacities and behavioral mechanisms that underlie vocal learning in songbirds and humans can provide valuable insights into the evolutionary origins of language. The experimental approaches I discuss use abnormal song and atypical linguistic input to study the processes of individual learning, social interaction, and cultural transmission. Atypical input places increased learning and communicative pressure on learners, so exploring how they respond to this type of input provides a particularly clear picture of the biases and constraints at work during learning and use. Furthermore, simulating the cultural transmission of these unnatural communication systems in the laboratory informs us about how learning and social biases influence the structure of communication systems in the long run. Findings based on these methods suggest fundamental similarities in the basic social-cognitive mechanisms underlying vocal learning in birds and humans, and continuing research promises insights into the uniquely human mechanisms and into how human cognition and social behavior interact, and ultimately impact on the evolution of language.

  7. Use of a geographic information system to assess accessibility to health facilities providing emergency obstetric and newborn care in Bangladesh. (United States)

    Chowdhury, Mahbub E; Biswas, Taposh K; Rahman, Monjur; Pasha, Kamal; Hossain, Mollah A


    To use a geographic information system (GIS) to determine accessibility to health facilities for emergency obstetric and newborn care (EmONC) and compare coverage with that stipulated by UN guidelines (5 EmONC facilities per 500 000 individuals, ≥1 comprehensive). A cross-sectional study was undertaken of all public facilities providing EmONC in 24 districts of Bangladesh from March to October 2012. Accessibility to each facility was assessed by applying GIS to estimate the proportion of catchment population (comprehensive 500 000; basic 100 000) able to reach the nearest facility within 2 hours and 1 hour of travel time, respectively, by existing road networks. The minimum number of public facilities providing comprehensive and basic EmONC services (1 and 5 per 500 000 individuals, respectively) was reached in 16 and 3 districts, respectively. However, after applying GIS, in no district did 100% of the catchment population have access to these services. A minimum of 75% and 50% of the population had accessibility to comprehensive services in 11 and 5 districts, respectively. For basic services, accessibility was much lower. Assessing only the number of EmONC facilities does not ensure universal coverage; accessibility should be assessed when planning health systems. © 2017 International Federation of Gynecology and Obstetrics.

  8. Optical devices having flakes suspended in a host fluid to provide a flake/fluid system providing flakes with angularly dependent optical properties in response to an alternating current electric field due to the dielectric properties of the system (United States)

    Kosc, Tanya Z [Rochester, NY; Marshall, Kenneth L [Rochester, NY; Jacobs, Stephen D [Pittsford, NY


    Optical devices utilizing flakes (also called platelets) suspended in a host fluid have optical characteristics, such as reflective properties, which are angular dependent in response to an AC field. The reflectivity may be Bragg-like, and the characteristics are obtained through the use of flakes of liquid crystal material, such as polymer liquid crystal (PLC) materials including polymer cholesteric liquid crystal (PCLC) and polymer nematic liquid crystal (PNLC) material or birefringent polymers (BP). The host fluid may be propylene carbonate, poly(ethylene glycol) or other fluids or fluid mixtures having fluid conductivity to support conductivity in the flake/host system. AC field dependent rotation of can be obtained at rates and field intensities dependent upon the frequency and magnitude of the AC field. The devices are useful in providing displays, polarizers, filters, spatial light modulators and wherever switchable polarizing, reflecting, and transmission properties are desired.

  9. The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services. (United States)

    Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L


    In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised

  10. Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme--a systems approach. (United States)

    Agyepong, Irene A; Aryeetey, Geneieve C; Nonvignon, Justice; Asenso-Boadi, Francis; Dzikunu, Helen; Antwi, Edward; Ankrah, Daniel; Adjei-Acquah, Charles; Esena, Reuben; Aikins, Moses; Arhinful, Daniel K


    Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear

  11. Medicare Provider Data - Hospice Providers (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...

  12. GUIdock-VNC: using a graphical desktop sharing system to provide a browser-based interface for containerized software. (United States)

    Mittal, Varun; Hung, Ling-Hong; Keswani, Jayant; Kristiyanto, Daniel; Lee, Sung Bong; Yeung, Ka Yee


    Software container technology such as Docker can be used to package and distribute bioinformatics workflows consisting of multiple software implementations and dependencies. However, Docker is a command line-based tool, and many bioinformatics pipelines consist of components that require a graphical user interface. We present a container tool called GUIdock-VNC that uses a graphical desktop sharing system to provide a browser-based interface for containerized software. GUIdock-VNC uses the Virtual Network Computing protocol to render the graphics within most commonly used browsers. We also present a minimal image builder that can add our proposed graphical desktop sharing system to any Docker packages, with the end result that any Docker packages can be run using a graphical desktop within a browser. In addition, GUIdock-VNC uses the Oauth2 authentication protocols when deployed on the cloud. As a proof-of-concept, we demonstrated the utility of GUIdock-noVNC in gene network inference. We benchmarked our container implementation on various operating systems and showed that our solution creates minimal overhead.

  13. The Use of Vegetation Maps and Geographic Information Systems For Assessing Conifer Lands in California (91-23)


    Goodchild, Michael F.; Davis, Frank W.; Painho, Marco; Storns, David M.


    This report summarizes research into the nature and sources of errors that occur in medium to small scale vegetation maps such as those used for statewide forestry and conservation planning. The objective of this research was to develop a coherent approach and specific methods for quantifying such errors by jointly analyzing ground observations and multiscale map data using Geographic Information Systems (GIS) operations. Section I of the report provides an overview of statistical approaches ...

  14. An international intercomparison of national network systems used to provide early warning of a nuclear accident having transboundary implications

    DEFF Research Database (Denmark)

    Thompson, I.M.G.; Andersen, C.E.; Bøtter-Jensen, L.


    Since the Chernobyl accident many countries now operate large national networks of radiation detectors that continuously monitor radiation levels in order to give early warning of nuclear accidents having transboundary implications. The networks are used to provide data to assist in determining...... of these detectors are used. During an accident the data produced by such systems will be exchanged between countries within the European Communities, (EC) and as required by the IAEA's Early Warning Convention between the rest of the world and Europe. It is therefore important to ensure that such data should...... be harmonised so that it can be accurately interpreted by other countries and by international organisations. To assist with such harmonisation an intercomparison was held during May/June 1999 at the Riso Natural Environmental Radiation Measurement Station in Denmark and at the PTB underground laboratory...

  15. Integration of National Laboratory and Low-Activity Waste Pre-Treatment System Technology Service Providers - 16435

    Energy Technology Data Exchange (ETDEWEB)

    Subramanian, Karthik H.; Thien, Michael G.; Wellman, Dawn M.; Herman, Connie C.


    The National Laboratories are a critical partner and provide expertise in numerous aspects of the successful execution of the Direct-Feed Low Activity Waste Program. The National Laboratories are maturing the technologies of the Low-Activity Waste Pre-Treatment System (LAWPS) consistent with DOE Order 413.3B “Program and Project Management for the Acquisition of Capital Assets” expectations. The National Laboratories continue to mature waste forms, i.e. glass and secondary waste grout, for formulations and predictions of long-term performance as inputs to performance assessments. The working processes with the National Laboratories have been developed in procurements, communications, and reporting to support the necessary delivery-based technology support. The relationship continues to evolve from planning and technology development to support of ongoing operations and integration of multiple highly coordinated facilities.

  16. [Barriers to the normalization of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts]. (United States)

    Roig, Francesc; Saigí, Francesc


    Despite the clear political will to promote telemedicine and the large number of initiatives, the incorporation of this modality in clinical practice remains limited. The objective of this study was to identify the barriers perceived by key professionals who actively participate in the design and implementation of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts. We performed a qualitative study based on data from semi-structured interviews with 17 key informants belonging to distinct Catalan health organizations. The barriers identified were grouped in four areas: technological, organizational, human and economic. The main barriers identified were changes in the healthcare model caused by telemedicine, problems with strategic alignment, resistance to change in the (re)definition of roles, responsibilities and new skills, and lack of a business model that incorporates telemedicine in the services portfolio to ensure its sustainability. In addition to suitable management of change and of the necessary strategic alignment, the definitive normalization of telemedicine in a mixed healthcare model based on purchasing of healthcare services using providers' contracts requires a clear and stable business model that incorporates this modality in the services portfolio and allows healthcare organizations to obtain reimbursement from the payer. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

  17. Natural wetlands are efficient at providing long-term metal remediation of freshwater systems polluted by acid mine drainage. (United States)

    Dean, Andrew P; Lynch, Sarah; Rowland, Paul; Toft, Benjamin D; Pittman, Jon K; White, Keith N


    This study describes the first long-term (14-year) evaluation of the efficacy of an established (>100 years) natural wetland to remediate highly acidic mine drainage (AMD). Although natural wetlands are highly valued for their biodiversity, this study demonstrates that they also provide important ecosystem service functions through their ability to consistently and reliably improve water quality by mitigating AMD. The Afon Goch river flows from Parys Mountain copper mine via a natural wetland, and was the major source of Zn and Cu contamination to the Irish Sea. Prior to 2003 the wetland received severe acidic metal contamination and retained a large proportion of the contamination (55, 64, and 37% in dissolved Fe, Zn, and Cu) leading to a greatly reduced metal flow to the Irish Sea. Reduced wetland loadings midway through the sampling period led to a reduction of metals by 83-94% and a pH increase from 2.7 to 5.5, resulting in long-term improvements in the downstream benthic invertebrate community. High root metal accumulation by the dominant wetland plant species and the association of acidophilic bacteria in the wetland rhizosphere indicate that multiple interacting processes provide an efficient and self-sustaining system to remediate AMD.

  18. "No diversion": a qualitative study of emergency medicine leaders in Boston, MA, and the effects of a statewide diversion ban policy. (United States)

    O'Keefe, Shannon D; Bibi, Salma; Rubin-Smith, Julia E; Feldman, James


    We examine the attitudes of emergency department (ED) key informants about the perceived effects of a statewide ban on ambulance diversion on patients, providers, and working relationships in a large urban emergency medical system. We performed a qualitative study to examine the effects of a diversion ban on Boston area hospitals. Key informants at each site completed semistructured interviews that explored relevant domains pre- and postban. Interviews were deidentified, transcribed, coded, and analyzed with grounded theory for emerging themes. We identified important themes focused on patient safety, quality of care, and relationships before and after implementation of the diversion ban. Nine of 9 eligible sites participated. Eighteen interviews were completed: 7 MD ED directors, 2 MD designees, and 9 registered nurse leaders. Although most participants had negative opinions about diversion, some had considered diversion a useful procedure. Key themes associated with diversion were adverse effects on patient care quality, patient satisfaction, and a source of conflict among ED staff and with emergency medical services (EMS). All key informants described some positive effect of the ban, including those who reported that the ban had no direct effect on their individual hospital. Although the period preceding the ban was reported to be a source of apprehension about its effects, most key informants believed the ban had improved quality of care and relationships between hospital staff and EMS. Key informants considered the diversion ban to have had a favorable effect on emergency medical care in Boston. These results may inform the discussion in other states considering a diversion ban. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  19. Providing Authentic Research Experiences for Pre-Service Teachers through UNH's Transforming Earth System Science Education (TESSE) Program (United States)

    Varner, R. K.; Furman, T.; Porter, W.; Darwish, A.; Graham, K.; Bryce, J.; Brown, D.; Finkel, L.; Froburg, E.; Guertin, L.; Hale, S. R.; Johnson, J.; von Damm, K.


    The University of New Hampshire's Transforming Earth System Science Education (UNH TESSE) project is designed to enrich the education and professional development of in-service and pre-service teachers, who teach or will teach Earth science curricula. As part of this program, pre-service teachers participated in an eight- week summer Research Immersion Experience (RIE). The main goal of the RIE is to provide authentic research experiences in Earth system science for teachers early in their careers in an effort to increase future teachers` comfort and confidence in bringing research endeavors to their students. Moreover, authentic research experiences for teachers will complement teachers` efforts to enhance inquiry-based instruction in their own classrooms. Eighteen pre-service teachers associated with our four participating institutions - Dillard University (4), Elizabeth City State University (4), Pennsylvania State University (5), and University of New Hampshire (UNH) (5) participated in the research immersion experience. Pre-service teachers were matched with a faculty mentor who advised their independent research activities. Each pre-service teacher was expected to collect and analyze his or her own data to address their research question. Some example topics researched by participants included: processes governing barrier island formation, comparison of formation and track of hurricanes Hugo and Katrina, environmental consequences of Katrina, numerical models of meander formation, climatic impacts on the growth of wetland plants, and the visual estimation of hydrothermal vent properties. Participants culminated their research experience with a public presentation to an audience of scientists and inservice teachers.

  20. Neuroanatomy of the vestimentiferan tubeworm Lamellibrachia satsuma provides insights into the evolution of the polychaete nervous system.

    Directory of Open Access Journals (Sweden)

    Norio Miyamoto

    Full Text Available Vestimentiferan tubeworms are marine invertebrates that inhabit chemosynthetic environments, and although recent molecular phylogenetic analyses have suggested that vestimentiferan tubeworms are derived from polychaete annelids, they show some morphological features that are different from other polychaetes. For example, vestimentiferans lack a digestive tract and have less body segments and comparative neuroanatomy can provide essential insight into the vestimentiferan body plan and its evolution. In the present study, we investigated the adult nervous system in the vestimentiferan Lamellibrachia satsuma using antibodies against synapsin, serotonin, FMRMamide and acetylated α-tubulin. We also examined the expressions of neural marker genes, elav and synaptotagmin to reveal the distribution of neuronal cell bodies. Brain anatomy shows simple organization in Lamellibrachia compared to other polychaetes. This simplification is probably due to the loss of the digestive tract, passing through the body between the brain and the subesophageal ganglion. In contrast, the ventral nerve cord shows a repeated organizational structure as in the other polychaetes, despite the absence of the multiple segmentation of the trunk. These results suggest that the brain anatomy is variable depending on the function and the condition of surrounding tissues, and that the formation of the rope ladder-like nervous system of the ventral nerve cord is independent from segmentation in polychaetes.

  1. Using Statewide Data on Health Care Quality to Assess the Effect of a Patient-Centered Medical Home Initiative on Quality of Care. (United States)

    Shippee, Nathan D; Finch, Michael; Wholey, Douglas


    Patient-centered medical homes comprise a large portion of modern health care redesign. However, most efforts have reflected rigid, limited models of transformation. In addition, evaluations of their impact on quality of care have relied on data designed for other purposes. Minnesota's Health Care Home (HCH) initiative is a statewide medical home model relying on state-run, adaptive certification and supportive data infrastructure. This longitudinal study leverages a unique statewide system of clinic-reported, patient-level quality data (2010-2013) to assess the effect of being in a HCH clinic on health care quality. Measures included optimal quality (meeting all targets) and average quality (number of targets met) for asthma, vascular, and diabetes care; colorectal cancer screening; depression follow-up; and depression remission. Depending on measure and year, the analytic sample included 246,023 - 3,335,994 child and adult patients in 404-651 clinics. Using endogenous treatment effects models to address endogeneity, and including patient- and clinic-level covariates and clinic-level selection bias corrections, the authors produced potential outcomes means and average treatment effects (ATEs). HCH patients received better quality versus non-HCH patients for most outcomes. For example, the adjusted rate receiving optimal diabetes care was 453.7/1000 adult HCH patients versus 327.2/1000 non-HCH adult patients (ATE = 126.5; P quality generally echoed optimal care findings. These findings indicate the usefulness of statewide quality data and support the effectiveness of adaptive, state-run medical home programs. Additional integration of services may be needed for mental health conditions.

  2. SU-E-T-571: Newly Emerging Integrated Transmission Detector Systems Provide Online Quality Assurance of External Beam Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, D; Chung, E; Hess, C; Stern, R; Benedict, S [UC Davis Cancer Center, Sacramento, CA (United States)


    Purpose: Two newly emerging transmission detectors positioned upstream from the patient have been evaluated for online quality assurance of external beam radiotherapy. The prototype for the Integral Quality Monitor (IQM), developed by iRT Systems GmbH (Koblenz, Germany) is a large-area ion chamber mounted on the linac accessory tray to monitor photon fluence, energy, beam shape, and gantry position during treatment. The ion chamber utilizes a thickness gradient which records variable response dependent on beam position. The prototype of Delta4 Discover™, developed by ScandiDos (Uppsala, Sweden) is a linac accessory tray mounted 4040 diode array that measures photon fluence during patient treatment. Both systems are employable for patient specific QA prior to treatment delivery. Methods: Our institution evaluated the reproducibility of measurements using various beam types, including VMAT treatment plans with both the IQM ion chamber and the Delta4 Discover diode array. Additionally, the IQM’s effect on photon fluence, dose response, simulated beam error detection, and the accuracy of the integrated barometer, thermometer, and inclinometer were characterized. The evaluated photon beam errors are based on the annual tolerances specified in AAPM TG-142. Results: Repeated VMAT treatments were measured with 0.16% reproducibility by the IQM and 0.55% reproducibility by the Delta4 Discover. The IQM attenuated 6, 10, and 15 MV photon beams by 5.43±0.02%, 4.60±0.02%, and 4.21±0.03% respectively. Photon beam profiles were affected <1.5% in the non-penumbra regions. The IQM’s ion chamber’s dose response was linear and the thermometer, barometer, and inclinometer agreed with other calibrated devices. The device detected variations in monitor units delivered (1%), field position (3mm), single MLC leaf positions (13mm), and photon energy. Conclusion: We have characterized two new transmissions detector systems designed to provide in-vivo like measurements upstream

  3. Development of a central data warehouse for statewide ITS and transportation data in Florida phase III : final report. (United States)


    This report documents Phase III of the development and operation of a prototype for the Statewide Transportation : Engineering Warehouse for Archived Regional Data (STEWARD). It reflects the progress on the development and : operation of STEWARD sinc...

  4. Can a clinical senate enhance state-wide clinician engagement? A survey study. (United States)

    Quinlivan, Julie A; Miller, Mary; Hutton, Marani


    Objective Clinician engagement correlates with quality, safety and efficacy outcomes. The aim of the present study was to explore whether a clinical senate model achieves clinical input into system manager and operational health service boards. Methods A mixed-methods survey was undertaken. Participants were current or immediate past members of the Clinical Senate of Western Australia (CS). For the 124 surveys sent out, the response rate was 60%. Results Respondents stated the CS played a role in clinician engagement (95%), contributed to healthcare reform (82%), knowledge of contemporary health issues (92%), feedback to decision makers (82%), clinician networking (94%), debate on important issues (93%), enabled clinicians to work on recommendations to improve health at a state level (87%), contributed to clinician thinking on health reform (88%) and enabled clinicians to share their knowledge (91%). Four major themes emerged in the qualitative analysis: (1) the need for a strong independent clinician forum and voice at a state level; (2) the need to strengthen clinician interactions with operational healthcare boards; (3) a strong belief that clinician engagement strengthened quality and safety outcomes at a state level; and (4) that membership was important and needed to be diverse, multidisciplinary and independent, but structurally representative of clinicians in the state. Conclusion A clinical senate model can facilitate state-wide clinician engagement. What is known about the topic? High levels of clinical engagement foster a culture within healthcare organisations that is associated with the delivery of sustained high-quality, safe and efficient services. This has led to a focus on strategies to optimise clinical engagement in healthcare planning and reform. However, there is limited data exploring how to achieve clinical engagement at a state, rather than local, level within the healthcare system. What does this paper add? This survey study evaluates the

  5. Validation and adaptation of the hospital consumer assessment of healthcare providers and systems in Arabic context: Evidence from Saudi Arabia. (United States)

    Alanazi, Mohammed R; Alamry, Ahmed; Al-Surimi, Khaled

    One of the main purposes of healthcare organizations is to serve patients by providing safe and high-quality patient-centered care. Patients are considered the most appropriate source to assess the quality level of healthcare services. The objectives of this paper were to describe the translation and adaptation process of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for Arabic speaking populations, examine the degree of equivalence between the original English version and the Arabic translated version, and estimate and report the validity and reliability of the translated Arabic HCAHPS version. The translation process had four main steps: (1) qualified bilingual translators translated the HCAHPS from English to Arabic; (2) the Arabic version was translated back to English and reviewed by experts to ensure content accuracy (content equivalence); (3) both Arabic and English versions were verified for accuracy and validity of the translation, checking for the similarities and differences (semantic equivalence); (4) finally, two independent bilinguals reviewed and made the final revision of both the Arabic and English versions separately and agreed on one final version that is similar and equivalent to the original English version in terms of content and meaning. The study findings showed that the overall Cronbach's α for the Arabic HCAHPS version was 0.90, showing good internal consistency across the 9 separate domains, which ranged from 0.70 to 0.97 Cronbach's α. The correlation coefficient between each statement for each separate domain revealed a highly positive significant correlation ranging from 0.72 to 0.89. The results of the study show empirical evidence of validity and reliability of HCAHPS in its Arabic version. Moreover, the Arabic version of HCAHPS in our study presented good internal consistency and it is highly recommended to be replicated and applied in the context of other Arab countries. Copyright © 2017

  6. A statewide assessment of lead screening histories of preschool children enrolled in a Medicaid managed care program. (United States)

    Vivier, P M; Hogan, J W; Simon, P; Leddy, T; Dansereau, L M; Alario, A J


    Despite the prominence of lead poisoning as a public health problem, recent Government Accounting Office reports indicate that only one fifth of children who are covered by Medicaid have been screened for lead poisoning. The purpose of this study was to examine the lead screening histories of children who were enrolled in a statewide, Medicaid managed care plan to determine the relative impact of the type of primary care provider site and family sociodemographic characteristics on the likelihood of being screened. The study also examined the prevalence of and risk factors for lead poisoning of children who had been screened. A random sample of 2000 preschool-age children was chosen from those who were enrolled continuously in the statewide, expanded, Medicaid managed care program for a 1-year period and between the ages of 19 and 35 months at the end of that year. Sociodemographic characteristics and lists of primary care providers were obtained from administrative data sets. Medical record audits at primary care provider sites were performed to obtain the lead screening histories of the children, including test dates and results. Data on 1988 children were used for study analyses, and 80% of these children had at least 1 documented blood lead level. Children whose primary care provider was an office-based physician were less likely to be screened as compared with patients of health centers, hospital-based clinics, and staff model health maintenance organizations (68%, 86%, 89%, and 91% respectively). Variation in screening rates persisted in a multivariate analysis controlling for family sociodemographic characteristics and practice level variation. Of the 1587 children who had a documented blood lead test, 467 children (29%) had a blood lead level of >/=10 mg/dL on at least 1 test. Blood lead screening rates in Rhode Island's Medicaid managed care program are dramatically higher than national estimates for children who are enrolled in Medicaid. Potential

  7. Impact of the feedback provided by a gastric electrical stimulation system on eating behavior and physical activity levels. (United States)

    Busetto, Luca; Torres, Antonio J; Morales-Conde, Salvador; Alarcón Del Agua, Isaias; Moretto, Carlo; Fierabracci, Paola; Rovera, Giuseppe; Segato, Gianni; Rubio, Miguel A; Favretti, Franco


    The closed-loop gastric electrical stimulation (CLGES) abiliti(®) system provides tailored gastric electrical stimulation activated by food entry into the stomach and sensor-based data to medical professionals. The aim of this study was to analyze behavior changes using sensor-based food intake and activity data in participants treated with the CLGES system. Food intake and activity data (3D accelerometer) were downloaded at baseline and monthly/bimonthly for 12 months in a subset of patients with obesity (N = 45) participating in a multicenter trial with CLGES. Measured food intake parameters included the number of intakes during allowed and disallowed periods, nighttime intakes, and between-meal snacks (average/d). Activity parameters included time in different levels of physical activity (min/d), sleep/sedentary (h/d), and estimated energy expenditure (EE). Weight loss at 12 months averaged 15.7 ± 7.7% of the baseline body weight. Stable reduction in the number of disallowed meals and between-meal snacks (P < 0.05), an increase in all levels of physical activity (P < 0.001), and an increase in activity-based EE (303 ± 53 kcal/d on average, P < 0.001) were seen. Significant improvement in eating and activity was seen in participants. It is hypothesized that feedback of the sensor-based data induced behavioral changes and contributed to weight loss in patients treated with CLGES. © 2017 The Obesity Society.

  8. An analysis of the immunization status of preschool children enrolled in a statewide Medicaid managed care program. (United States)

    Vivier, P M; Alario, A J; Peter, G; Leddy, T; Simon, P; Mor, V


    To measure immunization coverage rates for children enrolled in a statewide Medicaid managed care program and determine the impact of sociodemographic characteristics and the type of primary care provider site on immunization coverage. A random sample of 2000 was chosen from children between the ages of 19 and 35 months who had been continuously enrolled in the Medicaid managed care program for 1 year. Sociodemographic data and a list of primary care providers for the study children were obtained from administrative databases. Immunization histories were determined by medical record review. Vaccine-specific immunization rates for diphtheria-tetanus-pertussis, polio, Haemophilus influenzae type b, hepatitis B, and measles-mumps-rubella ranged from 87% to 94%, with an overall coverage rate of 75%. Overall immunization status varied by primary care provider site as follows: office-based, 72%; community health center, 75%; hospital-based clinic, 79%; and staff model health maintenance organization, 85% (chi(2) test, P =.008). Immunization rates compare favorably with national rates for this low-income group. Sociodemographic characteristics were not important predictors of underimmunization, but rates did vary by the type of primary care provider site.

  9. Geospatial analysis of hospital consumer assessment of healthcare providers and systems pain management experience scores in U.S. hospitals. (United States)

    Tighe, Patrick J; Fillingim, Roger B; Hurley, Robert W


    Although prior work has investigated the interplay between demographic and intrasurvey correlations of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, these prior studies have not included geospatial analyses, or analyses that take into account location effects. Here, we report the results of a geospatial analysis (not equivalent to simple geographical analysis) of patient experience scores pertaining to pain. HCAHPS data collected in 2011 were examined to test the hypothesis that HCAHPS patient experience with pain management (PEPM) scores were geospatially distributed throughout the United States using Moran's Index, which measures the association between PEPM scores and hospital location. After limiting the dataset to hospitals in the continental United States with nonzero HCAHPS response rates, 3645 hospitals were included in the analyses. "Always" responses were geospatially clustered amongst the analyzed hospitals. Clustering was significant in all distances tested from 10 to 5000km (P<0.0001). We identified 6 demarcated groups of hospitals. Taken together, these results strongly suggest a regional geographic effect on PEPM scores. These results may carry policy implications for U.S. hospitals with regard to acute pain outcomes. Further analyses will be necessary to evaluate policy explanations and implications of the regional geographic differences in PEPM results. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.


    Dockins, James; Abuzahrieh, Ramzi; Stack, Martin


    To translate and adapt an effective, validated, benchmarked, and widely used patient satisfaction measurement tool for use with an Arabic-speaking population. Translation of survey's items, survey administration process development, evaluation of reliability, and international benchmarking Three hundred-bed tertiary care hospital in Jeddah, Saudi Arabia. 645 patients discharged during 2011 from the hospital's inpatient care units. INTERVENTIONS; The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) instrument was translated into Arabic, a randomized weekly sample of patients was selected, and the survey was administered via telephone during 2011 to patients or their relatives. Scores were compiled for each of the HCAHPS questions and then for each of the six HCAHPS clinical composites, two non-clinical items, and two global items. Clinical composite scores, as well as the two non-clinical and two global items were analyzed for the 645 respondents. Clinical composites were analyzed using Spearman's correlation coefficient and Cronbach's alpha to demonstrate acceptable internal consistency for these items and scales demonstrated acceptable internal consistency for the clinical composites. (Spearman's correlation coefficient = 0.327 - 0.750, P translation and adaptation of the HCAHPS is a valid, reliable, and feasible tool for evaluation and benchmarking of inpatient satisfaction in Arabic speaking populations.

  11. The health system burden of chronic disease care: an estimation of provider costs of selected chronic diseases in Uganda. (United States)

    Settumba, Stella Nalukwago; Sweeney, Sedona; Seeley, Janet; Biraro, Samuel; Mutungi, Gerald; Munderi, Paula; Grosskurth, Heiner; Vassall, Anna


    To explore the chronic disease services in Uganda: their level of utilisation, the total service costs and unit costs per visit. Full financial and economic cost data were collected from 12 facilities in two districts, from the provider's perspective. A combination of ingredients-based and step-down allocation costing approaches was used. The diseases under study were diabetes, hypertension, chronic obstructive pulmonary disease (COPD), epilepsy and HIV infection. Data were collected through a review of facility records, direct observation and structured interviews with health workers. Provision of chronic care services was concentrated at higher-level facilities. Excluding drugs, the total costs for NCD care fell below 2% of total facility costs. Unit costs per visit varied widely, both across different levels of the health system, and between facilities of the same level. This variability was driven by differences in clinical and drug prescribing practices. Most patients reported directly to higher-level facilities, bypassing nearby peripheral facilities. NCD services in Uganda are underfunded particularly at peripheral facilities. There is a need to estimate the budget impact of improving NCD care and to standardise treatment guidelines. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  12. Impact of Maine’s Statewide Nutrition Policy on High School Food Environments


    Whatley Blum, Janet E.; Beaudoin, Christina M; O'Brien, Liam M.; Polacsek, Michele; Harris, David E.; O'Rourke, Karen A.


    Introduction We assessed the effect on the food environments of public high schools of Maine's statewide nutrition policy (Chapter 51), which banned "foods of minimal nutritional value" (FMNV) in public high schools that participated in federally funded meal programs. We documented allowable exceptions to the policy and describe the school food environments. Methods We mailed surveys to 89 high school food-service directors to assess availability pre–Chapter 51 and post–Chapter 51 of soda, ot...

  13. Using concept mapping for planning and evaluation of a statewide energy efficiency initiative

    Energy Technology Data Exchange (ETDEWEB)

    Schroeter, D.C.; Coryn, C.L.S.; Cullen, A.; Robertson, K.N.; Alyami, M. [Western Michigan University, 4405 Ellsworth Hall, Kalamazoo, MI 49008-5237 (United States)


    In this paper, concept mapping techniques for planning and evaluating energy efficiency initiatives are presented using a case example from an evaluability assessment of a statewide initiative in the USA. Cluster maps, point cluster maps, cluster rating maps, pattern matches, go-zones, and other information are used to demonstrate how concept mapping can inform non-arbitrary, defensible decisions and subsequent actions for energy efficiency and renewable energy financing, program planning, and evaluation.

  14. Employment change for bars and restaurants following a statewide clean indoor air policy. (United States)

    Klein, Elizabeth G; Forster, Jean L; Collins, Natalie M; Erickson, Darin J; Toomey, Traci L


    Clean indoor air policies have been adopted to protect employees in all workplaces from exposure to environmental tobacco smoke. Despite numerous studies where no significant economic effects were associated with clean indoor air policies, concerns persist that such policies will have a severe, negative effect on alcohol-licensed businesses. This study examines the effect of a comprehensive, statewide clean indoor air law on bar and restaurant employment in Minnesota as a whole, as well as by region in the state. Interrupted time-series analyses were conducted separately on bar and restaurant employment between 2004 and 2008 using data reported by businesses to the Minnesota Department of Employment and Economic Development. The statewide clean indoor air policy was implemented October 2007; analyses were conducted in 2009. After accounting for changes in employment in all other sectors for the state as a whole, there were no significant changes in statewide bar or restaurant employment associated with the state-level clean indoor air policy. Additionally, no significant changes were observed in regional bar or restaurant employment following enactment of the clean indoor air policy. Enactment of a comprehensive clean indoor air policy in Minnesota did not result in significant changes in bar or restaurant employment in rural or urban regions of the state or the state as a whole. In Minnesota, neither bars nor restaurants were associated with significant changes in employment following the enactment of a comprehensive, statewide clean indoor air policy. Copyright © 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Transitioning to Excellence in Nurse Staffing: A Statewide Initiative to Leverage the Evidence. (United States)

    Beglinger, Joan Ellis


    Successful transitions require leadership, focus, and tenacity. Substantive change rarely comes easily. Leaders are frequently challenged to determine when change is needed and how to best accomplish it. This month we will shine the spotlight on a statewide initiative in Wisconsin to transition the nurse staffing decision process, in every practice setting, from largely opinion based to evidence based. This leadership initiative capitalized on the leadership potential of a professional association and the power of consensus and a well-executed strategy.

  16. Using Statewide Youth Surveys to Evaluate Local Drug Use Policies and Interventions


    Paschall, Mallie J.; Flewellng, Robert L.; Grube, Joel W.


    This article summarizes two studies that use statewide school-based youth surveys to evaluate local initiatives to reduce alcohol and other substance abuse. The Vermont “New Directions” evaluation was conducted to assess the effects of a community-based intervention in 23 Vermont communities to reduce youth substance use. Outcome data were obtained from the Youth Risk Behavior Survey, which is administered to students in grades 8 through 12 every other year in almost all school districts in t...

  17. [Interhospital transport of intensive care patients in Lower Saxony : statewide need-based and effective management]. (United States)

    Roessler, M; Reinhardt, K; Lühmann, U; Bickel, A; Braun, J; Böhne, S; Gerberding, B; Hamann, A; Homann, M; Monnig, M; Panzer, W; Ruff, S; Flemming, A


    Since 2007 interhospital transport of intensive care patients in Lower Saxony appertains to the performance requirements of emergency medical services. Against this background the Working Group for Evaluation of Intensive Care Transport (Arbeitsgemeinschaft Evaluation Intensivverlegung) was established. This group formulated standardized definitions for the requirements of intensive care transport vehicles and a federal statewide monitoring of intensive care transport was implemented to analyze if simultaneously on-call intensive care transport systems (intensive care helicopter and ground based mobile intensive care units) can be deployed need-based and efficiently. A prospective follow-up study and evaluation of intensive care transport in Lower Saxony between April 1(st) 2008 and July 31(st) 2010 was carried out. A total of 6,779 data records were evaluated in this study of which 4,941 (72.9%) missions were located in Lower Saxony, 2,928 (43.2%) missions were carried out by helicopters and 3,851 (56.8%) by ground based mobile intensive care units. The mean duration of a mission was 3 h 59min±2 h 25 min, 4 h 39 min±2 h 23 min by ground based mobile intensive care units and 2 h 21 in±30 min by helicopter units. All systems proved to be feasible for intensive care transport. The degree of urgency was estimated correctly in 94.8% of the evaluated missions and 58.0% of the transfers could not be deployed. In 76.8% patients were transferred to hospitals with a higher level of medical care, 51.7% of patients were transferred for intensive care therapy and 40.4% for an operation/intervention. Of the patients 38.2% required mechanical ventilation and in 48.3% invasive monitoring was carried out. Interhospital transfer of intensive care patients can be carried out need-based with a limited number of intensive care transport vehicles if the missions are deployed effectively by standardized disposition in accordance with performance requirements.

  18. Administrator Views on Providing Self-Determination Instruction in Elementary and Secondary Schools (United States)

    Carter, Erik W.; Lane, Kathleen Lynne; Jenkins, Abbie B.; Magill, Lauren; Germer, Kathryn; Greiner, Steven M.


    We report findings from a statewide study of 333 administrators focused on (a) the extent to which they prioritize each of seven self-determination skills, (b) whether and where staff at their schools are providing instruction on these seven skills, and (c) potential avenues for equipping educators to learn strategies for fostering…

  19. Learning Outcome Testing: A Statewide Approach to Accountability. (United States)

    Willis, John A.


    Discusses the implementation of a software system that allows teachers to take advantage of large banks of questions in subject areas. Explains that this plan is the result of a 1981 court mandate to standardize learning outcomes. Follows the development of the system and choosing of the software. (MVL)

  20. ForWarn Forest Disturbance Change Detection System Provides a Weekly Snapshot of US Forest Conditions to Aid Forest Managers (United States)

    Hargrove, W. W.; Spruce, J.; Kumar, J.; Hoffman, F. M.


    The Eastern Forest Environmental Threat Assessment Center and Western Wildland Environmental Assessment Center of the USDA Forest Service have collaborated with NASA Stennis Space Center to develop ForWarn, a forest monitoring tool that uses MODIS satellite imagery to produce weekly snapshots of vegetation conditions across the lower 48 United States. Forest and natural resource managers can use ForWarn to rapidly detect, identify, and respond to unexpected changes in the nation's forests caused by insects, diseases, wildfires, severe weather, or other natural or human-caused events. ForWarn detects most types of forest disturbances, including insects, disease, wildfires, frost and ice damage, tornadoes, hurricanes, blowdowns, harvest, urbanization, and landslides. It also detects drought, flood, and temperature effects, and shows early and delayed seasonal vegetation development. Operating continuously since January 2010, results show ForWarn to be a robust and highly capable tool for detecting changes in forest conditions. To help forest and natural resource managers rapidly detect, identify, and respond to unexpected changes in the nation's forests, ForWarn produces sets of national maps showing potential forest disturbances at 231m resolution every 8 days, and posts the results to the web for examination. ForWarn compares current greenness with the "normal," historically seen greenness that would be expected for healthy vegetation for a specific location and time of the year, and then identifies areas appearing less green than expected to provide a strategic national overview of potential forest disturbances that can be used to direct ground and aircraft efforts. In addition to forests, ForWarn also tracks potential disturbances in rangeland vegetation and agriculural crops. ForWarn is the first national-scale system of its kind based on remote sensing developed specifically for forest disturbances. The ForWarn system had an official unveiling and rollout in

  1. Recommendations from primary care providers for integrating mental health in a primary care system in rural Nepal

    National Research Council Canada - National Science Library

    Acharya, Bibhav; Tenpa, Jasmine; Thapa, Poshan; Gauchan, Bikash; Citrin, David; Ekstrand, Maria


    .... Primary care provider perspectives are important for successful program implementation. We conducted three focus groups with all 24 primary care providers at a district-level hospital in rural Nepal...

  2. Transcriptome comparison and gene coexpression network analysis provide a systems view of citrus response to 'Candidatus Liberibacter asiaticus' infection. (United States)

    Zheng, Zhi-Liang; Zhao, Yihong


    Huanglongbing (HLB) is arguably the most destructive disease for the citrus industry. HLB is caused by infection of the bacterium, Candidatus Liberibacter spp. Several citrus GeneChip studies have revealed thousands of genes that are up- or down-regulated by infection with Ca. Liberibacter asiaticus. However, whether and how these host genes act to protect against HLB remains poorly understood. As a first step towards a mechanistic view of citrus in response to the HLB bacterial infection, we performed a comparative transcriptome analysis and found that a total of 21 Probesets are commonly up-regulated by the HLB bacterial infection. In addition, a number of genes are likely regulated specifically at early, late or very late stages of the infection. Furthermore, using Pearson correlation coefficient-based gene coexpression analysis, we constructed a citrus HLB response network consisting of 3,507 Probesets and 56,287 interactions. Genes involved in carbohydrate and nitrogen metabolic processes, transport, defense, signaling and hormone response were overrepresented in the HLB response network and the subnetworks for these processes were constructed. Analysis of the defense and hormone response subnetworks indicates that hormone response is interconnected with defense response. In addition, mapping the commonly up-regulated HLB responsive genes into the HLB response network resulted in a core subnetwork where transport plays a key role in the citrus response to the HLB bacterial infection. Moreover, analysis of a phloem protein subnetwork indicates a role for this protein and zinc transporters or zinc-binding proteins in the citrus HLB defense response. Through integrating transcriptome comparison and gene coexpression network analysis, we have provided for the first time a systems view of citrus in response to the Ca. Liberibacter spp. infection causing HLB.

  3. The Challenges Associated with Accounting for the Army's Force Provider (FP) System when Deployed in Support of Military Operations

    National Research Council Canada - National Science Library

    Correia, Carlos A; Horner, Allen; McLaughlin, James; Stewardson, Donald


    ...-making authority to control the system from production through deployment, and the financial implications that occur when the integrity of the FP System is lost due to re-distribution of major components...

  4. A statewide hepatitis B vaccination program for school children in Hawaii: vaccination series completion and participation rates over consecutive school years. (United States)

    Dilraj, Athmanundh; Strait-Jones, Judeth; Nagao, Marcia; Cui, Kate; Terrell-Perica, Steven; Effler, Paul V.


    OBJECTIVE: The authors assessed a statewide school-based Hepatitis B (HepB) vaccination program for preadolescents in Hawaii over three consecutive school years. Factors assessed included number of schools and students participating and number of students receiving three doses of hepatitis B vaccine. METHODS: Records of the program, which targeted 4th and/or 5th graders in public and private schools, were reviewed for the period from 1996 to 1999. RESULTS: The proportion of participating schools increased from 76% of all schools in the state in School Year 1 to 94% in School Year 3. The proportion of children with completed consent forms who received three doses of HepB vaccine at school exceeded 80% throughout the project. In School Year 1, 10,003 (70%) of 14,333 children enrolled at participating schools received three vaccine doses in school; however, this proportion declined over subsequent school years to 51% (7,722/15,013) in School Year 2 and 24% (7,344/30,429) in School Year 3. A survey of 477 parents not consenting to school vaccination indicated that 84% of their children completed the vaccine series at a private provider office. CONCLUSION: Statewide school-based HepB vaccination campaigns for at-risk populations can result in a majority of children in targeted age groups receiving three doses of hepatitis B vaccine, though declining participation may be observed as uptake in the private sector increases. PMID:12690066

  5. Statewide GIS mapping of recurring congestion corridors : final report. (United States)


    Recurring congestion occurs when travel demand reaches or exceeds the available roadway : capacity. This project developed an interactive geographic information system (GIS) map of the : recurring congestion corridors (labeled herein as hotspots) in ...

  6. A systems approach to developing staff training. (United States)

    Giffort, D W


    This chapter shows how concepts from organizational psychology can be used to design a comprehensive staff training model for a statewide mental health service system, and emphasizes the importance of competency identification in this model.

  7. Hawaii DAR Dealer Reporting System Data (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — In 2000 January, the Hawaii Division of Aquatic Resources (DAR) implemented a computerized data processing system for fish dealer data collected state-wide. Hawaii...

  8. A statewide review of postnatal care in private hospitals in Victoria, Australia (United States)


    Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19) and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11). Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth) was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and frequency of visitors. These

  9. A statewide review of postnatal care in private hospitals in Victoria, Australia

    Directory of Open Access Journals (Sweden)

    Forster Della A


    Full Text Available Abstract Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19 and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11. Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and

  10. Global Precipitation Measurement (GPM) Mission: Precipitation Processing System (PPS) GPM Mission Gridded Text Products Provide Surface Precipitation Retrievals (United States)

    Stocker, Erich Franz; Kelley, O.; Kummerow, C.; Huffman, G.; Olson, W.; Kwiatkowski, J.


    In February 2015, the Global Precipitation Measurement (GPM) mission core satellite will complete its first year in space. The core satellite carries a conically scanning microwave imager called the GPM Microwave Imager (GMI), which also has 166 GHz and 183 GHz frequency channels. The GPM core satellite also carries a dual frequency radar (DPR) which operates at Ku frequency, similar to the Tropical Rainfall Measuring Mission (TRMM) Precipitation Radar, and a new Ka frequency. The precipitation processing system (PPS) is producing swath-based instantaneous precipitation retrievals from GMI, both radars including a dual-frequency product, and a combined GMIDPR precipitation retrieval. These level 2 products are written in the HDF5 format and have many additional parameters beyond surface precipitation that are organized into appropriate groups. While these retrieval algorithms were developed prior to launch and are not optimal, these algorithms are producing very creditable retrievals. It is appropriate for a wide group of users to have access to the GPM retrievals. However, for researchers requiring only surface precipitation, these L2 swath products can appear to be very intimidating and they certainly do contain many more variables than the average researcher needs. Some researchers desire only surface retrievals stored in a simple easily accessible format. In response, PPS has begun to produce gridded text based products that contain just the most widely used variables for each instrument (surface rainfall rate, fraction liquid, fraction convective) in a single line for each grid box that contains one or more observations.This paper will describe the gridded data products that are being produced and provide an overview of their content. Currently two types of gridded products are being produced: (1) surface precipitation retrievals from the core satellite instruments GMI, DPR, and combined GMIDPR (2) surface precipitation retrievals for the partner constellation

  11. Results of Statewide TerraNova Testing, Fall 1998. (United States)

    La Marca, Paul M.

    This summary provides key findings about state, district, and school level performance on the TerraNova examinations (CTB/McGraw Hill) in Nevada in 1998-1999. The TerraNova tests are used to assess students in grades 4, 8, and 10 as stipulated by Nevada law. Within this summary, a description of performance as measured by national percentile…

  12. Telepractice: Creating a Statewide Network of Support in Rural Maine (United States)

    Hopkins, Karen; Keefe, Barbara; Bruno, Angela


    The Maine Educational Center for the Deaf and Hard of Hearing's (MECDHH's) "POINT" (Providing Opportunities for Integrating New Technologies) project is implementing a telepractice, distance learning collaborative in Maine with eight hub sites and 18 end points using Tandberg videoconferencing technology. This network is planned to be a…

  13. Teaching with Technology: A Statewide Professional Development Program. Evaluation Report. (United States)

    Ravitz, Jason; Mergendoller, John

    Teaching with Technology (TWT) is a multi-year development program for Idaho teachers, funded and developed by the J.A. and Kathryn Alberston Foundation. TWT is a complement to the Opportunity 1 initiative that made educational technology available to Idaho schools. TWT provides intensive summer training workshops and offers support to teachers…

  14. Alternate Assessment: No Child Left Behind during Statewide Testing. (United States)

    Hager, Karen D.; Slocum, Timothy A.

    The reauthorization of the Individuals with Disabilities Education Act (IDEA) in 1997 clarified that special education was to fully participate in educational accountability systems related to standards-based reform. Special education students could participate in the general assessment, with or without accommodations, or in an alternate…

  15. Simulated performance of the Thermo Active Building System (TABS) with respect to the provided thermal comfort and primary energy use

    DEFF Research Database (Denmark)

    Kolarik, Jakub; Olesen, Bjarne W.; Toftum, Jørn


    The central module of an office building conditioned by a Thermo Active Building System (TABS) coupled with constant volume ventilation was evaluated by means of dynamic computer simulations. Additionally, the same building model was simulated with a conventional all air VAV ventilation system...

  16. From the Provider-Led to an Employer-Led System: Implications of Apprenticeship Reform on the Private Training Market (United States)

    Chankseliani, Maia; Relly, Susan James


    Despite expending a great deal of public money, and after many government-led "reforms" to develop an apprenticeship system that rivals those found in other countries, the apprenticeship system in England still faces a number of challenges and failings, not least in the private training market. This paper explores the landscape of…

  17. Providing Individually Tailored Academic and Behavioral Support Services for Youth in the Juvenile Justice and Child Welfare Systems. Practice Guide (United States)

    Gonsoulin, S.; Darwin, M. J.; Read, N. W.


    Youth who are involved with the juvenile justice and child welfare systems face many challenges and barriers to academic and vocational success. Regardless of the reasons for their involvement, youth in these systems are "disproportionately children and youth of color who currently have, or have experienced, a host of risk factors that are…

  18. Statewide physical fitness testing: perspectives from the gym. (United States)

    Martin, Scott B; Ede, Alison; Morrow, James R; Jackson, Allen W


    This paper provides observations of physical fitness testing in Texas schools and physical education teachers' insights about large-scale testing using the FITNESSGRAM assessment (Cooper Institute, 2007) as mandated by Texas Senate Bill 530. In the first study, undergraduate and graduate students who were trained to observe and assess student fitness testing in grades 3 through 12 provided observations. In the second study, physical education teachers responded to selected interview questions during a focus group discussion. From the observations and responses, specific themes emerged related to teachers' knowledge and training about conducting fitness testing and managing data, students' knowledge and motivation, support and resources for conducting fitness assessments, and complexity of the fitness situation.

  19. How disease surveillance systems can serve as practical building blocks for a health information infrastructure: the Indiana experience. (United States)

    Grannis, Shaun J; Biondich, Paul G; Mamlin, Burke W; Wilson, Greg; Jones, Linda; Overhage, J Marc


    Although many organizations are beginning to develop strategies to implement and study regional and national health information exchanges, there are few operational examples to date. The Indiana Network for Patient Care (INPC) is an example of a currently operational Regional Health Information Organization (RHIO) built upon a foundation of open, robust healthcare information standards. Having demonstrated the scalability of this design, the Indiana State Department of Health (ISDH) contracted with the Regenstrief Institute to implement a statewide disease surveillance system incorporating encounter data from all 114 Indiana hospitals with emergency departments. We describe the 4-year implementation plan, including our design rationale and how we plan to address the specific implementation challenges of data collection, connectivity in diverse environments and current hospital buy-in. To date, 36 hospitals are in various stages of engagement, with 19 hospitals actively providing real-time surveillance data. We will discuss how this project creates the foundation for a potential statewide health information exchange.

  20. [Comparison of the systems used for providing local anesthesia in dentistry--the Wand (Milestone Scientific) and Injex (Rosch)]. (United States)

    Zarzecka, Joanna; Gończowski, Krzysztof; Kesek, Barbara; Darczuk, Dagmara; Zapała, Jan


    Local anesthesia is one of the basic and the most often executed interventions in dentistry. This procedure is very stressful for the patients because it is combined with pain. The new systems for delivering local anesthesia in dentistry have revolutionized the technique considerably by its simplify as well as reduction in pain. this study presents the comparison between the local anesthesia delivery systems used in dentistry--The Wand and Injex, taking into consideration pain intensity during performing anesthesia and the intensification of fear before executed anesthesia with the given system. the Visual Analogue Scale (VAS), verbal scale and questionnaires were used to evaluate pain and fear. On the basis of our investigations it can be concluded that there were statistically important differences between men and women in fear intensity combined with the anesthesia procedure--men were less afraid than women. The patients who were anaesthetized with system The WAND declared less fear before similar anesthesia in future. The average value of intensity of pain analyzed with both verbal and visual scales during anaesthetizing with the system Injex (independently from sex) was statistically significantly higher than for system The WAND--respectively 0.57 and 8.55 for The WAND, 2.02 and 32.18 for Injex (p = 0.001). on the basis of the results of this study it can be concluded that the less stressful and painful local anesthesia delivery system is the WAND.

  1. A mathematical model of metabolism an regulation provides a systems-level view of how Escherichia coli responds to oxigen

    NARCIS (Netherlands)

    Ederer, M.; Steinsiek, S.; Stagge, S.; Rolfe, M.D.; ter Beek, A.; Knies, D.; Teixeira De Mattos, M.J.; Sauter, T.; Green, J.; Poole, R.K.; Bettenbrock, K.; Sawodny, O.


    The efficient redesign of bacteria for biotechnological purposes, such as biofuel production, waste disposal or specific biocatalytic functions, requires a quantitative systems-level understanding of energy supply, carbon, and redox metabolism. The measurement of transcript levels, metabolite

  2. African green monkey kidney (Vero) cells provide an alternative host cell system for influenza A and B viruses.


    Govorkova, E A; Murti, G; Meignier, B; de Taisne, C; Webster, R G


    The preparation of live, attenuated human influenza virus vaccines and of large quantities of inactivated vaccines after the emergence or reemergence of a pandemic influenza virus will require an alternative host cell system, because embryonated chicken eggs will likely be insufficient and suboptimal. Preliminary studies indicated that an African green monkey kidney cell line (Vero) is a suitable system for the primary isolation and cultivation of influenza A viruses (E. A. Govorkova, N. V. K...

  3. Real time alert system: a disease management system leveraging health information exchange. (United States)

    Anand, Vibha; Sheley, Meena E; Xu, Shawn; Downs, Stephen M


    Rates of preventive and disease management services can be improved by providing automated alerts and reminders to primary care providers (PCPs) using of health information technology (HIT) tools. Using Adaptive Turnaround Documents (ATAD), an existing Health Information Exchange (HIE) infrastructure and office fax machines, we developed a Real Time Alert (RTA) system. RTA is a computerized decision support system (CDSS) that is able to deliver alerts to PCPs statewide for recommended services around the time of the patient visit. RTA is also able to capture structured clinical data from providers using existing fax technology. In this study, we evaluate RTA's performance for alerting PCPs when their patients with asthma have an emergency room visit anywhere in the state. Our results show that RTA was successfully able to deliver "just in time" patient-relevant alerts to PCPs across the state. Furthermore, of those ATADs faxed back and automatically interpreted by the RTA system, 35% reported finding the provided information helpful. The PCPs who reported finding information helpful also reported making a phone call, sending a letter or seeing the patient for follow up care. We have successfully demonstrated the feasibility of electronically exchanging important patient related information with the PCPs statewide. This is despite a lack of a link with their electronic health records. We have shown that using our ATAD technology, a PCP can be notified quickly of an important event such as a patient's asthma related emergency room admission so further follow up can happen in near real time.

  4. A review of mass and energy flow through a lava flow system: insights provided from a non-equilibrium perspective (United States)

    Tarquini, Simone


    A simple formula relates lava discharge rate to the heat radiated per unit time from the surface of active lava flows (the "thermal proxy"). Although widely used, the physical basis of this proxy is still debated. In the present contribution, lava flows are approached as open, dissipative systems that, under favorable conditions, can attain a non-equilibrium stationary state. In this system framework, the onset, growth, and demise of lava flow units can be explained as a self-organization phenomenon characterized by a given temporal frequency defined by the average life span of active lava flow units. Here, I review empirical, physical, and experimental models designed to understand and link the flow of mass and energy through a lava flow system, as well as measurements and observations that support a "real-world" view. I set up two systems: active lava flow system (or ALFS) for flowing, fluid lava and a lava deposit system for solidified, cooling lava. The review highlights surprising similarities between lava flows and electric currents, which typically work under stationary conditions. An electric current propagates almost instantaneously through an existing circuit, following the Kirchhoff law (a least dissipation principle). Flowing lavas, in contrast, build up a slow-motion "lava circuit" over days, weeks, or months by following a gravity-driven path down the steepest slopes. Attainment of a steady-state condition is hampered (and the classic thermal proxy does not hold) if the supply stops before completion of the "lava circuit." Although gravity determines initial flow path and extension, the least dissipation principle means that subsequent evolution of mature portions of the active lava flow system is controlled by increasingly insulated conditions.

  5. The Application of the DMC Strategy and Experience to Provide Additional Support to a European Global Monitoring System Programme (United States)

    Cutter, M. A.; Giwa, S. C.; Graham, K. L.; Hodgson, D. J.; Mackin, S.; Sweeting, M. N.; Vanotti, M.; Regan, A.


    Surrey Satellite Technology Ltd has reviewed the ability of small satellites to provide additional capability to the presently defined Global Monitoring for Environment and Security (GMES) space segment, allowing the broadest set of user requirements to be met. User- focused services have been compared with the instruments defined for the currently proposed Sentinels. SSTL has developed the Disaster Monitoring Constellation (DMC) of small satellites at a very low cost, which provide land-focused data products in the visible wavebands with daily access capability. The study undertaken by SSTL for the European Space Agency analysed the DMC operational concept in a GMES context, reviewing a range of possible services with different payload configurations on small satellite platforms. One concept was selected and an appropriate payload definition derived. The chosen mission concept was based on the provision of near time operational oceanography information using a constellation of small satellites. The aim is to provide sea surface height, significant wave height and wind speed.

  6. Effects of a statewide carve out on spending and access to substance abuse treatment in Massachusetts, 1992 to 1996. (United States)

    Shepard, D S; Daley, M; Ritter, G A; Hodgkin, D; Beinecke, R H


    We studied the first four years of the statewide carve out for Medicaid enrollees in Massachusetts to assess its effect on access and spending. Using administrative data, we compared the state's fiscal years 1992 (the last year before the carve out) through 1996 (the final year of the state's first carve-out vendor, MHMA). We evaluated the effect on spending by converting expenditures to constant (1996) prices using the medical services component of the Consumer Price Index for Boston and standardizing directly for the changing proportion of Medicaid enrollees who were disabled. We measured access through the penetration rate (proportion of enrollees using at least one substance abuse treatment service in a year . Overall this carve out reduced real adjusted spending per enrollee by 40 percent from 1992 to 1996. At the same time, access improved from 38 to 43 unduplicated users per 1,000 enrollees per year f rom 1992 to 1996, adjusted for changes in Medicaid eligibility. these savings were achieved by a shift in the type of 24-h our services (hospital, detox, and residential treatment ). In 1992, 87 percent of these services were provided in hospital compared to only 1 percent in 1996. the reductions were achieved within the first two years of the carve out and sustained, but not enhanced, in subsequent years. By arranging Medicaid reimbursement for lower levels of care and limiting use of the most expensive settings, managed care achieved substantial cost reductions over the first four years in Massachusetts.

  7. Development of a new statewide eating disorder service: The role of evidence in a real world setting. (United States)

    Wade, Tracey; Vall, Eva; Kuek, Angeline; Altman, Emma; Long, Randall; Mannion, John


    There are three aims of this report. First, to describe how research evidence informed a service development rationale for a new statewide eating disorder service (SEDS) for people aged 15 years and older. Second, to examine the profile of people accessing SEDS in the first 2 years of its operation with respect to the three broad dimensions: illness stage, illness severity, and previous history of treatment. Finally, to examine which patient characteristics resulted in the recommendation of ongoing treatment contact with SEDS. Over a 2-year period (July 2014 to July 2016) 292 people were referred to the service, 171 (59%) who consented to have their data used in research. Half of the referrals related to anorexia nervosa (AN; 51.2%), with the remainder split between bulimia nervosa (25.3%) and other specified feeding and eating disorders (23.5%); 65.9% had previously received treatment for an eating disorder. The initial information about the service was typically provided by the general practitioner/primary care physician. Compared with any other eating disorder diagnosis, people with AN were three times more likely to be recommended to retain treatment contact with SEDS. Service development informed by research evidence, clinical expertise, and consideration of patients' characteristics, values, and circumstances, allows for a flexible but accountable development strategy. © 2017 Wiley Periodicals, Inc.

  8. Methodical approaches to providing sustainable development of the transport industry management system based on self-organization (United States)

    Belyantseva, Oksana; Panenkov, Andrey; Safonova, Nataliya


    Current conditions of the cognitive economy formation demand to take into account the leading role of information, knowledge and human capital in the development of the transport industry management system. The article substantiates the conceptual approach to the self-organization of a management system on the basis of innovative changes. Human capital is the key aspect of self-organization, so the directions of improving the workforce quality are justified. Basing on the information-innovative genesis of the process of self-organization, the authors justified the necessity of preventing asymmetric information. For this pupose the actions against the resistance to innovations were proposed. The implementation of certain measures contributes to the effective development of the transport management system.

  9. Lessons learnt from an international intercomparison of national network systems used to provide early warning of a nuclear accident

    DEFF Research Database (Denmark)

    Saez-Vergara, J.C.; Thompson, I.M.G.; Funck, E.


    radiation quantities were measured by the systems (namely exposure, air kerma and ambient dose equivalent), the initial analysis of the intercomparison results was made in terms of the quantity air kerma rate. This report completes the analysis of the results and these are given in terms of air kerma rate......As part of the European Research Council's Fourth Framework Programme, the EURADOS Action Group on Monitoring of External Exposures held an intercomparison of national network systems. This took place during May/June 1999 at the Riso Natural Environmental Radiation Measurement Station in Denmark...... and at the Underground Laboratory for Dosimetry and Spectrometry (UDO) of the Physikalisch-Technische Bundesanstalt (PTB) in Germany. The network systems are used continuously to monitor radiation levels throughout a country in order to give early warning of nuclear accidents having transboundary implications...

  10. Providing Health Sciences Services in a Joint-Use Distributed Learning Library System: An Organizational Case Study. (United States)

    Enslow, Electra; Fricke, Suzanne; Vela, Kathryn


    The purpose of this organizational case study is to describe the complexities librarians face when serving a multi-campus institution that supports both a joint-use library and expanding health sciences academic partnerships. In a system without a centralized health science library administration, liaison librarians are identifying dispersed programs and user groups and collaborating to define their unique service and outreach needs within a larger land-grant university. Using a team-based approach, health sciences librarians are communicating to integrate research and teaching support, systems differences across dispersed campuses, and future needs of a new community-based medical program.

  11. Developing a state-wide infrastructure for safe sleep promotion. (United States)

    Ahlers-Schmidt, Carolyn R; Schunn, Christy; Kuhlmann, Stephanie; Kuhlmann, Zachary; Engel, Matthew


    Sleep-related deaths are the third leading cause of infant death in Kansas. This manuscript describes implementation of an infrastructure of regional trainers to educate on the American Academy of Pediatrics safe sleep recommendations. Prospective evaluation of training program on knowledge transfer. Instructors were recruited from throughout the state of Kansas and trained to provide safe sleep education in their communities. Instructors were a mix of healthcare workers and community members. Their trainees encompassed both professionals and caregivers. Instructors attended a 2-day training, including completing 18-item pre and post-training knowledge tests, a training evaluation survey, and performing a portion of the structured safe sleep presentation and crib demonstration for feedback. Instructors were evaluated before and after training. After conducting trainings in their region, instructors submitted trainees' pre and post-test results. Scores were compared using t-test. Twenty-three instructors were trained. Scores averaged 13.5 (SD=2.4) for the pre-test and 15.3 (SD=2.4) for the post-test. Those scoring sleep education at 21 events to a total of 378 trainees. Trainee scores averaged 11.4 (SD=2.7) on the pre-test and increased to 13.9 (SD=2.5) on the post-test (Psleep instructors can be trained to disseminate safe sleep guidelines; however, only half provided at least 1 training within 1 year. Future recommendations include over-recruiting potential instructors, incorporating trainings into existing positions or otherwise incentivizing trainers. Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

  12. Putting the "th" in Tenths: Providing Place-Value Labels Helps Reveal the Structure of Our Base-10 Numeral System (United States)

    Loehr, Abbey M.; Rittle-Johnson, Bethany


    Research has demonstrated that providing labels helps children notice key features of examples. Much less is known about how different labels impact children's ability to make inferences about the structure underlying mathematical notation. We tested the impact of labeling decimals such as 0.34 using formal place-value labels ("3 tenths and 4…

  13. Quantifying the role of National Forest system lands in providing surface drinking water supply for the Southern United States (United States)

    Peter Caldwell; Corinne Muldoon; Chelcy Ford-Miniat; Erika Cohen; Suzanne Krieger; Ge Sun; Steven McNulty; Paul V. Bolstad


    Forests and water are inextricably linked, and people are dependent on forested lands to provide clean, reliable water supplies for drinking and to support local economies. These water supplies are at risk of degradation from a growing population, continued conversion of forests to other land uses, and climate change. Given the variety of threats to surface water, it...

  14. Transphosphorylation of E. coli proteins during production of recombinant protein kinases provides a robust system to characterize kinase specificity (United States)

    Protein kinase specificity is of fundamental importance to pathway regulation and signal transduction. Here, we report a convenient system to monitor the activity and specificity of recombinant protein kinases expressed in E.coli. We apply this to the study of the cytoplasmic domain of the plant rec...


    Directory of Open Access Journals (Sweden)

    S. A. Peredkov


    Full Text Available Objectives. The aim of the study is to conduct an analysis of thermophysical processes in a thermoelectric system used for  providing the thermal regime of electronic equipment located in a cabinet. A cabinet design and thermoelectric system for efficient  heat removal from the condensing part of the heat pipe are  proposed. An additional advantage of the proposed design is the  obviation of significant additional power consumption requirement  for regulating the temperature of radio electronic equipment stored  in the cabinet.A distinctive feature of the constructive realisation is  the presence of an intermediate heat removal.Methods. The three-dimensionality of the problem and mixed boundary conditions lead to the need to develop a calculation  of heat transfer in the elements of the construction of the  thermoelectric system. The numerical calculation method is based on the method of energy balances. The analysis of the heat regimes of  the intermediate heat removal is performed on the basis of a mathematical model for a locally-heated and -cooled restricted plate.Results. A cabinet design and a thermoelectric system for efficient  heat removal from the condensing part of the heat pipe are  proposed. A distinctive feature of the constructive realisation is the  presence of an intermediate heat removal.Conclusion.The capacity of the intermediate heat removal for given dimensions and temperature of the source is weakly affected by its  thickness (in constructively reasonable limits, as well as the  temperature and area of the absorbing side of the thermoelectric  module; the total heat output from the heat source is determined by the dimensions and heat exchange conditions on the free surface of the intermediate heat removal, as well as by the temperature and dimensions of the heat absorbing side of the thermoelectric module. The use of an intermediate heat removal can significantly reduce the thermal load on


    Directory of Open Access Journals (Sweden)

    Svitlana Kropelnytska


    Full Text Available The article systematizes approaches to financial support and social adaptation of internally displaced persons (IDPs as well as their social protection, that is based on the analysis of legal framework, situation and sources of financial and social support to the EU member states of the IDPs in Ukraine and their social security. The study of the IDPs situation and the assessment of the required resources are based on a cluster approach, which defines optimal set of problem areas requiring priority social and financial support. This allowed to develop practical recommendations for the development of a comprehensive, transparent and unified policy of social protection through the development of a conceptual framework for the financial and economic provision of social protection IDPs, which will be the basic solution to the problems of social and financial provision forced migrants in Ukraine. Key words: forced migrants, internally displaced persons, cluster, social policy, social protection, social providing, financial providing.

  17. Predictors of Suicidal Ideation in a Statewide Sample of Transgender Individuals. (United States)

    Rood, Brian A; Puckett, Julia A; Pantalone, David W; Bradford, Judith B


    Transgender individuals experience violence and discrimination, which, in addition to gender transitioning, are established correlates of psychological distress. In a statewide sample of 350 transgender adults, we investigated whether a history of violence and discrimination increased the odds of reporting lifetime suicidal ideation (SI) and whether differences in SI were predicted by gender transition status. Violence, discrimination, and transition status significantly predicted SI. Compared with individuals with no plans to transition, individuals with plans or who were living as their identified gender reported greater odds of lifetime SI. We discuss implications for SI disparities using Meyer's minority stress model.

  18. An Analysis of Statewide Adoption Rates of Building Energy Code by Local Jurisdictions

    Energy Technology Data Exchange (ETDEWEB)

    Cort, Katherine A.; Butner, Ryan S.


    The purpose of this study is to generally inform the U.S. Department of Energy’s Building Energy Codes Program of the local, effective energy code adoption rate for a sample set of 21 states, some which have adopted statewide codes and some that have not. Information related to the residential energy code adoption process and status at the local jurisdiction was examined for each of the states. Energy code status information was gathered for approximately 2,800 jurisdictions, which effectively covered approximately 80 percent of the new residential building construction in the 21 states included in the study.

  19. Physicians' assessments of their ability to provide high-quality care in a changing health care system. (United States)

    Reschovsky, J; Reed, M; Blumenthal, D; Landon, B


    With the growth of managed care, there are increasing concerns but inconclusive evidence regarding deterioration in the quality of medical care. To assess physicians' perceptions of their ability to provide high-quality care and explore what factors, including managed care, affect these perceptions. Bivariate and multivariate analyses of the Community Tracking Study Physician Survey, a cross-sectional, nationally representative telephone survey of 12,385 patient-care physicians conducted in 1996/1997. The response rate was 65%. Physicians who provide direct patient care for > or =20 h/wk, excluding federal employees and those in selected specialties. Level of agreement with 4 statements: 1 regarding overall ability to provide high-quality care and 3 regarding aspects of care delivery associated with quality. Between 21% and 31% of physicians disagreed with the quality statements. Specialists were generally 50% more likely than primary care physicians to express concerns about their ability to provide quality care. Generally, the number of managed care contracts, but not the percent of practice revenue from managed care, was negatively associated with perceived quality. Market-level managed care penetration independently affected physicians' perceptions. Practice setting affected perceptions of quality, with physicians in group settings less likely to express concerns than physicians in solo and 2-physician practices. Specific financial incentives and care management tools had limited positive or negative associations with perceived quality. Managed care involvement is only modestly associated with reduced perceptions of quality among physicians, with some specific tools enhancing perceived quality. Physicians may be able to moderate some negative effects of managed care by altering their practice arrangements.

  20. Provider- and patient-related determinants of diabetes self-management among recent immigrants: Implications for systemic change. (United States)

    Hyman, Ilene; Shakya, Yogendra; Jembere, Nathaniel; Gucciardi, Enza; Vissandjée, Bilkis


    To examine provider- and patient-related factors associated with diabetes self-management among recent immigrants. Demographic and experiential data were collected using an international survey instrument and adapted to the Canadian context. The final questionnaire was pretested and translated into 4 languages: Mandarin, Tamil, Bengali, and Urdu. Toronto, Ont. A total of 130 recent immigrants with a self-reported diagnosis of type 2 diabetes mellitus who had resided in Canada for 10 years or less. Diabetes self-management practices (based on a composite of 5 diabetes self-management practices, and participants achieved a score for each adopted practice); and the quality of the provider-patient interaction (measured with a 5-point Likert-type scale that consisted of questions addressing participants' perceptions of discrimination and equitable care). A total of 130 participants in this study were recent immigrants to Canada from 4 countries of origin-Sri Lanka, Bangladesh, Pakistan, and China. Two factors were significant in predicting diabetes self-management among recent immigrants: financial barriers, specifically, not having enough money to manage diabetes expenses (P = .0233), and the quality of the provider-patient relationship (P = .0016). Participants who did not have enough money to manage diabetes were 9% less likely to engage in self-management practices; and participants who rated the quality of their interactions with providers as poor were 16% less likely to engage in self-management practices. Financial barriers can undermine effective diabetes self-management among recent immigrants. Ensuring that patients feel comfortable and respected and that they are treated in culturally sensitive ways is also critical to good diabetes self-management. Copyright© the College of Family Physicians of Canada.

  1. Renewable energy sources in providing services to the system; Fontes renovaveis no fornecimento de servicos ao sistema

    Energy Technology Data Exchange (ETDEWEB)

    Buehner, Volker [EUS GmbH/Kisters Group (Germany); Buchholz, Bernd Michael [NTB Technoservice (Germany)


    Today the participation of renewable energy sources in the energy and power reserve are vital to the stability of the electrical system. This article presents a study by the German Society for Energy Engineering, which proposes a model to increase the participation of renewable in the supply of ancillary services. In this model, the so-called 'virtual power plants' are identified as the key to a profitable market access.

  2. Ultrasound indoor positioning system based on a low-power wireless sensor network providing sub-centimeter accuracy. (United States)

    Medina, Carlos; Segura, José Carlos; De la Torre, Ángel


    This paper describes the TELIAMADE system, a new indoor positioning system based on time-of-flight (TOF) of ultrasonic signal to estimate the distance between a receiver node and a transmitter node. TELIAMADE system consists of a set of wireless nodes equipped with a radio module for communication and a module for the transmission and reception of ultrasound. The access to the ultrasonic channel is managed by applying a synchronization algorithm based on a time-division multiplexing (TDMA) scheme. The ultrasonic signal is transmitted using a carrier frequency of 40 kHz and the TOF measurement is estimated by applying a quadrature detector to the signal obtained at the A/D converter output. Low sampling frequencies of 17.78 kHz or even 12.31 kHz are possible using quadrature sampling in order to optimize memory requirements and to reduce the computational cost in signal processing. The distance is calculated from the TOF taking into account the speed of sound. An excellent accuracy in the estimation of the TOF is achieved using parabolic interpolation to detect of maximum of the signal envelope at the matched filter output. The signal phase information is also used for enhancing the TOF measurement accuracy. Experimental results show a root mean square error (rmse) less than 2 mm and a standard deviation less than 0.3 mm for pseudorange measurements in the range of distances between 2 and 6 m. The system location accuracy is also evaluated by applying multilateration. A sub-centimeter location accuracy is achieved with an average rmse of 9.6 mm.

  3. Ultrasound Indoor Positioning System Based on a Low-Power Wireless Sensor Network Providing Sub-Centimeter Accuracy

    Directory of Open Access Journals (Sweden)

    Ángel De la Torre


    Full Text Available This paper describes the TELIAMADE system, a new indoor positioning system based on time-of-flight (TOF of ultrasonic signal to estimate the distance between a receiver node and a transmitter node. TELIAMADE system consists of a set of wireless nodes equipped with a radio module for communication and a module for the transmission and reception of ultrasound. The access to the ultrasonic channel is managed by applying a synchronization algorithm based on a time-division multiplexing (TDMA scheme. The ultrasonic signal is transmitted using a carrier frequency of 40 kHz and the TOF measurement is estimated by applying a quadrature detector to the signal obtained at the A/D converter output. Low sampling frequencies of 17.78 kHz or even 12.31 kHz are possible using quadrature sampling in order to optimize memory requirements and to reduce the computational cost in signal processing. The distance is calculated from the TOF taking into account the speed of sound. An excellent accuracy in the estimation of the TOF is achieved using parabolic interpolation to detect of maximum of the signal envelope at the matched filter output. The signal phase information is also used for enhancing the TOF measurement accuracy. Experimental results show a root mean square error (rmse less than 2 mm and a standard deviation less than 0.3 mm for pseudorange measurements in the range of distances between 2 and 6 m. The system location accuracy is also evaluated by applying multilateration. A sub-centimeter location accuracy is achieved with an average rmse of 9.6 mm.

  4. Capability of a Mobile Monitoring System to Provide Real-Time Data Broadcasting and Near Real-Time Source Attribution (United States)

    Erickson, M.; Olaguer, J.; Wijesinghe, A.; Colvin, J.; Neish, B.; Williams, J.


    It is becoming increasingly important to understand the emissions and health effects of industrial facilities. Many areas have no or limited sustained monitoring capabilities, making it difficult to quantify the major pollution sources affecting human health, especially in fence line communities. Developments in real-time monitoring and micro-scale modeling offer unique ways to tackle these complex issues. This presentation will demonstrate the capability of coupling real-time observations with micro-scale modeling to provide real-time information and near real-time source attribution. The Houston Advanced Research Center constructed the Mobile Acquisition of Real-time Concentrations (MARC) laboratory. MARC consists of a Ford E-350 passenger van outfitted with a Proton Transfer Reaction Mass Spectrometer (PTR-MS) and meteorological equipment. This allows for the fast measurement of various VOCs important to air quality. The data recorded from the van is uploaded to an off-site database and the information is broadcast to a website in real-time. This provides for off-site monitoring of MARC's observations, which allows off-site personnel to provide immediate input to the MARC operators on how to best achieve project objectives. The information stored in the database can also be used to provide near real-time source attribution. An inverse model has been used to ascertain the amount, location, and timing of emissions based on MARC measurements in the vicinity of industrial sites. The inverse model is based on a 3D micro-scale Eulerian forward and adjoint air quality model known as the HARC model. The HARC model uses output from the Quick Urban and Industrial Complex (QUIC) wind model and requires a 3D digital model of the monitored facility based on lidar or industrial permit data. MARC is one of the instrument platforms deployed during the 2014 Benzene and other Toxics Exposure Study (BEE-TEX) in Houston, TX. The main goal of the study is to quantify and explain the

  5. Adaptation of Fusarium oxysporum and Fusarium dimerum to the specific aquatic environment provided by the water systems of hospitals. (United States)

    Steinberg, Christian; Laurent, Julie; Edel-Hermann, Véronique; Barbezant, Marie; Sixt, Nathalie; Dalle, Frédéric; Aho, Serge; Bonnin, Alain; Hartemann, Philippe; Sautour, Marc


    Members of the Fusarium group were recently detected in water distribution systems of several hospitals in the world. An epidemiological investigation was conducted over 2 years in hospital buildings in Dijon and Nancy (France) and in non-hospital buildings in Dijon. The fungi were detected only within the water distribution systems of the hospital buildings and also, but at very low concentrations, in the urban water network of Nancy. All fungi were identified as Fusarium oxysporum species complex (FOSC) and Fusarium dimerum species complex (FDSC) by sequencing part of the translation elongation factor 1-alpha (TEF-1α) gene. Very low diversity was found in each complex, suggesting the existence of a clonal population for each. Density and heterogeneous distributions according to buildings and variability over time were explained by episodic detachments of parts of the colony from biofilms in the pipes. Isolates of these waterborne populations as well as soilborne isolates were tested for their ability to grow in liquid medium in the presence of increasing concentrations of sodium hypochlorite, copper sulfate, anti-corrosion pipe coating, at various temperatures (4°-42 °C) and on agar medium with amphotericin B and voriconazole. The waterborne isolates tolerated higher sodium hypochlorite and copper sulfate concentrations and temperatures than did soilborne isolates but did not show any specific resistance to fungicides. In addition, unlike waterborne isolates, soilborne isolates did not survive in water even supplemented with glucose, while the former developed in the soil as well as soilborne isolates. We concluded the existence of homogeneous populations of FOSC and FDSC common to all contaminated hospital sites. These populations are present at very low densities in natural waters, making them difficult to detect, but they are adapted to the specific conditions offered by the complex water systems of public hospitals in Dijon and Nancy and probably other

  6. Prototype house provides test case for energy-efficient systems: Mitchell Homes, Pensacola, Florida; Building America Project summary fact sheet

    Energy Technology Data Exchange (ETDEWEB)

    Hendron, B.


    The Carbelle prototype house is a new design produced under the U.S. Department of Energy's Building America program. Working with other members of the Consortium for Advanced Residential Buildings, Mitchell Homes developed the Carbelle as an energy-efficient upgrade to one of their standard models. By treating all design aspects of the house as a system and involving all stakeholders in the process, Mitchell expects to decrease on-site energy use for space heating and cooling by as much as 40% compared to their typical construction.


    Directory of Open Access Journals (Sweden)

    V.M. Bakiko


    Full Text Available The model of anti-interference protective filter with due account taken of stray parameters of elements is developed. The algorithm of functioning of anti-interference protective filter with integrated system management, which forms the new class of intellectual devices of security of informative resources on the circles of power supply, is offered. The analysis of possibilities of dynamic magnetic biasing of direct current of pericardium of throttle with the use of latitudinal impulsive modulation is experimentally conducted. The efficiency of hardware-software complex of security of informative resources is explored.

  8. Appraising the Early-est earthquake monitoring system for tsunami alerting at the Italian Candidate Tsunami Service Provider (United States)

    Bernardi, F.; Lomax, A.; Michelini, A.; Lauciani, V.; Piatanesi, A.; Lorito, S.


    In this paper we present and discuss the performance of the procedure for earthquake location and characterization implemented in the Italian Candidate Tsunami Service Provider at the Istituto Nazionale di Geofisica e Vulcanologia (INGV) in Rome. Following the ICG/NEAMTWS guidelines, the first tsunami warning messages are based only on seismic information, i.e., epicenter location, hypocenter depth, and magnitude, which are automatically computed by the software Early-est. Early-est is a package for rapid location and seismic/tsunamigenic characterization of earthquakes. The Early-est software package operates using offline-event or continuous-real-time seismic waveform data to perform trace processing and picking, and, at a regular report interval, phase association, event detection, hypocenter location, and event characterization. Early-est also provides mb, Mwp, and Mwpd magnitude estimations. mb magnitudes are preferred for events with Mwp ≲ 5.8, while Mwpd estimations are valid for events with Mwp ≳ 7.2. In this paper we present the earthquake parameters computed by Early-est between the beginning of March 2012 and the end of December 2014 on a global scale for events with magnitude M ≥ 5.5, and we also present the detection timeline. We compare the earthquake parameters automatically computed by Early-est with the same parameters listed in reference catalogs. Such reference catalogs are manually revised/verified by scientists. The goal of this work is to test the accuracy and reliability of the fully automatic locations provided by Early-est. In our analysis, the epicenter location, hypocenter depth and magnitude parameters do not differ significantly from the values in the reference catalogs. Both mb and Mwp magnitudes show differences to the reference catalogs. We thus derived correction functions in order to minimize the differences and correct biases between our values and the ones from the reference catalogs. Correction of the Mwp

  9. Hospital catering systems and their impact on the sensorial profile of foods provided to older patients in the UK. (United States)

    Mavrommatis, Yiannis; Moynihan, Paula J; Gosney, Margot A; Methven, Lisa


    Impaired sensorial perception is very common in older people and low sensorial quality of foods is associated with decreased appetite and dietary intake. Hospital undernutrition in older patients could be linked to sensorial quality of hospital food if the quality were low or inappropriate for older people. The aim of this study was to examine changes in the sensorial quality of different foods that occur as a result of the food journey (i.e. freezing, regeneration, etc.) in the most common hospital catering systems in the UK. A trained sensory panel assessed sensorial descriptors of certain foods with and without the hospital food journey as it occurs in the in-house and cook/freeze systems. The results showed effects of the food journey on a small number of sensorial descriptors related to flavour, appearance and mouthfeel. The majority of these effects were due to temperature changes, which caused accumulation of condensation. A daily variation in sensorial descriptors was also detected and in some cases it was greater than the effect of the food journey. This study has shown that changes occur in the sensory quality of meals due to hospital food journeys, however these changes were small and are not expected to substantially contribute to acceptability or have a major role in hospital malnutrition. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Knowledge about food classification systems and value attributes provides insight for understanding complementary food choices in Mexican working mothers. (United States)

    Rodriguez-Oliveros, Maria Guadalupe; Bisogni, Carole A; Frongillo, Edward A


    Knowledge about mothers' perceptions of food classification and values about complementary feeding is necessary for designing educational and food supply interventions targeted to young children. To determine classification, attributes, and consumption/preparation routines of key complementary foods, 44 mothers of children attributes exercises. Hierarchical clustering showed that mothers identified nine classes of key foods, including milk derivatives, complements, junk food, infant products, chicken parts, and other meats. From multidimensional scaling, mothers used three primary classification systems: food groups, food introduction stages, and food processing. Secondary classification systems were healthy-junk, heavy-light, hot-cold, good-bad fat, and main dish-complement. Child health and nutrition, particularly vitamin content, were salient attributes. Fruits and vegetables were preferred for initiating complementary feeding on the second month of age. Consumption of guava, mango, and legumes, however, was associated with digestive problems (empacho). Red meats were viewed as cold-type, heavy, and hard, not suitable for young children, but right for toddlers. Chicken liver was considered nutritious but dirty and bitter. Egg and fish were viewed as a vitamin source but potentially allergenic. Mothers valued vitamin content, flavor, and convenience of processed foods, but some were suspicious about expiration date, chemical and excessive sugar content and overall safety of these foods. Mothers' perceptions and values may differ from those of nutritionists and program designers, and should be addressed when promoting opportune introduction of complementary foods in social programs. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. A robotic welding system using image processing techniques and a CAD model to provide information to a multi-intelligent decision module


    Sanders, David; Lambert, Gareth; Graham-Jones, J; Tewkesbury, Giles; Onuh, S.; Ndzi, David; Ross, Carl


    Design/methodology/approach – A pattern recognition system recognizes shipbuilding parts using shape contour information. Fourier-descriptors provide information and neural networks make decisions about shapes. Findings – The system has distinguished between various parts and programs have been generated so that the methods have proved to be valid approaches. Practical implications – The new system used a rudimentary curvature metric that measured Euclidean distance between two points in a wi...


    Directory of Open Access Journals (Sweden)

    V. V. Gromov


    Full Text Available Topicality article is to determine the composition of the technological elements of the strategic planning system, the interaction of which is aimed at achieving the planned economic results in the changing factors influence macro microenvironments on the activities of institutions and economic activities of services. The articles structurally is made on the basis of respect for the logical sequence of interactions of technological elements of strategic planning and combat their negative factors of external and internal environment. Active interaction of technological elements of strategic planning tools is to ensure long-term development planning authorities of economic entities, economic activities service sector for sustainable economic growth. Contribution of the author in the scope of this article is to generalize the definition of the target composition and installation of technological elements of strategic planning and development institutions and industry components of the service sector.

  13. Monitoring and use of antimycotic (micafungin for systemic use provided by the pharmacy of Marsala Hospital, Italy

    Directory of Open Access Journals (Sweden)

    Fabio Venturella


    Full Text Available Micafungin is an antimycotic drug and represents an important addition to the available therapies for the treatment of systemic fungal infections. Micafungin is used: in the treatment of invasive candidiasis, oesophageal and prophylaxis of Candida infections. It inhibits, in a non-competitive way, the synthesis of 1,3-β-D-glucan, a component of fungal cell wall and is rapidly distributed into the tissues. It has a high-rate respectful bond with plasma protein, which is independent from the concentration of the drug. It is metabolized through the liver, being not subject to intense metabolic transformations until the excretion. There is no evidence of systemic accumulation after repeated use. The steady-state is reached in 4-5 days. Medical records examined at the pharmacy of Marsala Hospital highlight that, from 01/06/2014 to 01/08/2014, in this hospital 12 vials were used by the hospitalized patients in the Department of Intensive Care: 8 patients between 75 and 83 years old had a body weight (BW higher than 40 kg; 3 patients between 40 and 60 years of age had a BW higher than 40 kg, and one 17 year-old patient had a BW of 40 kg. Two patients needed a dose increase, while for the other 10 patients the first dose resulted sufficient. Mycamine® was used for the treatment of hypovolemic post-operative shock. The most recorded adverse reactions were anemia, hypokalemia, hypomagnesemia, phlebitis, nausea, liver problems. Given the different weight of the subjects, the dosage was different.

  14. A crisis of credibility: professionals' concerns about the psychiatric care provided to clients of the child welfare system. (United States)

    McMillen, J Curtis; Fedoravicius, Nicole; Rowe, Jill; Zima, Bonnie T; Ware, Norma


    This study examined child welfare and mental health professionals' views of the quality of psychiatric services received by consumers of the child welfare system and explored root causes of perceived quality problems. One hundred and thirty child welfare, mental health and court professionals participated in qualitative interviews individually or in groups. Data analyses identified perceived problems in quality and perceived causes of quality problems. Participants in member checking groups were then asked to comment on and further clarify the results. The participants reported concerns related to overuse of psychotropic medication, overmedicated children, short inpatient stays, and continuity of psychiatric care. Overuse of psychotropic medications and overmedication were perceived to be driven by short evaluations, liability concerns, short inpatient stays and a lack of clinical feedback to psychiatrists from child welfare partners. Medicaid reimbursement policies were at the heart of several quality concerns. These problems contributed to a distrust of psychiatric practices among child welfare professionals. These findings underscore the adverse effects of modern marketplace medicine coupled with low Medicaid reimbursement rates on quality of care for vulnerable groups. Child welfare and mental health professionals and their associated stakeholders may together possess substantial clout to advocate for a reimbursement system and structure that promotes quality service. The findings also point to a crisis of credibility toward psychiatric practice among social service and other non-psychiatrist mental health professionals. Efforts are needed to increase the capacity for psychiatrists and child welfare professionals to communicate effectively with each other and for psychiatrists to receive the information that they need from their child welfare partners to ensure accurate diagnosis and effective treatment.

  15. A GIS-Enabled, Michigan-Specific, Hierarchical Groundwater Modeling and Visualization System (United States)

    Liu, Q.; Li, S.; Mandle, R.; Simard, A.; Fisher, B.; Brown, E.; Ross, S.


    Efficient management of groundwater resources relies on a comprehensive database that represents the characteristics of the natural groundwater system as well as analysis and modeling tools to describe the impacts of decision alternatives. Many agencies in Michigan have spent several years compiling expensive and comprehensive surface water and groundwater inventories and other related spatial data that describe their respective areas of responsibility. However, most often this wealth of descriptive data has only been utilized for basic mapping purposes. The benefits from analyzing these data, using GIS analysis functions or externally developed analysis models or programs, has yet to be systematically realized. In this talk, we present a comprehensive software environment that allows Michigan groundwater resources managers and frontline professionals to make more effective use of the available data and improve their ability to manage and protect groundwater resources, address potential conflicts, design cleanup schemes, and prioritize investigation activities. In particular, we take advantage of the Interactive Ground Water (IGW) modeling system and convert it to a customized software environment specifically for analyzing, modeling, and visualizing the Michigan statewide groundwater database. The resulting Michigan IGW modeling system (IGW-M) is completely window-based, fully interactive, and seamlessly integrated with a GIS mapping engine. The system operates in real-time (on the fly) providing dynamic, hierarchical mapping, modeling, spatial analysis, and visualization. Specifically, IGW-M allows water resources and environmental professionals in Michigan to: * Access and utilize the extensive data from the statewide groundwater database, interactively manipulate GIS objects, and display and query the associated data and attributes; * Analyze and model the statewide groundwater database, interactively convert GIS objects into numerical model features

  16. The Rhode Island Consortium for Autism Research and Treatment (RI-CART): a new statewide autism collaborative. (United States)

    Gerber, Alan; Morrow, Eric; Sheinkopf, Stephen J; Anders, Thomas


    Autism is a neurodevelopmental disorder characterized by core deficits in social interaction, language and repetitive behaviors. The need for services is rising sharply as the number of children identified with autism increases. The Rhode Island Consortium for Autism Research and Treatment (RI-CART) was founded in 2009 with the goal of increasing communication among autism researchers throughout the state and improving treatment for children with autism. RI-CART members have several exciting projects in progress, with its larger aim being the creation of a statewide research registry. A statewide registry would benefit research in Rhode Island and allow for larger collaborations nationally.

  17. Noninvasive Method for a Statewide Survey of Eastern Hellbenders Cryptobranchus alleganiensis Using Environmental DNA

    Directory of Open Access Journals (Sweden)

    Amy J. Santas


    Full Text Available Traditional survey methods of aquatic organisms may be difficult, lengthy, and destructive to the habitat. Some methods are invasive and can be harmful to the target species. The use of environmental DNA (eDNA has proven to be effective at detecting low population density aquatic macroorganisms. This study refined the technique to support statewide surveys. Hellbender presence was identified by using hellbender specific primers (cytochrome b gene to detect eDNA in water samples collected at rivers, streams and creeks in Ohio and Kentucky with historical accounts of the imperiled eastern hellbender (Cryptobranchus a. alleganiensis. Two sampling protocols are described; both significantly reduced the amount of water required for collection from the previously described 6 L collection. Two-liter samples were adequate to detect hellbender presence in natural waterways where hellbenders have been previously surveyed in both Ohio and Kentucky—1 L samples were not reliable. DNA extracted from 3 L of water collected onto multiple filters (1 L/filter could be combined and concentrated through ethanol precipitation, supporting amplification of hellbender DNA and dramatically reducing the filtration time. This method improves the efficiency and welfare implications of sampling methods for reclusive aquatic species of low population density for statewide surveys that involve collecting from multiple watersheds.

  18. Demonstrating the impact and model of care of a Statewide psychiatric intensive care service. (United States)

    Lee, Stuart; Hollander, Yitzchak; Scarff, Lisa; Dube, Ryan; Keppich-Arnold, Sandra; Stafrace, Simon


    To characterise patients and their outcomes following referral to a Statewide psychiatric intensive care service. This study conducted a medical audit for patients referred to the Statewide service during the first four years of operation (2007-2011). Demographics and the presence of alcohol and other drug and forensic comorbidities were documented along with the treatment received prior to and during admission. In the first four years of operation, 58 referrals were received, 41 resulting in admission and seven in secondary consultation delivered to the referring inpatient psychiatry service. Admitted patients were most commonly experiencing a psychotic illness, had high levels of substance comorbidities and antisocial personality traits, required lengthy admissions (mean days = 41.5), and were in most cases successfully discharged back to the referring inpatient psychiatry service or the community. Significant reductions in clinician-rated difficulties measured via the Health of the Nations Outcome Scale were found at discharge, and despite the significant presenting aggression risk, few attempted or actual assaults occurred. Improved outcomes were achieved with patients deemed unsafe for psychiatric care in high dependency units in other Victorian acute mental health services through management by an acute service that has developed special expertise in this area.

  19. Avoiding a knowledge gap in a multiethnic statewide social marketing campaign: is cultural tailoring sufficient? (United States)

    Buchthal, O Vanessa; Doff, Amy L; Hsu, Laura A; Silbanuz, Alice; Heinrich, Katie M; Maddock, Jay E


    In 2007, the State of Hawaii, Healthy Hawaii Initiative conducted a statewide social-marketing campaign promoting increased physical activity and nutrition. The campaign included substantial formative research to develop messages tailored for Hawaii's multiethnic Asian and Pacific Islander populations. The authors conducted a statewide random digital dialing telephone survey to assess the campaign's comparative reach among individuals with different ethnicities and different levels of education and income. This analysis suggests that the intervention was successful in reaching its target ethnic audiences. However, a knowledge gap related to the campaign appeared among individuals with incomes less than 130% of the poverty level and those with less than a high school education. These results varied significantly by message and the communication channel used. Recall of supermarket-based messages was significantly higher among individuals below 130% of the poverty level and those between 18 and 35 years of age, 2 groups that showed consistently lower recall of messages in other channels. Results suggest that cultural tailoring for ethnic audiences, although important, is insufficient for reaching low-income populations, and that broad-based social marketing campaigns should consider addressing socioeconomic status-related channel preferences in formative research and campaign design.

  20. A Multi-Period Optimization Model for Service Providers Using Online Reservation Systems: An Application to Hotels.

    Directory of Open Access Journals (Sweden)

    Ming Xu

    Full Text Available This paper presents a multi-period optimization model for high margin and zero salvage products in online distribution channels with classifying customers based on number of products required. Taking hotel customers as an example, one is regular customers who reserve rooms for one day, and the other is long term stay (LTS customers who reserve rooms for a number of days. LTS may guarantee a specific amount of demand and generate opportunity income for a certain number of periods, meanwhile with risk of punishment incurred by overselling. By developing an operational optimization model and exploring the effects of parameters on optimal decisions, we suggest that service providers should make decisions based on the types of customers, number of products required, and duration of multi-period to reduce the loss of reputation and obtain more profit; at the same time, multi-period buying customers should buy products early. Finally, the paper conducts a numerical experiment, and the results are consistent with prevailing situations.

  1. A Multi-Period Optimization Model for Service Providers Using Online Reservation Systems: An Application to Hotels (United States)

    Xu, Ming; Jiao, Yan; Li, Xiaoming; Cao, Qingfeng; Wang, Xiaoyang


    This paper presents a multi-period optimization model for high margin and zero salvage products in online distribution channels with classifying customers based on number of products required. Taking hotel customers as an example, one is regular customers who reserve rooms for one day, and the other is long term stay (LTS) customers who reserve rooms for a number of days. LTS may guarantee a specific amount of demand and generate opportunity income for a certain number of periods, meanwhile with risk of punishment incurred by overselling. By developing an operational optimization model and exploring the effects of parameters on optimal decisions, we suggest that service providers should make decisions based on the types of customers, number of products required, and duration of multi-period to reduce the loss of reputation and obtain more profit; at the same time, multi-period buying customers should buy products early. Finally, the paper conducts a numerical experiment, and the results are consistent with prevailing situations. PMID:26147663

  2. A Multi-Period Optimization Model for Service Providers Using Online Reservation Systems: An Application to Hotels. (United States)

    Xu, Ming; Jiao, Yan; Li, Xiaoming; Cao, Qingfeng; Wang, Xiaoyang


    This paper presents a multi-period optimization model for high margin and zero salvage products in online distribution channels with classifying customers based on number of products required. Taking hotel customers as an example, one is regular customers who reserve rooms for one day, and the other is long term stay (LTS) customers who reserve rooms for a number of days. LTS may guarantee a specific amount of demand and generate opportunity income for a certain number of periods, meanwhile with risk of punishment incurred by overselling. By developing an operational optimization model and exploring the effects of parameters on optimal decisions, we suggest that service providers should make decisions based on the types of customers, number of products required, and duration of multi-period to reduce the loss of reputation and obtain more profit; at the same time, multi-period buying customers should buy products early. Finally, the paper conducts a numerical experiment, and the results are consistent with prevailing situations.

  3. Individual, provider, and system risk factors for breast and cervical cancer screening among underserved Black, Latina, and Arab women. (United States)

    Roman, Leeanne; Meghea, Cristian; Ford, Sabrina; Penner, Louis; Hamade, Hiam; Estes, Tamika; Williams, Karen Patricia


    Socioeconomic and racial/ethnic disparities in breast and cervical cancer screening persist. An exploratory study was conducted to better understand co-occurring risk factors in underserved groups that could inform interventions to improve screening adherence. The objective of this study was to examine associations between breast and cervical cancer screening adherence and co-occurring risk factors in three racial/ethnic groups of underserved women. Black, Latina, and Arab women (N=514), ages 21 to 70 years, were enrolled into the Kin Keeper(SM) randomized controlled trial in communities around Detroit, Michigan. We used participant baseline assessments (e.g., demographic characteristics, health literacy) to explore screening risks using an additive approach and multivariate logistic analyses. For black women, having more health literacy risks were associated with reduced odds of a clinical breast exam (CBE), mammogram, and Papanicolaou (Pap) test; more competing priorities were associated with reduced odds of a Pap test; lack of doctor mammogram recommendation was significantly associated with decreased odds of CBE. For Latina women, lack of doctor recommendations were significantly associated with decreased odds of CBE, mammogram, and Pap test. For Arab women, lack of doctor recommendations were significantly associated with decreased odds of CBE, mammogram, and Pap test; more competing priorities were significantly associated with reduced odds of CBE and Pap test. All results were significant at pwomen. Interventions to improve screening should be tailored for racial/ethnic groups with particular attention to competing survival priorities, health literacy risks factors, and provider recommendations.

  4. Disconnected runoff contributing areas: Evidence provided by ancient watershed management systems in arid north-eastern Marmarica (NW-Egypt) (United States)

    Vetter, T.; Rieger, A.-K.; Nicolay, A.


    This study presents the importance of disconnectivity in dryland area runoff demonstrated by manmade water harvesting structures dated to Greco-Roman times. Located on the coastal strip of some 20 km width along the Mediterranean coast of modern northwestern Egypt covering the north-eastern part of the region known in antiquity as Marmarica, the area receives winterly rainfalls of up to 140 mm. Further south, precipitation decreases quickly and desert conditions become more pronounced. Bedrocks are predominantly calcareous, soils are loamy, stony, calcareous, and shallow, except in relief sinks with sedimentary deposits. The land rises from the coast up to 230 m a.s.l. on the Marmarica Plateau in a sequence of zonal northsloping plains and scarps the northern parts of which are dissected and drained by wadis. Agriculturally suitable areas comprise some 9% of the coastal zone and adjacent tablelands. Overland flow controls the discharge dynamics and is the main source of wadi runoff and hence agricultural water supply. The land use pattern is scattered because cropping areas depend mainly on suitability of soils and the generation of runoff harvest, which are closely interrelated because of the arid water and sediment regime. The patchiness of runoff generation increases further south where aridity is higher and topography inhibits greater drainage patterns. The abundance of cisterns, many of them originally Greco-Roman, is strong evidence that tableland overland flows occur and are frequently disconnected from larger drainage systems.

  5. [Providing quality pharmaceutical services in Brazil: items pending the unified health on the Unified Health System's agenda]. (United States)

    Vieira, Fabiola Sulpino


    To identify items on the agenda of Brazil's Unified Health System that are related to the quality of pharmaceutical services and have not yet been implemented. Data were collected from the inspection reports issued by the federal government's controllership office. Inspection reports completed from August 2004-July 2006, available on the Internet, were reviewed. The issues identified were classified into 15 categories. Of the 660 inspections that were carried out, 659 were analyzed (one was unavailable). In 62 cities pharmaceutical assistance services had not been audited, therefore, a the final sample of 597 cities was analyzed (10.7% of Brazil's municipalities). Of these, 90.3% had issues associated with the management of resources or services. In 71% of the municipalities, the reports indicated lack of or deficient inventory control, and in 39%, inadequate storage conditions. A shortage of drugs was observed in 24% of the municipalities. The goals of Brazil's national drug and pharmaceutical assistance policies are far from being met. Quality pharmaceutical services must again be included on the agenda at all three government levels since it is impossible to have effective health care without quality pharmaceutical services.

  6. A Promising Approach to Provide Appropriate Colon Target Drug Delivery Systems of Vancomycin HCL: Pharmaceutical and Microbiological Studies

    Directory of Open Access Journals (Sweden)

    Kadria A. Elkhodairy


    Full Text Available Vancomycin HCl was prepared as orally administered colon target drug delivery tablets for systemic therapy. Tablet matrices containing 10–60% of tablet weight of guar gum (F1–F6 were prepared by direct compression and subjected to in vitro release studies to explore their sustained release in the colon. Various synthetic and natural polymers were incorporated to F6 to modify the drug release rate. Different 15 matrix tablet formulations (F6–F20 were enteric coated with hydroxypropyl methyl cellulose phthalate. F6, F13 and F20 showed promising sustained release results having median dissolution time (MDT values: 8.25, 7.97, and 7.64, respectively. Microbiological assay was performed to test the efficacy of F6, F13, and F20 to inhibit clinical Staphylococcus aureus (SA isolates. Bactericidal activity of F6 was reached after 2, 4, and 24 hours of incubation against MSSA 18, MRSA 29, and MRSA 11 strains, respectively, while it was reached within 6–8 hours in case of F13, and F20 against all strains tested. F13 enhanced log microbial reduction by 1.74, 0.65 and 2.4 CFU/mL compared to F6 while it was 1, 2.57 and 1.57 compared to F20 against MSSA18, MRSA11 and MRSA29, respectively. Vancomycin HCl tablets displayed a promising sustained release in vitro and microbiological inhibitory action on all isolates tested.

  7. Undergraduate Research and Economic Development: A Systems Approach in Wisconsin (United States)

    Van Galen, Dean; Schneider-Rebozo, Lissa; Havholm, Karen; Andrews, Kris


    This chapter presents the state of Wisconsin and the University of Wisconsin System as an ongoing case study for best practices in systematic, intentional, statewide programming and initiatives connecting undergraduate research and economic development.

  8. 34 CFR 303.321 - Comprehensive child find system. (United States)


    ... other State agencies responsible for administering the various education, health, and social service... EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES Program and Service Components of a Statewide System of Early Intervention...

  9. Microarray analysis of siberian ginseng cyclic somatic embryogenesis culture systems provides insight into molecular mechanisms of embryogenic cell cluster generation.

    Directory of Open Access Journals (Sweden)

    Chenguang Zhou

    Full Text Available Four systems of cyclic somatic embryogenesis of Siberian ginseng (Eleutherococcus senticosus Maxim were used to study the mechanism of embryonic cell cluster generation. The first, direct somatic embryo induction (DSEI, generates secondary embryos directly from the primary somatic embryos; the second, direct embryogenic cell cluster induction (DEC, induces embryogenic cell clusters directly from somatic embryos in agar medium. Subsequently, we found that when DEC-derived somatic embryos are transferred to suspension culture or a bioreactor culture, only somatic embryos are induced, and embryogenic cell clusters cannot form. Therefore, these new lines were named DEC cultured by liquid medium (ECS and DEC cultured by bioreactor (ECB, respectively. Transmission electron microscopy showed that DEC epidermal cells contained a variety of inclusions, distinct from other lines. A cDNA library of DEC was constructed, and 1,948 gene clusters were obtained and used as probes. RNA was prepared from somatic embryos from each of the four lines and hybridized to a microarray. In DEC, 7 genes were specifically upregulated compared with the other three lines, and 4 genes were downregulated. EsXTH1 and EsPLT1, which were among the genes upregulated in DEC, were cloned using the rapid amplification of cDNA ends (RACE. Real-time quantitative PCR showed EsXTH1 was more highly expressed in DEC than in other lines throughout the culture cycle, and EsPLT1 expression in DEC increased as culture duration increased, but remained at a low expression level in other lines. These results suggest that EsXTH1 and EsPLT1 may be the essential genes that play important roles during the induction of embryogenic cell clusters.

  10. Portable traffic management system smart work zone application : operational test evaluation report (United States)


    As part of its statewide Intelligent Transportation System (ITS), The Minnesota Department of Transportation (Mn/DOT) sponsored an operational test of the Portable Traffic Management System (PTMS) in a work zone application in cooperation with its pr...

  11. Evaluation of a required statewide interdisciplinary rural health education program: student attitudes, career intents and perceived quality. (United States)

    Shannon, Claude K; Baker, Helen; Jackson, Jodie; Roy, Abira; Heady, Hilda; Gunel, Erdogan


    A shortage of healthcare providers in West Virginia led to the creation of a statewide, community-based program with a required three-month rural experience for most state-sponsored health professions students. Project description: Initiated using funding from the W. K. Kellogg Foundation and expanded using both state funds and Area Health Education Center support, the West Virginia Rural Health Education Partnerships (WVRHEP) program impacts institutions of higher learning, 50 counties, and 332 training sites, and all students in state-funded health professions schools. A longitudinal database has been constructed to study program effects on students' reported attitudes, service orientation, and career intents. Baseline data are collected from medical students, and students in all disciplines provide feedback on rotations and information about career intents, social responsibility, and attitudes towards rural practice. Data indicate an association between perceived quality of the rural experience and increased interest in rural health, social responsibility and confidence in becoming part of the community. Medical students may tend to rate social responsibility higher after completion of the first rural rotation. Students who anticipate practice in smaller towns also tend to rate the quality of the rotation higher, to anticipate careers in primary care, and to acknowledge social responsibility. As WVRHEP program graduates who have completed these surveys enter practice, both personal and community-specific program characteristics may be identified which strengthen interest in rural practice. The predictive validity of intermediate outcomes of attitudes and career intents in forecasting the ultimate outcomes of recruitment and retention may be studied.

  12. Transportation planning, management systems, public participation, and land use modeling. Transportation research record

    Energy Technology Data Exchange (ETDEWEB)



    This volume focuses on statewide and metropolitan transportation planning, management systems, and land use-transportation issues. The papers on statewide and metropolitan transportation planning concern an interactive planning modeling process (Wyoming), an area transportation partnership to assist in the development of the state transportation improvement program (Minnesota), the development of a customer perspective in the statewide transportation planning process (Colorado), a pilot transportation plan for an Indian reservation in western North Carolina, and a community-based, strategic, comprehensive planning process (Ithaca, New York). The papers that concern management systems fall into two categories: those which discuss congestion management and those which discuss management systems for transport infrastructure.

  13. Field tests experience from 1.6MW/400kWh Li-ion battery energy storage system providing primary frequency regulation service

    DEFF Research Database (Denmark)

    Swierczynski, Maciej Jozef; Stroe, Daniel Ioan; Stan, Ana-Irina


    Lithium-ion battery energy storage systems (BESSs) represent suitable alternatives to conventional generating units for providing primary frequency regulation on the Danish market. This paper presents aspects concerning the operation of the BESSs in the Danish energy market while providing upwards...... on the BESS demonstrator located in Western Denmark and initial results are introduced and discussed. These measurements can be used to validate models for battery ageing during realistic operation or to develop the diagnostic tools for the BESS....

  14. System and Patient Barriers to Care among People Living with HIV/AIDS in Houston/Harris County, Texas: HIV Medical Care Providers' Perspectives. (United States)

    Mgbere, Osaro; Khuwaja, Salma; Bell, Tanvir K; Rodriguez-Barradas, Maria C; Arafat, Raouf; Essien, Ekere James; Singh, Mamta; Aguilar, Jonathan; Roland, Eric


    In the United States, a considerable number of people diagnosed with HIV are not receiving HIV medical care due to some barriers. Using data from the Medical Monitoring Project survey of HIV medical care providers in Houston/Harris County, Texas, we assessed the HIV medical care providers' perspectives of the system and patient barriers to HIV care experienced by people living with HIV/AIDS (PLWHA). The study findings indicate that of the 14 HIV care barriers identified, only 1 system barrier and 7 patient barriers were considered of significant (P ≤ .05) importance, with the proportion of HIV medical care providers' agreement to these barriers ranging from 73.9% (cost of health care) to 100% (lack of social support systems and drug abuse problems). Providers' perception of important system and patient barriers varied significantly (P ≤ .05) by profession, race/ethnicity, and years of experience in HIV care. To improve access to and for consistent engagement in HIV care, effective intervention programs are needed to address the barriers identified especially in the context of the new health care delivery system. © The Author(s) 2014.

  15. A Chance to Do It Right: Assessing the Impact on Participants of a State-Wide Nutrition Education Program. (United States)

    Banta, Trudy; Cunningham, Jo Lynn

    Pursuant to the provisions of the National School Lunch Act and Nutrition Amendments of 1977, Tennessee instituted a statewide nutrition education program aimed at educators, school food service personnel, and children in schools and child care institutions. Establishment of an evaluation team early in the program development process proved…

  16. An Annual Report to the Legislature on Oregon Public Schools. Oregon Statewide Report Card. 2014-2015 (United States)

    Oregon Department of Education, 2015


    The Oregon Statewide Report Card is an annual publication required by law (ORS 329.115), which reports on the state of public schools and their progress towards the goals of the Oregon Educational Act for the 21st Century. The purpose of the Oregon Report Card is to monitor trends among school districts and Oregon's progress toward achieving the…

  17. Survey Response in a Statewide Social Experiment: Differences in Being Located and Collaborating, by Race and Hispanic Origin (United States)

    Nam, Yunju; Mason, Lisa Reyes; Kim, Youngmi; Clancy, Margaret; Sherraden, Michael


    This study examined whether and how survey response differs by race and Hispanic origin, using data from birth certificates and survey administrative data for a large-scale statewide experiment. The sample consisted of mothers of infants selected from Oklahoma birth certificates using a stratified random sampling method (N = 7,111). This study…

  18. Sharing Tails®: A State-Wide Public Outreach Program Teaching Children about Native Arizona Fish (United States)

    Pacey, Carol A.; Marsh, Paul C.


    Limited public outreach programs about Arizona native fish exist and those that do are passive, fee-based, or Web-oriented, while others limit their geographic range. The program this article addresses sought to improve this situation with development of a state-wide outreach program with a goal to educate Arizona's children about native fish with…

  19. Applying the APA/AERA/NCME "Standards": Evidence for the Validity and Reliability of Three Statewide Teaching Assessment Instruments. (United States)

    Rothenberg, Lori; Hessling, Peter A.

    The statewide teaching performance assessment instruments being used in Georgia, North Carolina, and Florida were examined. Forty-one reliability and validity studies regarding the instruments in use in each state were collected from state departments and universities. Georgia uses the Georgia Teacher Performance Assessment Instrument. North…

  20. A Guide to Effective Statewide Laws/Policies: Preventing Discrimination against LGBT Students in K-12 Schools. (United States)

    Lambda Legal Defense and Education Fund, New York, NY.

    This document presents guidance for stopping discrimination, harassment, and violence against lesbian, gay, bisexual, and transgender (LGBT) students in schools. Section 1, "Lambda Legal Defense and Education Fund on the Legal Considerations for Creating and Changing Statewide Laws and Policies," discusses the various types of statewide…

  1. A Multigrade, Multiyear Statewide Examination of Reading Achievement: Examination of Reading Achievement Examining Variability between Districts, Schools, and Students (United States)

    Adelson, Jill L.; Dickinson, Emily R.; Cunningham, Brittany C.


    This brief examined the patterns of reading achievement using statewide data from all students (Grades 3-10) in multiple years to examine gaps based on student, school, and district characteristics. Results indicate reading achievement varied most between students within schools and that students' prior achievement was the strongest predictor of…

  2. Changes in Obesity Awareness, Obesity Identification, and Self-Assessment of Health: Results from a Statewide Public Education Campaign (United States)

    Tsai, Adam G.; Boyle, Tracy F.; Hill, James O.; Lindley, Corina; Weiss, Karl


    Background: Due to the high prevalence of obesity, individuals may be desensitized to weight as a personal health concern. Purpose: To evaluate changes in obesity awareness associated with a statewide public education campaign in Colorado. Methods: Cross-sectional random digit dial telephone surveys (n = 1,107 pre, n = 1101 post) were conducted…

  3. Hospitalizations of Infants and Young Children with Down Syndrome: Evidence from Inpatient Person-Records from a Statewide Administrative Database (United States)

    So, S. A.; Urbano, R. C.; Hodapp, R. M.


    Background: Although individuals with Down syndrome are increasingly living into the adult years, infants and young children with the syndrome continue to be at increased risk for health problems. Using linked, statewide administrative hospital discharge records of all infants with Down syndrome born over a 3-year period, this study "follows…

  4. Results from a Multi-Modal Program Evaluation of a Four Year Statewide Juvenile Sex Offender Treatment and Reentry Program (United States)

    Underwood, Lee A.; Dailey, Frances L. L.; Merino, Carrie; Crump, Yolanda


    The results of the Program Evaluation show the OJJ Statewide Sex Offender Treatment program is exceptionally productive in meeting over 90% of its established performance markers. These markers included successful screening and assessment of risk and psychosocial needs, completion of initial and master treatment plans, establishment of sex…

  5. Accommodations Use for Statewide Standardized Assessments: Prevalence and Recommendations for Students Who Are Deaf or Hard of Hearing (United States)

    Cawthon, Stephanie W.


    The "Second Annual National Survey on Assessments and Accommodations for Students who are Deaf or Hard of Hearing" investigated the types of testing accommodations used on 2004-2005 statewide standardized assessments as well as recommendations for best practices. A total of 444 participants who served over 9,000 students as teachers,…

  6. The Usefulness of Individual-Level HIV Surveillance Data to Initiate Statewide HIV Partner Services: Experiences From Hawaii and New Mexico. (United States)

    Beltrami, John; Gans, Andrew; Wozniak, Michelle; Murphy, John; Puesta, Benjamin; Kennebrew, Daphne; Angie Allen, Mary; OʼConnor, Kevin


    Partner services are a broad array of services that should be offered to persons with human immunodeficiency virus (HIV) and that are based on a process through which HIV-infected persons are interviewed to elicit information about their sex and needle-sharing partners. Human immunodeficiency virus testing of partners can result in a high yield of newly diagnosed HIV positivity, but despite this yield and the benefits of partners knowing their exposures and HIV status, partner services are often not conducted. We sought to determine the newly diagnosed HIV positivity and benefits to 2 health departments that conducted demonstration projects that focused on statewide HIV partner services. The main sources of information used for this case study analysis included the health department funding applications, progress reports and final reports submitted to the Centers for Disease Control and Prevention, and records of communications between Centers for Disease Control and Prevention and the health departments. Required quantitative reporting included the number of partners tested and the number of partners with newly diagnosed confirmed HIV infection. Required qualitative reporting included how health departments benefited from their demonstration project activities. Hawaii and New Mexico. Sex and needle-sharing partners of persons who were newly diagnosed with HIV infection. The use of HIV surveillance data to initiate statewide HIV partner services. Newly diagnosed HIV positivity. During 2012-2015, the newly diagnosed HIV positivity among partners was 18% (78/427): 16% (17/108) in Hawaii and 19% (61/319) in New Mexico. The health departments benefited from improved collaborations among HIV prevention program and surveillance staff and among the health departments, providers, and AIDS service organizations. Hawaii and New Mexico each achieved a high newly diagnosed HIV positivity and benefited from improved local collaborations. As a result of the success of these

  7. Costs and effects of a state-wide health promotion program in primary schools in Germany - the Baden-Württemberg Study: A cluster-randomized, controlled trial.

    Directory of Open Access Journals (Sweden)

    Dorothea Kesztyüs

    Full Text Available To evaluate the cost-effectiveness of the state-wide implementation of the health promotion program "Join the Healthy Boat" in primary schools in Germany.Cluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER to identify the costs per case of averted abdominal obesity were calculated.The final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]. The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group.This study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases.German Clinical Trials Register (DRKS, Freiburg University, Germany, DRKS-ID: DRKS00000494.

  8. Preferred provider organizations. (United States)

    Davy, J D


    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.

  9. Design and implementation of an integrated, continuous evaluation, and quality improvement system for a state-based home-visiting program. (United States)

    McCabe, Bridget K; Potash, Dru; Omohundro, Ellen; Taylor, Cathy R


    To describe the design and implementation of an evaluation system to facilitate continuous quality improvement (CQI) and scientific evaluation in a statewide home visiting program, and to provide a summary of the system's progress in meeting intended outputs and short-term outcomes. Help Us Grow Successfully (HUGS) is a statewide home visiting program that provides services to at-risk pregnant/post-partum women, children (0-5 years), and their families. The program goals are to improve parenting skills and connect families to needed services and thus improve the health of the service population. The evaluation system is designed to: (1) integrate evaluation into daily workflow; (2) utilize standardized screening and evaluation tools; (3) facilitate a culture of CQI in program management; and, (4) facilitate scientifically rigorous evaluations. The review of the system's design and implementation occurred through a formative evaluation process (reach, dose, and fidelity). Data was collected through electronic and paper surveys, administrative data, and notes from management meetings, and medical chart review. In the design phase, four process and forty outcome measures were selected and are tracked using standardized screening and monitoring tools. During implementation, the reach and dose of training were adequate to successfully launch the evaluation/CQI system. All staff (n = 165) use the system for management of families; the supervisors (n = 18) use the system to track routine program activities. Data quality and availability is sufficient to support periodic program reviews at the region and state level. In the first 7 months, the HUGS evaluation system tracked 3,794 families (7,937 individuals). System use and acceptance is high. A successful implementation of a structured evaluation system with a strong CQI component is feasible in an existing, large statewide program. The evaluation/CQI system is an effective mechanism to drive modest change in management

  10. Cost-Effectiveness of a Statewide Campaign to Promote Aspirin Use for Primary Prevention of Cardiovascular Disease. (United States)

    Michaud, Tzeyu L; Abraham, Jean; Jalal, Hawre; Luepker, Russell V; Duval, Sue; Hirsch, Alan T


    The U.S. Preventive Services Task Force in 2009 recommended increased aspirin use for primary prevention of cardiovascular disease (CVD) in men ages 45 to 79 years and women ages 55 to 79 years for whom benefit outweighs risk. This study estimated the clinical efficacy and cost-effectiveness of a statewide public and health professional awareness campaign to increase regular aspirin use among the target population in Minnesota to reduce first CVD events. A state-transition Markov model was developed, adopting a payer perspective and lifetime time horizon. The main outcomes of interest were quality-adjusted life years, costs, and the number of CVD events averted among those without a prior CVD history. The model was based on real-world data about campaign effectiveness from representative state-specific aspirin use and event rates, and estimates from the scholarly literature. Implementation of a campaign was predicted to avert 9874 primary myocardial infarctions in men and 1223 primary ischemic strokes in women in the target population. Increased aspirin use was associated with as many as 7222 more major gastrointestinal bleeding episodes. The cost-effectiveness analysis indicated cost-saving results for both the male and female target populations. Using current U.S. Preventive Services Task Force recommendations, a state public and health professional awareness campaign would likely provide clinical benefit and be economically attractive. With clinician adjudication of individual benefit and risk, mechanisms can be made available that would facilitate achievement of aspirin's beneficial impact on lowering risk of primary CVD events, with minimization of adverse outcomes. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  11. Surveillance for cancer recurrence in long-term young breast cancer survivors randomly selected from a statewide cancer registry. (United States)

    Jones, Tarsha; Duquette, Debra; Underhill, Meghan; Ming, Chang; Mendelsohn-Victor, Kari E; Anderson, Beth; Milliron, Kara J; Copeland, Glenn; Janz, Nancy K; Northouse, Laurel L; Duffy, Sonia M; Merajver, Sofia D; Katapodi, Maria C


    This study examined clinical breast exam (CBE) and mammography surveillance in long-term young breast cancer survivors (YBCS) and identified barriers and facilitators to cancer surveillance practices. Data collected with a self-administered survey from a statewide, randomly selected sample of YBCS diagnosed with invasive breast cancer or ductal carcinoma in situ younger than 45 years old, stratified by race (Black vs. White/Other). Multivariate logistic regression models identified predictors of annual CBEs and mammograms. Among 859 YBCS (n = 340 Black; n = 519 White/Other; mean age = 51.0 ± 5.9; diagnosed 11.0 ± 4.0 years ago), the majority (> 85%) reported an annual CBE and a mammogram. Black YBCS in the study were more likely to report lower rates of annual mammography and more barriers accessing care compared to White/Other YBCS. Having a routine source of care, confidence to use healthcare services, perceived expectations from family members and healthcare providers to engage in cancer surveillance, and motivation to comply with these expectations were significant predictors of having annual CBEs and annual mammograms. Cost-related lack of access to care was a significant barrier to annual mammograms. Routine source of post-treatment care facilitated breast cancer surveillance above national average rates. Persistent disparities regarding access to mammography surveillance were identified for Black YBCS, primarily due to lack of access to routine source of care and high out-of-pocket costs. Public health action targeting cancer surveillance in YBCS should ensure routine source of post-treatment care and address cost-related barriers. Clinical Trials Registration Number: NCT01612338.

  12. Overall gambling behaviors and gambling treatment needs among a statewide sample of drug treatment clients in Ohio. (United States)

    Sherba, R Thomas; Martt, Nicholas J


    Casino gambling in Ohio became available for the first time in May 2012. This gambling expansion led the Ohio substance abuse monitoring (OSAM) Network, Ohio's drug abuse surveillance system that collects drug trend data on an ongoing basis, to amend its protocol in June 2011 to include collection of data related to problem and pathological gambling to inform current treatment and prevention needs. OSAM collected gambling data from July 2011 to June 2012 via focus group interviews of 714 drug users recruited from alcohol and other drug (AOD) treatment programs throughout Ohio. Participants who reported gambling during the past 6 months (N = 412) completed the South Oaks gambling screen. This study found a prevalence estimate of 12.1 % for probable pathological gambling among its statewide sample. Sizeable proportions of participants reported that they gambled more when using AOD (23.5 %) and used more AOD when gambling (19.4 %). A majority of study participants (59.2 %) reported participation in at least one type of gambling during the past 6 months, and of those participants, only 22.2 % reported ever having been asked about gambling while receiving AOD treatment services, with just 12.5 % reporting ever having had gambling treatment services offered to them. Men were 4.1 times more likely to screen positive for probable pathological gambling than women; non-Whites were 61.0 % more likely to screen positive than Whites. Findings presented in this report have the potential to help shape and strengthen problem and pathological gambling prevention and treatment measures in Ohio.

  13. Question No. 5: What Role Can Satellites Take, as a Complement to Ground Based Measurement Systems, to Provide Sustained Observations to Monitor GHG Emissions? (United States)

    Chahine, Moustafa; Olsen, Edward


    What role can satellites take, as a complement to ground based measurement systems, to provide sustained observations to monitor GHG emissions (e.g., CO2, CH4, O3, N2O, CFC s, NH3, and NF3) that contribute to global warming?

  14. Creating an Effective System of Education to Prepare Future Human Resources within the Context Provided by the Global Shift toward a "Green Economy" (United States)

    Dudin, Mikhail Nikolaevich; Frolova, Evgenia Evgenevna; Kucherenko, Petr Aleksandrovich; Samusenko, Tatyana Mikhailovna; Voikova, Natalya Andreevna


    This article explores the major aspects of putting together effective national systems of education oriented toward providing academic instruction to the population and preparing future human resources for work within the economy in specific alignment with the concept of environmental responsibility (or that of "green economy"). The…

  15. A statewide assessment of preferences of registered nurses desiring academic credit-bearing continuing education. (United States)

    Cannon, C A; Paulanka, B J; Bam, S


    As needs, mandates, and interests for continuing education (CE) in nursing increase, institutions of higher learning have growing opportunities and responsibilities to respond. Planning educational programs necessitates assessment of nurses' needs to deliver offerings responsive to topic, delivery method, and scheduling preferences. This nonrandomized statewide telephone survey of 535 registered nurses describes the preferences of the large subgroup (n = 359) of nurses who stated a desire for academic credit while participating in CE programs. Preferences were further examined in relation to the nurses' eligibility for undergraduate or master's level offerings. Results include a number of specific preferences with implications for educational institutions to increase their creativity and flexibility in developing credit CE offerings, and to become more responsive to the needs of nurses in practice. Findings suggest that partnerships between institutions of higher education and health care may better meet the continuing education needs of nurses.

  16. Developing and maintaining state-wide adolescent pregnancy prevention coalitions: a preliminary investigation. (United States)

    Nezlek, J B; Galano, J


    This paper presents the results of a study of state-wide adolescent pregnancy prevention coalitions. Key informants in five states throughout the southern United States were given semi-structured interviews regarding the adolescent pregnancy prevention coalitions in their states. From these interviews and other documents, conclusions were drawn regarding the nature and importance of the environments within which these coalitions operate, the universe of activities in which coalitions engage, and the stages of development of these coalitions. Katz and Kahn's model of social organizations served as the basis for understanding coalitions in terms of these three considerations. Future research should consider the utility of organizational models that can explain more fully the organization--committee hybrid structure that tends to characterize these coalitions.

  17. Transition to intensive care nursing: a state-wide, workplace centred program-12 years on. (United States)

    Juers, Alison; Wheeler, Margaret; Pascoe, Helen; Gregory, Nicola; Steers, Cheryl


    In November 1999, the Queensland Health (QH) Transition to Practice Nurse Education Program - Intensive Care (TPNEP-IC) was initiated in QH Intensive Care Units (ICUs) across Queensland. This 12-month, state-wide, workplace based education program has set minimum standards for intensive care nursing education and therefore minimum standards for intensive care nursing practice in QH. In the 12 years of operation, 824 nurses have completed TPNEP-IC, 761 achieving academic credit status and 453 utilising this academic credit status to undertake postgraduate study in critical/intensive care nursing at three Queensland universities. These outcomes were achieved through the appointment of nurse educators within ICUs who, through a united and strong commitment to this state-wide approach formed collaborative professional networks, which resulted in the development, implementation and maintenance of the program. Furthermore, these networks enabled a framework of support for discussion and dissemination of evidence based practice, to endorse quality processes for TPNEP-IC and to nurture leadership potential among educators. Challenges to overcome included obtaining adequate resources to support all aspects of the program, gaining local management and administrative support, and embedding TPNEP-IC within ICU culture. The 12 years of operation of the program have demonstrated its long term sustainability. The program is being launched through a new blended learning approach utilising e-learning strategies. To capitalise on the current success, a strong commitment by all stakeholders will be required to ensure the ongoing sustainability of the program. Copyright © 2011 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  18. Usability and feasibility of a mobile health system to provide comprehensive antenatal care in low-income countries: PANDA mHealth pilot study in Madagascar. (United States)

    Benski, Anne Caroline; Stancanelli, Giovanna; Scaringella, Stefano; Herinainasolo, Josea Léa; Jinoro, Jéromine; Vassilakos, Pierre; Petignat, Patrick; Schmidt, Nicole C


    Background Madagascar's maternal health mortality ratio in 2013 was 478 deaths per 100,000 live births. Most deaths are related to direct complications during pregnancy and childbirth and could be reduced by providing comprehensive antenatal care (ANC). Objective The objective of the study was to assess the usability and feasibility of a mobile health system (mHealth) to provide high-quality ANC, according to World Health Organization (WHO) recommendations. Methods PANDA (Pregnancy And Newborn Diagnostic Assessment) is an easy-to-use mHealth system that uses affordable communications technology to support diagnosis and health care worker decision-making regarding ANC. From January to March 2015, a cross-sectional pilot study was conducted in Ambanja District, Madagascar, in which ANC using PANDA was provided to 100 pregnant women. The collected data were transmitted to a database in the referral hospital to create individual electronic patient records. Accuracy and completeness of the data were closely controlled. The PANDA software was assessed and the number of abnormal results, treatments performed, and participants requiring referral to health care facilities were monitored. Results The PANDA system facilitated creation of individual electronic patient records that included socio-demographic and medical data for 100 participants. Duration of ANC visits averaged 29.6 min. Health care providers were able to collect all variables (100%) describing personal and medical data. No major technical problems were encountered and no data were lost. During 17 ANC visits (17%), an alert function was generated to highlight abnormal clinical results requiring therapy or referral to an affiliated hospital. Participants' acceptability of the system was very high. Conclusion This pilot study proved the usability and feasibility of the PANDA mHealth system to conduct complete and standardised ANC visits according to WHO guidelines, thus providing a promising solution to

  19. An imaging informatics-based ePR (electronic patient record) system for providing decision support in evaluating dose optimization in stroke rehabilitation (United States)

    Liu, Brent J.; Winstein, Carolee; Wang, Ximing; Konersman, Matt; Martinez, Clarisa; Schweighofer, Nicolas


    Stroke is one of the major causes of death and disability in America. After stroke, about 65% of survivors still suffer from severe paresis, while rehabilitation treatment strategy after stroke plays an essential role in recovery. Currently, there is a clinical trial (NIH award #HD065438) to determine the optimal dose of rehabilitation for persistent recovery of arm and hand paresis. For DOSE (Dose Optimization Stroke Evaluation), laboratory-based measurements, such as the Wolf Motor Function test, behavioral questionnaires (e.g. Motor Activity Log-MAL), and MR, DTI, and Transcranial Magnetic Stimulation (TMS) imaging studies are planned. Current data collection processes are tedious and reside in various standalone systems including hardcopy forms. In order to improve the efficiency of this clinical trial and facilitate decision support, a web-based imaging informatics system has been implemented together with utilizing mobile devices (eg, iPAD, tablet PC's, laptops) for collecting input data and integrating all multi-media data into a single system. The system aims to provide clinical imaging informatics management and a platform to develop tools to predict the treatment effect based on the imaging studies and the treatment dosage with mathematical models. Since there is a large amount of information to be recorded within the DOSE project, the system provides clinical data entry through mobile device applications thus allowing users to collect data at the point of patient interaction without typing into a desktop computer, which is inconvenient. Imaging analysis tools will also be developed for structural MRI, DTI, and TMS imaging studies that will be integrated within the system and correlated with the clinical and behavioral data. This system provides a research platform for future development of mathematical models to evaluate the differences between prediction and reality and thus improve and refine the models rapidly and efficiently.

  20. Tablet and Face-to-Face Hybrid Professional Development: Providing Earth Systems Science Educators Authentic Research Opportunities through The GLOBE Program at Purdue University (United States)

    Wegner, K.; Branch, B. D.; Smith, S. C.


    The Global Learning and Observations to Benefit the Environment (GLOBE) program is a worldwide hands-on, primary and secondary school-based science and education program ( GLOBE's vision promotes and supports students, teachers and scientists to collaborate on inquiry-based authentic science investigations of the environment and the Earth system working in close partnership with NASA, NOAA and NSF Earth System Science Projects (ESSP's) in study and research about the dynamics of Earth's environment. GLOBE Partners conduct face-to-face Professional Development in more than 110 countries, providing authentic scientific research experience in five investigation areas: atmosphere, earth as a system, hydrology, land cover, and soil. This presentation will provide a sample for a new framework of Professional Development that was implemented in July 2013 at Purdue University lead by Mr. Steven Smith who has tested GLOBE training materials for future training. The presentation will demonstrate how institutions can provide educators authentic scientific research opportunities through various components, including: - Carrying out authentic research investigations - Learning how to enter their authentic research data into the GLOBE database and visualize it on the GLOBE website - Learn how to access to NASA's Earth System Science resources via GLOBE's new online 'e-Training Program' - Exploring the connections of their soil protocol measurements and the history of the soil in their area through iPad soils app - LIDAR data exposure, Hydrology data exposure

  1. Frequency of Hand Decontamination of Intraoperative Providers and Reduction of Postoperative Healthcare-Associated Infections: A Randomized Clinical Trial of a Novel Hand Hygiene System. (United States)

    Koff, Matthew D; Brown, Jeremiah R; Marshall, Emily J; O'Malley, A James; Jensen, Jens T; Heard, Stephen O; Longtine, Karen; O'Neill, Melissa; Longtine, Jaclyn; Houston, Donna; Robison, Cindy; Moulton, Eric; Patel, Hetal M; Loftus, Randy W


    BACKGROUND Healthcare provider hands are an important source of intraoperative bacterial transmission events associated with postoperative infection development. OBJECTIVE To explore the efficacy of a novel hand hygiene improvement system leveraging provider proximity and individual and group performance feedback in reducing 30-day postoperative healthcare-associated infections via increased provider hourly hand decontamination events. DESIGN Randomized, prospective study. SETTING Dartmouth-Hitchcock Medical Center in New Hampshire and UMass Memorial Medical Center in Massachusetts. PATIENTS Patients undergoing surgery. METHODS Operating room environments were randomly assigned to usual intraoperative hand hygiene or to a personalized, body-worn hand hygiene system. Anesthesia and circulating nurse provider hourly hand decontamination events were continuously monitored and reported. All patients were followed prospectively for the development of 30-day postoperative healthcare-associated infections. RESULTS A total of 3,256 operating room environments and patients (1,620 control and 1,636 treatment) were enrolled. The mean (SD) provider hand decontamination event rate achieved was 4.3 (2.9) events per hour, an approximate 8-fold increase in hand decontamination events above that of conventional wall-mounted devices (0.57 events/hour); Phand hygiene system was not associated with a reduction in healthcare-associated infections (odds ratio, 1.07 [95% CI, 0.82-1.40], P=.626). CONCLUSIONS The hand hygiene system evaluated in this study increased the frequency of hand decontamination events without reducing 30-day postoperative healthcare-associated infections. Future work is indicated to optimize the efficacy of this hand hygiene improvement strategy. Infect Control Hosp Epidemiol 2016;37:888-895.

  2. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. (United States)

    Bello, Aminu K; Molzahn, Anita E; Girard, Louis P; Osman, Mohamed A; Okpechi, Ikechi G; Glassford, Jodi; Thompson, Stephanie; Keely, Erin; Liddy, Clare; Manns, Braden; Jinda, Kailash; Klarenbach, Scott; Hemmelgarn, Brenda; Tonelli, Marcello


    We assessed stakeholder perceptions on the use of an electronic consultation system (e-Consult) to improve the delivery of kidney care in Alberta. We aim to identify acceptability, barriers and facilitators to the use of an e-Consult system for ambulatory kidney care delivery. This was a qualitative focus group study using a thematic analysis design. Eight focus groups were held in four locations in the province of Alberta, Canada. In total, there were 72 participants in two broad stakeholder categories: patients (including patients' relatives) and providers (including primary care physicians, nephrologists, other care providers and policymakers). The e-Consult system was generally acceptable across all stakeholder groups. The key barriers identified were length of time required for referring physicians to complete the e-Consult due to lack of integration with current electronic medical records, and concerns that increased numbers of requests might overwhelm nephrologists and lead to a delayed response or an unsustainable system. The key facilitators identified were potential improvement of care coordination, dissemination of best practice through an educational platform, comprehensive data to make decisions without the need for face-to-face consultation, timely feedback to primary care providers, timeliness/reduced delays for patients' rapid triage and identification of cases needing urgent care and improved access to information to facilitate decision-making in patient care. Stakeholder perceptions regarding the e-Consult system were favourable, and the key barriers and facilitators identified will be considered in design and implementation of an acceptable and sustainable electronic consultation system for kidney care delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  3. Analysis of the design and economics of molten carbonate fuel cell tri-generation systems providing heat and power for commercial buildings and H2 for FC vehicles (United States)

    Li, Xuping; Ogden, Joan; Yang, Christopher


    This study models the operation of molten carbonate fuel cell (MCFC) tri-generation systems for “big box” store businesses that combine grocery and retail business, and sometimes gasoline retail. Efficiency accounting methods and parameters for MCFC tri-generation systems have been developed. Interdisciplinary analysis and an engineering/economic model were applied for evaluating the technical, economic, and environmental performance of distributed MCFC tri-generation systems, and for exploring the optimal system design. Model results show that tri-generation is economically competitive with the conventional system, in which the stores purchase grid electricity and NG for heat, and sell gasoline fuel. The results are robust based on sensitivity analysis considering the uncertainty in energy prices and capital cost. Varying system sizes with base case engineering inputs, energy prices, and cost assumptions, it is found that there is a clear tradeoff between the portion of electricity demand covered and the capital cost increase of bigger system size. MCFC Tri-generation technology provides lower emission electricity, heat, and H2 fuel. With NG as feedstock the CO2 emission can be reduced by 10%-43.6%, depending on how the grid electricity is generated. With renewable methane as feedstock CO2 emission can be further reduced to near zero.

  4. The Lower Sevier River Basin Crop Monitor and Forecast Decision Support System: Exploiting Landsat Imagery to Provide Continuous Information to Farmers and Water Managers (United States)

    Torres-Rua, A. F.; Walker, W. R.; McKee, M.


    The last century has seen a large number of innovations in agriculture such as better policies for water control and management, upgraded water conveyance, irrigation, distribution, and monitoring systems, and better weather forecasting products. In spite of this, irrigation management and irrigation water deliveries by farmers/water managers is still based on factors like water share amounts, tradition, and past experience on irrigation. These factors are not necessarily related to the actual crop water use; they are followed because of the absence of related information provided in a timely manner at an affordable cost. Thus, it is necessary to develop means to deliver continuous and personalized information about crop water requirements to water users/managers at the field and irrigation system levels so managers at these levels can better quantify the required versus available water for irrigation during the irrigation season. This study presents a new decision support system (DSS) platform that addresses the absence of information on actual crop water requirements and crop performance by providing continuous updated farm-based crop water use along with other farm performance indicators such as crop yield and farm management to irrigators and water managers. This DSS exploits the periodicity of the Landsat Satellite Mission (8 to 16 days, depending on the period of interest) to provide remote monitoring at the individual field and irrigation system levels. The Landsat satellite images are converted into information about crop water use, yield performance and field management through application of state-of-the-art semi-physical and statistical algorithms that provide this information at a pixel basis that are ultimately aggregated to field and irrigation system levels. A version of the DSS has been implemented for the agricultural lands in the Lower Sevier River, Utah, and has been operational since the beginning of the 2013 irrigation season. The main goal of

  5. Using a computerized provider order entry system to meet the unique prescribing needs of children: description of an advanced dosing model

    Directory of Open Access Journals (Sweden)

    Schellenberger Patricia


    Full Text Available Abstract Background It is well known that the information requirements necessary to safely treat children with therapeutic medications cannot be met with the same approaches used in adults. Over a 1-year period, Duke University Hospital engaged in the challenging task of enhancing an established computerized provider order entry (CPOE system to address the unique medication dosing needs of pediatric patients. Methods An advanced dosing model (ADM was designed to interact with our existing CPOE application to provide decision support enabling complex pediatric dose calculations based on chronological age, gestational age, weight, care area in the hospital, indication, and level of renal impairment. Given that weight is a critical component of medication dosing that may change over time, alerting logic was added to guard against erroneous entry or outdated weight information. Results Pediatric CPOE was deployed in a staggered fashion across 6 care areas over a 14-month period. Safeguards to prevent miskeyed values became important in allowing providers the flexibility to override the ADM logic if desired. Methods to guard against over- and under-dosing were added. The modular nature of our model allows us to easily add new dosing scenarios for specialized populations as the pediatric population and formulary change over time. Conclusions The medical needs of pediatric patients vary greatly from those of adults, and the information systems that support those needs require tailored approaches to design and implementation. When a single CPOE system is used for both adults and pediatrics, safeguards such as redirection and suppression must be used to protect children from inappropriate adult medication dosing content. Unlike other pediatric dosing systems, our model provides active dosing assistance and dosing process management, not just static dosing advice.

  6. In vivo testing of a prototype system providing simultaneous white light and near infrared autofluorescence image acquisition for detection of bladder cancer (United States)

    Jacobson, Michael C.; deVere White, Ralph; Demos, Stavros G.


    A prototype instrument developed to provide simultaneously ordinary visual endoscopy together with near infrared (NIR) autofluorescence imaging via parallel image acquisition is demonstrated. The two images are recorded concurrently and the instrument interfaces with any ordinary endoscope. Preliminary results of a pilot study focused on imaging of bladder tumors in vivo using this instrumentation are presented. The experimental results demonstrate the capabilities of this instrumentation design, imaging methodology, and define the current limitation for further development of the system.

  7. Military Lesbian, Gay, Bisexual, and Transgender (LGBT) Awareness Training for Health Care Providers Within the Military Health System [Formula: see text]. (United States)

    Shrader, Angela; Casero, Kellie; Casper, Bethany; Kelley, Mary; Lewis, Laura; Calohan, Jess

    Lesbian, gay, bisexual, and transgender (LGBT) individuals serving within the U.S. military and their beneficiaries have unique health care requirements. Department of Defense Directive 1304.26 "Don't Ask, Don't Tell" created a barrier for service members to speak candidly with their health care providers, which left specific health care needs unaddressed. There are no standardized cultural education programs to assist Military Health System (MHS) health care providers in delivering care to LGBT patients and their beneficiaries. The purpose of this project was to develop, implement, and evaluate the effectiveness of an LGBT educational program for health care providers within the MHS to increase cultural awareness in caring for this special population. This multisite educational program was conducted at Travis Air Force Base and Joint Base Lewis-McChord from November 15, 2014, to January 30, 2015. A 15-question multiple-choice questionnaire was developed based on the education program and was administered before and after the education program. A total of 51 individuals completed the program. Overall posttest scores improved compared to pretest scores. This program was designed to begin the process of educating health care providers about the unique health care issues of military LGBT Service Members and their beneficiaries. This program was the first to address the disparities in LGBT health care needs within the Department of Defense. It also provided a platform for facilitating open communication among providers regarding LGBT population health needs in the military.

  8. Primary care quality and safety systems in the English National Health Service: a case study of a new type of primary care provider. (United States)

    Baker, Richard; Willars, Janet; McNicol, Sarah; Dixon-Woods, Mary; McKee, Lorna


    Although the predominant model of general practice in the UK National Health Service (NHS) remains the small partnership owned and run by general practitioners (GPs), new types of provider are emerging. We sought to characterize the quality and safety systems and processes used in one large, privately owned company providing primary care through a chain of over 50 general practices in England. Senior staff with responsibility for policy on quality and safety were interviewed. We also undertook ethnographic observation in non-clinical areas and interviews with staff in three practices. A small senior executive team set policy and strategy on quality and safety, including a systematic incident reporting and investigation system and processes for disseminating learning with a strong emphasis on customer focus. Standardization of systems was possible because of the large number of practices. Policies appeared generally well implemented at practice level. However, there was some evidence of high staff turnover, particularly of GPs. This caused problems for continuity of care and challenges in inducting new GPs in the company's systems and procedures. A model of primary care delivery based on a corporate chain may be useful in standardizing policies and procedures, facilitating implementation of systems, and relieving clinical staff of administrative duties. However, the model also poses some risks, including those relating to stability. Provider forms that retain the long term, personal commitment of staff to their practices, such as federations or networks, should also be investigated; they may offer the benefits of a corporate chain combined with the greater continuity and stability of the more traditional general practice.

  9. State of Hawaii, Department of Health, Clean Water Branch State-wide Water Quality Sampling Dataset 1999-2006 (NODC Accession 0013723) (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Monitoring Section of the State of Hawaii, Department of Health, Clean Water Branch collects water quality data at over 300 coastal locations state-wide using...

  10. State of Hawaii, Department of Health, Clean Water Branch State-wide Water Quality Sampling Dataset 1973-1998 (NODC Accession 0013724) (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Monitoring Section of the State of Hawaii, Department of Health, Clean Water Branch collects water quality data at over 300 coastal locations state-wide using...

  11. Development of a statewide online system for traffic data quality control and sharing. (United States)


    The Washington State Department of Transportation (WSDOT) operates thousands of Inductive Loop : Detectors (ILDs) on the freeways and highways of Washington State. The collection and disbursement of : this data is handled at the regional level, which...

  12. 34 CFR 361.23 - Requirements related to the statewide workforce investment system. (United States)


    ... statistics, job vacancies, career planning, and workforce investment activities; (iii) The use of customer service features such as common intake and referral procedures, customer databases, resource information...

  13. 76 FR 58252 - Applications for New Awards; Statewide, Longitudinal Data Systems Program (United States)


    ... CFDA number's alpha suffix in your search (e.g., search for 84.372, not 84.372A). Please note the... requirements on reporting, please go to . 4...

  14. South Dakota Statewide Core Curriculum, Career Ladder, and Challenge System. A Case History. (United States)

    Brekke, Donald G.; Gildseth, Wayne M.

    The South Dakota Core Curriculum Project involving the career ladder approach to health manpower training, which began in 1970, had seven objectives including the following: (1) To organize a Health Manpower Council for the entire State; (2) to define the areas of basic commonality among the various training programs; and (3) to develop a core…

  15. Caseworkers' and Supervisors' Perceptions of Ohio's Statewide Automated Child Welfare Information System (United States)

    Kochis, Shelia P.


    Children represent the future of mankind and their safety, well-being, and permanency are goals of the Department of Health and Human Services. The Department of Health and Human Services is the primary funding source for child welfare and protection in the United States; their requirements, rules, and laws must be upheld and understood by every…

  16. Approaching the Hard-to-Reach in Organized Colorectal Cancer Screening: an Overview of Individual, Provider and System Level Coping Strategies

    Directory of Open Access Journals (Sweden)

    Jason Liwen Huang


    Full Text Available Background: Despite the proven effectiveness of colorectal cancer (CRC screening on reduction of CRC mortality, the uptake of CRC screening remains low. Participation rate is one of determinants for the success of organized population-based screening program. This review aims to identify those who are hard-to-reach, and summarize the strategies to increase their screening rate from individual, provider and system levels. Methods: A systematic search of electronic English databases was conducted on the factors and strategies of uptake in CRC screening for the hard-to-reach population up to May 2017. Discussion: The coverage rate and participation rate are two indexes to identify the hard-to-reach population in organized CRC screening program. However, the homeless, new immigrants, people with severe mental illness, the jail intimates, and people with characteristics including lower education levels and/or low socioeconomic status, living in rural/remote areas, without insurance, and racial minorities are usually recognized as hard-to-reach populations. For them, organized screening programs offer a better coverage, while novel invitation approaches for eligible individuals and multiple strategies from primary care physicians are still needed to enhance screening rates among subjects who are hard-to-reach. Suggestions implied the effectiveness of interventions at the system level, including linkages to general practice; use of decision making tools; enlisting supports from coalition; and the continuum from screening to diagnosis and treatment. Conclusion: Organized CRC screening offers a system access to approach the hard-to-reach populations. To increase their uptake, multiple and novel strategies from individual, provider and system levels should be applied. For policymakers, public healthcare providers and community stakeholders, it is a test to tailor their potential needs and increase their participation rates through continuous efforts to

  17. Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: a mixed methods approach. (United States)

    Devine, Emily Beth; Lee, Chia-Ju; Overby, Casey L; Abernethy, Neil; McCune, Jeannine; Smith, Joe W; Tarczy-Hornoch, Peter


    Pharmacogenomics (PGx) is positioned to have a widespread impact on the practice of medicine, yet physician acceptance is low. The presentation of context-specific PGx information, in the form of clinical decision support (CDS) alerts embedded in a computerized provider order entry (CPOE) system, can aid uptake. Usability evaluations can inform optimal design, which, in turn, can spur adoption. The study objectives were to: (1) evaluate an early prototype, commercial CPOE system with PGx-CDS alerts in a simulated environment, (2) identify potential improvements to the system user interface, and (3) understand the contexts under which PGx knowledge embedded in an electronic health record is useful to prescribers. Using a mixed methods approach, we presented seven cardiologists and three oncologists with five hypothetical clinical case scenarios. Each scenario featured a drug for which a gene encoding drug metabolizing enzyme required consideration of dosage adjustment. We used Morae(®) to capture comments and on-screen movements as participants prescribed each drug. In addition to PGx-CDS alerts, 'Infobutton(®)' and 'Evidence' icons provided participants with clinical knowledge resources to aid decision-making. Nine themes emerged. Five suggested minor improvements to the CPOE user interface; two suggested presenting PGx information through PGx-CDS alerts using an 'Infobutton' or 'Evidence' icon. The remaining themes were strong recommendations to provide succinct, relevant guidelines and dosing recommendations of phenotypic information from credible and trustworthy sources; any more information was overwhelming. Participants' median rating of PGx-CDS system usability was 2 on a Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree). Usability evaluation results suggest that participants considered PGx information important for improving prescribing decisions; and that they would incorporate PGx-CDS when information is presented in relevant and

  18. A patient-centered system in a provider-centered world: challenges of incorporating post-discharge wound data into practice. (United States)

    Sanger, Patrick C; Hartzler, Andrea; Lordon, Ross J; Armstrong, Cheryl Al; Lober, William B; Evans, Heather L; Pratt, Wanda


    The proposed Meaningful Use Stage 3 recommendations require healthcare providers to accept patient-generated health data (PGHD) by 2017. Yet, we know little about the tensions that arise in supporting the needs of both patients and providers in this context. We sought to examine these tensions when designing a novel, patient-centered technology - mobile Post-Operative Wound Evaluator (mPOWEr) - that uses PGHD for post-discharge surgical wound monitoring. As part of the iterative design process of mPOWEr, we conducted semistructured interviews and think-aloud sessions using mockups with surgical patients and providers. We asked participants how mPOWEr could enhance the current post-discharge process for surgical patients, then used grounded theory to develop themes related to conflicts and agreements between patients and providers. We identified four areas of agreement: providing contextual metadata, accessible and actionable data presentation, building on existing sociotechnical systems, and process transparency. We identified six areas of conflict, with patients preferring: more flexibility in data input, frequent data transfer, text-based communication, patient input in provider response prioritization, timely and reliable provider responses, and definitive diagnoses. We present design implications and potential solutions to the identified conflicts for each theme, illustrated using our work on mPOWEr. Our experience highlights the importance of bringing a variety of stakeholders, including patients, into the design process for PGHD applications. We have identified critical barriers to integrating PGHD into clinical care and describe design implications to help address these barriers. Our work informs future efforts to ensure the smooth integration of essential PGHD into clinical practice. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  19. 20 CFR 652.207 - How does a State meet the requirement for universal access to services provided under the Act? (United States)


    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false How does a State meet the requirement for universal access to services provided under the Act? 652.207 Section 652.207 Employees' Benefits EMPLOYMENT... Act, on a Statewide basis through: (i) Self-service; (ii) Facilitated self-help service; and (iii...

  20. A Typology of Multicampus Systems. (United States)

    Creswell, John W.; And Others


    Multicampus systems differ in the type of control (public or private) and the jurisdiction of the governing boards, the degree of similarity among campuses, and the administrative structures. These characteristics are combined to form a typology of multicampus systems: private, statewide, hetergeneous public, and homogeneous public. (Author/MLW)