Sample records for range improvement practices
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Critical cooperation range to improve spatial network robustness.
Directory of Open Access Journals (Sweden)
Vitor H P Louzada
Full Text Available A robust worldwide air-transportation network (WAN is one that minimizes the number of stranded passengers under a sequence of airport closures. Building on top of this realistic example, here we address how spatial network robustness can profit from cooperation between local actors. We swap a series of links within a certain distance, a cooperation range, while following typical constraints of spatially embedded networks. We find that the network robustness is only improved above a critical cooperation range. Such improvement can be described in the framework of a continuum transition, where the critical exponents depend on the spatial correlation of connected nodes. For the WAN we show that, except for Australia, all continental networks fall into the same universality class. Practical implications of this result are also discussed.
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Lanham, Holly J; McDaniel, Reuben R; Crabtree, Benjamin F; Miller, William L; Stange, Kurt C; Tallia, Alfred F; Nutting, Paula
2009-09-01
Understanding the role of relationships health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed. Data were drawn from four large National Institutes of Health (NIH)-funded studies, and an iterative analytic strategy and a grounded theory approach were used to understand the characteristics of relationships within primary care practices. This multimethod approach amassed rich and comparable data sets in all four studies, which were all aimed at primary care practice improvement. The broad range of data included direct observation of practices during work activities and of patient-clinician interactions, in-depth interviews with physicians and other key staff members, surveys, structured checklists of office environments, and chart reviews. Analyses focused on characteristics of relationships in practices that exhibited a range of success in achieving practice improvement. Complex adaptive systems theory informed these analyses. Trust, mindfulness, heedfulness, respectful interaction, diversity, social/task relatedness, and rich/lean communication were identified as important in practice improvement. A model of practice relationships was developed to describe how these characteristics work together and interact with reflection, sensemaking, and learning to influence practice-level quality outcomes. Although this model of practice relationships was developed from data collected in primary care practices, which differ from other HCOs in some important ways, the ideas that quality is emergent and that relationships influence quality of care are universally important for all HCOs and all medical specialties.
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Byrnes, Matthew C; Schuerer, Douglas J E; Schallom, Marilyn E; Sona, Carrie S; Mazuski, John E; Taylor, Beth E; McKenzie, Wendi; Thomas, James M; Emerson, Jeffrey S; Nemeth, Jennifer L; Bailey, Ruth A; Boyle, Walter A; Buchman, Timothy G; Coopersmith, Craig M
2009-10-01
To determine a) if a checklist covering a diverse group of intensive care unit protocols and objectives would improve clinician consideration of these domains and b) if improved consideration would change practice patterns. Pre- and post observational study. A 24-bed surgical/burn/trauma intensive care unit in a teaching hospital. A total of 1399 patients admitted between June 2006 and May 2007. The first component of the study evaluated whether mandating verbal review of a checklist covering 14 intensive care unit best practices altered verbal consideration of these domains. Evaluation was performed using real-time bedside audits on morning rounds. The second component evaluated whether the checklist altered implementation of these domains by changing practice patterns. Evaluation was performed by analyzing data from the Project IMPACT database after patients left the intensive care unit. Verbal consideration of evaluable domains improved from 90.9% (530/583) to 99.7% (669/671, p < .0001) after verbal review of the checklist was mandated. Bedside consideration improved on the use of deep venous thrombosis prophylaxis (p < .05), stress ulcer prophylaxis (p < .01), oral care for ventilated patients (p < 0.01), electrolyte repletion (p < .01), initiation of physical therapy (p < .05), and documentation of restraint orders (p < .0001). Mandatory verbal review of the checklist resulted in a greater than two-fold increase in transferring patients out of the intensive care unit on telemetry (16% vs. 35%, p < .0001) and initiation of physical therapy (28% vs. 42%, p < .0001) compared with baseline practice. A mandatory verbal review of a checklist covering a wide range of objectives and goals at each patient's bedside is an effective method to improve both consideration and implementation of intensive care unit best practices. A bedside checklist is a simple, cost-effective method to prevent errors of omission in basic domains of intensive care unit management that might
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Practice-level quality improvement interventions in primary care: a review of systematic reviews.
Irwin, Ryan; Stokes, Tim; Marshall, Tom
2015-11-01
To present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews. Quality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care--the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting. A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions. Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions. A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions. Audit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions. Evidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality
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Improved Range Searching Lower Bounds
DEFF Research Database (Denmark)
Larsen, Kasper Green; Nguyen, Huy L.
2012-01-01
by constructing a hard input set and query set, and then invoking Chazelle and Rosenberg's [CGTA'96] general theorem on the complexity of navigation in the pointer machine. For the group model, we show that input sets and query sets that are hard for range reporting in the pointer machine (i.e. by Chazelle...... and Rosenberg's theorem), are also hard for dynamic range searching in the group model. This theorem allows us to reuse decades of research on range reporting lower bounds to immediately obtain a range of new group model lower bounds. Amongst others, this includes an improved lower bound for the fundamental...
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Making perceptual learning practical to improve visual functions.
Polat, Uri
2009-10-01
Task-specific improvement in performance after training is well established. The finding that learning is stimulus-specific and does not transfer well between different stimuli, between stimulus locations in the visual field, or between the two eyes has been used to support the notion that neurons or assemblies of neurons are modified at the earliest stage of cortical processing. However, a debate regarding the proposed mechanism underlying perceptual learning is an ongoing issue. Nevertheless, generalization of a trained task to other functions is an important key, for both understanding the neural mechanisms and the practical value of the training. This manuscript describes a structured perceptual learning method that previously used (amblyopia, myopia) and a novel technique and results that were applied for presbyopia. In general, subjects were trained for contrast detection of Gabor targets under lateral masking conditions. Training improved contrast sensitivity and diminished the lateral suppression when it existed (amblyopia). The improvement was transferred to unrelated functions such as visual acuity. The new results of presbyopia show substantial improvement of the spatial and temporal contrast sensitivity, leading to improved processing speed of target detection as well as reaction time. Consequently, the subjects, who were able to eliminate the need for reading glasses, benefited. Thus, here we show that the transfer of functions indicates that the specificity of improvement in the trained task can be generalized by repetitive practice of target detection, covering a sufficient range of spatial frequencies and orientations, leading to an improvement in unrelated visual functions. Thus, perceptual learning can be a practical method to improve visual functions in people with impaired or blurred vision.
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Objectives for next generation of practical short-range atmospheric dispersion models
International Nuclear Information System (INIS)
Olesen, H.R.; Mikkelsen, T.
1992-01-01
The proceedings contains papers from the workshop ''Objectives for Next Generation of Practical Short-Range Atmospheric Dispersion Models''. They deal with two types of models, namely models for regulatory purposes and models for real-time applications. The workshop was the result of an action started in 1991 for increased cooperation and harmonization within atmospheric dispersion modelling. The focus of the workshop was on the management of model development and the definition of model objectives, rather than on detailed model contents. It was the intention to identify actions that can be taken in order to improve the development and use of atmospheric dispersion models. The papers in the proceedings deal with various topics within the broad spectrum of matters related to up-to-date practical models, such as their scientific basis, requirements for model input and output, meteorological preprocessing, standardisation within modelling, electronic information exchange as a potentially useful tool, model evaluation and data bases for model evaluation. In addition to the papers, the proceedings contain summaries of the discussions at the workshop. These summaries point to a number of recommended actions which can be taken in order to improve ''modelling culture''. (AB)
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Practical Approaches to Quality Improvement for Radiologists.
Kelly, Aine Marie; Cronin, Paul
2015-10-01
Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.
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Continuous Improvement in Schools: Understanding the Practice
Anderson, Stephen; Kumari, Roshni
2009-01-01
This article investigates conceptually and practically what it means for schools to engage in the practice of continuous improvement. The analysis draws upon prior research and discussion to predict core elements of the practice of continuous improvement in schools. The predictions are then applied to a case study of continuous improvement efforts…
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Improving Corporate Governance Practices
M. Huse; J. Gabrielsson; A. Minichilli
2009-01-01
Peak performing organizations may benefit from active value creating boards. Suggestions to improve board behaviour and corporate governance practices are presented in this article. The suggestions result from findings in the “Valued Creating Board” research programme. However, active boards working in a shareholder activism framework may destroy rather than support value creation processes within firms. In peak performing organizations corporate governance practices should be designed and de...
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Pattern of optometry practice and range of services in India.
Thite, Nilesh; Jaggernath, Jyoti; Chinanayi, Farai; Bharadwaj, Shrikant; Kunjeer, Gauri
2015-05-01
This study was conducted to evaluate the range of services provided by optometrists in various modes of optometric practice in India. An online questionnaire was administered to 1674 optometrists to collect information on the range of optometric services offered. Data were analyzed based on variables including sex, educational qualification, and modes of practice. Two-sample Wilcoxon rank sum tests, χ tests, and Fisher exact text were used to conduct inferential statistics. A total of 563 valid and completed survey questionnaires were received from graduates of 41 optometry institutes working across 23 states of India. Of these, 225 (40.0%) were female, 288 (51.2%) had completed postgraduate education, and 340 (60.5%) were involved in more than one mode of practice. The top three modes of practice were hospital-based practice (44.8%), academia (42.8%), and optical retail (33.0%). Of the 441, out of 563 (78.3%) respondents involved in patient care, the majority (98.4%) performed refraction and routine eye examination, 70.3% dispensed contact lenses, and 66.9% practiced optical dispensing. Lower involvement was seen in providing binocular-vision (45.1%) and low-vision services (30.2%). Higher education was associated with advanced level of practice (p < 0.05) except clinical investigative procedures. There was a significant association between postgraduate studies and involvement in academics and research (p < 0.01). Most optometrists are engaged in multiple modes of practice, with optical practice, hospital-based practice, and academia being the leading modes. Optometrists need to be more involved in providing the core optometric services of binocular vision and low vision. Higher education has an impact on the level of optometric practice.
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Practice management companies improve practices' financial position.
Dupell, T
1997-11-01
To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.
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Effectiveness of a quality-improvement program in improving management of primary care practices
Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja
2011-01-01
Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the
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Integrated Practice Improvement Solutions-Practical Steps to Operating Room Management.
Chernov, Mikhail; Pullockaran, Janet; Vick, Angela; Leyvi, Galina; Delphin, Ellise
2016-10-01
Perioperative productivity is a vital concern for surgeons, anesthesiologists, and administrators as the OR is a major source of hospital elective admissions and revenue. Based on elements of existing Practice Improvement Methodologies (PIMs), "Integrated Practice Improvement Solutions" (IPIS) is a practical and simple solution incorporating aspects of multiple management approaches into a single open source framework to increase OR efficiency and productivity by better utilization of existing resources. OR efficiency was measured both before and after IPIS implementation using the total number of cases versus room utilization, OR/anesthesia revenue and staff overtime (OT) costs. Other parameters of efficiency, such as the first case on-time start and the turnover time (TOT) were measured in parallel. IPIS implementation resulted in increased numbers of surgical procedures performed by an average of 10.7%, and OR and anesthesia revenue increases of 18.5% and 6.9%, respectively, with a simultaneous decrease in TOT (15%) and OT for anesthesia staff (26%). The number of perioperative adverse events was stable during the two-year study period which involved a total of 20,378 patients. IPIS, an effective and flexible practice improvement model, was designed to quickly, significantly, and sustainably improve OR efficiency by better utilization of existing resources. Success of its implementation directly correlates with the involvement of and acceptance by the entire OR team and hospital administration.
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Using Data to Improve Educational Practice
Directory of Open Access Journals (Sweden)
Matthijs Koopmans
2017-04-01
Full Text Available Review of the book “Action Research in the Classroom: Helping Teachers Assess and Improve their Work” by Sr. Mary Ann Jacobs and Bruce S. Cooper There are many ways in which research can contribute to the improvement of educational practice, and action research is one of them. Action research bridges the gap that typically separates research from practice by having practitioners conduct specific projects to address their own questions and improve their effectiveness based on the answers they obtain. One of the advantages of this type of research is that results are often immediately accessible and have actionable implications. Thus, action research is a good tool for making improvements to the field based on evidence.
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middle range theory evaluation: bridging the theory-practice gap
African Journals Online (AJOL)
The importance underlying the practice of nursing education must continue ... describes selected middle range theory evaluation as a tool for bridging ... engaging in innovative ways of acquiring competency. ..... performances, that guides learners attitudes towards ... Reference knowledge acquired by work experience.
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Newton, Warren P; Lefebvre, Ann; Donahue, Katrina E; Bacon, Thomas; Dobson, Allen
2010-01-01
Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3) quality-improvement consultants (QICs), or practice facilitators; (4) learning networks; and (5) alignment of incentives. We emphasized a community-based strategy and developing a statewide infrastructure. Results are reported from the first 2 years of the North Carolina Improving Performance in Practice (IPIP) project. A coalition was formed to include professional societies, North Carolina AHEC, Community Care of North Carolina, insurers, and other organizations. Wave One started with 18 practices in 2 of 9 regions of the state. Quality-improvement consultants recruited practices. Over 80 percent of practices attended all quarterly regional meetings. In 9 months, almost all diabetes measures improved, and a bundled asthma measure improved from 33 to 58 percent. Overall, the magnitude of improvement was clinically and statistically significant (P = .001). Quality improvements were maintained on review 1 year later. Wave Two has spread to 103 practices in all 9 regions of the state, with 42 additional practices beginning the enrollment process. Large-scale health care quality improvement is feasible, when broadly supported by statewide leadership and community infrastructure. Practice-collected data and lack of a control group are limitations of the study design. Future priorities include maintaining improved sustainability for practices and communities. Our long-term goal is to transform all 2000 primary-care practices in our state.
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Improvement of the severe accident practice tool
International Nuclear Information System (INIS)
Kawasaki, Ikuo; Takahashi, Shunsuke
2016-01-01
We developed the severe accident (SA) practice tool based on lessons learned in the accident at the Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Station. We utilized the developed SA practice tool and carried out the SA training for some employees of Kansai Electric Power Co., Inc. Afterwards, we examined the opinions given by trainees attending the training lecture and improved the SA practice tool to achieve a better educational effect. The main changes we made were improvement of the practice scenario for EAL judgments and addition of functions to the practice tool such as the EAL explanation document indication. As a result of having carried out the SA education using this practice tool, we determined the tool users could make the right EAL judgment and report the communication vote. Finally, we confirmed that the knowledge necessary for SA correspondence could be given satisfactorily by this practice tool. (author)
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Improved linearity using harmonic error rejection in a full-field range imaging system
Payne, Andrew D.; Dorrington, Adrian A.; Cree, Michael J.; Carnegie, Dale A.
2008-02-01
Full field range imaging cameras are used to simultaneously measure the distance for every pixel in a given scene using an intensity modulated illumination source and a gain modulated receiver array. The light is reflected from an object in the scene, and the modulation envelope experiences a phase shift proportional to the target distance. Ideally the waveforms are sinusoidal, allowing the phase, and hence object range, to be determined from four measurements using an arctangent function. In practice these waveforms are often not perfectly sinusoidal, and in some cases square waveforms are instead used to simplify the electronic drive requirements. The waveforms therefore commonly contain odd harmonics which contribute a nonlinear error to the phase determination, and therefore an error in the range measurement. We have developed a unique sampling method to cancel the effect of these harmonics, with the results showing an order of magnitude improvement in the measurement linearity without the need for calibration or lookup tables, while the acquisition time remains unchanged. The technique can be applied to existing range imaging systems without having to change or modify the complex illumination or sensor systems, instead only requiring a change to the signal generation and timing electronics.
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How Quality Improvement Practice Evidence Can Advance the Knowledge Base.
OʼRourke, Hannah M; Fraser, Kimberly D
2016-01-01
Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.
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Vaucher, Carla; Bovet, Emilie; Bengough, Theresa; Pidoux, Vincent; Grossen, Michèle; Panese, Francesco; Burnand, Bernard
2016-07-18
Multiple barriers to knowledge translation in medicine have been identified (ranging from information overload to abstraction of models), leading to important implementation gaps. This study aimed at assessing the suggestions of practicing physicians for possible improvements of knowledge translation (KT) effectiveness into clinical practice. We used a mixed methods design. French- German- and Italian-speaking general practitioners, psychiatrists, orthopaedic surgeons, cardiologists, and diabetologists practicing in Switzerland were interrogated through semi-structured interviews, focus group discussions, and an online survey. A total of 985 physicians from three regions of Switzerland participated in the online survey, whereas 39 participated in focus group discussions and 14 in face-to-face interviews. Physicians expressed limitations and difficulties related to KT into their daily practice. Several barriers were identified, including influence and pressure of pharmaceutical companies, non-publication of negative results, mismatch between guidelines and practice, education gaps, and insufficient collaboration between research and practice. Suggestions to overcome barriers were improving education concerning the evaluation of scientific publications, expanding applicability of guidelines, having free and easy access to independent journals, developing collaborations between research and practice, and creating tools to facilitate access to medical information. Our study provides suggestions for improving KT into daily medical practice, matching the views, needs and preferences of practicing physicians. Responding to suggestions for improvements brought up by physicians may lead to better knowledge translation, higher professional satisfaction, and better healthcare outcomes.
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Seda Cetin, Pinar; Eymur, Guluzar; Southerland, Sherry A.; Walker, Joi; Whittington, Kirby
2018-03-01
This study examines the influence of laboratory instruction that engages students in a wide range of the practices of science on Turkish high-school students' chemistry learning. In this mixed methods study, student learning in two different laboratory settings was compared, one that featured an instruction that engaged students in a wide range of disciplinary practices (through Argument-driven Inquiry - ADI) and similar laboratories in which a more traditional Structured Inquiry (SI) approach was employed. The data sources included a Chemistry Concept test, an Argumentative Writing Assessment, and Semi-structured interviews. After seven weeks of chemistry instruction, students experiencing ADI instruction scored higher on the Chemistry Concept test and the Argumentative Writing Assessment than students experiencing SI instruction. Furthermore, girls who experienced ADI instruction scored higher on the assessments than their majority peers in the same class. The results suggest that Turkish students can substantially improve their chemistry proficiency if they have an opportunity to engage in instruction featuring a broad array of the practices of science.
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Do Clinical Practice Guidelines Improve Quality?
Baldassari, Cristina M
2017-07-01
Controversy exists surrounding how to best define and assess quality in the health care setting. Clinical practice guidelines (CPGs) have been developed to improve the quality of medical care by highlighting key clinical recommendations based on recent evidence. However, data linking CPGs to improvements in outcomes in otolaryngology are lacking. Numerous barriers contribute to difficulties in translating CPGs to improvements in quality. Future initiatives are needed to improve CPG adherence and define the impact of CPG recommendations on the quality of otolaryngologic care provided to our patients.
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Wiechula, Rick; Kitson, Alison; Marcoionni, Danni; Page, Tammy; Zeitz, Kathryn; Silverston, Heidi
2009-12-01
This paper reports on a structured facilitation program where seven interdisciplinary teams conducted projects aimed at improving the care of the older person in the acute sector. Aims To develop and implement a structured intervention known as the Knowledge Translation (KT) Toolkit to improve the fundamentals of care for the older person in the acute care sector. Three hypotheses were tested: (i) frontline staff can be facilitated to use existing quality improvement tools and techniques and other resources (the KT Toolkit) in order to improve care of older people in the acute hospital setting; (ii) fundamental aspects of care for older people in the acute hospital setting can be improved through the introduction and use of specific evidence-based guidelines by frontline staff; and (iii) innovations can be introduced and improvements made to care within a 12-month cycle/timeframe with appropriate facilitation. Methods Using realistic evaluation methodology the impact of a structured facilitation program (the KT Toolkit) was assessed with the aim of providing a deeper understanding of how a range of tools, techniques and strategies may be used by clinicians to improve care. The intervention comprised three elements: the facilitation team recruited for specific knowledge, skills and expertise in KT, evidence-based practice and quality and safety; the facilitation, including a structured program of education, ongoing support and communication; and finally the components of the toolkit including elements already used within the study organisation. Results Small improvements in care were shown. The results for the individual projects varied from clarifying issues of concern and planning ongoing activities, to changing existing practices, to improving actual patient outcomes such as reducing functional decline. More importantly the study described how teams of clinicians can be facilitated using a structured program to conduct practice improvement activities
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Apekey, Tanefa A; McSorley, Gerry; Tilling, Michelle; Siriwardena, A Niroshan
2011-04-01
Leadership and innovation are currently seen as essential elements for the development and maintenance of high-quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice. Self-administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12-item scale to assess leadership behaviour, a seven-dimension self-rating scale for culture of innovation and questions on current use of quality improvement tools and techniques. Sixty-three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P improvement methods were not adopted by most participating practices. Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate. © 2010 Blackwell Publishing Ltd.
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Scientific considerations on the improvement of the range of ...
African Journals Online (AJOL)
This article provides the results of the investigation of biological effectiveness and the development of the regulations on the use of new agents for the improvement and expansion of the range of herbicides for the protection of sunflower crops. Keywords: range of pesticides, herbicides, sunflower, weeds, biological ...
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Improved optical ranging for space based gravitational wave detection
International Nuclear Information System (INIS)
Sutton, Andrew J; Shaddock, Daniel A; McKenzie, Kirk; Ware, Brent; De Vine, Glenn; Spero, Robert E; Klipstein, W
2013-01-01
The operation of 10 6 km scale laser interferometers in space will permit the detection of gravitational waves at previously unaccessible frequency regions. Multi-spacecraft missions, such as the Laser Interferometer Space Antenna (LISA), will use time delay interferometry to suppress the otherwise dominant laser frequency noise from their measurements. This is accomplished by performing sub-sample interpolation of the optical phase measurements recorded at each spacecraft for synchronization and cancellation of the otherwise dominant laser frequency noise. These sub-sample interpolation time shifts are dependent upon the inter-spacecraft range and will be measured using a pseudo-random noise ranging modulation upon the science laser. One limit to the ranging performance is mutual interference between the outgoing and incoming ranging signals upon each spacecraft. This paper reports on the demonstration of a noise cancellation algorithm which is shown to providing a factor of ∼8 suppression of the mutual interference noise. Demonstration of the algorithm in an optical test bed showed an rms ranging error of 0.06 m, improved from 0.19 m in previous results, surpassing the 1 m RMS LISA specification and potentially improving the cancellation of laser frequency noise. (paper)
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Fagnan, Lyle J; Walunas, Theresa L; Parchman, Michael L; Dickinson, Caitlin L; Murphy, Katrina M; Howell, Ross; Jackson, Kathryn L; Madden, Margaret B; Ciesla, James R; Mazurek, Kathryn D; Kho, Abel N; Solberg, Leif I
2018-04-01
The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. We developed a cost-of-recruitment template and used it to record personnel time and associated costs of travel and communication materials. A total of 3,669 practices were contacted during the 14- to 18-month recruitment period, resulting in 484 enrolled practices across the 6 states served by the 2 cooperatives. The average number of interactions per enrolled practice was 7, with a total of 29,100 hours and a total cost of $2.675 million, or $5,529 per enrolled practice. Prior partnerships predicted recruiting almost 1 in 3 of these practices as contrasted to 1 in 20 practices without a previous relationship or warm hand-off. Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more. © 2018 Annals of Family Medicine, Inc.
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Godény, Sándor
2012-02-05
The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.
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Improving practical atmospheric dispersion models
International Nuclear Information System (INIS)
Hunt, J.C.R.; Hudson, B.; Thomson, D.J.
1992-01-01
The new generation of practical atmospheric dispersion model (for short range ≤ 30 km) are based on dispersion science and boundary layer meteorology which have widespread international acceptance. In addition, recent improvements in computer skills and the widespread availability of small powerful computers make it possible to have new regulatory models which are more complex than the previous generation which were based on charts and simple formulae. This paper describes the basis of these models and how they have developed. Such models are needed to satisfy the urgent public demand for sound, justifiable and consistent environmental decisions. For example, it is preferable that the same models are used to simulate dispersion in different industries; in many countries at present different models are used for emissions from nuclear and fossil fuel power stations. The models should not be so simple as to be suspect but neither should they be too complex for widespread use; for example, at public inquiries in Germany, where simple models are mandatory, it is becoming usual to cite the results from highly complex computational models because the simple models are not credible. This paper is written in a schematic style with an emphasis on tables and diagrams. (au) (22 refs.)
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Practice Facilitators' and Leaders' Perspectives on a Facilitated Quality Improvement Program.
McHugh, Megan; Brown, Tiffany; Liss, David T; Walunas, Theresa L; Persell, Stephen D
2018-04-01
Practice facilitation is a promising approach to helping practices implement quality improvements. Our purpose was to describe practice facilitators' and practice leaders' perspectives on implementation of a practice facilitator-supported quality improvement program and describe where their perspectives aligned and diverged. We conducted interviews with practice leaders and practice facilitators who participated in a program that included 35 improvement strategies aimed at the ABCS of heart health (aspirin use in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation). Rapid qualitative analysis was used to collect, organize, and analyze the data. We interviewed 17 of the 33 eligible practice leaders, and the 10 practice facilitators assigned to those practices. Practice leaders and practice facilitators both reported value in the program's ability to bring needed, high-quality resources to practices. Practice leaders appreciated being able to set the schedule for facilitation and select among the 35 interventions. According to practice facilitators, however, relying on practice leaders to set the pace of the intervention resulted in a lower level of program intensity than intended. Practice leaders preferred targeted assistance, particularly electronic health record documentation guidance and linkages to state smoking cessation programs. Practice facilitators reported that the easiest interventions were those that did not alter care practices. The dual perspectives of practice leaders and practice facilitators provide a more holistic picture of enablers and barriers to program implementation. There may be greater opportunities to assist small practices through simple, targeted practice facilitator-supported efforts rather than larger, comprehensive quality improvement projects. © 2018 Annals of Family Medicine, Inc.
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Practical solution of plastic deformation problems in elastic-plastic range
Mendelson, A; Manson, S
1957-01-01
A practical method for solving plastic deformation problems in the elastic-plastic range is presented. The method is one of successive approximations and is illustrated by four examples which include a flat plate with temperature distribution across the width, a thin shell with axial temperature distribution, a solid cylinder with radial temperature distribution, and a rotating disk with radial temperature distribution.
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Improving coding accuracy in an academic practice.
Nguyen, Dana; O'Mara, Heather; Powell, Robert
2017-01-01
Practice management has become an increasingly important component of graduate medical education. This applies to every practice environment; private, academic, and military. One of the most critical aspects of practice management is documentation and coding for physician services, as they directly affect the financial success of any practice. Our quality improvement project aimed to implement a new and innovative method for teaching billing and coding in a longitudinal fashion in a family medicine residency. We hypothesized that implementation of a new teaching strategy would increase coding accuracy rates among residents and faculty. Design: single group, pretest-posttest. military family medicine residency clinic. Study populations: 7 faculty physicians and 18 resident physicians participated as learners in the project. Educational intervention: monthly structured coding learning sessions in the academic curriculum that involved learner-presented cases, small group case review, and large group discussion. overall coding accuracy (compliance) percentage and coding accuracy per year group for the subjects that were able to participate longitudinally. Statistical tests used: average coding accuracy for population; paired t test to assess improvement between 2 intervention periods, both aggregate and by year group. Overall coding accuracy rates remained stable over the course of time regardless of the modality of the educational intervention. A paired t test was conducted to compare coding accuracy rates at baseline (mean (M)=26.4%, SD=10%) to accuracy rates after all educational interventions were complete (M=26.8%, SD=12%); t24=-0.127, P=.90. Didactic teaching and small group discussion sessions did not improve overall coding accuracy in a residency practice. Future interventions could focus on educating providers at the individual level.
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Structuring diabetes care in general practices: many improvements, remaining challenges.
LENUS (Irish Health Repository)
Jennings, S
2009-08-07
BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.
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Hemler, Jennifer R; Hall, Jennifer D; Cholan, Raja A; Crabtree, Benjamin F; Damschroder, Laura J; Solberg, Leif I; Ono, Sarah S; Cohen, Deborah J
2018-01-01
Practice facilitators ("facilitators") can play an important role in supporting primary care practices in performing quality improvement (QI), but they need complete and accurate clinical performance data from practices' electronic health records (EHR) to help them set improvement priorities, guide clinical change, and monitor progress. Here, we describe the strategies facilitators use to help practices perform QI when complete or accurate performance data are not available. Seven regional cooperatives enrolled approximately 1500 small-to-medium-sized primary care practices and 136 facilitators in EvidenceNOW, the Agency for Healthcare Research and Quality's initiative to improve cardiovascular preventive services. The national evaluation team analyzed qualitative data from online diaries, site visit field notes, and interviews to discover how facilitators worked with practices on EHR data challenges to obtain and use data for QI. We found facilitators faced practice-level EHR data challenges, such as a lack of clinical performance data, partial or incomplete clinical performance data, and inaccurate clinical performance data. We found that facilitators responded to these challenges, respectively, by using other data sources or tools to fill in for missing data, approximating performance reports and generating patient lists, and teaching practices how to document care and confirm performance measures. In addition, facilitators helped practices communicate with EHR vendors or health systems in requesting data they needed. Overall, facilitators tailored strategies to fit the individual practice and helped build data skills and trust. Facilitators can use a range of strategies to help practices perform data-driven QI when performance data are inaccurate, incomplete, or missing. Support is necessary to help practices, particularly those with EHR data challenges, build their capacity for conducting data-driven QI that is required of them for participating in practice
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Improving and ensuring best practice continence management in residential aged care.
Heckenberg, Gayle
2008-06-01
Background Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives • Review the literature on best practice management of incontinence • Evaluate current practice in continence management for elderly residents within residential aged care services • Improve adherence to best practice strategies of care for incontinence • Raise awareness within the nursing home of the best practice management of incontinence • Promote appropriate and effective use of resources for continence management • Deliver individualised person-centred care to residents. • Ensure best practice in continence management Methods The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness
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Appreciative Inquiry for quality improvement in primary care practices.
Ruhe, Mary C; Bobiak, Sarah N; Litaker, David; Carter, Caroline A; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen J; Weyer, Sharon M; Werner, James J; Fry, Ronald E; Stange, Kurt C
2011-01-01
To test the effect of an Appreciative Inquiry (AI) quality improvement strategy on clinical quality management and practice development outcomes. Appreciative inquiry enables the discovery of shared motivations, envisioning a transformed future, and learning around the implementation of a change process. Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical-record review assessed change in PSD rates. Ethnographic field notes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. The PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives, and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited 1 or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective.
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78 FR 18954 - Incentives To Adopt Improved Cybersecurity Practices
2013-03-28
... [Docket Number 130206115-3115-01] Incentives To Adopt Improved Cybersecurity Practices AGENCY: U.S... best practices and standards, once adopted, are updated in the light of changing threats and new...
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Using data to improve medical practice by measuring processes and outcomes of care.
Nelson, E C; Splaine, M E; Godfrey, M M; Kahn, V; Hess, A; Batalden, P; Plume, S K
2000-12-01
The purpose of this article is to help clinicians expand their use of data to improve medical practice performance and to do improvement research. Clinical practices can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly improved by embedding measurement into the flow of daily work in the practice. WHY DO IT?: Four good reasons to build measures into daily medical practice are to (1) diagnose strengths and weaknesses in practice performance; (2) improve and innovate in providing care and services using improvement research; (3) manage patients and the practice; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical practice to analyze the practice, to manage it, and to improve it. One model views clinical practices as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based practice might look like if it were using front-line measurement to improve care and services most of the time and to conduct clinical improvement research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO IMPROVE PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and improve practice. HOW CAN A PRACTICE START TO USE DATA TO IMPROVE CARE AND CONDUCT IMPROVEMENT RESEARCH?: Practical challenges are involved in starting to use data for enhancing care and improvement research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not
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Directory of Open Access Journals (Sweden)
Andrew P. Wilper
2013-09-01
Full Text Available Background : The Accreditation Council for Graduate Medical Education (ACGME requires that training programs integrate system-based practice (SBP and practice-based learning and improvement (PBLI into internal medicine residency curricula. Context and setting : We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Methods : Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality improvement or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. Outcomes : We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants improved their understanding of the context in which they were practicing, and that their ability to engage in quality improvement projects increased. Blinded faculty reviewers favorably ranked the projects’ feasibility, impact, and appropriateness. The ‘Curriculum of Inquiry’ generated 11 quality improvement and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. Conclusions : A structured residency-based curriculum facilitates resident demonstration of SBP and practice-based learning and
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A Pilot Feasibility Study to Improve Food Parenting Practices.
Moore, Amy M; Clair-Michaud, Mary; Melanson, Kathleen J; Tovar, Alison
2018-03-01
We examined the feasibility and acceptability of a novel home-based intervention to improve the food parenting practices of low-income mothers with preschool-aged children. Mother-child dyads (N = 15) were recruited from WIC in southern Rhode Island. A non-experimental, pretest-posttest design was used to assess changes in maternal food parenting practices. Dyads participated in 3 home-based sessions that included baseline measures and an evening meal video recording at session 1, a motivational interviewing (MI) intervention that included feedback on the evening meal video recording at session 2, and a satisfaction ques- tionnaire at session 3. Pretest-posttest measures included 5 subscales of the Comprehensive Feeding Practices Questionnaire. Fifteen mother-child dyads (mothers: 32.3, SD = 4.6 years, 86.7% white; children: 3.2, SD = 0.9 years, male = 73.3%, 66.7% white) completed the study. Mothers reported improvements in food parenting practices following the home-based MI intervention. Overall, 93% of mothers 'strongly agreed' that it was worth their effort to participate in the study. A home-based MI intervention may be an effective strategy for improving maternal food parenting practices in low-income populations. Most mothers found that watching themselves was informative and applicable to their own lives.
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Directory of Open Access Journals (Sweden)
Carl J. Dunst
2017-08-01
Full Text Available Results from four early childhood practitioner field tests of performance checklists and early intervention practice guides are reported. Findings from the first field test were used to make changes and improvements in the checklists and practice guides evaluated in the second and third field tests, and findings from the latter two field tests were used to improve the checklist and practice guide evaluated in the fourth field test. Results indicated that changes made in response to practitioners’ suggestions and feedback were associated with (1 progressive increases in the practitioners’ social validity judgments of the checklists, practice guides, and checklist-practice guide correspondence, and (2 progressive decreases in the number of practitioner suggestions and feedback for improving the early intervention materials. The field-test research demonstrates the importance of practitioner input, suggestions, and feedback for improving the usefulness of early childhood intervention practices.
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Perioperative hair removal: A review of best practice and a practice improvement opportunity.
Spencer, Maureen; Barnden, Marsha; Johnson, Helen Boehm; Fauerbach, Loretta Litz; Graham, Denise; Edmiston, Charles E
2018-06-01
The current practice of perioperative hair removal reflects research-driven changes designed to minimize the risk of surgical wound infection. An aspect of the practice which has received less scrutiny is the clean-up of the clipped hair. This process is critical. The loose fibers represent a potential infection risk because of the micro-organisms they can carry, but their clean-up can pose a logistical problem because of the time required to remove them. Research has demonstrated that the most commonly employed means of clean-up, the use of adhesive tape or sticky mitts, can be both ineffective and time-consuming in addition to posing an infection risk from cross-contamination. Recently published research evaluating surgical clippers fitted with a vacuum-assisted hair collection device highlights the potential for significant practice improvement in the perioperative hair removal clean-up process. These improvements include not only further mitigation of potential infection risk but also substantial OR time and cost savings.
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Thoonen, E.E.J.; Sleegers, P.J.C.; Oort, F.J.; Peetsma, T.T.D.; Geijsel, F.P.
2011-01-01
Purpose: Although it is expected that building schoolwide capacity for teacher learning will improve teaching practices, there is little systematic evidence to support this claim. This study aimed to examine the relative impact of transformational leadership practices, school organizational
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33 CFR 334.20 - Gulf of Maine off Cape Small, Maine; naval aircraft practice mining range area.
2010-07-01
... REGULATIONS § 334.20 Gulf of Maine off Cape Small, Maine; naval aircraft practice mining range area. (a) The... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Gulf of Maine off Cape Small, Maine; naval aircraft practice mining range area. 334.20 Section 334.20 Navigation and Navigable Waters...
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Practical Forward-Secure Range and Sort Queries with Update-Oblivious Linked Lists
Directory of Open Access Journals (Sweden)
Blass Erik-Oliver
2015-06-01
Full Text Available We revisit the problem of privacy-preserving range search and sort queries on encrypted data in the face of an untrusted data store. Our new protocol RASP has several advantages over existing work. First, RASP strengthens privacy by ensuring forward security: after a query for range [a, b], any new record added to the data store is indistinguishable from random, even if the new record falls within range [a, b]. We are able to accomplish this using only traditional hash and block cipher operations, abstaining from expensive asymmetric cryptography and bilinear pairings. Consequently, RASP is highly practical, even for large database sizes. Additionally, we require only cloud storage and not a computational cloud like related works, which can reduce monetary costs significantly. At the heart of RASP, we develop a new update-oblivious bucket-based data structure. We allow for data to be added to buckets without leaking into which bucket it has been added. As long as a bucket is not explicitly queried, the data store does not learn anything about bucket contents. Furthermore, no information is leaked about data additions following a query. Besides formally proving RASP’s privacy, we also present a practical evaluation of RASP on Amazon Dynamo, demonstrating its efficiency and real world applicability.
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Evidence-based care: an innovation to improve nursing practice ...
African Journals Online (AJOL)
Evidence-based care: an innovation to improve nursing practice globally. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... best available evidence from research findings, expert ideas from specialists in the various health ... need to be addressed to enhance utilization of the best available evidence in nursing practice.
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Programme evaluation: Can it improve human resource management practice?
Directory of Open Access Journals (Sweden)
Johann Louw
2012-07-01
Full Text Available Orientation: This is the final article in the special edition on human resource (HR programmes and evaluation. Its starting point is that programme evaluation is the application of a wide range of social science research methods that provide credible information about the need, use, planning, effectiveness and cost of a programme. Research purpose: The purpose of this article is to review the other articles in this volume, and to draw out general conclusions about their contributions to knowledge in the field. Motivation for the study: If evaluations are undertaken in the HR domain in South Africa, they remain mostly unpublished, and thus cannot contribute to a knowledge base for the field. Research design, approach and method: This article provides a theory-based approach to programme evaluation. The seven articles were analysed in terms of two major functions of programme evaluation, namely to ask ‘How does a programme work?’, and ‘Does it work?‘ Main findings: Eight overarching themes are identified in the articles included in this volume. Practical/managerial implications: The evidence discussed here can be used to make better decisions, promote organisational learning, improve practice, and enhance employee wellbeing. Contribution/value-add: The main contribution of this concluding article is its argument that research and theory in this field can enhance the work of HR professionals, by providing evidence about how ‘good’ a programme is, and why it is good. This adds substantial value in a world characterised by accountability and evidence-based practice.
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Implementing practice management strategies to improve patient care: the EPIC project.
Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna
2012-01-01
Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.
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NOAA's Strategy to Improve Operational Weather Prediction Outlooks at Subseasonal Time Range
Schneider, T.; Toepfer, F.; Stajner, I.; DeWitt, D.
2017-12-01
NOAA is planning to extend operational global numerical weather prediction to sub-seasonal time range under the auspices of its Next Generation Global Prediction System (NGGPS) and Extended Range Outlook Programs. A unification of numerical prediction capabilities for weather and subseasonal to seasonal (S2S) timescales is underway at NOAA using the Finite Volume Cubed Sphere (FV3) dynamical core as the basis for the emerging unified system. This presentation will overview NOAA's strategic planning and current activities to improve prediction at S2S time-scales that are ongoing in response to the Weather Research and Forecasting Innovation Act of 2017, Section 201. Over the short-term, NOAA seeks to improve the operational capability through improvements to its ensemble forecast system to extend its range to 30 days using the new FV3 Global Forecast System model, and by using this system to provide reforecast and re-analyses. In parallel, work is ongoing to improve NOAA's operational product suite for 30 day outlooks for temperature, precipitation and extreme weather phenomena.
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The History and State of Neonatal Nursing Quality Improvement Practice and Education.
Kukla, Aniko; Dowling, Donna A; Dolansky, Mary A
2018-03-01
Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.
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E-learning to Improve Healthcare Professionals' Attitudes and Practices on Breastfeeding.
Colaceci, Sofia; Giusti, Angela; Chapin, Elise M; Bettinelli, Maria Enrica; De Angelis, Alessia; Zambri, Francesca; Vellone, Ercole; Alvaro, Rosaria; De Mei, Barbara
2017-12-01
Breastfeeding training has a crucial role in increasing healthcare professionals' attitudes and in improving professional support for breastfeeding. The collaboration between the Italian National Institute of Health, UNICEF, and the Local Health Authority of Milan has led to the development of an online course on lactation and infant feeding practices. To assess if the course was effective in improving healthcare professionals' attitudes and practices (APs). We conducted a prestudy-poststudy, comparing users' APs before (T0) and after (T1) the course through a 20-item questionnaire. Changes in APs were analyzed using paired t-test. Lower mean differences indicated more positive attitudes and more frequent professional practices favoring breastfeeding. Statistical analysis was carried out using SPSS version 15.0. The course had 26,009 registrants and was successfully completed by 91.3% of users. The dropout rate was 8.7%. The final cohort was composed of 15,004 participants. The course improved attitudes, while minor changes were observed on practices (p e-learning approach seems to be a useful tool for improving awareness and positive attitudes toward breastfeeding among healthcare professionals.
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Farmers' adoption of improved vegetable production practices under ...
African Journals Online (AJOL)
STORAGESEVER
2008-12-29
Dec 29, 2008 ... the annual income of the PFs and NPFs, respectively. ... Key words: Adoption, improved vegetable, production practices, farmers and national fadama ..... so, fixed cost components such as depreciation, insurance, repairs,.
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Can information technology improve my ambulatory practice ...
African Journals Online (AJOL)
eHealth is the use of information and communication technologies for health. mHealth is the use of mobile technology in health. As with all information technology (IT), advances in development are rapidly taking place. The application of such technology to individual ambulatory anaesthesia practice should improve the ...
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Business intelligence: using insight to improve the value and performance of your practice.
Coan, Tim
2007-01-01
Using information to improve the value of your practice can be a great way to create leverage and improve the performance of your practice. Business intelligence (BI) is the result of a complete system that produces meaningful insights by providing the information necessary to make business decisions. Changes made from these insights improve both the performance and value of your practice. It is important to identify the key elements required of a good BI system and the areas within a practice that can directly benefit from an effective BI system.
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Production Practice During Language Learning Improves Comprehension.
Hopman, Elise W M; MacDonald, Maryellen C
2018-04-01
Language learners often spend more time comprehending than producing a new language. However, memory research suggests reasons to suspect that production practice might provide a stronger learning experience than comprehension practice. We tested the benefits of production during language learning and the degree to which this learning transfers to comprehension skill. We taught participants an artificial language containing multiple linguistic dependencies. Participants were randomly assigned to either a production- or a comprehension-learning condition, with conditions designed to balance attention demands and other known production-comprehension differences. After training, production-learning participants outperformed comprehension-learning participants on vocabulary comprehension and on comprehension tests of grammatical dependencies, even when we controlled for individual differences in vocabulary learning. This result shows that producing a language during learning can improve subsequent comprehension, which has implications for theories of memory and learning, language representations, and educational practices.
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Newton, Warren P.; Lefebvre, Ann; Donahue, Katrina E.; Bacon, Thomas; Dobson, Allen
2010-01-01
Introduction: Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods: Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3)…
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Yudkowsky, Rachel; Luciano, Cristian; Banerjee, Pat; Schwartz, Alan; Alaraj, Ali; Lemole, G Michael; Charbel, Fady; Smith, Kelly; Rizzi, Silvio; Byrne, Richard; Bendok, Bernard; Frim, David
2013-02-01
Ventriculostomy is a neurosurgical procedure for providing therapeutic cerebrospinal fluid drainage. Complications may arise during repeated attempts at placing the catheter in the ventricle. We studied the impact of simulation-based practice with a library of virtual brains on neurosurgery residents' performance in simulated and live surgical ventriculostomies. Using computed tomographic scans of actual patients, we developed a library of 15 virtual brains for the ImmersiveTouch system, a head- and hand-tracked augmented reality and haptic simulator. The virtual brains represent a range of anatomies including normal, shifted, and compressed ventricles. Neurosurgery residents participated in individual simulator practice on the library of brains including visualizing the 3-dimensional location of the catheter within the brain immediately after each insertion. Performance of participants on novel brains in the simulator and during actual surgery before and after intervention was analyzed using generalized linear mixed models. Simulator cannulation success rates increased after intervention, and live procedure outcomes showed improvement in the rate of successful cannulation on the first pass. However, the incidence of deeper, contralateral (simulator) and third-ventricle (live) placements increased after intervention. Residents reported that simulations were realistic and helpful in improving procedural skills such as aiming the probe, sensing the pressure change when entering the ventricle, and estimating how far the catheter should be advanced within the ventricle. Simulator practice with a library of virtual brains representing a range of anatomies and difficulty levels may improve performance, potentially decreasing complications due to inexpert technique.
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Improving blood transfusion practice by regular education in the United Arab Emirates.
Sajwani, F H
2012-07-01
A cross-match to transfused unit ratio of less than 2.0 is frequently used to assess performance in many hospital blood banks. This brief report was initiated to evaluate the practice at a local hospital and to emphasize the importance of regular educational sessions to improve blood transfusion practice. Retrospective data on cross-match : transfused (C : T) ratio of all departments was collected and educational sessions were given to improve practice. Thereafter, a new set of data was collected and change in practice was assessed. Initial data showed total (C : T) ratio of 1.95. After medical staff education, analysis showed clinically significant improvement in blood utilization practice with a (C : T) ratio of 1.60. This brief report indicates the importance of regular physician education, the potential role of blood transfusion committee, and the need to implement clear guidelines for blood transfusion. © 2012 American Association of Blood Banks.
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Wroth, Thomas H; Boals, Joseph C
2005-01-01
This case study demonstrates the use of quality improvement methods to improve asthma care in a busy community practice. The practice used disease-management strategies, such as population identification, self-management education, and performance measurement and feedback. The practice then applied several practice-based quality improvement methods, such as PDSA cycles, to improve care. From 1998 to 2003, process measures, such as staging of asthmatics, use of long-term control medications, use of peak flow meters and spacers, and use of action plans, improved. There was also a substantial decrease in emergency department use and hospitalizations among patients with asthma. Although there have been several studies demonstrating the efficacy of disease management strategies, most lack generalizability to community practices. Often, interventions are so intensive and cumbersome, that they are unlikely to be replicated in primary care setting. Researchers have been unable to determine which components of the interventions are most effective and replicable. Furthermore, many studies of disease management strategies enroll participants who lack the co-morbidities seen in community practice. There are also few studies of disadvantaged populations that face other barriers to care, such as lack of transportation, poor access to specialists, and medical illiteracy. In this case study, there were several unique factors that enabled the practice to improve care for this population. The AccessCare case manager who worked with the practice not only provided data and feedback to the practice team, but also served as an improvement "coach," often pushing the team and facilitating many of the improvement efforts. AccessCare's approach is in contrast to many of the commercial disease management companies' "carve out" models that do not sufficiently involve providers or practices in their interventions. The other necessary ingredient for success in this project was organizational
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Current practice in software development for computational neuroscience and how to improve it.
Gewaltig, Marc-Oliver; Cannon, Robert
2014-01-01
Almost all research work in computational neuroscience involves software. As researchers try to understand ever more complex systems, there is a continual need for software with new capabilities. Because of the wide range of questions being investigated, new software is often developed rapidly by individuals or small groups. In these cases, it can be hard to demonstrate that the software gives the right results. Software developers are often open about the code they produce and willing to share it, but there is little appreciation among potential users of the great diversity of software development practices and end results, and how this affects the suitability of software tools for use in research projects. To help clarify these issues, we have reviewed a range of software tools and asked how the culture and practice of software development affects their validity and trustworthiness. We identified four key questions that can be used to categorize software projects and correlate them with the type of product that results. The first question addresses what is being produced. The other three concern why, how, and by whom the work is done. The answers to these questions show strong correlations with the nature of the software being produced, and its suitability for particular purposes. Based on our findings, we suggest ways in which current software development practice in computational neuroscience can be improved and propose checklists to help developers, reviewers, and scientists to assess the quality of software and whether particular pieces of software are ready for use in research.
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Current practice in software development for computational neuroscience and how to improve it.
Directory of Open Access Journals (Sweden)
Marc-Oliver Gewaltig
2014-01-01
Full Text Available Almost all research work in computational neuroscience involves software. As researchers try to understand ever more complex systems, there is a continual need for software with new capabilities. Because of the wide range of questions being investigated, new software is often developed rapidly by individuals or small groups. In these cases, it can be hard to demonstrate that the software gives the right results. Software developers are often open about the code they produce and willing to share it, but there is little appreciation among potential users of the great diversity of software development practices and end results, and how this affects the suitability of software tools for use in research projects. To help clarify these issues, we have reviewed a range of software tools and asked how the culture and practice of software development affects their validity and trustworthiness. We identified four key questions that can be used to categorize software projects and correlate them with the type of product that results. The first question addresses what is being produced. The other three concern why, how, and by whom the work is done. The answers to these questions show strong correlations with the nature of the software being produced, and its suitability for particular purposes. Based on our findings, we suggest ways in which current software development practice in computational neuroscience can be improved and propose checklists to help developers, reviewers, and scientists to assess the quality of software and whether particular pieces of software are ready for use in research.
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Performance improvement of professional printing systems : from theory to practice
Ezzeldin Mahdy Abdelmonem, M.
2012-01-01
Performance Improvement of Professional Printing Systems: from theory to practice Markets demand continuously for higher quality, higher speed, and more energy-efficient professional printers. In this thesis, control strategies have been developed to improve the performance of both professional
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Rajasekhar, Praveen T; Rees, Colin J; Nixon, Catherine; East, James E; Brown, Sally
2016-01-01
The quality improvement in colonoscopy study was a region wide service improvement study to improve adenoma detection rate at colonoscopy by implementing evidence into routine colonoscopy practice. Implementing evidence into clinical practice can be challenging. The purpose of this paper is to perform a qualitative interview study to evaluate factors that influenced implementation within the study. Semi-structured interviews were conducted with staff in endoscopy units taking part in the quality improvement in colonoscopy study, after study completion. Units and interviewees were purposefully sampled to ensure a range of experiences was represented. Interviews were conducted with 11 participants. Key themes influencing uptake of the quality improvement in colonoscopy evidence bundle included time, study promotion, training, engagement, positive outcomes and modifications. Areas within themes were increased awareness of quality in colonoscopy (QIC), emphasis on withdrawal time and empowerment of endoscopy nurses to encourage the use of quality measures were positive outcomes of the study. The simple, visible study posters were reported as useful in aiding study promotion. Feedback sessions improved engagement. Challenges included difficulty arranging set-up meetings and engaging certain speciality groups. This evaluation suggests that methods to implement evidence into clinical practice should include identification and empowerment of team members who can positively influence engagement, simple, visible reminders and feedback. Emphasis on timing of meetings and strategies to engage speciality groups should also be given consideration. Qualitative evaluations can provide important insights into why quality improvement initiatives are successful or not, across different sites.
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Directory of Open Access Journals (Sweden)
Oghenetejiri DIGUN-AWETO
2017-11-01
Full Text Available Aquaculture has shown capacities to serve as means of livelihood, improve living standards, provide employment and generate foreign exchange in many countries. Recent investment in Nigerian aquaculture has been target towards catfish farming. However, small quantity and poor quality fish seeds are one of the problems limiting production. Consequently, Lagos State government introduced improved breeding and hatchery management practices as a package to fish hatchery operators with the aim of improving fish seed quantity and quality in the state. Nevertheless, the dissemination of the package has not yielded the desired result. This study assessed the constraints to adoption of improved hatchery management practices among catfish farmers in Lagos State. With structured questionnaire, 150 catfish farmers, randomly selected from 12 local government areas spread across Lagos State were interviewed. Despite that majority of the respondents strongly agreed or agreed to the fact that improved hatchery management practices have positive impacts on breeding, hatching, and survival of fish fry, majority of them affirmed that high cost of acquisition, high technicality in using the improved management practices as well as inadequate information about the improved management practices are primary reasons for non-adoption of some of the improved practices. Some of the limitations faced by the respondents include insufficient capital, lack of technical expertise to use the methods adequately, non-availability of inputs, expensive cost of facility maintenance, poor information dissemination and insufficient technical support from the extension agents and the state government. Although the adoption of improved practices has not been total, due to these constraints, the farmers’ knowledge of the improved hatchery management practices is broad. There is a need for the state government to subsidize the improved hatchery technologies and inputs, in addition to
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Avoiding never events: Improving nasogastric intubation practice and standards
International Nuclear Information System (INIS)
Law, Robert L.; Pullyblank, Ann M.; Eveleigh, Mark; Slack, Nicola
2013-01-01
Aim: To identify and rectify weaknesses in nasogastric (NG) intubation practice in the North Bristol NHS Trust that resulted in the occurrence of a National patient Safety Agency defined “never event”. Material and methods: Root-cause analysis identified that a change in culture was required. Recommendations divided into four categories: documentation, intubation, interpretation training, and radiology. A 6 month prospective audit covering all aspects of NG intubation practice preceded implementation of the recommendations. All patients whose tubes were mis-sited formed the cohort of the study. A re-audit was undertaken 12 months after the implementation of the recommended changes. Results: Re-audit suggested significant improvements had occurred in all categories, particularly junior doctor check image interpretation errors, which in the study group were reduced from seven to one, and documentation, which has so far improved by 22%. Protocols and guidelines associated with NG tube check imaging have now been developed for radiologists and radiographers with check imaging and image interpretation being made a priority and respiratory tract intubation treated as an emergency. Conclusion: The service is still not perfect, but there is a focal awareness of patient safety associated with intubation practice, and image interpretation by junior doctors significantly improved with the introduction of the e-learning package. However, it is considered that the responsibility for developing safe practice with respect to NG tube check image interpretation ultimately lies with the department of radiology, which should take the lead on reducing the risk of never events being caused by the misinterpretation of these images
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Middel, H.G.A.; op de Weegh, S.; Gieskes, J.F.B.; Schuring, R.W.
2004-01-01
Continuous Improvement is a well-known and consolidated concept in literature and practice and is considered vital in today¿s business environment. In 2003 a survey, as part of the international CINet survey, has been performed in the Netherlands in order to gain insight into the current practices
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Mobile technology: streamlining practice and improving care
Blake, Holly
2013-01-01
The use of mobile phones in care delivery has the potential to improve the way in which care is delivered. When implemented effectively, mobile technologies can empower patients and enhance communication between patients and their health-care providers. When barriers are recognised and addressed, mobile technologies can change working lives, facilitating rapid access to information and supporting efficiency in practice.
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Rescue dose orders as an alternative to range orders: an evidence-based practice project.
Yi, Cassia
2015-06-01
Relief of pain is a fundamental aspect of optimal patient care. However, pain management in the inpatient setting is often constrained by concerns related to regulatory oversight, particularly with regard to the use of opioid dose range orders. These concerns can inadvertently result in the development of policies and practices that can negatively impact the health care team's ability to deliver optimal and individualized pain management. An evidence-based practice project was undertaken to address concerns about regulatory oversight of pain management processes by changing the way pain was managed in a large academic hospital setting. A novel pain management approach using rescue dose medications was established as an alternative to opioid dose range orders. The use of the rescue dose protocol was successfully implemented. Outcomes included an overall reduction in the administration of inappropriate intravenous opioids and opioid-acetaminophen combination medications, with a subsequent increase in single-entity first-line opioid analgesics. Rescue dose protocols may offer an alternative to opioid dose range orders as a means of effectively managing pain. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
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Thoonen, E.E.J.
2012-01-01
Schools are challenged to improve classroom practices as they are expected to enhance students’ motivation. While leadership, school organizational conditions and teacher factors are considered essential for improving classroom practices, more should be known about the interplay between school
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Wolfenden, Luke; Jones, Jannah; Williams, Christopher M; Finch, Meghan; Wyse, Rebecca J; Kingsland, Melanie; Tzelepis, Flora; Wiggers, John; Williams, Amanda J; Seward, Kirsty; Small, Tameka; Welch, Vivian; Booth, Debbie; Yoong, Sze Lin
2016-10-04
assessment via meta-analysis. However, we narratively synthesised the trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). We identified 10 trials as eligible and included them in the review. The trials sought to improve the implementation of policies and practices targeting healthy eating (two trials), physical activity (two trials) or both healthy eating and physical activity (six trials). Collectively the implementation strategies tested in the 10 trials included educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing. A total of 1053 childcare services participated across all trials. Of the 10 trials, eight examined implementation strategies versus a usual practice control and two compared alternative implementation strategies. There was considerable study heterogeneity. We judged all studies as having high risk of bias for at least one domain.It is uncertain whether the strategies tested improved the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention. No intervention improved the implementation of all policies and practices targeted by the implementation strategies relative to a comparison group. Of the eight trials that compared an implementation strategy to usual practice or a no intervention control, however, seven reported improvements in the implementation of at least one of the targeted policies or practices relative to control. For these trials the effect on the primary implementation outcome was as follows: among the three trials that reported score-based measures of implementation the scores ranged from 1 to 5.1; across four trials reporting the proportion of staff or services implementing a specific policy or practice this ranged from 0% to
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Directory of Open Access Journals (Sweden)
Xiaoyuan Wang
2017-02-01
Full Text Available The key to control the range extender generation system is to improve the efficiency and reduce the emissions of the electric vehicle (EV. In this paper, based on the purpose of efficiency optimization, both engine and generator are matched to get a public high efficiency region, and a partial power following control strategy was presented. The engine speed is constant in the defined power range, so the output power regulation of the range extender is only realized by the adjustment of the torque of the generator. Engine speed and generator torque were decoupled. An improved proportional resonant (PR controller is adopted to achieve fast output power regulation. In order to ensure the response characteristics of the control system and to improve the robustness, the impacts on system’s characteristics and stability caused by PR controller and parameters in the inner-current loop were analyzed via frequency response characteristics. A pre-Tustin with deviation compensation is proposed for PR controller’s discretization. A stable and robust power following control method is obtained for the range extender control system. Finally, simulation and experiment of the proposed control strategy illustrated its feasibility and correctness.
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Fayiga, A O; Saha, U K
2016-09-01
The total lead (Pb) concentrations of the surface soil, sub surface soil, vegetation and surface waters of outdoor shooting ranges are extremely high and above regulatory limits. Lead is dangerous at high concentrations and can cause a variety of serious health problems. Shooters and range workers are exposed to lead dust and can even take Pb dust home to their families while some animals around the shooting range can ingest the Pb bullets. The toxicity of Pb depends on its bioavailability which has been determined to be influenced greatly by the geochemical properties of each site. The bioavailability of Pb in shooting ranges has been found to be higher than other metal contaminated soils probably because of its very low residual Pb (soil, migration of Pb within shooting ranges and offsite has been reported in literature. Best management practices to reduce mobility of Pb in shooting ranges involve an integrated Pb management program which has been described in the paper. The adoption of the non-toxic "green bullet" which has been developed to replace Pb bullets may reduce or prevent environmental pollution at shooting ranges. However, the contaminated soil resulting from decades of operation of several shooting ranges still needs to be restored to its natural state. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Mazzocato, Pamela; Stenfors-Hayes, Terese; von Thiele Schwarz, Ulrica; Hasson, Henna; Nystr?m, Monica Elisabeth
2016-01-01
OBJECTIVES: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. METHODS: We analysed 186 structured kaizen documents containing improvement suggest...
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Talking about the elephant in the room: Improving fundamental assessment practices
Directory of Open Access Journals (Sweden)
Betty Gill
2015-08-01
Full Text Available This paper reports on an institution-wide strategy to improve first year assessment practices. Assessment is central to the student experience and to informing their developing conceptions of themselves as students. Despite this central importance, much national and international literature raises questions about the fitness-for-purpose of assessment practices in higher education. The reported strategy was developed in response to analysis of student feedback, which suggested, like the literature, substantial opportunity for improvement. Student feedback on their assessment experience was validated by an audit of first session assessment and used to inform the strategy. A significant improvement in quantitative and qualitative measures of student satisfaction across routine data sources is provided to demonstrate impact. This supports a conclusion that the first year student experience can be impacted by the systemic application of a small number of fundamental good practice assessment strategies which are outlined.
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IMPROVING WOMEN'S LIVES Practical support for women gives ...
International Development Research Centre (IDRC) Digital Library (Canada)
IMPROVING WOMEN'S LIVES Practical support for women gives communities a better future. October 26 ... Organized into small cooperatives, the women produce and market argan oil using a mix of traditional and modern methods. At the same time ... arts and craft. Technology helps Asian women balance family and work.
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Improving Inquiry Teaching through Reflection on Practice
Lotter, Christine R.; Miller, Cory
2017-08-01
In this paper, we explore middle school science teachers' learning of inquiry-based instructional strategies through reflection on practice teaching sessions during a summer enrichment program with middle level students. The reflection sessions were part of a larger year-long inquiry professional development program in which teachers learned science content and inquiry pedagogy. The program included a 2-week summer institute in which teachers participated in science content sessions, practice teaching to middle level students, and small group-facilitated reflection sessions on their teaching. For this study, data collection focused on teachers' recorded dialogue during the facilitator - run reflection sessions, the teachers' daily written reflections, a final written reflection, and a written reflection on a videotaped teaching session. We investigated the teachers' reflection levels and the themes teachers focused on during their reflection sessions. Teachers were found to reflect at various reflection levels, from simple description to a more sophisticated focus on how to improve student learning. Recurrent themes point to the importance of providing situated learning environments, such as the practice teaching with immediate reflection for teachers to have time to practice new instructional strategies and gain insight from peers and science educators on how to handle student learning issues.
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Mitchell, L
1996-01-01
The processes of benchmarking, benchmark data comparative analysis, and study of best practices are distinctly different. The study of best practices is explained with an example based on the Arthur Andersen & Co. 1992 "Study of Best Practices in Ambulatory Surgery". The results of a national best practices study in ambulatory surgery were used to provide our quality improvement team with the goal of improving the turnaround time between surgical cases. The team used a seven-step quality improvement problem-solving process to improve the surgical turnaround time. The national benchmark for turnaround times between surgical cases in 1992 was 13.5 minutes. The initial turnaround time at St. Joseph's Medical Center was 19.9 minutes. After the team implemented solutions, the time was reduced to an average of 16.3 minutes, an 18% improvement. Cost-benefit analysis showed a potential enhanced revenue of approximately $300,000, or a potential savings of $10,119. Applying quality improvement principles to benchmarking, benchmarks, or best practices can improve process performance. Understanding which form of benchmarking the institution wishes to embark on will help focus a team and use appropriate resources. Communicating with professional organizations that have experience in benchmarking will save time and money and help achieve the desired results.
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From theory to practice: improving the impact of health services research
Directory of Open Access Journals (Sweden)
Levine Robert
2005-01-01
Full Text Available Abstract Background While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers. Discussion Recognizing the importance of theory calls for new expectations in the practice of health services research. These include: the formation of interdisciplinary research teams; broadening the training for those who will practice health services research; and supportive organizational conditions that promote collaboration between researchers and decision makers. Further, funding bodies can provide a significant role in guiding and supporting the use of theory in the practice of health services research. Summary Institutions and researchers should incorporate the use of theory if health services research is to fulfill its potential for improving the delivery of health care.
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Berkas, W.R.; Femmer, Suzanne R.; Mesko, T.O.; Thompson, B.W.
1987-01-01
The U. S. Department of Agriculture, Soil Conservation Service, in accordance with Public Law 566, is implementing various types of water-land improvement practices in the Little Black River basin in southeastern Missouri. These practices are designed, in part, to decrease the suspended sediment (SS) transport in the basin, decrease flood damage in the basin, and improve drainage in the agricultural area. The general features of the basin, such as geology, groundwater hydrology, soils, land use, water use, and precipitation are described; surface water quantity, quality, and suspended sediment discharge are also described. The aquifers are the Mississippi River valley alluvial aquifer, which can yield about 3,500 gal/min to properly constructed wells, and the Ozark and St. Francois aquifers, which can yield from about 30 to 500 gal/min to properly constructed wells. Soils in the area have formed in loess and cherty residuum in the uplands or have formed in alluvial sediment in the lowlands. About 93% of the estimated 3 billion gal/year of water used in the basin is for crop irrigation. The average monthly precipitation varies slightly throughout the year, with an average annual precipitation of about 47 inches. Water quality data were collected at seven stations. Specific conductance values ranged from 50 to 400 microsiemens/cm at 25 C. Water temperatures ranged from 0.0 C in the winter to 33.5 C in summer. pH values ranged from 6.4 to 8.5 units. Dissolved oxygen concentrations ranged from 2.2 to 12.8 ml/l. Total nitrogen concentrations ranged from 0.13 to 2.20 ml/l as nitrogen, with organic nitrogen as the most abundant form. Phosphorus concentrations ranged from zero to 0.29 ml/l as phosphorus. Bacterial counts were largest during storm runoff in the basin with livestock waste as the significant contributor. For the period from October 1, 1980, to September 30, 1984, the average annual SS discharge ranged from 2,230 tons/yr in the headwater areas to 27,800 tons
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Improving low-wage, midsized employers' health promotion practices: a randomized controlled trial.
Hannon, Peggy A; Harris, Jeffrey R; Sopher, Carrie J; Kuniyuki, Alan; Ghosh, Donetta L; Henderson, Shelly; Martin, Diane P; Weaver, Marcia R; Williams, Barbara; Albano, Denise L; Meischke, Hendrika; Diehr, Paula; Lichiello, Patricia; Hammerback, Kristen E; Parks, Malcolm R; Forehand, Mark
2012-08-01
The Guide to Community Preventive Services (Community Guide) offers evidence-based intervention strategies to prevent chronic disease. The American Cancer Society (ACS) and the University of Washington Health Promotion Research Center co-developed ACS Workplace Solutions (WPS) to improve workplaces' implementation of Community Guide strategies. To test the effectiveness of WPS for midsized employers in low-wage industries. Two-arm RCT; workplaces were randomized to receive WPS during the study (intervention group) or at the end of the study (delayed control group). Forty-eight midsized employers (100-999 workers) in King County WA. WPS provides employers one-on-one consulting with an ACS interventionist via three meetings at the workplace. The interventionist recommends best practices to adopt based on the workplace's current practices, provides implementation toolkits for the best practices the employer chooses to adopt, conducts a follow-up visit at 6 months, and provides technical assistance. Employers' implementation of 16 best practices (in the categories of insurance benefits, health-related policies, programs, tracking, and health communications) at baseline (June 2007-June 2008) and 15-month follow-up (October 2008-December 2009). Data were analyzed in 2010-2011. Intervention employers demonstrated greater improvement from baseline than control employers in two of the five best-practice categories; implementing policies (baseline scores: 39% program, 43% control; follow-up scores: 49% program, 45% control; p=0.013) and communications (baseline scores: 42% program, 44% control; follow-up scores: 76% program, 55% control; p=0.007). Total best-practice implementation improvement did not differ between study groups (baseline scores: 32% intervention, 37% control; follow-up scores: 39% intervention, 42% control; p=0.328). WPS improved employers' health-related policies and communications but did not improve insurance benefits design, programs, or tracking. Many
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Directory of Open Access Journals (Sweden)
Fejzic J
2015-09-01
Full Text Available Background: Effective communication enables healthcare professionals and students to practise their disciplines in a professional and competent manner. Simulated-based education (SBE has been increasingly used to improve students’ communication and practice skills in Health Education. Objective: Simulated learning modules (SLMs were developed using practice-based scenarios grounded in effective communication competencies. The effect of the SLMs on Pharmacy students’ (i Practice skills and (ii Professionalism were evaluated. Methods: SLMs integrating EXCELL competencies were applied in the classroom to study their effect on a number of learning outcomes. EXcellence in Cultural Experiential Learning and Leadership (EXCELL Program is a schematic, evidence-based professional development resource centred around developing participants’ self-efficacy and generic communication competencies. Students (N=95 completed three hours of preliminary lectures and eight hours of SLM workshops including six scenarios focused on Pharmacy Practice and Experiential Placements. Each SLM included briefing, role-plays with actors, facilitation, and debriefing on EXCELL social interaction maps (SIMs. Evaluations comprised quantitative and qualitative survey responsed by students before and post-workshops, and post-placements, and teachers’ reflections. Surveys examine specific learning outcomes by using pharmacy professionalism and pharmacy practice effectiveness scales. Responses were measured prior to the commencement of SLMs, after completion of the two workshops and after students completed their block placement. Self-report measures enabled students to self-assess whether any improvements occurred. Results: Student responses were overwhelmingly positive and indicated significant improvements in their Pharmacy practice and professionalism skills, and commitment to professional ethics. Qualitative feedback strongly supported students’ improved communication
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Gilkes, Lucy A; Liira, Helena; Emery, Jon
Medical students benefit from their contact with clinicians and patients in the clinical setting. However, little is known about whether patients and clinicians also benefit from medical students. We developed an audit and feedback intervention activity to be delivered by medical students to their general practice supervisors. We tested whether the repeated cycle of audit had an effect on the preventive care practices of general practitioners (GPs). The students performed an audit on topics of preventive medicine and gave feedback to their supervisors. Each supervisor in the study had more than one student performing the audit over the academic year. After repetitive cycles of audit and feedback, the recording of social history items by GPs improved. For example, recording alcohol history increased from 24% to 36%. This study shows that medical students can be effective auditors, and their repeated audits may improve their general practice supervisors' recording of some aspects of social history.
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Improving the rate and quality of medicaid well child care exams in primary care practices.
Smith, Katy Duncan; Merchen, Eileen; Turner, Crystal D; Vaught, Cara; Fritz, Terrie; Mold, Jim
2010-07-01
Providing recommended well child care to children insured bythe Medicaid Program can be challenging. Members of the Department of Family and Preventive Medicine (DFPM) at the University of Oklahoma Health Sciences Center contracted to help practices improve the rates and quality of well child care visits within the Oklahoma Medicaid Program. Sixteen pediatric and family medicine practices in three Oklahoma counties chose to participate in this quality improvement initiative. The records of Sooner Care-insured children age 0-20 were reviewed for both rate and quality of well child care visits made during the previous twelve months. Performance feedback was provided. Practice guidelines, Sooner Care requirements, and tips from exemplary practices were provided. In two of the counties, a case manager helped practices with challenging patients. Practice Enhancement Assistants (PEAs) then helped practices implement a variety of strategies to increase visit rates and improve the quality of early and periodic screening, diagnosis, and treatment (EPSDT) visits. Information technology (IT) support was provided when needed. The average rates of visits, for all counties combined, increased. Visit rates increased more in the younger age groups (birth to two years). There was significant improvement in quality of visits. Rates and quality improved much more in some practices than in others. A combination of academic detailing, performance feedback, practice facilitation, case management, and IT support produced increases in the quality and rates of EPSDT exams.
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Quality Improvement Practices and Trends
DEFF Research Database (Denmark)
Dahlgaard, Jens J.; Hartz, Ove; Edgeman, Rick L.
1998-01-01
professor, as well as key individuals from various industries. In addition to the above activities, Rick will be working with the European Foundation for Quality Management on their "European Master's Programme in Total Quality Management." That program involves a consortium of European universities. Rick......The following article, "Quality Improvement Practices and Trends in Denmark," is the first in a series of papers arranged for and co-authored by Dr. Rick L. Edgeman. Rick is a member of QE's Editorial Board and is on sabbatical from Colorado State University. During the year, Rick and his family...... has begun the process of developing a comparable consortium of American universities for the same purpose-- an activity which is cosponsored by the Education Division of the American Society for Quality (ASQ)....
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Target recognition of ladar range images using slice image: comparison of four improved algorithms
Xia, Wenze; Han, Shaokun; Cao, Jingya; Wang, Liang; Zhai, Yu; Cheng, Yang
2017-07-01
Compared with traditional 3-D shape data, ladar range images possess properties of strong noise, shape degeneracy, and sparsity, which make feature extraction and representation difficult. The slice image is an effective feature descriptor to resolve this problem. We propose four improved algorithms on target recognition of ladar range images using slice image. In order to improve resolution invariance of the slice image, mean value detection instead of maximum value detection is applied in these four improved algorithms. In order to improve rotation invariance of the slice image, three new improved feature descriptors-which are feature slice image, slice-Zernike moments, and slice-Fourier moments-are applied to the last three improved algorithms, respectively. Backpropagation neural networks are used as feature classifiers in the last two improved algorithms. The performance of these four improved recognition systems is analyzed comprehensively in the aspects of the three invariances, recognition rate, and execution time. The final experiment results show that the improvements for these four algorithms reach the desired effect, the three invariances of feature descriptors are not directly related to the final recognition performance of recognition systems, and these four improved recognition systems have different performances under different conditions.
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Clark, Kait; Appelbaum, L. Gregory; van den Berg, Berry; Mitroff, Stephen R.; Woldorff, Marty G.
2015-01-01
Practice can improve performance on visual search tasks; the neural mechanisms underlying such improvements, however, are not clear. Response time typically shortens with practice, but which components of the stimulus-response processing chain facilitate this behavioral change? Improved search
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Performance improvement planning : developing effective billing and collection practices
anonymous
2008-01-01
Effective billing and collection systems are a critical component for ensuring the viability of a service provider. Improving billing and collection activities has an immediate impact on the revenue streams of a service provider that can, in turn, help the service provider in improving services. However, while effective billing and collection practices depend on many internal factors (including customer databases, the extent of metered and unmetered service provision, tariff and billing struc...
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Teacher coaching supported by formative assessment for improving classroom practices.
Fabiano, Gregory A; Reddy, Linda A; Dudek, Christopher M
2018-06-01
The present study is a wait-list controlled, randomized study investigating a teacher coaching approach that emphasizes formative assessment and visual performance feedback to enhance elementary school teachers' classroom practices. The coaching model targeted instructional and behavioral management practices as measured by the Classroom Strategies Assessment System (CSAS) Observer and Teacher Forms. The sample included 89 general education teachers, stratified by grade level, and randomly assigned to 1 of 2 conditions: (a) immediate coaching, or (b) waitlist control. Results indicated that, relative to the waitlist control, teachers in immediate coaching demonstrated significantly greater improvements in observations of behavior management strategy use but not for observations of instructional strategy use. Observer- and teacher-completed ratings of behavioral management strategy use at postassessment were significantly improved by both raters; ratings of instructional strategy use were significantly improved for teacher but not observer ratings. A brief coaching intervention improved teachers' use of observed behavior management strategies and self-reported use of behavior management and instructional strategies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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A Practice Indexes for Improving Facial Movements of Brass Instrument Players
Ito, Kyoko; Hirano, Takeshi; Noto, Kazufumi; Nishida, Shogo; Ohtsuki, Tatsuyuki
Two experimental studies have been conducted in order to propose practice indexes for the improvement of the embouchure of French horn players, two experimental studies have been conducted. In both studies, the same task was performed by advanced and amateur French horn players. The first study investigated the activity, while performing the above-mentioned task, of the 5 facial muscles (levator labii superioris, zygomaticus major, depressor anguli oris, depressor labii inferioris, and risorius muscles) on the right side of the face by surface electromyography, and the facial movement on the left side of the face by attaching two markers above each muscle and using two high-speed cameras simultaneously. The results of the study showed that it is possible for the four markers around the lower lip to practice indexes. The second study evaluated whether the above-mentioned markers are appropriate as practice indexes using a 3-D tracking system and questionnaires. The results showed that both the advanced and the amateur players assessed that the markers were suitable as practice indexes for improving the embouchure. This set of approaches could be useful for selecting practice indexes and developing scientific practice methods not only for the French horn but also for other instruments and other fields.
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Padula, William V; Mishra, Manish K; Makic, Mary Beth F; Valuck, Robert J
2014-06-01
To enhance the learner's competence with knowledge about a framework of quality improvement (QI) interventions to implement evidence-based practices for pressure ulcer (PrU) prevention. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Summarize the process of creating and initiating the best-practice framework of QI for PrU prevention.2. Identify the domains and QI interventions for the best-practice framework of QI for PrU prevention. Pressure ulcer (PrU) prevention is a priority issue in US hospitals. The National Pressure Ulcer Advisory Panel endorses an evidence-based practice (EBP) protocol to help prevent PrUs. Effective implementation of EBPs requires systematic change of existing care units. Quality improvement interventions offer a mechanism of change to existing structures in order to effectively implement EBPs for PrU prevention. The best-practice framework developed by Nelson et al is a useful model of quality improvement interventions that targets process improvement in 4 domains: leadership, staff, information and information technology, and performance and improvement. At 2 academic medical centers, the best-practice framework was shown to physicians, nurses, and health services researchers. Their insight was used to modify the best-practice framework as a reference tool for quality improvement interventions in PrU prevention. The revised framework includes 25 elements across 4 domains. Many of these elements support EBPs for PrU prevention, such as updates in PrU staging and risk assessment. The best-practice framework offers a reference point to initiating a bundle of quality improvement interventions in support of EBPs. Hospitals and clinicians tasked with quality improvement efforts can use this framework to problem-solve PrU prevention and other critical issues.
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What interventions can improve the mental health nursing practice environment?
Redknap, Robina; Twigg, Di; Towell, Amanda
2016-02-01
The nursing practice environment is an important factor for services to consider in the attraction and retention of a skilled workforce during future nursing shortages. Despite the significant number of international studies undertaken to understand the influence of the practice environment on nurse satisfaction and retention, few have been undertaken within the mental health setting. This paper reports on results from a survey conducted in a large Australian public mental health hospital to examine nurses' perceptions of their practice environment, and identifies interventions that could be implemented to improve the practice environment. The hospital is the only remaining, standalone public mental health hospital in Western Australia. © 2016 Australian College of Mental Health Nurses Inc.
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How Positive Practices Can Accelerate Transformation To a Lean Improvement Culture
DEFF Research Database (Denmark)
Jørgensen, Rasmus; Hansen, David; Lilja, Johan
2016-01-01
With increasing pressure on creating more value with fewer resources, many organizations pursue continuous improvement culture and practices in daily operations.In operations management Lean and the Toyota Way have been continuous improvement role models for describing tools and culture. However...
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Improving School Leadership. Volume 1: Policy and Practice
OECD Publishing (NJ3), 2008
2008-01-01
As countries strive to reform education systems and improve student results, school leadership is high on education policy agendas. But in many countries, the men and women who run schools are overburdened, underpaid and near retirement. And few people are lining up for their jobs. Based on an OECD study of school leadership practices and policies…
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Recommended Feeding and Dietary Practices To Improve Infant and Maternal Nutrition.
Academy for Educational Development, Washington, DC.
The LINKAGES Project is intended to improve breastfeeding and related complementary feeding and maternal dietary practices. The project, in consultation with technical experts and program managers, identified a set of recommended feeding and dietary practices intended to break the cycle of poor health and nutrition that passes from generation to…
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Value of wireless personal digital assistants for practice: perceptions of advanced practice nurses.
Garrett, Bernard; Klein, Gerri
2008-08-01
The aims were to explore advanced practice nurses' perceptions on wireless Personal Digital Assistant technologies, to establish the type and range of tools that would be useful to support their practice and to identify any requirements and limitations that may impact the implementation of wireless Personal Digital Assistants in practice. The wireless Personal Digital Assistant is becoming established as a hand-held computing tool for healthcare professionals. The reflections of advanced practice nurses' about the value of wireless Personal Digital Assistants and its potential to contribute to improved patient care has not been investigated. A qualitative interpretivist design was used to explore advanced practice nurses' perceptions on the value of wireless Personal Digital Assistant technologies to support their practice. The data were collected using survey questionnaires and individual and focus group interviews with nurse practitioners, clinical nurse specialists and information technology managers based in British Columbia, Canada. An open-coding content analysis was performed using qualitative data analysis software. Wireless Personal Digital Assistant's use supports the principles of pervasivity and is a technology rapidly being adopted by advanced practice nurses. Some nurses indicated a reluctance to integrate wireless Personal Digital Assistant technologies into their practices because of the cost and the short technological life cycle of these devices. Many of the barriers which precluded the use of wireless networks within facilities are being removed. Nurses demonstrated a complex understanding of wireless Personal Digital Assistant technologies and gave good rationales for its integration in their practice. Nurses identified improved client care as the major benefit of this technology in practice and the type and range of tools they identified included clinical reference tools such as drug and diagnostic/laboratory reference applications and wireless
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Using a standards committee to design practical procedure system improvements
International Nuclear Information System (INIS)
Grider, D.A.; Plung, D.
1993-01-01
In the post-Three Mile Island (TMI) environment, numerous reports have been issued on how to improve the quality of procedures used at government and commercial nuclear facilities. The studies tend to be long on what is wrong with existing procedures and short on practical directions on how to fix those faults. Few of these studies have been conducted by practitioners with full-time procedure-managing or procedure writing experience. None of these studies go into detail on how to improve the procedure system itself. Over the last 10 yr, various nuclear facilities within the US Department of Energy (DOE) have carried out individual programs to develop procedures that meet post-TMI standards. However, ∼2 yr ago, DOE formed a Procedures Standards Committee to advise DOE in developing a set of post-TMI guidelines that could be consistently applied throughout all DOE nuclear facilities. The committee has achieved not only its original mission by producing a series of integrated guidance documents but has also evolved a systems approach to procedures management that sets new standards for procedure quality and efficiency. As members of this committee, the authors want to describe what has made the group's approach so successful. The lessons learned may be translatable to a wide range of government and commercial industry procedure programs
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Quality improvement – rival or ally of practice development?
Directory of Open Access Journals (Sweden)
Gavin Lavery
2016-05-01
Full Text Available The majority of nurses, doctors, allied health professionals and other healthcare staff possess a strong desire to provide the best possible care and experience for their patients. Unfortunately, this sometimes falls short of what was planned or intended (Institute of Medicine, 2001, p 23. The gap between care intended and care delivered can be explained by problems with systems and processes and/or people and culture. The narrowing of this gap is the focus of many strategies, methodologies and approaches. Practice development is described as ‘an activity focused on developing people and practice for the ultimate purpose of achieving high-quality person-centred care’ and a ‘methodology that aims to achieve effective workplace cultures that are person-centred’ (Shaw, 2012; Manley et al., 2014. Practice development undoubtedly has a strong focus on people and culture and the potential to change processes and systems. Another approach, widely referred to as quality improvement, aims to improve safety, effectiveness and person-centredness in healthcare using principles proven effective in other industries such as manufacturing – notably car manufacturing (Toyota, oil production, nuclear power and aviation. The fundamental principles of quality improvement for healthcare include making care reliable (every patient receiving care as intended every time, using well-designed processes and reducing variation (agreeing a consistent way to provide care. At first glance this may appear to be an approach suited only to systems and processes. However, better processes, designed by those who use them, resulting in fewer errors and less re-working or working around problems, can reduce stress on staff, offer greater job satisfaction with improved morale and free up time to provide person-centred care. In his report, A Promise to Learn – a Commitment to Act (2013, p 24, Professor Don Berwick says: ‘Mastery of quality and patient safety sciences and
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Mazzocato, Pamela; Stenfors-Hayes, Terese; von Thiele Schwarz, Ulrica; Hasson, Henna
2016-01-01
Objectives Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. Methods We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated. Results 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions. Conclusions There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results. PMID:27473953
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Approaching the Practice Quality Improvement Project in Interventional Radiology.
Reis, Stephen P; White, Benjamin; Sutphin, Patrick D; Pillai, Anil K; Kalva, Sanjeeva P; Toomay, Seth M
2015-12-01
An important component of maintenance of certification and quality improvement in radiology is the practice quality improvement (PQI) project. In this article, the authors describe several methodologies for initiating and completing PQI projects. Furthermore, the authors illustrate several tools that are vital in compiling, analyzing, and presenting data in an easily understandable and reproducible manner. Last, they describe two PQI projects performed in an interventional radiology division that have successfully improved the quality of care for patients. Using the DMAIC (define, measure, analyze, improve, control) quality improvement framework, interventional radiology throughput has been increased, to lessen mediport wait times from 43 to 8 days, and mediport infection rates have decreased from more than 2% to less than 0.4%. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.
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Information Technology Management: Social Security Administration Practices Can Be Improved
National Research Council Canada - National Science Library
Shaw, Clay
2001-01-01
To improve SSAs IT management practices, we recommend that the Acting Commissioner of Social Security direct the Chief Information Officer and the Deputy Commissioner for Systems to complete the following actions...
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Fleiszer, Andrea R; Semenic, Sonia E; Ritchie, Judith A; Richer, Marie-Claire; Denis, Jean-Louis
2016-04-01
To describe how actions of nursing unit leaders influenced the long-term sustainability of a best practice guidelines (BPG) program on inpatient units. Several factors influence the initial implementation of evidence-based practice improvements in nursing, with leadership recognized as essential. However, there is limited knowledge about enduring change, including how frontline nursing leaders influence the sustainability of practice improvements over the long term. A qualitative descriptive case study included 39 in-depth interviews, observations, and document reviews. Four embedded nursing unit subcases had differing levels of program sustainability at 7 years (average) following implementation. Higher levels of BPG sustainability occurred on units where formal leadership teams used an integrated set of strategies and activities. Two key strategies were maintaining priorities and reinforcing expectations. The coordinated use of six activities (e.g., discussing, evaluating, integrating) promoted the continuation of BPG practices among staff. These leadership processes, fostering exchange and learning, contributed to sustainability-promoting environments characterized by teamwork and accountability. Unit leaders are required to strategically orchestrate several overlapping and synergistic efforts to achieve long-term sustainability of BPG-based practice improvements. As part of managing overall unit performance, unit leaders may influence practice improvement sustainability by aligning vision, strategies, and activities. © 2015 John Wiley & Sons Ltd.
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Hasegawa, Hideyuki
2017-07-01
The range spatial resolution is an important factor determining the image quality in ultrasonic imaging. The range spatial resolution in ultrasonic imaging depends on the ultrasonic pulse length, which is determined by the mechanical response of the piezoelectric element in an ultrasonic probe. To improve the range spatial resolution without replacing the transducer element, in the present study, methods based on maximum likelihood (ML) estimation and multiple signal classification (MUSIC) were proposed. The proposed methods were applied to echo signals received by individual transducer elements in an ultrasonic probe. The basic experimental results showed that the axial half maximum of the echo from a string phantom was improved from 0.21 mm (conventional method) to 0.086 mm (ML) and 0.094 mm (MUSIC).
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Improving prescribing practices with rapid diagnostic tests (RDTs)
DEFF Research Database (Denmark)
Burchett, Helen E D; Leurent, Baptiste; Baiden, Frank
2017-01-01
OBJECTIVES: The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts...... packages, supervision, supplies and community sensitisation. OUTCOME MEASURES: Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider...... characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for m...
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Improving water management practices to reduce nutrient export from rice paddy fields.
Zhang, Zhi-Jian; Yao, Ju-Xiang; Wang, Zhao-De; Xu, Xin; Lin, Xian-Yong; Czapar, George F; Zhang, Jian-Ying
2011-01-01
Nitrogen (N) and phosphorus (P) loss from rice paddy fields represents a significant threat to water quality in China. In this project, three irrigation-drainage regimes were compared, including one conventional irrigation-drainage regime, i.e. continuous submergence regime (CSR), and two improved regimes, i.e. the alternating submergence-nonsubmergence regime (ASNR) and the zero-drainage irrigation technology (ZDIT), to seek cost-effective practices for reducing nutrient loss. The data from these comparisons showed that, excluding the nutrient input from irrigation, the net exports of total N and total P via surface field drainage ranged from -3.93 to 2.39 kg ha and 0.17 to 0.95 g ha(-1) under the CSR operation, respectively, while N loss was -2.46 to -2.23 kg ha(-1) and P export was -0.65 to 0.31 kg ha(-1) under the improved regimes. The intensity of P export was positively correlated to the rate of P application. Reducing the draining frequency or postponing the draining operation would shift the ecological role of the paddy field from a nutrient export source to an interception sink when ASNR or the zero-drainage water management was used. In addition, since the rice yields are being guaranteed at no additional cost, the improved irrigation-drainage operations would have economic as well as environmental benefits.
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Improving rapeseed production practices in the southeastern United States
Energy Technology Data Exchange (ETDEWEB)
Thomas, D.L.; Breve, M.A.; Raymer, P.L.; Minton, N.A.; Sumner, D.R. (Georgia Univ., Tifton, GA (USA). Georgia Coastal Plain Experiment Station)
1990-04-01
Oilseed rape or rapeseed is a crop which offers a potential for double-cropping in the southeastern United States. This final project report describes the results from a three year study aimed at evaluating the effect of different planting and harvesting practices on establishment and yield of three rape cultivars, and the double cropping potential of rapeseed in the southeastern United States. The project was conducted on two yield sites in Tifton, Georgia during 1986--87, 1987--88 and 1988--89. The general objective of this research is to improve the seed and biomass yield of winter rapeseed in the southeastern United States by developing appropriate agronomic practices for the region. The primary constraint is to grow rapeseed within the allowable period for double cropping with an economically desirable crop, such as peanut or soybean. Planting and harvesting are the most critical steps in this process. Therefore, the specific objectives of this research were: evaluate and improve the emergence of rapeseed by developing planting techniques that enhance the soil, water and seed regimes for winter rapeseed in the southeast, and evaluate and improve the yields of harvested rapeseed by developing techniques for determining the optimum timing of harvest and efficient methods for harvesting winter rapeseed in the southeast. 6 refs., 12 figs., 9 tabs.
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Greener on the Other Side: Cultivating Community and Improvement through Sustainability Practices
Sterrett, William L.; Kensler, Lisa; McKey, Tania
2016-01-01
Sustainability practices that lead to greener schools are often overlooked in leadership preparation programs and in school improvement efforts. An urban middle school principal recognizes the potential to build community, foster a healthy learning environment, and redefine her school through focusing on sustainability practices in a collaborative…
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Choma, Kim; McKeever, Amy E
2015-02-01
The literature reports great variation in the knowledge levels and application of the recent changes of cervical cancer screening guidelines into clinical practice. Evidence-based screening guidelines for the prevention and early detection of cervical cancer offers healthcare providers the opportunity to improve practice patterns among female adolescents by decreasing psychological distress as well as reducing healthcare costs and morbidities associated with over-screening. The purpose of this pilot intervention study was to determine the effects of a Web-based continuing education unit (CEU) program on advanced practice nurses' (APNs) knowledge of current cervical cancer screening evidence-based recommendations and their application in practice. This paper presents a process improvement project as an example of a way to disseminate updated evidence-based practice guidelines among busy healthcare providers. This Web-based CEU program was developed, piloted, and evaluated specifically for APNs. The program addressed their knowledge level of cervical cancer and its relationship with high-risk human papillomavirus. It also addressed the new cervical cancer screening guidelines and the application of those guidelines into clinical practice. Results of the study indicated that knowledge gaps exist among APNs about cervical cancer screening in adolescents. However, when provided with a CEU educational intervention, APNs' knowledge levels increased and their self-reported clinical practice behaviors changed in accordance with the new cervical cancer screening guidelines. Providing convenient and readily accessible up-to-date electronic content that provides CEU enhances the adoption of clinical practice guidelines, thereby decreasing the potential of the morbidities associated with over-screening for cervical cancer in adolescents and young women. © 2014 Sigma Theta Tau International.
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Shi, Guang; Wang, Wen; Zhang, Fumin
2018-03-01
The measurement precision of frequency-modulated continuous-wave (FMCW) laser distance measurement should be proportional to the scanning range of the tunable laser. However, the commercial external cavity diode laser (ECDL) is not an ideal tunable laser source in practical applications. Due to the unavoidable mode hopping and scanning nonlinearity of the ECDL, the measurement precision of FMCW laser distance measurements can be substantially affected. Therefore, an FMCW laser ranging system with two auxiliary interferometers is proposed in this paper. Moreover, to eliminate the effects of ECDL, the frequency-sampling method and mode hopping influence suppression method are employed. Compared with a fringe counting interferometer, this FMCW laser ranging system has a measuring error of ± 20 μm at the distance of 5.8 m.
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Mazzocato, Pamela; Stenfors-Hayes, Terese; von Thiele Schwarz, Ulrica; Hasson, Henna; Nyström, Monica Elisabeth
2016-07-29
Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated. 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions. There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results. Published by the BMJ Publishing Group Limited. For
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Hickman, Louise D; DiGiacomo, Michelle; Phillips, Jane; Rao, Angela; Newton, Phillip J; Jackson, Debra; Ferguson, Caleb
2018-04-01
The nursing profession has a significant evidence to practice gap in an increasingly complex and dynamic health care environment. To evaluate effectiveness of teaching and learning strategies related to a capstone project within a Masters of Nursing program that encourage the development of evidence based practice capabilities. Systematic review that conforms to the PRISMA statement. Master's Nursing programs that include elements of a capstone project within a university setting. MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, ERIC and PsycInfo were used to search for RCT's or quasi experimental studies conducted between 1979 and 9 June 2017, published in a peer reviewed journal in English. Of 1592 studies, no RCT's specifically addressed the development of evidence based practice capabilities within the university teaching environment. Five quasi-experimental studies integrated blended learning, guided design processes, small group work, role play and structured debate into Masters of Nursing research courses. All five studies demonstrated some improvements in evidence based practice skills and/or research knowledge translation, with three out of five studies demonstrating significant improvements. There is a paucity of empirical evidence supporting the best strategies to use in developing evidence based practice skills and/or research knowledge translation skills for Master's Nursing students. As a profession, nursing requires methodologically robust studies that are discipline specific to identify the best approaches for developing evidence-based practice skills and/or research knowledge translation skills within the university teaching environment. Provision of these strategies will enable the nursing profession to integrate the best empirical evidence into nursing practice. Copyright © 2018. Published by Elsevier Ltd.
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Improving product development practice: An action-research based approach
DEFF Research Database (Denmark)
Harmsen, Hanne
In studies of new product development it has often been concluded that to a large extent new product suc-cess is tunder the influence of companies and long lists of direct norma-tive guide-lines have been formulated. Nevertheless descriptive studi that deve-lopment practice is still far from...... studies both purely descriptive and studies identifying success and failure factors, but almost no studies of how companies actually undertake improve-ments, which problems they encounter,, and how/whether they overcome these problems. Action research is proposed as a suitable method for studying...
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Interprofessional Collaborative Practice to Improve Patient Outcomes: A Pilot Study
Directory of Open Access Journals (Sweden)
Jennifer Styron
2014-06-01
Full Text Available This project focused on a pilot project implemented during the 2013-2014 academic year. The overall purpose was to facilitate interprofessional collaborative practice innovations through the development of leadership, core competencies, and the use of technology, especially among nurses. Nursing, medicine, and physician assistant students were educated on the IOM competencies for interprofessional teams and the core competencies identified by the Interprofessional Education Collaborative Expert Panel [1] to develop knowledge, skills, and attitudes needed to practice in the collaborative practice environments. The project addressed four goals: Develop faculty expertise and leadership in interprofessional collaborative practice to provide a current, high quality education to nursing, physician assistant, and medical students; Implement a culturally responsive and respectful collaborative interprofessional practice curriculum to prepare nurses, physician assistants, and medical students to deliver high quality, efficient, team-based care in a dynamically evolving environment; Focus interprofessional collaborative practice education on models and practices that lead to improvement in patient outcomes; and Evaluate the program and disseminate best practices. Findings from this pilot include strategies to engage different health professions' students and faculty, partnering with community agencies, building an effective interprofessional team to guide the project, and seeking funding for extension and expansion of the offerings.
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Improving farming practices reduces the carbon footprint of spring wheat production.
Gan, Yantai; Liang, Chang; Chai, Qiang; Lemke, Reynald L; Campbell, Con A; Zentner, Robert P
2014-11-18
Wheat is one of the world's most favoured food sources, reaching millions of people on a daily basis. However, its production has climatic consequences. Fuel, inorganic fertilizers and pesticides used in wheat production emit greenhouse gases that can contribute negatively to climate change. It is unknown whether adopting alternative farming practices will increase crop yield while reducing carbon emissions. Here we quantify the carbon footprint of alternative wheat production systems suited to semiarid environments. We find that integrating improved farming practices (that is, fertilizing crops based on soil tests, reducing summerfallow frequencies and rotating cereals with grain legumes) lowers wheat carbon footprint effectively, averaging -256 kg CO2 eq ha(-1) per year. For each kg of wheat grain produced, a net 0.027-0.377 kg CO2 eq is sequestered into the soil. With the suite of improved farming practices, wheat takes up more CO2 from the atmosphere than is actually emitted during its production.
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Operational practices of lean manufacturing: Potentiating environmental improvements
Directory of Open Access Journals (Sweden)
Marcos José Alves Pinto Junior
2017-10-01
Full Text Available Purpose: The objective of this paper is to investigate how environmental improvements can be achieved through operational practices of Lean Manufacturing. Design/methodology/approach: A literature review was conducted to analyze the relationship between operational practices of Lean and reduction of environmental impact in organizational contexts. Verified theoretically, this relationship was observed in a company of the electronics industry, through an exploratory research which contemplated a mixed approach. The adopted research method consisted of a single case study, by providing greater depth and detail of the study. Utilized a research protocol, validated test pilot. The instruments for data collection were semi-structured interviews, direct observation and document analysis. The information was examined qualitatively considering the technique for content analysis. Findings: As a result of the study, it was found that there is evidence for the existence of relationship between the practices of Lean, for example, Kaizen, PDCA (plan, do, check, act, Ishikawa Diagram, Poka-Yoke, Standardized Work and Value Stream Mapping, with the reduction of environmental impacts of an organization. This reduction was observed after application of these practices that resulted in the reduction of energy consumption, water and waste generation. These results were accounted for financially, contributing to a reduction of annual costs by about US$ 20,900. Originality/value: The study presents in detail, the application of operational practices of Lean Manufacturing, with an effective view to reducing the environmental impact and cost reduction. The literature review, a detailed description of the application process and financial results are important information that contributes to the scientific studies that address traditional operating practices and the search for better environmental performance.
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Operational practices of lean manufacturing: Potentiating environmental improvements
Energy Technology Data Exchange (ETDEWEB)
Pinto, Marcos José Alves Junior; Mendes, Juliana Veiga
2017-07-01
Purpose: The objective of this paper is to investigate how environmental improvements can be achieved through operational practices of Lean Manufacturing. Design/methodology/approach: A literature review was conducted to analyze the relationship between operational practices of Lean and reduction of environmental impact in organizational contexts. Verified theoretically, this relationship was observed in a company of the electronics industry, through an exploratory research which contemplated a mixed approach. The adopted research method consisted of a single case study, by providing greater depth and detail of the study. Utilized a research protocol, validated test pilot. The instruments for data collection were semi-structured interviews, direct observation and document analysis. The information was examined qualitatively considering the technique for content analysis. Findings: As a result of the study, it was found that there is evidence for the existence of relationship between the practices of Lean, for example, Kaizen, PDCA (plan, do, check, act), Ishikawa Diagram, Poka-Yoke, Standardized Work and Value Stream Mapping, with the reduction of environmental impacts of an organization. This reduction was observed after application of these practices that resulted in the reduction of energy consumption, water and waste generation. These results were accounted for financially, contributing to a reduction of annual costs by about US$ 20,900. Originality/value: The study presents in detail, the application of operational practices of Lean Manufacturing, with an effective view to reducing the environmental impact and cost reduction. The literature review, a detailed description of the application process and financial results are important information that contributes to the scientific studies that address traditional operating practices and the search for better environmental performance.
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Operational practices of lean manufacturing: Potentiating environmental improvements
International Nuclear Information System (INIS)
Pinto, Marcos José Alves Junior; Mendes, Juliana Veiga
2017-01-01
Purpose: The objective of this paper is to investigate how environmental improvements can be achieved through operational practices of Lean Manufacturing. Design/methodology/approach: A literature review was conducted to analyze the relationship between operational practices of Lean and reduction of environmental impact in organizational contexts. Verified theoretically, this relationship was observed in a company of the electronics industry, through an exploratory research which contemplated a mixed approach. The adopted research method consisted of a single case study, by providing greater depth and detail of the study. Utilized a research protocol, validated test pilot. The instruments for data collection were semi-structured interviews, direct observation and document analysis. The information was examined qualitatively considering the technique for content analysis. Findings: As a result of the study, it was found that there is evidence for the existence of relationship between the practices of Lean, for example, Kaizen, PDCA (plan, do, check, act), Ishikawa Diagram, Poka-Yoke, Standardized Work and Value Stream Mapping, with the reduction of environmental impacts of an organization. This reduction was observed after application of these practices that resulted in the reduction of energy consumption, water and waste generation. These results were accounted for financially, contributing to a reduction of annual costs by about US$ 20,900. Originality/value: The study presents in detail, the application of operational practices of Lean Manufacturing, with an effective view to reducing the environmental impact and cost reduction. The literature review, a detailed description of the application process and financial results are important information that contributes to the scientific studies that address traditional operating practices and the search for better environmental performance.
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Sherwood, Gwen; Nickel, Barbara
Despite intense scrutiny and process improvement initiatives, patient harm continues to occur in health care with alarming frequency. The Quality and Safety Education for Nursing (QSEN) project provides a roadmap to transform nursing by integrating 6 competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. As front-line caregivers, nurses encounter inherent risks in their daily work. Infusion therapy is high risk with multiple potential risks for patient harm. This study examines individual and system application of the QSEN competencies and the Infusion Nurses Society's 2016 Infusion Therapy Standards of Practice in the improvement of patient outcomes.
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Clarke, Christina M; Persaud, Drepaul David
2011-03-01
Many contemporary acute care facilities lack safe and effective clinical handover practices resulting in patient transitions that are vulnerable to discontinuities in care, medical errors, and adverse patient safety events. This article is intended to supplement existing handover improvement literature by providing practical guidance for leaders and managers who are seeking to improve the safety and the effectiveness of clinical handovers in the acute care setting. A 4-stage change model has been applied to guide the application of strategies for handover improvement. Change management and quality improvement principles, as well as concepts drawn from safety science and high-reliability organizations, were applied to inform strategies. A model for handover improvement respecting handover complexity is presented. Strategies targeted to stages of change include the following: 1. Enhancing awareness of handover problems and opportunities with the support of strategic directions, accountability, end user involvement, and problem complexity recognition. 2. Identifying solutions by applying and adapting best practices in local contexts. 3. Implementing locally adapted best practices supported by communication, documentation, and training. 4. Institutionalizing practice changes through integration, monitoring, and active dissemination. Finally, continued evaluation at every stage is essential. Although gaps in handover process and function knowledge remain, efforts to improve handover safety and effectiveness are still possible. Continued evaluation is critical in building this understanding and to ensure that practice changes lead to improvements in patient safety, organizational effectiveness, and patient and provider satisfaction. Through handover knowledge building, fundamental changes in handover policies and practices may be possible.
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Recipe Modification Improves Food Safety Practices during Cooking of Poultry.
Maughan, Curtis; Godwin, Sandria; Chambers, Delores; Chambers, Edgar
2016-08-01
Many consumers do not practice proper food safety behaviors when preparing food in the home. Several approaches have been taken to improve food safety behaviors among consumers, but there still is a deficit in actual practice of these behaviors. The objective of this study was to assess whether the introduction of food safety instructions in recipes for chicken breasts and ground turkey patties would improve consumers' food safety behaviors during preparation. In total, 155 consumers in two locations (Manhattan, KS, and Nashville, TN) were asked to prepare a baked chicken breast and a ground turkey patty following recipes that either did or did not contain food safety instructions. They were observed to track hand washing and thermometer use. Participants who received recipes with food safety instructions (n = 73) demonstrated significantly improved food safety preparation behaviors compared with those who did not have food safety instructions in the recipe (n = 82). In addition, the majority of consumers stated that they thought the recipes with instructions were easy to use and that they would be likely to use similar recipes at home. This study demonstrates that recipes could be a good source of food safety information for consumers and that they have the potential to improve behaviors to reduce foodborne illness.
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Changing classroom practices: the role of school-wide capacity for sustainable improvement
Sleegers, P.J.C.; Thoonen, E.E.J.; Oort, F.J.; Peetsma, T.T.D.
2014-01-01
Purpose: Elementary schools have been confronted with large-scale educational reforms as strategies to improve the educational quality. While building school-wide capacity for improvement is considered critical for changing teachers’ classroom practices, there is still little empirical evidence for
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Changing classroom practices: the role of school-wide capacity for sustainable improvement
Sleegers, P.J.C.; Thoonen, Eric E.J.; Oort, Frans J.; Peetsma, Thea T.D.
2015-01-01
Purpose – Elementary schools have been confronted with large-scale educational reforms as strategies to improve the educational quality. While building school-wide capacity for improvement is considered critical for changing teachers’ classroom practices, there is still little empirical evidence for
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Hull, Sally; Chowdhury, Tahseen A; Mathur, Rohini; Robson, John
2014-02-01
Structured diabetes care can improve outcomes and reduce risk of complications, but improving care in a deprived, ethnically diverse area can prove challenging. This report evaluates a system change to enhance diabetes care delivery in a primary care setting. All 35 practices in one inner London Primary Care Trust were geographically grouped into eight networks of four to five practices, each supported by a network manager, clerical staff and an educational budget. A multidisciplinary team developed a 'care package' for type 2 diabetes management, with financial incentives based on network achievement of targets. Monthly electronic performance dashboards enabled networks to track and improve performance. Network multidisciplinary team meetings including the diabetic specialist team supported case management and education. Key measures for improvement included the number of diabetes care plans completed, proportion of patients attending for digital retinal screen and proportions of patients achieving a number of biomedical indices (blood pressure, cholesterol, glycated haemoglobin). Between 2009 and 2012, completed care plans rose from 10% to 88%. The proportion of patients attending for digital retinal screen rose from 72% to 82.8%. The proportion of patients achieving a combination of blood pressure ≤ 140/80 mm Hg and cholesterol ≤ 4 mmol/L rose from 35.3% to 46.1%. Mean glycated haemoglobin dropped from 7.80% to 7.66% (62-60 mmol/mol). Investment of financial, organisational and education resources into primary care practice networks can achieve clinically important improvements in diabetes care in deprived, ethnically diverse communities. This success is predicated on collaborative working between practices, purposively designed high-quality information on network performance and engagement between primary and secondary care clinicians.
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Fernald, Douglas; Hamer, Mika; James, Kathy; Tutt, Brandon; West, David
2015-01-01
Family medicine and internal medicine physicians order diagnostic laboratory tests for nearly one-third of patient encounters in an average week, yet among medical errors in primary care, an estimated 15% to 54% are attributed to laboratory testing processes. From a practice improvement perspective, we (1) describe the need for laboratory testing process quality improvements from the perspective of primary care practices, and (2) describe the approaches and resources needed to implement laboratory testing process quality improvements in practice. We applied practice observations, process mapping, and interviews with primary care practices in the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)-affiliated practice-based research networks that field-tested in 2013 a laboratory testing process improvement toolkit. From the data collected in each of the 22 participating practices, common testing quality issues included, but were not limited to, 3 main testing process steps: laboratory test preparation, test tracking, and patient notification. Three overarching qualitative themes emerged: practices readily acknowledge multiple laboratory testing process problems; practices know that they need help addressing the issues; and practices face challenges with finding patient-centered solutions compatible with practice priorities and available resources. While practices were able to get started with guidance and a toolkit to improve laboratory testing processes, most did not seem able to achieve their quality improvement aims unassisted. Providing specific guidance tools with practice facilitation or other rapid-cycle quality improvement support may be an effective approach to improve common laboratory testing issues in primary care. © Copyright 2015 by the American Board of Family Medicine.
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MAP as a model for practice-based learning and improvement in child psychiatry training.
Kataoka, Sheryl H; Podell, Jennifer L; Zima, Bonnie T; Best, Karin; Sidhu, Shawn; Jura, Martha Bates
2014-01-01
Not only is there a growing literature demonstrating the positive outcomes that result from implementing evidence based treatments (EBTs) but also studies that suggest a lack of delivery of these EBTs in "usual care" practices. One way to address this deficit is to improve the quality of psychotherapy teaching for clinicians-in-training. The Accreditation Council for Graduate Medical Education (ACGME) requires all training programs to assess residents in a number of competencies including Practice-Based Learning and Improvements (PBLI). This article describes the piloting of Managing and Adapting Practice (MAP) for child psychiatry fellows, to teach them both EBT and PBLI skills. Eight child psychiatry trainees received 5 full days of MAP training and are delivering MAP in a year-long outpatient teaching clinic. In this setting, MAP is applied to the complex, multiply diagnosed psychiatric patients that present to this clinic. This article describes how MAP tools and resources assist in teaching trainees each of the eight required competency components of PBLI, including identifying deficits in expertise, setting learning goals, performing learning activities, conducting quality improvement methods in practice, incorporating formative feedback, using scientific studies to inform practice, using technology for learning, and participating in patient education. A case example illustrates the use of MAP in teaching PBLI. MAP provides a unique way to teach important quality improvement and practice-based learning skills to trainees while training them in important psychotherapy competence.
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Improving antibiotic use in daily hospital practice : The antibiotic checklist
van Daalen, F.V.
2018-01-01
Better use of current antibiotic agents is necessary to help control antimicrobial resistance (AMR). Antibiotic stewardship programs (ASPs) are introduced to coordinate activities to measure and improve appropriate antibiotic use in daily hospital practice. This thesis shows how the introduction of
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Practices for Improving Secondary School Climate: A Systematic Review of the Research Literature.
Voight, Adam; Nation, Maury
2016-09-01
School climate has received increased attention in education policy and, in response, educators are seeking strategies to improve the climates of their middle and high schools. However, there has been no comprehensive synthesis of the empirical evidence for what works in school climate improvement. This article constitutes a systematic review of programs and practices with empirical support for improving school climate. It defines school climate and provides a methodology for identifying and evaluating relevant studies. The review identified 66 studies with varying strength of evidence and nine common elements that cut across reviewed programs and practices. The review concludes with a critical appraisal of what we know about school climate improvement and what we still need to know. © Society for Community Research and Action 2016.
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Test of the Practicality and Feasibility of EDoF-Empowered Image Sensors for Long-Range Biometrics.
Hsieh, Sheng-Hsun; Li, Yung-Hui; Tien, Chung-Hao
2016-11-25
For many practical applications of image sensors, how to extend the depth-of-field (DoF) is an important research topic; if successfully implemented, it could be beneficial in various applications, from photography to biometrics. In this work, we want to examine the feasibility and practicability of a well-known "extended DoF" (EDoF) technique, or "wavefront coding," by building real-time long-range iris recognition and performing large-scale iris recognition. The key to the success of long-range iris recognition includes long DoF and image quality invariance toward various object distance, which is strict and harsh enough to test the practicality and feasibility of EDoF-empowered image sensors. Besides image sensor modification, we also explored the possibility of varying enrollment/testing pairs. With 512 iris images from 32 Asian people as the database, 400-mm focal length and F/6.3 optics over 3 m working distance, our results prove that a sophisticated coding design scheme plus homogeneous enrollment/testing setups can effectively overcome the blurring caused by phase modulation and omit Wiener-based restoration. In our experiments, which are based on 3328 iris images in total, the EDoF factor can achieve a result 3.71 times better than the original system without a loss of recognition accuracy.
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Moule, Pam; Clompus, Susan; Fieldhouse, Jon; Ellis-Jones, Julie; Barker, Jacqueline
2018-05-25
Underuse of anticoagulants in atrial fibrillation is known to increase the risk of stroke and is an international problem. The National Institute for Health Care and Excellence guidance CG180 seeks to reduce atrial fibrillation related strokes through prescriptions of Non-vitamin K antagonist Oral Anticoagulants. A quality improvement programme was established by the West of England Academic Health Science Network (West of England AHSN) to implement this guidance into General Practice. A realist evaluation identified whether the quality improvement programme worked, determining how and in what circumstances. Six General Practices in 1 region, became the case study sites. Quality improvement team, doctor, and pharmacist meetings within each of the General Practices were recorded at 3 stages: initial planning, review, and final. Additionally, 15 interviews conducted with the practice leads explored experiences of the quality improvement process. Observation and interview data were analysed and compared against the initial programme theory. The quality improvement resources available were used variably, with the training being valued by all. The initial programme theories were refined. In particular, local workload pressures and individual General Practitioner experiences and pre-conceived ideas were acknowledged. Where key motivators were in place, such as prior experience, the programme achieved optimal outcomes and secured a lasting quality improvement legacy. The employment of a quality improvement programme can deliver practice change and improvement legacy outcomes when particular mechanisms are employed and in contexts where there is a commitment to improve service. © 2018 John Wiley & Sons, Ltd.
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Spin-image surface matching based target recognition in laser radar range imagery
International Nuclear Information System (INIS)
Li, Wang; Jian-Feng, Sun; Qi, Wang
2010-01-01
We explore the problem of in-plane rotation-invariance existing in the vertical detection of laser radar (Ladar) using the algorithm of spin-image surface matching. The method used to recognize the target in the range imagery of Ladar is time-consuming, owing to its complicated procedure, which violates the requirement of real-time target recognition in practical applications. To simplify the troublesome procedures, we improve the spin-image algorithm by introducing a statistical correlated coefficient into target recognition in range imagery of Ladar. The system performance is demonstrated on sixteen simulated noise range images with targets rotated through an arbitrary angle in plane. A high efficiency and an acceptable recognition rate obtained herein testify the validity of the improved algorithm for practical applications. The proposed algorithm not only solves the problem of in-plane rotation-invariance rationally, but also meets the real-time requirement. This paper ends with a comparison of the proposed method and the previous one. (classical areas of phenomenology)
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International Nuclear Information System (INIS)
Glass, S. W.; Mohr, F.
2010-01-01
Non Destructive Examination (NDE) is a critical element of both Boiling Water and Pressurized Water Reactor outages. Frequently this includes critical path activity so both the utility and the inspection vendor are under intense pressure to perform the work quickly. Concurrent with AREVA's new global organization of NDE resources, AREVA NDE SOLUTIONS, efforts have intensified for global application of lessons learned and best practices. These best practices include new developments as well as continuous improvements to well established tools and NDE techniques. Advancements range from steam generator robots, advanced steam generator deposit characterization sensors and method, new phased array approaches for PWR and BWR reactor vessel examination, new sensors and approaches for RPV head examinations, plus advanced internals examination robots and methods. In addition to specialized tools and techniques, best practice includes numerous management innovations. AREVA's multi-disciplined integrated nuclear worker strategy helps to minimize the total number of personnel deployed to multi-task outages. Specific design and on-site practice has been implemented to minimize or eliminate foreign material from the reactor system and vigorous pursuit of dose management practices keeps our nuclear worker dose as low as reasonably achievable. The industry is moving to much more conservative nuclear worker dose limits. While this is proving to be an issue with many vendors, AREVA has had an internal policy of <2R since 2006. Globalizing the organization also helps AREVA manage peaks and unplanned emergency inspections from an enlarged pool of globally qualified inspection personnel and tools. (Author)
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Sellers, Morgan M; Hanson, Kristi; Schuller, Mary; Sherman, Karen; Kelz, Rachel R; Fryer, Jonathan; DaRosa, Debra; Bilimoria, Karl Y
2013-06-01
As patient-safety and quality efforts spread throughout health care, the need for physician involvement is critical, yet structured training programs during surgical residency are still uncommon. Our objective was to develop an extended quality-improvement curriculum for surgical residents that included formal didactics and structured practical experience. Surgical trainees completed an 8-hour didactic program in quality-improvement methodology at the start of PGY3. Small teams developed practical quality-improvement projects based on needs identified during clinical experience. With the assistance of the hospital's process-improvement team and surgical faculty, residents worked through their selected projects during the following year. Residents were anonymously surveyed after their participation to assess the experience. During the first 3 years of the program, 17 residents participated, with 100% survey completion. Seven quality-improvement projects were developed, with 57% completing all DMAIC (Define, Measure, Analyze, Improve, Control) phases. Initial projects involved issues of clinical efficiency and later projects increasingly focused on clinical care questions. Residents found the experience educationally important (65%) and believed they were well equipped to lead similar initiatives in the future (70%). Based on feedback, the timeline was expanded from 12 to 24 months and changed to start in PGY2. Developing an extended curriculum using both didactic sessions and applied projects to teach residents the theory and implementation of quality improvement is possible and effective. It addresses the ACGME competencies of practice-based improvement and learning and systems-based practice. Our iterative experience during the past 3 years can serve as a guide for other programs. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
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International Nuclear Information System (INIS)
Sorcini, B.B.; Andreo, P.; Hyoedynmaa, S.; Brahme, A.; Bielajew, A.F.
1995-01-01
A theoretically based analytical energy-range relationship has been developed and calibrated against well established experimental and Monte Carlo calculated energy-range data. Only published experimental data with a clear statement of accuracy and method of evaluation have been used. Besides published experimental range data for different uniform media, new accurate experimental data on the practical range of high-energy electron beams in water for the energy range 10-50 MeV from accurately calibrated racetrack microtrons have been used. Largely due to the simultaneous pooling of accurate experimental and Monte Carlo data for different materials, the fit has resulted in an increased accuracy of the resultant energy-range relationship, particularly at high energies. Up to date Monte Carlo data from the latest versions of the codes ITS3 and EGS4 for absorbers of atomic numbers between four and 92 (Be, C, H 2 O, PMMA, Al, Cu, Ag, Pb and U) and incident electron energies between 1 and 100 MeV have been used as a complement where experimental data are sparse or missing. The standard deviation of the experimental data relative to the new relation is slightly larger than that of the Monte Carlo data. This is partly due to the fact that theoretically based stopping and scattering cross-sections are used both to account for the material dependence of the analytical energy-range formula and to calculate ranges with the Monte Carlo programs. For water the deviation from the traditional energy-range relation of ICRU Report 35 is only 0.5% at 20 MeV but as high as - 2.2% at 50 MeV. An improved method for divergence and ionization correction in high-energy electron beams has also been developed to enable use of a wider range of experimental results. (Author)
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Padilha, J M; Sousa, P A F; Pereira, F M S
2018-03-01
To propose nursing clinical practice changes to improve the development of patient self-management. Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates. Control of the disease's progression, the preservation of autonomy in self-care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self-management. A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis. The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision-making process. The specific guidelines, the provision of material to support decision-making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self-management skills related to the awareness of the need for 'change', hope, involvement, knowledge and abilities. The implemented changes have improved health-related behaviours and clinical outcomes. To support self-management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours. The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes. © 2017 International Council of Nurses.
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Improvement of linear reactivity methods and application to long range fuel management
International Nuclear Information System (INIS)
Woehlke, R.A.; Quan, B.L.
1982-01-01
The original development of the linear reactivity theory assumes flat burnup, batch by batch. The validity of this assumption is explored using multicycle burnup data generated with a detailed 3-D SIMULATE model. The results show that the linear reactivity method can be improved by correcting for batchwise power sharing. The application of linear reactivity to long range fuel management is demonstrated in several examples. Correcting for batchwise power sharing improves the accuracy of the analysis. However, with regard to the sensitivity of fuel cost to changes in various parameters, the corrected and uncorrected linear reactivity theories give remarkably similar results
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Work management practices that reduce dose and improve efficiency
International Nuclear Information System (INIS)
Miller, D.W.; Hulin, M.
1998-01-01
Work management practices at nuclear power plants can dramatically affect the outcome of annual site dose goals and outage costs. This presentation discusses global work management practices that contribute to dose reduction including work philosophy, work selection, work planning, work scheduling, worker training, work implementation and worker feedback. The presentation is based on a two-year international effort (sponsored by NEA/IAEA ISOE) to study effective work practices that reduce dose. Experts in this area believe that effective work selection and planning practices can substantially reduce occupational dose during refueling outages. For example, some plants represented in the expert group complete refueling outages in 12-18 days (Finland) with doses below 0,90 person-Sv. Other plants typically have 50-75 day outages with substantially higher site doses. The fundamental reasons for longer outages and higher occupational doses are examined. Good work management principles that have a proven track record of reducing occupational dose are summarized. Practical methods to reduce work duration and dose are explained. For example, scheduling at nuclear power plants can be improved by not only sequencing jobs on a time line but also including zone and resource-based considerations to avoid zone congestion and manpower delays. An ongoing, global, benchmarking effort is described which provides current duration and dose information for repetitive jobs to participating utilities world-wide. (author)
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Gupta, Rajan T; Sexton, J Bryan; Milne, Judy; Frush, Donald P
2015-01-01
The goal of this study was to implement an evidence-based teamwork system to improve communication and teamwork skills among health care professionals (TeamSTEPPS) into an academic interventional ultrasound program and to assess safety and team-work climate across team members both before and after implementation. Members of a change team (including master trainers) selected specific tools available within TeamSTEPPS to implement into an academic interventional ultrasound service. Tools selected were based on preimplementation survey data obtained from team members (n = 64: 11 attending faculty physicians, 12 clinical abdominal imaging fellows or residents, 17 sonographers, 19 nurses, and five technologist aides or administrative personnel). The survey included teamwork climate and safety climate domains from the Safety Attitudes Questionnaire. Four months after implementation, respondents were resurveyed and post-implementation data were collected. Teamwork climate scores improved from a mean of 67.9 (SD, 12.8) before implementation to a mean of 87.8 (SD, 14.1) after implementation (t = -7.6; p ultrasound practice. The most notable improvements were seen in communication among team members and role clarification. We think that this model, which has been successfully implemented in many nonradiologic areas in medical care, is also applicable in imaging practice.
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Wilson, Kenneth C; Merli, Geno J
2011-10-01
Venous thromboembolism (VTE) is a common complication during and after hospitalization for acute medical illness or surgery. Despite the existence of evidence-based guidelines for VTE prevention, real-world prescribing practices are frequently suboptimal. Specific performance measures relating to VTE prevention and treatment have been developed by US health care organizations to increase adherence with best-practice recommendations and ultimately reduce the number of preventable VTE events. Two measures developed by the Surgical Care Improvement Project have been endorsed by the National Quality Forum (NQF) and focus on VTE prevention. In addition, six measures have been developed recently by The Joint Commission in collaboration with the NQF; three measures relate to VTE prevention and three focus on treatment. To attain widespread achievement of these performance goals, it is essential to raise awareness of their existence and specifications. It is also imperative that hospitals develop and implement effective VTE protocols. The use of multiple, active strategies, such as computer decision support systems with regular audit and feedback, may be particularly valuable approaches to improve current practices within an integrated quality improvement program. During practical implementation of VTE protocols at Norton Healthcare (Kentucky's largest healthcare system), strong leadership, physician engagement, and caregiver accountability were identified as key factors influencing the process. As such, more hospitals may be able to increase adherence with guidelines, improve achievement of quality goals, and help to reduce the substantial burden associated with avoidable VTE.
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Test of the Practicality and Feasibility of EDoF-Empowered Image Sensors for Long-Range Biometrics
Directory of Open Access Journals (Sweden)
Sheng-Hsun Hsieh
2016-11-01
Full Text Available For many practical applications of image sensors, how to extend the depth-of-field (DoF is an important research topic; if successfully implemented, it could be beneficial in various applications, from photography to biometrics. In this work, we want to examine the feasibility and practicability of a well-known “extended DoF” (EDoF technique, or “wavefront coding,” by building real-time long-range iris recognition and performing large-scale iris recognition. The key to the success of long-range iris recognition includes long DoF and image quality invariance toward various object distance, which is strict and harsh enough to test the practicality and feasibility of EDoF-empowered image sensors. Besides image sensor modification, we also explored the possibility of varying enrollment/testing pairs. With 512 iris images from 32 Asian people as the database, 400-mm focal length and F/6.3 optics over 3 m working distance, our results prove that a sophisticated coding design scheme plus homogeneous enrollment/testing setups can effectively overcome the blurring caused by phase modulation and omit Wiener-based restoration. In our experiments, which are based on 3328 iris images in total, the EDoF factor can achieve a result 3.71 times better than the original system without a loss of recognition accuracy.
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Improving Bridging from Informatics Practice to Theory.
Lehmann, C U; Gundlapalli, A V
2015-01-01
In 1962, Methods of Information in Medicine ( MIM ) began to publish papers on the methodology and scientific fundamentals of organizing, representing, and analyzing data, information, and knowledge in biomedicine and health care. Considered a companion journal, Applied Clinical Informatics ( ACI ) was launched in 2009 with a mission to establish a platform that allows sharing of knowledge between clinical medicine and health IT specialists as well as to bridge gaps between visionary design and successful and pragmatic deployment of clinical information systems. Both journals are official journals of the International Medical Informatics Association. As a follow-up to prior work, we set out to explore congruencies and interdependencies in publications of ACI and MIM. The objectives were to describe the major topics discussed in articles published in ACI in 2014 and to determine if there was evidence that theory in 2014 MIM publications was informed by practice described in ACI publications in any year. We also set out to describe lessons learned in the context of bridging informatics practice and theory and offer opinions on how ACI editorial policies could evolve to foster and improve such bridging. We conducted a retrospective observational study and reviewed all articles published in ACI during the calendar year 2014 (Volume 5) for their main theme, conclusions, and key words. We then reviewed the citations of all MIM papers from 2014 to determine if there were references to ACI articles from any year. Lessons learned in the context of bridging informatics practice and theory and opinions on ACI editorial policies were developed by consensus among the two authors. A total of 70 articles were published in ACI in 2014. Clinical decision support, clinical documentation, usability, Meaningful Use, health information exchange, patient portals, and clinical research informatics emerged as major themes. Only one MIM article from 2014 cited an ACI article. There
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Padilla-Marín, V; Corral-Baena, S; Domínguez-Guerrero, F; Santos-Rubio, M D; Santana-López, V; Moreno-Campoy, E
2012-01-01
To describe the strategy employed by Andalusian public health service hospitals to foster safe medication use. The self-evaluation questionnaire on drug system safety in hospitals, adapted by the Spanish Institute for Safe Medication Practices was used as a fundamental tool to that end. The strategy is developed in several phases. We analyse the report evaluating drug system safety in Andalusian public hospitals published by the Spanish Ministry of Health and Consumption in 2008 and establish a grading system to assess safe medication practices in Andalusian hospitals and prioritise areas needing improvement. We developed a catalogue of best practices available in the web environment belonging to the Andalusian health care quality agency's patient safety observatory. We publicised the strategy through training seminars and implemented a system allowing hospitals to evaluate the degree of compliance for each of the best practices, and based on that system, we were able to draw up a map of centres of reference. We found areas for improvement among several of the questionnaire's fundamental criteria. These areas for improvement were related to normal medication procedures in daily clinical practice. We therefore wrote 7 best practice guides that provide a cross-section of the assessment components of the questionnaire related to the clinical process needing improvement. The self-evaluation questionnaire adapted by ISMP-Spain is a good tool for designing a systematic, rational intervention to promote safe medication practices and intended for a group of hospitals that share the same values. Copyright © 2011 SEFH. Published by Elsevier Espana. All rights reserved.
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Impact of Training on Improving Proper Handwashing Practices among Elementary School Students
Directory of Open Access Journals (Sweden)
Theruna Huthamaputiran
2017-06-01
Full Text Available Background: Hand washing is among the most effective ways to prevent diseases. In Indonesia, only a quarter of the entire population practice proper handwashing techniques. Of these, children are the most vulnerable group for contracting diseases. Nevertheless, they also are crucial agent for behavior transformation as they are keen and open to new ideas. Therefore, this study was conducted to determine if training would have an improvement on a proper hand washing practices among elementary school students. Methods:An observational descriptive study design using random sampling was conducted from September to November 2013 in Jatinangor Subdistrict, West Java, Indonesia using primary data of one hundred elementary school students from four elementary schools. Questionnaires were given after informed consent. A demonstration on hand washing techniques and education on proper hand washing practices was then given. Two weeks later, the same questionnaire was given to measure the influence of the training. The collected data were presented using frequency tabulation. Results: Before the training on proper hand washing practices was conducted, only 86.9% students were practicing it properly. After the training was given, 90.7% of the students were doing it properly. For the hand washing technique, only 66.8% of students knew the correct steps before the intervention was given and 78.7% students did them correctly after the intervention. Conclusions:The training shows an overall improvement on the students’ hand washing practices. DOI: 10.15850/amj.v4n2.1073
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Strategic contracting practices to improve procurement of health commodities.
Arney, Leslie; Yadav, Prashant; Miller, Roger; Wilkerson, Taylor
2014-08-01
Public-sector entities responsible for procurement of essential medicines and health commodities in developing countries often lack the technical capacity to efficiently ensure supply security. Under strict public scrutiny and pressures to be transparent, many agencies continue to use archaic procurement methods and to depend on inflexible forecasts and cumbersome tendering processes. On the basis of semi-structured literature reviews and interviews, we identified framework agreements as a strategic procurement practice used by the U.S. federal government that may also be suitable for global health supply chains. Framework agreements are long-term contracts that provide the terms and conditions under which smaller repeat purchasing orders may be issued for a defined period of time. Such agreements are common in U.S. and United Nations procurement systems and in other developed countries and multilateral organizations. In contrast, framework agreements appear to be seldom used in procurement of health commodities in countries of sub-Saharan Africa. The current practice of floating tenders multiple times a year contributes to long lead times and stock-outs, and it hampers the manufacturer's or supplier's ability to plan and respond to the government's needs. To date, government's use of strategic contracting practices in public procurement of health commodities has not received much attention in most developing countries. It may present an opportunity for substantial improvements in procurement efficiency and commodity availability. Enabling legislation and strengthened technical capacity to develop and manage long-term contracts could facilitate the use of framework contracts in sub-Saharan Africa, with improved supply security and cost savings likely to result.
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Improvements in cross-infection control in general dental practice.
Bentley, E M; Sarll, D W
1995-07-08
A questionnaire about cross-infection control was sent to all GDPs in five FHSAs in the North Western Region. Replies came from 312 dentists, a response rate of 74%. They worked in 185 practices, a response rate of 85%. Gloves were worn routinely by 86% of dentists and 80% of DSAs. Handpieces were autoclaved between patients in 77% of practices. Much however, remains to be improved. DSAs could be better protected if more ultrasonic cleaners were used, eye protection encouraged and heavy duty gloves were available for cleaning instruments. BDA guidelines were reported as being the most influential factor, though it would appear that the media did persuade many practitioners to use autoclavable handpieces and sterilise them after each use.
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Does this range suit me? Range satisfaction of battery electric vehicle users.
Franke, Thomas; Günther, Madlen; Trantow, Maria; Krems, Josef F
2017-11-01
User satisfaction is a vital design criterion for sustainable systems. The present research aimed to understand factors relating to individually perceived range satisfaction of battery electric vehicle (BEV) users. Data from a large-scale BEV field trial (N = 72) were analyzed. Apart from an initial drop in range satisfaction, increasing practical experience was related to increased range satisfaction. Classical indicators of users' mobility profiles (daily travel distances) were only weakly related to lower range satisfaction (not significant), after controlling for practical experience and preferred coverage of mobility needs. The regularity/predictability of users' mobility patterns, the percentage of journeys not coverable because of range issues, and users' individual comfortable range accounted for variance in range satisfaction. Finally, range satisfaction was related to key indicators of general BEV acceptance (e.g., purchase intentions). These results underline the complex dynamics involved in individual range satisfaction, as well as its central role for BEV acceptance. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Reza, Syed Azer; Khwaja, Tariq Shamim; Mazhar, Mohsin Ali; Niazi, Haris Khan; Nawab, Rahma
2017-07-20
Various existing target ranging techniques are limited in terms of the dynamic range of operation and measurement resolution. These limitations arise as a result of a particular measurement methodology, the finite processing capability of the hardware components deployed within the sensor module, and the medium through which the target is viewed. Generally, improving the sensor range adversely affects its resolution and vice versa. Often, a distance sensor is designed for an optimal range/resolution setting depending on its intended application. Optical triangulation is broadly classified as a spatial-signal-processing-based ranging technique and measures target distance from the location of the reflected spot on a position sensitive detector (PSD). In most triangulation sensors that use lasers as a light source, beam divergence-which severely affects sensor measurement range-is often ignored in calculations. In this paper, we first discuss in detail the limitations to ranging imposed by beam divergence, which, in effect, sets the sensor dynamic range. Next, we show how the resolution of laser-based triangulation sensors is limited by the interpixel pitch of a finite-sized PSD. In this paper, through the use of tunable focus lenses (TFLs), we propose a novel design of a triangulation-based optical rangefinder that improves both the sensor resolution and its dynamic range through adaptive electronic control of beam propagation parameters. We present the theory and operation of the proposed sensor and clearly demonstrate a range and resolution improvement with the use of TFLs. Experimental results in support of our claims are shown to be in strong agreement with theory.
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Practical recommendations for the evaluation of improvement initiatives
Parry, Gareth; Coly, Astou; Goldmann, Don; Rowe, Alexander K; Chattu, Vijay; Logiudice, Deneil; Rabrenovic, Mihajlo; Nambiar, Bejoy
2018-01-01
Abstract A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution. PMID:29447410
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Moore, Adam; Gruber, Thomas; Derose, Jennifer; Malinowski, Peter
2012-01-01
Mindfulness-based meditation practices involve various attentional skills, including the ability to sustain and focus ones attention. During a simple mindful breathing practice, sustained attention is required to maintain focus on the breath while cognitive control is required to detect mind wandering. We thus hypothesized that regular, brief mindfulness training would result in improvements in the self-regulation of attention and foster changes in neuronal activity related to attentional control. A longitudinal randomized control group EEG study was conducted. At baseline (T1), 40 meditation naïve participants were randomized into a wait list group and a meditation group, who received three hours mindfulness meditation training. Twenty-eight participants remained in the final analysis. At T1, after eight weeks (T2) and after 16 weeks (T3), all participants performed a computerized Stroop task (a measure of attentional control) while the 64-channel EEG was recorded. Between T1 and T3 the meditators were requested to meditate daily for 10 min. Event-related potential (ERP) analysis highlighted two between group effects that developed over the course of the 16-week mindfulness training. An early effect at left and right posterior sites 160–240 ms post-stimulus indicated that meditation practice improved the focusing of attentional resources. A second effect at central posterior sites 310–380 ms post-stimulus reflects that meditation practice reduced the recruitment of resources during object recognition processes, especially for incongruent stimuli. Scalp topographies and source analyses (Variable Resolution Electromagnetic Tomography, VARETA) indicate relevant changes in neural sources, pertaining to left medial and lateral occipitotemporal areas for the early effect and right lateral occipitotemporal and inferior temporal areas for the later effect. The results suggest that mindfulness meditation may alter the efficiency of allocating cognitive resources
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Directory of Open Access Journals (Sweden)
Adam W Moore
2012-02-01
Full Text Available Mindfulness based meditation practices involve various attentional skills, including the ability to sustain and focus ones attention. During a simple mindful breathing practice, sustained attention is required to maintain focus on the breath while cognitive control is required to detect mind wandering. We thus hypothesized that regular, brief mindfulness training would result in improvements in the self regulation of attention and foster changes in neuronal activity related to attentional control.A longitudinal randomized control group EEG study was conducted. At baseline (T1, 40 meditation naïve participants were randomized into a wait list group and a meditation group, who received three hours mindfulness meditation training. 28 participants remained in the final analysis. At T1, after 8 weeks (T2 and after 16 weeks (T3, all participants performed a computerized Stroop task (a measure of attentional control while the 64-channel EEG was recorded. Between T1 and T3 the meditators were requested to meditate daily for ten minutes.Event-related potential (ERP analysis highlighted two between group effects that developed over the course of the 16-week mindfulness training. An early effect at left and right posterior sites 160 – 240 ms post stimulus indicated that meditation practice improved the focusing of attentional resources. A second effect at central posterior sites 310 – 380 ms post stimulus reflects that meditation practice reduced the recruitment of resources during object recognition processes, especially for incongruent stimuli. Scalp topographies and source analyses (VARETA indicate relevant changes in neural sources, pertaining to left medial and lateral occipitotemporal areas for the early effect and right lateral occipitotemporal and inferior temporal areas for the later effect.The results suggest that mindfulness meditation may alter the efficiency of allocating cognitive resources, leading to improved self regulation of
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Adorian, D; Silverberg, D S; Tomer, D; Wamosher, Z
1990-06-01
A management-by-objective approach was used by the health care administration of the Kupat Holim Sick Fund to improve care of hypertension in 20 family practices in the city of Ashdod in central Israel. The doctor-nurse teams in these clinics met jointly on a regular basis with a physician-instructor, reviewed the results of their care of hypertension and discussed ways of improving it. Over a seven-year period, until 1988, the percentage of the population treated increased from 4.0% to 9.2% and percentage of treated patients who had diastolic pressure of 100 mmHg or more fell from 29.6% to 13.4%. Dropout rate ranged from 2.3% to 3.1% per year over the whole period. In 20 other practices in the Ashdod area in 1988 used for comparison, only 5.9% of the population was treated and the per cent treated was less than Ashdod for all age groups above 30. Dropout rate was higher, averaging 9.8% per year, and the percentage of patients with diastolic pressures of 100 mmHg or more was higher (18.1%). Thus the use of regular discussions with feedback to the health care team was associated with better detection, treatment and follow-up of hypertension.
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de Leeuw, S.L.J.M.; van den Berg, J.P.
2011-01-01
It is generally believed that companies applying performance management practices outperform those that do not measure and manage their performance. Studies examining the link between performance management and performance improvement implicitly assume that performance management affects behavior of
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Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L
2018-03-31
To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.
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Bird, James J.; Dunaway, David M.; Hancock, Dawson R.; Wang, Chuang
2013-01-01
The purpose of this study was to explore the relationship between superintendent leadership and the operational processes of school improvement. School district superintendents (N = 226) from six southeastern states were surveyed concerning their leadership authenticity and school improvement practices. Descriptive statistics, analyzes of…
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Good practices for improved nuclear power plant performance
International Nuclear Information System (INIS)
1989-04-01
This report provides an overview of operational principles, practice and improvements which have contributed to good performance of eight selected world nuclear power stations. The IAEA Power Reactor Information System (PRIS) was used to identify a population of good performers. It is recognized that there are many other good performing nuclear power stations not included in this report. Specific criteria described in the introduction were used in selecting these eight stations. The information contained in this report was obtained by the staff from IAEA, Division of Nuclear Power. This was accomplished by visits to the stations and visits to a number of utility support groups and three independent organizations which provide support to more than one utility. The information in this report is intended as an aid for operating organizations to identify possible improvement initiatives to enhance plant performance. Figs and tabs
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Mulliniks, J T; Rius, A G; Edwards, M A; Edwards, S R; Hobbs, J D; Nave, R L G
2015-06-01
Despite overall increased production in the last century, it is critical that grazing production systems focus on improving beef and dairy efficiency to meet current and future global food demands. For livestock producers, production efficiency is essential to maintain long-term profitability and sustainability. This continued viability of production systems using pasture- and range-based grazing systems requires more rapid adoption of innovative management practices and selection tools that increase profitability by optimizing grazing management and increasing reproductive performance. Understanding the genetic variation in cow herds will provide the ability to select cows that require less energy for maintenance, which can potentially reduce total energy utilization or energy required for production, consequently improving production efficiency and profitability. In the United States, pasture- and range-based grazing systems vary tremendously across various unique environments that differ in climate, topography, and forage production. This variation in environmental conditions contributes to the challenges of developing or targeting specific genetic components and grazing systems that lead to increased production efficiency. However, across these various environments and grazing management systems, grazable forage remains the least expensive nutrient source to maintain productivity of the cow herd. Beef and dairy cattle can capitalize on their ability to utilize these feed resources that are not usable for other production industries. Therefore, lower-cost alternatives to feeding harvested and stored feedstuffs have the opportunity to provide to livestock producers a sustainable and efficient forage production system. However, increasing production efficiency within a given production environment would vary according to genetic potential (i.e., growth and milk potential), how that genetic potential fits the respective production environment, and how the grazing
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West, David R; Radcliff, Tiffany A; Brown, Tiffany; Cote, Murray J; Smith, Peter C; Dickinson, W Perry
2012-01-01
Information about the costs and experiences of collecting and reporting quality measure data are vital for practices deciding whether to adopt new quality improvement initiatives or monitor existing initiatives. Six primary care practices from Colorado's Improving Performance in Practice program participated. We conducted structured key informant interviews with Improving Performance in Practice coaches and practice managers, clinicians, and staff and directly observed practices. Practices had 3 to 7 clinicians and 75 to 300 patients with diabetes, half had electronic health records, and half were members of an independent practice association. The estimated per-practice cost of implementation for the data collection and reporting for the diabetes quality improvement program was approximately $15,552 per practice (about $6.23 per diabetic patient per month). The first-year maintenance cost for this effort was approximately $9,553 per practice ($3.83 per diabetic patient per month). The cost of implementing and maintaining a diabetes quality improvement effort that incorporates formal data collection, data management, and reporting is significant and quantifiable. Policymakers must become aware of the financial and cultural impact on primary care practices when considering value-based purchasing initiatives.
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Gyasi, Kwame
2015-01-01
Gyasi, Kwame. 2015. Participative leadership practice in junior high schools and actions to improve the practice: a case study of Sekyere south district, Ghana Master's Thesis in Education. University of Jyväskylä. Department of Education Participative leadership practice is seen as the kind of school leadership which recognizes parents’ contribution and teachers’ ability and talents in leadership by sharing with them roles and responsibilities in the school administrative process. Th...
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Kontio, Raija; Joffe, Grigori; Putkonen, Hanna; Kuosmanen, Lauri; Hane, Kimmo; Holi, Matti; Välimäki, Maritta
2012-01-01
This study explored psychiatric inpatients' experiences of, and their suggestions for, improvement of seclusion/restraint, and alternatives to their use in Finland. The data were collected by focused interviews (n= 30) and were analyzed with inductive content analysis. Patients' perspectives received insufficient attention during seclusion/restraint processes. Improvements (e.g., humane treatment) and alternatives (e.g., empathetic patient-staff interaction) to seclusion/restraint, as suggested by the patients, focused on essential parts of nursing practice but have not been largely adopted. Patients' basic needs have to be met, and patient-staff interaction has to also continue during seclusion/restraint. Providing patients with meaningful activities, planning beforehand, documenting the patients' wishes, and making patient-staff agreements reduce the need for restrictions and offer alternatives for seclusion/restraint. Service users must be involved in all practical development. © 2011 Wiley Periodicals, Inc.
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Improving practical reasoning and argumentation
Baumtrog, Michael David
2015-01-01
This thesis justifies the need for and develops a new integrated model of practical reasoning and argumentation. After framing the work in terms of what is reasonable rather than what is rational (chapter 1), I apply the model for practical argumentation analysis and evaluation provided by Fairclough and Fairclough (2012) to a paradigm case of unreasonable individual practical argumentation provided by mass murderer Anders Behring Breivik (chapter 2). The application shows that by following t...
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Middle range theory evaluation: bridging the theory-practice gap ...
African Journals Online (AJOL)
Nurse education is being challenged to maintain quality in light of shortage of practice professionals, societal demands and rapid changes in health care delivery. The importance underlying the practice of nursing education must continue to be explored through theories to bring about refinement of educational strategies for ...
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Riaz, Baizid Khoorshid; Alim, Md Abdul; Islam, Anm Shamsul; Amin, Km Bayzid; Sarker, Mohammad Abul Bashar; Hasan, Khaled; Ashad-Uz-Zaman, Md Noor; Selim, Shahjada; Quaiyum, Salman; Haque, Emdadul; Monir Hossain, Shah; Ryder, John; Khanam, Rokeya
2016-12-01
Unsafe food is linked to the deaths of an estimated two million people annually. Food containing harmful agents is responsible for more than 200 diseases ranging from diarrhoea to cancers. A one-sample pilot intervention study was conducted to evaluate the role of courtyard counselling meetings as the means of intervention for improving food safety knowledge and practices among household food handlers in a district of Bangladesh. The study was conducted in three phases: a baseline survey, the intervention and an end-line survey between April and November 2015 where 194 food handlers took part. Data were collected through observations and face-to-face interviews. The mean age of the respondents was 38.8 (±12.4) years, all of whom were females. Hand washing before eating, and washing utensils with soap were significantly improved at the end-line in comparison to the baseline (57% vs. 40% and 83% vs. 69%, respectively). Hand washing with soap was increased by 4%. The mean score of food handling practices was significantly increased after the intervention (20.5 vs. 22.1; Pfood and the necessity of thorough cooking were significantly increased after the intervention (88% from 64% and 34% from 21%, respectively). Mean scores of knowledge and practice on food safety were significantly increased by 1.9 and 1.6, respectively after the one month intervention. Thus this food safety education in rural communities should be scaled up and, indeed, strengthened using the courtyard counselling meetings in Bangladesh.
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Tennison, Janet; Rajeev, Deepthi; Woolsey, Sarah; Black, Jeff; Oostema, Steven J; North, Christie
2014-01-01
The Utah Improving Care through Connectivity and Collaboration (IC3) Beacon community (2010-2013) was spearheaded by HealthInsight, a nonprofit, community-based organization. One of the main objectives of IC(3) was to improve health care provided to patients with diabetes in three Utah counties, collaborating with 21 independent smaller clinics and two large health care enterprises. This paper will focus on the use of health information technology (HIT) and practice facilitation to develop and implement new care processes to improve clinic workflow and ultimately improve patients' diabetes outcomes at 21 participating smaller, independent clinics. Early in the project, we learned that most of the 21 clinics did not have the resources needed to successfully implement quality improvement (QI) initiatives. IC(3) helped clinics effectively use data generated from their electronic health records (EHRs) to design and implement interventions to improve patients' diabetes outcomes. This close coupling of HIT, expert practice facilitation, and Learning Collaboratives was found to be especially valuable in clinics with limited resources. Through this process we learned that (1) an extensive readiness assessment improved clinic retention, (2) clinic champions were important for a successful collaboration, and (3) current EHR systems have limited functionality to assist in QI initiatives. In general, smaller, independent clinics lack knowledge and experience with QI and have limited HIT experience to improve patient care using electronic clinical data. Additionally, future projects like IC(3) Beacon will be instrumental in changing clinic culture so that QI is integrated into routine workflow. Our efforts led to significant changes in how practice staff optimized their EHRs to manage and improve diabetes care, while establishing the framework for sustainability. Some of the IC(3) Beacon practices are currently smoothly transitioning to new models of care such as Patient
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Mahmoudi, Babak; Erfanian, Abbas
2006-11-01
Mental imagination is the essential part of the most EEG-based communication systems. Thus, the quality of mental rehearsal, the degree of imagined effort, and mind controllability should have a major effect on the performance of electro-encephalogram (EEG) based brain-computer interface (BCI). It is now well established that mental practice using motor imagery improves motor skills. The effects of mental practice on motor skill learning are the result of practice on central motor programming. According to this view, it seems logical that mental practice should modify the neuronal activity in the primary sensorimotor areas and consequently change the performance of EEG-based BCI. For developing a practical BCI system, recognizing the resting state with eyes opened and the imagined voluntary movement is important. For this purpose, the mind should be able to focus on a single goal for a period of time, without deviation to another context. In this work, we are going to examine the role of mental practice and concentration skills on the EEG control during imaginative hand movements. The results show that the mental practice and concentration can generally improve the classification accuracy of the EEG patterns. It is found that mental training has a significant effect on the classification accuracy over the primary motor cortex and frontal area.
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CONCEPTIONS AND PRACTICES OF ASSESSMENT: A CASE OF TEACHERS REPRESENTING IMPROVEMENT CONCEPTION
Directory of Open Access Journals (Sweden)
Astuti Azis
2015-07-01
Full Text Available Despite numerous quantitative studies on teachers’ conceptions and practices of assessment, little research exists regarding the unique assessment environment of Indonesia. This study uses both quantitative and qualitative data to examine how Indonesian junior high school teachers understand assessment and how their conceptions of assessment relate to their assessment practices. This mixed methods study adopted a participant selection model in which quantitative data was analysed to select participants for the qualitative phase. Participants of this study believed that the purpose of assessment was to improve teaching and learning and also to demonstrate the accountability of students and school. They tended to disagree with the view that assessment is irrelevant. Further analysis of the data revealed that teachers’ conceptions of assessment were conflicted. They were keen to use assessment practices to improve their classroom teaching, but felt that the state-wide examination policy requirements constrained their efforts. This suggests that government, policy makers, and curriculum developers must work to build a strong synergy among themselves in order to share consistent goals with teachers. If cultural expectations of school assessment and government policy were aligned, Indonesian teachers may be better able to resolve conflict between their beliefs and assessment practices.
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DOE program for improvement practices for shallow burial of radioactive waste
International Nuclear Information System (INIS)
Dieckhoner, J.E.
1978-01-01
The practice of burying solid radioactive waste in relatively shallow pits or trenches at government nuclear sites dates back to the Manhattan Project. In some cases, where local conditions were considered unfavorable, intersite shipment of waste has been required. This general concept was later used at commercially-operated sites under Federal or state regulation. The purpose, scope, and results of a DOE program begun several years ago for improvements of burial ground disposal methods are reviewed. The program includes the re-evaluation of the original siting and of operating practices at existing burial grounds (including monitoring for migration of activity); the development of improved criteria for siting of new grounds that might be required as the defense site operations continue; and development of corrective measures such as diking and better draining for possible unsatisfactory conditions that might be detected. The possible applications of these findings to commercial burial grounds is discussed
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A Scoping Review of Clinical Practice Improvement Methodology Use in Rehabilitation
Directory of Open Access Journals (Sweden)
Marie-Eve Lamontagne
2016-01-01
Full Text Available Context The Clinical Practice Improvement (CPI approach is a methodological and quality improvement approach that has emerged and is gaining in popularity. However, there is no systematic description of its use or the determinants of its practice in rehabilitation settings. Method We performed a scoping review of the use of CPI methodology in rehabilitation settings. Results A total of 103 articles were reviewed. We found evidence of 13 initiatives involving CPI with six different populations. A total of 335 citations of determinants were found, with 68.7% related to CPI itself. Little information was found about what type of external and internal environment, individual characteristics and implementation process might facilitate or hinder the use of CPI. Conclusion Given the growing popularity of this methodological approach, CPI initiatives would gain from increasing knowledge of the determinants of its success and incorporating them in future implementation.
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Applying industrial process improvement techniques to increase efficiency in a surgical practice.
Reznick, David; Niazov, Lora; Holizna, Eric; Siperstein, Allan
2014-10-01
The goal of this study was to examine how industrial process improvement techniques could help streamline the preoperative workup. Lean process improvement was used to streamline patient workup at an endocrine surgery service at a tertiary medical center utilizing multidisciplinary collaboration. The program consisted of several major changes in how patients are processed in the department. The goal was to shorten the wait time between initial call and consult visit and between consult and surgery. We enrolled 1,438 patients enrolled in the program. The wait time from the initial call until consult was reduced from 18.3 ± 0.7 to 15.4 ± 0.9 days. Wait time from consult until operation was reduced from 39.9 ± 1.5 to 33.9 ± 1.3 days for the overall practice and to 15.0 ± 4.8 days for low-risk patients. Patient cancellations were reduced from 27.9 ± 2.4% to 17.3 ± 2.5%. Overall patient flow increased from 30.9 ± 5.1 to 52.4 ± 5.8 consults per month (all P process improvement methodology, surgery patients can benefit from an improved, streamlined process with significant reduction in wait time from call to initial consult and initial consult to surgery, with reduced cancellations. This generalized process has resulted in increased practice throughput and efficiency and is applicable to any surgery practice. Copyright © 2014 Elsevier Inc. All rights reserved.
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Hughes, Roger; Margetts, Barrie
2012-11-01
The present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development. The bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices. Education and practice settings. This model will have applications for educators and practitioners. Modifications to existing models have been informed by the authors' observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice. Public health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.
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Figures in clinical trial reports: current practice & scope for improvement.
Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M
2007-11-19
Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.
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Figures in clinical trial reports: current practice & scope for improvement
Directory of Open Access Journals (Sweden)
Travison Thomas G
2007-11-01
Full Text Available Abstract Background Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. Purpose To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. Methods We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Results Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. Conclusion There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.
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Role of storms and forest practices in sedimentation of an Oregon Coast Range lake
Richardson, K.; Hatten, J. A.; Wheatcroft, R. A.; Guerrero, F. J.
2014-12-01
The design of better management practices in forested watersheds to face climate change and the associated increase in the frequency of extreme events requires a better understanding of watershed responses to extreme events in the past and also under management regimes. One of the most sensitive watershed processes affected is sediment yield. Lake sediments record events which occur in a watershed and provide an opportunity to examine the interaction of storms and forest management practices in the layers of the stratigraphy. We hypothesize that timber harvesting and road building since the 1900s has resulted in increases in sedimentation; however, the passage of the Oregon Forest Practices Act (OFPA) in 1972 has led to a decrease in sedimentation. Sediment cores were taken at Loon Lake in the Oregon Coast Range. The 32-m deep lake captures sediment from a catchment highly impacted by recent land use and episodic Pacific storms. We can use sedimentological tools to measure changes in sediment production as motivated by extreme floods before settlement, during a major timber harvesting period, and after installation of forestry Best Management Practices. Quantification of changes in particle size and elemental composition (C, N, C/N) throughout the cores can elucidate changes in watershed response to extreme events, as can changes in layer thickness. Age control in the cores is being established by Cesium-137 and radiocarbon dating. Given the instrumental meteorological data and decadal climate reconstructions, we will disentangle climate driven signals from changes in land use practices. The sediment shows distinct laminations and varying thickness of layers throughout the cores. Background deposition is composed of thin layers (events to determine if the OFPA is having an effect on reducing sedimentation rates as a result of extreme magnitude storm events.
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International Nuclear Information System (INIS)
Samosyuk, I.Z.; Fisenko, L.I.; Kolesnik, K.Eh.; Chukhraev, N.V.; Shimkov, G.E.
1998-01-01
Problems of extremely high frequency (EHF) therapy, microwave resonance therapy (MRT) and information-wave therapy (IWT) are considered. Possibilities of electromagnetic waves in millimeter energy range use in clinical and health resort practice are systematized. Recommendations on their use in treatment of different diseases are given. The main principles of selection of zones for meridian correction with the help of electromagnetic waves in millimeter energy range are exposed. The results of EFH-therapy clinical use indicate the possibility of its application practically in all cases, since positive results were obtained in most cases. The recommendations are prepared with account of possibilities and parameters of the apparatus ''MIT-1'' for reflexotherapy which was designed and produced by the Medical Innovative Centre in Kiev
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Rayner, A C; Gill, R; Brass, D; Willings, T H; Bright, A
2016-09-10
Smothering, when birds group together in a way that results in death from suffocation, is a welfare and economic concern for the egg industry. This questionnaire-based study explored correlations between disease, housing, management practices and smothering on free-range farms. A binomial logistic regression approach was used to test whether question responses predicted occurrence of nest box smothers (NBS) and panic and recurring smothers (PSRS) on farms. Breed (P=0.008) and nest box manufacturer (P=0.014) predicted NBS. Breed and nest box design have been previously reported to affect nesting behaviour. The affect of nest box manufacturer found in this study may illustrate the effect of nest box design features or house layouts. Nest box manufacturer (P=0.009), feeding oyster grit or grain on the litter (Prange use on a sunny day (Pranging) may contribute to smothering, whereas some management practices such as those aimed at occupying birds may be beneficial, illustrating the delicate balance of factors involved in free-range egg production. It is hoped that these results will stimulate further work exploring the suitability of housing design and management of laying hens in light of smothering. British Veterinary Association.
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Sobottka, Stephan B; Töpfer, Armin; Eberlein-Gonska, Maria; Schackert, Gabriele; Albrecht, D Michael
2010-01-01
Six Sigma is an innovative management- approach to reach practicable zero- defect quality in medical service processes. The Six Sigma principle utilizes strategies, which are based on quantitative measurements and which seek to optimize processes, limit deviations or dispersion from the target process. Hence, Six Sigma aims to eliminate errors or quality problems of all kinds. A pilot project to optimize the preparation for neurosurgery could now show that the Six Sigma method enhanced patient safety in medical care, while at the same time disturbances in the hospital processes and failure costs could be avoided. All six defined safety relevant quality indicators were significantly improved by changes in the workflow by using a standardized process- and patient- oriented approach. Certain defined quality standards such as a 100% complete surgical preparation at start of surgery and the required initial contact of the surgeon with the patient/ surgical record on the eve of surgery could be fulfilled within the range of practical zero- defect quality. Likewise, the degree of completion of the surgical record by 4 p.m. on the eve of surgery and their quality could be improved by a factor of 170 and 16, respectively, at sigma values of 4.43 and 4.38. The other two safety quality indicators "non-communicated changes in the OR- schedule" and the "completeness of the OR- schedule by 12:30 a.m. on the day before surgery" also show an impressive improvement by a factor of 2.8 and 7.7, respectively, corresponding with sigma values of 3.34 and 3.51. The results of this pilot project demonstrate that the Six Sigma method is eminently suitable for improving quality of medical processes. In our experience this methodology is suitable, even for complex clinical processes with a variety of stakeholders. In particular, in processes in which patient safety plays a key role, the objective of achieving a zero- defect quality is reasonable and should definitely be aspirated. Copyright
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Seda Cetin, Pinar; Eymur, Guluzar; Southerland, Sherry A.; Walker, Joi; Whittington, Kirby
2018-01-01
This study examines the influence of laboratory instruction that engages students in a wide range of the practices of science on Turkish high-school students' chemistry learning. In this mixed methods study, student learning in two different laboratory settings was compared, one that featured an instruction that engaged students in a wide range of…
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Mikula, Brendon D.; Heckler, Andrew F.
2017-06-01
We propose a framework for improving accuracy, fluency, and retention of basic skills essential for solving problems relevant to STEM introductory courses, and implement the framework for the case of basic vector math skills over several semesters in an introductory physics course. Using an iterative development process, the framework begins with a careful identification of target skills and the study of specific student difficulties with these skills. It then employs computer-based instruction, immediate feedback, mastery grading, and well-researched principles from cognitive psychology such as interleaved training sequences and distributed practice. We implemented this with more than 1500 students over 2 semesters. Students completed the mastery practice for an average of about 13 min /week , for a total of about 2-3 h for the whole semester. Results reveal large (>1 SD ) pretest to post-test gains in accuracy in vector skills, even compared to a control group, and these gains were retained at least 2 months after practice. We also find evidence of improved fluency, student satisfaction, and that awarding regular course credit results in higher participation and higher learning gains than awarding extra credit. In all, we find that simple computer-based mastery practice is an effective and efficient way to improve a set of basic and essential skills for introductory physics.
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Test results for triple-modulation radar electronics with improved range disambiguation
Energy Technology Data Exchange (ETDEWEB)
Pollastrone, Fabio, E-mail: fabio.pollastrone@enea.it; Neri, Carlo
2015-10-15
Highlights: • A new digital radar electronic system based on triple-modulation has been developed. • The triple-modulation system uses an improved algorithm for the range-disambiguation. • The new radar electronics has been applied in the IVVS optical radar prototype for ITER. • The performances obtained with IVVS double and triple-modulation were compared. - Abstract: The In Vessel Viewing System (IVVS) is an optical radar with sub milimetrical resolution that will be used for imaging and metrology pourposes in ITER. The electronics of the system is based on a Digital Radar Electronics developed in ENEA Frascati laboratories during the past years. Until the present study, the system was based on amplitude modulation technique having double-modulation frequency. The power of the laser is sinusoidally modulated and the distance of the points scanned by the laser beam is obtained measuring the phase difference between outgoing and echo signals. Recently a triple-modulation radar electronics version and an algorithm able to solve the range disambiguation were developed. The aim of the upgrade was the increase of the robustness in the range disambiguation. The paper briefly describes the updates carried out on the Digital Radar Electronics and extensively the test results obtained by comparing the performance of the triple modulation versus the double modulation techniques.
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2017-09-01
MODELING TO IMPROVE HUMAN DECISION-MAKING DURING TEST AND EVALUATION RANGE CONTROL by William Carlson September 2017 Thesis Advisor...the Office of Management and Budget, Paperwork Reduction Project (0704-0188) Washington, DC 20503. 1. AGENCY USE ONLY (Leave blank) 2. REPORT...MAKING DURING TEST AND EVALUATION RANGE CONTROL 5. FUNDING NUMBERS 6. AUTHOR(S) William Carlson 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES
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Mukuria, Altrena G; Martin, Stephanie L; Egondi, Thaddeus; Bingham, Allison; Thuita, Faith M
2016-03-01
We designed and tested an intervention that used dialogue-based groups to engage infants' fathers and grandmothers to support optimal infant feeding practices. The study's aim was to test the effectiveness of increased social support by key household influencers on improving mothers' complementary feeding practices. Using a quasi-experimental design, we enrolled mothers, fathers, and grandmothers from households with infants 6-9 months old in 3 rural communities (1 intervention arm with fathers, 1 intervention arm with grandmothers, and 1 comparison arm) in western Kenya. We engaged 79 grandmothers and 85 fathers in separate dialogue groups for 6 months from January to July 2012. They received information on health and nutrition and were encouraged to provide social support to mothers (defined as specific physical actions in the past 2 weeks or material support actions in the past month). We conducted a baseline household survey in December 2011 in the 3 communities and returned to the same households in July 2012 for an endline survey. We used a difference-in-difference (DiD) approach and logistic regression to evaluate the intervention. We surveyed 554 people at baseline (258 mothers, 165 grandmothers, and 131 fathers) and 509 participants at endline. The percentage of mothers who reported receiving 5 or more social support actions (of a possible 12) ranged from 58% to 66% at baseline in the 3 groups. By endline, the percentage had increased by 25.8 percentage points (P=.002) and 32.7 percentage points (P=.001) more in the father and the grandmother intervention group, respectively, than in the comparison group. As the number of social support actions increased in the 3 groups, the likelihood of a mother reporting that she had fed her infant the minimum number of meals in the past 24 hours also increased between baseline and endline (odds ratio [OR], 1.14; confidence interval [CI], 1.00 to 1.30; P=.047). When taking into account the interaction effects of
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Study on improving rail energy efficiency (E2) : best practices and strategies
2015-03-23
A recent Volpe Center report [1] for the Federal Railroad Administrations (FRA) Rail Energy, Environment, and Engine (E3) Technology research and development program reviewed rail industry best practices (BPs) and strategies for improving energy e...
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Young, Andrea C; Lowry, Garry; Mumford, Karen; Graaf, Christine
Increasing the adoption and implementation of evidence-based policies and practices is a key strategy for improving public health. Although there is widespread agreement about the importance of implementing evidence-based public health policies and practices, there are gaps between what has been shown to be effective and what is implemented at the state level. The Centers for Disease Control and Prevention (CDC) developed the Prevention Status Reports (PSRs), a performance measurement system, to highlight evidence-based public health policies and practices and catalyze state performance and quality improvement efforts across the nation. CDC selected a set of 10 topics representing some of the most important public health challenges in the nation. Stakeholders, including state health departments and other partners, helped conceptualize the PSRs and informed the development of the PSR framework, which provides an organizational structure for the system. CDC subject matter experts developed criteria for selecting policies and practices, indicators for each policy and practice, and a criteria-based rating system for each indicator. The PSRs were developed for all 50 states and the District of Columbia. The PSRs were developed and serve as a performance measurement system for monitoring the adoption, reach, and implementation fidelity of evidence-based public health policies and practices nationwide. The PSRs include 33 policy and practice indicators across the 10 health topics. They use a simple 3-level rating system-green, yellow, and red-to report the extent to which each state (and the District of Columbia) has implemented the policy or practice in accordance with supporting evidence or expert recommendations. Results from aggregate analyses show positive change or improvement. The PSRs are a unique part of CDC's work to improve the performance and accountability of the public health system, serving as both a monitoring tool and a call to action to improve health
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Energy Technology Data Exchange (ETDEWEB)
Muller, L; Soldner, A; Kirk, M; Fager, M; Solberg, T; Robert, L; Dolney, D [University of Pennsylvania, Philadelphia, PA (United States)
2016-06-15
Purpose: The beam range uncertainty presents a special challenge for proton therapy. Novel technologies currently under development offer strategies to reduce the range uncertainty [1,2]. This work quantifies the potential advantages that could be realized by such a reduction for dosimetrically challenging chordomas at the base of skull. Therapeutic improvement was assessed by evaluating tumor control probabilities (TCP) and normal tissue complication probabilities (NTCP). Methods: Treatment plans were made for a modulated-scanned proton delivery technique using the Eclipse treatment planning system. The prescription dose was 7920 cGy to the CTV. Three different range uncertainty scenarios were considered: 5 mm (3.5% of the beam range + 1 mm, representing current clinical practice, “Curr”), 2 mm (1.3%), and 1 mm (0.7%). For each of 4 patients, 3 different PTVs were defined via uniform expansion of the CTV by the value of the range uncertainty. Tumor control probability (TCP) and normal tissue complication probabilities (NTCPs) for organs-at-risk (OARs) were calculated using the Lyman-Kutcher-Burman[3] formalism and published model parameters [ref Terahara[4], quantec S10, Burman Red Journal v21 pp 123]. Our plan optimization strategy was to achieve PTV close to prescription while maintaining OAR NTCP values at or better than the Curr plan. Results: The average TCP values for the 5, 2, and 1 mm range uncertainty scenarios are 51%, 55% and 65%. The improvement in TCP for patients was between 4 and 30%, depending primarily on the proximity of the GTV to OAR. The average NTCPs for the brainstem and cord were about 4% and 1%, respectively, for all target margins. Conclusion: For base of skull chordomas, reduced target margins can substantially increase the TCP without increasing the NTCP. This work demonstrates the potential significance of a reduction in the range uncertainty for proton beams.
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Eccles, Martin P; Hrisos, Susan; Francis, Jill J; Stamp, Elaine; Johnston, Marie; Hawthorne, Gillian; Steen, Nick; Grimshaw, Jeremy M; Elovainio, Marko; Presseau, Justin; Hunter, Margaret
2011-06-09
Type 2 diabetes is an increasingly prevalent chronic illness and an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of primary care teams. This study aimed to: investigate theoretically-based organisational, team, and individual factors determining the multiple behaviours needed to manage diabetes; and identify multilevel determinants of different diabetes management behaviours and potential interventions to improve them. This paper describes the instrument development, study recruitment, characteristics of the study participating practices and their constituent healthcare professionals and administrative staff and reports descriptive analyses of the data collected. The study was a predictive study over a 12-month period. Practices (N = 99) were recruited from within the UK Medical Research Council General Practice Research Framework. We identified six behaviours chosen to cover a range of clinical activities (prescribing, non-prescribing), reflect decisions that were not necessarily straightforward (controlling blood pressure that was above target despite other drug treatment), and reflect recommended best practice as described by national guidelines. Practice attributes and a wide range of individually reported measures were assessed at baseline; measures of clinical outcome were collected over the ensuing 12 months, and a number of proxy measures of behaviour were collected at baseline and at 12 months. Data were collected by telephone interview, postal questionnaire (organisational and clinical) to practice staff, postal questionnaire to patients, and by computer data extraction query. All 99 practices completed a telephone interview and responded to baseline questionnaires. The organisational questionnaire was completed by 931/1236 (75.3%) administrative staff, 423/529 (80.0%) primary care doctors, and 255/314 (81.2%) nurses. Clinical questionnaires were completed by 326/361 (90
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2011-01-01
Background Type 2 diabetes is an increasingly prevalent chronic illness and an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of primary care teams. This study aimed to: investigate theoretically-based organisational, team, and individual factors determining the multiple behaviours needed to manage diabetes; and identify multilevel determinants of different diabetes management behaviours and potential interventions to improve them. This paper describes the instrument development, study recruitment, characteristics of the study participating practices and their constituent healthcare professionals and administrative staff and reports descriptive analyses of the data collected. Methods The study was a predictive study over a 12-month period. Practices (N = 99) were recruited from within the UK Medical Research Council General Practice Research Framework. We identified six behaviours chosen to cover a range of clinical activities (prescribing, non-prescribing), reflect decisions that were not necessarily straightforward (controlling blood pressure that was above target despite other drug treatment), and reflect recommended best practice as described by national guidelines. Practice attributes and a wide range of individually reported measures were assessed at baseline; measures of clinical outcome were collected over the ensuing 12 months, and a number of proxy measures of behaviour were collected at baseline and at 12 months. Data were collected by telephone interview, postal questionnaire (organisational and clinical) to practice staff, postal questionnaire to patients, and by computer data extraction query. Results All 99 practices completed a telephone interview and responded to baseline questionnaires. The organisational questionnaire was completed by 931/1236 (75.3%) administrative staff, 423/529 (80.0%) primary care doctors, and 255/314 (81.2%) nurses. Clinical questionnaires were
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Hayes, Christopher William; Goldmann, Don
2018-03-01
Failure to consider the impact of change on health care providers is a barrier to success. Initiatives that increase workload and have low perceived value are less likely to be adopted. A practical model and supporting tools were developed on the basis of existing theories to help quality improvement (QI) programs design more adoptable approaches. Models and theories from the diffusion of innovation and work stress literature were reviewed, and key-informant interviews and site visits were conducted to develop a draft Highly Adoptable Improvement (HAI) Model. A list of candidate factors considered for inclusion in the draft model was presented to an expert panel. A modified Delphi process was used to narrow the list of factors into main themes and refine the model. The resulting model and supporting tools were pilot tested by 16 improvement advisors for face validity and usability. The HAI Model depicts how workload and perceived value influence adoptability of QI initiatives. The supporting tools include an assessment guide and suggested actions that QI programs can use to help design interventions that are likely to be adopted. Improvement advisors reported good face validity and usability and found that the model and the supporting tools helped address key issues related to adoption and reported that they would continue to use them. The HAI Model addresses important issues regarding workload and perceived value of improvement initiatives. Pilot testing suggests that the model and supporting tools are helpful and practical in guiding design and implementation of adoptable and sustainable QI interventions. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.
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Metzger, M.; Brown, C.; Pérez-Soba, M.; Rounsevell, M.; Verweij, P.; Delbaere, B.; Cojocaru, G.; Saarikoski, H.; Harrison, P.; Zellmer, K.
2014-12-01
management. New insights, and improved or novel tools and instruments, will be tested in practice in case studies that cover a range of socio-ecological systems across locales, sectors, scales and time. This presentation will discuss the development of OPPLA and the communities of practice that are emerging around it.
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International Nuclear Information System (INIS)
Park, Peter C.; Schreibmann, Eduard; Roper, Justin; Elder, Eric; Crocker, Ian; Fox, Tim; Zhu, X. Ronald; Dong, Lei; Dhabaan, Anees
2015-01-01
Purpose: Computed tomography (CT) artifacts can severely degrade dose calculation accuracy in proton therapy. Prompted by the recently increased popularity of magnetic resonance imaging (MRI) in the radiation therapy clinic, we developed an MRI-based CT artifact correction method for improving the accuracy of proton range calculations. Methods and Materials: The proposed method replaces corrupted CT data by mapping CT Hounsfield units (HU number) from a nearby artifact-free slice, using a coregistered MRI. MRI and CT volumetric images were registered with use of 3-dimensional (3D) deformable image registration (DIR). The registration was fine-tuned on a slice-by-slice basis by using 2D DIR. Based on the intensity of paired MRI pixel values and HU from an artifact-free slice, we performed a comprehensive analysis to predict the correct HU for the corrupted region. For a proof-of-concept validation, metal artifacts were simulated on a reference data set. Proton range was calculated using reference, artifactual, and corrected images to quantify the reduction in proton range error. The correction method was applied to 4 unique clinical cases. Results: The correction method resulted in substantial artifact reduction, both quantitatively and qualitatively. On respective simulated brain and head and neck CT images, the mean error was reduced from 495 and 370 HU to 108 and 92 HU after correction. Correspondingly, the absolute mean proton range errors of 2.4 cm and 1.7 cm were reduced to less than 2 mm in both cases. Conclusions: Our MRI-based CT artifact correction method can improve CT image quality and proton range calculation accuracy for patients with severe CT artifacts
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Ho, Dora Choi Wa
2010-01-01
Research Findings: This article describes research into leadership practice for school improvement in Hong Kong preschools at a time when there was a move toward increased accountability. Two schools were selected for study, both of which were rated as excellent in the quality assurance inspections of the Education Bureau. Leadership practice for…
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Improved measurement linearity and precision for AMCW time-of-flight range imaging cameras.
Payne, Andrew D; Dorrington, Adrian A; Cree, Michael J; Carnegie, Dale A
2010-08-10
Time-of-flight range imaging systems utilizing the amplitude modulated continuous wave (AMCW) technique often suffer from measurement nonlinearity due to the presence of aliased harmonics within the amplitude modulation signals. Typically a calibration is performed to correct these errors. We demonstrate an alternative phase encoding approach that attenuates the harmonics during the sampling process, thereby improving measurement linearity in the raw measurements. This mitigates the need to measure the system's response or calibrate for environmental changes. In conjunction with improved linearity, we demonstrate that measurement precision can also be increased by reducing the duty cycle of the amplitude modulated illumination source (while maintaining overall illumination power).
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Impact of Company Size on Manufacturing Improvement Practices: An empirical study
International Nuclear Information System (INIS)
Syan, C S; Ramoutar, K
2014-01-01
There is a constant search for ways to achieve a competitive advantage through new manufacturing techniques. Best performing manufacturing companies tend to use world-class manufacturing (WCM) practices. Although the last few years have witnessed phenomenal growth in the use of WCM techniques, their effectiveness is not well understood specifically in the context of less developed countries. This paper presents an empirical study to investigate the impact of company size on improving manufacturing performance in manufacturing organizations based in Trinidad and Tobago (T and T). Empirical data were collected via a questionnaire survey which was send to 218 manufacturing firms in T and T. Five different company sizes and seven different industry sectors were studied. The analysis of survey data was performed with the aid of Statistical Package for Social Sciences (SPSS) software. The study signified facilitating and impeding factors towards improving manufacturing performance. Their relative impact/importance is dependent on varying company size and industry sectors. Findings indicate that T and T manufacturers are still practicing traditional approaches, when compared with world class manufacturers. In the majority of organizations, these practices were not 100% implemented even though they started the implementation process more than 5 years ago. The findings provided some insights in formulating more optimal operational strategies, and later develop action plans towards more effective implementation of WCM in T and T manufacturers
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Impact of Company Size on Manufacturing Improvement Practices: An empirical study
Syan, C. S.; Ramoutar, K.
2014-07-01
There is a constant search for ways to achieve a competitive advantage through new manufacturing techniques. Best performing manufacturing companies tend to use world-class manufacturing (WCM) practices. Although the last few years have witnessed phenomenal growth in the use of WCM techniques, their effectiveness is not well understood specifically in the context of less developed countries. This paper presents an empirical study to investigate the impact of company size on improving manufacturing performance in manufacturing organizations based in Trinidad and Tobago (T&T). Empirical data were collected via a questionnaire survey which was send to 218 manufacturing firms in T&T. Five different company sizes and seven different industry sectors were studied. The analysis of survey data was performed with the aid of Statistical Package for Social Sciences (SPSS) software. The study signified facilitating and impeding factors towards improving manufacturing performance. Their relative impact/importance is dependent on varying company size and industry sectors. Findings indicate that T&T manufacturers are still practicing traditional approaches, when compared with world class manufacturers. In the majority of organizations, these practices were not 100% implemented even though they started the implementation process more than 5 years ago. The findings provided some insights in formulating more optimal operational strategies, and later develop action plans towards more effective implementation of WCM in T&T manufacturers.
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Directory of Open Access Journals (Sweden)
Vandana Bassoo
2015-12-01
Full Text Available Vehicular communication is a widely researched field and aims at developing technologies that may complement systems such as the advanced driver assistance systems. It is therefore important to analyse and infer on the performance of vehicular technologies for different driving and on-road criteria. This study considers the dedicated short range communications technology and more precisely the IEEE 802.11p standard for a performance and practicability analysis. There is also the proposal of a new classification scheme for typical driving conditions, which includes the main categories of Emergency and Safety scenarios while sub-classifications of Critical and Preventive Safety also exist. The scheme is used to build up scenarios as well as related equations relevant to developing countries for practical network simulation. The results obtained indicate that the relative speed of nodes is a determining factor in the overall performance and effectiveness of wireless vehicular communication systems. Moreover, delay values of low order were observed while an effective communication range of about 800 m was calculated for highway scenarios. The research thus indicates suitability of the system for an active use in collision avoidance even though independent factors such as climatic conditions and driver behaviour may affect its effectiveness in critical situations.
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Cohen, Deborah J; Dorr, David A; Knierim, Kyle; DuBard, C Annette; Hemler, Jennifer R; Hall, Jennifer D; Marino, Miguel; Solberg, Leif I; McConnell, K John; Nichols, Len M; Nease, Donald E; Edwards, Samuel T; Wu, Winfred Y; Pham-Singer, Hang; Kho, Abel N; Phillips, Robert L; Rasmussen, Luke V; Duffy, F Daniel; Balasubramanian, Bijal A
2018-04-01
Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports-but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.
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Directory of Open Access Journals (Sweden)
Malcolm W. Battersby
2010-03-01
Full Text Available BackgroundSupporting self management is seen as an important healthservice strategy in dealing with the large and increasing healthburden of chronic conditions. Several types of selfmanagementprograms are available. Evidence to datesuggests that disease-specific and lay-led self managementprograms provide only part of the support needed forimproved outcomes. The Flinders Program is promising as ageneric self management intervention, which can becombined with targeted disease-specific and lay-ledinterventions, but it has yet to be evaluated for a range ofchronic conditions using a rigorous controlled trial design. Thispaper gives the rationale for a randomised controlled trial andprocess evaluation of the Flinders Program of chroniccondition self-management in community practice, and detailsand justifies the design of such a study.MethodThe design for a randomised trial and associated processevaluation, suited to evaluation of a complex and behaviouralintervention as it is applied in actual practice, is presented andjustified.ConclusionA randomised trial of the Flinders Program is required and afunctional design is presented. Results from this trial,currently underway, will test the effectiveness of the FlindersProgram in improving patient competencies in selfmanagementof chronic conditions in practice conditions.A process evaluation alongside the trial will exploresystem, provider and patient factors associated withgreater and lesser Program effectiveness.
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MacLennan, Sara J; MacLennan, Steven; Bex, Axel; Catto, James W F; De Santis, Maria; Glaser, Adam W; Ljungberg, Borje; N'Dow, James; Plass, Karin; Trapero-Bertran, Marta; Van Poppel, Hendrik; Wright, Penny; Giles, Rachel H
2017-08-01
Effective stakeholder integration for guideline development should improve outcomes and adherence to clinical practice guidelines. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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Vanderpool, Robin C.; Brownson, Ross C.; Mays, Glen P.; Crosby, Richard A.; Wyatt, Stephen W.
2015-01-01
Strategic collaborations are essential in moving public health research and practice forward1, particularly in light of escalating fiscal and environmental challenges facing the public health community. This commentary provides background and context for an emerging partnership between two national networks, Prevention Research Centers (PRCs) and Public Health Practice-Based Research Networks (PBRNs), to impact public health practice. Supported by CDC, PRCs are celebrating over 25 years of transdisciplinary applied prevention research grounded in community and stakeholder engagement. Public Health PBRNs, funded by the Robert Wood Johnson Foundation, conduct innovative public health services and systems research with public health agencies and community partners to improve public health decision-making. By utilizing each of the networks’ respective strengths and resources, collaborative ventures between PRCs and Public Health PBRNs can enhance the translation of applied prevention research to evidence-based practice and empirically investigate novel public health practices developed in the field. Three current PRC-Public Health PBRNs projects are highlighted and future research directions are discussed. Improving the interconnectedness of prevention research and public health practice is essential to improve the health of the Nation. PMID:24237918
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Manufacturing best practices and performance
DEFF Research Database (Denmark)
Szász, Levente; Demeter, Krisztina; Boer, Harry
2014-01-01
whether a) home and host country characteristics moderate the association between manufacturing practices and performance, and, thus, whether b) there are manufacturing practices that are universally best. Manufacturing practices and performance are measured using data collected through the fifth round...... analysis is used to develop groups of companies based on home and host country development. Exploratory factor analysis is applied to create bundles of manufacturing practices and performance measures. Then, using moderated multiple regressions (MMR) with interaction factor, and separate multiple...... regression analyses for each group of companies, bundles of manufacturing practices are identified that lead to best-in-class performance improvements. A range of control variables is introduced to help interpret the results. The study shows that home and host country context does affect the association...
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Silvicultural and agronomic practices for improving Tuber magnatum habitat in natural woodlands
Directory of Open Access Journals (Sweden)
Tagliaferro F
2007-01-01
Full Text Available Since 2003 IPLA is taking part, in the project “Innovative interventions for the natural habitat protection and connection in order to create an ecological network” promoted by GAL Alta Langa. The final aim of the project, that has finished at the end of 2006, is to realize an ecological network where the elements are also truffi�res in which management practices are carried out in order to improve the Tuber magnatum Pico habitat. Using two SIR (Site of regional interest, located in Langa, as core areas three truffi�res have been selected; since spring 2004, the experimental activities have been carried out. The first truffi�res (Barbaresco, CN is located in a mixed white poplar wood with black locust. The first practices were the trees and shrubs thinning in order to increase the light and water availability and improve the organic matter cycle. The second one (Monchiero-CN is an oak (Quercus robur and black poplar wood of limited extension (less than 1000 square meters. Here the first practices were the shrubs thinning and the digging of narrow channels in contour in order to make easier the soil wetting. The last truffi�res (Murazzano-CN is a young black poplar wood grown after the cutting of some big trees; here at first Rubus sp., that covers a great part of the undergrowth, has been cut. This first management practices gave good results and the experimental activities will be carried on.
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Directory of Open Access Journals (Sweden)
Ankeet D. Udani
2014-01-01
Full Text Available Introduction. Properly performing a subarachnoid block (SAB is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents’ next three patients were evaluated in the operating room (OR. Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P<0.02. The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P<0.03. The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.
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Udani, Ankeet D; Macario, Alex; Nandagopal, Kiruthiga; Tanaka, Maria A; Tanaka, Pedro P
2014-01-01
Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents' next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P < 0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P < 0.03). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.
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Directory of Open Access Journals (Sweden)
Deborah Sitrin
2015-03-01
Full Text Available Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective: This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design: Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW during pregnancy (0, 1–2, 3+ – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results: There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion: Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of
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International Nuclear Information System (INIS)
McCabe, D.E.; Zerbst, U.; Heerens, J.
1993-01-01
This report covers the resolution of several issues that are relevant to the ductile to brittle transition range of structural steels. One of this issues was to compare a statistical-based weakest-link method to constraint data adjustment methods for modeling the specimen size effects on fracture toughness. Another was to explore the concept of a universal transition temperature curve shape (Master Curve). Data from a Materials Properties Council round robin activity were used to test the proposals empirically. The findings of this study are inclosed in an activity for the development of a draft standard test procedure ''Test Practice for Fracture Toughness in the Transition Range''. (orig.) [de
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Practice and documentation of palliative sedation: a quality improvement initiative
McKinnon, M.; Azevedo, C.; Bush, S.H.; Lawlor, P.; Pereira, J.
2014-01-01
Background Palliative sedation (ps), the continuous use of sedating doses of medication to intentionally reduce consciousness and relieve refractory symptoms at end of life, is ethically acceptable if administered according to standards of best practice. Procedural guidelines outlining the appropriate use of ps and the need for rigorous documentation have been developed. As a quality improvement strategy, we audited the practice and documentation of ps on our palliative care unit (pcu). Methods A pharmacy database search of admissions in 2008 identified, for a subsequent chart review, patients who had received either a continuous infusion of midazolam (≥10 mg/24 h), regular parenteral dosing of methotrimeprazine (≥75 mg daily), or regular phenobarbital. Documentation of the decision-making process, consent, and medication use was collected using a data extraction form based on current international ps standards. Results Interpretation and comparison of data were difficult because of an apparent lack of a consistent operational definition of ps. Patient records had no specific documentation in relation to ps initiation, to clearly identified refractory symptoms, and to informed consent in 60 (64.5%), 43 (46.2%), and 38 (40.9%) charts respectively. Variation in the medications used was marked: 54 patients (58%) were started on a single agent and 39 (42%), on multiple agents. The 40 patients (43%) started on midazolam alone received a mean daily dose of 21.4 mg (standard deviation: 24.6 mg). Conclusions The lack of documentation and standardized practice of ps on our pcu has resulted in a quality improvement program to address those gaps. They also highlight the importance of conducting research and developing clinical guidelines in this area. PMID:24764700
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Capturing the complexity of practice an insider:
DEFF Research Database (Denmark)
Clausen, Jette Aaroe; Santos, Mario
2017-01-01
offers a new set of theories to help explain the nature of maternity care provision across Europe and beyond, including complexity theory, salutogenesis, and new concepts of organisational culture. The aim of the book is to examine the nature of these theories, and to apply them to a range of practical......New Thinking on Improving Maternity Care is the result of years of comparative international research, with the goal of finding and generating the best possible evidence across a range of childbirth practices, contexts, and issues in Europe. There is a general shift towards a more risk...
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A Standardized Shift Handover Protocol: Improving Nurses’ Safe Practice in Intensive Care Units
Directory of Open Access Journals (Sweden)
Javad Malekzadeh
2013-08-01
Full Text Available Introduction: For maintaining the continuity of care and improving the quality of care, effective inter-shift information communication is necessary. Any handover error can endanger patient safety. Despite the importance of shift handover, there is no standard handover protocol in our healthcare settings. Methods In this one-group pretest-posttest quasi-experimental study conducted in spring and summer of 2011, we recruited a convenience sample of 56 ICU nurses. The Nurses’ Safe Practice Evaluation Checklist was used for data collection. The Content Validity Index and the inter-rater correlation coefficient of the checklist was 0.92 and 89, respectively. We employed the SPSS 11.5 software and the Mc Nemar and paired-samples t test for data analysis. Results: Study findings revealed that nurses’ mean score on the Safe Practice Evaluation Checklist increased significantly from 11.6 (2.7 to 17.0 (1.8 (P < 0.001. Conclusion: using a standard handover protocol for communicating patient’s needs and information improves nurses’ safe practice in the area of basic nursing care.
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Krumm, Andrew E.; Beattie, Rachel; Takahashi, Sola; D'Angelo, Cynthia; Feng, Mingyu; Cheng, Britte
2016-01-01
This paper outlines the development of practical measures of productive persistence using digital learning system data. Practical measurement refers to data collection and analysis approaches originating from improvement science; productive persistence refers to the combination of academic and social mindsets as well as learning behaviours that…
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2013-09-01
This report surveys the state-of-practice of transit railcar maintenance management and fleet management practices. It emphasizes a lifecycle management approach to fleet management. It also emphasizes the role of performance improvement programs and...
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International Nuclear Information System (INIS)
Waisley, Sandra L.; Lackey, Michael B.; Dusek, Lansing G.
2008-01-01
Approximately $150 billion of work currently remains in the United States Department of Energy's (DoE's) Office of Environmental Management (EM) life cycle budget for U.S. projects. Contractors who manage facilities for the DOE have been challenged to identify transformational changes to reduce the life cycle costs and to develop a knowledge-management system that identifies, disseminates, and tracks the implementation of lessons learned and best practices. This paper discusses DoE's rationale for using lessons learned and best practices to improve safety and performance while reducing life cycle costs for Deactivation and Decommissioning (D and D) projects. It also provides an update on the Energy Facility Contractors Group's (EFCOG's) progress in supporting DoE's efforts. At this juncture the best practice efforts described are in developmental stages; however, the commitment to and the concrete nature of the work thus far is noteworthy in regard to improving the way D and D lessons learned and best practices are identified, disseminated and implemented across the DOE Complex
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Improving Practice through Research.
Rose, Terry L.
1989-01-01
The article discusses the need for communication of research findings involving exceptional individuals, the need for resolution of the research-practice dichotomy, and the types of papers which will appear in the new column. (JDD)
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On the use of small integrating spheres to improve the linearity range of RASNIKS systems
International Nuclear Information System (INIS)
Alberdi, J.; Burgos, C.; Ferrando, A.; Molinero, A.; Schvachkin, V.; Figueroa, C.F.; Matorras, F.; Rodrigo, T.; Ruiz, A.; Vila, I.
1997-10-01
Rasniks elements will be used in the CMS alignment system. The large displacements of the different sub detectors expected in the CMS experiment demands large linearity response of this system. By the use of a small integrating sphere we have optimized the source definition such that a factor three improvement in the linearity range with respect to conventional Rasniks configurations is obtained. The response range reached coincides with the maximum one can get with the components used in the test
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Passive Back Support Exoskeleton Improves Range of Motion Using Flexible Beams
Directory of Open Access Journals (Sweden)
Matthias B. Näf
2018-06-01
Full Text Available In the EU, lower back pain affects more than 40% of the working population. Mechanical loading of the lower back has been shown to be an important risk factor. Peak mechanical load can be reduced by ergonomic interventions, the use of cranes and, more recently, by the use of exoskeletons. Despite recent advances in the development of exoskeletons for industrial applications, they are not widely adopted by industry yet. Some of the challenges, which have to be overcome are a reduced range of motion, misalignment between the human anatomy and kinematics of the exoskeleton as well as discomfort. A body of research exists on how an exoskeleton can be designed to compensate for misalignment and thereby improve comfort. However, how to design an exoskeleton that achieves a similar range of motion as a human lumbar spine of up to 60° in the sagittal plane, has not been extensively investigated. We addressed this need by developing and testing a novel passive back support exoskeleton, including a mechanism comprised of flexible beams, which run in parallel to the spine, providing a large range of motion and lowering the peak torque requirements around the lumbo-sacral (L5/S1 joint. Furthermore, we ran a pilot study to test the biomechanical (N = 2 and functional (N = 3 impact on subjects while wearing the exoskeleton. The biomechanical testing was once performed with flexible beams as a back interface and once with a rigid structure. An increase of more than 25% range of motion of the trunk in the sagittal plane was observed by using the flexible beams. The pilot functional tests, which are compared to results from a previous study with the Laevo device, suggest, that the novel exoskeleton is perceived as less hindering in almost all tested tasks.
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Singh, Mini; Ruhnke, Isabelle; de Koning, Carolyn; Drake, Kelly; Skerman, Alan G.; Hinch, Geoff N.; Glatz, Philip C.
2017-01-01
Baseline information on demographics and practices on semi-intensive free-range egg farms with an outdoor stocking density of ≤1500 hens/hectare in Australia is presented. Free-range egg production is changing the structure of the egg industry in Australia and a broad variety and tiers of free-range systems have emerged due to lack of concrete legislative standards on outdoor stocking densities in the past. Information was extracted from a pre-existing online free-range poultry survey dataset...
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Energy Technology Data Exchange (ETDEWEB)
Briggs, Sam; Hudson, Malcolm D., E-mail: mdh@soton.ac.uk
2013-01-15
Ecological Impact Assessment (EcIA) is an important tool for conservation and achieving sustainable development. 'Significant' impacts are those which disturb or alter the environment to a measurable degree. Significance is a crucial part of EcIA, our understanding of the concept in practice is vital if it is to be effective as a tool. This study employed three methods to assess how the determination of significance has changed through time, what current practice is, and what would lead to future improvements. Three data streams were collected: interviews with expert stakeholders, a review of 30 Environmental Statements and a broad-scale survey of the United Kingdom Institute of Ecology and Environmental Management (IEEM) members. The approach taken in the determination of significance has become more standardised and subjectivity has become constrained through a transparent framework. This has largely been driven by a set of guidelines produced by IEEM in 2006. The significance of impacts is now more clearly justified and the accuracy with which it is determined has improved. However, there are limitations to accuracy and effectiveness of the determination of significance. These are the quality of baseline survey data, our scientific understanding of ecological processes and the lack of monitoring and feedback of results. These in turn are restricted by the limited resources available in consultancies. The most notable recommendations for future practice are the implementation of monitoring and the publication of feedback, the creation of a central database for baseline survey data and the streamlining of guidance. - Highlights: Black-Right-Pointing-Pointer The assessment of significance has changed markedly through time. Black-Right-Pointing-Pointer The IEEM guidelines have driven a standardisation of practice. Black-Right-Pointing-Pointer Currently limited by quality of baseline data and scientific understanding. Black-Right-Pointing-Pointer Monitoring
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Hadden, Kristie; Prince, Latrina Y; Schnaekel, Asa; Couch, Cory G; Stephenson, John M; Wyrick, Theresa O
2016-08-01
This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement. A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources. The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices. Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons. Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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36 CFR 222.9 - Range improvements.
2010-07-01
... performed by a cooperator or permittee on National Forest System lands shall not confer the exclusive right..., to maintain improvements to specified standards. (d) Grazing fees or the number of animal months...
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Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E
2002-01-01
BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children. PMID:12528583
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Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E
2002-12-01
Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.
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[Use of PubMed to improve evidence-based medicine in routine urological practice].
Rink, M; Kluth, L A; Shariat, S F; Chun, F K; Fisch, M; Dahm, P
2013-03-01
Applying evidence-based medicine in daily clinical practice is the basis of patient-centered medicine and knowledge of accurate literature acquisition skills is necessary for informed clinical decision-making. PubMed is an easy accessible, free bibliographic database comprising over 21 million citations from the medical field, life-science journals and online books. The article summarizes the effective use of PubMed in routine urological clinical practice based on a common case scenario. This article explains the simple use of PubMed to obtain the best search results with the highest evidence. Accurate knowledge about the use of PubMed in routine clinical practice can improve evidence-based medicine and also patient treatment.
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Behavioural informatics for improving water hygiene practice based on IoT environment.
Fu, Yang; Wu, Wenyan
2018-02-01
The development of Internet of Things (IoT) and latest Information and Communication Technologies (ICT) have changed the nature of healthcare monitoring and health behaviour intervention in many applications. Water hygiene and water conservation behaviour intervention as important influence factors to human health are gaining much attentions for improving sustained sanitation practice. Based on face-to-face delivery, typical behaviour intervention method is costly and hardly to provide all day access to personalised intervention guidance and feedbacks. In this study, we presented a behavioural information system and water use behaviour model using IoT platform. Using Expanded Theory of Planned Behaviour (ETPB) and adopted structure equation model, this study offers a solution for understanding the behaviour intervention mechanism and methodology for developing empirical model. A case study of behaviour intervention model is presented by utilising residential water conservation behaviour data collected in China. Results suggested that cultural differences have significant influences on the understanding of intervention drivers, promoting projects and increasing awareness, which could improve the behaviour intervention efficiency and further facilitate the improvement of water hygiene practice. The performance evaluation of water saving dimension is discussed as well in the paper. Copyright © 2017 Elsevier Inc. All rights reserved.
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McNab, Duncan; McKay, John; Bowie, Paul
2015-11-01
Small-scale quality improvement projects are expected to make a significant contribution towards improving the quality of healthcare. Enabling doctors-in-training to design and lead quality improvement projects is important preparation for independent practice. Participation is mandatory in speciality training curricula. However, provision of training and ongoing support in quality improvement methods and practice is variable. We aimed to design and deliver a quality improvement training package to core medical and general practice specialty trainees and evaluate impact in terms of project participation, completion and publication in a healthcare journal. A quality improvement training package was developed and delivered to core medical trainees and general practice specialty trainees in the west of Scotland encompassing a 1-day workshop and mentoring during completion of a quality improvement project over 3 months. A mixed methods evaluation was undertaken and data collected via questionnaire surveys, knowledge assessment, and formative assessment of project proposals, completed quality improvement projects and publication success. Twenty-three participants attended the training day with 20 submitting a project proposal (87%). Ten completed quality improvement projects (43%), eight were judged as satisfactory (35%), and four were submitted and accepted for journal publication (17%). Knowledge and confidence in aspects of quality improvement improved during the pilot, while early feedback on project proposals was valued (85.7%). This small study reports modest success in training core medical trainees and general practice specialty trainees in quality improvement. Many gained knowledge of, confidence in and experience of quality improvement, while journal publication was shown to be possible. The development of educational resources to aid quality improvement project completion and mentoring support is necessary if expectations for quality improvement are to be
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System Leadership for School Improvement: A Developing Concept and Set of Practices
Dimmock, Clive
2016-01-01
System leadership is a developing concept and practice increasingly seen as a tool for school improvement, as policymakers switch from traditional top-down reform to professional models of schools working collaboratively. System leadership is being championed by the Scottish College for Educational Leadership (SCEL), but is still in its infancy in…
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Funder, David C; Levine, John M; Mackie, Diane M; Morf, Carolyn C; Sansone, Carol; Vazire, Simine; West, Stephen G
2014-02-01
In this article, the Society for Personality and Social Psychology (SPSP) Task Force on Publication and Research Practices offers a brief statistical primer and recommendations for improving the dependability of research. Recommendations for research practice include (a) describing and addressing the choice of N (sample size) and consequent issues of statistical power, (b) reporting effect sizes and 95% confidence intervals (CIs), (c) avoiding "questionable research practices" that can inflate the probability of Type I error, (d) making available research materials necessary to replicate reported results, (e) adhering to SPSP's data sharing policy, (f) encouraging publication of high-quality replication studies, and (g) maintaining flexibility and openness to alternative standards and methods. Recommendations for educational practice include (a) encouraging a culture of "getting it right," (b) teaching and encouraging transparency of data reporting, (c) improving methodological instruction, and (d) modeling sound science and supporting junior researchers who seek to "get it right."
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International Nuclear Information System (INIS)
Meng, Jianxin; Mei, Deqing; Yang, Keji; Fan, Zongwei
2014-01-01
In existing ultrasonic transportation methods, the long-range transportation of micro-particles is always realized in step-by-step way. Due to the substantial decrease of the driving force in each step, the transportation is lower-speed and stair-stepping. To improve the transporting velocity, a non-stepping ultrasonic transportation approach is proposed. By quantitatively analyzing the acoustic potential well, an optimal region is defined as the position, where the largest driving force is provided under the condition that the driving force is simultaneously the major component of an acoustic radiation force. To keep the micro-particle trapped in the optimal region during the whole transportation process, an approach of optimizing the phase-shifting velocity and phase-shifting step is adopted. Due to the stable and large driving force, the displacement of the micro-particle is an approximately linear function of time, instead of a stair-stepping function of time as in the existing step-by-step methods. An experimental setup is also developed to validate this approach. Long-range ultrasonic transportations of zirconium beads with high transporting velocity were realized. The experimental results demonstrated that this approach is an effective way to improve transporting velocity in the long-range ultrasonic transportation of micro-particles
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International Nuclear Information System (INIS)
Samosyuk, I.Z.; Chukhraev, N.V.; Shimkov, G.E.; Bitson, A.V.
1999-01-01
EHF-therapy method is a principally new method of treatment which is based on the peculiarities in perception by human organism the magnetic radiation of millimeter energy range. Practical use of this method has shown its high therapeutic efficiency at influencing on acupuncture points. This monography is completely devoted to description of EHF-therapy effects on acupuncture points with account of the Chinese reflexotherapy. Apparats of 'MIT' and 'Eleknronika-EHF' series do not provoke any damages in biological structures and refer to the safe class. The proposed scientific and practical materials on the use of physical factors in clinical and health resort practice are edited in addition to the previous monograph under the same title. These materials are of use for physicians of different specializations and listeners of medical advanced courses
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Quality Factor Effect on the Wireless Range of Microstrip Patch Antenna Strain Sensors
Directory of Open Access Journals (Sweden)
Ali Daliri
2014-01-01
Full Text Available Recently introduced passive wireless strain sensors based on microstrip patch antennas have shown great potential for reliable health and usage monitoring in aerospace and civil industries. However, the wireless interrogation range of these sensors is limited to few centimeters, which restricts their practical application. This paper presents an investigation on the effect of circular microstrip patch antenna (CMPA design on the quality factor and the maximum practical wireless reading range of the sensor. The results reveal that by using appropriate substrate materials the interrogation distance of the CMPA sensor can be increased four-fold, from the previously reported 5 to 20 cm, thus improving considerably the viability of this type of wireless sensors for strain measurement and damage detection.
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Quality Factor Effect on the Wireless Range of Microstrip Patch Antenna Strain Sensors
Daliri, Ali; Galehdar, Amir; Rowe, Wayne S. T.; John, Sabu; Wang, Chun H.; Ghorbani, Kamran
2014-01-01
Recently introduced passive wireless strain sensors based on microstrip patch antennas have shown great potential for reliable health and usage monitoring in aerospace and civil industries. However, the wireless interrogation range of these sensors is limited to few centimeters, which restricts their practical application. This paper presents an investigation on the effect of circular microstrip patch antenna (CMPA) design on the quality factor and the maximum practical wireless reading range of the sensor. The results reveal that by using appropriate substrate materials the interrogation distance of the CMPA sensor can be increased four-fold, from the previously reported 5 to 20 cm, thus improving considerably the viability of this type of wireless sensors for strain measurement and damage detection. PMID:24451457
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Campbell, D L M; Hinch, G N; Dyall, T R; Warin, L; Little, B A; Lee, C
2017-01-01
The number and size of free-range laying hen (Gallus gallus domesticus) production systems are increasing within Australia in response to consumer demand for perceived improvement in hen welfare. However, variation in outdoor stocking density has generated consumer dissatisfaction leading to the development of a national information standard on free-range egg labelling by the Australian Consumer Affairs Ministers. The current Australian Model Code of Practice for Domestic Poultry states a guideline of 1500 hens/ha, but no maximum density is set. Radio-frequency identification (RFID) tracking technology was used to measure daily range usage by individual ISA Brown hens housed in six small flocks (150 hens/flock - 50% of hens tagged), each with access to one of three outdoor stocking density treatments (two replicates per treatment: 2000, 10 000, 20 000 hens/ha), from 22 to 26, 27 to 31 and 32 to 36 weeks of age. There was some variation in range usage across the sampling periods and by weeks 32 to 36 individual hens from the lowest stocking density on average used the range for longer each day (Prange with 2% of tagged hens in each treatment never venturing outdoors and a large proportion that accessed the range daily (2000 hens/ha: 80.5%; 10 000 hens/ha: 66.5%; 20 000 hens/ha: 71.4%). On average, 38% to 48% of hens were seen on the range simultaneously and used all available areas of all ranges. These results of experimental-sized flocks have implications for determining optimal outdoor stocking densities for commercial free-range laying hens but further research would be needed to determine the effects of increased range usage on hen welfare.
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Singh, Mini; Ruhnke, Isabelle; de Koning, Carolyn; Drake, Kelly; Skerman, Alan G; Hinch, Geoff N; Glatz, Philip C
2017-01-01
Baseline information on demographics and practices on semi-intensive free-range egg farms with an outdoor stocking density of ≤1500 hens/hectare in Australia is presented. Free-range egg production is changing the structure of the egg industry in Australia and a broad variety and tiers of free-range systems have emerged due to lack of concrete legislative standards on outdoor stocking densities in the past. Information was extracted from a pre-existing online free-range poultry survey dataset, consisting of a total of 79 questions related to nutrition, pasture management, welfare and health, animal housing, environmental impact and economics. Forty-one free-range egg farms, with an outdoor stocking density of ≤1500 hens/hectare, were identified in the dataset from all major Australian states. Two types of semi-intensive free-range housing systems were documented: mobile (modified caravan/trailer) housing (56%), and fixed sheds (44%). Seventy-two percent of respondents reported >75% of the hens in the flock used the outdoor range. All respondents reported ingestion of range components by hens in the form of vegetation, insects, stones and grit. Up to 10% mortality was reported by 40% respondents with predation (34%), cannibalism (29%), heat stress (24%) and grass impaction (19.5%) as major causes. Biosecurity on farms was sub-optimal with 8 of the 10 actions implemented by free-range egg production. This study resulted in identification of current practices and key challenges on semi-intensive free-range egg farms. Applied research and communication of results to farmers is highly recommended to ensure optimum health and welfare of free-range laying hens and sustained egg production.
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Energy Technology Data Exchange (ETDEWEB)
Rosa, Josianne Claudia Sales, E-mail: jcsrosa@usp.br; Sánchez, Luis E., E-mail: lsanchez@usp.br
2015-01-15
Considering ecosystem services (ES) could foster innovation and improve environmental and social impact assessment (ESIA) practice, but is the potential being fulfilled? In order to investigate how ES have been treated in recent international practice, three questions are asked: (i) were the tasks of an ES analysis carried out? (ii) how is such analysis integrated with other analysis presented in the ESIA? (iii) does ES analysis result in additional or improved mitigation or enhancement measures? These research questions were unfolded into 15 auxiliary questions for reviewing five ESIA reports prepared for mining, hydroelectric and transportation infrastructure projects in Africa, Asia and South America. All cases incorporated ES into ESIA to meet a requirement of the International Finance Corporation's Performance Standards on Environmental and Social Sustainability. It was found that: (i) in only three cases most tasks recommended by current guidance were adopted (ii) all reports feature a dedicated ES chapter or section, but in three of them no evidence was found that the ES analysis was integrated within impact assessment (iii) in the two ESIAs that followed guidance, ES analysis resulted in specific mitigation measures. Few evidence was found that the ES concept is improving current ESIA practice. Key challenges are: (i) integrating ES analysis in such a way that it does not duplicate other analysis; (ii) adequately characterizing the beneficiaries of ES; and (iii) quantifying ES supply for impact prediction. - Highlights: • Incorporating ecosystem services analysis in impact assessment can improve results. • Additional impacts and mitigation were identified. • Challenges include developing appropriate indicators for impact prediction. • A key challenge is integrating the concept in such a way that it does not duplicate other analysis.
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International Nuclear Information System (INIS)
Rosa, Josianne Claudia Sales; Sánchez, Luis E.
2015-01-01
Considering ecosystem services (ES) could foster innovation and improve environmental and social impact assessment (ESIA) practice, but is the potential being fulfilled? In order to investigate how ES have been treated in recent international practice, three questions are asked: (i) were the tasks of an ES analysis carried out? (ii) how is such analysis integrated with other analysis presented in the ESIA? (iii) does ES analysis result in additional or improved mitigation or enhancement measures? These research questions were unfolded into 15 auxiliary questions for reviewing five ESIA reports prepared for mining, hydroelectric and transportation infrastructure projects in Africa, Asia and South America. All cases incorporated ES into ESIA to meet a requirement of the International Finance Corporation's Performance Standards on Environmental and Social Sustainability. It was found that: (i) in only three cases most tasks recommended by current guidance were adopted (ii) all reports feature a dedicated ES chapter or section, but in three of them no evidence was found that the ES analysis was integrated within impact assessment (iii) in the two ESIAs that followed guidance, ES analysis resulted in specific mitigation measures. Few evidence was found that the ES concept is improving current ESIA practice. Key challenges are: (i) integrating ES analysis in such a way that it does not duplicate other analysis; (ii) adequately characterizing the beneficiaries of ES; and (iii) quantifying ES supply for impact prediction. - Highlights: • Incorporating ecosystem services analysis in impact assessment can improve results. • Additional impacts and mitigation were identified. • Challenges include developing appropriate indicators for impact prediction. • A key challenge is integrating the concept in such a way that it does not duplicate other analysis
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Neff, Gina; Tanweer, Anissa; Fiore-Gartland, Brittany; Osburn, Laura
2017-06-01
What would data science look like if its key critics were engaged to help improve it, and how might critiques of data science improve with an approach that considers the day-to-day practices of data science? This article argues for scholars to bridge the conversations that seek to critique data science and those that seek to advance data science practice to identify and create the social and organizational arrangements necessary for a more ethical data science. We summarize four critiques that are commonly made in critical data studies: data are inherently interpretive, data are inextricable from context, data are mediated through the sociomaterial arrangements that produce them, and data serve as a medium for the negotiation and communication of values. We present qualitative research with academic data scientists, "data for good" projects, and specialized cross-disciplinary engineering teams to show evidence of these critiques in the day-to-day experience of data scientists as they acknowledge and grapple with the complexities of their work. Using ethnographic vignettes from two large multiresearcher field sites, we develop a set of concepts for analyzing and advancing the practice of data science and improving critical data studies, including (1) communication is central to the data science endeavor; (2) making sense of data is a collective process; (3) data are starting, not end points, and (4) data are sets of stories. We conclude with two calls to action for researchers and practitioners in data science and critical data studies alike. First, creating opportunities for bringing social scientific and humanistic expertise into data science practice simultaneously will advance both data science and critical data studies. Second, practitioners should leverage the insights from critical data studies to build new kinds of organizational arrangements, which we argue will help advance a more ethical data science. Engaging the insights of critical data studies will
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Ultra-low-pressure sputtering to improve exchange bias and tune linear ranges in spin valves
Energy Technology Data Exchange (ETDEWEB)
Tang, XiaoLi, E-mail: tangtang1227@163.com; Yu, You; Liu, Ru; Su, Hua; Zhang, HuaiWu; Zhong, ZhiYong; Jing, YuLan
2017-05-01
A series of CoFe/IrMn exchange bilayers was grown by DC-sputtering at different ultra-low argon pressures ranging from 0.008 to 0.1 Pa. This pressure range was one to two orders lower than the normal sputtering pressure. Results revealed that the exchange bias increased from 140 to 250 Oe in CoFe(10 nm)/IrMn (15 nm) bilayers of fixed thickness because of the improved crystalline structure and morphological uniformity of films. Since ferromagnetic /antiferromagnetic (FM/AF) bilayers are always used in linear magnetic sensors as detection layers, the varying exchange bias can successfully achieve tunable linear range in a crossed pinning spin valve. The linear range could be adjustable from −80 Oe – +80 Oe to −150 Oe – +150 Oe on the basis of giant magnetoresistance responses. Therefore, this method provides a simple method to tune the operating range of magnetic field sensors. - Highlights: • Increasing exchange bias was achieved in bilayer at ultra-low-pressure sputtering. • The low void density and smooth surface were achieved in low pressure. • Varying exchange bias achieved tunable linear range in spin valve.
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Tan, Lindsay; Hong, Miyoung; Albert, Taneshia West
2017-10-01
This case study explores the influence of the healthcare design studio experience on students' short-term professional goals as measured through rates of healthcare-related certification and internship/employment. The value and relevance of interior design is evident in the healthcare design sector. However, interior design students may not perceive this value if it is not communicated through their design education. Students' experience in the design studio plays a crucial role in determining career choices, and students may be more committed to career goals when there is clear connection between major coursework and professional practice. The authors compared healthcare-related certification and internship/employment levels between two student cohorts in a capstone undergraduate interior design healthcare design studio course. The first cohort was led by the existing curriculum. The second cohort was led by the revised curriculum that specifically aimed at encouraging students to commit to healthcare-related design practice. When measured at 3 months from graduation, the second cohort, led by the revised curriculum, saw a 30% increase in Evidence-based Design Accreditation and Certification exam pass rates and a 40% increase in healthcare-related internship/employment. The challenge of interior design education is to instill in emerging professionals not only professional competence but also those professional attitudes that will make them better prepared to design spaces that improve quality of life, particularly in healthcare environments. The results exceeded the project goals, and so this could be considered a promising practice for courses focused on healthcare design education.
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Tomolo, A M; Lawrence, R H; Aron, D C
2009-10-01
In 2002, the Accreditation Council for Graduate Medical Education (ACGME) introduced a new requirement: residents must demonstrate competency in Practice-Based Learning and Improvement (PBLI). Training in this domain is still not consistently integrated into programmes, with few, if any, adequately going beyond knowledge of basic content and addressing all components of the requirement. To summarise the implementation of a PBLI curriculum designed to address all components of the requirement and to evaluate the impact on the practice system. A case-study approach was used for identifying and evaluating the steps for delivering the curriculum, along with the Model for Improvement's successive Plan-Do-Study-Act (PDSA) cycles (July 2004-May 2006). Notes from curriculum development meetings, notes and presentation slides made by teams about their projects, resident curriculum exit evaluations curriculum and interviews. Residents reported high levels of comfort by applying PBLI-related knowledge and skills and that the curriculum improved their ability to do various PBLI tasks. The involvement of multiple stakeholders increased. Twelve of the 15 teams' suggestions with practical systems-relevant outcomes were implemented and sustained beyond residents' project periods. While using the traditional PDSA cycles was helpful, there were limitations. A PBLI curriculum that is centred around practice-based quality improvement projects can fulfil the objectives of this ACGME competency while accomplishing sustained outcomes in quality improvement. A comprehensive curriculum is an investment but offers organisational rewards. We propose a more realistic and informative representation of rapid PDSA cycle changes.
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Joosen, Margot C. W.; van Beurden, Karlijn M.; Terluin, Berend; van Weeghel, Jaap; Brouwers, Evelien P. M.; van der Klink, Jac J. L.
2015-01-01
Background: Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived
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Spatial Cognition and Range Use in Free-Range Laying Hens.
Campbell, Dana L M; Talk, Andrew C; Loh, Ziyang A; Dyall, Tim R; Lee, Caroline
2018-02-08
Radio-frequency identification tracking shows individual free-range laying hens vary in range use, with some never going outdoors. The range is typically more environmentally complex, requiring navigation to return to the indoor resources. Outdoor-preferring hens may have improved spatial abilities compared to indoor-preferring hens. Experiment 1 tested 32 adult ISA Brown hens in a T-maze learning task that showed exclusively-indoor birds were slowest to reach the learning success criterion ( p 0.05), the age that coincided with the onset of lay. Enriched birds that were faster to learn the maze task showed more range visits in the first 4 weeks of range access. Enriched and non-enriched birds showed no differences in telencephalon or hippocampal volume ( p > 0.05). Fear may reduce spatial abilities but further testing with more pen replicates per early rearing treatments would improve our understanding of the relationship between spatial cognitive abilities and range use.
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Practice improvement, part II: trends in employment versus private practice.
Coleman, Mary Thoesen; Roett, Michelle A
2013-11-01
A growing percentage of physicians are selecting employment over solo practice, and fewer family physicians have hospital admission privileges. Results from surveys of recent medical school graduates indicate a high value placed on free time. Factors to consider when choosing a practice opportunity include desire for independence, decision-making authority, work-life balance, administrative responsibilities, financial risk, and access to resources. Compensation models are evolving from the simple fee-for-service model to include metrics that reward panel size, patient access, coordination of care, chronic disease management, achievement of patient-centered medical home status, and supervision of midlevel clinicians. When a practice is sold, tangible personal property and assets in excess of liabilities, patient accounts receivable, office building, and goodwill (ie, expected earnings) determine its value. The sale of a practice includes a broad legal review, addressing billing and coding deficiencies, noncompliant contractual arrangements, and potential litigations as well as ensuring that all employment agreements, leases, service agreements, and contracts are current, have been executed appropriately, and meet regulatory requirements. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.
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LENUS (Irish Health Repository)
Owens, P
2015-03-01
As part of the National Clinical Programme on healthcare-associated infection prevention, a Royal College of Surgeons in Ireland (RCSI) and Royal College of Physicians of Ireland (RCPI) working group developed a quality improvement tool for prevention of surgical site infection (SS). We aimed to validate the effectiveness of an educational campaign, which utilises this quality improvement tool to prevent SSI in a tertiary hospital. Prior to the SSI educational campaign, surgical patients were prospectively audited and details of antibiotic administration recorded. Prophylactic antibiotic administration recommendations were delivered via poster and educational presentations. Post-intervention, the audit was repeated. 50 patients were audited pre-intervention, 45 post-intervention. Post-intervention, prophylaxis within 60 minutes prior to incision increased from 54% to 68% (p = 0.266). Appropriate postoperative prescribing improved from 71% to 92% (p = 0.075). A multifaceted educational program may be effective in changing SSI prevention practices.
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Babin, Erin Pevey
2017-01-01
The biggest challenge facing American public schools today is increasing student achievement, and this depends on the educational system's ability to improve the quality of instruction. Principals play a key role in improving the quality of instruction on their campus through the instructional leadership practices they engage in on a daily basis.…
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Directory of Open Access Journals (Sweden)
Mini Singh
Full Text Available Baseline information on demographics and practices on semi-intensive free-range egg farms with an outdoor stocking density of ≤1500 hens/hectare in Australia is presented. Free-range egg production is changing the structure of the egg industry in Australia and a broad variety and tiers of free-range systems have emerged due to lack of concrete legislative standards on outdoor stocking densities in the past. Information was extracted from a pre-existing online free-range poultry survey dataset, consisting of a total of 79 questions related to nutrition, pasture management, welfare and health, animal housing, environmental impact and economics. Forty-one free-range egg farms, with an outdoor stocking density of ≤1500 hens/hectare, were identified in the dataset from all major Australian states. Two types of semi-intensive free-range housing systems were documented: mobile (modified caravan/trailer housing (56%, and fixed sheds (44%. Seventy-two percent of respondents reported >75% of the hens in the flock used the outdoor range. All respondents reported ingestion of range components by hens in the form of vegetation, insects, stones and grit. Up to 10% mortality was reported by 40% respondents with predation (34%, cannibalism (29%, heat stress (24% and grass impaction (19.5% as major causes. Biosecurity on farms was sub-optimal with 8 of the 10 actions implemented by <50% respondents. Customer demand, consumer sentiment and welfare were the major factors for farmers moving into free-range egg production. This study resulted in identification of current practices and key challenges on semi-intensive free-range egg farms. Applied research and communication of results to farmers is highly recommended to ensure optimum health and welfare of free-range laying hens and sustained egg production.
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Aibana, Omowunmi; Franke, Molly; Teng, Jessica; Hilaire, Johanne; Raymond, Max; Ivers, Louise C.
2013-01-01
Background Haiti's cholera epidemic has been devastating partly due to underlying weak infrastructure and limited clean water and sanitation. A comprehensive approach to cholera control is crucial, yet some have argued that oral cholera vaccination (OCV) might result in reduced hygiene practice among recipients. We evaluated the impact of an OCV campaign on knowledge and health practice in rural Haiti. Methodology/Principal Findings We administered baseline surveys on knowledge and practice relevant to cholera and waterborne disease to every 10th household during a census in rural Haiti in February 2012 (N = 811). An OCV campaign occurred from May–June 2012 after which we administered identical surveys to 518 households randomly chosen from the same region in September 2012. We compared responses pre- and post-OCV campaign. Post-vaccination, there was improved knowledge with significant increase in percentage of respondents with ≥3 correct responses on cholera transmission mechanisms (odds ratio[OR] 1.91; 95% confidence interval[CI] 1.52–2.40), preventive methods (OR 1.83; 95% CI 1.46–2.30), and water treatment modalities (OR 2.75; 95% CI 2.16–3.50). Relative to pre-vaccination, participants were more likely post-OCV to report always treating water (OR 1.62; 95% CI 1.28–2.05). Respondents were also more likely to report hand washing with soap and water >4 times daily post-vaccine (OR 1.30; 95% CI 1.03–1.64). Knowledge of treating water as a cholera prevention measure was associated with practice of always treating water (OR 1.47; 95% CI 1.14–1.89). Post-vaccination, knowledge was associated with frequent hand washing (OR 2.47; 95% CI 1.35–4.51). Conclusion An OCV campaign in rural Haiti was associated with significant improvement in cholera knowledge and practices related to waterborne disease. OCV can be part of comprehensive cholera control and reinforce, not detract from, other control efforts in Haiti. PMID:24278498
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Directory of Open Access Journals (Sweden)
Omowunmi Aibana
2013-11-01
Full Text Available Haiti's cholera epidemic has been devastating partly due to underlying weak infrastructure and limited clean water and sanitation. A comprehensive approach to cholera control is crucial, yet some have argued that oral cholera vaccination (OCV might result in reduced hygiene practice among recipients. We evaluated the impact of an OCV campaign on knowledge and health practice in rural Haiti.We administered baseline surveys on knowledge and practice relevant to cholera and waterborne disease to every 10th household during a census in rural Haiti in February 2012 (N = 811. An OCV campaign occurred from May-June 2012 after which we administered identical surveys to 518 households randomly chosen from the same region in September 2012. We compared responses pre- and post-OCV campaign. Post-vaccination, there was improved knowledge with significant increase in percentage of respondents with ≥ 3 correct responses on cholera transmission mechanisms (odds ratio[OR] 1.91; 95% confidence interval[CI] 1.52-2.40, preventive methods (OR 1.83; 95% CI 1.46-2.30, and water treatment modalities (OR 2.75; 95% CI 2.16-3.50. Relative to pre-vaccination, participants were more likely post-OCV to report always treating water (OR 1.62; 95% CI 1.28-2.05. Respondents were also more likely to report hand washing with soap and water >4 times daily post-vaccine (OR 1.30; 95% CI 1.03-1.64. Knowledge of treating water as a cholera prevention measure was associated with practice of always treating water (OR 1.47; 95% CI 1.14-1.89. Post-vaccination, knowledge was associated with frequent hand washing (OR 2.47; 95% CI 1.35-4.51.An OCV campaign in rural Haiti was associated with significant improvement in cholera knowledge and practices related to waterborne disease. OCV can be part of comprehensive cholera control and reinforce, not detract from, other control efforts in Haiti.
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Problems in implementing improved range management on ...
African Journals Online (AJOL)
Keywords: Africa; Australia; Livestock development; Pastoral communities; Rangeland development; Rangeland systems; Sustainability; development; ecology; holism; pastoralism; range management; strategies; environment; water; health; crop production; rangelands; resource management; north africa; holistic approach ...
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Flottorp, S.A.; Oxman, A.D.; Krause, J.; Musila, N.R.; Wensing, M.; Godycki-Cwirko, M.; Baker, R.; Eccles, M.P.
2013-01-01
BACKGROUND: Determinants of practice are factors that might prevent or enable improvements. Several checklists, frameworks, taxonomies, and classifications of determinants of healthcare professional practice have been published. In this paper, we describe the development of a comprehensive,
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Incorrect results in software engineering experiments: How to improve research practices
Jørgensen, Magne; Dybå, Tore; Liestøl, Knut; Sjøberg, Dag
2016-01-01
Context The trustworthiness of research results is a growing concern in many empirical disciplines. Aim The goals of this paper are to assess how much the trustworthiness of results reported in software engineering experiments is affected by researcher and publication bias, given typical statistical power and significance levels, and to suggest improved research practices. Method First, we conducted a small-scale survey to document the presence of researcher and publication biases in software...
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Improving Agile Software Practice
DEFF Research Database (Denmark)
Tjørnehøj, Gitte
2006-01-01
Software process improvement in small and agile organizations is often problematic, but achieving good SPI-assessments can still be necessary to stay in the marked or to meet demands of multinational owners. The traditional norm driven, centralized and control centered improvement approaches has...
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THE NEED TO IMPROVE PRACTICAL INFORMATION SYSTEM IN AGRICULTURE AND SPECIALIZED INDUSTRY
Directory of Open Access Journals (Sweden)
Romeo Cătălin CREŢU
2015-04-01
Full Text Available In Romania, the establishment of the market economy has required the elaboration and implementation of agricultural, alimentary and nutritional policies, based on scientific criteria, to ensure that the structure of Romanian agriculture would come close to that of the European Union agriculture. Agricultural policy needs to be coherent, flexible and directed towards the economic, social and environmental protection performance. Worldwide practice shows that empiric experience of economic agents does not suffice, but requires plenty of scientific knowledge. The hereby study undertakes to carry out a radiography of the production potential of agricultural operations in Romania and to demonstrate the need for improving practical information systems in agriculture and specialized industry.
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Practice Tests for the TOEFL iBT
Stirling, Bruce
2012-01-01
Practice Tests for the TOEFL iBT contains four TOEFL tests, with answer keys. Perfect for self-study and classrooms. Each TOEFL iBT Practice Test...* reflects the design of the official TOEFL internet-based test* tests academic English-language proficiency expected of university students in the United States, Canada, Australia, New Zealand, Ireland, Scotland and England* provides extra practice before you take the official TOEFL iBT* will help you identify those areas of academic English you need to improve for a higher TOEFL iBT score* will give you an unofficial, TOEFL iBT range score within
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Contextualizing learning to improve care using collaborative communities of practices.
Jeffs, Lianne; McShane, Julie; Flintoft, Virginia; White, Peggy; Indar, Alyssa; Maione, Maria; Lopez, A J; Bookey-Bassett, Sue; Scavuzzo, Lauren
2016-09-02
The use of interorganizational, collaborative approaches to build capacity in quality improvement (QI) in health care is showing promise as a useful model for scaling up and accelerating the implementation of interventions that bridge the "know-do" gap to improve clinical care and provider outcomes. Fundamental to a collaborative approach is interorganizational learning whereby organizations acquire, share, and combine knowledge with other organizations and have the opportunity to learn from their respective successes and challenges in improvement areas. This learning approach aims to create the conditions for collaborative, reflective, and innovative experiential systems that enable collective discussions regarding daily practice issues and finding solutions for improvement. The concepts associated with interorganizational learning and deliberate learning activities within a collaborative 'Communities-of-practice'(CoP) approach formed the foundation of the of an interactive QI knowledge translation initiative entitled PERFORM KT. Nine teams participated including seven teams from two acute care hospitals, one from a long term care center, and one from a mental health sciences center. Six monthly CoP learning sessions were held and teams, with the support of an assigned mentor, implemented a QI project and monitored their results which were presented at an end of project symposium. 47 individuals participated in either a focus group or a personal interview. Interviews were transcribed and analyzed using an iterative content analysis. Four key themes emerged from the narrative dataset around experiences and perceptions associated with the PERFORM KT initiative: 1) being successful and taking it to other levels by being systematic, structured, and mentored; 2) taking it outside the comfort zone by being exposed to new concepts and learning together; 3) hearing feedback, exchanging stories, and getting new ideas; and 4) having a pragmatic and accommodating approach to
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An improved lattice Boltzmann scheme for multiphase fluid with multi-range interactions
Energy Technology Data Exchange (ETDEWEB)
Maquignon, Nicolas; Duchateau, Julien; Roussel, Gilles; Rousselle, François; Renaud, Christophe [Laboratoire Informatique Signal et Image de la Côte d' Opale, 50 rue Ferdinand Buisson, 62100 Calais (France); Université du Littoral Côte d' Opale, 1 place de l' Yser, 59140, Dunkerque (France); Association INNOCOLD, MREI 1, 145 (France)
2014-10-06
Modeling of fluids with liquid to gas phase transition has become important for understanding many environmental or industrial processes. Such simulations need new techniques, because traditional solvers are often limited. The Lattice Boltzmann Model (LBM) allows simulate complex fluids, because its mesoscopic nature gives possibility to incorporate additional physics in comparison to usual methods. In this work, an improved lattice Boltzmann model for phase transition flow will be introduced. First, the state of art for Shan and Chen (SC) type of LBM will be reminded. Then, link to real thermodynamics will be established with Maxwell equal areas construction. Convergence to isothermal liquid vapor equilibrium will be shown and discussed. Inclusion of an equation of state for real fluid and better incorporation of force term is presented. Multi-range interactions have been used for SC model, but it hasn't been yet applied to real fluid with non-ideal equation of state. In this work, we evaluate this model when it is applied to real liquid-vapor equilibrium. We show that important differences are found for evaluation of gas density. In order to recover thermodynamic consistency, we use a new scheme for calculation of force term, which is a combination of multi range model and numerical weighting used by Gong and Cheng. We show the superiority of our new model by studying convergence to equilibrium values over a large temperature range. We prove that spurious velocities remaining at equilibrium are decreased.
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Shabbir, Muhammad; Khalid, M. Ibrahim; Bakhsh, Khuda; Mohsin, Muhammad Naeem; Rasool, Shafqat; Mohsin, M. Saleem
2016-01-01
The rationalization of this research was to investigate about improving professional development system through Quality Assurance Practices (QAP) in the Universities of Pakistan pertaining to the opinions of students, teachers and Directors of Quality Enhancement Cells (QECs) and to differentiate the ideas of students, teachers and Directors of…
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Design of Trypanosoma rangeli sialidase mutants with improved trans-sialidase activity.
Directory of Open Access Journals (Sweden)
Christian Nyffenegger
Full Text Available A sialidase (EC 3.2.1.18 from the non-pathogenic Trypanosoma rangeli, TrSA, has been shown to exert trans-sialidase activity after mutation of five specific amino acids in the active site (M96V, A98P, S120Y, G249Y, Q284P to form the so-called TrSA5mut enzyme. By computational and hypothesis driven approaches additional mutations enhancing the trans-sialidase activity have been suggested. In the present work, we made a systematic combination of these mutations leading to seven new variants of the T. rangeli sialidase, having 6-16 targeted amino acid mutations. The resulting enzyme variants were analyzed via kinetics for their ability to carry out trans-sialidase reaction using CGMP and D-lactose as substrates. The sialidase variants with 15 and 16 mutations, respectively, exhibited significantly improved trans-sialidase activity for D-lactose sialylation. Our results corroborate, that computational studies of trans-glycosylation can be a valuable input in the design of novel trans-glycosidases, but also highlight the importance of experimental validation in order to assess the performance. In conclusion, two of the seven mutants displayed a dramatic switch in specificity from hydrolysis towards trans-sialylation and constitute the most potent trans-sialidase mutants of TrSA described in literature to date.
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Directory of Open Access Journals (Sweden)
Cécile Souty
2016-11-01
Full Text Available Abstract Background In surveillance networks based on voluntary participation of health-care professionals, there is little choice regarding the selection of participants’ characteristics. External information about participants, for example local physician density, can help reduce bias in incidence estimates reported by the surveillance network. Methods There is an inverse association between the number of reported influenza-like illness (ILI cases and local general practitioners (GP density. We formulated and compared estimates of ILI incidence using this relationship. To compare estimates, we simulated epidemics using a spatially explicit disease model and their observation by surveillance networks with different characteristics: random, maximum coverage, largest cities, etc. Results In the French practice-based surveillance network – the “Sentinelles” network – GPs reported 3.6% (95% CI [3;4] less ILI cases as local GP density increased by 1 GP per 10,000 inhabitants. Incidence estimates varied markedly depending on scenarios for participant selection in surveillance. Yet accounting for change in GP density for participants allowed reducing bias. Applied on data from the Sentinelles network, changes in overall incidence ranged between 1.6 and 9.9%. Conclusions Local GP density is a simple measure that provides a way to reduce bias in estimating disease incidence in general practice. It can contribute to improving disease monitoring when it is not possible to choose the characteristics of participants.
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Bilderbeck, A.C.; Brazil, I.A.; Farias, M.
2015-01-01
Objectives. In the first randomized controlled trial of yoga on UK prisoners, we previously showed that yoga practice was associated with improved mental wellbeing and cognition. Here, we aimed to assess how class attendance, self-practice, and demographic factors were related to outcome amongst
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Application of mathematical removal of positron range blurring in positron emission tomography
International Nuclear Information System (INIS)
Haber, S.F.; Derenzo, S.E.; Uber, D.
1990-01-01
The range of positrons in tissue is an important limitation to the ultimate spatial resolution achievable in positron emission tomography. In this work the authors have applied a Fourier deconvolution technique to remove range blurring in images taken by the Donner 600-crystal positron tomograph. Using phantom data, the authors have found significant improvement in the image quality and the FWHM for both 68 Ga and 82 Rb. These were successfully corrected so that the images and FWHM almost matched those of 18 F which has negligible positron range. However, statistical noise was increased by the deconvolution process and it was not practical to recover the full spatial resolution of the tomograph
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Continuous quality improvement in daily clinical practice: a proof of concept study.
Directory of Open Access Journals (Sweden)
Jonathan A Lorch
Full Text Available Continuous Quality Improvement (CQI is an iterative process of: planning to improve a product or process, plan implementation, analyzing and comparing results against those expected, and corrective action on differences between actual and expected results. It is little used in clinical medicine. Anemia, a complex problem in End Stage Renal Disease patients, served to test the ability of an unique electronic medical record (EMR optimized for daily care to empower CQI in practice. We used data collected during daily care, stored in the EMR, and organized to display temporal relationships between clinical, laboratory, and therapeutic events. Our aims were optimal hemoglobin with minimum epoetin, and maintaining stable hemoglobin and epoetin. The study was done on 250 patients treated by maintenance hemodialysis (HD, receiving epoetin prior to February 1, 2010 and followed to July 31, 2011. Repleting iron, ensuring iron sufficiency, slow epoetin reduction, and decision support tools enabling data display over long periods in patient-centered reports were key elements. Epoetin dose, adjusted 6-8 weekly, was based on current clinical conditions and past responses. Hemoglobin increased by months 1-2; epoetin decreased from month 4. By months 16-18, epoetin had decreased 42% to 9,720 units/week while hemoglobin increased 8% to 123.6 g/L. Hemoglobin and epoetin were stable from month 7 onward. New epoetin orders decreased 83%. Transferrin saturation increased after the study start. Individual patient hemoglobin variation decreased by 23%, range by 27%. Mortality, 11.78 per 100 patient years, was 42% less than United States dialysis patient mortality. Allowable epoetin charges decreased by $15.33 per treatment and were $22.88 less than current Medicare allowance. The study validates the hypothesis that an EMR optimized for daily patient care can empower CQI in clinical medicine and serve to monitor medical care quality and cost.
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Chapter 7. Assessing soil factors in wildland improvement programs
Arthur R. Tiedemann; Carlos F. Lopez
2004-01-01
Soil factors are an important consideration for successful wildland range development or improvement programs. Even though many soil improvement and amelioration practices are not realistic for wildlands, their evaluation is an important step in selection of adapted plant materials for revegetation. This chapter presents information for wildland managers on: the...
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Information Technology and the QS Practice
Directory of Open Access Journals (Sweden)
Peter Smith
2011-08-01
Full Text Available The paper examines how Quantity Surveying practices can improve their business performance, market share and profit levels by embracing and evolving with the latest technological developments in electronic business practices and data/information analysis and exchange in the construction industry. Firms in the new millenium will need towork smarterto gain competitive advantage and electronic commerce provides probably the greatest scope for this to be achieved. More importantly, current project procurement trends strongly indicate that firms not able to communicating electronically at all levels with project participants will find it increasingly difficult to secure work. The results of three nationwide surveys of the Australian Quantity Surveying profession spanning from 1995 to 1999 are used to identify current business practices and technology utilisation by Quantity Surveying firms and to analyse whether firms are positioning themselves to meet future industryrequirements. The paper concludes with a range of Information Technology strategies aimed at improving business opportunities and performance for Quantity Surveying firms.
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Using Patient-Reported Information to Improve Clinical Practice.
Schlesinger, Mark; Grob, Rachel; Shaller, Dale
2015-12-01
To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries. We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians. First, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the
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Dickinson, L Miriam; Dickinson, W Perry; Nutting, Paul A; Fisher, Lawrence; Harbrecht, Marjie; Crabtree, Benjamin F; Glasgow, Russell E; West, David R
2015-04-01
Efforts to improve primary care diabetes management have assessed strategies across heterogeneous groups of patients and practices. However, there is substantial variability in how well practices implement interventions and achieve desired outcomes. To examine practice contextual features that moderate intervention effectiveness. Secondary analysis of data from a cluster randomized trial of three approaches for implementing the Chronic Care Model to improve diabetes care. Forty small to mid-sized primary care practices participated, with 522 clinician and staff member surveys. Outcomes were assessed for 822 established patients with a diagnosis of type 2 diabetes who had at least one visit to the practice in the 18 months following enrollment. The primary outcome was a composite measure of diabetes process of care, ascertained by chart audit, regarding nine quality measures from the American Diabetes Association Physician Recognition Program: HgA1c, foot exam, blood pressure, dilated eye exam, cholesterol, nephropathy screen, flu shot, nutrition counseling, and self-management support. Data from practices included structural and demographic characteristics and Practice Culture Assessment survey subscales (Change Culture, Work Culture, Chaos). Across the three implementation approaches, demographic/structural characteristics (rural vs. urban + .70(p = .006), +2.44(p Culture (high vs. low: -.86(p = .048), +1.71(p = .005), +.34(p = .22)), Work Culture (high vs. low: -.67(p = .18), +2.41(p Culture (high vs. low: -.24(p = .006), -.20(p = .0771), -.44(p = .0019) and Work Culture (high vs. low: +.56(p = .3160), -1.0(p = .008), -.25 (p = .0216) were associated with trajectories of change in diabetes process of care, either directly or differentially by study arm. This study supports the need for broader use of methodological approaches to better examine contextual effects on implementation and effectiveness of quality improvement interventions in primary care settings.
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MO-F-211-01: Methods for Completing Practice Quality Improvement (PQI).
Johnson, J; Brown, K; Ibbott, G; Pawlicki, T
2012-06-01
Practice Quality Improvement (PQI) is becoming an expected part of routine practice in healthcare as an approach to provide more efficient, effective and high quality care. Additionally, as part of the ABR's Maintenance of Certification (MOC) pathway, medical physicists are now expected to complete a PQI project. This session will describe the history behind and benefits of the ABR's MOC program, provide details of quality improvement methods and how to successfully complete a PQI project. PQI methods include various commonly used engineering and management tools. The Plan-Do-Study-Act (PDSA) cycle will be presented as one project planning and implementation tool. Other PQI analysis instruments such as flowcharts, Pareto charts, process control charts and fishbone diagrams will also be explained with examples. Cause analysis, solution development and implementation, and post-implementation measurement will be presented. Project identification and definition as well as appropriate measurement tool selection will be offered. Methods to choose key quality metrics (key quality indicators) will also be addressed. Several sample PQI projects and templates available through the AAPM and other organizations will be described. At least three examples of completed PQI projects will be shared. 1. Identify and define a PQI project 2. Identify and select measurement methods/techniques for use with the PQI project 3. Describe example(s) of completed projects. © 2012 American Association of Physicists in Medicine.
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Improving the global efficiency in small hydropower practice
Razurel, P.; Gorla, L.; Crouzy, B.; Perona, P.
2015-12-01
The global increase in energy production from renewable sources has seen river exploitation for small hydropower plants to also grow considerably in the last decade. River intakes used to divert water from the main course to the power plant are at the base of such practice. A key issue concern with finding innovative concepts to both design and manage such structures in order to improve classic operational rules. Among these, the Minimal Flow Release (MFR) concept has long been used in spite of its environmental inconsistency.In this work, we show that the economical and ecological efficiency of diverting water for energy production in small hydropower plants can be improved towards sustainability by engineering a novel class of flow-redistribution policies. We use the mathematical form of the Fermi-Dirac statistical distribution to define non-proportional dynamic flow-redistribution rules, which broadens the spectrum of dynamic flow releases based on proportional redistribution. The theoretical background as well as the economic interpretation is presented and applied to three case studies in order to systematically test the global performance of such policies. Out of numerical simulations, a Pareto frontier emerges in the economic vs environmental efficiency plot, which show that non-proportional distribution policies improve both efficiencies with respect to those obtained from some traditional MFR and proportional policies. This picture is shown also for long term climatic scenarios affecting water availability and the natural flow regime.In a time of intense and increasing exploitation close to resource saturation, preserving natural river reaches requires to abandon inappropriate static release policies in favor of non-proportional ones towards a sustainable use of the water resource.
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Measures to Improve Diagnostic Safety in Clinical Practice.
Singh, Hardeep; Graber, Mark L; Hofer, Timothy P
2016-10-20
Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health-care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
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Nease, Beth M; Haney, Tina S
Astute observation, description, and problem identification skills provide the underpinning for nursing assessment, surveillance, and prevention of failure to rescue events. Art-based education has been effective in nursing schools for improving observation, description, and problem identification. The authors describe a randomized controlled pilot study testing the effectiveness of an art-based educational intervention aimed at improving these skills in practicing nurses.
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Quality Improvement Practices in Academic Emergency Medicine: Perspectives from the Chairs
Directory of Open Access Journals (Sweden)
DelliFraine, Jami L
2010-12-01
Full Text Available Objective: To assess academic emergency medicine (EM chairs’ perceptions of quality improvement (QI training programs.Methods: A voluntary anonymous 20 item survey was distributed to a sample of academic chairs of EM through the Association of Academic Chairs of Emergency Medicine. Data was collected to assess the percentage of academic emergency physicians who had received QI training, the type of training they received, their perception of the impact of this training on behavior, practice and outcomes, and any perceived barriers to implementing QI programs in the emergency department.Results: The response rate to the survey was 69% (N = 59. 59.3% of respondents report that their hospital has a formal QI program for physicians. Chairs received training in a variety of QI programs. The type of QI program used by respondents was perceived as having no impact on goals achieved by QI (χ2 = 12.382; p = 0.260, but there was a statistically significant (χ2 = 14.383; p = 0.006 relationship between whether or not goals were achieved and academic EM chairs’ perceptions about return on investment for QI training. Only 22% of chairs responded that they have already made changes as a result of the QI training. 78.8% of EM chairs responded that quality programs could have a significant positive impact on their practice and the healthcare industry. Chairs perceived that QI programs had the most potential value in the areas of understanding and reducing medical errors and improving patient flow and throughput. Other areas of potential value of QI include improving specific clinical indicators and standardizing physician care.Conclusion: Academic EM chairs perceived that QI programs were an effective way to drive needed improvements. The results suggest that there is a high level of interest in QI but a low level of adoption of training and implementation.[West J Emerg Med. 2010; 11(5:479-485.
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Kislov, Roman; Walshe, Kieran; Harvey, Gill
2012-10-15
Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs), this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process. The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester-a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010-2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team. The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors, competition and strong
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Directory of Open Access Journals (Sweden)
Kislov Roman
2012-10-01
Full Text Available Abstract Background Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs, this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process. Methods The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC for Greater Manchester—a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010–2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team. Findings The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas
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Job design, employment practices and well-being: a systematic review of intervention studies.
Daniels, Kevin; Gedikli, Cigdem; Watson, David; Semkina, Antonina; Vaughn, Oluwafunmilayo
2017-09-01
There is inconsistent evidence that deliberate attempts to improve job design realise improvements in well-being. We investigated the role of other employment practices, either as instruments for job redesign or as instruments that augment job redesign. Our primary outcome was well-being. Where studies also assessed performance, we considered performance as an outcome. We reviewed 33 intervention studies. We found that well-being and performance may be improved by: training workers to improve their own jobs; training coupled with job redesign; and system wide approaches that simultaneously enhance job design and a range of other employment practices. We found insufficient evidence to make any firm conclusions concerning the effects of training managers in job redesign and that participatory approaches to improving job design have mixed effects. Successful implementation of interventions was associated with worker involvement and engagement with interventions, managerial commitment to interventions and integration of interventions with other organisational systems. Practitioner Summary: Improvements in well-being and performance may be associated with system-wide approaches that simultaneously enhance job design, introduce a range of other employment practices and focus on worker welfare. Training may have a role in initiating job redesign or augmenting the effects of job design on well-being.
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Stakeholder-Driven Quality Improvement: A Compelling Force for Clinical Practice Guidelines.
Rosenfeld, Richard M; Wyer, Peter C
2018-01-01
Clinical practice guideline development should be driven by rigorous methodology, but what is less clear is where quality improvement enters the process: should it be a priority-guiding force, or should it enter only after recommendations are formulated? We argue for a stakeholder-driven approach to guideline development, with an overriding goal of quality improvement based on stakeholder perceptions of needs, uncertainties, and knowledge gaps. In contrast, the widely used topic-driven approach, which often makes recommendations based only on randomized controlled trials, is driven by epidemiologic purity and evidence rigor, with quality improvement a downstream consideration. The advantages of a stakeholder-driven versus a topic-driven approach are highlighted by comparisons of guidelines for otitis media with effusion, thyroid nodules, sepsis, and acute bacterial rhinosinusitis. These comparisons show that stakeholder-driven guidelines are more likely to address the quality improvement needs and pressing concerns of clinicians and patients, including understudied populations and patients with multiple chronic conditions. Conversely, a topic-driven approach often addresses "typical" patients, based on research that may not reflect the needs of high-risk groups excluded from studies because of ethical issues or a desire for purity of research design.
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Long-Range Big Quantum-Data Transmission
Zwerger, M.; Pirker, A.; Dunjko, V.; Briegel, H. J.; Dür, W.
2018-01-01
We introduce an alternative type of quantum repeater for long-range quantum communication with improved scaling with the distance. We show that by employing hashing, a deterministic entanglement distillation protocol with one-way communication, one obtains a scalable scheme that allows one to reach arbitrary distances, with constant overhead in resources per repeater station, and ultrahigh rates. In practical terms, we show that, also with moderate resources of a few hundred qubits at each repeater station, one can reach intercontinental distances. At the same time, a measurement-based implementation allows one to tolerate high loss but also operational and memory errors of the order of several percent per qubit. This opens the way for long-distance communication of big quantum data.
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Kingsland, Melanie; Wolfenden, Luke; Tindall, Jennifer; Rowland, Bosco; Sidey, Maree; McElduff, Patrick; Wiggers, John H
2015-07-01
Despite an increased prevalence of risky alcohol consumption and alcohol-related harm among members of sporting groups and at sporting venues, sporting clubs frequently fail to implement alcohol management practices consistent with liquor legislation and best practice guidelines. The aim of this study was to assess the impact of a multi-strategy intervention in improving the implementation of responsible alcohol management practices by sports clubs. A randomised controlled trial was conducted with 87 football clubs, with half randomised to receive a multi-strategy intervention to support clubs to implement responsible alcohol management practices. The 2-year intervention, which was based on implementation and capacity building theory and frameworks, included project officer support, funding, accreditation rewards, printed resources, observational audit feedback, newsletters, training and support from state sporting organisations. Interviews were undertaken with club presidents at baseline and post-intervention to assess alcohol management practice implementation. Post-intervention, 88% of intervention clubs reported implementing '13 or more' of 16 responsible alcohol management practices, which was significantly greater than the proportion of control groups reporting this level of implementation (65%) [odds ratio: 3.7 (95% confidence interval: 1.1-13.2); P = 0.04]. All intervention components were considered highly useful and three-quarters or more of clubs rated the amount of implementation support to be sufficient. The multi-strategy intervention was successful in improving alcohol management practices in community sports clubs. Further research is required to better understand implementation barriers and to assess the long-term sustainability of the change in club alcohol management practices. © 2015 Australasian Professional Society on Alcohol and other Drugs.
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The scope of private practice nursing in an Australian sample.
Wilson, Anne; Averis, Andrea; Walsh, Ken
2004-01-01
The changing Australian health care system is creating new opportunities for nurses who work directly with clients in private practice settings. This study examines the scope of practice of a cohort of nurses in private practice. In a questionnaire sent to 106 self-employed nurse entrepreneurs, questions were asked pertaining to the participants' scope of practice, their clients, the types of services offered, and their fee structures. Questions about scope of practice were divided into domains of clinical practice, business consultancy, education, and research. Quantitative and qualitative data were collected for a final sample 54 eligible responses. Participants had been in private practice for an average of 7.6 years (range: 1-20) and reported a mean of 21 years of nursing experience (range: 4-42) before entering private practice. Over half held diplomas in specialty areas. Most participants reported clinical practice, consultancy, or education as the primary work domain; research was much less important as a work activity. Nurses reported difficulties with building client base and receiving adequate fees for service, particularly in clinical practice. Increasing awareness within the nursing profession and health sector about various aspects of private practice nursing could improve service quality for their clients.
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National Research Council Canada - National Science Library
Lee, John
2000-01-01
.... This paper briefly explores project management principles, leadership theory, and commercial business practices, suggesting improvements to the Army's modeling and simulation development process...
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Listening to parents to improve health visiting practice.
Morton, Alison; Hargreaves, Sharon; Taylor, Liz
2015-05-01
Listening to the "voice" of the service user is now widely accepted as central to the delivery of high quality healthcare. This paper presents an overview of the importance of service user engagement and personalised care in health visiting with a brief review of recent policy and research. A personalised approach to health visiting practice is recommended to improve service user experience and uptake of the health visiting service offer and this is considered most significant when engaging "hard to reach" groups. A project report on a service user experience strategy within the 0-19 service of a NHS Trust in England is presented which describes initiatives to develop a health visiting and school nursing service that listens to service users. A cyclical service user engagement model which incorporates continuous reviews and service reconfiguration is described with examples of service changes in response to expressed local needs.
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Cost to primary care practices of responding to payer requests for quality and performance data.
Halladay, Jacqueline R; Stearns, Sally C; Wroth, Thomas; Spragens, Lynn; Hofstetter, Sara; Zimmerman, Sheryl; Sloane, Philip D
2009-01-01
We wanted to determine how much it costs primary care practices to participate in programs that require them to gather and report data on care quality indicators. Using mixed quantitative-qualitative methods, we gathered data from 8 practices in North Carolina that were selected purposively to be diverse by size, ownership, type, location, and medical records. Formal practice visits occurred between January 2008 and May 2008. Four quality-reporting programs were studied: Medicare's Physician Quality Reporting Initiative (PQRI), Community Care of North Carolina (CCNC), Bridges to Excellence (BTE), and Improving Performance in Practice (IPIP). We estimated direct costs to the practice and on-site costs to the quality organization for implementation and maintenance phases of program participation. Major expenses included personnel time for planning, training, registry maintenance, visit coding, data gathering and entry, and modification of electronic systems. Costs per full-time equivalent clinician ranged from less than $1,000 to $11,100 during program implementation phases and ranged from less than $100 to $4,300 annually during maintenance phases. Main sources of variation included program characteristics, amount of on-site assistance provided, experience and expertise of practice personnel, and the extent of data system problems encountered. The costs of a quality-reporting program vary greatly by program and are important to anticipate and understand when undertaking quality improvement work. Incentives that would likely improve practice participation include financial payment, quality improvement skills training, and technical assistance with electronic system troubleshooting.
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Godény, Sándor
2012-01-22
In Hungary, financing of healthcare has decreased relative to the GDP, while the health status of the population is still ranks among the worst in the European Union. Since healthcare financing is not expected to increase, the number of practicing doctors per capita is continuously decreasing. In the coming years, it is an important question that in this situation what methods can be used to prevent further deterioration of the health status of the Hungarian population, and within this is the role of the quality approach, and different methods of quality management. In the present and the forthcoming two articles those standpoints will be summarized which support the need for the integration of quality assurance in the everyday medical practice. In the first part the importance of quality thinking, quality management, quality assurance, necessity of quality measurement and improvement, furthermore, advantages of the quality systems will be discussed.
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Optimizing strategies to improve interprofessional practice for veterans, part 1
Directory of Open Access Journals (Sweden)
Bhattacharya SB
2014-04-01
Full Text Available Shelley B Bhattacharya,1–3 Michelle I Rossi,1,2 Jennifer M Mentz11Geriatric Research Education and Clinical Center (GRECC, Veteran's Affairs Pittsburgh Healthcare System, 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 3Albert Schweitzer Fellowship Program, Pittsburgh, PA, USAIntroduction: Interprofessional patient care is a well-recognized path that health care systems are striving toward. The Veteran's Affairs (VA system initiated interprofessional practice (IPP models with their Geriatric Evaluation and Management (GEM programs. GEM programs incorporate a range of specialties, including but not limited to, medicine, nursing, social work, physical therapy and pharmacy, to collaboratively evaluate veterans. Despite being a valuable resource, they are now faced with significant cut-backs, including closures. The primary goal of this project was to assess how the GEM model could be optimized at the Pittsburgh, Pennsylvania VA to allow for the sustainability of this important IPP assessment. Part 1 of the study evaluated the IPP process using program, patient, and family surveys. Part 2 examined how well the geriatrician matched patients to specialists in the GEM model. This paper describes Part 1 of our study.Methods: Three strategies were used: 1 a national GEM program survey; 2 a veteran/family satisfaction survey; and 3 an absentee assessment.Results: Twenty-six of 92 programs responded to the GEM IPP survey. Six strategies were shared to optimize IPP models throughout the country. Of the 34 satisfaction surveys, 80% stated the GEM clinic was beneficial, 79% stated their concerns were addressed, and 100% would recommend GEM to their friends. Of the 24 absentee assessments, the top three reasons for missing the appointments were transportation, medical illnesses, and not knowing/remembering about the appointment. Absentee rate diminished from 41% to 19% after instituting a reminder phone call policy.Discussion: Maintaining the
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Report #10-P-0194, August 23, 2010. Although EPA indicated it could avoid spending more than $115.4 million over 8.5 years by consolidating the desktop computing environment, improved management practices are needed.
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Hardy, Maryann; Johnson, Louise; Sharples, Rachael; Boynes, Stephen; Irving, Donna
2016-06-01
To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma. 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality. Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.
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Directory of Open Access Journals (Sweden)
Dan Allman
Full Text Available BACKGROUND: This paper presents findings from a qualitative investigation of ethical and participatory issues related to the conduct of biomedical HIV prevention trials among marginalized populations in Thailand. This research was deemed important to conduct, as several large-scale biomedical HIV prevention trials among marginalized populations had closed prematurely in other countries, and a better understanding of how to prevent similar trial closures from occurring in the future was desired. METHODS: In-depth key informant interviews were held in Bangkok and Chiang Mai, Thailand. Interviews were audio recorded, transcribed, translated and thematically analyzed. The Good Participatory Practice Guidelines for Biomedical HIV Prevention Trials (GPP guided this work. RESULTS: Fourteen interviews were conducted: 10 with policymakers, academic and community-based researchers and trial staff and four with representatives of non-governmental organizations (NGOs. Suggested ways to improve ethical and participatory practice centered on standards of HIV prevention, informed consent, communication and human rights. In particular, the need to overcome language and literacy differences was identified. Key informants felt communication was the basis of ethical understanding and trust within biomedical HIV prevention trial contexts, and thus fundamental to trial participants' ability to exercise free will. DISCUSSION: Biomedical HIV prevention trials present opportunities for inclusive and productive ethical and participatory practice. Key informants suggested that efforts to improve practice could result in better relationships between research stakeholders and research investigative teams and by extension, better, more ethical participatory trials. This research took place in Thailand and its findings apply primarily to Thailand. However, given the universality of many ethical considerations, the results of this study can inform the improvement of ethical
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Allman, Dan; Ditmore, Melissa Hope; Kaplan, Karyn
2014-01-01
This paper presents findings from a qualitative investigation of ethical and participatory issues related to the conduct of biomedical HIV prevention trials among marginalized populations in Thailand. This research was deemed important to conduct, as several large-scale biomedical HIV prevention trials among marginalized populations had closed prematurely in other countries, and a better understanding of how to prevent similar trial closures from occurring in the future was desired. In-depth key informant interviews were held in Bangkok and Chiang Mai, Thailand. Interviews were audio recorded, transcribed, translated and thematically analyzed. The Good Participatory Practice Guidelines for Biomedical HIV Prevention Trials (GPP) guided this work. Fourteen interviews were conducted: 10 with policymakers, academic and community-based researchers and trial staff and four with representatives of non-governmental organizations (NGOs). Suggested ways to improve ethical and participatory practice centered on standards of HIV prevention, informed consent, communication and human rights. In particular, the need to overcome language and literacy differences was identified. Key informants felt communication was the basis of ethical understanding and trust within biomedical HIV prevention trial contexts, and thus fundamental to trial participants' ability to exercise free will. Biomedical HIV prevention trials present opportunities for inclusive and productive ethical and participatory practice. Key informants suggested that efforts to improve practice could result in better relationships between research stakeholders and research investigative teams and by extension, better, more ethical participatory trials. This research took place in Thailand and its findings apply primarily to Thailand. However, given the universality of many ethical considerations, the results of this study can inform the improvement of ethical and participatory practice in other parts of the world where
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Using Relational Reasoning Strategies to Help Improve Clinical Reasoning Practice.
Dumas, Denis; Torre, Dario M; Durning, Steven J
2018-05-01
Clinical reasoning-the steps up to and including establishing a diagnosis and/or therapy-is a fundamentally important mental process for physicians. Unfortunately, mounting evidence suggests that errors in clinical reasoning lead to substantial problems for medical professionals and patients alike, including suboptimal care, malpractice claims, and rising health care costs. For this reason, cognitive strategies by which clinical reasoning may be improved-and that many expert clinicians are already using-are highly relevant for all medical professionals, educators, and learners.In this Perspective, the authors introduce one group of cognitive strategies-termed relational reasoning strategies-that have been empirically shown, through limited educational and psychological research, to improve the accuracy of learners' reasoning both within and outside of the medical disciplines. The authors contend that relational reasoning strategies may help clinicians to be metacognitive about their own clinical reasoning; such strategies may also be particularly well suited for explicitly organizing clinical reasoning instruction for learners. Because the particular curricular efforts that may improve the relational reasoning of medical students are not known at this point, the authors describe the nature of previous research on relational reasoning strategies to encourage the future design, implementation, and evaluation of instructional interventions for relational reasoning within the medical education literature. The authors also call for continued research on using relational reasoning strategies and their role in clinical practice and medical education, with the long-term goal of improving diagnostic accuracy.
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Three-Dimensional Modeling May Improve Surgical Education and Clinical Practice.
Jones, Daniel B; Sung, Robert; Weinberg, Crispin; Korelitz, Theodore; Andrews, Robert
2016-04-01
Three-dimensional (3D) printing has been used in the manufacturing industry for rapid prototyping and product testing. The aim of our study was to assess the feasibility of creating anatomical 3D models from a digital image using 3D printers. Furthermore, we sought face validity of models and explored potential opportunities for using 3D printing to enhance surgical education and clinical practice. Computed tomography and magnetic resonance images were reviewed, converted to computer models, and printed by stereolithography to create near exact replicas of human organs. Medical students and surgeons provided feedback via survey at the 2014 Surgical Education Week conference. There were 51 respondents, and 95.8% wanted these models for their patients. Cost was a concern, but 82.6% found value in these models at a price less than $500. All respondents thought the models would be useful for integration into the medical school curriculum. Three-dimensional printing is a potentially disruptive technology to improve both surgical education and clinical practice. As the technology matures and cost decreases, we envision 3D models being increasingly used in surgery. © The Author(s) 2015.
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Exposure to lead in South African shooting ranges
International Nuclear Information System (INIS)
Mathee, Angela; Jager, Pieter de; Naidoo, Shan; Naicker, Nisha
2017-01-01
Introduction: Lead exposure in shooting ranges has been under scrutiny for decades, but no information in this regard is available in respect of African settings, and in South Africa specifically. The aim of this study was to determine the blood lead levels in the users of randomly selected private shooting ranges in South Africa's Gauteng province. Methods: An analytical cross sectional study was conducted, with participants recruited from four randomly selected shooting ranges and three archery ranges as a comparator group. Results: A total of 118 (87 shooters and 31 archers) were included in the analysis. Shooters had significantly higher blood lead levels (BLL) compared to archers with 36/85 (42.4%) of shooters versus 2/34 (5.9%) of archers found to have a BLL ≥10 μg/dl (p<0.001). Conclusion: Shooting ranges may constitute an import site of elevated exposure to lead. Improved ventilation, low levels of awareness of lead hazards, poor housekeeping, and inadequate personal hygiene facilities and practices at South African shooting ranges need urgent attention. - Highlights: • This is the first study, to our knowledge, of lead exposure in shooting ranges in an African setting. • This study indicates highly elevated lead exposure amongst the users of certain private shooting ranges in South Africa. • Lead exposure may be a serious, yet under-studied, source of adult lead exposure in South Africa, and possibly elsewhere on the African continent.
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Exposure to lead in South African shooting ranges
Energy Technology Data Exchange (ETDEWEB)
Mathee, Angela [South African Medical Research Council, Environment & Health Research Unit, PO Box 87373, Houghton 2041 (South Africa); University of the Witwatersrand (School of Public Health), PO Box Wits, Johannesburg 2050 (South Africa); University of Johannesburg (Environmental Health Department, Faculty of Health Sciences), PO Box 524, Auckland Park, Johannesburg 2006 (South Africa); Jager, Pieter de [University of the Witwatersrand (School of Public Health), PO Box Wits, Johannesburg 2050 (South Africa); National Health Laboratory Service (Epidemiology and Surveillance Unit, National Institute for Occupational Health), PO Box 4788, Johannesburg 2000 (South Africa); Naidoo, Shan [University of the Witwatersrand (School of Public Health), PO Box Wits, Johannesburg 2050 (South Africa); Naicker, Nisha [South African Medical Research Council, Environment & Health Research Unit, PO Box 87373, Houghton 2041 (South Africa); University of the Witwatersrand, School of Public Health, PO Box Wits, Johannesburg 2050 (South Africa); University of Johannesburg, Environmental Health Department, Faculty of Health Sciences, PO Box 524, Auckland Park, Johannesburg 2006 (South Africa)
2017-02-15
Introduction: Lead exposure in shooting ranges has been under scrutiny for decades, but no information in this regard is available in respect of African settings, and in South Africa specifically. The aim of this study was to determine the blood lead levels in the users of randomly selected private shooting ranges in South Africa's Gauteng province. Methods: An analytical cross sectional study was conducted, with participants recruited from four randomly selected shooting ranges and three archery ranges as a comparator group. Results: A total of 118 (87 shooters and 31 archers) were included in the analysis. Shooters had significantly higher blood lead levels (BLL) compared to archers with 36/85 (42.4%) of shooters versus 2/34 (5.9%) of archers found to have a BLL ≥10 μg/dl (p<0.001). Conclusion: Shooting ranges may constitute an import site of elevated exposure to lead. Improved ventilation, low levels of awareness of lead hazards, poor housekeeping, and inadequate personal hygiene facilities and practices at South African shooting ranges need urgent attention. - Highlights: • This is the first study, to our knowledge, of lead exposure in shooting ranges in an African setting. • This study indicates highly elevated lead exposure amongst the users of certain private shooting ranges in South Africa. • Lead exposure may be a serious, yet under-studied, source of adult lead exposure in South Africa, and possibly elsewhere on the African continent.
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Directory of Open Access Journals (Sweden)
Łukasz Hadaś
2012-09-01
Full Text Available Background: The complexity of the manufacturing environments of today's mechanical engineering companies and the number of both internal and external restrictions affecting to need of building tailored production planning and control systems. This statement is particularly important in conditions of companies with a wide range of products and different customer service strategies (different locations of the logistics decoupling point otherwise called "order penetration point". Streams of materials in these conditions require different management what is the main reason for carrying out research in business conditions by the authors. Material and methods: The research was carried out in industrial engineering in complex environmental conditions of production. This was a specializing in technology, multi-departments environment, with multiple streams of values and a wide range of products (about 500 items. The work was carried out under the transformation of the production system from the "push" logic of flow to "pull" logic of flow and building a dedicated system based on the best practice approach. Results: The paper describes the process of building tailored hybrid systems in the area of planning and shop flow control of production. The authors present the theoretical considerations on the issue and practical experiences. The authors present factors of selection of the transformation path and its road map. The article describes the part of the authors' own experience in the work on the methodology of transformation of Polish companies in the running business condition. Conclusions: Establishing the methodology of transformation of the production system is not a simple task. This paper presents only selected aspects of complex decision-making process. However, the authors presented work shows the important aspect of the transformation of production systems for these organizational conditions.
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Downs, R. R.; Lenhardt, W. C.; Robinson, E.
2014-12-01
Science software is integral to the scientific process and must be developed and managed in a sustainable manner to ensure future access to scientific data and related resources. Organizations that are part of the scientific enterprise, as well as members of the scientific community who work within these entities, can contribute to the sustainability of science software and to practices that improve scientific community capabilities for science software sustainability. As science becomes increasingly digital and therefore, dependent on software, improving community practices for sustainable science software will contribute to the sustainability of science. Members of the Earth science informatics community, including scientific data producers and distributers, end-user scientists, system and application developers, and data center managers, use science software regularly and face the challenges and the opportunities that science software presents for the sustainability of science. To gain insight on practices needed for the sustainability of science software from the science software experiences of the Earth science informatics community, an interdisciplinary group of 300 community members were asked to engage in simultaneous roundtable discussions and report on their answers to questions about the requirements for improving scientific software sustainability. This paper will present an analysis of the issues reported and the conclusions offered by the participants. These results provide perspectives for science software sustainability practices and have implications for actions that organizations and their leadership can initiate to improve the sustainability of science software.
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Holden, Stacey; Ferguson, Megan; Brimblecombe, Julie; Palermo, Claire E
2015-01-01
This study aimed to determine the influence on practice of a community of practice designed for public health nutritionists who work with retail stores in remote Indigenous communities in Australia. A descriptive evaluation of the community of practice participants' perspectives using the most significant change technique and individual in-depth interviews was conducted. Data were analysed using thematic and content analysis with a focus on answering the evaluation questions. Twelve public health nutritionists employed to work with remote Indigenous community stores were involved. The community of practice was reported to develop competence through problem solving, knowledge sharing and building confidence for innovative work. Building competence was achieved through accessible and timely professional support. Sharing stories and being encouraged to reflect on practice was valued and supported the participant's practice. Working to improve the food supply is challenging but there is value in being supported by like-minded colleagues to stay focused on this work. Most participants perceived the community of practice intervention to be an effective strategy to improve their work. These findings provide evidence of a promising intervention for building the public health nutrition workforce in remote Indigenous community store retail settings.
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Interrogating Your Wisdom of Practice to Improve Classroom Practices
Chappell, Philip
2017-01-01
This article presents a heuristic for language teachers to articulate and explore their fundamental theories of and philosophical stances towards language, language learning, and language teaching. It includes tools with which teachers can interrogate those theories, weighing them up against their actual classroom practices. Through presenting…
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Nordstrom, Benjamin R; Saunders, Elizabeth C; McLeman, Bethany; Meier, Andrea; Xie, Haiyi; Lambert-Harris, Chantal; Tanzman, Beth; Brooklyn, John; King, Gregory; Kloster, Nels; Lord, Clifton Frederick; Roberts, William; McGovern, Mark P
2016-01-01
Rapidly escalating rates of heroin and prescription opioid use have been widely observed in rural areas across the United States. Although US Food and Drug Administration-approved medications for opioid use disorders exist, they are not routinely accessible to patients. One medication, buprenorphine, can be prescribed by waivered physicians in office-based practice settings, but practice patterns vary widely. This study explored the use of a learning collaborative method to improve the provision of buprenorphine in the state of Vermont. We initiated a learning collaborative with 4 cohorts of physician practices (28 total practices). The learning collaborative consisted of a series of 4 face-to-face and 5 teleconference sessions over 9 months. Practices collected and reported on 8 quality-improvement data measures, which included the number of patients prescribed buprenorphine, and the percent of unstable patients seen weekly. Changes from baseline to 8 months were examined using a p-chart and logistic regression methodology. Physician engagement in the learning collaborative was favorable across all 4 cohorts (85.7%). On 6 of the 7 quality-improvement measures, there were improvements from baseline to 8 months. On 4 measures, these improvements were statistically significant (P learning collaborative approach to engage physicians, modestly improve patient access, and significantly reduce practice variation. The strategy is potentially generalizable to other systems and regions struggling with this important public health problem.
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R and D proposals to improve outages operation. Methods, practices and tools
International Nuclear Information System (INIS)
Dionis, Francois
2014-01-01
This paper deals with outage operation improvement. It offers a number of tracks on the interactions between the operation activities and maintenance, with a methodological perspective and proposals concerning the Information System. On the methodological point of view, a clever plant systems modeling may allow representing the needed characteristics in order to optimize tagouts, alignment procedures and the schedule. Tools must be taken n into account for new tagout practices such as tags sharing. It is possible to take advantage of 2D drawings integrated into the information system in order to improve the data controls and to visualize operation activities. An integrated set of mobile applications should allow field operators to join the information system for a better and safer performance. (author)
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Scott, Angela Bullanday; Singh, Mini; Toribio, Jenny-Ann; Hernandez-Jover, Marta; Barnes, Belinda; Glass, Kathryn; Moloney, Barbara; Lee, Amanda; Groves, Peter
2017-01-01
There are few published studies describing the unique management practices, farm design and housing characteristics of commercial meat chicken and layer farms in Australia. In particular, there has been a large expansion of free range poultry production in Australia in recent years, but limited information about this enterprise exists. This study aimed to describe features of Australian commercial chicken farms, with particular interest in free range farms, by conducting on-farm interviews of 25 free range layer farms, nine cage layer farms, nine barn layer farms, six free range meat chicken farms and 15 barn meat chicken farms in the Sydney basin bioregion and South East Queensland. Comparisons between the different enterprises (cage, barn and free range) were explored, including stocking densities, depopulation procedures, environmental control methods and sources of information for farmers. Additional information collected for free range farms include range size, range characteristics and range access. The median number of chickens per shed was greatest in free range meat chicken farms (31,058), followed by barn meat chicken (20,817), free range layer (10,713), barn layer (9,300) and cage layer farms (9,000). Sheds had cooling pads and tunnel ventilation in just over half of both barn and free range meat chicken farms (53%, n = 8) and was least common in free range layer farms (16%, n = 4). Range access in free range meat chicken farms was from sunrise to dark in the majority (93%, n = 14) of free range meat chicken farms. Over half of free range layer farms (56%, n = 14) granted range access at a set time each morning; most commonly between 9:00 to 10.00am (86%, n = 12), and chickens were placed back inside sheds when it was dusk.
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Schuch, Linda, Ed.
2004-01-01
"Viewpoints" is a multimedia package containing two audio CDs and a short, informative booklet. This volume of "Viewpoints" focuses on using scientifically based practices to improve student achievement and teacher effectiveness. The audio CDs provide the voices, or viewpoints, of various leaders from the education field who have worked closely…
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Errors in laboratory medicine: practical lessons to improve patient safety.
Howanitz, Peter J
2005-10-01
Patient safety is influenced by the frequency and seriousness of errors that occur in the health care system. Error rates in laboratory practices are collected routinely for a variety of performance measures in all clinical pathology laboratories in the United States, but a list of critical performance measures has not yet been recommended. The most extensive databases describing error rates in pathology were developed and are maintained by the College of American Pathologists (CAP). These databases include the CAP's Q-Probes and Q-Tracks programs, which provide information on error rates from more than 130 interlaboratory studies. To define critical performance measures in laboratory medicine, describe error rates of these measures, and provide suggestions to decrease these errors, thereby ultimately improving patient safety. A review of experiences from Q-Probes and Q-Tracks studies supplemented with other studies cited in the literature. Q-Probes studies are carried out as time-limited studies lasting 1 to 4 months and have been conducted since 1989. In contrast, Q-Tracks investigations are ongoing studies performed on a yearly basis and have been conducted only since 1998. Participants from institutions throughout the world simultaneously conducted these studies according to specified scientific designs. The CAP has collected and summarized data for participants about these performance measures, including the significance of errors, the magnitude of error rates, tactics for error reduction, and willingness to implement each of these performance measures. A list of recommended performance measures, the frequency of errors when these performance measures were studied, and suggestions to improve patient safety by reducing these errors. Error rates for preanalytic and postanalytic performance measures were higher than for analytic measures. Eight performance measures were identified, including customer satisfaction, test turnaround times, patient identification
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Adoption of JMM practices - A key to performance improvement of a local automotive industry
Mohiuddin, A. K. M.; Haji, A. Jabbar Julia Bt.; Khan, Ahsan Ali; Mustafizul Karim, A. N.
2017-03-01
It is imperative for a manufacturing company all over the world to constantly look for ways to increase productivity and at the same time to lower cost to secure a competitive position. It is recognized that practices associated with Japanese Manufacturing Management (JMM) can yield a superior competitive advantage in terms of productivity, quality and provide overall successful business performance. This paper discusses the transfer of the best practices of the JMM locally and analyses the impact of adoption and adaptation of the management system as an in-depth case study conducted in a Malaysian automotive company. This study is to identify what are the changes in terms of the philosophy and practices undertaken by the company and ascertain the impact of the JMM on its manufacturing and financial performances. The elements of business performance from the viewpoint of manufacturing are based on safety, Parts Per Million (PPM), in-line Defect per Unit (DPU), First Time Quality (FTQ), cycle time, productivity, efficiency and stock level. The results show a positive impact to the automotive plant manufacturing performance. For example, safety index has reduced to 0 major accident occurrences. The PPM and In-line DPU have improved by 98% and 91% respectively whereas the FTQ has improved by 167%. Cycle time has reduced from 20 to 6 minutes and productivity increased up to 43% whilst the efficiency reached at 99.9%. The stock level was reduced from half month to 3 days after the adoption of the JMM. The revenue has increased up to 92%, the percentage of expenses has reduced from 11.04% to 3.06% giving an improvement of 72% whilst the net profit has increased from 5.33% to 8.15%. The Return of Asset (RoA) and Return of Equity (RoE) also showed slight improvement despite the effects from the restructuring exercise, Tsunami calamity and fluctuation in Japanese exchange rate.
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New progress of ranging technology at Wuhan Satellite Laser Ranging Station
Xia, Zhiz-Hong; Ye, Wen-Wei; Cai, Qing-Fu
1993-01-01
A satellite laser ranging system with an accuracy of the level of centimeter has been successfully developed at the Institute of Seismology, State Seismological Bureau with the cooperation of the Institute of Geodesy and Geophysics, Chinese Academy of Science. With significant improvements on the base of the second generation SLR system developed in 1985, ranging accuracy of the new system has been upgraded from 15 cm to 3-4 cm. Measuring range has also been expanded, so that the ETALON satellite with an orbit height of 20,000 km launched by the former U.S.S.R. can now be tracked. Compared with the 2nd generation SLR system, the newly developed system has the following improvements. A Q modulated laser is replaced by a mode-locked YAG laser. The new device has a pulse width of 150 ps and a repetition rate of 1-4 pps. A quick response photomultiplier has been adopted as the receiver for echo; for example, the adoption of the MCP tube has obviously reduced the jitter error of the transit time and has improved the ranging accuracy. The whole system is controlled by an IBM PC/XT Computer to guide automatic tracking and measurement. It can carry out these functions for satellite orbit calculation, real-time tracking and adjusting, data acquisition and the preprocessed of observing data, etc. The automatization level and reliability of the observation have obviously improved.
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How to improve mental health competency in general practice training?--a SWOT analysis.
van Marwijk, Harm
2004-06-01
It is quite evident there is room for improvement in the primary care management of common mental health problems. Patients respond positively when GPs adopt a more proactive role in this respect. The Dutch general practice curriculum is currently being renewed. The topics discussed here include the Strengths, Weaknesses, Opportunities and Threats (SWOT) of present primary mental healthcare teaching. What works well and what needs improving? Integrated teaching packages are needed to help general practice trainees manage various presentations of psychological distress. Such packages comprise training videotapes, in which models such as problem-solving treatment (PST) are demonstrated, as well as roleplaying material for new skills, self-report questionnaires for patients, and small-group video feedback of consultations. While GP trainees can effectively master such skills, it is important to query the level of proficiency required by registrars. Are these skills of use only to connoisseur GPs, or to all? More room for specialisation and differentiation among trainees may be the way forward. We have just developed a new curriculum for the obligatory three-month psychiatry housemanship. It is competency oriented, self-directed and assignment driven. This new curriculum will be evaluated in due course.
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Review of forestry practices in caribou habitat in southeastern British Columbia, Canada
Directory of Open Access Journals (Sweden)
Susan K. Stevenson
1986-06-01
Full Text Available Woodland caribou (Rangifer tarandus caribou in southeastern British Columbia feed mainly on arboreal lichens in winter. Some modified forestry practices that have been used or proposed for caribou ranges are reviewed. Partial cutting results in the retention of some forage lichens. Partial cutting and small patch harvesting may improve lichen growth on the remaining trees. Retention of advanced regeneration and some residual trees may improve lichen growth in the remaining stand. Extension of the rotation age increases the amount of harvestable forest useful to caribou at any one time. Progressive cutting minimizes road access to caribou ranges, and may be combined with partial cutting. Most forestry practices intended to maintain lichen production will result in increased human activity in caribou ranges, unless road access is controlled. The management strategy selected depends on site conditions and on the relative importance assigned to the impact of habitat alteration and human activity on caribou.
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Directory of Open Access Journals (Sweden)
Devon Cooper
2017-08-01
Full Text Available Dental caries is the most prevalent chronic childhood disease in the United States. Dental caries affects the health of 60–90% of school-aged children worldwide. The prevalence of untreated early childhood dental caries is 19% for children 2–5 years of age in the U.S. Some factors that contribute to the progression of dental caries include socioeconomic status, access to dental care, and lack of anticipatory guidance. The prevalence of dental caries remains highest for children from specific ethnic or racial groups, especially those living in underserved areas where there may be limited access to a dentist. Although researchers have acknowledged the various links between oral health and overall systemic health, oral health care is not usually a component of pediatric primary health care. To address this public health crisis and oral health disparity in children, new collaborative efforts among health professionals is critical for dental disease prevention and optimal oral health. This evaluation study focused on a 10-week interprofessional practice and education (IPE course on children’s oral health involving dental, osteopathic medical, and nurse practitioner students at the University of California, San Francisco. This study’s objective was to evaluate changes in knowledge, confidence, attitude, and clinical practice in children’s oral health of the students completed the course. Thirty-one students participated in the IPE and completed demographic questionnaires and four questionnaires before and after the IPE course: (1 course content knowledge, (2 confidence, (3 attitudes, and (4 clinical practice. Results showed a statistically significant improvement in the overall knowledge of children’s oral health topics, confidence in their ability to provide oral health services, and clinical practice. There was no statistically significant difference in attitude, but there was an upward trend toward positivity. To conclude, this IPE
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High Precision Ranging and Range-Rate Measurements over Free-Space-Laser Communication Link
Yang, Guangning; Lu, Wei; Krainak, Michael; Sun, Xiaoli
2016-01-01
We present a high-precision ranging and range-rate measurement system via an optical-ranging or combined ranging-communication link. A complete bench-top optical communication system was built. It included a ground terminal and a space terminal. Ranging and range rate tests were conducted in two configurations. In the communication configuration with 622 data rate, we achieved a two-way range-rate error of 2 microns/s, or a modified Allan deviation of 9 x 10 (exp -15) with 10 second averaging time. Ranging and range-rate as a function of Bit Error Rate of the communication link is reported. They are not sensitive to the link error rate. In the single-frequency amplitude modulation mode, we report a two-way range rate error of 0.8 microns/s, or a modified Allan deviation of 2.6 x 10 (exp -15) with 10 second averaging time. We identified the major noise sources in the current system as the transmitter modulation injected noise and receiver electronics generated noise. A new improved system will be constructed to further improve the system performance for both operating modes.
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S. P. Gaba
1984-01-01
The paper deals with underwater laser ranging system, its principle of operation and maximum depth capability. The sources of external noise and methods to improve signal-to-noise ratio are also discussed.
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Education Trust, 2016
2016-01-01
All across the country, leaders in colleges and universities are asking the same question: What can we do to improve student success, especially for the low-income students and students of color whose graduation rates often lag behind? This second practice guide: "Using Data to Improve Student Outcomes: Learning from Leading Colleges"…
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Liu, Jun; Zhou, Hui; Yang, Xiaoqin
2017-02-18
The present study was performed to quantitatively examine nurse satisfaction, to investigate the associated factors influencing satisfaction, and to evaluate the effect of improvement measures based on these factors. A survey using the 38-item Chinese version of the Practice Environment Scale (CPPE-38) was performed in a university-affiliated tertiary hospital in Shanghai, China in 2013. Linear regression analysis was performed to screen for associated factors related to each CPPE-3 score and the total satisfaction score. Several improvement measures were established to improve nurse satisfaction, and the CPPE-38 survey was again performed in 2015 to evaluate the effect of these improvement measures. A total of 1,050 respondents were recruited in 2013, with a response rate of 87.6%. The total satisfaction score of the CPPE-38 was 2.99±0.64. The lowest score in a subscale of the CPPE-38 was 2.40±0.59 for interpersonal interaction and the highest score was 3.15±0.40 for internal work motivation. Work location was associated with scores for work motivation and total satisfaction, while the highest education degree was associated with scores for internal relationship and autonomy. The scores for internal work motivation, control over practice, interpersonal interaction, and internal relationship and autonomy were significantly improved in 2015 after two years of improvement efforts, while the total satisfaction score was not significantly different compared to the 2013 score. Working location and education degree were two factors correlated with CPPE-38 scores in our hospital. Humanistic concerns, continuing education, and pay raise may improve the practice satisfaction of nurses.
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2012-01-01
Background In 2005, we reported on the success of Comprehensive School Health (CSH) in improving diets, activity levels, and body weights. The successful program was recognized as a "best practice" and has inspired the development of the Alberta Project Promoting active Living and healthy Eating (APPLE) Schools. The project includes 10 schools, most of which are located in socioeconomically disadvantaged areas. The present study examines the effectiveness of a CSH program adopted from a "best practice" example in another setting by evaluating temporal changes in diets, activity levels and body weight. Methods In 2008 and 2010, we surveyed grade 5 students from approximately 150 randomly selected schools from the Canadian province of Alberta and students from 10 APPLE Schools. Students completed the Harvard Youth/Adolescent Food Frequency Questionnaire, questions on physical activity, and had their height and weight measured. Multilevel regression methods were used to analyze changes in diets, activity levels, and body weight between 2008 and 2010. Results In 2010 relative to 2008, students attending APPLE Schools were eating more fruits and vegetables, consuming fewer calories, were more physically active and were less likely obese. These changes contrasted changes observed among students elsewhere in the province. Conclusions These findings provide evidence on the effectiveness of CSH in improving health behaviors. They show that an example of "best practice" may lead to success in another setting. Herewith the study provides the evidence that investments for broader program implementation based on "best practice" are justified. PMID:22413778
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DEFF Research Database (Denmark)
Danielsen, Søren Lykke; Hansen, Peter Bukhave; Jørgensen, Carsten
1997-01-01
be improved compared to switch blocks without IWCs. This is especially important at high bit rates where the cascadability of the SOA gates decreases. Here, more than 15 dB improvement of the input power dynamic range is achieved at 20 Gbit/s using a high-speed Michelson interferometer wavelength converter...
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Evaluating online continuing medical education seminars: evidence for improving clinical practices.
Weston, Christine M; Sciamanna, Christopher N; Nash, David B
2008-01-01
The purpose of this study was to evaluate the potential for online continuing medical education (CME) seminars to improve quality of care. Primary care physicians (113) participated in a randomized controlled trial to evaluate an online CME series. Physicians were randomized to view either a seminar about type 2 diabetes or a seminar about systolic heart failure. Following the seminar, physicians were presented with 4 clinical vignettes and asked to describe what tests, treatments, counseling, or referrals they would recommend. Physicians who viewed the seminars were significantly more likely to recommend guideline-consistent care to patients in the vignettes. For example, physicians who viewed the diabetes seminar were significantly more likely to order an eye exam for diabetes patients (63%) compared with physicians in the control group (27%). For some guidelines there were no group differences. These results provide early evidence of the effectiveness of online CME programs to improve physician clinical practice.
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Workplace road safety risk management: An investigation into Australian practices.
Warmerdam, Amanda; Newnam, Sharon; Sheppard, Dianne; Griffin, Mark; Stevenson, Mark
2017-01-01
In Australia, more than 30% of the traffic volume can be attributed to work-related vehicles. Although work-related driver safety has been given increasing attention in the scientific literature, it is uncertain how well this knowledge has been translated into practice in industry. It is also unclear how current practice in industry can inform scientific knowledge. The aim of the research was to use a benchmarking tool developed by the National Road Safety Partnership Program to assess industry maturity in relation to risk management practices. A total of 83 managers from a range of small, medium and large organisations were recruited through the Victorian Work Authority. Semi-structured interviews aimed at eliciting information on current organisational practices, as well as policy and procedures around work-related driving were conducted and the data mapped onto the benchmarking tool. Overall, the results demonstrated varying levels of maturity of risk management practices across organisations, highlighting the need to build accountability within organisations, improve communication practices, improve journey management, reduce vehicle-related risk, improve driver competency through an effective workplace road safety management program and review organisational incident and infringement management. The findings of the study have important implications for industry and highlight the need to review current risk management practices. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Sterr, Annette; Dean, Phil J A; Szameitat, Andre J; Conforto, Adriana Bastos; Shen, Shan
2014-05-01
Initial evidence suggests that the integrity of the ipsilesional corticospinal tract (CST) after stroke is strongly related to motor function in the chronic state but not the treatment gain induced by motor rehabilitation. We examined the association of motor status and treatment benefit by testing patients with a wide range of severity of hemiparesis of the left and right upper extremity. Diffusion tensor imaging was performed in 22 patients beyond 12 months after onset of stroke with severe to moderate hemiparesis. Motor function was tested before and after 2 weeks of modified constraint-induced movement therapy. CST integrity, but not lesion volume, correlated with the motor ability measures of the Wolf Motor Function Test and the Motor Activity Log. No differences were found between left and right hemiparesis. Motor performance improved significantly with the treatment regime, and did so equally for patients with left and right arm paresis. However, treatment benefit was not associated with either CST integrity or lesion volume. CST integrity correlated best in this small trial with chronic long-term status but not treatment-induced improvements. The CST may play a different role in the mechanisms mediating long-term outcome compared to those underlying practice-induced gains after a chronic plateau in motor function.
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International Nuclear Information System (INIS)
Kun, Larry E.; Haffty, Bruce G.; Bosma, Jennifer; Strife, Janet L.; Hattery, Robert R.
2007-01-01
Maintenance of Certification is a physician-based response to public concerns about the quality of medical care and physician competency in a rapidly evolving, technically demanding specialty. American Board of Radiology (ABR) has previously described the first three components of the Maintenance of Certification. The ABR is currently developing a program in practice performance, completing Part IV of the competencies. The Practice Quality Improvement (PQI) program is meant to critically evaluate meaningful aspects of a physician's practice in a simple manner, using identifiable metrics and self-assessment to include an action plan for quality improvement. Each diplomate will be expected to complete three PQI projects during a full 10-year Maintenance of Certification cycle. Current diplomates with time-limited certificates will find prorated requirements determined by their year of certification on the ABR Website. Diplomates will have the option of completing zero to two Type I PQI projects (assessing factors relevant to clinical practice by peer review and self-reporting) and one to three Type II projects (i.e., at least one Type II projects of the three required, assessing parameters of practice by comparison with evidence-based guidelines, consensus statements, or peer comparisons; Type II projects are initiated and managed by professional societies). Several examples of Type I projects that might be offered by societies or directly through the ABR are provided, as well as highlights of the two Type II projects that have sought ABR qualification: American Society for Therapeutic Radiology and Oncology's Performance Assessment for the Advancement of Radiation Oncology Treatment program and American College of Radiology's RO-PEER program. An additional objective of the PQI is to develop national databases for future reference using aggregate data from the PQI projects
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Congruence of Personal and Organizational Values: Moving Beyond Practice
Directory of Open Access Journals (Sweden)
Jolita Vveinhardt
2017-06-01
Full Text Available The purpose of this paper is to review and clarify the knowledge of practice related literature on the concept of congruence between personal and organizational values and to develop the framework for strengthening the congruence between personal and organizational values in order to improve understanding about how the theory is turned into practice. This paper thoroughly analyses an extensive literature in relation to value congruence and its practical management and discusses the relationships between theoretical knowledge and practical implications. By organizing a wide range of practice related aspects into meaningful categories, the paper presents specific practical suggestions how to strengthen the congruence of personal and organizational values. The paper gives clear practical guidance for those who intend to develop and implement the congruence between personal and organizational values, since the model may be useful in selecting the most suitable practices for specific situations in organizations.
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Johnson, Genevieve Marie
2015-01-01
In higher education, assessment integrity is pivotal to student learning and satisfaction, and, therefore, a particularly important target of continuous quality improvement. This paper reports on the preliminary development and application of a process of recording and analysing current assessment moderation practices, with the aim of identifying…
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Improvement in Cuba of the regulatory mark in the industrial X-ray practice
International Nuclear Information System (INIS)
Lopez Forteza; Yamil; Quevedo Garcia, Jose R.; Jerez Vegueria, Pablo F.; Dumenigo Gonzalez, Cruz; De la Fuente Puch, Andres; Diaz Guerra, Pedro
2003-01-01
The Cuban regulatory mark as regards nuclear and radiological security until the year 2002 had not had a Guide of Security linked to the practice of Industrial X-ray. The improvement of the national regulatory mark, by the light of the international recommendations and the national experience of the inspection and licensing regulatory activity of this practice took to necessity of the existence of a Guide of Security that allowed in an effective way to make complete the established approaches of security in the Basic Norms of Security (NBS), during the operation of the teams of Industrial X-ray. The present work exposes and they expose the main aspects that are included in this document that they constitute from an or another way precision to that settled down in the NBS
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Shaikh, U; Nettiksimmons, J; Joseph, JG; Tancredi, D; Romano, PS
2014-01-01
© 2013 by the American College of Medical Quality. This study assessed the impact of participation in a virtual quality improvement (QI) learning network on adherence to clinical guidelines for childhood obesity prevention in rural clinics. A total of 7 primary care clinics in rural California included in the Healthy Eating Active Living TeleHealth Community of Practice and 288 children seen in these clinics for well-child care participated in this prospective observational pre-post study. Cl...
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El Dakhakhny, A M; Hesham, M A; Hassan, T H; El Awady, S; Hanfy, M M
2014-07-01
Nowadays, health education has been elevated to a higher standing in healthcare systems in managing chronic illness; yet, this approach has not received sufficient support in developing countries as these societies still tend to the traditional stage of 'treatment after disease'. Adolescence is a critical period and voyage into adulthood can be more challenging for haemophilia teens. For teens with haemophilia, learning to care for their own disorder is a giant step forward in asserting their independence and preparation for adult life. We aimed to determine impact of health instructions on improving knowledge and practices of haemophilia A adolescents. An interventional study was conducted on 50 haemophilia A adolescents at outpatient clinic of Pediatric Hematology Unit of Zagazig University Hospitals. Three tools were used. The first was a structured interview sheet to evaluate patients' knowledge. The second was a clinical checklist to evaluate patients' practices. The third was health instructions program. Tools were developed by the researchers based on a thorough review of related literature and a full understanding of the needs of haemophilic adolescents. Evaluation of health instructions success was based on comparing scores of tool I and tool II before health instructions (pretest) and after health instructions immediately (posttest) and after 2 months (follow-up test). There was a significant improvement in knowledge and practices of haemophilia A adolescents in posttest and follow-up test compared to pretest. Health instructions have an impact on improving knowledge and practices of haemophilia A adolescents. © 2014 John Wiley & Sons Ltd.
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Boaz, Annette; Baeza, Juan; Fraser, Alec
2011-06-22
The gap between research findings and clinical practice is well documented and a range of interventions has been developed to increase the implementation of research into clinical practice. A review of systematic reviews of the effectiveness of interventions designed to increase the use of research in clinical practice. A search for relevant systematic reviews was conducted of Medline and the Cochrane Database of Reviews 1998-2009. 13 systematic reviews containing 313 primary studies were included. Four strategy types are identified: audit and feedback; computerised decision support; opinion leaders; and multifaceted interventions. Nine of the reviews reported on multifaceted interventions. This review highlights the small effects of single interventions such as audit and feedback, computerised decision support and opinion leaders. Systematic reviews of multifaceted interventions claim an improvement in effectiveness over single interventions, with effect sizes ranging from small to moderate. This review found that a number of published systematic reviews fail to state whether the recommended practice change is based on the best available research evidence. This overview of systematic reviews updates the body of knowledge relating to the effectiveness of key mechanisms for improving clinical practice and service development. Multifaceted interventions are more likely to improve practice than single interventions such as audit and feedback. This review identified a small literature focusing explicitly on getting research evidence into clinical practice. It emphasizes the importance of ensuring that primary studies and systematic reviews are precise about the extent to which the reported interventions focus on changing practice based on research evidence (as opposed to other information codified in guidelines and education materials).
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Improving access for patients – a practice manager questionnaire
Directory of Open Access Journals (Sweden)
Brown James S
2006-06-01
Full Text Available Abstract Background The administrative and professional consequences of access targets for general practices, as detailed in the new GMS contract, are unknown. This study researched the effect of implementing the access targets of the new GP contract on general practice appointment systems, and practice manager satisfaction in a UK primary health care setting. Methods A four-part postal questionnaire was administered. The questionnaire was modified from previously validated questionnaires and the findings compared with data obtained from the Western Health and Social Services Board (WHSSB in N Ireland. Practice managers from the 59 general practices in the WHSSB responded to the questionnaire. Results There was a 94.9% response rate. Practice managers were generally satisfied with the introduction of access targets for patients. Some 57.1% of responding practices, most in deprived areas (Odds ratio 3.13 -95% CI 1.01 – 9.80, p = 0.0256 had modified their appointment systems. Less booking flexibility was reported among group practices (p = 0.006, urban practices (p Conclusion The findings demonstrated the ability of general practices within the WHSSB to adjust to a demanding component of the new GP contract. Issues relating to the flexibility of patient appointment booking systems, receptionists' training and the development of the primary care nursing role were highlighted by the study.
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An improved method to estimate reflectance parameters for high dynamic range imaging
Li, Shiying; Deguchi, Koichiro; Li, Renfa; Manabe, Yoshitsugu; Chihara, Kunihiro
2008-01-01
Two methods are described to accurately estimate diffuse and specular reflectance parameters for colors, gloss intensity and surface roughness, over the dynamic range of the camera used to capture input images. Neither method needs to segment color areas on an image, or to reconstruct a high dynamic range (HDR) image. The second method improves on the first, bypassing the requirement for specific separation of diffuse and specular reflection components. For the latter method, diffuse and specular reflectance parameters are estimated separately, using the least squares method. Reflection values are initially assumed to be diffuse-only reflection components, and are subjected to the least squares method to estimate diffuse reflectance parameters. Specular reflection components, obtained by subtracting the computed diffuse reflection components from reflection values, are then subjected to a logarithmically transformed equation of the Torrance-Sparrow reflection model, and specular reflectance parameters for gloss intensity and surface roughness are finally estimated using the least squares method. Experiments were carried out using both methods, with simulation data at different saturation levels, generated according to the Lambert and Torrance-Sparrow reflection models, and the second method, with spectral images captured by an imaging spectrograph and a moving light source. Our results show that the second method can estimate the diffuse and specular reflectance parameters for colors, gloss intensity and surface roughness more accurately and faster than the first one, so that colors and gloss can be reproduced more efficiently for HDR imaging.
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Directory of Open Access Journals (Sweden)
Juan Ariel Muñoz Olivero
2016-06-01
Full Text Available Education for youngsters and adults (in Spanish, EPJA has reached prominence in the Chilean educational system. It has had to give a new chance to a large number of young people who, for one reason or another, did not complete their studies in traditional training. In this scenario, it explores pedagogical practices developed by teachers working with youngsters and adults, especially those who refer to learning assessment. Therefore, the purpose of this study is to present the results of a reflection carried out by a group of teachers from a comprehensive adult education center, in order to improve their practices to evaluate their students’ learning. The research model is based on the qualitative approach with a case study design. It makes a comprehensive diagnostic of teaching practices, conducted through discussion groups. The analysis of the results shows that most teachers working at this educational center follow traditional assessment practices. They tend to copy conceptions of assessment centered around products that can be scored in order to check goal achievement, rather than around providing feedback that promotes self-regulated learning. However, the reflection also shows that teachers are willing to participate in pedagogical reflection sessions that guide them to improve their assessment practices.
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How do technical improvements change radiographers' practice – A practice theory perspective
International Nuclear Information System (INIS)
Lundvall, L.-L.; Abrandt-Dahlgren, M.; Wirell, S.
2015-01-01
Introduction: The two plane imaging techniques are gradually being replaced by multidimensional imaging. How it affects radiographers' professional practice has not been investigated. Aim: To explore how technical development affects the relations between different actors and their actions in the practice of Computer Tomography. Method: A qualitative design with data collection by open interviews (n = 8) and open observations (n = 10) of radiographers during their work with Computer Tomography. Data was first analyzed inductively resulting in seven codes. Secondly abduction was carried out by interpreting the content in the codes with a practice theory. This resulted in four themes. Result: First theme: Changed materiality makes the practical action easier. The actual image production has become practically easier. Second theme: Changed machines cause conflict between the arrangements of the work and the patients' needs. The time for the machine to carry out image production is easy to foresee, but information about the patient's individual status and needs is missing and this leads to difficulties in giving individual planned care. Third theme: Changing materiality prefigure learning. The different apparatus in use and the continuously changing methods of image production is co-constitutive of the practitioners' activities and learning. Fourth theme: Radiography is arranged for patient safety in relation to radiation doses and medical security risks. But the radiographers, who meet the patients, have to check the accuracy of the planned examination in relation to the clinical observed information about patient safety risks with the examination. - Highlights: • The arrangements of CT practice make it difficult to achieve individual planned care. • Continuously learning has become an essential part of radiographers' practice. • Radiographers' planning of each examination is important for secure patient safety
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Grebennikov, Valery V.; Grudtsina, Ludmila Yu.; Marchuk, Nikolay N.; Sangadgiev, Badma V.; Kudyashev, Nail K.
2016-01-01
The research urgency is caused by the transition to the knowledge society and new demands for training and methodical provision of professional pedagogical education. The purpose of this paper is to develop practical recommendations to improve the quality of training and methodical support of professional pedagogical education. The leading…
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Does the Texas First Dental Home Program Improve Parental Oral Care Knowledge and Practices?
Thompson, Charmaine L; McCann, Ann L; Schneiderman, Emet D
2017-03-15
This study evaluated the effectiveness of the Texas Medicaid First Dental Home (FDH) by comparing the oral health knowledge, practices, and opinions of participating vs. non-participating parents. A 29-question survey (English & Spanish) was developed and administered to 165 parents of children under three years old (FDH=49, Non-FDH=116) who visited qualifying Medicaid clinics in Texas. Mann Whitney U tests showed that FDH parents scored higher on overall knowledge (P=0.001) and practice scores (Pparents responded correctly more often than non-FDH about the recommended amount of toothpaste for toddlers (Pparents knew tap water was a potential source of fluoride (Pparents scored marginally higher about when a child should have the first dental visit (P=0.051). More Non-FDH parents let their child go to sleep with a bottle, sippy cup or pacifier (Pparents by increasing their oral healthcare knowledge and practices. This is the first step towards improving the oral health of children.
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Naccarella, Lucio; Biuso, Catuscia; Jennings, Amanda; Patsamanis, Harry
2018-05-29
Evidence exists for the association between health literacy and heart health outcomes. Cardiac rehabilitation is critical for recovery from heart attack and reducing hospital readmissions. Despite this, literacy. This brief case study reflects and documents practice-based initiatives by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. Three key initiatives, namely the Six Steps To Cardiac Recovery resource, the Love Your Heart book and the nurse ambassador program, were implemented informed by mixed methods that assessed need and capacity at the individual, organisational and systems levels. Key outcomes included increased access to recovery information for patients with low health literacy, nurse knowledge and confidence to engage with patients on recovery information, improved education of patients and improved availability and accessibility of information for patients in diverse formats. Given the challenges involved in addressing heart health literacy, multifaceted practice-based approaches are essential to improve access to recovery information for patients with low literacy levels. What is known about the topic? Significant challenges exist for patients with lower health literacy receiving recovery information after a heart attack in hospitals. What does this paper add? This case study provides insights into a practice-based initiative by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. What are the implications for practitioners? Strategies to improve recovery through increased heart health literacy must address the needs of patients, nursing staff and the health system within hospitals. Such strategies need to be multifaceted and designed to build the capacity of nurses, heart patients and their carers, as well as support from hospital management.
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The Role of Work-Life Balance Practices in Order to Improve Organizational Performance
IOAN LAZAR; CODRUTA OSOIAN; PATRICIA RATIU
2010-01-01
Well known in the literature as work life balance, the quality relationship between paid work and unpaid responsibilities is critical for success in today’s competitive business world. The issue of work-life balance has been developed in response to demographic, economic and cultural changes. The purpose of this paper is to establish whether work-life balance initiatives and practices can be considered as strategic human resource management decisions that can translate into improved individua...
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Directory of Open Access Journals (Sweden)
Fung Christina
2012-03-01
Full Text Available Abstract Background In 2005, we reported on the success of Comprehensive School Health (CSH in improving diets, activity levels, and body weights. The successful program was recognized as a "best practice" and has inspired the development of the Alberta Project Promoting active Living and healthy Eating (APPLE Schools. The project includes 10 schools, most of which are located in socioeconomically disadvantaged areas. The present study examines the effectiveness of a CSH program adopted from a "best practice" example in another setting by evaluating temporal changes in diets, activity levels and body weight. Methods In 2008 and 2010, we surveyed grade 5 students from approximately 150 randomly selected schools from the Canadian province of Alberta and students from 10 APPLE Schools. Students completed the Harvard Youth/Adolescent Food Frequency Questionnaire, questions on physical activity, and had their height and weight measured. Multilevel regression methods were used to analyze changes in diets, activity levels, and body weight between 2008 and 2010. Results In 2010 relative to 2008, students attending APPLE Schools were eating more fruits and vegetables, consuming fewer calories, were more physically active and were less likely obese. These changes contrasted changes observed among students elsewhere in the province. Conclusions These findings provide evidence on the effectiveness of CSH in improving health behaviors. They show that an example of "best practice" may lead to success in another setting. Herewith the study provides the evidence that investments for broader program implementation based on "best practice" are justified.
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International Nuclear Information System (INIS)
Frey, G. Donald; Ibbott, Geoffrey S.; Morin, Richard L.; Paliwal, Bhudatt R.; Thomas, Stephen R.; Bosma, Jennifer
2007-01-01
Recent initiatives of the American Board of Medical Specialties (ABMS) in the area of maintenance of certification (MOC) have been reflective of the response of the medical community to address public concerns regarding quality of care, medical error reduction, and patient safety. In March 2000, the 24 member boards of the ABMS representing all medical subspecialties in the USA agreed to initiate specialty-specific maintenance of certification (MOC) programs. The American Board of Radiology (ABR) MOC program for diagnostic radiology, radiation oncology, and radiologic physics has been developed, approved by the ABMS, and initiated with full implementation for all three disciplines beginning in 2007. The overriding objective of MOC is to improve the quality of health care through diplomate-initiated learning and quality improvement. The four component parts to the MOC process are: Part I: Professional standing, Part II: Evidence of life long learning and periodic self-assessment, Part III: Cognitive expertise, and Part IV: Evaluation of performance in practice (with the latter being the focus of this paper). The key components of Part IV require a physicist-based response to demonstrate commitment to practice quality improvement (PQI) and progress in continuing individual competence in practice. Diplomates of radiologic physics must select a project to be completed over the ten-year cycle that potentially can improve the quality of the diplomate's individual or systems practice and enhance the quality of care. Five categories have been created from which an individual radiologic physics diplomate can select one required PQI project: (1) Safety for patients, employees, and the public, (2) accuracy of analyses and calculations, (3) report turnaround time and communication issues, (4) practice guidelines and technical standards, and (5) surveys (including peer review of self-assessment reports). Each diplomate may select a project appropriate for an individual
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Edward, Karen-Leigh; Walker, Kim; Duff, Jed
2017-10-01
Healthcare is complex and we know that evidence takes nearly 20 years to find its way into clinical practice. The slow process of translating research points to the need for effective translational research models to ensure patient care quality and safety are not compromised by such an epistemic failure. Our model to achieve reasonably rapid and enduring improvements to clinical care draws on that developed and promulgated by the Institute for Healthcare Improvement in the United States of America model as well as that developed by the Johns Hopkins Quality and Safety Group known as the Translating Research into Practice implementation model. The core principle of our hybrid model was to engage those most likely to be affected by the changes being introduced through a series of face-to-face and web-enabled meetings that act both as drivers of information but also as a means of engaging all stakeholders across the healthcare system involved in the change towards their pre-established goals. The model was piloted on the focused topic of the management of inadvertent perioperative hypothermia across nine hospitals within Australia (four sites in Victoria, three sites in New South Wales and two sites in Queensland). Improvement in management of hypothermia in these patients was achieved and sustained over time. Our model aims to engage the hearts and minds of healthcare clinicians, and others in order to empower them to make the necessary improvements to enhance patient care quality and safety. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
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ANTITUBERCULOSIS DRUG DOSAGE FORMS: RANGE, KEY BENEFITS AND PROSPECTS OF TECHNOLOGICAL IMPROVEMENT
Directory of Open Access Journals (Sweden)
M. E. Kim
2016-01-01
Full Text Available Interest to research in the development of new formulations of antituberculosis drugs due to the high incidence of tuberculosis in the Republic of Kazakhstan and the Russian Federation nowadays, including with acquired drug resistance. The reason for the development of acquired drug resistance is to interrupt the treatment of patients is the high toxicity of antituberculosis drugs. The improving the efficiency of antituberculosis therapy remains one of the most pressing.The aim this study was to review the dosage forms of antituberculosis drugs currently used and the ways to improve them.Methods. The study was conducted on the basis of scientific analysis (eLibrary database, PubMed, Cyberleninca, patent (kzpatents, reference (Klifar, Drugs register and technical literature.Results. It was revealed that the antituberculosis drugs are available in the form of tablets, capsules, granules for oral use and injection solutions. The advantages and disadvantages of oral dosage forms of antituberculosis drugs: tablets, capsules, granules, syrups, suspensions are described. The importance of the development and implementation in practice of pediatric formulations of antituberculosis drugs is mentioned. The state of current research inhaled formulations for the treatment of tuberculosis is described. The prospects of directional inhalation exposure by immobilization of antituberculosis drugs in liposomes, niosomes, nanocapsules, micelles, micro- and nanoparticles are mentioned. The prospect of the rectal formulations use is described. The increase in interest in the molecular encapsulation of medicinal substances with cyclodextrins in connection with the possibility of increasing the bioavailability of active ingredients, reduce the harmful effects on the gastrointestinal tract, extension, elimination of interaction of incompatible components in combination preparations, the protection of unstable substances is
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Steinfeld, Bradley; Scott, Jennifer; Vilander, Gavin; Marx, Larry; Quirk, Michael; Lindberg, Julie; Koerner, Kelly
2015-10-01
To effectively implement evidence-based practices (EBP) in behavioral health care, an organization needs to have operating structures and processes that can address core EBP implementation factors and stages. Lean, a widely used quality improvement process, can potentially address the factors crucial to successful implementation of EBP. This article provides an overview of Lean and the relationship between Lean process improvement steps, and EBP implementation models. Examples of how Lean process improvement methodologies can be used to help plan and carry out implementation of EBP in mental health delivery systems are presented along with limitations and recommendations for future research and clinical application.
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Effective Interpersonal Communication: A Practical Guide to Improve Your Life.
Vertino, Kathleen A
2014-09-30
Use of effective interpersonal communication strategies by nurses in both personal and professional settings, may reduce stress, promote wellness, and therefore, improve overall quality of life. This article briefly explores the concept of interpersonal communication as it relates to Maslow's hierarchy of human needs; describes personal variables and the interaction of internal and external variables that can impact communication; and discusses possible causes and consequences of ineffective communication. Drawing on both the literature and experiences as a longtime provider of care in the mental health field, the author offers multiple practical strategies, with specific examples of possible responses for effective communication. Recommendations in this article are intended for nurses to consider as they seek healthy communication strategies that may be useful in both their personal and professional lives.
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Liddy, Clare; Rowan, Margo; Valiquette-Tessier, Sophie-Claire; Drosinis, Paul; Crowe, Lois; Hogg, William
2018-01-01
To examine the barriers to and facilitators of practice facilitation experienced by participants in the Improving Delivery of Cardiovascular Care (IDOCC) project. Case studies of practice facilitators' narrative reports. Eastern Ontario. Primary care practices that participated in the IDOCC project. Cases were identified by calculating sum scores in order to determine practices' performance relative to their peers. Two case exemplars were selected that scored within ± 1 SD of the total mean score, and a qualitative analysis of practice facilitators' narrative reports was conducted using a 5-factor implementation framework to identify barriers and facilitators. Narratives were divided into 3 phases: planning, implementation, and sustainability. Barriers and facilitators fluctuated over the intervention's 3 phases. Site A reported more barriers (n = 47) than facilitators (n = 38), while site B reported a roughly equal number of barriers (n = 144) and facilitators (n = 136). In both sites, the most common barriers involved organizational and provider factors and the most common facilitators were associated with innovation and structural factors. Both practices encountered various barriers and facilitators throughout the IDOCC's 3 phases. The case studies reveal the complex interactions of these factors over time, and provide insight into the implementation of practice facilitation programs. Copyright© the College of Family Physicians of Canada.
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Directory of Open Access Journals (Sweden)
I Made Darma Oka
2017-12-01
Full Text Available Hospitality Study Program, Politeknik Negeri Bali (PNB, hadn’t implemented integrated learning practice optimally. The aim of this research was improving the learning process method as an integrated practice learning model involving three courses (Food Production, FB Service, English for Restaurant in the same topic. This study was conducted on the forth semester of Hotel Study Program as the sample used in this research. After the random sampling was selected two classes as research samples, those were IVA class as an experiment group and IVB class as a control. Thus the samples could be determined according to the number of students in each class as many as 26 people. The application of integrated practice learning had an effect on the achievement of student competency in waiter/s occupation at Hotel Studies Program. The result of statistical test showed that there was a significant difference of competency achievement between integrated learning practices with partial practice learning students groups. It’s suggested to the management Hospitality Study Program to encourage and to facilitate the lecturers especially of core subjects to apply integrated learning practices in order to achieve the competency.
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Dreischulte, Tobias; Grant, Aileen; Hapca, Adrian; Guthrie, Bruce
2018-01-05
The cluster randomised trial of the Data-driven Quality Improvement in Primary Care (DQIP) intervention showed that education, informatics and financial incentives for general medical practices to review patients with ongoing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets reduced the primary end point of high-risk prescribing by 37%, where both ongoing and new high-risk prescribing were significantly reduced. This quantitative process evaluation examined practice factors associated with (1) participation in the DQIP trial, (2) review activity (extent and nature of documented reviews) and (3) practice level effectiveness (relative reductions in the primary end point). Invited practices recruited (n=33) and not recruited (n=32) to the DQIP trial in Scotland, UK. (1) Characteristics of recruited versus non-recruited practices. Associations of (2) practice characteristics and 'adoption' (self-reported implementation work done by practices) with documented review activity and (3) of practice characteristics, DQIP adoption and review activity with effectiveness. (1) Recruited practices had lower performance in the quality and outcomes framework than those declining participation. (2) Not being an approved general practitioner training practice and higher self-reported adoption were significantly associated with higher review activity. (3) Effectiveness ranged from a relative increase in high-risk prescribing of 24.1% to a relative reduction of 77.2%. High-risk prescribing and DQIP adoption (but not documented review activity) were significantly associated with greater effectiveness in the final multivariate model, explaining 64.0% of variation in effectiveness. Intervention implementation and effectiveness of the DQIP intervention varied substantially between practices. Although the DQIP intervention primarily targeted review of ongoing high-risk prescribing, the finding that self-reported DQIP adoption was a stronger predictor of
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Improving religious slaughter practices in the U.S.
Directory of Open Access Journals (Sweden)
Temple Grandin
2006-05-01
Full Text Available Cet article, fondé sur trente années d’expérience dans les abattoirs, explore les aspects techniques de l’abattage des animaux de boucherie en Amérique du Nord, tout particulièrement l’abattage religieux, kasher et halal. La description minutieuse des différentes méthodes utilisées vise à éclairer les éléments posant problème et faisant atteinte au « bien-être » des animaux. L’auteur propose ensuite des mesures permettant d’améliorer le traitement des différentes espèces d’animaux et d’alléger les souffrances au moment de l’abattage.This paper, based on thirty years of experience in developing equipment for handling cattle, explores the technical aspects of animal slaughtering in Northern America, particularly halal and kosher slaughter practices. It gives first hand description of the different methods which are in use, always in relation to animal welfare concerns. The author then draws concrete conclusions regarding means of ensuring an improved treatment for all types of animals to be slaughtered.
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Ganni, Sandeep; Botden, Sanne M B I; Schaap, Dennis P; Verhoeven, Bas H; Goossens, Richard H M; Jakimowicz, Jack J
To establish whether a systematized approach to self-assessment in a laparoscopic surgical skills course improves accordance between expert- and self-assessment. A systematic training course in self-assessment using Competency Assessment Tool was introduced into the normal course of evaluation within a Laparoscopic Surgical Skills training course for the test group (n = 30). Differences between these and a control group (n = 30) who did not receive the additional training were assessed. Catharina Hospital, Eindhoven, The Netherlands (n = 27), and GSL Medical College, Rajahmundry, India (n = 33). Sixty postgraduate year 2 and 3 surgical residents who attended the 2-day Laparoscopic Surgical Skills grade 1 level 1 curriculum were invited to participate. The test group (n = 30) showed better accordance between expert- and self-assessment (difference of 1.5, standard deviation [SD] = 0.2 versus 3.83, SD = 0.6, p = 0.009) as well as half the number (7 versus 14) of cases of overreporting. Furthermore, the test group also showed higher overall mean performance (mean = 38.1, SD = 0.7 versus mean = 31.8, SD = 1.0, p assessment can be viewed as responsible for this and can be seen as "reflection-before-practice" within the framework of reflective practice as defined by Donald Schon. Our results suggest that "reflection-before-practice" in implementing self-assessment is an important step in the development of surgical skills, yielding both better understanding of one's strengths and weaknesses and also improving overall performance. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
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Directory of Open Access Journals (Sweden)
Wei Wang
2016-09-01
Full Text Available A Fourier transform spectrometer (FTS that incorporates a closed-loop controlled, electrothermally actuated microelectromechanical systems (MEMS micromirror is proposed and experimentally verified. The scan range and the tilting angle of the mirror plate are the two critical parameters for MEMS-based FTS. In this work, the MEMS mirror with a footprint of 4.3 mm × 3.1 mm is based on a modified lateral-shift-free (LSF bimorph actuator design with large piston and reduced tilting. Combined with a position-sensitive device (PSD for tilt angle sensing, the feedback controlled MEMS mirror generates a 430 µm stable linear piston scan with the mirror plate tilting angle less than ±0.002°. The usable piston scan range is increased to 78% of the MEMS mirror’s full scan capability, and a spectral resolution of 0.55 nm at 531.9 nm wavelength, has been achieved. It is a significant improvement compared to the prior work.
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Babatunde, Folarin Omoniyi; MacDermid, Joy Christine; MacIntyre, Norma
2017-01-01
Nonadherence to treatment remains high among patients with musculoskeletal conditions with negative impact on the treatment outcomes, use of personal and cost of care. An active knowledge translation (KT) strategy may be an effective strategy to support practice change. The purpose of this study was to deliver a brief, interactive, multifaceted and targeted KT program to improve physiotherapist knowledge and confidence in performing adherence enhancing activities related to risk, barriers, assessment and interventions. We utilised a 2-phase approach in this KT project. Phase 1 involved the development of an adherence tool kit following a synthesis of the literature and an iterative process involving 47 end-users. Clinicians treating patients with musculoskeletal conditions were recruited from two Physiotherapy and Occupational therapy national conferences in Canada. The intervention, based on the acronym SIMPLE TIPS was tested on 51 physiotherapists in phase 2. A pre- and post-repeated measures design was used in Phase 2. Graham's knowledge-to-action cycle was used as the conceptual framework. Participants completed a pre-intervention assessment, took part in a 1-h educational session and completed a post-intervention assessment. A questionnaire was used to measure knowledge of evidence-based treatment adherence barriers, interventions and measures and confidence to perform evidence-based adherence practice activities. Data was analysed using descriptive statistics (frequency and percentage), Fisher's exact test and Wilcoxon Sign-Ranked tests. Barriers and facilitators of adherence were identified under three domains (therapist, patient, health system) in phase 1. Seventy percent of the participants completed the questionnaire. Results indicated that 46.8% of respondents explored barriers including the use of behaviour change strategies and 45.7% reported that they measured adherence but none reported the use of validated outcomes. A significant improvement in
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["Practical clinical competence" - a joint programme to improve training in surgery].
Ruesseler, M; Schill, A; Stibane, T; Damanakis, A; Schleicher, I; Menzler, S; Braunbeck, A; Walcher, F
2013-12-01
Practical clinical competence is, as a result of the complexity of the required skills and the immediate consequences of their insufficient mastery, fundamentally important for undergraduate medical education. However, in the daily clinical routine, undergraduate training competes with patient care and experimental research, mostly to the disadvantage of the training of clinical skills and competencies. All students have to spend long periods in compulsory surgical training courses during their undergraduate studies. Thus, surgical undergraduate training is predestined to exemplarily develop, analyse and implement a training concept comprising defined learning objectives, elaborated teaching materials, analysed teaching methods, as well as objective and reliable assessment methods. The aim of this project is to improve and strengthen undergraduate training in practical clinical skills and competencies. The project is funded by the German Federal Ministry of Education and Research with almost two million Euro as a joint research project of the medical faculties of the universities of Frankfurt/Main, Gießen and Marburg, in collaboration with the German Society of Surgery, the German Society of Medical Education and the German Medical Students' Association. Nine packages in three pillars are combined in order to improve undergraduate medical training on a methodical, didactic and curricular level in a nation-wide network. Each partner of this network provides a systematic contribution to the project based on individual experience and competence. Based on the learning objectives, which were defined by the working group "Education" of the German Society of Surgery, teaching contents will be analysed with respect to their quality and will be available for both teachers and students as mobile learning tool (first pillar). The existing surgical curricula at the cooperating medical faculties will be analysed and teaching methods as well as assessment methods for clinical
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Joosen, Margot C W; van Beurden, Karlijn M; Terluin, Berend; van Weeghel, Jaap; Brouwers, Evelien P M; van der Klink, Jac J L
2015-04-24
Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs' barriers were evaluated. OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs' experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training. The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.
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Smith, Michelle K.; Jones, Francis H. M.; Gilbert, Sarah L.; Wieman, Carl E.
2013-01-01
Instructors and the teaching practices they employ play a critical role in improving student learning in college science, technology, engineering, and mathematics (STEM) courses. Consequently, there is increasing interest in collecting information on the range and frequency of teaching practices at department-wide and institution-wide scales. To…
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Developer Stories: Improving Architecture in Agile Practice
DEFF Research Database (Denmark)
Tjørnehøj, Gitte; Jensen, Rolf Njor; Platz, Niels
2007-01-01
of viable architectures. To strengthen XP in this regard a new practice: Developer Stories ([2]) was introduced in 2006 - mainly based on a theoretical argumentation. This paper reports from extensive experimentation with, and elaboration of the new practice. Results from this experimentation shows...... that using Developer Stories increases the likelihood of developing a viable architecture through a series of deliberate choices, through creating disciplined and recurring activities that: 1) Facilitate sharing and embodying of knowledge about architectural issues, and 2) heighten visibility of refactorings...
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Magruder, J Trent; Blasco-Colmenares, Elena; Crawford, Todd; Alejo, Diane; Conte, John V; Salenger, Rawn; Fonner, Clifford E; Kwon, Christopher C; Bobbitt, Jennifer; Brown, James M; Nelson, Mark G; Horvath, Keith A; Whitman, Glenn R
2017-01-01
Variation in red blood cell (RBC) transfusion practices exists at cardiac surgery centers across the nation. We tested the hypothesis that significant variation in RBC transfusion practices between centers in our state's cardiac surgery quality collaborative remains even after risk adjustment. Using a multiinstitutional statewide database created by the Maryland Cardiac Surgery Quality Initiative (MCSQI), we included patient-level data from 8,141 patients undergoing isolated coronary artery bypass (CAB) or aortic valve replacement at 1 of 10 centers. Risk-adjusted multivariable logistic regression models were constructed to predict the need for any intraoperative RBC transfusion, as well as for any postoperative RBC transfusion, with anonymized center number included as a factor variable. Unadjusted intraoperative RBC transfusion probabilities at the 10 centers ranged from 13% to 60%; postoperative RBC transfusion probabilities ranged from 16% to 41%. After risk adjustment with demographic, comorbidity, and operative data, significant intercenter variability was documented (intraoperative probability range, 4% -59%; postoperative probability range, 13%-39%). When stratifying patients by preoperative hematocrit quartiles, significant variability in intraoperative transfusion probability was seen among all quartiles (lowest quartile: mean hematocrit value, 30.5% ± 4.1%, probability range, 17%-89%; highest quartile: mean hematocrit value, 44.8% ± 2.5%; probability range, 1%-35%). Significant variation in intercenter RBC transfusion practices exists for both intraoperative and postoperative transfusions, even after risk adjustment, among our state's centers. Variability in intraoperative RBC transfusion persisted across quartiles of preoperative hematocrit values. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Smith, Teresa M; Blaser, Casey; Geno-Rasmussen, Cristy; Shuell, Julie; Plumlee, Catherine; Gargano, Tony; Yaroch, Amy L
2017-08-31
The National Early Care and Education Learning Collaboratives (ECELC) project aims to facilitate best practices in nutrition, physical activity, screen time, and breastfeeding support and infant feeding among early care and education (ECE) programs across multiple states. The project uses a train-the-trainer approach with 5, in-person learning-collaborative sessions, technical assistance, and action planning. We describe the longitudinal practice-based evaluation of the project and assess whether ECE programs evaluated (n = 104) sustained changes in policies and practices 1 year after completing the project. The number of best practices increased from pre-assessment to post-assessment (P professional development and training focused on improving best practices for environment-level child nutrition and physical activity, which is one strategy among many that are warranted for obesity prevention in young children.
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Super-ranging. A new ranging strategy in European badgers.
Directory of Open Access Journals (Sweden)
Aoibheann Gaughran
Full Text Available We monitored the ranging of a wild European badger (Meles meles population over 7 years using GPS tracking collars. Badger range sizes varied seasonally and reached their maximum in June, July and August. We analysed the summer ranging behaviour, using 83 home range estimates from 48 individuals over 6974 collar-nights. We found that while most adult badgers (males and females remained within their own traditional social group boundaries, several male badgers (on average 22% regularly ranged beyond these traditional boundaries. These adult males frequently ranged throughout two (or more social group's traditional territories and had extremely large home ranges. We therefore refer to them as super-rangers. While ranging across traditional boundaries has been recorded over short periods of time for extraterritorial mating and foraging forays, or for pre-dispersal exploration, the animals in this study maintained their super-ranges from 2 to 36 months. This study represents the first time such long-term extra-territorial ranging has been described for European badgers. Holding a super-range may confer an advantage in access to breeding females, but could also affect local interaction networks. In Ireland & the UK, badgers act as a wildlife reservoir for bovine tuberculosis (TB. Super-ranging may facilitate the spread of disease by increasing both direct interactions between conspecifics, particularly across social groups, and indirect interactions with cattle in their shared environment. Understanding super-ranging behaviour may both improve our understanding of tuberculosis epidemiology and inform future control strategies.
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Kanagy-Borofka, Lori
2013-01-01
This study examined effects of integrating mindfulness practices into the 5th grade curriculum to improve attention-to-task, including inattention and executive functioning, hyperactivity/impulsivity, and social relations. As academic requirements become more rigorous, students have been expected to demonstrate increased skills in…
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Directory of Open Access Journals (Sweden)
Fraser Alec
2011-06-01
Full Text Available Abstract Background The gap between research findings and clinical practice is well documented and a range of interventions has been developed to increase the implementation of research into clinical practice. Findings A review of systematic reviews of the effectiveness of interventions designed to increase the use of research in clinical practice. A search for relevant systematic reviews was conducted of Medline and the Cochrane Database of Reviews 1998-2009. 13 systematic reviews containing 313 primary studies were included. Four strategy types are identified: audit and feedback; computerised decision support; opinion leaders; and multifaceted interventions. Nine of the reviews reported on multifaceted interventions. This review highlights the small effects of single interventions such as audit and feedback, computerised decision support and opinion leaders. Systematic reviews of multifaceted interventions claim an improvement in effectiveness over single interventions, with effect sizes ranging from small to moderate. This review found that a number of published systematic reviews fail to state whether the recommended practice change is based on the best available research evidence. Conclusions This overview of systematic reviews updates the body of knowledge relating to the effectiveness of key mechanisms for improving clinical practice and service development. Multifaceted interventions are more likely to improve practice than single interventions such as audit and feedback. This review identified a small literature focusing explicitly on getting research evidence into clinical practice. It emphasizes the importance of ensuring that primary studies and systematic reviews are precise about the extent to which the reported interventions focus on changing practice based on research evidence (as opposed to other information codified in guidelines and education materials.
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Good practices in heavy water reactor operation
International Nuclear Information System (INIS)
2010-06-01
The value and importance of organizations in the nuclear industry engaged in the collection and analysis of operating experience and best practices has been clearly identified in various IAEA publications and exercises. Both facility safety and operational efficiency can benefit from such information sharing. Such sharing also benefits organizations engaged in the development of new nuclear power plants, as it provides information to assist in optimizing designs to deliver improved safety and power generation performance. In cooperation with Atomic Energy of Canada, Ltd, the IAEA organized the workshop on best practices in Heavy Water Reactor Operation in Toronto, Canada from 16 to 19 September 2008, to assist interested Member States in sharing best practices and to provide a forum for the exchange of information among participating nuclear professionals. This workshop was organized under Technical Cooperation Project INT/4/141, on Status and Prospects of Development for and Applications of Innovative Reactor Concepts for Developing Countries. The workshop participants were experts actively engaged in various aspects of heavy water reactor operation. Participants presented information on activities and practices deemed by them to be best practices in a particular area for consideration by the workshop participants. Presentations by the participants covered a broad range of operational practices, including regulatory aspects, the reduction of occupational dose, performance improvements, and reducing operating and maintenance costs. This publication summarizes the material presented at the workshop, and includes session summaries prepared by the chair of each session and papers submitted by the presenters
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Gieskes, J.F.B.; Baudet, F.C.M.; Baudet, Frank; Schuring, R.W.; Boer, Harm
1997-01-01
In order to get insight into the current continuous-improvement practices in European industry, EuroCINet carried out a survey in its member countries. In this article, continuous-improvement activities in a sample of 135 Dutch industrial companies are described. The results show that CI is a
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Improving Integrated Care: Modelling the performance of an online community of practice
Directory of Open Access Journals (Sweden)
Ángel Díaz-Chao
2014-03-01
Full Text Available Introduction: This article aims to confirm the following core hypothesis: a Community of Practice’s use of a Web 2.0 platform for communication between primary and hospital care leads to improved primary care and fewer hospital referrals. This core hypothesis will be corroborated by testing a further five partial hypotheses that complete the main hypothesis being estimated.Methods: An ad-hoc questionnaire was designed and sent to a sample group of 357 professionals from the Badalona-Sant Adrià de Besòs Primary Care Service in Catalonia, Spain, which includes nine primary care centres and three specialist care centres. The study sample was formed by 159 respondents. The partial least squares methodology was used to estimate the model of the causal relationship and the proposed hypotheses.Results: It was found that when healthcare staff used social networks and information and communication technologies professionally, and the more contact hours they have with patients, the more a Web 2.0 platform was likely to be used for communication between primary and hospital care professionals. Such use led to improved primary care and fewer hospital referrals according to the opinions of health professionals on its use.Conclusions: The research suggests that the efficiency of medical practice is explained by the intensity of Web 2.0 platform use for communication between primary and specialist care professionals. Public policies promoting the use of information and communication technologies in communities of practice should go beyond the technological dimension and consider other professional, organisational and social determinants.
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Improvement of environmental health and hygiene practices--case study in the Northern Province.
Mathekgana, M A; Chauke, L K; Otieno, F A
2001-01-01
The primary purpose of an improved water supply and sanitation is the achievement of acceptable health and hygiene standards as well as the sustainable improvement of the environment. Many governments recognize this and so they budget for large sums of money to improve these services to the communities. The purpose of this study was to investigate the different gaps in environmental health and hygiene practices with the aim of suggesting a strategy of improving this in the Northern Province of South Africa. To do this, 231 households and 30 schools were surveyed. Workshops and visits to different government departments were also used. This paper reports the results from this study which indicate that the situation in schools was not any better than that in households, with more than 90% of the villages still dependent on the unimproved pit latrines and 56,6% relying on standpipes which were (70% of the time) non-operational. The main problems identified seem to those associated with implementation and maintenance. The study concludes that with proper training of the water committees and their active involvement with the government and NGOs, environmental health and hygiene problems can be minimized or eliminated.
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Carbon, Claus-Christian; Gebauer, Fabian
2017-10-01
The Safe-Range-Inventory (SRI) was constructed in order to help public authorities to improve the charging infrastructures for electric vehicles [1; 10.1016/j.trf.2017.04.011]. Specifically, the impact of fast (vs slow) charging stations on people's range anxiety was examined. Ninety-seven electric vehicle users from Germany (81 male; M age =46.3 years, SD =12.1) were recruited to participate in the experimental design. Statistical analyses were conducted using ANOVA for repeated measures to test for interaction effects of available charging stations and remaining range with the dependent variable range anxiety . The full data set is publicly available via https://osf.io/bveyw/ (Carbon and Gebauer, 2017) [2].
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DEFF Research Database (Denmark)
Laugen, Bjørge Timenes; Boer, Harry; Acur, Nuran
2006-01-01
, twenty-seven analysers and seven defenders (Miles and Snow, 1978) suggests that the NPD improvement motives and practices of these three types of strategies are less different than we expected. Our explanation for this finding is that the three strategic types are growing towards each other, forced...
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West, Sarah Katherine
2016-01-01
This article aims to summarize the successes and future implications for a nurse practitioner-driven committee on process improvement in trauma. The trauma nurse practitioner is uniquely positioned to recognize the need for clinical process improvement and enact change within the clinical setting. Application of the Strong Model of Advanced Practice proves to actively engage the trauma nurse practitioner in process improvement initiatives. Through enhancing nurse practitioner professional engagement, the committee aims to improve health care delivery to the traumatically injured patient. A retrospective review of the committee's first year reveals trauma nurse practitioner success in the domains of direct comprehensive care, support of systems, education, and leadership. The need for increased trauma nurse practitioner involvement has been identified for the domains of research and publication.
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Scott, Angela Bullanday; Singh, Mini; Groves, Peter; Hernandez-Jover, Marta; Barnes, Belinda; Glass, Kathryn; Moloney, Barbara; Black, Amanda; Toribio, Jenny-Ann
2018-01-01
This paper describes the level of adoption of biosecurity practices performed on Australian commercial chicken meat and layer farms and farmer-perceived importance of these practices. On-farm interviews were conducted on 25 free range layer farms, nine cage layer farms, nine barn layer farms, six free range meat chicken farms and 15 barn meat chicken farms in the Sydney basin bioregion and South East Queensland. There was a high level of treatment of drinking water across all farm types; town water was the most common source. In general, meat chicken farms had a higher level of adoption of biosecurity practices than layer farms. Cage layer farms had the shortest median distance between sheds (7.75m) and between sheds and waterbodies (30m). Equipment sharing between sheds was performed on 43% of free range meat chicken farms compared to 92% of free range layer farms. There was little disinfection of this shared equipment across all farm types. Footbaths and visitor recording books were used by the majority of farms for all farm types except cage layer farms (25%). Wild birds in sheds were most commonly reported in free range meat chicken farms (73%). Dogs and cats were kept across all farm types, from 56% of barn layer farms to 89% of cage layer farms, and they had access to the sheds in the majority (67%) of cage layer farms and on the range in some free range layer farms (44%). Most biosecurity practices were rated on average as 'very important' by farmers. A logistic regression analysis revealed that for most biosecurity practices, performing a practice was significantly associated with higher perceived farmer importance of that biosecurity practice. These findings help identify farm types and certain biosecurity practices with low adoption levels. This information can aid decision-making on efforts used to improve adoption levels.
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Gotsman, Israel; Ezra, Orly; Hirsh Raccah, Bruria; Admon, Dan; Lotan, Chaim; Dekeyser Ganz, Freda
2017-08-01
Many patients with heart failure need anticoagulants, including warfarin. Good control is particularly challenging in heart failure patients, with range, thereby increasing the risk of complications. This study aimed to evaluate the effect of a patient-specific tailored intervention on anticoagulation control in patients with heart failure. Patients with heart failure taking warfarin therapy (n = 145) were randomized to either standard care or a 1-time intervention assessing potential risk factors for lability of INR, in which they received patient-specific instructions. Time in therapeutic range (TTR) using Rosendaal's linear model was assessed 3 months before and after the intervention. The patient-tailored intervention significantly increased anticoagulation control. The median TTR levels before intervention were suboptimal in the interventional and control groups (53% vs 45%, P = .14). After intervention the median TTR increased significantly in the interventional group compared with the control group (80% [interquartile range, 62%-93%] vs 44% [29%-61%], P <.0001). The intervention resulted in a significant improvement in the interventional group before versus after intervention (53% vs 80%, P <.0001) but not in the control group (45% vs 44%, P = .95). The percentage of patients with a TTR ≥60%, considered therapeutic, was substantially higher in the interventional group: 79% versus 25% (P <.0001). The INR variability (standard deviation of each patient's INR measurements) decreased significantly in the interventional group, from 0.53 to 0.32 (P <.0001) after intervention but not in the control group. Patient-specific tailored intervention significantly improves anticoagulation therapy in patients with heart failure. Copyright © 2017 Elsevier Inc. All rights reserved.
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Organizational climate and hospital nurses' caring practices: a mixed-methods study.
Roch, Geneviève; Dubois, Carl-Ardy; Clarke, Sean P
2014-06-01
Organizational climate in healthcare settings influences patient outcomes, but its effect on nursing care delivery remains poorly understood. In this mixed-methods study, nurse surveys (N = 292) were combined with a qualitative case study of 15 direct-care registered nurses (RNs), nursing personnel, and managers. Organizational climate explained 11% of the variation in RNs' reported frequency of caring practices. Qualitative data suggested that caring practices were affected by the interplay of organizational climate dimensions with patients and nurses characteristics. Workload intensity and role ambiguity led RNs to leave many caring practices to practical nurses and assistive personnel. Systemic interventions are needed to improve organizational climate and to support RNs' involvement in a full range of caring practices. © 2014 Wiley Periodicals, Inc.
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Holmboe, Eric S.; Meehan, Thomas P.; Lynn, Lorna; Doyle, Paula; Sherwin, Tierney; Duffy, F. Daniel
2006-01-01
Introduction: The American Board of Internal Medicine (ABIM) recognized that certification and recertification must be based on an assessment of performance in practice as well as an examination of medical knowledge. Physician self-assessment of practice performance is proposed as one method that certification boards may use to evaluate competence…
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Collet, Jean-Paul; Skippen, Peter W; Mosavianpour, Mir Kaber; Pitfield, Alexander; Chakraborty, Bubli; Hunte, Garth; Lindstrom, Ronald; Kissoon, Niranjan; McKellin, William H
2014-01-08
Despite considerable efforts, engaging staff to lead quality improvement activities in practice settings is a persistent challenge. At British Columbia Children's Hospital (BCCH), the pediatric intensive care unit (PICU) undertook a new phase of quality improvement actions based on the Community of Practice (CoP) model with Participatory Action Research (PAR). This approach aims to mobilize the PICU 'community' as a whole with a focus on practice; namely, to create a 'community of practice' to support reflection, learning, and innovation in everyday work. An iterative two-stage PAR process using mixed methods has been developed among the PICU CoP to describe the environment (stage 1) and implement specific interventions (stage 2). Stage 1 is ethnographic description of the unit's care practice. Surveys, interviews, focus groups, and direct observations describe the clinical staff's experiences and perspectives around bedside care and quality endeavors in the PICU. Contrasts and comparisons across participants, time and activities help understanding the PICU culture and experience. Stage 2 is a succession of PAR spirals, using results from phase 1 to set up specific interventions aimed at building the staff's capability to conduct QI projects while acquiring appropriate technical skills and leadership capacity (primary outcome). Team communication, information, and interaction will be enhanced through a knowledge exchange (KE) and a wireless network of iPADs. Lack of leadership at the staff level in order to improve daily practice is a recognized challenge that faces many hospitals. We believe that the PAR approach within a highly motivated CoP is a sound method to create the social dynamic and cultural context within which clinical teams can grow, reflect, innovate and feel proud to better serve patients.
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Improving needle tip identification during ultrasound-guided procedures in anaesthetic practice.
Scholten, H J; Pourtaherian, A; Mihajlovic, N; Korsten, H H M; A Bouwman, R
2017-07-01
Ultrasound guidance is becoming standard practice for needle-based interventions in anaesthetic practice, such as vascular access and peripheral nerve blocks. However, difficulties in aligning the needle and the transducer can lead to incorrect identification of the needle tip, possibly damaging structures not visible on the ultrasound screen. Additional techniques specifically developed to aid alignment of needle and probe or identification of the needle tip are now available. In this scoping review, advantages and limitations of the following categories of those solutions are presented: needle guides; alterations to needle or needle tip; three- and four-dimensional ultrasound; magnetism, electromagnetic or GPS systems; optical tracking; augmented (virtual) reality; robotic assistance; and automated (computerised) needle detection. Most evidence originates from phantom studies, case reports and series, with few randomised clinical trials. Improved first-pass success and reduced performance time are the most frequently cited benefits, whereas the need for additional and often expensive hardware is the greatest limitation to widespread adoption. Novice ultrasound users seem to benefit most and great potential lies in education. Future research should focus on reporting relevant clinical parameters to learn which technique will benefit patients most in terms of success and safety. © 2017 The Association of Anaesthetists of Great Britain and Ireland.
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Directory of Open Access Journals (Sweden)
B. O. Kashongwe
2017-01-01
Full Text Available This study characterized wheat straw feeding practices in smallholder farms using cross sectional survey and the results informed the design of an experiment to improve the nutritive value of wheat straw with urea and yeast culture treatment. Three diets tested in 49 days’ feeding trial were farmers’ rainy season feeding practice (FP, addition of urea to wheat straw at the time of feeding (USWS, and 14 days’ incubation of straw with urea (UTWS. Yeast culture (15 g/day was mixed with commercial dairy meal at the point of feeding. Survey data identified farmers’ strategies in utilizing crop residues of which most important were improving storage facility (77.6%, adding molasses (54.5%, and buying a shredding machine (45.1%. On-farm feeding trial showed that intake was higher for UTWS than (p<0.05 for USWS while milk yield was higher with FP than (p<0.005 with UTWS or USWS but not different (p≥0.05 between UTWS and USWS. Results imply that farmers feeding practices of crop residues may be improved for dairy cows’ feeding and therefore UTWS could be used to support maintenance and milk production during dry season. Improving farmers feed storage facilities and training on incubation of wheat straw for dairy cattle feeding were recommended.
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Health knowledge, attitude and practice among Iranian pilgrims.
Tabatabaei, Aminreza; Mortazavi, Seyyed Mostafa; Shamspour, Navvab; Shushtarizadeh, Naser
2015-02-01
Iran has the highest number of Umrah pilgrims among Islamic countries. Health care plays a major role in fulfilling the Umrah rites. Pilgrims' health situation depends on their health knowledge, attitude, and practice (KAP). In this study, we aimed to determine the health KAP among Iranian Umrah pilgrims. In this cross-sectional study, 157 Iranian Umrah pilgrims were randomly selected in Mecca, Saudi Arabia in June 2011. Data were collected using a questionnaire. The questionnaire consisted of demographic information (sex, age, degree of education, and resource of health knowledge), health knowledge (5 questions), health attitude (5 questions) and health practice (10 questions). Level of knowledge were very low in 12.1%, low in 25.2%, average in 38.1%, good in 20.4% and very good in 4.2% of respondents. Mean and standard deviation of attitude score was 18.58 ± 2.20 out of 25 (ranged between 13.00 and 25.00). The pilgrims were given 74.2 % out of total score. The Mean and standard deviation of practice score was 8.19 ± 1.32 out of 10 (ranged between 3 and 10). Although the old and low educated pilgrims had little knowledge of health tips, they had a good health attitude and practice. Educational strategy to improve knowledge regarding health-related problems and to develop health practices among pilgrims is needed.
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Perceptual learning improves visual performance in juvenile amblyopia.
Li, Roger W; Young, Karen G; Hoenig, Pia; Levi, Dennis M
2005-09-01
To determine whether practicing a position-discrimination task improves visual performance in children with amblyopia and to determine the mechanism(s) of improvement. Five children (age range, 7-10 years) with amblyopia practiced a positional acuity task in which they had to judge which of three pairs of lines was misaligned. Positional noise was produced by distributing the individual patches of each line segment according to a Gaussian probability function. Observers were trained at three noise levels (including 0), with each observer performing between 3000 and 4000 responses in 7 to 10 sessions. Trial-by-trial feedback was provided. Four of the five observers showed significant improvement in positional acuity. In those four observers, on average, positional acuity with no noise improved by approximately 32% and with high noise by approximately 26%. A position-averaging model was used to parse the improvement into an increase in efficiency or a decrease in equivalent input noise. Two observers showed increased efficiency (51% and 117% improvements) with no significant change in equivalent input noise across sessions. The other two observers showed both a decrease in equivalent input noise (18% and 29%) and an increase in efficiency (17% and 71%). All five observers showed substantial improvement in Snellen acuity (approximately 26%) after practice. Perceptual learning can improve visual performance in amblyopic children. The improvement can be parsed into two important factors: decreased equivalent input noise and increased efficiency. Perceptual learning techniques may add an effective new method to the armamentarium of amblyopia treatments.
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Saeed, Sy Atezaz; Bloch, Richard M; Silver, Stuart
2015-09-01
It's been well documented that health care does not reliably transfer what we know from science into clinical practice. As a result, Americans do not always receive the care suggested by the scientific evidence. Despite the best intentions of a dedicated and skilled healthcare workforce, this can often lead to poor clinical outcomes. As research and technology rapidly advance, this gap between science and practice appears to be widening. There is an increasing public concern about a lack of access to appropriate treatment, pervasiveness of unsafe practices, and wasteful uses of precious health care resources leading to suboptimum treatment outcomes. Leadership has a critical role in creating and sustaining the environment that supports health services for individuals and populations that increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Leadership has some responsibility to improve outcomes by insuring effective use of evidence-based treatment guidelines; measurement-based care; knowledge and skills management; care coordination; and information technologies. This paper addresses leadership issues in these components of a system's ability to improve treatment outcomes.
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Cisneros-Cohernour, Edith J.; Lopez-Avila, Maria T.; Barrera-Bustillos, Maria E.
2007-01-01
This paper presents findings of a project aimed to improve the quality of science education in Southeast Mexico by the creation of a community of practice among scientists, researchers and teachers, involved in the design, implementation and evaluation of a professional development program for mathematics, chemistry, biology and physics secondary…
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Leeman, Jennifer; Birken, Sarah A; Powell, Byron J; Rohweder, Catherine; Shea, Christopher M
2017-11-03
Strategies are central to the National Institutes of Health's definition of implementation research as "the study of strategies to integrate evidence-based interventions into specific settings." Multiple scholars have proposed lists of the strategies used in implementation research and practice, which they increasingly are classifying under the single term "implementation strategies." We contend that classifying all strategies under a single term leads to confusion, impedes synthesis across studies, and limits advancement of the full range of strategies of importance to implementation. To address this concern, we offer a system for classifying implementation strategies that builds on Proctor and colleagues' (2013) reporting guidelines, which recommend that authors not only name and define their implementation strategies but also specify who enacted the strategy (i.e., the actor) and the level and determinants that were targeted (i.e., the action targets). We build on Wandersman and colleagues' Interactive Systems Framework to distinguish strategies based on whether they are enacted by actors functioning as part of a Delivery, Support, or Synthesis and Translation System. We build on Damschroder and colleague's Consolidated Framework for Implementation Research to distinguish the levels that strategies target (intervention, inner setting, outer setting, individual, and process). We then draw on numerous resources to identify determinants, which are conceptualized as modifiable factors that prevent or enable the adoption and implementation of evidence-based interventions. Identifying actors and targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up. In our descriptions of each class, we identify the level of the Interactive System Framework at which the strategy is enacted (actors), level and determinants targeted (action targets), and outcomes used to
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Enhancing and Adapting Treatment Foster Care: Lessons Learned in Trying to Change Practice.
Murray, Maureen M; Southerland, Dannia; Farmer, Elizabeth M; Ballentine, Kess
2010-01-01
Evidence-based practices to improve outcomes for children with severe behavioral and emotional problems have received a great deal of attention in children's mental health. Therapeutic Foster Care (TFC), a residential intervention for youth with emotional or behavioral problems, is one of the few community-based programs that is considered to be evidence-based. However, as for most treatment approaches, the vast majority of existing programs do not deliver the evidence-based version. In an attempt to fill this gap and improve practice across a wide range of TFC agencies, we developed an enhanced model of TFC based on input from both practice and research. It includes elements associated with improved outcomes for youth in "usual care" TFC agencies as well as key elements from Chamberlain's evidence-based model. The current manuscript describes this "hybrid" intervention - Together Facing the Challenge - and discusses key issues in implementation. We describe the sample and settings, highlight key implementation strategies, and provide "lessons learned" to help guide others who may wish to change practice in existing agencies.
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Welsh, Wayne N; Lin, Hsiu-Ju; Peters, Roger H; Stahler, Gerald J; Lehman, Wayne E K; Stein, Lynda A R; Monico, Laura; Eggers, Michele; Abdel-Salam, Sami; Pierce, Joshua C; Hunt, Elizabeth; Gallagher, Colleen; Frisman, Linda K
2015-07-01
This implementation study examined the impact of an organizational process improvement intervention (OPII) on a continuum of evidence based practices related to assessment and community reentry of drug-involved offenders: Measurement/Instrumentation, Case Plan Integration, Conveyance/Utility, and Service Activation/Delivery. To assess implementation outcomes (staff perceptions of evidence-based assessment practices), a survey was administered to correctional and treatment staff (n=1509) at 21 sites randomly assigned to an Early- or Delayed-Start condition. Hierarchical linear models with repeated measures were used to examine changes in evidence-based assessment practices over time, and organizational characteristics were examined as covariates to control for differences across the 21 research sites. Results demonstrated significant intervention and sustainability effects for three of the four assessment domains examined, although stronger effects were obtained for intra- than inter-agency outcomes. No significant effects were found for Conveyance/Utility. Implementation interventions such as the OPII represent an important tool to enhance the use of evidence-based assessment practices in large and diverse correctional systems. Intra-agency assessment activities that were more directly under the control of correctional agencies were implemented most effectively. Activities in domains that required cross-systems collaboration were not as successfully implemented, although longer follow-up periods might afford detection of stronger effects. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Fiander, Michelle; McGowan, Jessie; Grad, Roland; Pluye, Pierre; Hannes, Karin; Labrecque, Michel; Roberts, Nia W; Salzwedel, Douglas M; Welch, Vivian; Tugwell, Peter
2015-03-14
(odds ratio (OR), interquartile ranges (IQR)). Due to high heterogeneity across studies, meta-analysis was not feasible. We included two RCTs and four CRCTs involving 352 physicians, 48 residents, and 135 allied health practitioners. Overall risk of bias was low as was quality of the evidence. One comparison was supported by three studies and three comparisons were supported by single studies, but outcomes across the three studies were highly heterogeneous. We found no studies to support EHI versus no alternative. Given these factors, it was not possible to determine the relative effectiveness of interventions. All studies reported practitioner use of EHI, two reported on compliance with electronic practice guidelines, and none reported on patient outcomes.One trial (139 participants) measured guideline adherence for an electronic versus printed guideline, but reported no difference between groups (median OR 0.85, IQR 0.74 to 1.08). One small cross-over trial (10 participants) reported increased use of clinical guidelines when provided with a mobile versus stationary, desktop computer (mean use per shift: intervention group (IG) 3.6, standard deviation (SD) 1.7 vs. control group (CG) 2.0 (SD 1.9), P value = 0.033). One cross-over trial (203 participants) reported that using a customized versus a generic interface had little impact on practitioners' use of EHI (mean difference in adjusted end-of-study rate: 0.77 logins/month/user, 95% confidence interval (CI) CI 0.43 to 1.11). Three trials included education or training and reported increased use of EHI by practitioners following training. This review provided no evidence that the use of EHI translates into improved clinical practice or patient outcomes, though it does suggest that when practitioners are provided with EHI and education or training, the use of EHI increases. We have defined use as the activity of logging into an EHI resource, but based on our findings use does not automatically translate to the
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Malhi, Saima Mahmood; Ajmal, Kiran; Shamim, Sumbul; Ata, Saniya; Farooq, Salman; Sharib, Syed Muhammad; Muntaha, Sidrat-ul
2017-01-01
Objectives & Background: Good curriculum is reflected as the backbone for standard universities to develop competitive professionals having great potential. Pharmacy education in Pakistan has gone through the same developmental stages as in other countries, but is still striving for improvement. In the present study, we want (i) to know the opinion on whether the current pharmacy curriculum requires any improvement in order to meet the training needs of pharmacy professionals regarding clinical knowledge and pharmacy practice; and (ii) to present some humble suggestions to decision-making authorities in order to improve it with respect to patient-focused programs (PFP). Methods: The study was conducted in two sessions. In first session, a questionnaire was distributed to pharmacy students of eight public/private sector universities of Karachi (N = 354) offering Pharm. D degrees. The second session dealt with the pharmacy teachers, deans, and practicing pharmacists in health care facilities (who are in any ways also related to academia), in order to take their opinions on and suggestions for the development of a better Pharm. D curriculum (N = 135). Results: Our results showed that 75.2% of respondents agree that the Pharm. D curriculum does not meet the international standards of practice, and 88.4% of respondents support the addition of more clinical aspects than industrial ones, as Pharm. D could be both clinically and industrially oriented, according to the needs of the Pakistani people. Furthermore, 80.2% of respondents are of the view that an apprenticeship should be included in last two years, while 88.4% demand a ‘paid residency program’ to facilitate the hospital, clinical and compounding areas of pharmacy. In addition, we also received a number of verbal suggestions for improving the Pharm. D curriculum being followed in Pakistan. Discussion & Conclusions: We conclude that our Pharm. D curriculum needs additions in terms of clinical practice by
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Effectiveness of a short-course in improving knowledge and skills on evidence-based practice
Directory of Open Access Journals (Sweden)
Jiménez-Villa Josep
2011-06-01
Full Text Available Abstract Background To assess the effectiveness (change in knowledge and skills measured by the Fresno test of a short course in Evidence Based Practice (EBP carried out in a group of family medicine residents Methods Before-after study. Participants' were 152 Family Medicine residents in their second year of the training programme. Settings were Primary Care Teaching Units in Catalonia. Intervention was comprised of a four half-day training course designed to develop the knowledge and skills required to practice evidence-based care. The main outcome measure was change in EBP knowledge and skills, measured using the Spanish version of the Fresno test (score range, 0-212 Results The mean difference between pre-test and post-test was 47.7, a statistically significant result with 95% CI of 42.8-52.5 (p Conclusions The study provides evidence for responsiveness to changes in knowledge and skills in EBP after an educational intervention.
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Embedding technology into inter-professional best practices in home safety evaluation.
Burns, Suzanne Perea; Pickens, Noralyn Davel
2017-08-01
To explore inter-professional home evaluators' perspectives and needs for building useful and acceptable decision-support tools for the field of home modifications. Twenty semi-structured interviews were conducted with a range of home modification professionals from different regions of the United States. The interview transcripts were analyzed with a qualitative, descriptive, perspective approach. Technology supports current best practice and has potential to inform decision making through features that could enhance home evaluation processes, quality, efficiency and inter-professional communication. Technological advances with app design have created numerous opportunities for the field of home modifications. Integrating technology and inter-professional best practices will improve home safety evaluation and intervention development to meet client-centred and societal needs. Implications for rehabilitation Understanding home evaluators technology needs for home safety evaluations contributes to the development of app-based assessments. Integrating inter-professional perspectives of best practice and technological needs in an app for home assessments improves processes. Novice and expert home evaluators would benefit from decision support systems embedded in app-based assessments. Adoption of app-based assessment would improve efficiency while remaining client-centred.
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Standardization of radiation protection measurements in mixed fields of an extended energy range
International Nuclear Information System (INIS)
Hoefert, M.; Stevenson, G.R.
1977-01-01
The improved ICRU concept of dose equivalent index aims at standardizing both area and personnel dose measurements so that the results on the dosimetry of external irradiations in radiation protection become compatible. It seems that for photon and neutron energies up to 3 and 20 MeV respectively the realization of dose-equivalent index is straightforward, but the inclusion of higher energies and/or other types of radiation will lead both to conceptual and practical difficulties. It will be shown that practical measurements in mixed radiation fields of an extended energy range for protection purposes will overestimate the standardized quantity. While area measurements can be performed to represent a good approximation, greater uncertainties have to be accepted in personnel dosimetry for stray radiation fields around GeV proton accelerators
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Iyengar, Kirti; Jain, Motilal; Thomas, Sunil; Dashora, Kalpana; Liu, William; Saini, Paramsukh; Dattatreya, Rajesh; Parker, Indrani; Iyengar, Sharad
2014-08-13
After the launch of Janani Suraksha Yojana, a conditional cash transfer scheme in India, the proportion of women giving birth in institutions has rapidly increased. However, there are important gaps in quality of childbirth services during institutional deliveries. The aim of this intervention was to improve the quality of childbirth services in selected high caseload public health facilities of 10 districts of Rajasthan. This intervention titled "Parijaat" was designed by Action Research & Training for Health, in partnership with the state government and United Nations Population Fund. The intervention was carried out in 44 public health facilities in 10 districts of Rajasthan, India. These included district hospitals (9), community health centres (32) and primary health centres (3). The main intervention was orientation training of doctors and program managers and regular visits to facilities involving assessment, feedback, training and action. The adherence to evidence based practices before, during and after this intervention were measured using structured checklists and scoring sheets. Main outcome measures included changes in practices during labour, delivery or immediate postpartum period. Use of several unnecessary or harmful practices reduced significantly. Most importantly, proportion of facilities using routine augmentation of labour reduced (p = 0), episiotomy for primigravidas (p = 0.0003), fundal pressure (p = 0.0003), and routine suction of newborns (0 = 0.0005). Among the beneficial practices, use of oxytocin after delivery increased (p = 0.0001) and the practice of listening foetal heart sounds during labour (p = 0.0001). Some practices did not show any improvements, such as dorsal position for delivery, use of partograph, and hand-washing. An intervention based on repeated facility visits combined with actions at the level of decision makers can lead to substantial improvements in quality of childbirth practices at health facilities.
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An On-Chip RBC Deformability Checker Significantly Improves Velocity-Deformation Correlation
Directory of Open Access Journals (Sweden)
Chia-Hung Dylan Tsai
2016-10-01
Full Text Available An on-chip deformability checker is proposed to improve the velocity–deformation correlation for red blood cell (RBC evaluation. RBC deformability has been found related to human diseases, and can be evaluated based on RBC velocity through a microfluidic constriction as in conventional approaches. The correlation between transit velocity and amount of deformation provides statistical information of RBC deformability. However, such correlations are usually only moderate, or even weak, in practical evaluations due to limited range of RBC deformation. To solve this issue, we implemented three constrictions of different width in the proposed checker, so that three different deformation regions can be applied to RBCs. By considering cell responses from the three regions as a whole, we practically extend the range of cell deformation in the evaluation, and could resolve the issue about the limited range of RBC deformation. RBCs from five volunteer subjects were tested using the proposed checker. The results show that the correlation between cell deformation and transit velocity is significantly improved by the proposed deformability checker. The absolute values of the correlation coefficients are increased from an average of 0.54 to 0.92. The effects of cell size, shape and orientation to the evaluation are discussed according to the experimental results. The proposed checker is expected to be useful for RBC evaluation in medical practices.
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Directory of Open Access Journals (Sweden)
Dr Sylod Chimhenga
2017-07-01
Full Text Available Supervisors are expected to observe how student teachers prepare deliver the lesson and conduct themselves as members of teaching profession and are expected to advise the students on how to improve their teaching skills. The present study is a descriptive survey which sought to analyze student teachers perception towards teaching practice as an exercise for grading or improvement and examine student teachers perception towards student-supervisor comments during discussion after classroom assessment. The sample comprised of 50 second year Diploma in Education who had undergone teaching practice in 2016. The students were purposefully sampled. In purposeful sampling the researcher selects the participants because they possess particular characteristics or knowledge being sought. A questionnaire was used to collect data for this study. The findings indicated that majority of student teachers who participated in the teaching practice perceived that the supervisors gave grades which did not reflect the comments made about the teaching performance of the student teacher. Based on the findings recommendations were made among others that assessment should match the comments on areas needing improvement and meaningful accompanying comments should be made to guide student teachers in the desired directions during teaching practice encourage student teachers to try harder or to give credit for work done well.
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IMPROVING SITE MANAGEMENT PRACTICES IN THE NIGERIAN ...
African Journals Online (AJOL)
Osondu
This study assessed management practices on ... technological methods adopted and huge ... Ethiopian Journal of Environmental Studies and Management EJESM Vol. 5 No. .... perspectives. .... specifications, cost data, programmes, plus.
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Effectiveness of motor practice in lucid dreams: a comparison with physical and mental practice.
Stumbrys, Tadas; Erlacher, Daniel; Schredl, Michael
2016-01-01
Motor practice in lucid dreams is a form of mental rehearsal where the dreamer can consciously rehearse motor skills in the dream state while being physically asleep. A previous pilot study showed that practice in lucid dreams can improve subsequent performance. This study aimed to replicate those findings with a different task (finger-tapping) and compare the effectiveness of lucid dream practice (LDP) not only to physical but also to mental practice (MP) in wakefulness. An online experiment was completed by 68 participants within four groups: LDP group, MP group, physical practice (PP) group and control (no practice) group. Pre-test was accomplished in the evening, post-test in the next morning, while the practice was done during the night. All three practice groups significantly improved their performance from pre-test to post-test, but no significant improvements were observed for the control group. Subjective sleep quality was not affected by night practice. This study thus corroborates the previous findings that practice in lucid dreams is effective in improving performance. Its effects seem to be similar to actual PP and MP in wakefulness. Future studies should establish reliable techniques for lucid dream induction and verify the effects of LDP in sleep laboratory conditions.
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Ultra-wideband ranging precision and accuracy
International Nuclear Information System (INIS)
MacGougan, Glenn; O'Keefe, Kyle; Klukas, Richard
2009-01-01
This paper provides an overview of ultra-wideband (UWB) in the context of ranging applications and assesses the precision and accuracy of UWB ranging from both a theoretical perspective and a practical perspective using real data. The paper begins with a brief history of UWB technology and the most current definition of what constitutes an UWB signal. The potential precision of UWB ranging is assessed using Cramer–Rao lower bound analysis. UWB ranging methods are described and potential error sources are discussed. Two types of commercially available UWB ranging radios are introduced which are used in testing. Actual ranging accuracy is assessed from line-of-sight testing under benign signal conditions by comparison to high-accuracy electronic distance measurements and to ranges derived from GPS real-time kinematic positioning. Range measurements obtained in outdoor testing with line-of-sight obstructions and strong reflection sources are compared to ranges derived from classically surveyed positions. The paper concludes with a discussion of the potential applications for UWB ranging
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Linearity improvement on wide-range log signal of neutron measurement system for HANARO
International Nuclear Information System (INIS)
Kim, Young-Ki; Tuetken, Jeffrey S.
1998-01-01
This paper discusses engineering activities for improving the linearity characteristics of the Log Power signal from the neutron measurement system for HANARO. This neutron measurement system uses a fission chamber based detector which covers 10.3 decade-wide range from 10 -8 % full power(FP) up to 200%FP, The Log Power signal is designed to control the reactor at low power levels where most of the reactor physics tests are carried out. Therefore, the linearity characteristics of the Log Power signal is the major factor for accurate reactor power control. During the commissioning of the neutron measurement system, it was found that the linearity characteristics of the Log Power signal, especially near 10 -2 %FP, were not accurate enough for controlling the reactor during physics testing. Analysis of the system linearity data directly measured with reactor operating determined that the system was not operating per the design characteristics established from previous installations. The linearity data, which were taken as the reactor was increased in power, were sent to manufacturer's engineering group and a follow-up measures based on the analysis were then fed back to the field. Through step by step trouble-shooting activities, which included minor circuit modifications and alignment procedure changes, the linearity characteristics have been successfully improved and now exceed minimum performance requirements. This paper discusses the trouble-shooting techniques applied, the changes in the linearity characteristics, special circumstances in the HANARO application and the final resolution. (author)
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Wallin, Olof; Söderberg, Johan; Van Guelpen, Bethany; Stenlund, Hans; Grankvist, Kjell; Brulin, Christine
2010-09-01
Scand J Caring Sci; 2010; 24; 581-591 Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories Most errors in venous blood testing result from human mistakes occurring before the sample reach the laboratory. To survey venous blood sampling (VBS) practices in hospital wards and to compare practices with hospital laboratories. Staff in two hospitals (all wards) and two hospital laboratories (314 respondents, response rate 94%), completed a questionnaire addressing issues relevant to the collection of venous blood samples for clinical chemistry testing. The findings suggest that instructions for patient identification and the collection of venous blood samples were not always followed. For example, 79% of the respondents reported the undesirable practice (UDP) of not always using wristbands for patient identification. Similarly, 87% of the respondents noted the UDP of removing venous stasis after the sampling is finished. Compared with the ward staff, a significantly higher proportion of the laboratory staff reported desirable practices regarding the collection of venous blood samples. Neither education nor the existence of established sampling routines was clearly associated with VBS practices among the ward staff. The results of this study, the first of its kind, suggest that a clinically important risk of error is associated with VBS in the surveyed wards. Most important is the risk of misidentification of patients. Quality improvement of blood sample collection is clearly needed, particularly in hospital wards. © 2009 The Authors. Journal compilation © 2009 Nordic College of Caring Science.
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Ruhnke, Isabelle; de Koning, Carolyn; Drake, Kelly; Skerman, Alan G.; Hinch, Geoff N.; Glatz, Philip C.
2017-01-01
Baseline information on demographics and practices on semi-intensive free-range egg farms with an outdoor stocking density of ≤1500 hens/hectare in Australia is presented. Free-range egg production is changing the structure of the egg industry in Australia and a broad variety and tiers of free-range systems have emerged due to lack of concrete legislative standards on outdoor stocking densities in the past. Information was extracted from a pre-existing online free-range poultry survey dataset, consisting of a total of 79 questions related to nutrition, pasture management, welfare and health, animal housing, environmental impact and economics. Forty-one free-range egg farms, with an outdoor stocking density of ≤1500 hens/hectare, were identified in the dataset from all major Australian states. Two types of semi-intensive free-range housing systems were documented: mobile (modified caravan/trailer) housing (56%), and fixed sheds (44%). Seventy-two percent of respondents reported >75% of the hens in the flock used the outdoor range. All respondents reported ingestion of range components by hens in the form of vegetation, insects, stones and grit. Up to 10% mortality was reported by 40% respondents with predation (34%), cannibalism (29%), heat stress (24%) and grass impaction (19.5%) as major causes. Biosecurity on farms was sub-optimal with 8 of the 10 actions implemented by farms. Applied research and communication of results to farmers is highly recommended to ensure optimum health and welfare of free-range laying hens and sustained egg production. PMID:29065169
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Yee, Nathan K; Dong, Yong; Kapadia, Suresh R; Song, Jinhua J
2002-11-29
A practical and improved synthesis of (3S,5S)-3-[(tert-butyloxycarbonyl)methyl]-5-[(methanesulfonyloxy)methyl]-2-pyrrolidinone (1) is described. The key transformations involve a highly efficient reaction sequence consisting of ethoxycarbonylation, alkylation, hydrolysis, and decarboxylation to produce compound 10. The process described herein is practical, robust, and cost-effective, and it has been successfully implemented in a pilot plant to produce a multikilogram quantity of mesylate 1.
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Fuller, Jeffrey; Koehne, Kristy; Verrall, Claire C; Szabo, Natalie; Bollen, Chris; Parker, Sharon
2015-01-01
This paper draws on the implementation experience of the South Australian GP Plus Practice Nurse Initiative in order to establish what is needed to support the development of the chronic disease management role of practice nurses. The Initiative was delivered between 2007 and 2010 to recruit, train and place 157 nurses across 147 General Practices in Adelaide. The purpose was to improve chronic disease management in General Practice, by equipping nurses to work as practice nurses who would coordinate care and establish chronic disease management systems. Secondary analysis of qualitative data contained in the Initiative evaluation report, specifically drawing on quarterly project records and four focus groups conducted with practice nurses, practice nurse coordinators and practice nurse mentors. As evidenced by the need to increase the amount of support provided during the implementation of the Initiative, nurses new to General Practice faced challenges in their new role. Nurses described a big learning curve as they dealt with role transition to a new work environment and learning a range of new skills while developing chronic disease management systems. Informants valued the skills development and support offered by the Initiative, however the ongoing difficulties in implementing the role suggested that change is also needed at the level of the Practice. While just over a half of the placement positions were retained, practice nurses expressed concern with having to negotiate the conditions of their employment. In order to advance the role of practice nurses as managers of chronic disease support is needed at two levels. At one level support is needed to assist practice nurses to build their own skills. At the level of the Practice, and in the wider health workforce system, support is also needed to ensure that Practices are organisationally ready to include the practice nurse within the practice team.
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Education in Quality Improvement for Pediatric Practice: an online program to teach clinicians QI.
Bundy, David G; Morawski, Lori F; Lazorick, Suzanne; Bradbury, Scott; Kamachi, Karen; Suresh, Gautham K
2014-01-01
Education in Quality Improvement for Pediatric Practice (EQIPP) is an online program designed to improve evidence-based care delivery by teaching front-line clinicians quality improvement (QI) skills. Our objective was to evaluate EQIPP data to characterize 1) participant enrollment, use patterns, and demographics; 2) changes in performance in clinical QI measures from baseline to follow-up measurement; and 3) participant experience. We conducted an observational study of EQIPP participants utilizing 1 of 3 modules (asthma, immunizations, gastroesophageal reflux disease) from 2009 to 2013. Enrollment and use, demographic, and quality measure data were extracted directly from the EQIPP system; participant experience was assessed via an optional online survey. Study participants (n = 3501) were diverse in their gender, age, and race; most were board certified. Significant quality gaps were observed across many of the quality measures at baseline; sizable improvements were observed across most quality measures at follow-up. Participants were generally satisfied with their experience. The most influential module elements were collecting and analyzing data, creating and implementing aim statements and improvement plans, and completing "QI Basics." Online educational programs, such as EQIPP, hold promise for front-line clinicians to learn QI. The sustainability of the observed improvements in care processes and their linkage to improvements in health outcomes are unknown and are an essential topic for future study. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
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International Nuclear Information System (INIS)
Galvez-Martos, Jose-Luis; Styles, David; Schoenberger, Harald
2013-01-01
The retail trade sector has been identified as a target sector for the development of sectoral reference documents on best environmental management practices under the Eco-Management and Audit Scheme. This paper focuses on the important energy-related needs in retailers' stores such as for food refrigeration and lighting, as well as heating, ventilation and air conditioning of the building. For the definition of best environmental management practices in the European framework, frontrunner retailers have been identified as those retailers integrating energy minimization and saving measures as standard practice systematically across stores. These best performers also integrate a comprehensive monitoring system in the energy management of every store or building belonging to the company, enabling the rapid identification of energy saving opportunities. An integrative approach is needed to define how best practices should be implemented in combination to optimize energy management within stores: building aspects such as insulation of the building envelope or the heating, ventilation and air conditioning system, should be optimized in combination with best options for refrigeration in food retailers. Refrigeration systems are responsible for half of the final energy use in stores and of their carbon footprint. Natural refrigerants, heat recovery from the condensation stage and covering of display cases are measures with high environmental benefits to reduce the impact of refrigeration. Finally, practices for lighting, as optimal lighting strategies, and the integration of renewable energy sources in overall zero energy building concepts can save considerable amounts of fossil energy, reduce the carbon footprint and produce significant cost-savings in the long term. - highlights: • There is a high energy performance improvement potential of the retail trade sector. • We propose techniques with a high performance level and applied by frontrunners. • We identified
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Blok, Amanda C
2017-04-01
To report an analysis of the concept of self-management behaviors. Self-management behaviors are typically associated with disease management, with frequent use by nurse researchers related to chronic illness management and by international health organizations for development of disease management interventions. A concept analysis was conducted within the context of Orem's self-care framework. Walker and Avant's eight-step concept analysis approach guided the analysis. Academic databases were searched for relevant literature including CIHAHL, Cochrane Databases of Systematic Reviews and Register of Controlled Trials, MEDLINE, PsycARTICLES and PsycINFO, and SocINDEX. Literature using the term "self-management behavior" and published between April 2001 and March 2015 was analyzed for attributes, antecedents, and consequences. A total of 189 journal articles were reviewed. Self-management behaviors are defined as proactive actions related to lifestyle, a problem, planning, collaborating, and mental support, as well as reactive actions related to a circumstantial change, to achieve a goal influenced by the antecedents of physical, psychological, socioeconomic, and cultural characteristics, as well as collaborative and received support. The theoretical definition and middle-range explanatory theory of self-management behaviors will guide future collaborative research and clinical practice for disease management. © 2016 Wiley Periodicals, Inc.
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Advanced Energy Retrofit Guide: Practical Ways to Improve Energy Performance, K-12 Schools (Book)
Energy Technology Data Exchange (ETDEWEB)
2013-12-01
The U.S. Department of Energy developed the Advanced Energy Retrofit Guides (AERGs) to provide specific methodologies, information, and guidance to help energy managers and other stakeholders plan and execute energy efficiency improvements. Detailed technical discussion is fairly limited. Instead, we emphasize actionable information, practical methodologies, diverse case studies, and unbiased evaluations of the most promising retrofit energy efficiency measures for each building type. A series of AERGs is under development, addressing key segments of the commercial building stock. K-12 schools were selected as one of the highest priority building sectors, because schools affect the lives of most Americans. They also represent approximately 8% of the energy use and 10% of the floor area in commercial buildings nationwide. U.S. K-12 school districts spend more than $8 billion each year on energy - more than they spend on computers and textbooks combined. Most occupy older buildings that often have poor operational performance - more than 30% of schools were built before 1960. The average age of a school is about 42 years - which is nearly the expected serviceable lifespan of the building. K-12 schools offer unique opportunities for deep, cost-effective energy efficiency improvements, and this guide provides convenient and practical guidance for exploiting these opportunities in the context of public, private, and parochial schools.
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International Nuclear Information System (INIS)
Yoshino, Hironori; Wada, Kenji; Horinaka, Hiromichi; Cho, Yoshio; Umeda, Tokuo; Osawa, Masahiko.
1995-01-01
The Lambert-Beer law holding for pulsed lights transmitted through a scattering medium was examined using a streak camera. The Lambert-Beer law dynamic range is found to be limited by floor levels that are caused by scattered photons and are controllable by the use of a temporal gate on the transmitted pulse. The dynamic range improvement obtained for a scattering medium of 2.8 cm -1 scattering coefficient of a thickness of 80 mm by a temporal gate of 60 ps was as much as 50 dB and the Lambert-Beer law dynamic rang reached to 140 dB. (author)
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Innovation in clinical pharmacy practice and opportunities for academic--practice partnership.
Gubbins, Paul O; Micek, Scott T; Badowski, Melissa; Cheng, Judy; Gallagher, Jason; Johnson, Samuel G; Karnes, Jason H; Lyons, Kayley; Moore, Katherine G; Strnad, Kyle
2014-05-01
Clinical pharmacy has a rich history of advancing practice through innovation. These innovations helped to mold clinical pharmacy into a patient-centered discipline recognized for its contributions to improving medication therapy outcomes. However, innovations in clinical pharmacy practice have now waned. In our view, the growth of academic–practice partnerships could reverse this trend and stimulate innovation among the next generation of pioneering clinical pharmacists. Although collaboration facilitates innovation,academic institutions and health care systems/organizations are not taking full advantage of this opportunity. The academic–practice partnership can be optimized by making both partners accountable for the desired outcomes of their collaboration, fostering symbiotic relationships that promote value-added clinical pharmacy services and emphasizing continuous quality improvement in the delivery of these services. Optimizing academic–practice collaboration on a broader scale requires both partners to adopt a culture that provides for dedicated time to pursue innovation, establishes mechanisms to incubate ideas, recognizes where motivation and vision align, and supports the purpose of the partnership. With appropriate leadership and support, a shift in current professional education and training practices, and a commitment to cultivate future innovators, the academic–practice partnership can develop new and innovative practice advancements that will improve patient outcomes.
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Motivational Interviewing: An Evidence-Based Practice for Improving Student Practice Skills
Hohman, Melinda; Pierce, Paloma; Barnett, Elizabeth
2015-01-01
Motivational interviewing (MI) is an evidence-based communication method to assist clients in resolving their ambivalence regarding change. With a school emphasis on evidence-based practice and learning outcomes, a social work department implemented a semester-long course on MI. The purpose of this study was to determine baseline skills and…
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Gardiner, Paula; Filippelli, Amanda C; Kabbara, Karim; Lin, Steven C; Sadikova, Ekaterina; Kaptchuk, Ted J; Kemper, Kathi
2015-10-01
Little is known about the feasibility of online education in improving communication and documentation of dietary supplements (DS) among clinicians. This prospective educational study included clinicians at an urban teaching hospital. The curriculum included video streams, didactics, and interactive case presentations to discuss (1) DS safety and effectiveness, (2) cultural competency, (3) managing DS in a hospital setting, and (4) DS adverse events. Participants were surveyed, at baseline and after training, about DS knowledge, confidence, communication, and documentation practices. Thirty-nine of 61 (64%) recruited clinicians completed all four patient cases and post-tests. Most (82%) were women and 59% were physicians. The mean DS knowledge test score increased after the curriculum (p online curriculum is an effective tool for presenting DS education to clinicians with the goal of improving clinicians' knowledge, confidence, and documentation practices about DS.
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Camden, Chantal; Rivard, Lisa M; Hurtubise, Karen; Héguy, Léa; Berbari, Jade
2017-07-01
Communities of practice (CoPs) are useful knowledge translation (KT) strategies, but little is known about their impact on physical therapists' self-perceived practice. The impact of a CoP on physical therapists' self-perceived practice was evaluated, and factors influencing changes in self-perceived knowledge, skills, and practice related to developmental coordination disorder (DCD) were explored. An explanatory sequential mixed-methods design was used, guided by the Theory of Reasoned Action and Theory of Planned Behavior. Physical therapists participated in a DCD physical therapist CoP, which included 2 full-day, face-to-face workshops, with access to a 5-month online forum between the workshops, and completed questionnaires at 3 time-points: before the first workshop, before accessing the online forum, and following the second workshop. Measures completed before and after the CoP included closed-ended questions providing global scores on therapists' self-perceived knowledge, skills, and practice. Physical therapists' sociodemographic characteristics, information-seeking style, use of the online forum, and behavioral change goals were also collected. Paired t-tests, ANCOVAs, and linear regression models were used to analyze the data. Forty-one physical therapists completed all questionnaires. Their self-perceived knowledge, skills, and practice change scores were significantly higher (+0.47, +1.23, and +2.61, respectively; P behavioral changes influence patient outcomes. © 2017 American Physical Therapy Association
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Directory of Open Access Journals (Sweden)
Amy C. Bilderbeck
2015-01-01
Full Text Available Objectives. In the first randomized controlled trial of yoga on UK prisoners, we previously showed that yoga practice was associated with improved mental wellbeing and cognition. Here, we aimed to assess how class attendance, self-practice, and demographic factors were related to outcome amongst prisoners enrolled in the 10-week yoga intervention. Methods. The data of 55 participants (52 male, 3 female who completed a 10-week yoga course were analysed. Changes in pre- and postyoga measures of affect, perceived stress, and psychological symptoms were entered into linear regression analyses with bias-corrected and accelerated bootstrap confidence intervals. Class attendance, self-practice, demographic variables, and baseline psychometric variables were included as regressors. Results. Participants who attended more yoga classes and those who engaged in frequent (5 times or more self-practice reported significantly greater decreases in perceived stress. Decreases in negative affect were also significantly related to high frequency self-practice and greater class attendance at a near-significant level. Age was positively correlated with yoga class attendance, and higher levels of education were associated with greater decreases in negative affect. Conclusions. Our results suggest that there may be progressive beneficial effects of yoga within prison populations and point to subpopulations who may benefit the most from this practice.
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Directory of Open Access Journals (Sweden)
Elise Ramstad
2015-01-01
Full Text Available This paper examines the association of high-involvement innovation practices (HIIPs and simultaneous improvement of productivity and the quality of working life (QWL. HIIPs refer to work, managerial, and organizational practices that are intended for supporting continuous improvement and broad participation. The data are based on the evaluation surveys carried out by the Finnish Workplace Development Programme TYKES (2004–2010. TYKES was a governmental programme for promoting simultaneous improvements in productivity and the QWL in workplaces through changes in work, managerial, and organizational practices. Information obtained via two different surveys has been combined for the purposes of this article: a survey on HIIPs within a work organization (HIIP and a self-assessment survey of project outcomes (SA. The survey material comprises altogether 253 responses from 163 different workplaces. The analysis provides evidence in favor of a view that publicly funded workplace development projects constitute appropriate means to support productivity and the QWL simultaneously. The results provide evidence that HIIPs, including decentralized decision making, competence development, internal cooperation, and external cooperation, are of importance when trying to gain better results in both productivity and the QWL from both management and employees’ point of view. In addition, the development process itself, that is, how the practices are implemented and good skills in project management, is highlighted. Concerning the supervisor’s supportive role in employees’ innovation activities, the picture is more mixed and surprising.
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Gupta, Munish; Kaplan, Heather C
2017-09-01
Quality improvement (QI) is based on measuring performance over time, and variation in data measured over time must be understood to guide change and make optimal improvements. Common cause variation is natural variation owing to factors inherent to any process; special cause variation is unnatural variation owing to external factors. Statistical process control methods, and particularly control charts, are robust tools for understanding data over time and identifying common and special cause variation. This review provides a practical introduction to the use of control charts in health care QI, with a focus on neonatology. Copyright © 2017 Elsevier Inc. All rights reserved.
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A Novel Realization of Low-Power and Low-Distortion Multiplier Circuit with Improved Dynamic Range
Directory of Open Access Journals (Sweden)
Ali Naderi Saatlo
2017-01-01
Full Text Available A novel topology of four-quadrant analog multiplier circuit is presented in this paper. The voltage mode technique is employed to design the circuit in CMOS technology. The dynamic input and output ranges of the circuit are improved owing to the fact that the circuit works in the saturation region not in weak inversion. Also the proposed multiplier is suitable for low voltage operation and its power consumption is relatively low. In order to verify the performance of the proposed circuit, performance of the circuit affected by second order effects including transistor mismatch and mobility reduction is analyzed in detail. It will be shown that any conceivable mismatch in the transistor parameters leads to second harmonic distortion. Additionally, the effect of mobility reduction in the third harmonic distortion will be computed. In order to simulate the circuit, Cadence and HSPICE software are used with TSMC level 49 (BSIM3v3 parameters for 0.18 μm CMOS technology, where under supply voltage of 1.5 V, total power consumption is 44 µW, the corresponding average nonlinearity remains as low as 1 %, and the input range of the circuit is ± 400 mV.
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Medium Range Flood Forecasting for Agriculture Damage Reduction
Fakhruddin, S. H. M.
2014-12-01
Early warning is a key element for disaster risk reduction. In recent decades, major advancements have been made in medium range and seasonal flood forecasting. This progress provides a great opportunity to reduce agriculture damage and improve advisories for early action and planning for flood hazards. This approach can facilitate proactive rather than reactive management of the adverse consequences of floods. In the agricultural sector, for instance, farmers can take a diversity of options such as changing cropping patterns, applying fertilizer, irrigating and changing planting timing. An experimental medium range (1-10 day) flood forecasting model has been developed for Bangladesh and Thailand. It provides 51 sets of discharge ensemble forecasts of 1-10 days with significant persistence and high certainty. This type of forecast could assist farmers and other stakeholders for differential preparedness activities. These ensembles probabilistic flood forecasts have been customized based on user-needs for community-level application focused on agriculture system. The vulnerabilities of agriculture system were calculated based on exposure, sensitivity and adaptive capacity. Indicators for risk and vulnerability assessment were conducted through community consultations. The forecast lead time requirement, user-needs, impacts and management options for crops were identified through focus group discussions, informal interviews and community surveys. This paper illustrates potential applications of such ensembles for probabilistic medium range flood forecasts in a way that is not commonly practiced globally today.
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Multi-objective optimization to improve the product range of baking systems
Hadiyanto, M.; Boom, R.M.; Straten, van G.; Boxtel, van A.J.B.; Esveld, D.C.
2009-01-01
The operational range of a food production system can be used to obtain a variation in certain product characteristics. The range of product characteristics that can be simultaneously realized by an optimal choice of the process conditions is inherently limited. Knowledge of this feasible product
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Job satisfaction of practice assistants in general practice in Germany: an observational study.
Goetz, Katja; Campbell, Stephen; Broge, Bjoern; Brodowski, Marc; Steinhaeuser, Jost; Wensing, Michel; Szecsenyi, Joachim
2013-08-01
Job satisfaction of practice staff is important for optimal health care delivery and for minimizing the turnover of non-medical professions. To document the job satisfaction of practice assistants in German general practice and to explore associations between job satisfaction, staff characteristics and culture in general practice organizations. The study was based on data from the European Practice Assessment accreditation scheme for general practices and used an observational design. The study population consisted of 1158 practice assistants from 345 general practices across Germany. Job satisfaction was measured with the 10-item Warr-Cook-Wall questionnaire. Organizational culture was evaluated with four items. A linear regression analysis was performed in which each of the job satisfaction items was handled as dependent variable. Out of 1716 staff member questionnaires handed out to practice assistants, 1158 questionnaires were completed (response rate: 67.5%). Practice assistants were most satisfied with their colleagues and least satisfied with their income. Higher job satisfaction was associated with issues of organizational culture, particularly a good working atmosphere, opportunities to suggest and influence areas for improvement and clear responsibilities within the practice team. Prioritizing initiatives to maintain high levels of, or to improve the job satisfaction of practice assistants, is important for recruitment and retention. It will also help to improve working conditions for both practice assistants and GPs and create an environment to provide better quality care.
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Directory of Open Access Journals (Sweden)
Lofters AK
2017-03-01
Full Text Available AK Lofters,1–4 M Vahabi,5 V Prakash,6 L Banerjee,7 P Bansal,8 S Goel,7,8 S Dunn1,2,9 1Department of Family and Community Medicine, 2Dalla Lana School of Public Health, University of Toronto, 3Department of Family and Community Medicine, 4Centre for Urban Health Solutions, St Michael’s Hospital, 5Daphne Cockwell School of Nursing, Ryerson University, Toronto, 6Screening Saves Lives Program, Canadian Cancer Society, Mississauga, 7Wise Elephant Family Health Team, Brampton, 8Mississauga Halton Central West Regional Cancer Program, Mississauga, 9Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada Background: Cancer screening uptake is known to be low among South Asian residents of Ontario. The objective of this pilot study was to determine if lay health educators embedded within the practices of primary care providers could improve willingness to screen and cancer screening uptake for South Asian patients taking a quality improvement approach.Materials and methods: Participating physicians selected quality improvement initiatives to use within their offices that they felt could increase willingness to screen and cancer screening uptake. They implemented initiatives, adapting as necessary, for six months.Results: Four primary care physicians participated in the study. All approximated that at least 60% of their patients were of South Asian ethnicity. All physicians chose to work with a preexisting lay health educator program geared toward South Asians. Health ambassadors spoke to patients in the office and telephoned patients. For all physicians, ~60% of South Asian patients who were overdue for cancer screening and who spoke directly to health ambassadors stated they were willing to be screened. One physician was able to track actual screening among contacted patients and found that screening uptake was relatively high: from 29.2% (colorectal cancer to 44.6% (breast cancer of patients came in for screening
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Moore, Lora
2017-10-01
Implementation of evidence-based practice (EBP) at the bedside has been difficult to achieve. Significant gaps between current research and actual practice have been identified and must be addressed in effort to increase utilization of EBP. The purpose of this study was to evaluate the efficacy of an online EBP educational intervention and to examine the relationship between educational preparation and years of nursing experience on nurses' practice, attitudes, and knowledge and skills of EBP. An experimental pretest-posttest design study with three randomized groups utilizing the EBPQ instrument was conducted. No significant differences were noted in EBPQ subscale scores of practice, attitude, or knowledge and skills from pre- to posttest. In addition, no statistical difference in EBPQ subscale scores regarding educational preparation or years of experience were noted. While nurses report positive attitudes toward EBP, their perceptions of practice and knowledge and skills score much lower. Educational interventions are needed for practicing nurses to overcome this knowledge deficit to successfully implement EBP. However, the use of online, independent, computer-based learning modules, while cost-efficient and offer several benefits when educating nurses, may not necessarily be the most effective method for teaching EBP knowledge and skills to practicing nurses. © 2017 Sigma Theta Tau International.
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Pradhan, Aliza; Idol, Travis; Roul, Pravat K.
2016-01-01
Traditional agriculture in rainfed uplands of India has been experiencing low agricultural productivity as the lands suffer from poor soil fertility, susceptibility to water erosion and other external pressures of development and climate change. A shift toward more sustainable cropping systems such as conservation agriculture production systems (CAPSs) may help in maintaining soil quality as well as improving crop production and farmer’s net economic benefit. This research assessed the effects over 3 years (2011–2014) of reduced tillage, intercropping, and cover cropping practices customized for maize-based production systems in upland areas of Odisha, India. The study focused on crop yield, system productivity and profitability through maize equivalent yield and dominance analysis. Results showed that maize grain yield did not differ significantly over time or among CAPS treatments while cowpea yield was considered as an additional yield in intercropping systems. Mustard and horsegram grown in plots after maize cowpea intercropping recorded higher grain yields of 25 and 37%, respectively, as compared to those without intercropping. Overall, the full CAPS implementation, i.e., minimum tillage, maize–cowpea intercropping and mustard residue retention had significantly higher system productivity and net benefits than traditional farmer practices, i.e., conventional tillage, sole maize cropping, and no mustard residue retention. The dominance analysis demonstrated increasing benefits of combining conservation practices that exceeded thresholds for farmer adoption. Given the use of familiar crops and technologies and the magnitude of yield and income improvements, these types of CAPS should be acceptable and attractive for smallholder farmers in the area. This in turn should support a move toward sustainable intensification of crop production to meet future household income and nutritional needs. PMID:27471508
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Directory of Open Access Journals (Sweden)
Aliza Pradhan
2016-07-01
Full Text Available Traditional agriculture in rainfed uplands of India has been experiencing low agricultural productivity as the lands suffer from poor soil fertility, susceptibility to water erosion and other external pressures of development and climate change. A shift towards more sustainable cropping systems such as conservation agriculture production systems (CAPS may help in maintaining soil quality as well as improving crop production and farmer’s net economic benefit. This research assessed the effects over three years (2011-2014 of reduced tillage, intercropping, and cover cropping practices customized for maize-based production systems in upland areas of Odisha, India. The study focused on crop yield, system productivity and profitability through maize equivalent yield and dominance analysis. Results showed that maize grain yield did not differ significantly over time or among CAPS treatments while cowpea yield was considered as an additional yield in intercropping systems. Mustard and horsegram grown in plots after maize cowpea intercropping recorded higher grain yields of 25 and 37%, respectively, as compared to those without intercropping. Overall, the full CAPS implementation i.e. minimum tillage, maize-cowpea intercropping and mustard residue retention had significantly higher system productivity and net benefits than traditional farmer practices, i.e. conventional tillage, sole maize cropping, and no mustard residue retention. The dominance analysis demonstrated increasing benefits of combining conservation practices that exceeded thresholds for farmer adoption. Given the use of familiar crops and technologies and the magnitude of yield and income improvements, these types of CAPS should be acceptable and attractive for smallholder farmers in the area. This in turn should support a move toward sustainable intensification of crop production to meet future household income and nutritional needs.
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Pradhan, Aliza; Idol, Travis; Roul, Pravat K
2016-01-01
Traditional agriculture in rainfed uplands of India has been experiencing low agricultural productivity as the lands suffer from poor soil fertility, susceptibility to water erosion and other external pressures of development and climate change. A shift toward more sustainable cropping systems such as conservation agriculture production systems (CAPSs) may help in maintaining soil quality as well as improving crop production and farmer's net economic benefit. This research assessed the effects over 3 years (2011-2014) of reduced tillage, intercropping, and cover cropping practices customized for maize-based production systems in upland areas of Odisha, India. The study focused on crop yield, system productivity and profitability through maize equivalent yield and dominance analysis. Results showed that maize grain yield did not differ significantly over time or among CAPS treatments while cowpea yield was considered as an additional yield in intercropping systems. Mustard and horsegram grown in plots after maize cowpea intercropping recorded higher grain yields of 25 and 37%, respectively, as compared to those without intercropping. Overall, the full CAPS implementation, i.e., minimum tillage, maize-cowpea intercropping and mustard residue retention had significantly higher system productivity and net benefits than traditional farmer practices, i.e., conventional tillage, sole maize cropping, and no mustard residue retention. The dominance analysis demonstrated increasing benefits of combining conservation practices that exceeded thresholds for farmer adoption. Given the use of familiar crops and technologies and the magnitude of yield and income improvements, these types of CAPS should be acceptable and attractive for smallholder farmers in the area. This in turn should support a move toward sustainable intensification of crop production to meet future household income and nutritional needs.
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Schädlich, Melanie; Erlacher, Daniel; Schredl, Michael
2017-12-01
In a lucid dream, the dreamer is aware of the dream state and can deliberately practice motor skills. Two field studies indicated that lucid dream practice can improve waking performance in simple motor tasks. The present pilot study investigated the effect of lucid dream practice in a controlled sleep laboratory setting, using a pre-post design with dart throwing in the evening and morning. The experimental group practiced darts in lucid dreams. Because some participants were distracted during lucid dream practice, the group was divided into lucid dreamers with few (n = 4) and many distractions (n = 5). Change of performance was compared to a physical practice group (n = 9) and a control group (n = 9), showing a significant interaction (P = .013, η 2 = .368). Only the lucid dreamers with few distractions improved (18%) significantly over time (P = .005, d = 3.84). Even though these results have to be considered preliminary, the present study indicates that lucid dream practice can be an effective tool in sports practice if lucid dreamers find ways to minimise distractions during lucid dream practice. Moreover, the study emphasises the necessity to investigate lucid dream practice experiences on a qualitative level.
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Fary, Robyn E; Slater, Helen; Chua, Jason; Ranelli, Sonia; Chan, Madelynn; Briggs, Andrew M
2015-07-01
To examine the effectiveness of a physiotherapy-specific, web-based e-learning platform, "RAP-el," in best-practice management of rheumatoid arthritis (RA) using a single-blind, randomized controlled trial (RCT) and prospective cohort study. Australian-registered physiotherapists were electronically randomized into intervention and control groups. The intervention group accessed RAP-eL over 4 weeks. Change in self-reported confidence in knowledge and skills was compared between groups at the end of the RCT using linear regression conditioned for baseline scores by a blinded assessor, using intent-to-treat analysis. Secondary outcomes included physiotherapists' satisfaction with RA management and responses to RA-relevant clinical statements and practice-relevant vignettes. Retention was evaluated in a cohort study 8 weeks after the RCT. Eighty physiotherapists were randomized into the intervention and 79 into the control groups. Fifty-six and 48, respectively, provided baseline data. Significant between-group differences were observed for change in confidence in knowledge (mean difference 8.51; 95% confidence interval [95% CI] 6.29, 10.73; effect size 1.62) and skills (mean difference 7.26; 95% CI 5.1, 9.4; effect size 1.54), with the intervention group performing better. Satisfaction in ability to manage RA, 4 of the 6 clinical statements, and responses to vignettes demonstrated significant improvement in the intervention group. Although 8-week scores showed declines in most outcomes, their clinical significance remains uncertain. RAP-eL can improve self-reported confidence, likely practice behaviors and satisfaction in physiotherapists' ability to manage people with RA, and improve their clinical knowledge in several areas of best-practice RA management in the short term. © 2015, American College of Rheumatology.
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Exploration and practice in-class practice teaching mode
Zang, Xue-Ping; Wu, Wei-Feng
2017-08-01
According to the opto-electronic information science and engineering professional course characteristics and cultivate students' learning initiative, raised the teaching of photoelectric professional course introduce In-class practice teaching mode. By designing different In-class practice teaching content, the students' learning interest and learning initiative are improved, deepen students' understanding of course content and enhanced students' team cooperation ability. In-class practice teaching mode in the course of the opto-electronic professional teaching practice, the teaching effect is remarkable.
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Moon, Rachel Y; Hauck, Fern R; Colson, Eve R; Kellams, Ann L; Geller, Nicole L; Heeren, Timothy; Kerr, Stephen M; Drake, Emily E; Tanabe, Kawai; McClain, Mary; Corwin, Michael J
2017-07-25
Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12
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Improving practices in nanomedicine through near real-time pharmacokinetic analysis
Magafia, Isidro B.
More than a decade into the development of gold nanoparticles, with multiple clinical trials underway, ongoing pre-clinical research continues towards better understanding in vivo interactions. The goal is treatment optimization through improved best practices. In an effort to collect information for healthcare providers enabling informed decisions in a relevant time frame, instrumentation for real-time plasma concentration (multi-wavelength photoplethysmography) and protocols for rapid elemental analysis (energy dispersive X-Ray fluorescence) of biopsied tumor tissue have been developed in a murine model. An initial analysis, designed to demonstrate the robust nature and utility of the techniques, revealed that area under the bioavailability curve (AUC) alone does not currently inform tumor accumulation with a high degree of accuracy (R2=0.56), marginally better than injected dose (R2=0.46). This finding suggests that the control of additional experimental and physiological variables (chosen through modeling efforts) may yield more predictable tumor accumulation. Subject core temperature, blood pressure, and tumor perfusion are evaluated relative to particle uptake in a murine tumor model. New research efforts are also focused on adjuvant therapies that are employed to modify circulation parameters, including the AUC, of nanorods and gold nanoshells. Preliminary studies demonstrated a greater than 300% increase in average AUC using a reticuloendothelial blockade agent versus control groups. Given a better understanding of the relative importance of the physiological factors that influence rates of tumor accumulation, a set of experimental best practices is presented. This dissertation outlines the experimental protocols conducted, and discusses the real-world needs discovered and how these needs became specifications of developed protocols.
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2014-01-01
Background Despite considerable efforts, engaging staff to lead quality improvement activities in practice settings is a persistent challenge. At British Columbia Children’s Hospital (BCCH), the pediatric intensive care unit (PICU) undertook a new phase of quality improvement actions based on the Community of Practice (CoP) model with Participatory Action Research (PAR). This approach aims to mobilize the PICU ‘community’ as a whole with a focus on practice; namely, to create a ‘community of practice’ to support reflection, learning, and innovation in everyday work. Methodology An iterative two-stage PAR process using mixed methods has been developed among the PICU CoP to describe the environment (stage 1) and implement specific interventions (stage 2). Stage 1 is ethnographic description of the unit’s care practice. Surveys, interviews, focus groups, and direct observations describe the clinical staff’s experiences and perspectives around bedside care and quality endeavors in the PICU. Contrasts and comparisons across participants, time and activities help understanding the PICU culture and experience. Stage 2 is a succession of PAR spirals, using results from phase 1 to set up specific interventions aimed at building the staff’s capability to conduct QI projects while acquiring appropriate technical skills and leadership capacity (primary outcome). Team communication, information, and interaction will be enhanced through a knowledge exchange (KE) and a wireless network of iPADs. Relevance Lack of leadership at the staff level in order to improve daily practice is a recognized challenge that faces many hospitals. We believe that the PAR approach within a highly motivated CoP is a sound method to create the social dynamic and cultural context within which clinical teams can grow, reflect, innovate and feel proud to better serve patients. PMID:24401288
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Phase transformation based pyroelectric waste heat energy harvesting with improved practicality
International Nuclear Information System (INIS)
Jo, Hwan Ryul; Lynch, Christopher S
2016-01-01
In 2014, almost 60% of thermal energy produced in the United States was lost to the environment as waste heat. Ferroelectric based pyroelectric devices can be used to convert some of this waste heat into usable electrical energy using the Olsen cycle, an ideal thermodynamic cycle, but there are a number of barriers to its realization in a practical device. This study uses the Olsen cycle to benchmark a less efficient thermodynamic cycle that is more easily implemented in devices. The ferroelectric pyroelectric material used was (Pb 0.97 La 0.02 )(Zr 0.55 Sn 0.32 Ti 0.13 )O 3 ceramic, a ferroelectric material that undergoes a temperature driven phase transformation. A net energy density of 0.27 J cm −3 per cycle was obtained from the ferroelectric material using the modified cycle with a temperature change between 25°C and 180°C. This is 15.5% of the Olsen cycle result with the same temperature range and 1–8 MV m −1 applied electric field range. The power density was estimated to 13.5 mW cm −3 with given experimental conditions. A model is presented that quantitatively describes the effect of several parameters on output energy density and can be used to design ferroelectric based pyroelectric energy converters. The model indicates that optimization of material geometry and heating conditions can increase the output power by an order or magnitude. (paper)
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International Nuclear Information System (INIS)
Nguyen Xuan Hai; Nguyen Nhi Dien; Pham Dinh Khang; Pham Ngoc Tuan; Tuong Thi Thu Huong
2016-01-01
This report presents results of a research project “Improving practical training ability at Nuclear Research Institute oriented to nuclear human resource development within first phase”. In the frameworks of the project, a guiding document on 27 Ortec’s experiments was translated into Vietnamese. Several equipment are used in the experiments such as neutron howitzer, gamma counter, multi-channel analyzer and alpha-gamma coincidence spectroscopy were designed and fabricated. These products contributed to improving the ability of research and training of Training and Education Center, Nuclear Research Institute (NRI). (author)
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Directory of Open Access Journals (Sweden)
Jennifer Leeman
2017-11-01
Full Text Available Abstract Background Strategies are central to the National Institutes of Health’s definition of implementation research as “the study of strategies to integrate evidence-based interventions into specific settings.” Multiple scholars have proposed lists of the strategies used in implementation research and practice, which they increasingly are classifying under the single term “implementation strategies.” We contend that classifying all strategies under a single term leads to confusion, impedes synthesis across studies, and limits advancement of the full range of strategies of importance to implementation. To address this concern, we offer a system for classifying implementation strategies that builds on Proctor and colleagues’ (2013 reporting guidelines, which recommend that authors not only name and define their implementation strategies but also specify who enacted the strategy (i.e., the actor and the level and determinants that were targeted (i.e., the action targets. Main body We build on Wandersman and colleagues’ Interactive Systems Framework to distinguish strategies based on whether they are enacted by actors functioning as part of a Delivery, Support, or Synthesis and Translation System. We build on Damschroder and colleague’s Consolidated Framework for Implementation Research to distinguish the levels that strategies target (intervention, inner setting, outer setting, individual, and process. We then draw on numerous resources to identify determinants, which are conceptualized as modifiable factors that prevent or enable the adoption and implementation of evidence-based interventions. Identifying actors and targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up. In our descriptions of each class, we identify the level of the Interactive System Framework at which the strategy is enacted (actors, level and
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Directory of Open Access Journals (Sweden)
M Laopaiboon
2008-07-01
Full Text Available The burden of mortality and morbidity related to pregnancy and childbirth remains concentrated in developing countries. SEA-ORCHID (South East Asia Optimising Reproductive and Child Health In Developing countries is evaluating whether a multifaceted intervention to strengthen capacity for research synthesis, evidence-based care and knowledge implementation improves adoption of best clinical practice recommendations leading to better health for mothers and babies. In this study we assessed current practices in perinatal health care in four South East Asian countries and determined whether they were aligned with best practice recommendations.We completed an audit of 9550 medical records of women and their 9665 infants at nine hospitals; two in each of Indonesia, Malaysia and The Philippines, and three in Thailand between January-December 2005. We compared actual clinical practices with best practice recommendations selected from the Cochrane Library and the World Health Organization Reproductive Health Library. Evidence-based components of the active management of the third stage of labour and appropriately treating eclampsia with magnesium sulphate were universally practiced in all hospitals. Appropriate antibiotic prophylaxis for caesarean section, a beneficial form of care, was practiced in less than 5% of cases in most hospitals. Use of the unnecessary practices of enema in labour ranged from 1% to 61% and rates of episiotomy for vaginal birth ranged from 31% to 95%. Other appropriate practices were commonly performed to varying degrees between countries and also between hospitals within the same country.Whilst some perinatal health care practices audited were consistent with best available evidence, several were not. We conclude that recording of clinical practices should be an essential step to improve quality of care. Based on these findings, the SEA-ORCHID project team has been developing and implementing interventions aimed at increasing
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International Nuclear Information System (INIS)
Wirrwar, A.; Vosberg, H.; Herzog, H.; Halling, H.; Weber, S.; Mueller-Gaertner, H.W.; Forschungszentrum Juelich GmbH
1997-01-01
The authors have theoretically and experimentally investigated the extent to which homogeneous magnetic fields up to 7 Tesla reduce the spatial distance positrons travel before annihilation (positron range). Computer simulations of a noncoincident detector design using a Monte Carlo algorithm calculated the positron range as a function of positron energy and magnetic field strength. The simulation predicted improvements in resolution, defined as full-width at half-maximum (FWHM) of the line-spread function (LSF) for a magnetic field strength up to 7 Tesla: negligible for F-18, from 3.35 mm to 2.73 mm for Ga-68 and from 3.66 mm to 2.68 mm for Rb-82. Also a substantial noise suppression was observed, described by the full-width at tenth-maximum (FWTM) for higher positron energies. The experimental approach confirmed an improvement in resolution for Ga-68 from 3.54 mm at 0 Tesla to 2.99 mm FWHM at 4.5 Tesla and practically no improvement for F-18 (2.97 mm at 0 Tesla and 2.95 mm at 4.5 Tesla). It is concluded that the simulation model is appropriate and that a homogeneous static magnetic field of 4.5 Tesla reduces the range of high-energy positrons to an extent that may improve spatial resolution in positron emission tomography
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Cultivating Mathematical Skills: From Drill-and-Practice to Deliberate Practice
Lehtinen, Erno; Hannula-Sormunen, Minna; McMullen, Jake; Gruber, Hans
2017-01-01
Contemporary theories of expertise development highlight the crucial role of deliberate practice in the development of high level performance. Deliberate practice is practice that intentionally aims at improving one's skills and competencies. It is not a mechanical or repetitive process of making performance more fluid. Instead, it involves a…
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Acquisition and improvement of human motor skills: Learning through observation and practice
Iba, Wayne
1991-01-01
Skilled movement is an integral part of the human existence. A better understanding of motor skills and their development is a prerequisite to the construction of truly flexible intelligent agents. We present MAEANDER, a computational model of human motor behavior, that uniformly addresses both the acquisition of skills through observation and the improvement of skills through practice. MAEANDER consists of a sensory-effector interface, a memory of movements, and a set of performance and learning mechanisms that let it recognize and generate motor skills. The system initially acquires such skills by observing movements performed by another agent and constructing a concept hierarchy. Given a stored motor skill in memory, MAEANDER will cause an effector to behave appropriately. All learning involves changing the hierarchical memory of skill concepts to more closely correspond to either observed experience or to desired behaviors. We evaluated MAEANDER empirically with respect to how well it acquires and improves both artificial movement types and handwritten script letters from the alphabet. We also evaluate MAEANDER as a psychological model by comparing its behavior to robust phenomena in humans and by considering the richness of the predictions it makes.
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Quality Nutrition Care: Measuring Hospital Staff’s Knowledge, Attitudes, and Practices
Directory of Open Access Journals (Sweden)
Celia Laur
2016-10-01
Full Text Available Understanding the knowledge, attitudes, and practices (KAP of hospital staff is needed to improve care activities that support the detection/prevention/treatment of malnutrition, yet quality measures are lacking. The purpose was to develop (study 1 and assess the administration and discriminative potential (study 2 of using such a KAP measure in acute care. In study 1, a 27-question KAP questionnaire was developed, face validated (n = 5, and tested for reliability (n = 35. Kappa and Intraclass Correlation (ICC were determined. In study 2, the questionnaire was sent to staff at five diverse hospitals (n = 189. Administration challenges were noted and analyses completed to determine differences across sites, professions, and years of practice. Study 1 results demonstrate that the knowledge/attitude (KA and the practice (P subscales are reliable (KA: ICC = 0.69 95% CI 0.45–0.84, F = 5.54, p < 0.0001; P: ICC = 0.84 95% CI 0.68−0.92, F = 11.12, p < 0.0001. Completion rate of individual questions in study 2 was high and suggestions to improve administration were identified. The KAP mean score was 93.6/128 (range 51–124 with higher scores indicating more knowledge, better attitudes and positive practices. Profession and years of practice were associated with KAP scores. The KAP questionnaire is a valid and reliable measure that can be used in needs assessments to inform improvements to nutrition care in hospital.
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Knowledge Management Practice on Construction Project ...
African Journals Online (AJOL)
Likewise, the results further indicated 19 benefits of KM practice for improving construction project performance and include: improve project quality, cost and time; practice and process improvement; encourage effective teamwork and innovation; improve the client satisfaction; boost productivity of employees and processes; ...
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Melnyk, Bernadette Mazurek; Fineout-Overholt, Ellen; Hockenberrry, Marilyn; Huth, Myra; Jamerson, Patricia; Latta, Linda; Lewandowski, Linda; Gance-Cleveland, Bonnie
2007-01-01
Although major healthcare and professional organizations as well as key leaders have long emphasized the importance of evidence-based practice (EBP) in improving patient care and outcomes, the majority of healthcare professionals do not implement EBP. There is a huge gap in time that exists between the generation of research findings and the translation of those findings into clinical practice. Many efficacious interventions are not being used in clinical practice even though research findings suggest that they improve child and adolescent health and development. Conversely, many clinical practices are being implemented without sufficient evidence to support their use. Because of the need to accelerate EBP and to generate evidence to support best practices, the first EBP Leadership Summit focused on children and adolescents was conducted in February 2007. Several nationally recognized EBP experts and healthcare leaders from a number of children's hospitals and colleges of nursing across the U.S. participated in the Summit. This article describes the process used and outcomes generated from this landmark event in child and adolescent healthcare, including the launching of the new National Consortium for Pediatric and Adolescent EBP (NCPAEP). Future directions of the consortium also are highlighted.
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Quality assessment and improvements in pathology practice
Kuijpers, C.C.H.J.
2016-01-01
Every patient has the right to receive optimal quality health care. With regard to pathology practice, a small (interpretational) difference can have major impact for the patient, because prognosis and treatment selection are often based on the pathology report. Unfortunately, it is inevitable that
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Speth, Timothy; Saifer, Steffen; Forehand, Gregory
2008-01-01
Although the No Child Left Behind Act of 2001 (NCLB) spells out parent involvement requirements for schools in need of improvement, the majority of the Northwest Region school improvement plans reviewed failed to include such provisions. Reported findings include: (1) Despite a wide range of parent involvement practices discussed in legislation…
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Practical methods to improve the development of computational software
International Nuclear Information System (INIS)
Osborne, A. G.; Harding, D. W.; Deinert, M. R.
2013-01-01
The use of computation has become ubiquitous in science and engineering. As the complexity of computer codes has increased, so has the need for robust methods to minimize errors. Past work has show that the number of functional errors is related the number of commands that a code executes. Since the late 1960's, major participants in the field of computation have encouraged the development of best practices for programming to help reduce coder induced error, and this has lead to the emergence of 'software engineering' as a field of study. Best practices for coding and software production have now evolved and become common in the development of commercial software. These same techniques, however, are largely absent from the development of computational codes by research groups. Many of the best practice techniques from the professional software community would be easy for research groups in nuclear science and engineering to adopt. This paper outlines the history of software engineering, as well as issues in modern scientific computation, and recommends practices that should be adopted by individual scientific programmers and university research groups. (authors)
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Collaborative Practice Model: Improving the Delivery of Bad News.
Bowman, Pamela N; Slusser, Kim; Allen, Deborah
2018-02-01
Ideal bad news delivery requires skilled communication and team support. The literature has primarily focused on patient preferences, impact on care decisions, healthcare roles, and communication styles, without addressing systematic implementation. This article describes how an interdisciplinary team, led by advanced practice nurses, developed and implemented a collaborative practice model to deliver bad news on a unit that had struggled with inconsistencies. Using evidence-based practices, the authors explored current processes, role perceptions and expectations, and perceived barriers to developing the model, which is now the standard of care and an example of interprofessional team collaboration across the healthcare system. This model for delivering bad news can be easily adapted to meet the needs of other clinical units. .
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Improving long-range dispersion predictions with ETEX real-time and a-posteriori model evaluations
International Nuclear Information System (INIS)
Desiato, F.
1997-01-01
The Italian environmental Protection Agency (ANPA), which is responsible for the evaluation of the consequences of accidental releases into the atmosphere, has participated to both the real-time (phase-1) and a-posteriori (phase-2) ETEX model evaluations. The double benchmark actually constituted an invaluable experience for better understanding the skill and limits of the present long-range dispersion modelling capabilities. In particular, the strong difference between phase-1 and phase-2 model performance emphasised the opportunity to modify, improve or tune a number of specific aspects of the overall simulation. ETEX model runs were carried out with the Lagrangian particle model APOLLO. The meteorological input was constituted by ECMWF fields. Three-hourly average concentrations paired in space and time and time-integrated concentrations were used in the evaluation of the results, based on a set of statistical indexes and concentration contour lines and scatter diagrams
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Perez Ruiz, Fernando; Sanchez-Piedra, Carlos A; Sanchez-Costa, Jesus T; Andrés, Mariano; Diaz-Torne, Cesar; Jimenez-Palop, Mercedes; De Miguel, Eugenio; Moragues, Carmen; Sivera, Francisca
2018-06-01
The objective of the study was to evaluate changes regarding main European League Against Rheumatism (EULAR) recommendations on diagnosis and treatment of gout compared to a previous assessment. The GEMA-2 (Gout Evaluation and MAnagement) is a transversal assessment of practice for gout by rheumatologists. Main outcome variables were improvement of the previous GEMA assessment regarding the rate of crystal-proven diagnosis and that reaching therapeutic serum urate target below 6 mg/dl at last visit. Other management variables (prophylaxis, treatment of flares, lifestyle change advice) were also evaluated along with general characteristics. The sample was powered to include at least 483 patients for up to 50% change. Data on management of 506 patients were retrieved from 38 out of 41 rheumatology units that participated in the previous GEMA audit. Crystal-proved diagnosis rate increased from 26% to 32% (31% improvement) and was higher in gout-dedicated practices; ultrasonography contributed to diagnosis in less than 1% of cases. Therapeutic serum urate at last visit improved from 41% to 64% of all patients (66% of patients on urate-lowering medications), in any case over 50% improvement from the previous assessment. The use of any urate-lowering medication available was not prescribed as per label dosing in patients who failed to achieve target serum urate. Clinical inertia to increase doses of either allopurinol or febuxostat was still present in clinical practice. Over 50% improvement in targeting therapeutic serum urate has been observed, but clinical inertia is still present. Diagnosis is still mostly clinically based, ultrasonography not being commonly contributive. Menarini España.
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Improving operation notes to meet British Orthopaedic Association guidelines.
Morgan, David; Fisher, Noel; Ahmad, Aman; Alam, Fazle
2009-04-01
Operation notes are an important part of medical records for clinical, academic and medicolegal reasons. This study audited the quality of operative note keeping for total knee replacements against the standards set by the British Orthopaedic Association (BOA). A prospective review of all patients undergoing total knee replacement at a district general hospital over 8 months. Data recorded were compared with those required by the BOA good-practice guidelines. Change in practice was implemented and the audit cycle completed. Data were statistically analysed. A total of 129 operation notes were reviewed. There was a significant improvement in the mean number of data points recorded from 9.6 to 13.1. The least well recorded data were diagnosis, description of findings, alignment and postoperative flexion range. All had a significant improvement except description of findings. The operating surgeon writing the note improved from 56% to 67%. Detailed postoperative instructions also improved in quality. Surgeon education and the use of a checklist produce better quality total knee replacement operation notes in line with BOA guidelines. Further improvements may be made by making the data points part of the operation note itself.
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Directory of Open Access Journals (Sweden)
Roya Kelishadi
2010-12-01
Full Text Available AbstractINTRODUCTION: Lifelong behavior and risk factors of chronic diseases extend from earlylife to adulthood. It seems that dietary habits and unhealthy food consumption, as well aspassive smoking play an important role in the development of such diseases. Multiplestudies have shown that healthy lifestyle education in preschool children improves theirknowledge, attitude and practice about healthy lifestyle. This study was conducted toevaluate the effect of lifestyle education with educational posters in daycare centers onpreschool children.METHODS: In an interventional study, 250 preschool children were selected via 2-stagerandom cluster sampling and taught tips on healthy lifestyle via educational posters. Theirknowledge on healthy lifestyle was assessed before and after (1 week and 3 monthseducation via a picture-questionnaire, and their practice and behavior were assessed beforeand after education via their favorite choice of snack in daycare centers. Collected datawere analyzed using SPSS13 by paired t-test and Man Whitney test.RESULTS: The knowledge and practice scores of the studied subjects improvedsignificantly one week after intervention compared with baseline, and persisted until the thirdmonth after education.DISCUSSION: Healthy lifestyle education via poster for preschool children can significantlyimprove their knowledge and practice towards healthy lifestyle.Keywords • Healthy life style • Education • Preschool children
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van der Linden, Sander; Maibach, Edward; Leiserowitz, Anthony
2015-11-01
Despite being one of the most important societal challenges of the 21st century, public engagement with climate change currently remains low in the United States. Mounting evidence from across the behavioral sciences has found that most people regard climate change as a nonurgent and psychologically distant risk-spatially, temporally, and socially-which has led to deferred public decision making about mitigation and adaptation responses. In this article, we advance five simple but important "best practice" insights from psychological science that can help governments improve public policymaking about climate change. Particularly, instead of a future, distant, global, nonpersonal, and analytical risk that is often framed as an overt loss for society, we argue that policymakers should (a) emphasize climate change as a present, local, and personal risk; (b) facilitate more affective and experiential engagement; (c) leverage relevant social group norms; (d) frame policy solutions in terms of what can be gained from immediate action; and (e) appeal to intrinsically valued long-term environmental goals and outcomes. With practical examples we illustrate how these key psychological principles can be applied to support societal engagement and climate change policymaking. © The Author(s) 2015.
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Benchmarking D and D procurement best practices at four commercial nuclear power plants
International Nuclear Information System (INIS)
Arflin, J.; Baker, G.; Bidwell, B.; Bugielski, D.; Cavanagh, J.; Sandlin, N.
1998-01-01
In conclusion, if the Department of Energy is going to achieve the strategic objectives of the world's largest environment clean-up of contaminated sites, then they are going to have to identify and implement leading edge thinking, practices and solutions. This report should serve not as the end of best practices, identification and implementation rather it creates a platform for a wide range of beginnings, and establishes a starting point for continuous improvement of DOE and contractor's processes, practices and initiatives to allow D and D to be performed safer, faster, better at reduced costs. The approaches identified in this report will come to life by being shared, debated, and implemented in the context of organizational realities. Then, where appropriate, they need to be used and improved upon. We encourage the procurement and technical communities to use this document to facilitate an on-going dialog
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Benchmarking D and D procurement best practices at four commercial nuclear power plants.
Energy Technology Data Exchange (ETDEWEB)
Arflin, J.; Baker, G.; Bidwell, B.; Bugielski, D.; Cavanagh, J.; Sandlin, N.
1998-11-06
In conclusion, if the Department of Energy is going to achieve the strategic objectives of the world's largest environment clean-up of contaminated sites, then they are going to have to identify and implement leading edge thinking, practices and solutions. This report should serve not as the end of best practices, identification and implementation rather it creates a platform for a wide range of beginnings, and establishes a starting point for continuous improvement of DOE and contractor's processes, practices and initiatives to allow D&D to be performed safer, faster, better at reduced costs. The approaches identified in this report will come to life by being shared, debated, and implemented in the context of organizational realities. Then, where appropriate, they need to be used and improved upon. We encourage the procurement and technical communities to use this document to facilitate an on-going dialog.
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Pitch range variations improve cognitive processing of audio messages
Rodero Antón, Emma; Potter, Rob F.; Prieto Vives, Pilar, 1965-
2017-01-01
This study explores the effect of different speaker intonation strategies in audio messages on attention, autonomic arousal, and memory. An experiment was conducted in which participants listened to 16 radio commercials produced to vary in pitch range across sentences. Dependent variables were self-reported effectiveness and adequacy, psychophysiological arousal and attention, immediate word recall and recognition of information. Results showed that messages conveyed with pitch variations ach...
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A practice analysis of toxicology.
Wood, Carol S; Weis, Christopher P; Caro, Carla M; Roe, Amy
2016-12-01
In 2015, the American Board of Toxicology (ABT), with collaboration from the Society of Toxicology (SOT), in consultation with Professional Examination Service, performed a practice analysis study of the knowledge required for general toxicology. The purpose of this study is to help assure that the examination and requirements for attainment of Diplomate status are relevant to modern toxicology and based upon an empirical foundation of knowledge. A profile of the domains and tasks used in toxicology practice was developed by subject-matter experts representing a broad range of experiences and perspectives. An on-line survey of toxicologists, including Diplomates of the ABT and SOT members, confirmed the delineation. Results of the study can be used to improve understanding of toxicology practice, to better serve all toxicologists, and to present the role of toxicologists to those outside the profession. Survey results may also be used by the ABT Board of Directors to develop test specifications for the certifying examination and will be useful for evaluating and updating the content of professional preparation, development, and continuing education programs. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
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Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty.
Ishii, Lisa E; Tollefson, Travis T; Basura, Gregory J; Rosenfeld, Richard M; Abramson, Peter J; Chaiet, Scott R; Davis, Kara S; Doghramji, Karl; Farrior, Edward H; Finestone, Sandra A; Ishman, Stacey L; Murphy, Robert X; Park, John G; Setzen, Michael; Strike, Deborah J; Walsh, Sandra A; Warner, Jeremy P; Nnacheta, Lorraine C
2017-02-01
Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice
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The Standley allotment: a history of range recovery.
Gerald S. Strickler; Wade B. Hall
1980-01-01
One of the first range research programs on National Forest lands was conducted by Dr. Arthur W. Sampson in the Wallowa Mountains, Oregon, between 1907 and 1911. This paper reviews the historical perspective of and the basic range management principles and practices developed from Sampson's studies as well as the land and grazing management of the study area to...
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Value of recruitment strategies used in a primary care practice-based trial.
Ellis, Shellie D; Bertoni, Alain G; Bonds, Denise E; Clinch, C Randall; Balasubramanyam, Aarthi; Blackwell, Caroline; Chen, Haiying; Lischke, Michael; Goff, David C
2007-05-01
"Physicians-recruiting-physicians" is the preferred recruitment approach for practice-based research. However, yields are variable; and the approach can be costly and lead to biased, unrepresentative samples. We sought to explore the potential efficiency of alternative methods. We conducted a retrospective analysis of the yield and cost of 10 recruitment strategies used to recruit primary care practices to a randomized trial to improve cardiovascular disease risk factor management. We measured response and recruitment yields and the resources used to estimate the value of each strategy. Providers at recruited practices were surveyed about motivation for participation. Response to 6 opt-in marketing strategies was 0.40% (53/13290), ranging from 0% to 2.86% by strategy; 33.96% (18/53) of responders were recruited to the study. Of those recruited from opt-out strategies, 8.68% joined the study, ranging from 5.35% to 41.67% per strategy. A strategy that combined both opt-in and opt-out approaches resulted in a 51.14% (90/176) response and a 10.80% (19/90) recruitment rate. Cost of recruitment was $613 per recruited practice. Recruitment approaches based on in-person meetings (41.67%), previous relationships (33.33%), and borrowing an Area Health Education Center's established networks (10.80%), yielded the most recruited practices per effort and were most cost efficient. Individual providers who chose to participate were motivated by interest in improving their clinical practice (80.5%); contributing to CVD primary prevention (54.4%); and invigorating their practice with new ideas (42.1%). This analysis provides suggestions for future recruitment efforts and research. Translational studies with limited funds could consider multi-modal recruitment approaches including in-person presentations to practice groups and exploitation of previous relationships, which require the providers to opt-out, and interactive opt-in approaches which rely on borrowed networks. These
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Cattet, Marc R L; Obbard, Martyn E
2010-01-01
We assessed the efficacy and safety of hyaluronidase to improve chemical immobilization of free-ranging polar bears (Ursus maritimus) captured from helicopter by remote drug delivery along the Ontario coast line of northwestern James Bay and southern Hudson Bay during September 2005 and October 2007. We used a single blind study design in which one person prepared and loaded all darts without the shooter knowing whether hyaluronidase (150 IU per dart) or sterile water was added to the immobilizing drug mixture of xylazine and zolazepam-tiletamine (XZT). We found that we often required more than one dart to immobilize bears in the control group (XZT+sterile water; >1 dart for 15 of 28 captures) versus the treatment group (XZT+hyaluronidase; >1 dart for seven of 26 captures). As a consequence, treatment bears were generally immobilized with smaller XZT dosages (7.9 vs. 9.4 mg/kg; P = 0.08) and shorter induction (10 vs. 15 min; P = 0.004) than control bears. We found no differences in vital rates and serum biochemistry results between control and treatment bears. We did find, however, that induction times correlated directly with rectal temperature at polar bears. Overall we found hyaluronidase to be effective and safe for capture of polar bears. We recommend further study to determine whether effects of hyaluronidase are dose dependent and recommend that others involved with capture of seasonally fat species such as polar bears consider use of hyaluronidase to improve chemical immobilization.
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Keat, Chan Huan; Sooaid, Nor Suhada; Yun, Cheng Yi; Sriraman, Malathi
2013-01-01
An increasing trend of cytotoxic drug use, mainly in cancer treatment, has increased the occupational exposure among the nurses. This study aimed to assess the change of nurses' safety-related knowledge as well as attitude levels and subsequently to assess the change of cytotoxic drug handling practices in wards after a series of pharmacist-based interventions. This prospective interventional study with a before and after design requested a single group of 96 nurses in 15 wards actively providing chemotherapy to answer a self-administered questionnaire. A performance checklist was then used to determine the compliance of all these wards with the recommended safety measures. The first and second assessments took 2 months respectively with a 9-month intervention period. Pharmacist-based interventions included a series of technical, educational and administrative support measures consisting of the initiation of closed-system cytotoxic drug reconstitution (CDR) services, courses, training workshops and guideline updates. The mean age of nurses was 32.2∓6.19 years. Most of them were female (93.8%) and married (72.9%). The mean knowledge score of nurses was significantly increased from 45.5∓10.52 to 73.4∓8.88 out of 100 (p<0.001) at the end of the second assessment. Overall, the mean practice score among the wards was improved from 7.6∓5.51 to 15.3∓2.55 out of 20 (p<0.001). The pharmacist-based interventions improved the knowledge, attitude and safe practices of nurses in cytotoxic drug handling. Further assessment may help to confirm the sustainability of the improved practices.
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Arslan, Musa T.; Tofighi, Mohammad; Sevimli, Rasim A.; ćetin, Ahmet E.
2015-05-01
One of the main disadvantages of using commercial broadcasts in a Passive Bistatic Radar (PBR) system is the range resolution. Using multiple broadcast channels to improve the radar performance is offered as a solution to this problem. However, it suffers from detection performance due to the side-lobes that matched filter creates for using multiple channels. In this article, we introduce a deconvolution algorithm to suppress the side-lobes. The two-dimensional matched filter output of a PBR is further analyzed as a deconvolution problem. The deconvolution algorithm is based on making successive projections onto the hyperplanes representing the time delay of a target. Resulting iterative deconvolution algorithm is globally convergent because all constraint sets are closed and convex. Simulation results in an FM based PBR system are presented.
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Harper, Richard W; Nasis, Arthur; Sundararajan, Vijaya
2015-09-21
Rising health care costs above inflation are placing serious strains on the sustainability of the Australian Medicare system in its current structure. The Medicare Benefits Schedule (MBS), which lists rebates payable to patients for private medical services provided on a fee-for-service basis, is the cornerstone of the Australian health care system. Introduced in the 1980s, the MBS has changed little despite major advances in the evidence base for the practice of cardiology. We outline how we believe sensible changes to the MBS listings for four cardiac services--invasive coronary angiography, computed tomography coronary angiography, stress testing and percutaneous coronary intervention--would improve the clinical practice of cardiology and save substantial amounts of taxpayer money.
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Bryant, Louise D; Burkinshaw, Paula; House, Allan O; West, Robert M; Ward, Vicky
2017-08-22
The number of women entering medicine has increased significantly, yet women are still under-represented at senior levels in academic medicine. To support the gender equality action plan at one School of Medicine, this study sought to (1) identify the range of viewpoints held by staff on how to address gender inequality and (2) identify attitudinal barriers to change. Q methodology. 50 potential interventions representing good practice or positive action, and addressing cultural, organisational and individual barriers to gender equality, were ranked by participants according to their perception of priority. The School of Medicine at the University of Leeds, UK. Fifty-five staff members were purposively sampled to represent gender and academic pay grade. Principal components analysis identified six competing viewpoints on how to address gender inequality. Four viewpoints favoured positive action interventions: (1) support careers of women with childcare commitments, (2) support progression of women into leadership roles rather than focus on women with children, (3) support careers of all women rather than just those aiming for leadership, and (4) drive change via high-level financial and strategic initiatives. Two viewpoints favoured good practice with no specific focus on women by (5) recognising merit irrespective of gender and (6) improving existing career development practice. No viewpoint was strongly associated with gender, pay grade or role; however, latent class analysis identified that female staff were more likely than male to prioritise the setting of equality targets. Attitudinal barriers to the setting of targets and other positive action initiatives were identified, and it was clear that not all staff supported positive action approaches. The findings and the approach have utility for those involved in gender equality work in other medical and academic institutions. However, the impact of such initiatives needs to be evaluated in the longer term.
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Greene, Laurence; Moreo, Kathleen
2015-01-01
Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high
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Smith, Michelle K.; Jones, Francis H. M.; Gilbert, Sarah L.; Wieman, Carl E.
2013-01-01
Instructors and the teaching practices they employ play a critical role in improving student learning in college science, technology, engineering, and mathematics (STEM) courses. Consequently, there is increasing interest in collecting information on the range and frequency of teaching practices at department-wide and institution-wide scales. To help facilitate this process, we present a new classroom observation protocol known as the Classroom Observation Protocol for Undergraduate STEM or C...
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Directory of Open Access Journals (Sweden)
Pezhman Mohammadi
2012-04-01
Full Text Available In this work, surge of prevention is a critical problem in oil and gas industries, particularly when return gas flow or gas flow reduces in transportation of gas pipelines. This paper is illustrated new results about surge control of centrifugal compressors .surge phenomenon is flow unsteady state in compressors which causes damages seriously in compressor construction. Furthermore, it also demonstrates in comparison with anti surge control ،active surge control expands stability range.Active surge control which based on fuzzy logic،is the main idea that used in this investigation. Using fuzzy controller causes an improvement in compressor's condition and increase performance range of the compressor, in addition to prevention of any instability in compressor. The simulation results is also satisfactory.
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Prediction ranges. Annual review
Energy Technology Data Exchange (ETDEWEB)
Parker, J.C.; Tharp, W.H.; Spiro, P.S.; Keng, K.; Angastiniotis, M.; Hachey, L.T.
1988-01-01
Prediction ranges equip the planner with one more tool for improved assessment of the outcome of a course of action. One of their major uses is in financial evaluations, where corporate policy requires the performance of uncertainty analysis for large projects. This report gives an overview of the uses of prediction ranges, with examples; and risks and uncertainties in growth, inflation, and interest and exchange rates. Prediction ranges and standard deviations of 80% and 50% probability are given for various economic indicators in Ontario, Canada, and the USA, as well as for foreign exchange rates and Ontario Hydro interest rates. An explanatory note on probability is also included. 23 tabs.
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Energy Technology Data Exchange (ETDEWEB)
Zui, H. [Setsunan University, Osaka (Japan). Faculty of Engineering; Shinke, T. [Kobe Technical College, Kobe, Kobe (Japan); Hamazaki, Y. [Kobe Steel, Ltd., Kobe (Japan)
1995-10-21
The vibration method is usually utilized on the measurement of cable tension during construction of cable bridge such as Nielsen bridges or cable stayed bridges. Practical formula for the vibration method previously proposed by authors is often used where bending rigidity is taken into account. These formula, however, have a certain limit of application and do not yield good results when the cable is not slender or not enough mentioned. The practical formula is modified to improve the accuracy and new formulas are made. The new practical formulas are applicable to any cables, regardless of its length and tension in it. The accuracy is confirmed through comparison of the value obtained by practical formulas with measured values and calculated value by F.E.M. 2 refs., 4 figs., 1 tab.
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Jeffs, Lianne; Wilson, Gail; Ferris, Ella; Cardiff, Brenda; Ng, San; Lanceta, Mary; White, Peggy; Pringle, Dorothy
2012-03-01
Ontario's Health Outcomes for Better Information and Care (HOBIC) is designed to help organizations and nurses plan and evaluate care by comparing patient outcomes with historical data on similar cases. Yet, fewer than 15% of patients in a 2010 study were found to have complete admission and discharge data sets. This low utilization rate of HOBIC measures prompted the current qualitative study, in which nurses from three clinical settings in an academic teaching hospital were interviewed to gain their perceptions related to collecting and using HOBIC measures in practice. The objective was to identify factors that promote or impede the collection and use of HOBIC data in clinical practice to improve patient care and outcomes. Analysis of interview results produced four key themes related to (a) use of HOBIC measures to inform patient care, (b) collecting and documenting HOBIC measures, (c) HOBIC as an afterthought and "black hole" and (d) impediments to assessing and documenting HOBIC measures because of language barriers, patients' cognitive status and lack of time. Recommendations to improve uptake include developing, implementing and evaluating a communication and learning plan that promotes HOBIC's values and benefits, and determining how managers and administrators perceive utilization of HOBIC at the clinical unit and organizational levels.
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Energy Technology Data Exchange (ETDEWEB)
Hendron, B.
2013-07-01
The U.S. Department of Energy developed the Advanced Energy Retrofit Guides (AERGs) to provide specific methodologies, information, and guidance to help energy managers and other stakeholders successfully plan and execute energy efficiency improvements. Detailed technical discussion is fairly limited in these guides. Instead, we emphasize actionable information, practical methodologies, diverse case studies, and unbiased evaluations of the most promising retrofit measures for each building type. A series of AERGs is under development, addressing key segments of the commercial building stock. Grocery stores were selected as one of the highest priority sectors, because they represent one of the most energy-intensive market segments.
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Perspectives from practice: complexities of personal care workers.
Martyn, Julie-Anne; Zanella, Sally; Wilkinson, Adele
2017-11-14
Personal care workers (PCWs) make up the bulk of the workforce in residential and community care services. The knowledge and skill set needed for safe and effective practice in care settings is extensive. A diverse range of registered training organisations (RTOs) offering Certificate III and IV in Individual Support (aging, home and community) are tasked with producing job-ready PCWs. However, the curricula of these programs vary. Additionally, a national code of conduct for healthcare workers became effective in October 2015 as a governance framework for PCWs. The language of the code statements is ambiguous making it unclear how this framework should be translated by RTOs and applied in the preservice practice preparation of PCWs. Employers of PCWs need to feel confident that the content of the preservice education of PCWs satisfactorily prepares them for the diverse contexts of their practice. Likewise, the health professionals who supervise PCWs must be assured about the knowledge and skills of the PCW if they are to safely delegate care activities. The perspectives presented in this discussion make it clear that investigation into the nebulous nature of PCW education, regulation and practice is needed to identify the shortcomings and enable improved practice.
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Versatile composite resins simplifying the practice of restorative dentistry.
Margeas, Robert
2014-01-01
After decades of technical development and refinement, composite resins continue to simplify the practice of restorative dentistry, offering clinicians versatility, predictability, and enhanced physical properties. With a wide range of products available today, composite resins are a reliable, conservative, multi-functional restorative material option. As manufacturers strive to improve such properties as compression strength, flexural strength, elastic modulus, coefficient of thermal expansion, water sorption, and wear resistance, several classification systems of composite resins have been developed.
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Directory of Open Access Journals (Sweden)
Evelyn L. Rhodes
2014-10-01
Full Text Available Global efforts are underway to develop and promote improved cookstoves which may reduce the negative health and environmental effects of burning solid fuels on health and the environment. Behavioral studies have considered cookstove user practices, needs and preferences in the design and implementation of cookstove projects; however, these studies have not examined the implications of the traditional stove use and design across multiple resource-poor settings in the implementation and promotion of improved cookstove projects that utilize a single, standardized stove design. We conducted in-depth interviews and direct observations of meal preparation and traditional, open-fire stove use of 137 women aged 20–49 years in Kenya, Peru and Nepal prior in the four-month period preceding installation of an improved cookstove as part of a field intervention trial. Despite general similarities in cooking practices across sites, we identified locally distinct practices and norms regarding traditional stove use and desired stove improvements. Traditional stoves are designed to accommodate specific cooking styles, types of fuel, and available resources for maintenance and renovation. The tailored stoves allow users to cook and repair their stoves easily. Women in each setting expressed their desire for a new stove, but they articulated distinct specific alterations that would meet their needs and preferences. Improved cookstove designs need to consider the diversity of values and needs held by potential users, presenting a significant challenge in identifying a “one size fits all” improved cookstove design. Our data show that a single stove design for use with locally available biomass fuels will not meet the cooking demands and resources available across the three sites. Moreover, locally produced or adapted improved cookstoves may be needed to meet the cooking needs of diverse populations while addressing health and environmental concerns of
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Rhodes, Evelyn L.; Dreibelbis, Robert; Klasen, Elizabeth; Naithani, Neha; Baliddawa, Joyce; Menya, Diana; Khatry, Subarna; Levy, Stephanie; Tielsch, James M.; Miranda, J. Jaime; Kennedy, Caitlin; Checkley, William
2014-01-01
Global efforts are underway to develop and promote improved cookstoves which may reduce the negative health and environmental effects of burning solid fuels on health and the environment. Behavioral studies have considered cookstove user practices, needs and preferences in the design and implementation of cookstove projects; however, these studies have not examined the implications of the traditional stove use and design across multiple resource-poor settings in the implementation and promotion of improved cookstove projects that utilize a single, standardized stove design. We conducted in-depth interviews and direct observations of meal preparation and traditional, open-fire stove use of 137 women aged 20–49 years in Kenya, Peru and Nepal prior in the four-month period preceding installation of an improved cookstove as part of a field intervention trial. Despite general similarities in cooking practices across sites, we identified locally distinct practices and norms regarding traditional stove use and desired stove improvements. Traditional stoves are designed to accommodate specific cooking styles, types of fuel, and available resources for maintenance and renovation. The tailored stoves allow users to cook and repair their stoves easily. Women in each setting expressed their desire for a new stove, but they articulated distinct specific alterations that would meet their needs and preferences. Improved cookstove designs need to consider the diversity of values and needs held by potential users, presenting a significant challenge in identifying a “one size fits all” improved cookstove design. Our data show that a single stove design for use with locally available biomass fuels will not meet the cooking demands and resources available across the three sites. Moreover, locally produced or adapted improved cookstoves may be needed to meet the cooking needs of diverse populations while addressing health and environmental concerns of traditional stoves. PMID
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Mbuthia, Jackson Mwenda; Rewe, Thomas Odiwuor; Kahi, Alexander Kigunzu
2015-02-01
This study evaluated pig production practices by smallholder farmers in two distinct production systems geared towards addressing their constraints and prospects for improvement. The production systems evaluated were semi-intensive and extensive and differed in remoteness, market access, resource availability and pig production intensity. Data were collected using structured questionnaires where a total of 102 pig farmers were interviewed. Qualitative and quantitative research methods were employed to define the socioeconomic characteristics of the production systems, understanding the different roles that pigs play, marketing systems and constraints to production. In both systems, regular cash income and insurance against emergencies were ranked as the main reasons for rearing pigs. Marketing of pigs was mainly driven by the type of production operation. Finances, feeds and housing were identified as the major constraints to production. The study provides important parameters and identifies constraints important for consideration in design of sustainable production improvement strategies. Feeding challenges can be improved through understanding the composition and proper utilization of local feed resources. Provision of adequate housing would improve the stocking rates and control mating.
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Autonomous Target Ranging Techniques
DEFF Research Database (Denmark)
Jørgensen, Peter Siegbjørn; Jørgensen, John Leif; Denver, Troelz
2003-01-01
of this telescope, a fast determination of the range to and the motion of the detected targets are important. This is needed in order to prepare the future observation strategy for each target, i.e. when is the closest approach where imaging will be optimal. In order to quickly obtain such a determination two...... ranging strategies are presented. One is an improved laser ranger with an effective range with non-cooperative targets of at least 10,000 km, demonstrated in ground tests. The accuracy of the laser ranging will be approximately 1 m. The laser ranger may furthermore be used for trajectory determination...... of nano-gravity probes, which will perform direct mass measurements of selected targets. The other is triangulation from two spacecraft. For this method it is important to distinguish between detection and tracking range, which will be different for Bering since different instruments are used...
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Scott-Jones, Joseph; Lucas, Sarah
2013-09-01
Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.
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Malek, A. K.; Muhammad, H. I.; Rosmaini, A.; Alaa, A. S.; Falah, A. M.
2017-09-01
Development and improvement process are essential to the companies and factories of various kinds and this necessity is related aspects of cost, time and risk that can be avoided, these aspects are available at the nuclear power stations essential demands cannot be ignored. The lean management technique is one of the recent trends in the management system. Where the lean management is stated as the system increases the customer value and reduces the wastage process in an industry or in a power plants. Therefore, there is an urgent necessity to ensure the development and improvement in nuclear power plants in the pre-established in process of being established and stage of the management and production. All of these stages according to the study are closely related to the necessity operationalize and apply lean manufacturing practices that these applications are ineffective and clear contribution to reduce costs and control of production processes and the process of reducing future risks that could be exposed to the station.
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Ranging Behaviour of Commercial Free-Range Broiler Chickens 1: Factors Related to Flock Variability.
Taylor, Peta S; Hemsworth, Paul H; Groves, Peter J; Gebhardt-Henrich, Sabine G; Rault, Jean-Loup
2017-07-20
Little is known about the ranging behaviour of chickens. Understanding ranging behaviour is required to improve management and shed and range design to ensure optimal ranging opportunities. Using Radio Frequency Identification technology, we tracked 300 individual broiler chickens in each of four mixed sex ROSS 308 flocks on one commercial farm across two seasons. Ranging behaviour was tracked from the first day of range access (21 days of age) until 35 days of age in winter and 44 days of age in summer. Range use was higher than previously reported from scan sampling studies. More chickens accessed the range in summer (81%) than winter (32%; p range use was greater in summer flocks (4.4 ± 0.1 visits for a total of 26.3 ± 0.8 min/day) than winter flocks (3.2 ± 0.2 visits for a total of 7.9 ± 1.0 min/day). Seasonal differences were only marginally explained by weather conditions and may reflect the reduction in range exposure between seasons (number of days, hours per day, and time of day). Specific times of the day ( p ranging and external factors that may explain ranging preferences.
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Kensler, Lisa A. W.; Reames, Ellen; Murray, John; Patrick, Lynne
2012-01-01
Teachers and administrators have access to large volumes of data but research suggests that they lack the skills to use data effectively for continuous school improvement. This study involved a cross-case analysis of two high school leadership teams' early stages of evidence-based practice development; differing forms of external support were…
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National Research Council Canada - National Science Library
Foote, Eric
2006-01-01
.... One such practice may be prescribed or controlled burning, which is used on military training ranges for a variety of purposes including safety clearance prior to detection and demolition of unexploded ordnance (UXO...
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Lim, Sung-Ah; Cheong, Kwang-Jo
2015-09-01
The aim of the present study is to highlight the beneficial effects of yoga practice on bio-parameters, such as oxidative stress, antioxidant components, immune functions, and secretion of stress hormones, in healthy young people. This study was conducted on healthy volunteers recruited from among university students, who were divided into two groups: a control (no yoga intervention, n=13) group and a yoga (n=12) group. Yoga practice was with an instructor for 90 minutes once a week spread over 12 weeks, with recommendations to practice daily at home for 40 minutes with the help of a DVD. The yoga program consisted of yoga body poses (asanas), exercises involving awareness, voluntary regulation of breath (pranayama), and meditational practices. Whole blood samples were collected when the volunteers had fasted for 8 hours at 0 and 12 weeks. The oxidative stress/antioxidant components, immune-related cytokines, and stress hormones were evaluated in serum or plasma. Serum levels of nitric oxide, F2-isoprostane, and lipid peroxide were significantly decreased by yoga practice (pstress and improved antioxidant levels of the body. Moreover, yoga beneficially affected stress hormone releases as well as partially improved immune function.
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Continuous Improvement and Collaborative Improvement: Similarities and Differences
Middel, H.G.A.; Boer, Harm; Fisscher, O.A.M.
2006-01-01
A substantial body of theoretical and practical knowledge has been developed on continuous improvement. However, there is still a considerable lack of empirically grounded contributions and theories on collaborative improvement, that is, continuous improvement in an inter-organizational setting. The
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Prostate-specific antigen testing accuracy in community practice
Directory of Open Access Journals (Sweden)
Adams-Cameron Meg
2002-10-01
Full Text Available Abstract Background Most data on prostate-specific antigen (PSA testing come from urologic cohorts comprised of volunteers for screening programs. We evaluated the diagnostic accuracy of PSA testing for detecting prostate cancer in community practice. Methods PSA testing results were compared with a reference standard of prostate biopsy. Subjects were 2,620 men 40 years and older undergoing (PSA testing and biopsy from 1/1/95 through 12/31/98 in the Albuquerque, New Mexico metropolitan area. Diagnostic measures included the area under the receiver-operating characteristic curve, sensitivity, specificity, and likelihood ratios. Results Cancer was detected in 930 subjects (35%. The area under the ROC curve was 0.67 and the PSA cutpoint of 4 ng/ml had a sensitivity of 86% and a specificity of 33%. The likelihood ratio for a positive test (LR+ was 1.28 and 0.42 for a negative test (LR-. PSA testing was most sensitive (90% but least specific (27% in older men. Age-specific reference ranges improved specificity in older men (49% but decreased sensitivity (70%, with an LR+ of 1.38. Lowering the PSA cutpoint to 2 ng/ml resulted in a sensitivity of 95%, a specificity of 20%, and an LR+ of 1.19. Conclusions PSA testing had fair discriminating power for detecting prostate cancer in community practice. The PSA cutpoint of 4 ng/ml was sensitive but relatively non-specific and associated likelihood ratios only moderately revised probabilities for cancer. Using age-specific reference ranges and a PSA cutpoint below 4 ng/ml improved test specificity and sensitivity, respectively, but did not improve the overall accuracy of PSA testing.
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Higgins, Rosemary; Murphy, Barbara; Worcester, Marian; Daffey, Angela
2012-01-01
To support self-management, health professionals need to adopt a client-centred approach and learn to deliver evidence-based behaviour change interventions. This paper reports on the evaluation of 1- and 2-day training programs developed to improve health professionals' capacity to support chronic disease self-management (CDSM). The 321 participants attended one of eighteen supporting CDSM courses held in urban and rural settings. Participants included nurses, allied health professionals, Aboriginal health workers and general practitioners. Data were collected at three time points: before participation; immediately after the training; and, for a sub-sample of 37 participants, 2 months after the training. Results revealed a significant and sustained increase in CDSM self-efficacy following training regardless of participants' gender, age or qualifications. A thematic analysis of the responses concerning intended practice revealed four main areas of intended practice change, namely: use behavioural strategies; improve communication with clients; adopt a client-centred approach; and improve goal setting. The number of practice changes at 2 months reported by a sub-sample of participants ranged from 1 to 20 with a mean of 14 (s.d.=4). The three most common areas of practice change point to the adoption by health professionals of a collaborative approach with chronic disease patients. Lack of staff trained in CDSM was seen as a major barrier to practice change, with lack of support and finance also named as barriers to practice change. Participants identified that increased training, support and awareness of the principles of supporting CDSM would help to overcome barriers to practice change. These results indicate a readiness among health professionals to adopt a more collaborative approach given the skills and the tools to put this approach into practice.
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Fink, Regina; Gilmartin, Heather; Richard, Angela; Capezuti, Elizabeth; Boltz, Marie; Wald, Heidi
2012-10-01
Indwelling urinary catheters (IUCs) are commonly used in hospitalized patients, especially elders. Catheter-associated urinary tract infections (CAUTIs) account for 34% of all health care associated infections in the United States, associated with excess morbidity and health care costs. Adherence to CAUTI prevention practices has not been well described. This study used an electronic survey to examine IUC care practices for CAUTI prevention in 3 areas-(1) equipment and alternatives and insertion and maintenance techniques; (2) personnel, policies, training, and education; and (3) documentation, surveillance, and removal reminders-at 75 acute care hospitals in the Nurses Improving the Care of Healthsystem Elders (NICHE) system. CAUTI prevention practices commonly followed included wearing gloves (97%), handwashing (89%), maintaining a sterile barrier (81%), and using a no-touch insertion technique (73%). Silver-coated catheters were used to varying degrees in 59% of the hospitals; 4% reported never using a catheter-securing device. Urethral meatal care was provided daily by 43% of hospitals and more frequently that that by 41% of hospitals. Nurses were the most frequently reported IUC inserters. Training in aseptic technique and CAUTI prevention at the time of initial nursing hire was provided by 64% of hospitals; however, only 47% annually validated competency in IUC insertion. Systems for IUC removal were implemented in 56% of hospitals. IUC documentation and routine CAUTI surveillance practices varied widely. Although many CAUTI prevention practices at NICHE hospitals are in alignment with evidence-based guidelines, there is room for improvement. Further research is needed to identify the effect of enhanced compliance with CAUTI prevention practices on the prevalence of CAUTI in NICHE hospitals. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
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Is Treating Motor Problems in DCD Just a Matter of Practice and More Practice?
Schoemaker, Marina M; Smits-Engelsman, Bouwien C M
Developmental coordination disorder (DCD) is often called a motor learning deficit. The question addressed in this paper is whether improvement of motor skills is just a matter of mere practice. Without any kind of intervention, children with DCD do not improve their motor skills generally, whereas they do improve after task-oriented intervention. Merely offering children the opportunity to practice motor skills, for instance by playing active video games, did lead to improved motor performance according to recent research findings, but to a lesser extent than task-oriented intervention. We argue that children with DCD lack the required motor problem-solving skills necessary to further improve their performance. Explicit motor teaching with an emphasis on developing these problem-solving skills is a necessary ingredient of intervention in DCD, leveraging the effectiveness of intervention above that of mere practicing.
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McConnell, Karen J; Delate, Thomas; Newlon, Carey L
2015-04-25
To assess the long-term sustainability of continuing professional development (CPD) training in pharmacy practice and learning behaviors. This was a 3-year posttrial survey of pharmacists who had participated in an unblinded randomized controlled trial of CPD. The online survey assessed participants' perceptions of pharmacy practice, learning behaviors, and sustainability of CPD. Differences between groups on the posttrial survey responses and changes from the trial's follow-up survey to the posttrial survey responses within the intervention group were compared. Of the 91 pharmacists who completed the original trial, 72 (79%) participated in the sustainability survey. Compared to control participants, a higher percentage of intervention participants reported in the sustainability survey that they had utilized the CPD concept (45.7% vs 8.1%) and identified personal learning objectives (68.6% vs 43.2%) during the previous year. Compared to their follow-up survey responses, lower percentages of intervention participants reported identifying personal learning objectives (94.3% vs 68.6%), documenting their learning plan (82.9% vs 22.9%) and participating in learning by doing (42.9% vs 14.3%) in the sustainability survey. In the intervention group, many of the improvements to pharmacy practice items were sustained over the 3-year period but were not significantly different from the control group. Sustainability of a CPD intervention over a 3-year varied. While CPD-trained pharmacists reported utilizing CPD concepts at a higher rate than control pharmacists, their CPD learning behaviors diminished over time.
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Martin, Graham; Ozieranski, Piotr; Willars, Janet; Charles, Kathryn; Minion, Joel; McKee, Lorna; Dixon-Woods, Mary
2014-07-01
Walkrounds, introduced as Leadership (or Executive) WalkRounds, are a widely advocated model for increasing leadership engagement in patient safety to improve safety culture, but evidence for their effectiveness is mixed. In the English National Health Service (NHS), hospitals have been strongly encouraged to make use of methods closely based on the walkrounds approach. A study was conducted to explore how walkrounds are used in practice and to identify variations in implementation that might mediate their impact on safety and culture. The data, collected from 82 semistructured interviews in the English NHS, were drawn from two components of a wider study of culture and behavior around quality and safety in the English system. Analysis was based on the constant comparative method. Our analysis highlights how local, pragmatic adjustments to the walkrounds approach could radically alter its character and the way in which it is received by those at the front line. The modification and expansion of walkrounds to increase the scope of knowledge produced could increase the value that executives draw from them. However, it risks replacing the main objectives of walkrounds--specific, actionable knowledge about safety issues, and a more positive safety culture and relationship between ward and board--with a form of surveillance that could alienate frontline staff and produce fallible insights. The studys findings suggest some plausible explanations for the mixed evidence for walkrounds' effectiveness in creating a safety culture. On a practical level, they point to critical questions that executives must ask themselves in practicing interventions of this nature to ensure that adaptations align rather than conflict with the intervention's model of change.
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Directory of Open Access Journals (Sweden)
Davies Gawaine
2010-08-01
Full Text Available Abstract Background The Health Improvement and Prevention Study (HIPS study aims to evaluate the capacity of general practice to identify patients at high risk for developing vascular disease and to reduce their risk of vascular disease and diabetes through behavioural interventions delivered in general practice and by the local primary care organization. Methods/Design HIPS is a stratified randomized controlled trial involving 30 general practices in NSW, Australia. Practices are randomly allocated to an 'intervention' or 'control' group. General practitioners (GPs and practice nurses (PNs are offered training in lifestyle counselling and motivational interviewing as well as practice visits and patient educational resources. Patients enrolled in the trial present for a health check in which the GP and PN provide brief lifestyle counselling based on the 5As model (ask, assess, advise, assist, and arrange and refer high risk patients to a diet education and physical activity program. The program consists of two individual visits with a dietician or exercise physiologist and four group sessions, after which patients are followed up by the GP or PN. In each practice 160 eligible patients aged between 40 and 64 years are invited to participate in the study, with the expectation that 40 will be eligible and willing to participate. Evaluation data collection consists of (1 a practice questionnaire, (2 GP and PN questionnaires to assess preventive care attitudes and practices, (3 patient questionnaire to assess self-reported lifestyle behaviours and readiness to change, (4 physical assessment including weight, height, body mass index (BMI, waist circumference and blood pressure, (5 a fasting blood test for glucose and lipids, (6 a clinical record audit, and (7 qualitative data collection. All measures are collected at baseline and 12 months except the patient questionnaire which is also collected at 6 months. Study outcomes before and after the
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Abbott, Eduardo F; Thompson, Whitney; Pandian, T K; Zendejas, Benjamin; Farley, David R; Cook, David A
2017-11-01
Compare the effect of personalized feedback (PF) vs. task demonstration (TD), both delivered via video, on laparoscopic knot-tying skills and perceived workload; and evaluate the effect of repeated practice. General surgery interns and research fellows completed four repetitions of a simulated laparoscopic knot-tying task at one-month intervals. Midway between repetitions, participants received via e-mail either a TD video (demonstration by an expert) or a PF video (video of their own performance with voiceover from a blinded senior surgeon). Each participant received at least one video per format, with sequence randomly assigned. Outcomes included performance scores and NASA Task Load Index (NASA-TLX) scores. To evaluate the effectiveness of repeated practice, scores from these trainees on a separate delayed retention test were compared against historical controls who did not have scheduled repetitions. Twenty-one trainees completed the randomized study. Mean change in performance scores was significantly greater for those receiving PF (difference = 23.1 of 150 [95% confidence interval (CI): 0, 46.2], P = .05). Perceived workload was also significantly reduced (difference = -3.0 of 20 [95% CI: -5.8, -0.3], P = .04). Compared with historical controls (N = 93), the 21 with scheduled repeated practice had higher scores on the laparoscopic knot-tying assessment two weeks after the final repetition (difference = 1.5 of 10 [95% CI: 0.2, 2.8], P = .02). Personalized video feedback improves trainees' procedural performance and perceived workload compared with a task demonstration video. Brief monthly practice sessions support skill acquisition and retention.
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Directory of Open Access Journals (Sweden)
Lovarini Meryl
2005-12-01
Full Text Available Abstract Background Many health professionals lack the skills to find and appraise published research. This lack of skills and associated knowledge needs to be addressed, and practice habits need to change, for evidence-based practice to occur. The aim of this before and after study was to evaluate the effect of a multifaceted intervention on the knowledge, skills, attitudes and behaviour of allied health professionals. Methods 114 self-selected occupational therapists were recruited. The intervention included a 2-day workshop combined with outreach support for eight months. Support involved email and telephone contact and a workplace visit. Measures were collected at baseline, post-workshop, and eight months later. The primary outcome was knowledge, measured using the Adapted Fresno Test of Evidence-Based Practice (total score 0 to 156. Secondary outcomes were attitude to evidence-based practice (% reporting improved skills and confidence; % reporting barriers, and behaviour measured using an activity diary (% engaging/not engaging in search and appraisal activities, and assignment completion. Results Post-workshop, there were significant gains in knowledge which were maintained at follow-up. The mean difference in the Adapted Fresno Test total score was 20.6 points (95% CI, 15.6 to 25.5. The change from post-workshop to follow-up was small and non-significant (mean difference 1.2 points, 95% CI, -6.0 to 8.5. Fewer participants reported lack of searching and appraisal skills as barriers to evidence-based practice over time (searching = 61%, 53%, 24%; appraisal 60%, 65%, 41%. These differences were statistically significant (p = 0.0001 and 0.010 respectively. Behaviour changed little. Pre-workshop, 6% engaged in critical appraisal increasing to 18% post-workshop and 18% at follow-up. Nearly two thirds (60% were not reading any research literature at follow-up. Twenty-three participants (20.2% completed their assignment. Conclusion Evidence
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Boussier, Rémi; Rogez, Sylvie; François, Bruno; Denes, Eric; Ploy, Marie-Cécile; Garnier, Fabien
2013-03-01
Positive heart valve (HV) culture is a major Duke's criterion for the diagnosis of infective endocarditis but is poorly sensitive. Two broad-range 16S rDNA polymerase chain reaction (PCR) methods were applied to 31 HV samples: first, a real-time method, then conventional end-point PCR was applied to HV samples on which the first PCR was negative. Five specific real-time PCR procedures were also used in order to identify Bartonella spp., Tropheryma whipplei, Chlamydophila pneumoniae, Mycoplasma pneumonia, and Coxiella burnetii. A strategy combining the 2-step broad-range PCR methods improved the sensitivity of the molecular method from 38.7% to 58%. Specific PCR identified 1 T. whipplei, which was also identified by conventional end-point PCR. These results confirm that blood culture is the gold standard for the diagnosis of infective endocarditis, shows that molecular methods applied to HV can be useful when blood culture is negative, and that 2-step broad-range PCR approach seems to be more sensitive. Copyright © 2013 Elsevier Inc. All rights reserved.
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Implementing collaborative improvement - top-down, bottom-up or both?
DEFF Research Database (Denmark)
Kaltoft, Rasmus; Boer, Harry; Caniato, Federico
2007-01-01
, the study identifies three different implementation approaches. The bottom-up learning-by-doing approach starts at a practical level, with simple improvement activities, and aims at gradually developing a wide range of CoI knowledge, skills and initiatives. The top-down directive approach starts...... with aligning the partners' CoI objectives and an assessment of their collaboration and CoI maturity in order to provide a common platform before actually starting improvement activities. The laissez-faire approach builds on shared goals/vision, meetings on equal terms and joint work, in a non-directive and non......-facilitated way, though. The article demonstrates how and why the different approaches have different effects on the development of collaborative improvement....
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Directory of Open Access Journals (Sweden)
Norman Uphoff
2015-06-01
expression of rice plants' genetic potential, thereby creating more productive and robust phenotypes from given rice genotypes. Data indicate that increased plant density does not necessarily enhance crop yield potential, as classical breeding methods suggest. Developing cultivars that can achieve their higher productivity under a wide range of plant densities—breeding for density-neutral cultivars using alternative selection strategies—will enable more effective exploitation of available crop growth resources. Density-neutral cultivars that achieve high productivity under ample environmental growth resources can also achieve optimal productivity under limited resources, where lower densities can avert crop failure due to overcrowding. This will become more important to the extent that climatic and other factors become more adverse to crop production. Focusing more on which management practices can evoke the most productive and robust phenotypes from given genotypes is important for rice breeding and improvement programs since it is phenotypes that feed our human populations.
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Morrow, Susan; Daines, Luke; Wiener-Ogilvie, Sharon; Steed, Liz; McKee, Lorna; Caress, Ann-Louise; Taylor, Stephanie J C; Pinnock, Hilary
2017-07-18
Despite an overwhelming evidence base, supported self-management of asthma is poorly implemented into routine practice. Strategies for implementation must address organisational routines, as well as provide resources for patients and training to improve professionals' skills. We aimed to explore the priority that primary care practices attach to asthma self-management, to describe their existing asthma management routines, and to generate innovative implementation strategies. We recruited 33 participants (23 general practitioners; seven nurses; three administrative staff) from 14 general practices. The 12 interviews and three focus groups were transcribed, coded and analysed thematically. Supported self-management was largely a nurse-led task within clinic-based annual reviews. Barriers included poor attendance at asthma clinics, lack of time, demarcation of roles, limited access to a range of tailored resources, and competing agendas in consultation, often due to multimorbidity. Suggestions for initiatives to improve the provision of supported self-management included emphasising the evidence for benefit (to influence prioritisation), improving teamwork (including team-based education), organisational strategies (including remote consulting) which need to fit within existing practice routines. Technology offers some potential solutions (e.g., improved templates, 'app'-based plans), but must be integrated with the practice information technology systems. Building on these insights, we will now develop a theoretically-based implementation strategy that will address patient, professional, and organisational buy-in, provide team-based education and offer a range of practical options and tools, which can be adapted and integrated within existing routines of individual practices.OVERCOMING THE ORGANISATIONAL BARRIERS TO IMPLEMENTING ASTHMA SELF-MANAGEMENT: Understanding the routines of primary care practices can suggest strategies to implement supported self
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Researchers' Roles in Patient Safety Improvement.
Pietikäinen, Elina; Reiman, Teemu; Heikkilä, Jouko; Macchi, Luigi
2016-03-01
In this article, we explore how researchers can contribute to patient safety improvement. We aim to expand the instrumental role researchers have often occupied in relation to patient safety improvement. We reflect on our own improvement model and experiences as patient safety researchers in an ongoing Finnish multi-actor innovation project through self-reflective narration. Our own patient safety improvement model can be described as systemic. Based on the purpose of the innovation project, our improvement model, and the improvement models of the other actors in the project, we have carried out a wide range of activities. Our activities can be summarized in 8 overlapping patient safety improvement roles: modeler, influencer, supplier, producer, ideator, reflector, facilitator, and negotiator. When working side by side with "practice," researchers are offered and engage in several different activities. The way researchers contribute to patient safety improvement and balance between different roles depends on the purpose of the study, as well as on the underlying patient safety improvement models. Different patient safety research paradigms seem to emphasize different improvement roles, and thus, they also face different challenges. Open reflection on the underlying improvement models and roles can help researchers with different backgrounds-as well as other actors involved in patient safety improvement-in structuring their work and collaborating productively.
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Influence of mental practice on development of voluntary control of a novel motor acquisition task.
Creelman, Jim
2003-08-01
The purpose of this investigation was to assess whether mental practice facilitates the development of voluntary control over the recruitment of the abductor hallucis muscle to produce isolated big toe abduction. A sample of convenience of 15 women and 20 men with a mean age of 28.8 yr. (SD=5.7) and healthy feet, who were unable voluntarily to abduct the big toe, were randomly assigned to one of three groups, a mental practice group, a physical practice group, and a group who performed a control movement during practice. Each subject received neuromuscular electrical stimulation to introduce the desired movement prior to each of five practice bouts over a single session lasting 2 hr. Big toe abduction active range of motion and surface electromyographic (EMG) output of the abductor hallucis and extensor digitorum brevis muscles were measured prior to the first practice bout and following each practice bout, yielding seven acquisition trials. Acquisition is defined as an improvement in both active range of motion and in the difference between the integrated EMG of the abductor hallucis and extensor digitorum brevis muscles during successive acquisition trials. Seven members of both the mental and physical practice groups and one member of the control group met the acquisition criteria. Chi-square analysis indicated the group difference was statistically significant, suggesting mental practice was effective for this task.
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Deliberate practice theory: relevance, effort, and inherent enjoyment of music practice.
Hyllegard, Randy; Bories, Tamara L
2008-10-01
This study examined three assumptions of the theory of deliberate practice for practice playing music on an electronic keyboard. 40 undergraduate students, divided into two separate groups, practiced one of two music sequences and rated the relevance of practice for improving performance on the sequences, the amount of effort needed to learn the sequences, and the inherent enjoyment of practice sessions. Findings for each assumption were consistent with those suggested by theory but also showed that perceptions are affected by the amount of practice completed and performance of the skill.
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Improvements in medium range weather forecasting system of India
Indian Academy of Sciences (India)
system is based on the latest Grid Statistical Interpolation (GSI) scheme and it has the provision to use most of .... ified Simplified-Arakawa Scheme (SAS) (Han and. Pan 2010). ..... Kim Y-J and Arakawa A 1995 Improvement of orographic gravity wave ... Yang F, Mitchell K, Hou Y-T, Dai Y, Deng X, Wang Z and. Liang X-Z ...
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Farr, Fiona
2015-01-01
Do you want to improve your teaching practice? Do you need to know more about getting the most out of student feedback? This textbook covers all topics in preparing TESOL teachers for the practical component of their programme.
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PNRA: Practically Improving Safety Culture within the Regulatory Body
International Nuclear Information System (INIS)
Bhatti, S.A.N.; Habib, M.A.
2016-01-01
The prevalence of a good safety culture is equally important for all kind of organizations involved in nuclear business including operating organizations, designers, regulator, etc., and this should be reflected through the processes and activities of these organizations. The need for inculcating safety culture into regulatory processes and practices is gradually increasing since the major nuclear accident of Fukushima, Japan. Accordingly, several international fora in last few years repeatedly highlighted the importance of prevalence of safety culture in regulatory bodies as well. The utilisation of concept of safety culture remained applicable in regulatory activities of PNRA in the form of core values. After the Fukushima accident, PNRA considered it important to check the extent of utilisation of safety culture concept in organizational activities and decided to conduct its “Safety Culture Self-Assessment (SCSA)” for presenting itself as role model in-order to endorse the fact that safety culture at regulatory authority plays an important role to influence safety culture at licenced facilities. Considering the complexity of cultural assessment starting from visual manifestations to the basic assumptions at the deeper level, PNRA decided to utilise IAEA emerging methodology for assessment of culture and then used modified IAEA normative framework (made it applicable for regulatory body) for assessing safety culture at a regulatory body. PNRA SCSA team utilised safety culture assessment tools (observations, focus groups, surveys, interviews and document analysis) for collecting cultural facts by including all level of personnel involved in different activities and functions in the organization. Different challenges were encountered during implementation of these tools which were tackled with the background of training on SCSA and with the help of experts during support missions arranged by IAEA. Before formally starting the SCSA process, pre-launch activities
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Directory of Open Access Journals (Sweden)
Scott-Jones J
2013-09-01
Full Text Available INTRODUCTION: Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. AIM: To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. METHODS: A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. RESULTS: The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. DISCUSSION: Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.
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Wang, Huan; Song, Zhenfeng; Ba, Yanhui; Zhu, Lin; Wen, Ying
2014-10-01
To describe the knowledge, attitudes and practices of type 2 diabetics in Yakeshi City and to assess the effect of implementation of nutritional and eating education in enhancing knowledge and practices regarding a healthy diet. A questionnaire-based survey was conducted with 162 diabetics to determine their nutrition knowledge, attitudes and practices; fifty-four participants received nutritional and eating education for 6 months. Diabetes-related nutrition knowledge, awareness, practice accuracy, dietary intake and glycaemic control were assessed before and after education. Yakeshi, a remote city in northern China. A total of 162 type 2 diabetics recruited from three hospitals, fifty-four of whom were selected randomly to receive education. Among the 162 respondents, most diabetics (75%) considered that controlling diet was important in the methods of controlling blood glucose. Scores for knowledge, practices and overall KAP (knowledge-attitude-practice) were low, but scores for attitude were high. Participants with diabetes education experiences, practice duration over 1 year or high education level all had higher scores for KAP (P nutrition knowledge, awareness and practice accuracy improved significantly (P nutrition knowledge and practices. Nutritional and eating education was effective in improving diabetics' nutrition knowledge and practices, and this optimal practice helped them control blood glucose effectively.
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Internet research: improving traditional community analysis before launching a practice.
Barresi, B; Scott, C
2000-01-01
Optometric practice management experts have always recommended that optometrists thoroughly research the communities in which they are considering practicing. Until the Internet came along, demographic research was possible but often daunting. Today, say these authors, it's becoming quite a bit easier ... and they show us how.
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Energy-range relation and mean energy variation in therapeutic particle beams
International Nuclear Information System (INIS)
Kempe, Johanna; Brahme, Anders
2008-01-01
Analytical expressions for the mean energy and range of therapeutic light ion beams and low- and high-energy electrons have been derived, based on the energy dependence of their respective stopping powers. The new mean energy and range relations are power-law expressions relevant for light ion radiation therapy, and are based on measured practical ranges or known tabulated stopping powers and ranges for the relevant incident particle energies. A practical extrapolated range, R p , for light ions was defined, similar to that of electrons, which is very closely related to the extrapolated range of the primary ions. A universal energy-range relation for light ions and electrons that is valid for all material mixtures and compounds has been developed. The new relation can be expressed in terms of the range for protons and alpha particles, and is found to agree closely with experimental data in low atomic number media and when the difference in the mean ionization energy is low. The variation of the mean energy with depth and the new energy-range relation are useful for accurate stopping power and mass scattering power calculations, as well as for general particle transport and dosimetry applications
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Wan, Xiang; Wang, Wenqian; Liu, Jiming; Tong, Tiejun
2014-12-19
In systematic reviews and meta-analysis, researchers often pool the results of the sample mean and standard deviation from a set of similar clinical trials. A number of the trials, however, reported the study using the median, the minimum and maximum values, and/or the first and third quartiles. Hence, in order to combine results, one may have to estimate the sample mean and standard deviation for such trials. In this paper, we propose to improve the existing literature in several directions. First, we show that the sample standard deviation estimation in Hozo et al.'s method (BMC Med Res Methodol 5:13, 2005) has some serious limitations and is always less satisfactory in practice. Inspired by this, we propose a new estimation method by incorporating the sample size. Second, we systematically study the sample mean and standard deviation estimation problem under several other interesting settings where the interquartile range is also available for the trials. We demonstrate the performance of the proposed methods through simulation studies for the three frequently encountered scenarios, respectively. For the first two scenarios, our method greatly improves existing methods and provides a nearly unbiased estimate of the true sample standard deviation for normal data and a slightly biased estimate for skewed data. For the third scenario, our method still performs very well for both normal data and skewed data. Furthermore, we compare the estimators of the sample mean and standard deviation under all three scenarios and present some suggestions on which scenario is preferred in real-world applications. In this paper, we discuss different approximation methods in the estimation of the sample mean and standard deviation and propose some new estimation methods to improve the existing literature. We conclude our work with a summary table (an Excel spread sheet including all formulas) that serves as a comprehensive guidance for performing meta-analysis in different
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Coetzee, Hendri; Nell, Werner; van Rensburg, Leon
2014-03-26
This article explores cultural beliefs and practices related to the Southern Ground-Hornbill (SGH) (Bucorvus leadbeateri) in nine southern and east-African countries. A qualitative, thematic content-analysis approach was followed. Ninety-eight participants took part in the study. Interviews and group discussions were used as the main data gathering methods. Each interview was digitally recorded and transcribed. Data were analysed by means of thematic content analysis. The main themes that emerged from the data analysis indicated that beliefs and practices relate to the SGH as being (a) a bringer or signifier of death/destruction/loss/ deprivation, with the bird commonly being regarded as a bad omen of evil spirits and announcer of calamities; (b) a protector against evil spirits, against lightning and against drought; (c) an enabler/causer of altered perceptions, which include remote viewing, foreseeing the future, and creating an illusion; and (d) a timekeeper that announces the beginning and end of a working day and of seasonal changes. Knowledge about the use of the SGH in cultural practices can contribute to conservation efforts in at least two significant ways: Firstly, beliefs and practices that were identified in this study as having potentially protective consequences for the SGH can now be specifically targeted and strengthened in future interventions. Secondly, destructive beliefs and practices that were identified can now be changed by means of the implementation of an intervention programme in countries where it is needed.
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Brueton, Valerie; Stenning, Sally P; Stevenson, Fiona; Tierney, Jayne; Rait, Greta
2017-08-01
To develop best practice guidance for the use of retention strategies in randomized clinical trials (RCTs). Consensus development workshops conducted at two UK Clinical Trials Units. Sixty-six statisticians, clinicians, RCT coordinators, research scientists, research assistants, and data managers associated with RCTs participated. The consensus development workshops were based on the consensus development conference method used to develop best practice for treatment of medical conditions. Workshops commenced with a presentation of the evidence for incentives, communication, questionnaire format, behavioral, case management, and methodological retention strategies identified by a Cochrane review and associated qualitative study. Three simultaneous group discussions followed focused on (1) how convinced the workshop participants were by the evidence for retention strategies, (2) barriers to the use of effective retention strategies, (3) types of RCT follow-up that retention strategies could be used for, and (4) strategies for future research. Summaries of each group discussion were fed back to the workshop. Coded content for both workshops was compared for agreement and disagreement. Agreed consensus on best practice guidance for retention was identified. Workshop participants agreed best practice guidance for the use of small financial incentives to improve response to postal questionnaires in RCTs. Use of second-class post was thought to be adequate for postal communication with RCT participants. The most relevant validated questionnaire was considered best practice for collecting RCT data. Barriers identified for the use of effective retention strategies were: the small improvements seen in questionnaire response for the addition of monetary incentives, and perceptions among trialists that some communication strategies are outdated. Furthermore, there was resistance to change existing retention practices thought to be effective. Face-to-face and electronic follow
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DEFF Research Database (Denmark)
Zeuner, Birgitte; Riisager, Anders; Mikkelsen, Jørn Dalgaard
2014-01-01
hexafluorophosphate), were examined as co-solvents for the improvement of the synthesis versus hydrolysis ratio in the trans-sialylation of lactose, catalysed by an engineered sialidase from Trypanosoma rangeli. The use of 25 % (v/v) t-butanol as co-solvent significantly increased 3'-sialyllactose production by 40...... % from 1.04 ± 0.09 to 1.47 ± 0.01 mM. The synthesis versus hydrolysis ratio increased correspondingly by 1.2-times. 1-2.5 % (v/v) EAN or [C2OHMIm][PF6] improved the synthesis versus hydrolysis ratio up to 2.5-times but simultaneously decreased the 3'-sialyllactose yield, probably due to enzyme...... inactivation caused by the ionic liquid. [MMIm][MeSO4] had a detrimental effect on the trans-sialylation yield and on the ratio between synthesis and hydrolysis....
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Radiographic quality and radiation protection in general medical practice and small hospitals
International Nuclear Information System (INIS)
Williamson, B.D.P.; Le Heron, J.C.
1988-01-01
Radiation protection and image quality were assessed in a survey of 22 general medical practices (GP) and the 24 smallest hospitals with x-ray facilities. Limited radiography, usually of extremities for trauma, was being performed in these facilities since access to regular radiology services was restricted, mainly for geographic reasons. An anthropomorphic phantom foot and ankle with two simulated fractures of the lateral and medical malleoli was presented at each facility for radiography, and the resulting films assessed for radiographic technique and basic diagnostic usefulness. The x-ray equipment was adequate for the range of procedures performed. While the standard of radiographic techniques was lower than in regular x-ray departments, most films of the phantom ankle were still diagnostically useful and only four were rejected entirely. The principal deficiency in general practice x-ray was in darkrooms and x-ray film processing. Consultation in this regard with registered medical radiation technologists is recommended. Generally, the x-ray equipment and working procedures complied with the National Radiation Laboratory Code of Safe Practice for the Use of X-rays in Diagnosis (Medical). Radiation doses to the phantom ankle ranged widely for effectively the same procedure, although none was excessive. Improved x-ray film processing, and tighter x-ray beam collimation, would result in a narrower range of doses to patients. Personnel exposures to radiation were satisfactorily low and special shieldings are not required in general practice. (author). 7 refs., 4 figs., 2 tabs
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Chandani, Yasmin; Duffy, Malia; Lamphere, Barbara; Noel, Megan; Heaton, Alexis; Andersson, Sarah
2017-11-01
Supply chain bottlenecks that prevent community health workers (CHWs) from accessing essential medicines significantly increase under-5 child mortality, particularly in poor and rural areas. Using implementation research, interventions aimed at improving supply chain practices and access to medicines were tested in Malawi and Rwanda. These interventions included simple demand-based resupply procedures, using mobile technology and traditional methods for communication, and multilevel, performance-driven quality improvement (QI) teams. Mixed-method evaluations were conducted at baseline (2010), midline (2013), and endline (2014). Baseline assessments identified common bottlenecks and established performance levels. Midline assessments identified which intervention package had the greatest impact. Endline surveys measured the progress of scale-up and institutionalization of each innovation. In both Rwanda and Malawi CHWs, health center staff, and district managers all cited many benefits of the establishment of resupply procedures and QI teams: such as providing structure and processes, a means to analyze and discuss problems and enhance collaboration between staff. Implementing simple, streamlined, demand-based resupply procedures formed the basis for informed and regular resupply, and increased the visibility of appropriate and timely community logistics data. QI teams played a critical role in reinforcing resupply procedures and routinely unlocking the bottlenecks that prevent the continuous flow of critical health products. While simple, streamlined, demand-based resupply procedures provide the basis for regular, functional, and efficient resupply of CHWs, the procedures alone are not sufficient to create consistent change in product availability. Supporting these procedures with multilevel QI teams reinforces the correct and consistent use of resupply procedures. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
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Power theories for improved power quality
Pasko, Marian
2012-01-01
Power quality describes a set of parameters of electric power and the load’s ability to function properly under specific conditions. It is estimated that problems relating to power quality costs the European industry hundreds of billions of Euros annually. In contrast, financing for the prevention of these problems amount to fragments of these costs. Power Theories for Improved Power Quality addresses this imbalance by presenting and assessing a range of methods and problems related to improving the quality of electric power supply. Focusing particularly on active compensators and the DSP based control algorithms, Power Theories for Improved Power Quality introduces the fundamental problems of electrical power. This introduction is followed by chapters which discuss: •‘Power theories’ including their historical development and application to practical problems, •operational principles of active compensator’s DSP control based algorithms using examples and results from laboratory research, and •t...
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Directory of Open Access Journals (Sweden)
Dandan Su
2017-12-01
Full Text Available This paper proposes an improved continuous-time model predictive control (CTMPC of permanent magnetic synchronous motors (PMSMs for a wide-speed range, including the constant torque region and the flux-weakening (FW region. In the constant torque region, the mathematic models of PMSMs in dq-axes are decoupled without the limitation of DC-link voltage. However, in the FW region, the mathematic models of PMSMs in dq-axes are cross-coupled together with the limitation of DC-link voltage. A nonlinear PMSMs mathematic model in the FW region is presented based on the voltage angle. The solving of the nonlinear mathematic model of PMSMs in FW region will lead to heavy computation load for digital signal processing (DSP. To overcome such a problem, a linearization method of the voltage angle is also proposed to reduce the computation load. The selection of transiting points between the constant torque region and FW regions is researched to improve the performance of the driven system. Compared with the proportional integral (PI controller, the proposed CTMPC has obvious advantages in dealing with systems’ nonlinear constraints and improving system performance by restraining overshoot current under step torque changing. Both simulation and experimental results confirm the effectiveness of the proposed method in achieving good steady-state performance and smooth switching between the constant torque and FW regions.
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CONTINUOUS IMPROVEMENT PRACTICE IN LARGE ENTERPRISES: STUDY RESULTS
Directory of Open Access Journals (Sweden)
Dorota Stadnicka
2015-03-01
Full Text Available Continuous improvement is indispensable for ensuring the company's development and its survival on the constantly changing global market. Continuous improvement is particularly important in the quality and production management systems. A company should deliver a product compliant with a client's requirements in a specified time and at an appropriate price. That is why, continuous improvement refers to different areas of an organization's functioning and it is an integral part of Lean Manufacturing. This article presents the results of the study conducted in production enterprises on a limited area. The aim of the study was the assessment of the implementation of continuous improvement in Lean Manufacturing, and, in particular, employees' involvement in the problem identification and in reporting improvements as well as the way of motivating employees to involve themselves. The authors also tried to identify the factors influencing the elements of a continuous improvement system.
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Long-range terms in atomic collisions
International Nuclear Information System (INIS)
McGuire, J.H.; Weaver, O.L.
1986-01-01
Various separations, or ''gauge choices,'' are possible for the decomposition of the total Hamiltonian into electronic and internuclear terms. We show that, for one particular choice, all long-range Coulomb terms are associated with the internuclear motion. The potential then associated with electronic transitions is non-Coulombic. Some practical consequences of this gauge choice are discussed
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AGIM REXHEPI; KURTESH SHERIFI; PETER SCHEINERT; LINDA GRAPCI-KOTORRI
2014-01-01
The viral diseases of rainbow trout are of worldwide concern including infectious pancreatic necrosis (IPN). On this study good sanitary practices are applied to prevent outbreaks and minimize losses caused from IPN disease. To highlight importance of improvements on sanitary practices in IPN prevention were compared results from two studies, first conducted in year 2006-2009 with results from one year later study conducted in 2010. In year 2010, samples of organs are collected from 260 fish ...
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Johnson, Kenneth L.; White, K. Preston, Jr.
2012-01-01
The NASA Engineering and Safety Center was requested to improve on the Best Practices document produced for the NESC assessment, Verification of Probabilistic Requirements for the Constellation Program, by giving a recommended procedure for using acceptance sampling by variables techniques as an alternative to the potentially resource-intensive acceptance sampling by attributes method given in the document. In this paper, the results of empirical tests intended to assess the accuracy of acceptance sampling plan calculators implemented for six variable distributions are presented.
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Quality Assurance Practices in Obstetric Care: A Survey of Hospitals in California.
Lundsberg, Lisbet S; Lee, Henry C; Dueñas, Grace Villarin; Gregory, Kimberly D; Grossetta Nardini, Holly K; Pettker, Christian M; Illuzzi, Jessica L; Xu, Xiao
2018-02-01
To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices. Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities. The association between institutional characteristics and adoption of evidence-supported practices (ie, those supported by prior literature or recommended by professional organizations as beneficial for improving birth outcome or patient safety) was examined using bivariate analysis and appropriate statistical tests. Most hospitals regularly audited adherence to written protocols regarding critical areas of care; however, 77.7% and 16.8% reported not having written guidelines on diagnosis of labor arrest and management of abnormal fetal heart rate, respectively. Private nonprofit hospitals were more likely to have a written protocol for management of abnormal fetal heart rate (P=.002). One in 10 hospitals (9.7%) did not regularly review cases with significant morbidity or mortality, and only 69.0% regularly tracked indications for cesarean delivery. Moreover, 26.3%, 14.3%, and 8.7% of the hospitals reported never performing interprofessional simulations for eclampsia, shoulder dystocia, or postpartum hemorrhage, respectively. Teaching status was associated with more frequent simulations in these three areas (P≤.04 for all), while larger volume was associated with more frequent simulations for eclampsia (P=.04). Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.
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Scientific analysis of satellite ranging data
Smith, David E.
1994-01-01
A network of satellite laser ranging (SLR) tracking systems with continuously improving accuracies is challenging the modelling capabilities of analysts worldwide. Various data analysis techniques have yielded many advances in the development of orbit, instrument and Earth models. The direct measurement of the distance to the satellite provided by the laser ranges has given us a simple metric which links the results obtained by diverse approaches. Different groups have used SLR data, often in combination with observations from other space geodetic techniques, to improve models of the static geopotential, the solid Earth, ocean tides, and atmospheric drag models for low Earth satellites. Radiation pressure models and other non-conservative forces for satellite orbits above the atmosphere have been developed to exploit the full accuracy of the latest SLR instruments. SLR is the baseline tracking system for the altimeter missions TOPEX/Poseidon, and ERS-1 and will play an important role in providing the reference frame for locating the geocentric position of the ocean surface, in providing an unchanging range standard for altimeter calibration, and for improving the geoid models to separate gravitational from ocean circulation signals seen in the sea surface. However, even with the many improvements in the models used to support the orbital analysis of laser observations, there remain systematic effects which limit the full exploitation of SLR accuracy today.
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Ritchie, Stephen D
2011-01-01
Pro .NET Best Practices is a practical reference to the best practices that you can apply to your .NET projects today. You will learn standards, techniques, and conventions that are sharply focused, realistic and helpful for achieving results, steering clear of unproven, idealistic, and impractical recommendations. Pro .NET Best Practices covers a broad range of practices and principles that development experts agree are the right ways to develop software, which includes continuous integration, automated testing, automated deployment, and code analysis. Whether the solution is from a free and
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Why invest, and what it will take to improve breastfeeding practices?
Rollins, Nigel C; Bhandari, Nita; Hajeebhoy, Nemat; Horton, Susan; Lutter, Chessa K; Martines, Jose C; Piwoz, Ellen G; Richter, Linda M; Victora, Cesar G
2016-01-30
Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women's work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. The marketing of breastmilk substitutes negatively affects breastfeeding: global sales in 2014 of US$44·8 billion show the industry's large, competitive claim on infant feeding. Not breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0·49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women, and society. To realise these gains, political support and financial investment are needed to protect, promote, and support breastfeeding. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Seven unconfirmed ideas to improve future ICU practice
Marini, J.J. (John J.); D. de Backer (Daniel); C. Ince (Can); Singer, M. (Mervyn); F.M.P. Van Haren; M. Westphal (Manfred); Wischmeyer, P. (Paul)
2017-01-01
textabstractWith imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or