WorldWideScience

Sample records for range improvement practices

  1. 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...

  2. 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...... from their new multinational owners. In the project we experimented to reach a less centralized and control centered SPI approach trying to meet the agile culture of the firm both within diagnosing, improvement planning, process design and evaluation eventhough the goal was applying to the norm. After...... having chosen the improvement area; requirement management, a more formal culture assessment and comparisons with the culture of the CMM-norm helped guiding the design of the new processes and tools. The paper suggests a SPI -approach based on problem diagnosis instead of formal CMMI-assessment, culture...

  3. Quality Improvement Practices and Trends

    DEFF Research Database (Denmark)

    Dahlgaard, Jens J.; Hartz, Ove; Edgeman, Rick L.

    1998-01-01

    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...

  4. 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.

  5. Improving clinical practice guidelines for practicing cardiologists.

    Science.gov (United States)

    Benhorin, Jesaia; Bodenheimer, Monty; Brown, Mary; Case, Robert; Dwyer, Edward M; Eberly, Shirley; Francis, Charles; Gillespie, John A; Goldstein, Robert E; Greenberg, Henry; Haigney, Mark; Krone, Ronald J; Klein, Helmut; Lichstein, Edgar; Locati, Emanuela; Marcus, Frank I; Moss, Arthur J; Oakes, David; Ryan, Daniel H; Bloch Thomsen, Poul E; Zareba, Wojciech

    2015-06-15

    Cardiac-related clinical practice guidelines have become an integral part of the practice of cardiology. Unfortunately, these guidelines are often long, complex, and difficult for practicing cardiologists to use. Guidelines should be condensed and their format upgraded, so that the key messages are easier to comprehend and can be applied more readily by those involved in patient care. After presenting the historical background and describing the guideline structure, we make several recommendations to make clinical practice guidelines more user-friendly for clinical cardiologists. Our most important recommendations are that the clinical cardiology guidelines should focus exclusively on (1) class I recommendations with established benefits that are supported by randomized clinical trials and (2) class III recommendations for diagnostic or therapeutic approaches in which quality studies show no benefit or possible harm. Class II recommendations are not evidence based but reflect expert opinions related to published clinical studies, with potential for personal bias by members of the guideline committee. Class II recommendations should be published separately as "Expert Consensus Statements" or "Task Force Committee Opinions," so that both majority and minority expert opinions can be presented in a less dogmatic form than the way these recommendations currently appear in clinical practice guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Characteristics of improved formative assessment practice

    National Research Council Canada - National Science Library

    Andersson, Catarina; Palm, Torulf

    2017-01-01

    An earlier study showed that the changes in teachers’ classroom practice, after participation in a professional development program in formative assessment, significantly improved student achievement in mathematics...

  7. Practical ways to facilitate ergonomics improvements in occupational health practice.

    Science.gov (United States)

    Kogi, Kazutaka

    2012-12-01

    Recent advances in participatory programs for improving workplace conditions are discussed to examine practical ways to facilitate ergonomics improvements. Participatory training programs are gaining importance, particularly in promoting occupational health and safety in small-scale workplaces. These programs have led to many improvements that can reduce work-related risks in varied situations. Recent experiences in participatory action-oriented training programs in small workplaces and agriculture are reviewed.The emphasis of the review is on training steps, types of improvements achieved, and the use of action tools by trainers and training participants. Immediate improvements in multiple technical areas are targeted, including materials handling,workstation design, physical environment, welfare facilities, and work organization. In facilitating ergonomics improvements in each local situation, it is important to focus on (a) building on local good practices; (b) applying practical, simple improvements that apply the basic principles of ergonomics; and (c) developing action-oriented toolkits for direct use by workers and managers. This facilitation process is effective when locally designed action toolkits are used by trainers, including local good examples, action checklists, and illustrated how-to guides. Intervention studies demonstrate the effectiveness of participatory steps that use these toolkits in promoting good practices and reducing work-related risks. In facilitating ergonomics improvements in small-scale workplaces, it is important to focus on practical, low-cost improvements that build on local good practices. The use of action-oriented toolkits reflecting basic ergonomics principles is helpful.The promotion of the intercountry networking of positive experiences in participatory training is suggested.

  8. Improved Space Bounds for Cache-Oblivious Range Reporting

    DEFF Research Database (Denmark)

    Afshani, Peyman; Zeh, Norbert

    2011-01-01

    second main result shows that any cache-oblivious 2-d three-sided range reporting data structure with the optimal query bound has to use Ω(N logε N) space, thereby improving on a recent lower bound for the same problem. Using known transformations, the lower bound extends to 3-d dominance reporting and 3......We provide improved bounds on the size of cacheoblivious range reporting data structures that achieve the optimal query bound of O(logB N + K/B) block transfers. Our first main result is an O(N √ logN log logN)-space data structure that achieves this query bound for 3-d dominance reporting and 2-d...... three-sided range reporting. No cache-oblivious o(N log N/ log logN)-space data structure for these problems was known before, even when allowing a query bound of O(logO(1) 2 N + K/B) block transfers.1 Our result also implies improved space bounds for general 2-d and 3-d orthogonal range reporting. Our...

  9. Reflective Practice: Creating Capacities for School Improvement.

    Science.gov (United States)

    Montie, Jo; York-Barr, Jennifer; Kronberg, Robi; Stevenson, Jane; Vallejo, Barb; Lunders, Cheri

    This monograph addresses the importance of and strategies for improving education through reflective practice, defined as cognitive processes and an open perspective that involve conscious self-examination in order to gain understandings and improve the lives of students. Chapter 1 provides an overview and explains origins of reflective practice…

  10. Characterization Of Farm Management Practices And Improved ...

    African Journals Online (AJOL)

    The need to increase yields and farm income, stimulate agricultural growth, alleviate poverty and promote food security in rural communities necessitated the introduction of improved farm management practices and crops varieties in northern Nigeria. Like every well-intended innovation, the benefits of the improved systems ...

  11. Hip joint range of motion improvements using three different interventions.

    Science.gov (United States)

    Moreside, Janice M; McGill, Stuart M

    2012-05-01

    The purpose of this study was to analyze the effect of 3 different exercise interventions plus a control group on passive hip range of motion (ROM). Previous research studies into the methods of improving passive hip mobility have focused on stretching protocols aimed specifically at the hip joint. The effect of core stabilization, motor training, and myofascial stretching techniques on hip mobility in a selected asymptomatic group with limited hip mobility is unclear. In this study, 24 young men with limited hip mobility (stretching, stretching with motor control exercises for the hip and trunk, core endurance with motor control exercises, and the control group. Six-week home exercise programs were individually prescribed based on the assigned group, hip ROM, movement patterns, and timed core endurance. Two-way analyses of variances were conducted to analyze the effect of group assignment on hip ROM improvements. Both stretching groups demonstrated significant improvements in hip ROM (p stretching also demonstrated a moderate increase in ROM but only significantly so in rotation. Average core endurance holding times improved 38-53%. These results indicate that stretches aimed at the myofascial components of the upper body, in addition to the hip joint, resulted in dramatic increases in hip ROM in a group of young men with limited hip mobility. Hip ROM also improved in the group that did no active stretching, highlighting the potential role of including stabilization or "proximal stiffening training" when rehabilitating the extremities.

  12. Improving detection range via correlation of long PN codes

    Science.gov (United States)

    Subedi, Saurav; Wang, Zhonghai; Zheng, Y. Rosa

    2012-06-01

    This paper proposes a correlation method for detecting super-regenerative RF receivers via stimulation. Long PN sequences are used as to stimulate the unintended emissions from the RF receivers. High correlation between known PN sequence and stimulated unintended emissions from RF receivers helps improving the detection range compared to passive detection and power detection methods. Although RF receivers generate unintended emissions from their nonlinear devices, without stimulation, the power of these unintended emission is usually lower than --70dBm, as per the FCC regulations. Direct detection (passive detection) of these emissions is a challenging task specially in noisy conditions. When a stimulation signal is transmitted from distance, superregenerative receivers generate unintended emissions that contain the stimulation signal and its harmonics. Excellent correlation property of PN sequence enables us to improve the range and accuracy of detecting the super-regenerative receivers through stimulation method even in noisy conditions. The experiment involves detection of wireless doorbell, a commercially available super-regenerative receiver. USRP is used for transmitting the stimulant signal and receiving unintended stimulated emissions from the doorbell. Experiments show that the detection range of the proposed method with long PN sequences is much larger than passive detection and power detection methods.

  13. Educational Intervention to Improve the Practice of ...

    African Journals Online (AJOL)

    In the face of the growing usage of herbs, pharmacovigilance of herbal medicine is still in its infancy. Literatures have indicated lack of awareness as one of the major barriers to pharmacovigilance. This study evaluates the impact of an educational intervention in improving the practice of pharmacovigilance among ...

  14. Mobile technology: streamlining practice and improving care

    OpenAIRE

    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.

  15. 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 ...

  16. Astym therapy improves function and range of motion following mastectomy

    Directory of Open Access Journals (Sweden)

    Davies CC

    2016-03-01

    Full Text Available Claire C Davies,1 Dorothy Brockopp,2 Krista Moe2 1Baptist Health Rehabilitation, 2Research Department, Baptist Health Lexington, Lexington, KY, USA Abstract: Hypersensitive scar tissue formation along the incision line and drain site is a common side effect following mastectomy. If this scar tissue is not addressed, it can lead to decreased flexibility and function in the involved upper quadrant. Astym® treatment is a new approach to soft tissue injuries, and is evidenced in animal studies to promote the healing and regeneration of soft tissues. It has also been found to reduce pain and increase function in people with soft tissue dysfunction. The aim of Astym treatment is to engage the regenerative mechanisms of the body in order to resorb scar tissue, stimulate tissue turnover, and regenerate soft tissues. Handheld instrumentation is applied topically to locate and treat the underlying dysfunctional soft tissue through specific protocols for the application of particular pressures and shear forces. The purpose of this study was to examine the effects of Astym treatment on activities of daily living in women who had undergone a mastectomy following a diagnosis of breast cancer. A quasi-experiment involving 40 women, following a mastectomy, evaluated five outcome measures pre- and post-Astym treatment. All five measurement scores: Disabilities of the Arm, Shoulder, and Hand Outcome Measure; a clothing questionnaire on their ability to wear a bra; Patient-Specific Functional Scale; active range of motion of shoulder flexion; and active range of motion of abduction were also measured and all demonstrated significant changes. In this study, Astym treatment improved active range of motion in the involved quadrant and also improved function in patients following a mastectomy. Keywords: breast cancer, quality of life, scar tissue treatment, physical therapy

  17. Design of a quality and performance improvement project for small primary care practices: reflections on the Center for Practice Innovation.

    Science.gov (United States)

    Marsteller, Jill A; Woodward, Paula; Underwood, William S; Hsiao, Chun-Ju; Barr, Michael S

    2011-01-01

    Small practices often lack the human, financial and technical resources to make necessary practice improvements and infrastructure investments in order to achieve sustainable change that promotes quality and efficiency. To report on an effort to assist small primary care practices in improving quality of care and efficiency of practice management to meet the needs of patients, improve physician satisfaction and enhance the ability of these small practices to survive. We report on an intervention design and the reflections of the implementers on what they learned and what went well or poorly during implementation. Results of the intervention are reported separately (in Quality in Primary Care). Thirty practices underwent the entire intervention. The practices were selected on the basis of practice size, diversity in patient factors, apparent dedication to making practice improvements and geographic location. The main components of the intervention were two site visits to the participating practices by Center for Practice Innovation (CPI); now known as the Centre for Practice Improvement and Innovation, team members. The CPI team provided ongoing advice and support in focus areas selected by practices after initial site visit and assessment. A customised session focusing on the practice report and on helping practices to think about which areas they wished to improve was more effective in engaging practices than didactic presentation. Quality and practice management improvements were observed in information posting, patient education, staff communication and patient safety practices. Having a strong physician champion and a strong office manager determined to make quality improvement changes were important elements for successful change. In addition, practices with greater stability of staff and strong finances were more likely to meet project goals. Small practices today are facing a range of important challenges. The CPI sought to provide successful guidance to

  18. A metrological large range atomic force microscope with improved performance.

    Science.gov (United States)

    Dai, Gaoliang; Wolff, Helmut; Pohlenz, Frank; Danzebrink, Hans-Ulrich

    2009-04-01

    A metrological large range atomic force microscope (Met. LR-AFM) has been set up and improved over the past years at Physikalisch-Technische Bundesanstalt (PTB). Being designed as a scanning sample type instrument, the sample is moved in three dimensions by a mechanical ball bearing stage in combination with a compact z-piezostage. Its topography is detected by a position-stationary AFM head. The sample displacement is measured by three embedded miniature homodyne interferometers in the x, y, and z directions. The AFM head is aligned in such a way that its cantilever tip is positioned on the sample surface at the intersection point of the three interferometer measurement beams for satisfying the Abbe measurement principle. In this paper, further improvements of the Met. LR-AFM are reported. A new AFM head using the beam deflection principle has been developed to reduce the influence of parasitic optical interference phenomena. Furthermore, an off-line Heydemann correction method has been applied to reduce the inherent interferometer nonlinearities to less than 0.3 nm (p-v). Versatile scanning functions, for example, radial scanning or local AFM measurement functions, have been implemented to optimize the measurement process. The measurement software is also improved and allows comfortable operations of the instrument via graphical user interface or script-based command sets. The improved Met. LR-AFM is capable of measuring, for instance, the step height, lateral pitch, line width, nanoroughness, and other geometrical parameters of nanostructures. Calibration results of a one-dimensional grating and a set of film thickness standards are demonstrated, showing the excellent metrological performance of the instrument.

  19. Middle range theory evaluation: bridging the theory-practice gap ...

    African Journals Online (AJOL)

    The importance underlying the practice of nursing education must continue to be explored through theories to bring about refinement of educational strategies for nursing discipline. The involvement of students learning using this process will help create learning values that serve to retain inquisitive and reflective nursing ...

  20. Improving Bridging from Informatics Theory to Practice.

    Science.gov (United States)

    Haux, R; Koch, S

    2015-01-01

    In 1962, Methods of Information in Medicine (MIM) began to publish papers on the methodology and scientific fundamentals of managing data, information, and knowledge in biomedicine and health care. Meeting an increasing demand for research about practical implementation of health information systems, the journal Applied Clinical Informatics (ACI) was launched in 2009. Both journals are official journals of the International Medical Informatics Association (IMIA). Based on prior analyses, we aimed to describe major topics published in MIM during 2014 and to explore whether theory of MIM influenced practice of ACI. Our objectives were further to describe lessons learned and to discuss possible editorial policies to improve bridging from theory to practice. We conducted a retrospective, observational study reviewing MIM articles published during 2014 (N=61) and analyzing reference lists of ACI articles from 2014 (N=70). Lessons learned and opinions about MIM editorial policies were developed in consensus by the two authors. These have been influenced by discussions with the journal's associate editors and editorial board members. The publication topics of MIM in 2014 were broad, covering biomedical and health informatics, medical biometry and epidemiology. Important topics discussed were biosignal interpretation, boosting methodologies, citation analysis, health-enabling and ambient assistive technologies, health record banking, safety, and standards. Nine ACI practice articles from 2014 cited eighteen MIM theory papers from any year. These nine ACI articles covered mainly the areas of clinical documentation and medication-related decision support. The methodological basis they cited from was almost exclusively related to evaluation. We could show some direct links where theory impacted practice. These links are however few in relation to the total amount of papers published. Editorial policies such as publishing systematic methodological reviews and clarification of

  1. Improving Inquiry Teaching through Reflection on Practice

    Science.gov (United States)

    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.

  2. Improving Bridging from Informatics Practice to Theory.

    Science.gov (United States)

    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

  3. Improvements in medium range weather forecasting system of India

    Indian Academy of Sciences (India)

    Medium range weather forecasts are being generated in real time using Global Data Assimilation Forecasting System (GDAFS) at NCMRWF since 1994. The system has been continuously upgraded in terms of data usage, assimilation and forecasting system. Recently this system was upgraded to a horizontal resolution of ...

  4. Improvements in medium range weather forecasting system of India

    Indian Academy of Sciences (India)

    Spectral Radiometer) Ozone, EUMETSAT-9 atmospheric motion vectors. Using uniform thinning mesh for brightness. Change in land/snow/ice skin temperature variance temperature data. Improving assimilation of GPS radial occultation data. RE-tuned observation errors. ASCAT (Advanced Scatterometer) winds included.

  5. Improving Mental Health Reporting Practices in Between Personnel Security Investigations

    Science.gov (United States)

    2017-06-01

    Improving Mental Health Reporting Practices in Between Personnel Security Investigations Stephanie L. Jaros Donna L. Tadle David Ciani Keith B...2017 Improving Mental Health Reporting Practices in Between Personnel Security Investigations Stephanie L. Jaros, Donna L. Tadle, David Ciani, Keith...COVERED: 4. Improving Mental Health Reporting Practices in Between Personnel Security Investigations 5a. CONTRACT NUMBER: 5b. GRANT NUMBER: 5c

  6. Improved cumulative probabilities and range accuracy of a pulsed Geiger-mode avalanche photodiode laser ranging system with turbulence effects.

    Science.gov (United States)

    Luo, Hanjun; Ouyang, Zhengbiao; Liu, Qiang; Lu, Zhenli; Li, Bin

    2017-10-10

    There exists a performance limitation in a pulsed Geiger-mode avalanche photodiode laser ranging system because of the echo intensity random fluctuation caused by turbulence effects. To suppress the influence of turbulence effects, we present a cumulative pulse detection technique with the ability to achieve improved cumulative probabilities and range accuracy. Based on the modulated Poisson model, the cumulative probabilities, range accuracy, and their influencing factors are investigated for a cumulative Q-switched laser pulse train. The results show that the improved cumulative probabilities and range accuracy can be obtained by utilizing cumulative pulse detection, with the condition that the echo intensity is 10, the echo pulse width is 10 ns, and the turbulence degree is 3, the target detection probability increases by 0.4, the false alarm probability decreases by 0.08, and the accuracy and precision increase by 46 cm and 27 cm, respectively.

  7. Continuously improving the practice of cardiology

    NARCIS (Netherlands)

    M.L. Simoons (Maarten); M.J. de Boer (Menko Jan); H. Boersma (Eric); H.J.G.M. Crijns; J.W. Deckers (Jaap); J. Funke Küpper; M.J. Lenzen (Mattie); K.I. Lie (Kong); H.R. Michels (Herman); R. Nieuwlaat; J.P. Ottervanger (Jan Paul); P. Polak; W.J.M. Scholte op Reimer (Wilma); E. de Swart; F. Vermeer (Frank); E.E. van der Wall (Ernst)

    2004-01-01

    textabstractGuidelines for the management of patients with cardiovascular disease are designed to assist cardiologists and other physicans in their practice. Surveys are conducted to assess whether guidelines are followed in practice. The results of surveys on acute coronary syndromes, coronary

  8. Perceptions of the Full Range Leadership Model Practiced by Select High School Administrators in Tennessee

    Science.gov (United States)

    Prater, Michelle L.

    2013-01-01

    The purpose of this research was to study the three leadership styles on the Full Range Leadership Model (FRLM) practiced by high school administrators in the educational organization. The aspects of studying leadership styles was to determine the degree high school administrators practiced leadership styles; the degree of perceptional congruence…

  9. Designing a Large-Scale Multilevel Improvement Initiative: The Improving Performance in Practice Program

    Science.gov (United States)

    Margolis, Peter A.; DeWalt, Darren A.; Simon, Janet E.; Horowitz, Sheldon; Scoville, Richard; Kahn, Norman; Perelman, Robert; Bagley, Bruce; Miles, Paul

    2010-01-01

    Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and…

  10. IMPROVING SITE MANAGEMENT PRACTICES IN THE NIGERIAN ...

    African Journals Online (AJOL)

    Osondu

    Horner and Duff (2001); Mohammed and. Anumba (2006); Zietsman (2008) and Taiwo and Afolami (2011). Respondents were asked to rank these problems from the 1 (the least) to. 5 (the highest). Apart from this, the respondents were asked to comment generally on site management practices from their own perspectives.

  11. Improving business performance through brand management practice

    Directory of Open Access Journals (Sweden)

    Veljković Saša

    2016-01-01

    Full Text Available The aims of this study are to determine which variables are common as brand management practices, how these variables affect a company’s business performance, and whether there are statistically significant differences between companies in the sample in terms of individual elements of the Brand Management Practice (BMP model. The research took place in Serbia, and comprised 118 managers and specialists involved in marketing and brand management. After validating the proposed BMP model, we found a link between certain variables of the model and companies’ business performance. There are statistically significant differences between companies in terms of individual elements of brand management practice, and we identify three clusters: brand-guided companies, emerging brand companies, and brand-agnostic companies. They differ from each other in terms of: brand-oriented approach, innovativeness, brand support activities, unique marketing offers, marketing channel relationships, brand performance measurement, brand barriers, company size, and specific business area of a key-brand. They also differ according to estimated and actual business and financial performance. The results are valuable for explaining the main drivers of good brand management practice and their effects on business performance in different industry sectors. The implications for managers of domestic companies are also discussed.

  12. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified by the introduction of experience-rated malpractice liability insurance. Our identification...... in the probability of performing a C-section from 2.3 to 3.7 percentage points (7% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained...... by a reduction in the discretion of obstetric decision making rather than by patient cream skimming.Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified...

  13. Is haemovigilance improving transfusion practice?--The european experience.

    Science.gov (United States)

    Strengers, P F W

    2007-01-01

    Improving transfusion practice for a donor means a safer donation process and maximal use of the donation. From the clinical perspective, it includes the production of the right type of blood component of adequate quality, administered at the right dose at the right moment to the right patient in order to obtain the expected or anticipated effect in absence of harm. Transfusion practice involves not only the complete blood chain, i.e. from the donation to clinical usage, but also the input from the competent authority that bears responsibility for the concepts of improving health care practice. In Europe, experience has shown that haemovigilance offers an effective tool in improving transfusion practice.

  14. Adoption of improved aquaculture practices by shrimp farmers in ...

    African Journals Online (AJOL)

    To achieve eco-friendly and sustainable development of shrimp farming, adoption of improved shrimp farming practices is necessary. An attempt has been made in this study to collect data from shrimp farmers along the south Konkan region of Maharashtra to judge the level of adoption of improved aquaculture practices.

  15. How to improve teaching practices: the role of teacher motivation, organizational factors and leadership practices

    NARCIS (Netherlands)

    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

  16. Improving Initial Assessment: Guide to Good Practice

    Science.gov (United States)

    Knasel, Eddy; Meed, John; Rossetti, Anna; Read, Hilary

    2006-01-01

    This guide is aimed at anyone in work-based training who is responsible for learners during their first few weeks. Readers will (1) understand the value and purpose of initial assessment in key skills and Skills for Life; (2) become familiar with a range of techniques for the initial assessment; (3) plan an initial assessment system that is…

  17. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    2015-01-01

    is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7–11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream......Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court...

  18. Improving Student's Lab Practices: the Performance Grade

    CERN Document Server

    Lippi, G L

    2015-01-01

    Instilling good laboratory working attitudes in students is a difficult but very important task, especially in the first level courses. The introduction of a grade, based on the observation of work practices during laboratory sessions, can be strongly beneficial towards the acquisition of positive skills covering not only the technical aspects, but also the acquisition of both independence and team work. Explicit suggestions are given for basing the grade on specific observations and a quantitative analysis is performed to guarantee that the higher intrinsic volatility of the Performance Grade does not affect the final laboratory grade.

  19. Improving drug treatment in general practice

    NARCIS (Netherlands)

    Veninga, CCM; Denig, P; Zwaagstra, R; Haaijer-Ruskamp, FM

    In the international Drug Education Project, an educational program involving auditing and feedback in peer groups to improve the treatment of asthma and urinary tract infections (UTI) was developed and tested in primary care. Individualized feedback was provided and discussed in 24 Dutch peer

  20. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identied by the introduction of experience-rated malpractice liability insurance. Our identication...... in the probability of performing a C-section from 2.3 to 3.7 percentage points (7% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained...... by a reduction in the discretion of obstetric decision making rather than by patient cream skimming....

  1. INSTRUCTIONAL DESIGN FOR TEACHERS: Improving classroom practice

    OpenAIRE

    Reviewed by Yavuz Akbulut

    2011-01-01

    The key to successful learning in most formal instructional settings is effective instructional design (ID). Instructional design for teachers serves as an organized source of directions, which can help classroom teachers to integrate available resources to improve students‘ acquisition of the instructional goals. The book is consisted of 151 pages (+xvii) covering eight chapters which address a commonsense model of instructional design to guide K-12 teachers during their unique instructional...

  2. General practice in urban and rural Europe: the range of curative services.

    NARCIS (Netherlands)

    Boerma, W.G.W.; Groenewegen, P.P.; Zee, J. van der

    1998-01-01

    The variation in the range of services provided by general practitioners (GPs) is not only related to personal characteristics and features of the country's health care system but also to the geographical circumstances of the practice location. In conurbations health services are more widely

  3. 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.

  4. Home-based primary care practices in the United States: current state and quality improvement approaches.

    Science.gov (United States)

    Leff, Bruce; Weston, Christine M; Garrigues, Sarah; Patel, Kanan; Ritchie, Christine

    2015-05-01

    To describe the characteristics of home-based primary care practices: staffing, administrative, population served, care practices, and quality of care challenges. Survey of home-based primary care practices. Home-based primary care practices in the United States. Members of the American Academy of Home Care Medicine and nonmember providers identified by surveyed members. A 58-item questionnaire that assessed practice characteristics, care provided by the practice, and how the quality of care that the practice provided was assessed. Survey response rate was 47.9%, representing 272 medical house calls practices. Mean average daily census was 457 patients (median 100 patients, range 1-30,972 patients). Eighty-eight percent of practices offered around-the-clock coverage for urgent concerns, 60% held regularly scheduled team meetings, 89% used an electronic medical record, and one-third used a defined quality improvement process. The following factors were associated with practices that used a defined quality improvement process: practice holds regularly scheduled team meetings to discuss specific patients (odds ratio (OR)=2.07, 95% confidence interval (CI)=1.02-4.21), practice conducts surveys of patients (OR=8.53, 95% CI=4.07-17.88), and practice is involved in National Committee for Quality Assurance patient-centered medical home (OR=3.27, 95% CI=1.18-9.07). Ninety percent of practices would or might participate in quality improvement activities that would provide them timely feedback on patient and setting-appropriate quality indicators. There is a substantial heterogeneity of home-based primary care practice types. Most practices perform activities that lend themselves to robust quality improvement efforts, and nearly all indicated interest in a national registry to inform quality improvement. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  5. Mental practice maintains range of motion despite forearm immobilization: a pilot study in healthy persons.

    Science.gov (United States)

    Frenkel, Marie O; Herzig, Daniela S; Gebhard, Florian; Mayer, Jan; Becker, Clemens; Einsiedel, Thomas

    2014-03-01

    To determine whether mental practice of wrist movements during forearm immobilization maintains range of motion. Randomized controlled trial. Eighteen healthy young men aged between 20 and 30 years were assigned to either a control or a mental practice group. Both groups were immobilized with a circular forearm cast for 3 weeks to simulate a distal radial fracture. The mental practice group received 1 × 60-min, followed by 3 × 30-min, sessions of supervised mental practice. Consecutively, they were asked to perform 15 min/day of self-guided imagery sessions, during which they mentally exercised motion sequences of the immobilized joint. The training program followed the Mental Gait Training procedure. The control group did no training. Wrist movement was measured with a goniometer before and after immobilization. Mental practice preserved dorsal extension and ulnar abduction. The sedentary control group showed due to this variables a significant decrease after cast removal. There was no significant change in palmar flexion and radial abduction in either group. Despite the study limitations, these results suggest that mental practice may be useful in preventing loss of hand function associated with mid-term immobilization. Because of the expected clinical benefits, the low cost and simple application of the intervention, the effects of mental practice in orthopedic rehabilitation of the upper extremity warrant further study.

  6. Appreciative Inquiry for Quality Improvement in Primary Care Practices

    Science.gov (United States)

    Ruhe, Mary C.; Bobiak, Sarah N.; Litaker, David; Carter, Caroline A.; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen; Weyer, Sharon M.; Werner, James J.; Fry, Ronald E.; Stange, Kurt C.

    2014-01-01

    Purpose To test the effect of an Appreciative Inquiry (AI) quality improvement strategy, on clinical quality management and practice development outcomes. AI enables discovery of shared motivations, envisioning a transformed future, and learning around implementation of a change process. Methods 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 fieldnotes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. Results 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 one 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. Conclusions 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. PMID:21192206

  7. Improving Standards in Practice ThrOugh Medical Audit

    African Journals Online (AJOL)

    appraisal of health a ' practices to improve efficiency in the management of available resources Fourthly, in the current era of evidence-based medicine, the data acquired from systematic medical audit makes an indispensable contribution to the body.

  8. Improving Your Daily Practice: A Guide for Effective School Leadership

    Science.gov (United States)

    Berkey, Timothy B.

    2009-01-01

    This book will show principals how they can change daily practices to invest more time in the improvement of teaching and learning. It redirects leadership to effective practices in instructional leadership. Contents include an Introduction and the following chapters: (1) Why Change the Way I Lead?; (2) The Path to Effective School Leadership; (3)…

  9. Assessing quality improvement in health care: theory for practice.

    Science.gov (United States)

    Kleinman, Lawrence C; Dougherty, Denise

    2013-03-01

    To review the role of theory as a means to enhance the practice of quality improvement (QI) research and to propose a novel conceptual model focused on the operations of health care. Conceptual model, informed by literature review. To optimize learning across QI studies requires the integration of small-scale theories (middle-range theories, theories of change) within the context of larger unifying theories. We propose that health care QI research would benefit from a theory that describes the operations of health care delivery, including the multiplicity of roles that interpersonal interactions play. The broadest constructs of the model are entry into the system, and assessment and management of the patient, with the subordinate operations of access; recognition, assessment, and diagnosis; and medical decision-making (developing a plan), coordination of care, execution of care, referral and reassessment, respectively. Interpersonal aspects of care recognize the patient/caregiver as a source of information, an individual in a cultural context, a complex human being, and a partner in their care. Impacts to any and all of these roles may impact the quality of care. Such a theory can promote opportunities for moving the field forward and organizing the planning and interpretation of comparable studies. The articulation of such a theory may simultaneously provide guidance for the QI researcher and an opportunity for refinement and improvement.

  10. Soil pollution at outdoor shooting ranges: Health effects, bioavailability and best management practices.

    Science.gov (United States)

    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 (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.

  11. Effect of tillage practices on least limiting water range in Northwest India

    Science.gov (United States)

    Kahlon, Meharban S.; Chawla, Karitika

    2017-04-01

    Tillage practices affect mechanical and hydrological characteristics of soil and subsequently the least limiting water range. This quality indicator under the wheat-maize system of northwest India has not been studied yet. The treatments included four tillage modes, namely conventional tillage, no-tillage without residue, no-tillage with residue, and deep tillage as well as three irrigation regimes based on the irrigation water and pan evaporation ratio i.e. 1.2, 0.9, and 0.6. The experiment was conducted in a split plot design with three replications. At the end of cropping system, the mean least limiting water range (m3 m-3) was found to be highest in deep tillage (0.26) and lowest in notillage without residue (0.15). The field capacity was a limiting factor for the upper range of the least limiting water range beyond soil bulk density 1.41 Mg m-3 and after that 10% air filled porosity played a major role. However, for the lower range, the permanent wilting point was a critical factor beyond soil bulk density 1.50 Mg m-3 and thereafter, the penetration resistance at 2 MPa becomes a limiting factor. Thus, deep tillage under compaction and no-tillage with residue under water stress is appropriate practice for achieving maximum crop and water productivity.

  12. A Systematic Review of Electric-Acoustic Stimulation: Device Fitting Ranges, Outcomes, and Clinical Fitting Practices

    OpenAIRE

    Incerti, Paola V.; Ching, Teresa Y. C.; Cowan, Robert

    2013-01-01

    Cochlear implant systems that combine electric and acoustic stimulation in the same ear are now commercially available and the number of patients using these devices is steadily increasing. In particular, electric-acoustic stimulation is an option for patients with severe, high frequency sensorineural hearing impairment. There have been a range of approaches to combining electric stimulation and acoustic hearing in the same ear. To develop a better understanding of fitting practices for devic...

  13. Improving patient safety culture in general practice: an interview study.

    Science.gov (United States)

    Verbakel, Natasha J; de Bont, Antoinette A; Verheij, Theo J M; Wagner, Cordula; Zwart, Dorien L M

    2015-12-01

    When improving patient safety a positive safety culture is key. As little is known about improving patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an intervention for improving safety culture. To gain insight into how two interventions affected patient safety culture in everyday practice. After conducting a randomised control trial of two interventions, this was a qualitative study conducted in 30 general practices to aid interpretation of the previous quantitative findings. Interviews were conducted at practice locations (n = 27) with 24 GPs and 24 practice nurses. The theory of communities of practice--in particular, its concepts of a domain, a community, and a practice--was used to interpret the findings by examining which elements were or were not present in the participating practices. Communal awareness of the problem was only raised after getting together and discussing patient safety. The combination of a questionnaire and workshop enhanced the interaction of team members and nourished team feelings. This shared experience also helped them to understand and develop tools and language for daily practice. In order for patient safety culture to improve, the safety culture questionnaire was more successful when accompanied by a practice workshop. Initial discussion and negotiation of shared goals during the workshop fuelled feelings of coherence and belonging to a community wishing to learn about enhancing patient safety. Team meetings and day-to-day interactions enhanced further liaison and sharing, making patient safety a common and conscious goal. © British Journal of General Practice 2015.

  14. Improving Leadership and Management Practices: One Step at a Time

    Science.gov (United States)

    Bella, Jill

    2008-01-01

    Taking small steps toward change is a sensible way to improve the leadership and management practices in an early care and education program. A director must be able to make continuous improvements without alienating staff by asking them to make drastic changes that seem overwhelming and unachievable. Taking on change one step at a time is a way…

  15. adoption of improved aquaculture practices by shrimp farmers

    African Journals Online (AJOL)

    Dr.Adesope

    ABSTRACT. To achieve eco-friendly and sustainable development of shrimp farming, adoption of improved shrimp farming practices is necessary. An attempt has been made in this study to collect data from shrimp farmers along the south Konkan region of Maharashtra to judge the level of adoption of improved aquaculture ...

  16. Expected Improvement in NIMA Precise Orbit and Clock Estimates Due to Adding Crosslink Ranging Data

    National Research Council Canada - National Science Library

    Merrigan, Michael J; Swift, Everett R

    1999-01-01

    .... This study addresses the expected improvement in the National Imagery and Mapping Agency (NIMA) precise orbit and clock estimates with the inclusion of crosslink ranging data with the station tracking data...

  17. Patient advisory groups in practice improvement: sample case presentation with a discussion of best practices.

    Science.gov (United States)

    Angstman, Kurt B; Bender, Robert O; Bruce, Steven M

    2009-01-01

    Using patient advisory groups can affect practice changes and create a patient-centric focus for a primary care practice. A successful patient advisory group has been developed for our primary care clinics. Utilizing this group, we have implemented practice improvement changes that have had a significant impact in patient care. This will be demonstrated in a case presentation involving the implementation of depression care managers at our practice sites. We will review key "best practices," as defined by the group, regarding size, composition, and meeting frequency that can be used for the development of a clinical patient advisory group.

  18. Using the American Board of Internal Medicine Practice Improvement Modules to Teach Internal Medicine Residents Practice Improvement

    Science.gov (United States)

    Shunk, Rebecca; Dulay, Maya; Julian, Kathy; Cornett, Patricia; Kohlwes, Jeffrey; Tarter, Laura; Hollander, Harry; O'Brien, Bridget; O'Sullivan, Patricia

    2010-01-01

    Background Although residency programs must prepare physicians who can analyze and improve their practice, practice improvement (PI) is new for many faculty preceptors. We describe the pilot of a PI curriculum incorporating a practice improvement module (PIM) from the American Board of Internal Medicine for residents and their faculty preceptors. Methods Residents attended PI didactics and completed a PIM during continuity clinic and outpatient months working in groups under committed faculty. Results All residents participated in PI group projects. Residents agreed or strongly agreed that the projects and the curriculum benefited their learning and patient care. A self-assessment revealed significant improvement in PI competencies, but residents were just reaching a “somewhat confident” level. Conclusion A PI curriculum incorporating PIMs is an effective way to teach PI to both residents and faculty preceptors. We recommend the team approach and use of the PIM tutorial approach especially for faculty. PMID:21975892

  19. Interventions that improved a practice environment: "making a difference".

    Science.gov (United States)

    van der Wal, Rena; Globerman, Judith

    2008-01-01

    This paper reports on the intervention phase of a participatory action study designed to improve the practice environment within a critical care unit in a research teaching hospital. The intervention strategy involved the hiring of a facilitator who worked with unit staff to engage in a process of addressing their priority issues related to the practice environment. Examples of interventions included staff retreats, communication workshops, task groups and leadership training. Challenges and key learnings are reported.

  20. How to Improve Teaching Practices: The Role of Teacher Motivation, Organizational Factors, and Leadership Practices

    Science.gov (United States)

    Thoonen, Erik E. J.; Sleegers, Peter J. C.; Oort, Frans J.; Peetsma, Thea T. D.; Geijsel, Femke 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 conditions, teacher motivational factors, and teacher…

  1. Improving Self-Regulated Learning With a Retrieval Practice Intervention.

    Science.gov (United States)

    Ariel, Robert; Karpicke, Jeffrey D

    2017-06-12

    Repeated retrieval practice is a powerful learning tool for promoting long-term retention, but students use this tool ineffectively when regulating their learning. The current experiments evaluated the efficacy of a minimal intervention aimed at improving students' self-regulated use of repeated retrieval practice. Across 2 experiments, students made decisions about when to study, engage in retrieval practice, or stop learning a set of foreign language word pairs. Some students received direct instruction about how to use repeated retrieval practice. These instructions emphasized the mnemonic benefits of retrieval practice over a less effective strategy (restudying) and told students how to use repeated retrieval practice to maximize their performance-specifically, that they should recall a translation correctly 3 times during learning. This minimal intervention promoted more effective self-regulated use of retrieval practice and better retention of the translations compared to a control group that received no instruction. Students who experienced this intervention also showed potential for long-term changes in self-regulated learning: They spontaneously used repeated retrieval practice 1 week later to learn new materials. These results provide a promising first step for developing guidelines for teaching students how to regulate their learning more effectively using repeated retrieval practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  2. A systematic review of electric-acoustic stimulation: device fitting ranges, outcomes, and clinical fitting practices.

    Science.gov (United States)

    Incerti, Paola V; Ching, Teresa Y C; Cowan, Robert

    2013-03-01

    Cochlear implant systems that combine electric and acoustic stimulation in the same ear are now commercially available and the number of patients using these devices is steadily increasing. In particular, electric-acoustic stimulation is an option for patients with severe, high frequency sensorineural hearing impairment. There have been a range of approaches to combining electric stimulation and acoustic hearing in the same ear. To develop a better understanding of fitting practices for devices that combine electric and acoustic stimulation, we conducted a systematic review addressing three clinical questions: what is the range of acoustic hearing in the implanted ear that can be effectively preserved for an electric-acoustic fitting?; what benefits are provided by combining acoustic stimulation with electric stimulation?; and what clinical fitting practices have been developed for devices that combine electric and acoustic stimulation? A search of the literature was conducted and 27 articles that met the strict evaluation criteria adopted for the review were identified for detailed analysis. The range of auditory thresholds in the implanted ear that can be successfully used for an electric-acoustic application is quite broad. The effectiveness of combined electric and acoustic stimulation as compared with electric stimulation alone was consistently demonstrated, highlighting the potential value of preservation and utilization of low frequency hearing in the implanted ear. However, clinical procedures for best fitting of electric-acoustic devices were varied. This clearly identified a need for further investigation of fitting procedures aimed at maximizing outcomes for recipients of electric-acoustic devices.

  3. Managing Intermountain rangelands - improvement of range and wildlife habitats: proceedings; 1981 September 15-17; Twin Falls, ID; 1982 June 22-24; Elko, NV

    Science.gov (United States)

    Stephen B. Monsen; Nancy Shaw

    1983-01-01

    The proceedings summarizes recent research and existing literature pertaining to the restoration and management of game and livestock ranges in the Intermountain Region. Improved plant materials and planting practices are emphasized. The series of 28 papers was presented at the Restoration of Range and Wildlife Habitat Training Sessions held in Twin Falls, Idaho,...

  4. Why Output Only Modal Analysis is a Desirable Tool for a Wide Range of Practical Applications

    OpenAIRE

    Brincker, Rune; Ventura, C.; Andersen, P.

    2003-01-01

    In this paper the basic principles in output modal testing and analysis are presented and discussed. A brief review of the techniques for output-only modal testing and identification is presented, and it is argued, that there is now a wide range of techniques for effective identification of modal parameters of practical interest - including the mode shape scaling factor - with a high degree of accuracy. It is also argued that the output-only technology offers the user a number of advantages o...

  5. Why Output Only Modal Analysis is a Desirable Tool for a Wide Range of Practical Applications

    DEFF Research Database (Denmark)

    Brincker, Rune; Ventura, C.; Andersen, P.

    2003-01-01

    In this paper the basic principles in output modal testing and analysis are presented and discussed. A brief review of the techniques for output-only modal testing and identification is presented, and it is argued, that there is now a wide range of techniques for effective identification of modal...... parameters of practical interest - including the mode shape scaling factor - with a high degree of accuracy. It is also argued that the output-only technology offers the user a number of advantages over traditional modal testing. The output-only modal technology allows the user to perform a modal analysis...... in an easier way and in many cases more effectively than traditional modal analysis methods. It can be applied for modal testing and analysis on a wide range of structures and not only for problems generally investigated using traditional modal analysis, but also for those requiring load estimation, vibration...

  6. 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.

  7. Independent practice associations and physician-hospital organizations can improve care management for smaller practices.

    Science.gov (United States)

    Casalino, Lawrence P; Wu, Frances M; Ryan, Andrew M; Copeland, Kennon; Rittenhouse, Diane R; Ramsay, Patricia P; Shortell, Stephen M

    2013-08-01

    Pay-for-performance, public reporting, and accountable care organization programs place pressures on physicians to use health information technology and organized care management processes to improve the care they provide. But physician practices that are not large may lack the resources and size to implement such processes. We used data from a unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which independent practice associations (IPAs) and physician-hospital organizations (PHOs) might make it possible for these smaller practices to share resources to improve care. Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients. On average, practices participating in these organizations provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did (10.4 versus 3.8). Half of these processes were provided only by IPAs or PHOs. These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations.

  8. A practical communication strategy to improve implementation of evidence-based practice.

    Science.gov (United States)

    Diedrick, Lee A; Schaffer, Marjorie A; Sandau, Kristin E

    2011-11-01

    The purpose of this study was to determine if a consistent communication strategy for implementation of evidence-based practice (EBP), developed with input from staff nurses, improved staff nurse satisfaction with communication of practice changes. Integration of EBP knowledge into clinical practice supports optimal nursing care. Awareness of a practice change and the ability to reference the information may be problematic. A quasi-experimental single group before-after design was used to survey all RNs of a level III neonatal ICU for satisfaction before and after implementation of the EBP communication strategy. Registered nurse satisfaction improved regarding the amount of communication (P strategy can improve nurse satisfaction with communication of EBP changes. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

  9. Improving nurse initiated X-ray practice through action research.

    Science.gov (United States)

    Thompson, Nadine; Murphy, Margaret; Robinson, John; Buckley, Thomas

    2016-12-01

    Due to increasing demands on hospital Emergency Departments (EDs), the role of registered nurses, with additional training, has been extended to include requesting X-ray examinations. The aim of this study was to evaluate nurse practice guidelines for requesting X-rays in the ED setting and to utilise inter-professional learning and change management theory to promote practice improvements. Three hundred and one nurse initiated X-ray (NIX) requests were randomly selected between January and March 2012, and reviewed for observance of local department guidelines and quality of clinical history. The results of this preliminary review were used to inform the investigating team in order to improve and support practice. A collaborative educational intervention utilising inter-professional learning and change management theory was implemented with an aim of improving the clinical history provided in NIX requests and development of a new policy to support clinical practice. A second review was repeated from February to April 2014 to evaluate the success of the educational intervention. Observance of NIX guidelines improved from pre-intervention to post-intervention (48% vs. 90%, P > 0.001). Quality of clinical history also significantly improved in all four essential variable criteria: (1) mechanism of injury; (2) injury location; (3) side of injury; and (4) clinical question. This study demonstrates that utilising inter-professional learning and change management theory can contribute to significant improvements in and support clinical practice of NIX in the emergency setting. © 2016 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.

  10. Basic equipments for improved practical performance in creative arts ...

    African Journals Online (AJOL)

    This paper addresses the issue of adequate provision equipment for improved practical performance of ceramics study in Nigerian higher institutions. It was noted that ceramics equipments are very expensive yet they are indispensable to the study of ceramics. Nigerian Journal of Technology and Education in Nigeria Vol.

  11. Adoption of improved poultry production practices by rural women in ...

    African Journals Online (AJOL)

    The Adoption of improved poultry production practices by rural women in Imo state was studied with the objectives of analyzing the socio-economic determinants of the adoption and making policy recommendations. Data were generated from 258 randomly sampled rural women from the three agricultural zones of the state ...

  12. Improving Site Management Practices in the Nigerian Construction ...

    African Journals Online (AJOL)

    Improving Site Management Practices in the Nigerian Construction Industry: The Builders' Perspective. ... Abstract. Site management involves a combination of activities, which turn basic resources into a finished product. ... Thirty-two problems were identified from literature and respondents were asked to rank the problems.

  13. Acceptability of improved crop production practices among rural ...

    African Journals Online (AJOL)

    STORAGESEVER

    2009-02-04

    Feb 4, 2009 ... The acceptance of improved crop production practices by rural women in Aguata Agricultural Zone of .... their multiple roles. Again, FAO (1985) observed that in. Nigeria, about 45 percent of rural population is made up of women farmers. In effect, women are the ..... role in the overall disaster management.

  14. Evaluation of suckling and post weaning practices for improving ...

    African Journals Online (AJOL)

    Mo

    Evaluation of suckling and post weaning practices for improving reproductive efficiency in Nepalese Pakhribas pigs ... competition. It also helps to take the pressure off a good milking sow, which will help to minimise the weight loss and restore positive nutrient balance just before weaning. (English, 1988). However, this ...

  15. Availability Of Improved Crop Production Practices In Aguata Area ...

    African Journals Online (AJOL)

    Findings of the study revealed that that the following improved crop production practices were available to the respondents: adequate crop spacing, optimum plant population, seed dressing, use of fertilizer, use of insecticides, regular weeding, adequate disease control measures, timeliness of planting, yam minisett ...

  16. Improving antibiotic use in daily hospital practice : The antibiotic checklist

    NARCIS (Netherlands)

    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

  17. Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice.

    Science.gov (United States)

    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 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.

  18. 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

  19. Approaching the Practice Quality Improvement Project in Interventional Radiology.

    Science.gov (United States)

    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.

  20. Improvement of range spatial resolution of medical ultrasound imaging by element-domain signal processing

    Science.gov (United States)

    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).

  1. 'Pastoral practices' for quality improvement in a Kenyan clinical network.

    Science.gov (United States)

    McGivern, Gerry; Nzinga, Jacinta; English, Mike

    2017-12-01

    We explain social and organisational processes influencing health professionals in a Kenyan clinical network to implement a form of quality improvement (QI) into clinical practice, using the concept of 'pastoral practices'. Our qualitative empirical case study, conducted in 2015-16, shows the way practices constructing and linking local evidence-based guidelines and data collection processes provided a foundation for QI. Participation in these constructive practices gave network leaders pastoral status to then inscribe use of evidence and data into routine care, through championing, demonstrating, supporting and mentoring, with the support of a constellation of local champions. By arranging network meetings, in which the professional community discussed evidence, data, QI and professionalism, network leaders also facilitated the reconstruction of network members' collective professional identity. This consequently strengthened top-down and lateral accountability and inspection practices, disciplining evidence and audit-based QI in local hospitals. By explaining pastoral practices in this way and setting, we contribute to theory about governmentality in health care and extend Foucauldian analysis of QI, clinical networks and governance into low and middle income health care contexts. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Quality improvement through clinical communities: eight lessons for practice.

    Science.gov (United States)

    Aveling, Emma-Louise; Martin, Graham; Armstrong, Natalie; Banerjee, Jay; Dixon-Woods, Mary

    2012-01-01

    Approaches to quality improvement in healthcare based on clinical communities are founded in practitioner networks, peer influence and professional values. However, evidence for the value of this approach, and how to make it effective, is spread across multiple disciplines. The purpose of this paper is to review and synthesise relevant literature to provide practical lessons on how to use community-based approaches to improve quality. Diverse literatures were identified, analysed and synthesised in a manner that accounted for the heterogeneity of methods, models and contexts they covered. A number of overlapping but distinct community-based approaches can be identified in the literature, each suitable for different problems. The evidence for the effectiveness of these is mixed, but there is some agreement on the challenges that those adopting such approaches need to address, and how these can be surmounted. Key lessons include: the need for co-ordination and leadership alongside the lateral influence of peers; advantages of starting with a clear programme theory of change; the need for training and resources; dealing with conflict and marginalisation; fostering a sense of community; appropriate use of data in prompting behavioural change; the need for balance between "hard" and "soft" strategies; and the role of context. The paper brings together diverse literatures with important implications for community-based approaches to quality improvement, drawing on these to offer practical lessons for those engaged in improving healthcare quality in practice.

  3. Qualitative evaluation of general practices developing training for a range of health disciplines.

    Science.gov (United States)

    Hughes, Lesley A

    2014-01-01

    This study adopted an interpretative approach, using focus groups and face-to-face interviews to evaluate the development of a five-year pilot project within general practice. The aim of the project is for these practices to offer training to a range of health disciplines from varying academic levels, develop capacity and provide interprofessional education as part of the learning ethos. Eight consortia are involved in the project, which is funded by the workforce and education directorate and the Deanery of the Yorkshire and Humber Strategic Health Authority. The evaluation was undertaken 18 months into the project, to understand the views and experiences of primary care practitioners and university educationalists, in order to identify achievements and barriers to the project's development. The study revealed positive attitudes towards the project, and that steps are being taken to engage in dialogue with universities to increase student numbers, but progress is slow. Early experiences of student nurses taking up placements in the practices reveal incompatible learning outcomes between what is expected for curriculum and learning opportunities within primary care. A common concern is the impact increased students may pose on existing support structures, and that this may compromise student learning. Concern is evident over self-belief and competencies to teach across professions, and the ambiguity over the learning outcomes for IPE and the training required to support this. It is recommended that a systems theory be adopted to provide strategic planning across clinical and education organisations to ensure that structures of communication, leadership and training adequately meet the aims of the project. The paper will be of interest to practitioners in primary care who may be considering expanding services and training, and to educationalists seeking to allocate students to placements in primary care.

  4. Developing and using evidence to improve rehabilitation practice.

    Science.gov (United States)

    Seel, Ronald T; Dijkers, Marcel P; Johnston, Mark V

    2012-08-01

    The Clinical Practice Committee of the American Congress of Rehabilitation sponsored this supplement to address 2 critical, related issues for the rehabilitation field: how to develop clinical rehabilitation research to generate useful, high-quality evidence and how to use evidence to improve rehabilitation practice. The 2 are linked by the methods of evidence-based practice (EBP) used to evaluate research evidence and make recommendations for practice. Supplement authors tackle challenges, such as identifying treatment effects and how study design decisions can impact the internal and external validity of research findings, in 4 articles that describe: a 3-phase process for the development of rehabilitation treatments; small-N study designs; the design, implementation, and statistical analysis of rehabilitation clinical trials; and observational research designs used to compare the effectiveness of rehabilitation treatments. Two articles present contemporary best methods for developing and evaluating rehabilitation prediction models and outcome measures. The supplement also addresses issues of evaluating research evidence and translating evidence into clinical decisions or recommendations. An overview of tools that EBP adherents have developed to help the clinician find, synthesize, and apply evidence is presented, followed by an article that identifies 8 primary steps in the production of a systematic review. The last article outlines 13 recommendations for improving systematic evidence reviews and applying their resulting knowledge to clinical practice. In addition to recommending best methods, the supplement addresses challenges specific to the behavioral complexity of developing rehabilitation research and applying it in a way that improves the health, function, and quality of life of persons served. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  5. Improving patient and staff outcomes using practice development.

    Science.gov (United States)

    Hennessey, Catherine Elizabeth; Fry, Margaret

    2016-10-10

    Purpose The purpose of this paper is to examine the impact of a practice development program, "Essentials of Care" (EOC), on patient and staff outcomes, workplace culture and service delivery. Design/methodology/approach A descriptive study design was used to explore the impact of EOC in a district hospital rehabilitation ward. EOC focuses on embedding a person-centered culture within clinical areas and is structured from practice development methodologies. EOC was implemented in a metropolitan district hospital rehabilitation, older person 20-bed, ward. Findings Two projects were implemented during EOC. These projects led to nine significant patient and staff outcomes for medication and continence care practices. Outcomes included a reduction in older person complaints by 80 percent, pressure injuries by 62 percent, ward multi resistant staphylococcus aureus infection rates by 50 percent, clinical incidents by 22 percent, older person falls by 14 percent (per 1,000 bed days) and nursing sick leave by 10 percent. There was also a 13 percent improvement in the post nursing workplace satisfaction survey. Research limitations/implications This is a single site study and findings may not be suitable for generalizing across ward settings and broader population groups. Originality/value The EOC program led to significant improvements for and in clinical practices, staff satisfaction and ward culture. Specifically, the EOC program also identified significant cost savings and brought together the healthcare team in a cohesive and integrated way not previously experienced by staff. Practice development strategies can champion service quality improvement, optimal patient outcomes and consistency within healthcare.

  6. A Proportional Resonant Control Strategy for Efficiency Improvement in Extended Range Electric Vehicles

    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.

  7. Value of medium range weather forecasts in the improvement of seasonal hydrologic prediction skill

    Directory of Open Access Journals (Sweden)

    S. Shukla

    2012-08-01

    Full Text Available We investigated the contribution of medium range weather forecasts with lead times of up to 14 days to seasonal hydrologic prediction skill over the conterminous United States (CONUS. Three different Ensemble Streamflow Prediction (ESP based experiments were performed for the period 1980–2003 using the Variable Infiltration Capacity (VIC hydrology model to generate forecasts of monthly runoff and soil moisture (SM at lead-1 (first month of the forecast period to lead-3. The first experiment (ESP used a resampling from the retrospective period 1980–2003 and represented full climatological uncertainty for the entire forecast period. In the second and third experiments, the first 14 days of each ESP ensemble member were replaced by either observations (perfect 14-day forecast or by a deterministic 14-day weather forecast. We used Spearman rank correlations of forecasts and observations as the forecast skill score. We estimated the potential and actual improvement in baseline skill as the difference between the skill of experiments 2 and 3 relative to ESP, respectively. We found that useful runoff and SM forecast skill at lead-1 to -3 months can be obtained by exploiting medium range weather forecast skill in conjunction with the skill derived by the knowledge of initial hydrologic conditions. Potential improvement in baseline skill by using medium range weather forecasts for runoff [SM] forecasts generally varies from 0 to 0.8 [0 to 0.5] as measured by differences in correlations, with actual improvement generally from 0 to 0.8 of the potential improvement. With some exceptions, most of the improvement in runoff is for lead-1 forecasts, although some improvement in SM was achieved at lead-2.

  8. Improved Semiconductor Lattice Parameters and Band Gaps from a Middle-Range Screened Hybrid Functional

    OpenAIRE

    Lucero, Melissa J.; Henderson, Thomas M.; Scuseria, Gustavo E.

    2011-01-01

    We show that the middle-range exchange-correlation hybrid of Henderson, Izmaylov, Scuseria and Savin (HISS) performs extremely well for elemental and binary semiconductors with narrow or visible spectrum band gaps, as well as some wider gap or more ionic systems used commercially. The lattice parameters are superior to those predicted by the screened hybrid functional of Heyd, Scuseria and Ernzerhof (HSE), and provide a significant improvement over geometries predicted by semilocal functional...

  9. Recipe Modification Improves Food Safety Practices during Cooking of Poultry.

    Science.gov (United States)

    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.

  10. Organizational management practices for achieving software process improvement

    Science.gov (United States)

    Kandt, Ronald Kirk

    2004-01-01

    The crisis in developing software has been known for over thirty years. Problems that existed in developing software in the early days of computing still exist today. These problems include the delivery of low-quality products, actual development costs that exceed expected development costs, and actual development time that exceeds expected development time. Several solutions have been offered to overcome out inability to deliver high-quality software, on-time and within budget. One of these solutions involves software process improvement. However, such efforts often fail because of organizational management issues. This paper discusses business practices that organizations should follow to improve their chances of initiating and sustaining successful software process improvement efforts.

  11. Michigan oncology practices showed varying adherence rates to practice guidelines, but quality interventions improved care.

    Science.gov (United States)

    Blayney, Douglas W; Severson, Jane; Martin, C Jane; Kadlubek, Pamela; Ruane, Thomas; Harrison, Kimberley

    2012-04-01

    Despite improvements in care for patients with cancer, and in their survival rates, it is not clear that best practices are uniformly delivered to patients. We measured the quality of outpatient cancer care, using validated quality measures, in a consortium of thirty-six outpatient oncology practices in Michigan. We discovered that throughout the measurement period, for breast and colorectal cancer care, there was a more than 85 percent rate of adherence to quality care processes. For end-of-life care processes, the adherence rate was 73 percent, and for symptom and toxicity management care processes, adherence was 56 percent. In particular, we found variations in care around the fundamental oncologic task of management of cancer pain. To address quality gaps, we developed interventions to improve adherence to treatment guidelines, improve pain management, and incorporate palliative care into oncology practice. We concluded that statewide consortia that assume much of the cost burden of quality improvement activities can bring together oncology providers and payers to measure quality and design interventions to improve care.

  12. 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.

  13. 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.

  14. Instituting systems-based practice and practice-based learning and improvement: a curriculum of inquiry

    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

  15. Does self-control improve with practice? Evidence from a six-week training program.

    Science.gov (United States)

    Miles, Eleanor; Sheeran, Paschal; Baird, Harriet; Macdonald, Ian; Webb, Thomas L; Harris, Peter R

    2016-08-01

    Can self-control be improved through practice? Several studies have found that repeated practice of tasks involving self-control improves performance on other tasks relevant to self-control. However, in many of these studies, improvements after training could be attributable to methodological factors (e.g., passive control conditions). Moreover, the extent to which the effects of training transfer to real-life settings is not yet clear. In the present research, participants (N = 174) completed a 6-week training program of either cognitive or behavioral self-control tasks. We then tested the effects of practice on a range of measures of self-control, including lab-based and real-world tasks. Training was compared with both active and no-contact control conditions. Despite high levels of adherence to the training tasks, there was no effect of training on any measure of self-control. Trained participants did not, for example, show reduced ego depletion effects, become better at overcoming their habits, or report exerting more self-control in everyday life. Moderation analyses found no evidence that training was effective only among particular groups of participants. Bayesian analyses suggested that the data were more consistent with a null effect of training on self-control than with previous estimates of the effect of practice. The implication is that training self-control through repeated practice does not result in generalized improvements in self-control. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  16. Effectiveness of Proprioceptive Neuromuscular Facilitation (PNF) in Improving Shoulder Range of Motion. A Pilot Study.

    Science.gov (United States)

    Olędzka, Marianna; Jaczewska-Bogacka, Joanna

    2017-05-10

    [b]Background.[/b] Subacromial impingement syndrome is a condition of the shoulder girdle which limits daily activities. It is worth seeking fast and effective treatment options. The aim of this study was to assess the impact of single-session proprioceptive neuromuscular facilitation (PNF) therapy on the shoulder range of motion and pain level in patients with subacromial impingement syndrome.[b]Materials and methods. [/b]The experimental group consisted of 11 patients with subacromial impingement syndrome who had undergone therapy based on the PNF concept. A control group consisted of 12 patients with subacromial impingement syndrome who had undergone laser therapy, magnetic field therapy and local cryotherapy. Both before and after the therapeutic interventions, the painless passive and active ranges of abduction, flexion, and external and internal rotation of the shoulder joint were measured on the same day with the use of a goniometer and measuring tape. Patients also evaluated their pain levels. They were asked to fill in DASH questionnaires in order to evaluate their baseline functional status. Nonparametric tests were used for the statistical analysis.[b]Results:[/b] After single-session PNF therapy, the mean shoulder range of motion increased by 15° (active) and 14° (passive). Active abduction improved by 13° and passive abduction by 18°. The ranges of active and passive external rotation increased by 8° and 7°, respectively. Active and passive internal rotation increased by 4°. 73% of patients who underwent the therapy stated that their pain had decreased. The magnetic field therapy, laser therapy and cryotherapy alone did not contribute to increased ranges of motion.[b]Conclusions.[/b] 1. Subacromial impingement syndrome significantly limits function in daily life. 2. Single-session therapy with the use of the techniques and patterns of proprioceptive neuromuscular facilitation can improve both the active and passive range of shoulder movement. 3

  17. A Middle-Range Explanatory Theory of Self-Management Behavior for Collaborative Research and Practice.

    Science.gov (United States)

    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.

  18. Static progressive stretch improves range of motion in arthrofibrosis following total knee arthroplasty.

    Science.gov (United States)

    Bonutti, Peter M; Marulanda, German A; McGrath, Mike S; Mont, Michael A; Zywiel, Michael G

    2010-02-01

    Arthrofibrosis is a relatively common complication after total knee arthroplasty that negatively affects function and quality of life. Static progressive stretching is a technique that has shown promising results in the treatment of contractures of the elbow, ankle, wrist and knee. This study evaluated a static progressive stretching device as a treatment method for patients who had refractory knee stiffness after total knee arthroplasty. Twenty-five patients who had knee stiffness and no improvement with conventional physical therapy modalities were treated with the device. After a median of 7 weeks (range, 3-16 weeks), the median increase in range of motion was 25 degrees (range, 8-82 degrees). The median gain in knee active flexion was 19 degrees (range, 5-80 degrees). Ninety-two percent of patients were satisfied with the results. The authors believe static progressive stretching devices may be an effective method for increasing the ranges of motion and satisfaction levels of patients who develop arthrofibrosis after total knee arthroplasty.

  19. Breast cancer practice guidelines: evaluation and quality improvement.

    Science.gov (United States)

    Edge, S B

    1997-11-01

    The utility of practice guidelines in breast cancer management remains unproved. This paper examines the scope and goals of published guidelines and their utility in the process of breast cancer treatment quality improvement. Although existing breast cancer guidelines vary widely in scope and intent, they provide a framework for meaningful quality-of-care evaluation. Among the few comprehensive breast cancer guideline programs are those developed by the Ontario Cancer Treatment Practice Guidelines Initiative, the Revlon/UCLA Breast Center, the Association of Community Cancer Centers (ACCC), the Society of Surgical Oncology (SSO), and the National Comprehensive Cancer Network (NCCN). Ultimately, guidelines will prove useful only if they are utilized as part of a comprehensive program to improve quality, cost-effectiveness, and outcomes. To accomplish this, they must include mechanisms for revision and evaluation. The evaluation of guideline utility in quality improvement, particularly in breast cancer care, is a complex long-term process, which should include input from practitioners, institutions, payors, and government.

  20. Interventions to improve antibiotic prescribing practices for hospital inpatients.

    Science.gov (United States)

    Davey, Peter; Marwick, Charis A; Scott, Claire L; Charani, Esmita; McNeil, Kirsty; Brown, Erwin; Gould, Ian M; Ramsay, Craig R; Michie, Susan

    2017-02-09

    Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients. To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, and Embase. We searched for additional studies using the bibliographies of included articles and personal files. The last search from which records were evaluated and any studies identified incorporated into the review was January 2015. We included randomised controlled trials (RCTs) and non-randomised studies (NRS). We included three non-randomised study designs to measure behavioural and clinical outcomes and analyse variation in the effects: non- randomised trials (NRT), controlled before-after (CBA) studies and interrupted time series (ITS) studies. For this update we also included three additional NRS designs (case control, cohort, and qualitative studies) to identify unintended consequences. Interventions included any professional or structural interventions as defined by the Cochrane Effective Practice and Organisation of Care Group. We defined restriction as 'using rules to reduce the opportunity to engage in the target behaviour (or increase the target behaviour by reducing the opportunity to engage in competing behaviours)'. We defined enablement as 'increasing means/reducing barriers to increase capability or opportunity'. The main comparison was between intervention and

  1. 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...

  2. Screenwriting: A Strategy for the Improvement of Writing Instructional Practices

    Directory of Open Access Journals (Sweden)

    Hernán Amado

    2010-10-01

    Full Text Available This article presents a pedagogical experience that addresses the use of an instructional strategy called screenwriting aimed at improving the teaching of writing in an educational context. This pedagogical intervention took place in a private English language school, where three adult students willingly participated to create their own short scripts. The idea was to introduce and reinforce the importance of screenwriting to observe its usefulness in education. Students participated in writing workshops for a 3-month period. The workshops included the respective screenwriting theory and activities that helped them to achieve completion of their final stories. Students' final pieces proved that the writing instructional practices were enriching and beneficial.

  3. 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

  4. Upgrades to improve the usability, reliability, and spectral range of the MST Thomson scattering diagnostic

    Science.gov (United States)

    Kubala, S. Z.; Borchardt, M. T.; Den Hartog, D. J.; Holly, D. J.; Jacobson, C. M.; Morton, L. A.; Young, W. C.

    2016-11-01

    The Thomson scattering diagnostic on MST records both equilibrium and fluctuating electron temperature with a range capability of 10 eV-5 keV. Standard operation with two modified commercial Nd:YAG lasers allows measurements at rates of 1 kHz-25 kHz. Several subsystems of the diagnostic are being improved. The power supplies for the avalanche photodiode detectors (APDs) that record the scattered light are being replaced to improve usability, reliability, and maintainability. Each of the 144 APDs will have an individual rack mounted switching supply, with bias voltage adjustable to match the APD. Long-wavelength filters (1140 nm center, 80 nm bandwidth) have been added to the polychromators to improve capability to resolve non-Maxwellian distributions and to enable directed electron flow measurements. A supercontinuum (SC) pulsed white light source has replaced the tungsten halogen lamp previously used for spectral calibration of the polychromators. The SC source combines substantial brightness produced in nanosecond pulses with a spectrum that covers the entire range of the polychromators.

  5. Continuous quality improvement in small general medical practices: the attitudes of general practitioners and other practice staff.

    NARCIS (Netherlands)

    Geboers, H.J.A.M.; Mokkink, H.G.A.; Montfort, P.A.P. van; Hoogen, H.J.M. van den; Bosch, W.J.H.M. van den; Grol, R.P.T.M.

    2001-01-01

    OBJECTIVES: Continuous quality improvement (CQI) offers opportunities to improve care in small-scale office-based practice. Little is yet known about the implementation of CQI in small primary care practices. We studied the attitudes of physicians and staff in small family practices to a model of

  6. Improving the Dynamic Emissivity Measurement Above 1000 K by Extending the Spectral Range

    Science.gov (United States)

    Urban, D.; Krenek, S.; Anhalt, K.; Taubert, D. R.

    2018-01-01

    To improve the dynamic emissivity measurement, which is based on the laser-flash method, an array spectrometer is characterized regarding its spectral radiance responsivity for a spectrally resolved emissivity measurement above 1000 K in the wavelength range between 550 nm and 1100 nm. Influences like dark signals, the nonlinearity of the detector, the size-of-source effect, wavelength calibration and the spectral radiance responsivity of the system are investigated to obtain an uncertainty budget for the spectral radiance and emissivity measurements. Uncertainties for the spectral radiance of lower than a relative 2 % are achieved for wavelengths longer than 550 nm. Finally, the spectral emissivity of a graphite sample was determined in the temperature range between 1000 K and 1700 K, and the experimental data show a good repeatability and agreement with literature data.

  7. Design of Trypanosoma rangeli sialidase mutants with improved trans-sialidase activity

    DEFF Research Database (Denmark)

    Nyffenegger, Christian; Nordvang, Rune Thorbjørn; Jers, Carsten

    2017-01-01

    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...

  8. Fuzzy approach to business improvement of holding equipment in the conditions of decreased production range

    Directory of Open Access Journals (Sweden)

    Tadić Branko

    2007-01-01

    Full Text Available In recent years, manufacturing industry has been characterized by a decreased production range and a demand for a rapid change of production programs. In such conditions holding equipment costs are considerably larger. In this paper, we review and analyze possible ways of business improvement concerning holding equipment in specific production conditions characterized by the decreased production range and lack of financial sources for applying systems of assembled and disassembled equipment. Classification of elements and group of elements of those systems is performed by applying a new fuzzy ABC method presented in this paper. Selected optimization criteria describe the performance measures of elements and group of elements of assembled and disassembled equipment whereas their relative weights are not the same. It is assumed that the values of imprecise optimization criteria and their relative weights are described by discrete fuzzy numbers. The developed procedure is illustrated by an example with real input data.

  9. Improved semiconductor lattice parameters and band gaps from a middle-range screened hybrid exchange functional.

    Science.gov (United States)

    Lucero, M J; Henderson, T M; Scuseria, G E

    2012-04-11

    We show that the middle-range exchange-correlation hybrid of Henderson, Izmaylov, Scuseria and Savin (HISS) performs extremely well for elemental and binary semiconductors with narrow or visible spectrum band gaps, as well as some wider gap or more ionic systems used in devices. The lattice parameters are superior to those predicted by the screened hybrid functional of Heyd, Scuseria and Ernzerhof (HSE), and provide a significant improvement over the geometries predicted by typical semilocal functionals, yielding results competitive with PBEsol, which was specially tuned for solids. HISS also yields band gaps superior to those produced by functionals developed specifically for the solid state. Timings indicate that HISS is more computationally efficient than HSE, implying that the high quality lattice constants coupled with improved optical band gap predictions render HISS a useful adjunct to HSE in the modeling of geometry-sensitive semiconductors.

  10. Strategic contracting practices to improve procurement of health commodities.

    Science.gov (United States)

    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.

  11. Improving detection range, signal-to-noise ratio, and measurement time through hyperentanglement

    Science.gov (United States)

    Smith, James F.

    2017-07-01

    An atmospheric imaging system based on quantum hyperentanglement has been developed. Hyper-entanglement can increase the maximum detection range of the system by more than a factor of 10, improve the signal-to-noise ratio (SNR) by more than a factor of 10,000, and decrease measurement time. Hyperentanglement refers to entanglement in more than one degree of freedom. A design for creating states hyperentangled in the degrees of freedom polarization, energy-time, orbital angular momentum (OAM), and the radial quantum number is examined. The design helps reduce propagation loss. Figures of merit related to generation and detection efficiencies, the SNR, signal to interference ratio, the measurement time, and phase estimation are provided in closed form. A formula describing how hyperentanglement greatly improves the maximum detection range of the system is derived. Hermite-Gaussian modes, Laguerre-Gaussian (LG) modes, OAM dependence of the LG modes, and mode conversion are discussed. Bell state generation and Bell state measurement, i.e., the ability to distinguish the various Bell states, is discussed. Mathematical and circuit representations of Bell state generation and the Bell state analyzer are provided. Signatures for unique detection of the various Bell states are developed. The formalism permits random noise and entangled or nonentangled sources of interference to be modeled.

  12. 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.

  13. Orthogonal Range Reporting: Query Lower Bounds, Optimal Structures in 3-d, and Higher Dimensional Improvements

    DEFF Research Database (Denmark)

    Afshani, Peyman; Arge, Lars Allan; Larsen, Kasper Dalgaard

    2010-01-01

    , this is not the case in higher dimensions. In this paper we provide a space optimal pointer machine data structure for 3-d orthogonal range reporting that answers queries in O(log n + k) time. Thus we settle the complexity of the problem in 3-d. We use this result to obtain improved structures in higher dimensions...... data structure for the d-dimensional orthogonal range reporting problem in the pointer machine model of computation that uses S(n) space must spend Ω((log n/ log(S(n)/n))⌊d/2⌋--1) time to answer queries. Thus, if S(n)/n is poly-logarithmic, then the query time is at least Ω((log n/ log log n)⌊d/2......Orthogonal range reporting is the problem of storing a set of n points in d-dimensional space, such that the k points in an axis-orthogonal query box can be reported efficiently. While the 2-d version of the problem was completely characterized in the pointer machine model more than two decades ago...

  14. Interprofessional collaboration to improve professional practice and healthcare outcomes.

    Science.gov (United States)

    Reeves, Scott; Pelone, Ferruccio; Harrison, Reema; Goldman, Joanne; Zwarenstein, Merrick

    2017-06-22

    Poor interprofessional collaboration (IPC) can adversely affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes. To assess the impact of practice-based interventions designed to improve interprofessional collaboration (IPC) amongst health and social care professionals, compared to usual care or to an alternative intervention, on at least one of the following primary outcomes: patient health outcomes, clinical process or efficiency outcomes or secondary outcomes (collaborative behaviour). We searched CENTRAL (2015, issue 11), MEDLINE, CINAHL, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform to November 2015. We handsearched relevant interprofessional journals to November 2015, and reviewed the reference lists of the included studies. We included randomised trials of practice-based IPC interventions involving health and social care professionals compared to usual care or to an alternative intervention. Two review authors independently assessed the eligibility of each potentially relevant study. We extracted data from the included studies and assessed the risk of bias of each study. We were unable to perform a meta-analysis of study outcomes, given the small number of included studies and their heterogeneity in clinical settings, interventions and outcomes. Consequently, we summarised the study data and presented the results in a narrative format to report study methods, outcomes, impact and certainty of the evidence. We included nine studies in total (6540 participants); six cluster-randomised trials and three individual randomised trials (1 study randomised clinicians, 1 randomised patients, and 1 randomised clinicians and patients). All studies were conducted in high-income countries (Australia, Belgium, Sweden, UK and USA) across primary, secondary, tertiary and community care settings and had a follow-up of up to 12

  15. The EASE Quality Improvement Project: Improving Safe Sleep Practices in Ohio Children's Hospitals.

    Science.gov (United States)

    Macklin, Jamie R; Gittelman, Michael A; Denny, Sarah A; Southworth, Hayley; Arnold, Melissa Wervey

    2016-10-01

    Despite American Academy of Pediatrics (AAP) recommendations, many hospitalized infants are not observed in the appropriate safe sleep environment. Caregivers tend to model sleep patterns observed in a hospital setting. This project assessed the change in infant safe sleep practices within 6 children's hospitals after the implementation of a statewide quality improvement program. The AAP recruited hospitalists from each of the state's children's hospitals and asked them to form "safe sleep teams" within their institutions. Teams used a standardized data tool to collect information on the infant's age and sleep position/environment. They collected baseline data and then weekly for the duration of the 12-month project. Teams were required to implement at least 3 Plan-Do-Study-Act cycles. We calculated changes in safe sleep practices over time. Providers received Maintenance of Certification Part IV credit for participation. Teams collected 5343 audits at all participating sites. At baseline, only 279 (32.6%) of 856 of the sleeping infants were observed to follow AAP recommendations, compared with 110 (58.2%) of 189 (P sleep practices from 48.2% to 75.4% (P hospitals improved observed infant safe sleep behaviors and family report of safe sleep education. These behavior changes may lead to more appropriate safe sleep practices at home. Copyright © 2016 by the American Academy of Pediatrics.

  16. Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters.

    Science.gov (United States)

    Halperin, Israel; Aboodarda, Saied Jalal; Button, Duane C; Andersen, Lars L; Behm, David G

    2014-02-01

    Limited dorsiflexion range of motion (ROM) has been linked to lower limb injuries. Improving limited ankle ROM may decrease injury rates. Static stretching (SS) is ubiquitously used to improve ROM but can lead to decreases in force and power if performed prior to the activity. Thus, alternatives to improve ROM without performance decrements are needed. To compare the effects of SS and self massage (SM) with a roller massage of the calf muscles on ankle ROM, maximal voluntary contraction (MVC) force F100 (force produced in the first 100 ms of the MVC), electromyography (EMG of soleus and tibialis anterior) characteristics of the plantar flexors, and a single limb balance test. Fourteen recreationally trained subjects were tested on two separate occasions in a randomized cross-over design. After a warm up, subjects were assessed for passive dorsiflexion ROM, MVC, and a single-limb balance test with eyes closed. The same three measurements were repeated after 10 minutes (min) of rest and prior to the interventions. Following the pre-test, participants randomly performed either SS or SM for 3 sets of 30 seconds (s) with 10s of rest between each set. At one and 10 min post-interventions the participants repeated the three measurements, for a third and fourth cycle of testing. Roller massage increased and SS decreased maximal force output during the post-test measurements, with a significant difference occurring between the two interventions at 10 min post-test (p massage (p massage with a roller massager led to small improvements in MVC force relative to SS at 10 min post-intervention. These results highlight the effectiveness of a roller massager relative to SS. These results could affect the type of warm-up prior to activities that depend on high force and sufficient ankle ROM. 2c.

  17. Effective Interpersonal Communication: A Practical Guide to Improve Your Life.

    Science.gov (United States)

    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.

  18. Comparisons of management practices and farm design on Australian commercial layer and meat chicken farms: Cage, barn and free range.

    Directory of Open Access Journals (Sweden)

    Angela Bullanday Scott

    Full Text Available 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.

  19. Contextualizing learning to improve care using collaborative communities of practices.

    Science.gov (United States)

    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

  20. Improvements in Renal Replacement Therapy Practice Patterns in Estonia

    Directory of Open Access Journals (Sweden)

    Külli Kõlvald

    2014-07-01

    Full Text Available Background: The clinical performance indicators (CPI are important tools to assess and improve the quality of renal replacement therapy (RRT. The aim of the current study was to compare the results of a longitudinal set of CPI in RRT patients and to determine the extent to which the guidelines for anaemia, calcium phosphate management and other CPI are met in Estonian renal centres. Methods: A long-term retrospective, observational, cross-sectional CPI analysis was undertaken in RRT patients from 2007 to 2011. The following CPI set of well-designed measures based on good evidence was analysed: anaemia management variables, laboratory analyses of mineral metabolism, nutritional status variables and dialysis adequacy variables. Results: Relatively small changes in the analysed mean CPI values were noticed during the study period. In the course of the study, we noticed an improvement in anaemia control, but not all centres achieved the standard of >80% of the dialysis patients with a haemoglobin (Hb level >100 g/l. There was a trend of decreasing Hb concentrations below 125 g/l in both haemodialysis (HD and peritoneal dialysis (PD patients. In 2011, hyperphosphataemia was present in 58% of the HD and 47% of the PD patients, whereas centre differences varied between 50 and 60% of both the HD and PD patients. HD adequacy was achieved in 77% of the HD patients. Conclusion: An improvement in the data collection was noticed, and the analysis of CPI allows renal centres to assess and compare their practices with others. The collection and evaluation of CPI of RRT patients is an important improvement and significantly increases the awareness of nephrologists.

  1. Standardised proformas improve patient handover: Audit of trauma handover practice

    Directory of Open Access Journals (Sweden)

    Metcalfe Andrew J

    2008-09-01

    Full Text Available Abstract Background The implementation of the European Working Time Directive has meant the introduction of shift patterns of working for junior doctors. Patient handover between shifts has become a necessary part of practice in order to reduce the risk of medical errors. Data handed over between shifts are used to prioritise clinical jobs outstanding, and to create theatre lists. We present a closed-loop audit of handover practice to assess whether standardised proformas improve clinical data transfer between shifts during handover in our Orthopaedic Unit. Methods We collected data handed over between shifts for a period of one week at our department. The data were in the form of hand written data on plain paper used to assist verbal handover. Data were analysed and a standardised handover sheet was trialled. After feedback from juniors the sheet was revised and implemented. A re-audit, of handover data, was then undertaken using the revised standardised proforma during a period of 1 week. Results Forty-eight patients were handed over in week 1 while 55 patients were handed over during re-audit. The standardised proformas encouraged use of pre-printed patient labels which contained legible patient identifiers, use of labels increased from 72.9% to 93.4%. Handover of outstanding jobs increased from 31.25% to 100%. Overall data handed over increased from 72.6% to 93.2%. Handover of relevant blood results showed little improvement from 18.8% to 20.7% Conclusion This audit highlights the issue of data transfer between shifts. Standardised proformas encourage filling of relevant fields and increases the data transferred between shifts thereby reducing the potential for clinical error cause by shift patterns.

  2. Improving classroom practices: the impact of leadership, school organizational conditions, and teacher factors

    NARCIS (Netherlands)

    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

  3. Design Optimization for the Measurement Accuracy Improvement of a Large Range Nanopositioning Stage

    Directory of Open Access Journals (Sweden)

    Marta Torralba

    2016-01-01

    Full Text Available Both an accurate machine design and an adequate metrology loop definition are critical factors when precision positioning represents a key issue for the final system performance. This article discusses the error budget methodology as an advantageous technique to improve the measurement accuracy of a 2D-long range stage during its design phase. The nanopositioning platform NanoPla is here presented. Its specifications, e.g., XY-travel range of 50 mm × 50 mm and sub-micrometric accuracy; and some novel designed solutions, e.g., a three-layer and two-stage architecture are described. Once defined the prototype, an error analysis is performed to propose improvement design features. Then, the metrology loop of the system is mathematically modelled to define the propagation of the different sources. Several simplifications and design hypothesis are justified and validated, including the assumption of rigid body behavior, which is demonstrated after a finite element analysis verification. The different error sources and their estimated contributions are enumerated in order to conclude with the final error values obtained from the error budget. The measurement deviations obtained demonstrate the important influence of the working environmental conditions, the flatness error of the plane mirror reflectors and the accurate manufacture and assembly of the components forming the metrological loop. Thus, a temperature control of ±0.1 °C results in an acceptable maximum positioning error for the developed NanoPla stage, i.e., 41 nm, 36 nm and 48 nm in X-, Y- and Z-axis, respectively.

  4. An improved method for including upper size range plasmids in metamobilomes.

    Directory of Open Access Journals (Sweden)

    Anders Norman

    Full Text Available Two recently developed isolation methods have shown promise when recovering pure community plasmid DNA (metamobilomes/plasmidomes, which is useful in conducting culture-independent investigations into plasmid ecology. However, both methods employ multiple displacement amplification (MDA to ensure suitable quantities of plasmid DNA for high-throughput sequencing. This study demonstrates that MDA greatly favors smaller circular DNA elements (10 Kbp. Throughout the study, we used two model plasmids, a 4.4 Kbp cloning vector (pBR322, and a 56 Kbp conjugative plasmid (pKJK10, to represent lower- and upper plasmid size ranges, respectively. Subjecting a mixture of these plasmids to the overall isolation protocol revealed a 34-fold over-amplification of pBR322 after MDA. To address this bias, we propose the addition of an electroelution step that separates different plasmid size ranges prior to MDA in order to reduce size-dependent competition during incubation. Subsequent analyses of metamobilome data from wastewater spiked with the model plasmids showed in silica recovery of pKJK10 to be very poor with the established method and a 1,300-fold overrepresentation of pBR322. Conversely, complete recovery of pKJK10 was enabled with the new modified protocol although considerable care must be taken during electroelution to minimize cross-contamination between samples. For further validation, non-spiked wastewater metamobilomes were mapped to more than 2,500 known plasmid genomes. This displayed an overall recovery of plasmids well into the upper size range (median size: 30 kilobases with the modified protocol. Analysis of de novo assembled metamobilome data also suggested distinctly better recovery of larger plasmids, as gene functions associated with these plasmids, such as conjugation, was exclusively encoded in the data output generated through the modified protocol. Thus, with the suggested modification, access to a large uncharacterized pool of

  5. Use of a patient-controlled stretching device to improve the ankle range of motion.

    Science.gov (United States)

    Trevino, Saul G; Buford, William L; Vallurupalli, Santaram; Rowell, Margaret; Panchbhavi, Vinod K

    2009-02-01

    Ankle and subtalar stiffness are widely associated with many foot and ankle conditions and functional deficits. Loss of range of motion, particularly dorsiflexion, results in significant gait dysfunction. A variety of methods have been evaluated to address this problem, including yoga, manipulation, dance training, jogging and static stretching exercises. No tools have been described that effectively and efficiently stretch the ankle and subtalar joint without requiring supervision or assistance of a trained physical therapist. Twenty-two subjects with varying foot and ankle diagnoses who had little or no improvement in range of motion after traditional assisted physical therapy were recruited from a foot and ankle orthopaedic clinic. The subjects' ankle and subtalar range of motion (ROM) in plantarflexion (PF), dorsiflexion (DF), inversion (INV), and eversion (EVR) were measured using a standard goniometer by a single physiotherapist prior to using the stretching device. The subjects were trained on the proper use of the stretching device and then instructed to use it daily for a 6-week period. Then the same examiner repeated the above measurements. Statistical analysis was performed using a two sample t-test assuming unequal variances. There were statistically significant increases in ROM in all planes tested: DF to PF (p = 0.0052), and INV to EVR (p = 0.018). Stretching with the device significantly increased ankle and subtalar ROM. The stretching device can be used at home on a regular basis with minimal training and can effectively treat stiffness of the ankle and subtalar joints. It can be cost-effective when compared to use of physiotherapy services.

  6. A comprehensive educational approach to improving patient isolation practice.

    Science.gov (United States)

    Kidd, F; Heitkemper, P; Kressel, A B

    1999-01-01

    To describe a workable plan for the successful education of a large, diverse group of healthcare workers in a university hospital setting. A prospective, nonrandomized study of compliance with infection control isolation practice following various educational interventions. 300-bed tertiary-care, academic medical center with out-patient clinics. Hospital employees and contract workers. The infection control department introduced a plan to implement the Centers for Disease Control and Prevention's new isolation guidelines. A comprehensive proposal was presented to administration. It included a time line for institution and a comprehensive educational and performance-improvement plan, including standard lectures and a video that explained Standard and Transmission-Based Precautions. Follow-up consisted of customized in-services and one-on-one continued education tailored to the individual units. Compliance with isolation procedure after standardized lectures and video alone was poor. Compliance improved after institution of smaller, more intensive in-services tailored to individual departments and given during all shifts. Intensive, individualized education is the key to compliance. This requires sufficient infection control staffing and administrative support.

  7. Designing tailored Web-based instruction to improve practicing physicians' preventive practices.

    Science.gov (United States)

    Casebeer, Linda L; Strasser, Sheryl M; Spettell, Claire M; Wall, Terry C; Weissman, Norman; Ray, Midge N; Allison, Jeroan J

    2003-01-01

    The World Wide Web has led to the rapid growth of medical information and continuing medical educational offerings. Ease of access and availability at any time are advantages of the World Wide Web. Existing physician-education sites have often been designed and developed without systematic application of evidence and cognitive-educational theories; little rigorous evaluation has been conducted to determine which design factors are most effective in facilitating improvements in physician performance and patient-health outcomes that might occur as a result of physician participation in Web-based education. Theory and evidence-based Web design principles include the use of: needs assessment, multimodal strategies, interactivity, clinical cases, tailoring, credible evidence-based content, audit and feedback, and patient-education materials. Ease of use and design to support the lowest common technology denominator are also important. Using these principles, design and develop a Web site including multimodal strategies for improving chlamydial-screening rates among primary care physicians. We used office-practice data in needs assessment and as an audit/feedback tool. In the intervention introduced in 4 phases over 11 months, we provided a series of interactive, tailored, case vignettes with feedback on peer answers. We included a quality-improvement toolbox including clinical practice guidelines and printable patient education materials. In the formative evaluation of the first 2 chlamydia modules, data regarding the recruitment, enrollment, participation, and reminders have been examined. Preliminary evaluation data from a randomized, controlled trial has tested the effectiveness of this intervention in improving chlamydia screening rates with a significant increase in intervention physicians' chlamydia knowledge, attitude, and skills compared to those of a control group. The application of theory in the development and evaluation of a Web-based continuing medical

  8. Promoting Equitable Biology Lab Instruction by Engaging All Students in a Broad Range of Science Practices: An Exploratory Study

    Science.gov (United States)

    Strimaitis, Anna M.; Southerland, Sherry A.; Sampson, Victor; Enderle, Patrick; Grooms, Jonathon

    2017-01-01

    This study examines what students enrolled in the honors and general sections of a high school biology course offered at the same school learn when they have an opportunity to participate in a broad or narrow range of science practices during their laboratory experiences. The results of our analysis suggest that the students enrolled in the…

  9. Practical solutions to the aircraft minimum fuel, fixed-range, fixed time-of-arrival trajectory optimization problem

    Science.gov (United States)

    Sorensen, J. A.; Waters, M. H.

    1980-01-01

    A practical scheme is presented for generating fixed range, minimum fuel vertical flight profiles that also satisfy time-of-arrival constraints. The resulting algorithm is suitable for incorporation into an on-board flight management system. Example results show that such a capability can save up to 6% of fuel burned in flights subject to delays because of terminal area congestion.

  10. Self-Assessment of Practice Performance: Development of the ABIM Practice Improvement Module (PIM[superscript SM])

    Science.gov (United States)

    Duffy, F. Daniel; Lynn, Lorna A.; Didura, Halyna; Hess, Brian; Caverzagie, Kelly; Grosso, Louis; Lipner, Rebecca A.; Holmboe, Eric S.

    2008-01-01

    Background: Quality measurement and improvement in practice are requirements for Maintenance of Certification by the American Board of Medical Specialties boards and a component of many pay for performance programs. Objective: To describe the development of the American Board of Internal Medicine (ABIM) Practice Improvement Module (PIM[superscript…

  11. 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

  12. Family Astronomy: Improving Practices and Developing New Approaches

    Science.gov (United States)

    Noel-Storr, J.; Drobnes, E.; Mitchell, S. E.

    2008-06-01

    We present effective strategies for family astronomy programs based on the experiences in recent years developing programs around four key elements: child and parent engagement in the process of science; family cohesiveness and cooperation; parent ``professional development''; and continuity of learning beyond the programs we create. We present strategies developed by workshop attendees to implement or improve family programs that can be facilitated in a variety of settings, with an emphasis on creativity and innovation to push the field forwards. We discuss the design of evaluation tools and education research questions centered on family learning that will ensure the value that family astronomy programs add to Science, Technology, Engineering and Mathematics (STEM) education in a range of communities is increased and better understood.

  13. FORAGES AND PASTURES SYMPOSIUM: Improving efficiency of production in pasture- and range-based beef and dairy systems.

    Science.gov (United States)

    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

  14. Evaluating practice-based learning and improvement: efforts to improve acceptance of portfolios.

    Science.gov (United States)

    Fragneto, Regina Y; Dilorenzo, Amy Noel; Schell, Randall M; Bowe, Edwin A

    2010-12-01

    The Accreditation Council for Graduate Medical Education (ACGME) recommends resident portfolios as 1 method for assessing competence in practice-based learning and improvement. In July 2005, when anesthesiology residents in our department were required to start a portfolio, the residents and their faculty advisors did not readily accept this new requirement. Intensive education efforts addressing the goals and importance of portfolios were undertaken. We hypothesized that these educational efforts improved acceptance of the portfolio and retrospectively audited the portfolio evaluation forms completed by faculty advisors. Intensive education about the goals and importance of portfolios began in January 2006, including presentations at departmental conferences and one-on-one education sessions. Faculty advisors were instructed to evaluate each resident's portfolio and complete a review form. We retrospectively collected data to determine the percentage of review forms completed by faculty. The portfolio reviews also assessed the percentage of 10 required portfolio components residents had completed. Portfolio review forms were completed by faculty advisors for 13% (5/38) of residents during the first advisor-advisee meeting in December 2005. Initiation of intensive education efforts significantly improved compliance, with review forms completed for 68% (26/38) of residents in May 2006 (P portfolios between May and December of 2006. Portfolios are considered a best methods technique by the ACGME for evaluation of practice-based learning and improvment. We have found that intensive education about the goals and importance of portfolios can enhance acceptance of this evaluation tool, resulting in improved compliance in completion and evaluation of portfolios.

  15. HEPS4Power - Extended-range Hydrometeorological Ensemble Predictions for Improved Hydropower Operations and Revenues

    Science.gov (United States)

    Bogner, Konrad; Monhart, Samuel; Liniger, Mark; Spririg, Christoph; Jordan, Fred; Zappa, Massimiliano

    2015-04-01

    In recent years large progresses have been achieved in the operational prediction of floods and hydrological drought with up to ten days lead time. Both the public and the private sectors are currently using probabilistic runoff forecast in order to monitoring water resources and take actions when critical conditions are to be expected. The use of extended-range predictions with lead times exceeding 10 days is not yet established. The hydropower sector in particular might have large benefits from using hydro meteorological forecasts for the next 15 to 60 days in order to optimize the operations and the revenues from their watersheds, dams, captions, turbines and pumps. The new Swiss Competence Centers in Energy Research (SCCER) targets at boosting research related to energy issues in Switzerland. The objective of HEPS4POWER is to demonstrate that operational extended-range hydro meteorological forecasts have the potential to become very valuable tools for fine tuning the production of energy from hydropower systems. The project team covers a specific system-oriented value chain starting from the collection and forecast of meteorological data (MeteoSwiss), leading to the operational application of state-of-the-art hydrological models (WSL) and terminating with the experience in data presentation and power production forecasts for end-users (e-dric.ch). The first task of the HEPS4POWER will be the downscaling and post-processing of ensemble extended-range meteorological forecasts (EPS). The goal is to provide well-tailored forecasts of probabilistic nature that should be reliable in statistical and localized at catchment or even station level. The hydrology related task will consist in feeding the post-processed meteorological forecasts into a HEPS using a multi-model approach by implementing models with different complexity. Also in the case of the hydrological ensemble predictions, post-processing techniques need to be tested in order to improve the quality of the

  16. Predicting Short-Range Order in Multicomponent Alloys from an Improved Mean-Field Theory

    Science.gov (United States)

    Ong, Zhun-Yong; Johnson, Duane

    2007-03-01

    In alloys the atomic short-range order (SRO) indicates the nascent ordering to which the disordered alloy is tending at high temperatures. Direct first-principles prediction based upon KKR-CPA and mean-field thermodynamics have been successful in predicting system-specific SRO [1], if, at a minimum, corrections are included to satisfy the diffuse scattering sum rule in k-space. However, such models do not account for k-dependence of the corrections. Here, we present an analytic generalization to multicomponent alloys that includes ``cyclic diagrams'' [2,3] for composition, temperature, and k-dependent corrections to SRO. We first explore the improvement to SRO in model fcc ternary alloys via the generalized Ising model. We find that there is much better agreement to Monte Carlo simulations than with standard Bragg-Williams with(out) Onsager corrections. Then we implement this within the KKR-CPA linear-response theory of SRO.Work was supported by DOE (Award DEFG02-03ER46026 and NSF (DMR-0325939). [1] J.B. Staunton, D.D. Johnson, and F.J. Pinski, Phys. Rev. Lett. 65, 1259 (1990); Phys. Rev. B 50, 1450 (1994); ibid, 57, 15177 (1998). [2] R. Brout, Phys. Rev. 115, 824-835 (1959). [3] R.V. Chepulski, et al, Phys. Rev. 65, 064201-7 (2002).

  17. Improving the effectiveness of detailed processing by dynamic control of processing with high sports range

    Directory of Open Access Journals (Sweden)

    Yu.V. Shapoval

    2017-12-01

    Full Text Available In this article the possibility of increasing the efficiency of the processing of parts with a diameter of up to 20 mm is analyzed, namely: vibration resistance of the cutting process at pinching due to cutting speed control in the processing, forecasting and selection of rotational frequencies, which ensure the stability of the processing system, controlling the dynamics of the process of displacement of the additional mass. The method of investigation of vibration processes during the sharpening is developed. As a result of the processing of experimental data, it was found that when an oscillatory motion is applied to the spindle rotation, the overall level of oscillation decreases, which is reflected on the quality of the treated surface. The choice of a previously known spindle rotation frequency range at which the lowest value of the oscillation amplitude of the instrument is observed in the radial direction to the detail part, allows you to increase the processing efficiency while maintaining the drawing requirements for roughness by increasing the spindle rotational speed. The combination of the node of the own forms of oscillation and the cutting zone, by dynamically controlling the fluctuations of the lathe armature due to the increase of the inertia characteristics of the machine and the reduction of the oscillation amplitude of the tool, can improve the accuracy of machining and roughness of the processed surface of the component at higher spindle speeds.

  18. Improvement of cyclic operation on pulverized coal fired boilers by applying wide range burners

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Toshihiko; Watanabe, Shinji; Kiga, Takashi; Koyata, Kazuo

    1999-07-01

    There are recently urgent requirements to operate pulverized coal fired power plants as well as oil fired units cyclically or at low loads. In order to cope with this, wide range burners (WRB) were jointly developed to obtain a high turndown operation by the Central Research Institute of Electric Power Industry (CRIEPI) and Ishikawajima-Harima Heavy Industries Co., Ltd. (IHI). In accordance with the results of various fundamental researches, including combustion tests with a tunnel furnace of 12 MW[thermal], it was confirmed the stability of the flame and the combustion characteristics at low loads as well as that of ordinary burners. The WRB have been applied to the new actual boilers that are Saijo Power Station NO. 2 unit of Sikoku Electric Power Co., Inc., Nanao-Ota Power Station NO. 2 unit of Hokuriku Electric Power Co., Inc. and Miike Power Station NO. 1 unit of Miike Thermal Power Co., Ltd.. The results of the trial operation have shown that the minimum burner load was below half of that of conventional burners, and accordingly the pulverized coal firing minimum load could be reduced. This paper explains about the cyclic operation of their boilers and the improvement effect by applying WRBs.

  19. Improving multimodel medium range forecasts over the Greater Horn of Africa using the FSU superensemble

    Science.gov (United States)

    Kipkogei, O.; Bhardwaj, A.; Kumar, V.; Ogallo, L. A.; Opijah, F. J.; Mutemi, J. N.; Krishnamurti, T. N.

    2016-08-01

    This study makes use of the WMO's multimodel data set called THORPEX integrated grand global ensemble (TIGGE) towards the construction of multimodel superensemble forecasts covering a period of 10 days. The goal of this study is to explore the forecast skill for precipitation forecasts over the Greater Horn of Africa (this is a consortium of 11 countries). The multimodels include forecast data set from a suite of models that include: The European Centre for Medium Range Weather Forecasts (ECMWF), the National Centre for Environmental Prediction (NCEP), the Center for Weather Forecast and Climatic Studies (CPTEC) and the United Kingdom Meteorological Office (UKMO). After performing a training phase for the superensemble weights covering the previous 450 days of October, November and December months of 2008-2012, forecasts of precipitation were prepared for the multimodel superensemble. These covered day 1 to day 10 of forecasts over the region. Various skill metrics were prepared to validate the forecast rainfall against the tropical rainfall measuring mission (TRMM) observed rainfall data. This study shows that the construction of the multimodel superensemble was a worthwhile effort since it provided the best overall skills for the RMS errors, the spatial correlations and the equitable threat scores and their bias errors for precipitation forecasts from day 1 to day 10 over all of the countries covered by the Greater Horn of Africa. The best among the member model was the UKMO model. This study strongly suggests the usefulness of a product such as the multimodel superensemble for improved precipitation forecasts over East Africa.

  20. 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.

  1. Transformational Teaching: Connecting the Full-Range Leadership Theory and Graduate Teaching Practice

    Science.gov (United States)

    Kim, Won J.

    2012-01-01

    Reliable measurements for effective teaching are lacking. In contrast, some theories of leadership (particularly transformational leadership) have been tested and found to have efficacy in a variety of organizational settings. In this study, the full-range leadership theory, which includes transformational leadership, was applied to the…

  2. Bluetooth: The invisible connector. Short-range wireless technology for the contemporary orthodontic practice.

    Science.gov (United States)

    Mupparapu, Muralidhar

    2007-06-01

    Although it sounds like a nonvital tooth, Bluetooth is actually one of technology's hottest trends. It is an industrial specification for wireless personal area networks, but for a busy orthodontic practice, it translates to freedom from cables and cords. Despite its enigmatic name, Bluetooth-based devices and the wireless technology that these gadgets work with are here to stay. They promise to make life easier for the electronic-device users of all stripes, and orthodontists are no exception. The purpose of this article is to orient orthodontists, office staff, and auxiliary personnel to this universal wireless technology that is slowly becoming an integral part of every office.

  3. Development and pilot study of the Primary Care Practice Improvement Tool (PC-PIT): an innovative approach.

    Science.gov (United States)

    Crossland, Lisa; Janamian, Tina; Sheehan, Mary; Siskind, Victor; Hepworth, Julie; Jackson, Claire L

    2014-08-04

    To assess the usability and validity of the Primary Care Practice Improvement Tool (PC-PIT), a practice performance improvement tool based on 13 key elements identified by a systematic review. It was co-created with a range of partners and designed specifically for primary health care. This pilot study examined the PC-PIT using a formative assessment framework and mixed-methods research design. Six high-functioning general practices in Queensland, Australia, between February and July 2013. A total of 28 staff participated - 10 general practitioners, six practice or community nurses, 12 administrators (four practice managers; one business manager and eight reception or general administrative staff). Readability, content validity and staff perceptions of the PC-PIT. The PC-PIT offers an appropriate and acceptable approach to internal quality improvement in general practice. Quantitative assessment scores and qualitative data from all staff identified two areas in which the PC-PIT required modification: a reduction in the indicative reading age, and simplification of governance-related terms and concepts. The PC-PIT provides an innovative approach to address the complexity of organisational improvement in general practice and primary health care. This initial validation will be used to develop a suite of supporting, high-quality and free-to-access resources to enhance the use of the PC-PIT in general practice. Based on these findings, a national trial is now underway.

  4. Department of Defense Best Management Practices for Munitions Constituents on Operational Ranges

    Science.gov (United States)

    2014-04-01

    or part of the solution) at numerous U.S. Department of Defense (DoD) sites impacted with chlorinated solvents, petroleum hydrocarbons, and...monitoring wells throughout the plume. Analytical techniques (e.g., compound specific isotope analysis) may be required to demonstrate and quantify the...last resort for training range applications for situations where other management options are not possible or are ineffective, and/or an important

  5. 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.

  6. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty.

    Science.gov (United States)

    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

  7. Operational practices of lean manufacturing: Potentiating environmental improvements

    National Research Council Canada - National Science Library

    Marcos José Alves; Pinto Junior; Juliana Veiga Mendes

    2017-01-01

    .... 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...

  8. Screenwriting: A Strategy for the Improvement of Writing Instructional Practices

    Directory of Open Access Journals (Sweden)

    Amado Hernán

    2010-11-01

    Full Text Available This article presents a pedagogical experience that addresses the use of an instructional strategy called screenwriting aimed at improving the teaching of writing in an educational context. This pedagogical intervention took place in a private English language school, where three adult students willingly participated to create their own short scripts. The idea was to introduce and reinforce the importance of screenwriting to observe its usefulness in education. Students participated in writing workshops for a 3-month period. The workshops included the respective screenwriting theory and activities that helped them to achieve completion of their final stories. Students’ final pieces proved that the writing instructional practices were enriching and beneficial. En este artículo se presenta una experiencia pedagógica sobre el uso de una estrategia instruccional llamada "la escritura de guiones", y cuyo objetivo es mejorar la enseñanza de la escritura en un contexto educativo. Esta intervención pedagógica tuvo lugar en una institución privada, dedicada a la enseñanza de lengua inglesa, donde tres estudiantes adultos participaron en la creación de sus propios guiones cortos. La idea era introducir y reforzar la importancia de la escritura de guiones para observar su utilidad en la educación. Los estudiantes participaron durante tres meses en talleres de escritura creativa. Estos incluyeron teoría y actividades para la escritura de guiones respectivos que los ayudaron a lograr sus historias finales. Los trabajos finales de los estudiantes mostraron que las prácticas instruccionales de escritura fueron enriquecedoras y benéficas.

  9. Ranking agricultural practices on soil water improvements: a meta-analysis

    Science.gov (United States)

    Basche, A.; DeLonge, M. S.; Gonzalez, J.

    2016-12-01

    Increased rainfall variability is well documented in the historic record and predicted to intensify with future climate change. Managing excess water in periods of heavy rain and a lack of water in periods of inadequate precipitation will continue to be a challenge. Improving soil resiliency through increased water storage is a promising strategy to combat effects of both rainfall extremes. The goal of this research is to quantify to what extent various conservation and ecological practices can improve soil hydrology. We are conducting a global meta-analysis focused on studies where conservation and ecological practices are compared to more conventional management. To date we have analyzed 100 studies with more than 450 paired comparisons to understand the effect of management on water infiltration rates, a critical process that ensures water enters the soil profile for crop use, water storage and runoff prevention. The database will be expanded to include studies measuring soil porosity and the water retained at field capacity. Statistical analysis has been done both with both a bootstrap method and a mixed model that weights studies based on precision while accounting for between-study variation. We find that conservation and ecological practices, ranging from no-till, cover crops, crop rotation, perennial crops and agroforestry, on average significantly increased water infiltration rates relative to more conventional practice controls (mean of 75%, standard error 25%). There were significant differences between practices, where perennial and agroforestry systems show the greatest potential for improving water infiltration rates (> 100% increase). Cover crops also lead to a significant increase in water infiltration rates (> 60%) while crop rotations and no-till systems did not consistently demonstrate increases. We also found that studies needed to include alternative management for more than two years to detect a significant increase. Overall this global meta

  10. Current practice in software development for computational neuroscience and how to improve it.

    Science.gov (United States)

    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.

  11. 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.

  12. Overcoming synecdoche: why practice development and quality improvement approaches should be better integrated

    Directory of Open Access Journals (Sweden)

    Kim Manley

    2017-05-01

    Full Text Available We are pleased to be provided with an opportunity to comment on the thoughtful article by Gavin Lavery about the relationship between practice development and quality improvement, published in 2016 in the IPDJ. We also respect and value the opportunity to bring different perspectives together – something alluded to in Lavery’s article when discussing the relationship between service improvement and quality improvement. We acknowledge Lavery’s humility and openness to different perspectives as demonstrated by his willingness to participate in a foundation practice development school. We also accept that there are many different ways of achieving the same outcomes, by using a range of tools flexibly based on shared and common principles, as well as knowing the people you work with and being clear about purpose. At a time of scant resources in healthcare, it is vital that we avoid duplication and integrate approaches if service users are to experience the continuity and seamlessness of a person-centred approach to meeting the health and social care needs of individuals and communities. Lavery makes reference to ‘systems and processes’. It is important when discussing systems that we have a sense of shared meaning, as systems comprise structures, processes and patterns of behaviour. It is often the latter that are most challenging to address when trying to develop practice and improve quality (McCormack et al., 2008. Patterns of behaviours are an important focus when engaging staff in learning and reflection. Helping practitioners to become self-aware about the consequences of their actions on others (enlightenment, particularly in relation to being person-centred, has a strong history in practice development, linked to using the workplace as the main resource for active learning (Dewing, 2008. While these insights have relevance for both practice development and quality improvement, it is the former, through its theoretical development

  13. Multi-objective optimization to improve the product range of baking systems

    NARCIS (Netherlands)

    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

  14. DEFENSE SCIENCE AND TECHNOLOGY Adopting Best Practices Can Improve Innovation Investments and Management

    Science.gov (United States)

    2017-06-01

    DEFENSE SCIENCE AND TECHNOLOGY Adopting Best Practices Can Improve Innovation Investments and Management Report...Can Improve Innovation Investments and Management What GAO Found The eight leading companies whose practices GAO assessed take a disciplined...the figure. Incremental development improves product lines whereas disruptive development is for riskier innovative and potentially market-shifting

  15. Improving Student Commitment to Healthcare-Related Design Practice by Improving the Studio Learning Experience.

    Science.gov (United States)

    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.

  16. A Practical, Robust and Fast Method for Location Localization in Range-Based Systems.

    Science.gov (United States)

    Huang, Shiping; Wu, Zhifeng; Misra, Anil

    2017-12-11

    Location localization technology is used in a number of industrial and civil applications. Real time location localization accuracy is highly dependent on the quality of the distance measurements and efficiency of solving the localization equations. In this paper, we provide a novel approach to solve the nonlinear localization equations efficiently and simultaneously eliminate the bad measurement data in range-based systems. A geometric intersection model was developed to narrow the target search area, where Newton's Method and the Direct Search Method are used to search for the unknown position. Not only does the geometric intersection model offer a small bounded search domain for Newton's Method and the Direct Search Method, but also it can self-correct bad measurement data. The Direct Search Method is useful for the coarse localization or small target search domain, while the Newton's Method can be used for accurate localization. For accurate localization, by utilizing the proposed Modified Newton's Method (MNM), challenges of avoiding the local extrema, singularities, and initial value choice are addressed. The applicability and robustness of the developed method has been demonstrated by experiments with an indoor system.

  17. Improving clinical practices for children with language and learning disorders.

    Science.gov (United States)

    Kamhi, Alan G

    2014-04-01

    This lead article of the Clinical Forum addresses some of the gaps that exist between clinical practice and current knowledge about instructional factors that influence learning and language development. Topics reviewed and discussed include principles of learning, generalization, treatment intensity, processing interventions, components of language therapy, grammar goals, and goal prioritization for students with language and learning difficulties. The gaps that exist between current knowledge about learning, language development, and clinical practice often do not receive as much attention as the gaps in the evidence base that addresses the efficacy and effectiveness of language intervention practices and service delivery models. Fortunately, clinicians do not have to wait for future intervention studies to apply their knowledge of learning and language development to clinical practices.

  18. Farmers' adoption of improved vegetable production practices under ...

    African Journals Online (AJOL)

    STORAGESEVER

    2008-12-29

    Dec 29, 2008 ... so, fixed cost components such as depreciation, insurance, repairs, taxes and interest on ..... methods of field preparation were still being used. Planting distance ..... concepts, principles and practices. Paper presented at the ...

  19. Improvement for equipment in the practices of basic veterinary medicine

    OpenAIRE

    市原, 伸恒

    2010-01-01

    The practices (veterinary anatomy laboratory, veterinarian physiology laboratory I, veterinarian physiology laboratory II, and veterinarian physiology chemistry laboratory) in the area of basic veterinary medicine are important subjects for acquiring knowledge and the technique by the process of shifting from the liberal arts subject to a specialized subjects for the area of applied veterinary medicine and clinical veterinary medicine. The number of equipment is insufficient to practice effec...

  20. Improving Mathematics Teaching as Deliberate Practice through Chinese Lesson Study

    Science.gov (United States)

    Huang, Rongjin; Prince, Kyle M.; Barlow, Angela T.

    2017-01-01

    This study examined how a ninth grade teacher improved an Algebra I lesson through a lesson study approach. We used multiple data sources to investigate the improvement of the lesson towards student-centered mathematics instruction, perceived benefits of the teacher, and factors associated with the improvement of teaching. The lesson group…

  1. Formal Process Modeling to Improve Human Decision-Making in Test and Evaluation Acoustic Range Control

    Science.gov (United States)

    2017-09-01

    INTRODUCTION The purpose of this chapter is to present problems faced by undersea test ranges in the area of human decision-making and the lack of pre-test...noted that Range Officer training focuses on recognizing and understanding normal and expected conditions for the particular test and on using...These factors place increased burden on the test facility to conduct accurate and successful tests that produce the intended test conditions , which

  2. Improving Delay-Range-Dependent Stability Condition for Systems with Interval Time-Varying Delay

    Directory of Open Access Journals (Sweden)

    Wei Qian

    2013-01-01

    Full Text Available This paper discusses the delay-range-dependent stability for systems with interval time-varying delay. Through defining the new Lyapunov-Krasovskii functional and estimating the derivative of the LKF by introducing new vectors, using free matrices and reciprocally convex approach, the new delay-range-dependent stability conditions are obtained. Two well-known examples are given to illustrate the less conservatism of the proposed theoretical results.

  3. 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.

  4. Nursing clinical handover improvement practices among acute inpatients in a tertiary hospital in Sydney: a best practice implementation project.

    Science.gov (United States)

    Wainwright, Craig; Wright, Kylie M

    2016-10-01

    The nursing handover normally occurs at the beginning of a nurse's shift and is considered essential for continuity of care. Nursing handovers have the potential to communicate accurate information about a patient's condition, treatment and anticipated needs but also to be ineffective or even harmful if information is incomplete or omitted. The Australian Commission on Safety and Quality in Health Care has recognized clinical handover as a National Standard, thus reinforcing its importance. This project aimed to conduct an audit of nursing clinical handover practices to implement evidence-based best practice recommendations to assess the effectiveness of these strategies to maximize the effectiveness of clinical handover across 11 units in a large tertiary hospital. The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in healthcare practice. A baseline audit of 330 observations of nursing clinical handover was conducted and measured against seven best practice recommendations, followed by the implementation of targeted strategies and a follow-up audit. The baseline audit revealed significant deficits between current practice and best practice in all but one criterion. Barriers for implementation of nursing clinical handover best practice criteria were identified by the project team, and a bundled education strategy was implemented. There were significantly improved outcomes across all best practice criteria in the follow-up audit. The findings showed how audits may be used to promote best practice in healthcare and that focused education and provision of relevant resources can have an immediate and positive impact on clinical practice. Some of the measured criteria improved to a moderate degree, leaving room for improvement; however, by the end of the project attitudes toward nursing clinical handover had been "transformed" from a passive routine "must do

  5. Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice

    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

  6. Improve Motor System Efficiency for a Broad Range of Motors with MotorMaster+ International

    Energy Technology Data Exchange (ETDEWEB)

    None

    2005-05-01

    Available at no charge, MotorMaster+ International is designed to support motor systems improvement planning at industrial facilities by identifying the most cost-effective choice when deciding to repair or replace older motor models.

  7. Improved Feature Detection in Fused Intensity-Range Images with Complex SIFT (ℂSIFT

    Directory of Open Access Journals (Sweden)

    Boris Jutzi

    2011-09-01

    Full Text Available The real and imaginary parts are proposed as an alternative to the usual Polar representation of complex-valued images. It is proven that the transformation from Polar to Cartesian representation contributes to decreased mutual information, and hence to greater distinctiveness. The Complex Scale-Invariant Feature Transform (ℂSIFT detects distinctive features in complex-valued images. An evaluation method for estimating the uniformity of feature distributions in complex-valued images derived from intensity-range images is proposed. In order to experimentally evaluate the proposed methodology on intensity-range images, three different kinds of active sensing systems were used: Range Imaging, Laser Scanning, and Structured Light Projection devices (PMD CamCube 2.0, Z+F IMAGER 5003, Microsoft Kinect.

  8. Continuous improvement in the Netherlands: A survey-based study into the current practices of continuous improvement

    NARCIS (Netherlands)

    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

  9. Best practices for improving flow and care of pediatric patients in the emergency department.

    Science.gov (United States)

    Barata, Isabel; Brown, Kathleen M; Fitzmaurice, Laura; Griffin, Elizabeth Stone; Snow, Sally K

    2015-01-01

    This report provides a summary of best practices for improving flow, reducing waiting times, and improving the quality of care of pediatric patients in the emergency department. Copyright © 2015 by the American Academy of Pediatrics.

  10. Improving the Implementation of Evidence-Based Clinical Practices in Adolescent Reproductive Health Care Services.

    Science.gov (United States)

    Romero, Lisa M; Middleton, Dawn; Mueller, Trisha; Avellino, Lia; Hallum-Montes, Rachel

    2015-11-01

    The purposes of the study were to describe baseline data in the implementation of evidence-based clinical practices among health center partners as part of a community-wide teen pregnancy prevention initiative and to identify opportunities for health center improvement. Health center partner baseline data were collected in the first year (2011) and before program implementation of a 5-year community-wide teen pregnancy prevention initiative. A needs assessment on health center capacity and implementation of evidence-based clinical practices was administered with 51 health centers partners in 10 communities in the United States with high rates of teen pregnancy. Health centers reported inconsistent implementation of evidence-based clinical practices in providing reproductive health services to adolescents. Approximately 94.1% offered same-day appointments, 91.1% had infrastructure to reduce cost barriers, 90.2% offered after-school appointments, and 80.4% prescribed hormonal contraception without prerequisite examinations or testing. Approximately three quarters provided visual and audio privacy in examination rooms (76.5%) and counseling areas (74.5%). Fewer offered a wide range of contraceptive methods (67.8%) and took a sexual health history at every visit (54.9%). Only 45.1% reported Quick Start initiation of hormonal contraception, emergency contraception (43.1%), or intrauterine devices (12.5%) were "always" available to adolescents. The assessment highlighted opportunities for health center improvement. Strategies to build capacity of health center partners to implement evidence-based clinical practices may lead to accessibility and quality of reproductive health services for adolescents in the funded communities. Published by Elsevier Inc.

  11. A Long Range Plan for Improving Education and Urban Life in St. Paul Minnesota.

    Science.gov (United States)

    Saint Paul Public Schools, Minn.

    Recommendations for overhauling the educational facilities in St. Paul, Minnesota, envision an overhauling of the structure of the community itself. Of the 200 recommendations made, two stand out. One calls for the establishment of a nerve center for the school system in the downtown area, and the second calls for a long-range (30-year) plan to…

  12. Improving patient safety culture in general practice: an interview study

    NARCIS (Netherlands)

    Verbakel, N.J.; de Bont, A.A.; Verheij, T.J.M.; Wagner, C.; Zwart, D.L.M.

    2015-01-01

    Background When improving patient safety a positive safety culture is key. As little is known about improving patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an intervention for

  13. Improving patient safety culture in general practice: An interview study

    NARCIS (Netherlands)

    N.J. Verbakel (Natasha J.); A.A. de Bont (Antoinette); T.J. Verheij; C. Wagner (Cordula); D.L.M. Zwart (Dorien)

    2015-01-01

    textabstractBackground When improving patient safety a positive safety culture is key. As little is known about improving patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an

  14. evidence-based care: an innovation to improve nursing practice ...

    African Journals Online (AJOL)

    user

    2014-10-13

    Oct 13, 2014 ... Thus, as important as the practice of nursing that is based on evidence could be, there are however contending issues that should be addressed for success to be achieved. As a fairly new concept, Stetler, Brunnel,. Giuliano, Morsi, Prince and Newell-Stokes (2008) asserted that its meaning is not always ...

  15. Clinical Vignettes Improve Performance in Anatomy Practical Assessment

    Science.gov (United States)

    Ikah, December S. K.; Finn, Gabrielle M.; Swamy, Meenakshi; White, Pamela M.; McLachlan, John C.

    2015-01-01

    Although medical curricula now adopt an integrated teaching approach, this is not adequately reflected in assessment of anatomy knowledge and skills. In this study, we aimed to explore the impact of the addition of clinical vignette to item stems on students' performance in anatomy practical examinations. In this study, 129 undergraduate medical…

  16. Regular Football Practice Improves Autonomic Cardiac Function in Male Children

    Science.gov (United States)

    Fernandes, Luis; Oliveira, Jose; Soares-Miranda, Luisa; Rebelo, Antonio; Brito, Joao

    2015-01-01

    Background: The role of the autonomic nervous system (ANS) in the cardiovascular regulation is of primal importance. Since it has been associated with adverse conditions such as cardiac arrhythmias, sudden death, sleep disorders, hypertension and obesity. Objectives: The present study aimed to investigate the impact of recreational football practice on the autonomic cardiac function of male children, as measured by heart rate variability. Patients and Methods: Forty-seven male children aged 9 - 12 years were selected according to their engagement with football oriented practice outside school context. The children were divided into a football group (FG; n = 22) and a control group (CG; n = 25). The FG had regular football practices, with 2 weekly training sessions and occasional weekend matches. The CG was not engaged with any physical activity other than complementary school-based physical education classes. Data from physical activity, physical fitness, and heart rate variability measured in time and frequency domains were obtained. Results: The anthropometric and body composition characteristics were similar in both groups (P > 0.05). The groups were also similar in time spent daily on moderate-to-vigorous physical activities (FG vs. CG: 114 ± 64 vs. 87 ± 55 minutes; P > 0.05). However, the FG performed better (P football practice presented enhanced physical fitness and autonomic function, by increasing vagal tone at rest. PMID:26448848

  17. 78 FR 18954 - Incentives To Adopt Improved Cybersecurity Practices

    Science.gov (United States)

    2013-03-28

    ..., security, business confidentiality, privacy and civil liberties through a partnership with the owners and... receiving government financial guarantees or assistance in relevant sectors? How can liability structures... organizations to conform to a set of principles, guidelines, and operations based on best practices, standards...

  18. Improving Clinical Practices for Children with Language and Learning Disorders

    Science.gov (United States)

    Kamhi, Alan G.

    2014-01-01

    Purpose: This lead article of the Clinical Forum addresses some of the gaps that exist between clinical practice and current knowledge about instructional factors that influence learning and language development. Method: Topics reviewed and discussed include principles of learning, generalization, treatment intensity, processing interventions,…

  19. Use of fluconazole in daily practice: still room for improvement.

    NARCIS (Netherlands)

    Natsch, S.S.; Steeghs, M.H.M.; Hekster, Y.A.; Meis, J.F.G.M.; Meer, J.W.M. van der; Kullberg, B.J.

    2001-01-01

    One hundred courses of fluconazole treatment in a university hospital and 81 courses in a non-university teaching hospital have been analysed in a prospective audit to evaluate prescribing practices. The quality of treatments was assessed by an infectious disease specialist and a pharmacist

  20. Improving clinical practice through simulation: A case study of ...

    African Journals Online (AJOL)

    Acquisition of knowledge and skills by nursing students before real-life practice is a familiar nursing education challenge. The use of clinical simulation in nursing education provides many opportunities for students to learn and apply theoretical principles of nursing care in a safe environment. The purpose of this study was ...

  1. Design in Practice: Scenarios for Improving Management Education

    Science.gov (United States)

    Schlenker, Lee; Chantelot, Sébastien

    2014-01-01

    Despite the increasing attention given to design in business, Design Thinking has had little impact on the quality of business school education. Building upon the foundations of long-standing critiques of management education and the potential for student-centric learning, the authors propose that the use of Design in Practice can significantly…

  2. 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...

  3. The Classroom Manager: Procedures and Practices to Improve Instruction

    Science.gov (United States)

    Houff, Suzanne G.

    2009-01-01

    Using William Glasser's five basic needs as a foundation, "The Classroom Manager" provides a theoretical base to guide readers in the understanding and development of an effective classroom management program. The topics of survival, belonging and love, power, fun, and freedom are explored through definitions, practical recommendations and case…

  4. Using Retrieval Practice and Metacognitive Skills to Improve Content Learning

    Science.gov (United States)

    Littrell-Baez, Megan K.; Friend, Angela; Caccamise, Donna; Okochi, Christine

    2015-01-01

    Classroom tests have been traditionally used to assess student growth and content mastery. However, a wealth of research in cognitive and educational psychology has demonstrated that retrieval practice (testing) as a form of low-stakes, rather than traditional high-stakes testing, can also be used as an effective pedagogical tool, improving…

  5. Heart Failure in Zambia: Evidence for Improving Clinical Practice.

    African Journals Online (AJOL)

    Esem

    Electrocardiography in clinical practice. Arrhythmias and conduction defects are quite common in. HF, the most common being Atrial Fibrillation (AF) which has serious consequences. In the study, 8% of patients had AF and few other arrhythmias are described. The limitations outlines by the authors are appreciated. Indeed ...

  6. A practical manual to assess and improve farm performances

    NARCIS (Netherlands)

    Aarts, H.F.M.; Grignard, A.; Boonen, J.; Haan, de M.; Hennart, S.; Oenema, J.; Lorinquer, E.; Sylvain, F.; Herrmann, K.; Elsaesser, M.; Castellan, E.; Kohnen, H.

    2013-01-01

    The business of a dairy farmer is to supply society with dairy products in a way that provides him sufficient income and satisfaction. But he has to avoid farming practices hampering the rural area to deliver other valuable products, like clean drinking water, biodiversity, and attractive recreation

  7. Improved laser-based triangulation sensor with enhanced range and resolution through adaptive optics-based active beam control.

    Science.gov (United States)

    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.

  8. Improving child health promotion practices in multiple sectors – outcomes of the Swedish Salut Programme

    Directory of Open Access Journals (Sweden)

    Edvardsson Kristina

    2012-10-01

    Full Text Available Abstract Background To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme on professionals’ self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation. Methods A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points. Results Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1 an increase in the extent to which midwives in antenatal care raised issues related to men’s violence against women, 2 an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3 an increased use of motivational interviewing (MI and separate ‘fathers visits’ in child health care 4 improvements in the supply of healthy snacks and beverages in open pre-schools and 5 increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff. Conclusion This multisectoral programme for health promotion, based on sector

  9. Improved superconducting hot-electron bolometer devices for the THz range

    NARCIS (Netherlands)

    Klapwijk, T.M.; Barends, R.; Gao, J.R.; Hajenius, M.; Baselmans, J.J.A.

    2004-01-01

    Improved and reproducible heterodyne mixing (noise temperatures of 950 K at 2.5 THz) has been realized with NbN based hot-electron superconducting devices with low contact resistances. A distributed temperature numerical model of the NbN bridge, based on a local electron and a phonon temperature,

  10. An Improved Method for Including Upper Size Range Plasmids in Metamobilomes

    DEFF Research Database (Denmark)

    Norman, Anders; Riber, Leise; Luo, Wenting

    2014-01-01

    cloning vector (pBR322), and a 56 Kbp conjugative plasmid (pKJK10), to represent lower- and upper plasmid size ranges, respectively. Subjecting a mixture of these plasmids to the overall isolation protocol revealed a 34-fold over-amplification of pBR322 after MDA. To address this bias, we propose...... the addition of an electroelution step that separates different plasmid size ranges prior to MDA in order to reduce size-dependent competition during incubation. Subsequent analyses of metamobilome data from wastewater spiked with the model plasmids showed in silica recovery of pKJK10 to be very poor...... with the established method and a 1,300-fold overrepresentation of pBR322. Conversely, complete recovery of pKJK10 was enabled with the new modified protocol although considerable care must be taken during electroelution to minimize cross-contamination between samples. For further validation, non-spiked wastewater...

  11. Improvement of Transformer Relay Protection Sensitivity with Wide Range of Voltage Control

    Directory of Open Access Journals (Sweden)

    V. V. Kourganov

    2009-01-01

    Full Text Available The paper shows that it is possible to increase a design sensitivity coefficient of the transformer relay protection with voltage switch  ∆UРПН= ±16%  due to application of more precise method for calculation of minimum and maximum short circuit currents beyond  a transformer with intermediate branches of  a load control switch that correspond to an actual voltage variation range in 110 kV networks.

  12. Improving Range Estimation of a 3-Dimensional Flash Ladar via Blind Deconvolution

    Science.gov (United States)

    2010-09-01

    scannerless Multiple-Slit Streak Tube Imaging LiDAR (MS- STIL ), [22] reports on LiDAR tests that demonstrate target imaging through foliage and other...calculated and then compared to produce a range so that each image frame within the data cube corresponds to the same distance. In the spatial domain...transverse 50 shifts between cubes are accomplished by the vector projection method by calculating the global shifts between corresponding frames in each

  13. Fluorescent Protein Based FRET Pairs with Improved Dynamic Range for Fluorescence Lifetime Measurements

    Science.gov (United States)

    George Abraham, Bobin; Sarkisyan, Karen S.; Mishin, Alexander S.; Santala, Ville; Tkachenko, Nikolai V.; Karp, Matti

    2015-01-01

    Fluorescence Resonance Energy Transfer (FRET) using fluorescent protein variants is widely used to study biochemical processes in living cells. FRET detection by fluorescence lifetime measurements is the most direct and robust method to measure FRET. The traditional cyan-yellow fluorescent protein based FRET pairs are getting replaced by green-red fluorescent protein variants. The green-red pair enables excitation at a longer wavelength which reduces cellular autofluorescence and phototoxicity while monitoring FRET. Despite the advances in FRET based sensors, the low FRET efficiency and dynamic range still complicates their use in cell biology and high throughput screening. In this paper, we utilized the higher lifetime of NowGFP and screened red fluorescent protein variants to develop FRET pairs with high dynamic range and FRET efficiency. The FRET variations were analyzed by proteolytic activity and detected by steady-state and time-resolved measurements. Based on the results, NowGFP-tdTomato and NowGFP-mRuby2 have shown high potentials as FRET pairs with large fluorescence lifetime dynamic range. The in vitro measurements revealed that the NowGFP-tdTomato has the highest Förster radius for any fluorescent protein based FRET pairs yet used in biological studies. The developed FRET pairs will be useful for designing FRET based sensors and studies employing Fluorescence Lifetime Imaging Microscopy (FLIM). PMID:26237400

  14. Fluorescent Protein Based FRET Pairs with Improved Dynamic Range for Fluorescence Lifetime Measurements.

    Directory of Open Access Journals (Sweden)

    Bobin George Abraham

    Full Text Available Fluorescence Resonance Energy Transfer (FRET using fluorescent protein variants is widely used to study biochemical processes in living cells. FRET detection by fluorescence lifetime measurements is the most direct and robust method to measure FRET. The traditional cyan-yellow fluorescent protein based FRET pairs are getting replaced by green-red fluorescent protein variants. The green-red pair enables excitation at a longer wavelength which reduces cellular autofluorescence and phototoxicity while monitoring FRET. Despite the advances in FRET based sensors, the low FRET efficiency and dynamic range still complicates their use in cell biology and high throughput screening. In this paper, we utilized the higher lifetime of NowGFP and screened red fluorescent protein variants to develop FRET pairs with high dynamic range and FRET efficiency. The FRET variations were analyzed by proteolytic activity and detected by steady-state and time-resolved measurements. Based on the results, NowGFP-tdTomato and NowGFP-mRuby2 have shown high potentials as FRET pairs with large fluorescence lifetime dynamic range. The in vitro measurements revealed that the NowGFP-tdTomato has the highest Förster radius for any fluorescent protein based FRET pairs yet used in biological studies. The developed FRET pairs will be useful for designing FRET based sensors and studies employing Fluorescence Lifetime Imaging Microscopy (FLIM.

  15. Fluorescent Protein Based FRET Pairs with Improved Dynamic Range for Fluorescence Lifetime Measurements.

    Science.gov (United States)

    George Abraham, Bobin; Sarkisyan, Karen S; Mishin, Alexander S; Santala, Ville; Tkachenko, Nikolai V; Karp, Matti

    2015-01-01

    Fluorescence Resonance Energy Transfer (FRET) using fluorescent protein variants is widely used to study biochemical processes in living cells. FRET detection by fluorescence lifetime measurements is the most direct and robust method to measure FRET. The traditional cyan-yellow fluorescent protein based FRET pairs are getting replaced by green-red fluorescent protein variants. The green-red pair enables excitation at a longer wavelength which reduces cellular autofluorescence and phototoxicity while monitoring FRET. Despite the advances in FRET based sensors, the low FRET efficiency and dynamic range still complicates their use in cell biology and high throughput screening. In this paper, we utilized the higher lifetime of NowGFP and screened red fluorescent protein variants to develop FRET pairs with high dynamic range and FRET efficiency. The FRET variations were analyzed by proteolytic activity and detected by steady-state and time-resolved measurements. Based on the results, NowGFP-tdTomato and NowGFP-mRuby2 have shown high potentials as FRET pairs with large fluorescence lifetime dynamic range. The in vitro measurements revealed that the NowGFP-tdTomato has the highest Förster radius for any fluorescent protein based FRET pairs yet used in biological studies. The developed FRET pairs will be useful for designing FRET based sensors and studies employing Fluorescence Lifetime Imaging Microscopy (FLIM).

  16. adoption of improved aquaculture practices by shrimp farmers in ...

    African Journals Online (AJOL)

    Dr.Adesope

    Development Programme (DTADP) provides extension services to farmers in all the ... Agricultural extension is a service or system which assists farm people through educational procedures, improve farming methods and techniques, increase ... with extension services, agricultural support and rural development services.

  17. Improving patient safety and healthcare quality: examples of good practice.

    Science.gov (United States)

    Tingle, John

    2017-07-27

    John Tingle, Reader in Health Law at Nottingham Trent University, discusses a recent report by the Care Quality Commission that showcases eight NHS trusts that have improved their patient safety and healthcare quality.

  18. Business intelligence: using insight to improve the value and performance of your practice.

    Science.gov (United States)

    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.

  19. Effect of a single-session meditation training to reduce stress and improve quality of life among health care professionals: a "dose-ranging" feasibility study.

    Science.gov (United States)

    Prasad, Kavita; Wahner-Roedler, Dietlind L; Cha, Stephen S; Sood, Amit

    2011-01-01

    The primary aim of the study was to assess the feasibility of incorporating a single-session meditation-training program into the daily activities of healthy employees of a tertiary-care academic medical center. The study also assessed the most preferred duration of meditation and the effect of the meditation program on perceived stress, anxiety, and overall quality of life (QOL). Seventeen healthy clinic employees were recruited for this study. After an initial group instruction session covering basic information about meditation, Paced Breathing Meditation (PBM) was taught to the participants. Participants were instructed to self-practice meditation with the help of a DVD daily for a total of 4 weeks. The DVD had three different programs of 5, 15, and 30 minutes with a menu option to choose one of the programs. (1) Patient diary, (2) Perceived Stress Scale (PSS), (3) Linear Analogue Self-Assessment (LASA), (4) Smith Anxiety Scale (SAS). Primary outcome measures were compared using the paired t-test. All participants were female; median age was 48 years (range 33-60 y). The 5-minute meditation session was practiced by 14 participants a total of 137 times during the 4-week trial period, the 15-minute session by 16 participants a total of 223 times, and the 30-minute session by 13 participants 71 times. The median number of days practiced was 25 (range 10-28 d); the average total time practiced was 394 minutes (range 55-850 min). After 4 weeks of practice, the scores of the following instruments improved significantly from baseline: PSS (P stress, anxiety, and QOL.

  20. School policies and practices that improve indoor air quality.

    Science.gov (United States)

    Everett Jones, Sherry; Smith, Alisa M; Wheeler, Lani S; McManus, Tim

    2010-06-01

    To determine whether schools with a formal indoor air quality management program were more likely than schools without a formal program to have policies and practices that promote superior indoor air quality. This study analyzed school-level data from the 2006 School Health Policies and Programs Study, a national study of school health programs and policies at the state, district, and school levels. Using chi-square analyses, the rates of policies and practices that promote indoor air quality were compared between schools with and schools without a formal indoor air quality program. The findings of this study show that 51.4% of schools had a formal indoor air quality management program, and that those schools were significantly more likely than were schools without a program to have policies and use strategies to promote superior indoor air quality. These findings suggest that schools with a formal indoor air quality program are more likely support policies and engage in practices that promote superior indoor air quality.

  1. Comparing self-reported optometric dry eye clinical practices in Australia and the United Kingdom: is there scope for practice improvement?

    Science.gov (United States)

    Downie, Laura E; Rumney, Nicholas; Gad, Anne; Keller, Peter R; Purslow, Christine; Vingrys, Algis J

    2016-03-01

    The aim of this study was to compare the self-reported clinical practice behaviours of optometrists in Australia and the United Kingdom (UK) with respect to the diagnosis and management of dry eye disease (DED). We also sought to examine whether the reported practices of clinicians in each region were consistent with current evidence-based recommendations for DED. An online survey was distributed to optometrists (Australia, n = 654; UK, n = 1006). Respondents provided information about practice modality, years of optometric experience, preferred diagnostic and management strategies (stratified by DED severity) and the information/evidence base used to guide patient care. A total of 317 completed surveys were received (response rates, Australia: 21%, UK: 17%). Optometrists in both regions demonstrated similarly strong knowledge of tear film assessment and adopted both subjective and objective techniques to diagnose DED. Patient symptoms were considered the most important, valuable and commonly performed assessment by both Australian and UK respondents. UK practitioners valued and utilised conjunctival signs and tear meniscus height assessments more than Australian optometrists (p practices was continuing education conferences. This study highlights a range of parallels and divergences in dry eye clinical practice between Australian and UK optometrists. Our data identify both areas of strength in the adoption of evidence-based practice, as well as some potential to improve international translation of dry eye research evidence into practice. © 2016 The Authors Ophthalmic & Physiological Optics © 2016 The College of Optometrists.

  2. Practical recommendations for improvement of the physical health care of patients with severe mental illness.

    Science.gov (United States)

    van Hasselt, F M; Oud, M J T; Loonen, A J M

    2015-05-01

    Health care for the physical health of patients with severe mental illness (SMI) needs to be improved. Therefore, we aimed to develop policy recommendations to improve this physical health care in the Netherlands based on consensus (general agreement) between the major stakeholders. A modified Delphi was used to explore barriers and subsequently establish policy recommendations with all key stakeholders. Consensus was sought between patients with SMI, their family carers, general practitioners, and mental healthcare professionals--all experts in the everyday practice of health care. Consensus was reached on policy recommendations regarding (i) improvements in collaboration between healthcare professionals, (ii) the need for professional education on the specific medical risks of patients with SMI, and (iii) the distinguished responsibilities of general practitioners on the one hand and mental healthcare professionals on the other hand in taking care of patients' physical health. This article provides a range of policy recommendations that could lead to considerable improvements in the physical health of SMI patients. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. The muscular flexibility training and the range of movement improvement: a critical literature review

    Directory of Open Access Journals (Sweden)

    L.F. Coelho

    2008-01-01

    Full Text Available The muscular flexibility training put in evidence a train of neurophysiological principals and an intricate amount of muscular and viscous-elastic properties. There are a lot of stretching methods, used on the clinical and sport contexts. Despite its common utilization, it isn’t usual the health and educational professionals reflect about the compounds and efficacy of the diverse stretching methods. In this article, we realize a critical review about the diverse methods used on the flexibility training, as the principles and parameters related with that. We will done special emphasis to the principles of the proprioceptive neuromuscular facilitation and the diverse local relaxation methods, like warming. We will also have in count the revealing data relating to the Elasticity Coefficient paradox, witch can help to conceive an intervention philosophy of the flexibility training different from what it have being defended and practiced.

  4. The muscular flexibility training and the range of movement improvement: a critical literature review

    Directory of Open Access Journals (Sweden)

    Luís Filipe dos Santos Coelho

    2007-12-01

    Full Text Available The muscular flexibility training put in evidence a train of neurophysiological principals and an intricate amount of muscular and viscous-elastic properties. There are a lot of stretching methods, used on the clinical and sport contexts. Despite its common utilization, it isn’t usual the health and educational professionals reflect about the compounds and efficacy of the diverse stretching methods. In this article, we realize a critical review about the diverse methods used on the flexibility training, as the principles and parameters related with that. We will done special emphasis to the principles of the proprioceptive neuromuscular facilitation and the diverse local relaxation methods, like warming. We will also have in count the revealing data relating to the Elasticity Coefficient paradox, witch can help to conceive an intervention philosophy of the flexibility training different from what it have being defended and practiced.

  5. The muscular flexibility training and the range of movement improvement: A critical literature review

    Directory of Open Access Journals (Sweden)

    Luís Filipe dos Santos Coelho

    2008-12-01

    Full Text Available The muscular flexibility training put in evidence a train of neurophysiological principals and an intricate amount of muscular and viscous-elastic properties. There are a lot of stretching methods, used on the clinical and sport contexts. Despite its common utilization, it isn’t usual the health and educational professionals reflect about the compounds and efficacy of the diverse stretching methods. In this article, we realize a critical review about the diverse methods used on the flexibility training, as the principles and parameters related with that. We will done special emphasis tothe principles of the proprioceptive- neuromuscular facilitation and the diverse local relaxation methods, like warming. We will also have incount the revealing data relating tothe Elasticity Coefficient paradox, which can help to conceive an intervention philosophy of the flexibility training different from what it have being defended and practiced.

  6. Integrating Safe Sleep Practices into a Pediatric Hospital: Outcomes of a Quality Improvement Project.

    Science.gov (United States)

    Rowe, Angela D; Sisterhen, Laura L; Mallard, Ellen; Borecky, Betsy; Schmid, Barbara; Rettiganti, Mallikarjuna; Luo, Chunqiao

    2016-01-01

    A quality improvement project for implementing safe sleep practices (SSP) was conducted at a large, U.S children's hospital. The intervention involved education of staff and standardization of infant sleep practices utilizing a multifaceted approach. Staff surveys and environmental audits were conducted pre- and post-intervention. Safe Sleep Environment (SSE) audits showed an improvement from 23% to 34% (phospital setting. Infant safe sleep practices have the potential to reduce infant mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Improving reliability of clinical care practices for ventilated patients in the context of a patient safety improvement initiative.

    Science.gov (United States)

    Pinto, Anna; Burnett, Susan; Benn, Jonathan; Brett, Stephen; Parand, Anam; Iskander, Sandra; Vincent, Charles

    2011-02-01

    To investigate perceived factors relating to the reliable application of four clinical care practices targeting ventilator-associated pneumonias, in the context of a patient safety improvement initiative called the Safer Patients Initiative (SPI). Qualitative case study. Seventeen semi-structured individual interviews with clinical operational leads, programme coordinators and executive managers who were involved in the implementation of the programme's critical care work stream during its pilot phase. The interviews had a focus on perceived aspects pertaining to the reliable implementation of the four clinical practices, promoted by the Institute for Healthcare Improvement as the 'ventilator care bundle'. Thematic analysis of the verbatim transcripts revealed three overarching themes experienced by the participants during the implementation of the clinical practices included in the SPI ventilator care bundle: the power of measurement, feedback to peers and experts and improvement tools specific to SPI. Consistent measurement of compliance with the four elements of the bundle and outcomes made the staff realize that their engagement in previous improvement work for ventilated patients was inadequate and motivated them to apply the introduced clinical practices more reliably. Feedback to experts and peers of staff compliance with the four clinical practices and outcome improvement was perceived as a very influential aspect of SPI. Small tests of change (Plan-Do-Study-Act cycles), teaching sessions and daily goal sheets were quoted as particularly useful tools throughout the implementation of the four clinical care practices. Future initiatives that aim to improve the adherence of clinical staff with clinical practice guidelines in intensive care units could benefit from integrating in their methodology consistent measurement and feedback practices of both process compliance and outcome data. © 2010 Blackwell Publishing Ltd.

  8. An Improved Correction for Range Restricted Correlations Under Extreme, Monotonic Quadratic Nonlinearity and Heteroscedasticity.

    Science.gov (United States)

    Culpepper, Steven Andrew

    2016-06-01

    Standardized tests are frequently used for selection decisions, and the validation of test scores remains an important area of research. This paper builds upon prior literature about the effect of nonlinearity and heteroscedasticity on the accuracy of standard formulas for correcting correlations in restricted samples. Existing formulas for direct range restriction require three assumptions: (1) the criterion variable is missing at random; (2) a linear relationship between independent and dependent variables; and (3) constant error variance or homoscedasticity. The results in this paper demonstrate that the standard approach for correcting restricted correlations is severely biased in cases of extreme monotone quadratic nonlinearity and heteroscedasticity. This paper offers at least three significant contributions to the existing literature. First, a method from the econometrics literature is adapted to provide more accurate estimates of unrestricted correlations. Second, derivations establish bounds on the degree of bias attributed to quadratic functions under the assumption of a monotonic relationship between test scores and criterion measurements. New results are presented on the bias associated with using the standard range restriction correction formula, and the results show that the standard correction formula yields estimates of unrestricted correlations that deviate by as much as 0.2 for high to moderate selectivity. Third, Monte Carlo simulation results demonstrate that the new procedure for correcting restricted correlations provides more accurate estimates in the presence of quadratic and heteroscedastic test score and criterion relationships.

  9. Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

    OpenAIRE

    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 ...

  10. Personal informatics in practice: Improving quality of life through data

    DEFF Research Database (Denmark)

    Li, Ian; Medynskiy, Yevgeniy; Froehlich, Jon

    2012-01-01

    Personal informatics refers to a class of software and hardware systems that help individuals collect personal information to improve self-understanding. Improving self-understanding can foster self-insight and promote positive behaviors: healthy living, energy conservation, etc. The development...... of personal informatics applications poses new challenges for human-computer interaction and creates opportunities for applications in various domains related to quality of life, such as fitness, nutrition, wellness, mental health, and sustainability. This workshop will continue the conversations from the CHI...

  11. Soft Tissue Mobilization and PNF Improve Range of Motion and Minimize Pain Level in Shoulder Impingement.

    Science.gov (United States)

    Al Dajah, Salameh Bweir

    2014-11-01

    [Purpose] The aim of this study was to evaluate the effects of soft tissue mobilization and PNF on pain level, and shoulder ROM in patients with shoulder impingement syndrome. [Subjects and Methods] Thirty patients with painful and limited glenohumeral ROM activities were selected. The subjects were randomly assigned to an experimental group (n=15), which received treatment consisting of soft tissues mobilization and the PNF technique. The control group received an ultrasound treatment. Pain level, glenohumeral external rotation and overhead reach were measured before and after the intervention in groups. [Results] The experimental group showed a significant reduction in pain level in comparison with the control group. The values for Shoulder external rotation showed a significant improvement. The mean value for overhead reach in the experimental group significantly increased. [Conclusion] The combination of soft tissue mobilization for the subscapularis for 7 minutes and 5 repetitions of the contract-relax PNF technique for the shoulder internal rotator muscles followed by 5 repetitions of a PNF facilitated abduction and external rotation diagonal pattern was found to be effective in reducing pain and improving glenohumeral external rotation and overhead reach during a single intervention session.

  12. Principals' Participation Levels in Best Practices for School Improvement

    Science.gov (United States)

    Stogdill, Christopher T.

    2010-01-01

    The purpose of this study was to identify Nebraska principal perceptions regarding the level of participation the AdvancED school improvement process. Further, the study identified differences among principals' knowledge, based on demographic characteristics of years of experience, size of school enrollments, and formal training in school…

  13. Nairobi solid waste management practices: Need for improved ...

    African Journals Online (AJOL)

    The paper argues for the need to have strong publicprivate partnership, community participation and capacity building to enhance effective awareness building, waste source separation and recycling as strategies for an improved waste management system. Keywords: Waste generation, public-private partnership, ...

  14. adoption of improved aquaculture practices by shrimp farmers in ...

    African Journals Online (AJOL)

    Dr.Adesope

    be made to massively multiply improved cassava stems and effectively distribute at affordable prices to increase utilization of the .... Primary school. 14. 34. Secondary school. 15. 37. Tertiary. 11. 29. Educational status of the respondents was relatively low considering the strategic position they occupy in technology transfer.

  15. Improving health worker performance : in search of promising practices

    NARCIS (Netherlands)

    Dieleman, M.A.; Harnmeijer, JW

    2006-01-01

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

  16. adoption of improved aquaculture practices by shrimp farmers in ...

    African Journals Online (AJOL)

    Dr.Adesope

    ABSTRACT. Crop production in the Sahel is limited by nutrients availability. The study aimed to estimate the contribution of avifauna, crop rotation and trees to soil fertility and crop production improvement. Pot experiment was carried out with soils sampled in Faidherbia albida parklands in cotton production zone of West ...

  17. adoption of improved aquaculture practices by shrimp farmers

    African Journals Online (AJOL)

    Dr.Adesope

    ABSTRACT. Improved production technologies of sweet potato were jointly developed by International. Institute of Tropical Agriculture (IITA) Ibadan and National Root Crops Research Institute. (NRCRI) Umudike to eliminate constraints associated with farmers' use of local production technologies. Several years after ...

  18. Driving Performance Improvements by Integrating Competencies with Human Resource Practices

    Science.gov (United States)

    Lee, Jin Gu; Park, Yongho; Yang, Gi Hun

    2010-01-01

    This study explores the issues in the development and application of a competency model and provides implications for more precise integration of competencies into human resource (HR) functions driving performance improvement. This research is based on a case study from a Korean consumer corporation. This study employed document reviews,…

  19. Home-based practices of complementary foods improvement are ...

    African Journals Online (AJOL)

    Items related to the early and current breastfeeding patterns and the mode of complementary feeding were recorded by interview of the mothers. Fortified cereals were defined as home-based improved flours by mixing “soumbala,” fishmeal, toasted groundnut, or several of these local foods with cereal. Soumbala is a ...

  20. Adapting Job Analysis Methodology to Improve Evaluation Practice

    Science.gov (United States)

    Jenkins, Susan M.; Curtin, Patrick

    2006-01-01

    This article describes how job analysis, a method commonly used in personnel research and organizational psychology, provides a systematic method for documenting program staffing and service delivery that can improve evaluators' knowledge about program operations. Job analysis data can be used to increase evaluators' insight into how staffs…

  1. The challenges of improving statistical practice in alcohol treatment research.

    Science.gov (United States)

    Harris, Alex H S; Boden, Matthew T; Finlay, Andrea K; Rubinsky, Anna D

    2013-12-01

    This commentary discusses the paper by Hallgren and Witkiewitz (2013) which evaluated 5 methods for addressing missing data in clinical trials of interventions for alcohol use disorders. The authors conclude that commonly used methods (e.g., complete case analysis, single imputation methods) can produce misleading results and that better alternatives exist (e.g., multiple imputation [MI]). The problems of using inferior approaches are well-known and well-illustrated by the analysis in this paper, which serves as an educational reminder to use more statistically justified practices. Findings of this paper are put in context of the broader statistical literature. Strategies to promote common usage of superior missing data methods are discussed. Solving the poor uptake of statistically justified missing data methods will require a multilevel diagnosis of the problem and likely a multifaceted response, perhaps including the establishment, publication, and enforcement of standards by scientific funding and regulatory agencies, scientific journals, and graduate program accreditation bodies. Little disagreement exists regarding the importance of addressing missing data in a statistically justified manner (e.g., with MI or other maximum likelihood methods). However, as with the implementation of other evidence-based practices, knowing what should be done does not alone make it happen. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

  2. Improving Short-Range Ensemble Kalman Storm Surge Forecasting Using Robust Adaptive Inflation

    KAUST Repository

    Altaf, Muhammad

    2013-08-01

    This paper presents a robust ensemble filtering methodology for storm surge forecasting based on the singular evolutive interpolated Kalman (SEIK) filter, which has been implemented in the framework of the H∞ filter. By design, an H∞ filter is more robust than the common Kalman filter in the sense that the estimation error in the H∞ filter has, in general, a finite growth rate with respect to the uncertainties in assimilation. The computational hydrodynamical model used in this study is the Advanced Circulation (ADCIRC) model. The authors assimilate data obtained from Hurricanes Katrina and Ike as test cases. The results clearly show that the H∞-based SEIK filter provides more accurate short-range forecasts of storm surge compared to recently reported data assimilation results resulting from the standard SEIK filter.

  3. Practice of contemporary dance improves cognitive flexibility in aging.

    Science.gov (United States)

    Coubard, Olivier A; Duretz, Stéphanie; Lefebvre, Virginie; Lapalus, Pauline; Ferrufino, Lena

    2011-01-01

    As society ages and frequency of dementia increases exponentially, counteracting cognitive aging decline is a challenging issue for countries of the developed world. Previous studies have suggested that physical fitness based on cardiovascular and strength training helps to improve attentional control in normal aging. However, how motor activity based on motor-skill learning can also benefit attentional control with age has been hitherto a neglected issue. This study examined the impact of contemporary dance (CD) improvisation on attentional control of older adults, as compared to two other motor training programs, fall prevention and Tai Chi Chuan. Participants performed setting, suppressing, and switching attention tasks before and after 5.7-month training in either CD or fall prevention or Tai Chi Chuan. Results indicated that CD improved switching but not setting or suppressing attention. In contrast, neither fall prevention nor Tai Chi Chuan showed any effect. We suggest that CD improvisation works as a training for change, inducing plasticity in flexible attention.

  4. Improving family-centered care practices in the NICU.

    Science.gov (United States)

    Lee, Laurie A; Carter, Melondie; Stevenson, Sharon B; Harrison, H Allen

    2014-01-01

    Family presence and participation in care in the NICU is fundamental to the recovery and well-being of the sick neonate and family. However, some NICU visitation policies are not supportive of families. A new visitor-management program was initiated at a local hospital. The program included open visitation for parents and others chosen by parents to be a support during their hospital stay. This quality-improvement project evaluated if there was any improvement in parents' perceptions and experiences of family-centered care after the implementation of the new visitor-management program. The NICU parent survey data revealed a modest positive difference in parent responses after the implementation of the program.

  5. REVIEW: Instructional Design For Teachers: Improving Classroom Practice

    OpenAIRE

    AKBULUT, Reviewed By Yavuz

    2011-01-01

    The key to successful learning in most formal instructional settings is effective instructional design (ID). Instructional design for teachers serves as an organized source of directions, which can help classroom teachers to integrate available resources to improve students’ acquisition of the instructional goals. The book is consisted of 151 pages (+xvii) covering eight chapters which address a commonsense model of instructional design to guide K-12 teachers during their unique instructional...

  6. Improving adherence to hand hygiene practice: a multidisciplinary approach.

    OpenAIRE

    Pittet, D.

    2001-01-01

    Hand hygiene prevents cross-infection in hospitals, but health-care workers' adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol- based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates. This article reviews barriers to appropriate han...

  7. Whole practice productivity applies 'big picture' solution to performance improvement.

    Science.gov (United States)

    2003-12-01

    When health care organizations look at improving productivity, they typically focus on a few specific measures--work RVUs, office visits per day, or gross charges per physician, for instance--in which they've identified variations among physicians or clinics. Instead of relying strictly on the collection of a handful of isolated data points, two consultants affiliated with the Medical Group Management Association are trying to convince provider groups to become more efficient by looking at the bigger picture.

  8. Utilizing multiple state variables to improve the dynamic range of analog switching in a memristor

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, YeonJoo; Kim, Sungho; Lu, Wei D., E-mail: wluee@eecs.umich.edu [Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, 48109 (United States)

    2015-10-26

    Memristors and memristive systems have been extensively studied for data storage and computing applications such as neuromorphic systems. To act as synapses in neuromorphic systems, the memristor needs to exhibit analog resistive switching (RS) behavior with incremental conductance change. In this study, we show that the dynamic range of the analog RS behavior can be significantly enhanced in a tantalum-oxide-based memristor. By controlling different state variables enabled by different physical effects during the RS process, the gradual filament expansion stage can be selectively enhanced without strongly affecting the abrupt filament length growth stage. Detailed physics-based modeling further verified the observed experimental effects and revealed the roles of oxygen vacancy drift and diffusion processes, and how the diffusion process can be selectively enhanced during the filament expansion stage. These findings lead to more desirable and reliable memristor behaviors for analog computing applications. Additionally, the ability to selectively control different internal physical processes demonstrated in the current study provides guidance for continued device optimization of memristor devices in general.

  9. Quality improvement in small office settings: an examination of successful practices

    Directory of Open Access Journals (Sweden)

    Sofaer Shoshanna

    2009-02-01

    Full Text Available Abstract Background Physicians in small to moderate primary care practices in the United States (U.S. ( Methods We undertook a qualitative study, based on semi-structured, open-ended interviews conducted with practices (N = 39 that used performance data to drive quality improvement activities. Results Physicians indicated that benefits to performing measurement and QI included greater practice efficiency, patient and staff retention, and higher staff and clinician satisfaction with practice. Internal facilitators included the designation of a practice champion, cooperation of other physicians and staff, and the involvement of practice leaders. Time constraints, cost of activities, problems with information management and or technology, lack of motivated staff, and a lack of financial incentives were commonly reported as barriers. Conclusion These findings shed light on how physicians engage in quality improvement activities, and may help raise awareness of and aid in the implementation of future initiatives in small practices more generally.

  10. Yoga Practice Improves Physiological and Biochemical Status at High Altitudes: A Prospective Case-control Study.

    Science.gov (United States)

    Himashree, Gidugu; Mohan, Latika; Singh, Yogesh

    2016-09-01

    Context • High altitude (HA) is a psychophysiological stressor for natives of lower altitudes. Reducing the morbidity and optimizing the performance of individuals deployed in an HA region has been attempted and reported with varied results. Objective • The present study intended to explore the effects of comprehensive yogic practices on the health and performance of Indian soldiers deployed at HAs. Design • The research team designed a prospective, randomized, case-control study. The study was done at Karu, Leh, India, at an altitude of 3445 m. Participants • Fully acclimatized soldiers in the Indian army were randomly selected from those posted to HA regions (ie, altitudes >3000 m). Intervention • The soldiers were divided into 2 groups of equal size. The first group, the control group, carried out the routine activities for physical training in the Indian army. The second group, the intervention group practiced a comprehensive yoga package, including physical asanas, pranayama, and meditation, and did not perform the physical training that the first group did. Both groups were monitored during their activities. Outcome Measures • A wide and comprehensive range of anthropometrical, physiological, biochemical, and psychological parameters were measured: (1) height and weight; (2) body fat percentage (BFP); (3) heart rate (HR); (4) respiratory rate (RR); (5) systolic and diastolic blood pressure (DPB); (6) peripheral saturation of oxygen; (7) end tidal CO2 (EtCO2); (8) chest expansion; (9) pulmonary function; (10) physical work capacity (VO2Max); (11) hematological variables; (12) lipid profile; (13) serum urea; (14) creatinine; (15) liver enzymes; (16) blood glucose; and (17) anxiety scores. Measurements were made at baseline and postintervention. Results • Two-hundred soldiers took part in the study. The yoga group showed a significant improvement in health indices and performance as compared with the control group. They had lower weights, BFPs, RRs

  11. Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting.

    Science.gov (United States)

    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.

  12. Building Self-Control Strength: Practicing Self-Control Leads to Improved Self-Control Performance

    OpenAIRE

    Muraven, Mark

    2010-01-01

    Self-control performance may be improved by the regular practice of small acts of self-control. Ninety-two adults’ self-control capacity was assessed using the stop signal paradigm before they started practicing self-control and again at the end of two weeks. Participants who practiced self-control by cutting back on sweets or squeezing a handgrip exhibited significant improvement in stop signal performance relative to those who practiced tasks that did not require self-control. Participants ...

  13. Haemovigilance: an effective tool for improving transfusion practice.

    Science.gov (United States)

    de Vries, R R P; Faber, J-C; Strengers, P F W

    2011-01-01

    Haemovigilance is a tool to improve the quality of the blood transfusion chain, primarily focusing on safety. In this review we discuss the history and present state of this relatively new branch of transfusion medicine as well as some developments that we foresee in the near future. The top 10 results and conclusions are: (1) Haemovigilance systems have shown that blood transfusion is relatively safe compared with the use of medicinal drugs and that at least in Europe blood components have reached a high safety standard. (2) The majority of the serious adverse reactions and events occur in the hospital. (3) The majority of preventable adverse reactions are due to clerical errors. (4) Some adverse reactions such as anaphylactic reactions often are not avoidable and therefore have to be considered as an inherent risk of blood transfusion. (5) Well-functioning haemovigilance systems have not only indicated how safety should be improved, but also documented the success of various measures. (6) The type of organisation of a haemovigilance system is of relative value, and different systems may have the same outcome. (7) International collaboration has been extremely useful. (8) Haemovigilance systems may be used for the vigilance and surveillance of alternatives for allogeneic blood transfusion such as cell savers. (9) Haemovigilance systems and officers may be used to improve the quality of aspects of blood transfusion other than safety, such as appropriate use. (10) Haemovigilance systems will be of benefit also for vigilance and surveillance of the treatment with other human products such as cells, tissues and organs. © 2010 The Author(s). Vox Sanguinis © 2010 International Society of Blood Transfusion.

  14. Improving risk management: from lame excuses to principled practice.

    Science.gov (United States)

    Paté-Cornell, Elisabeth; Cox, Louis Anthony

    2014-07-01

    The three classic pillars of risk analysis are risk assessment (how big is the risk and how sure can we be?), risk management (what shall we do about it?), and risk communication (what shall we say about it, to whom, when, and how?). We propose two complements as important parts of these three bases: risk attribution (who or what addressable conditions actually caused an accident or loss?) and learning from experience about risk reduction (what works, and how well?). Failures in complex systems usually evoke blame, often with insufficient attention to root causes of failure, including some aspects of the situation, design decisions, or social norms and culture. Focusing on blame, however, can inhibit effective learning, instead eliciting excuses to deflect attention and perceived culpability. Productive understanding of what went wrong, and how to do better, thus requires moving past recrimination and excuses. This article identifies common blame-shifting "lame excuses" for poor risk management. These generally contribute little to effective improvements and may leave real risks and preventable causes unaddressed. We propose principles from risk and decision sciences and organizational design to improve results. These start with organizational leadership. More specifically, they include: deliberate testing and learning-especially from near-misses and accident precursors; careful causal analysis of accidents; risk quantification; candid expression of uncertainties about costs and benefits of risk-reduction options; optimization of tradeoffs between gathering additional information and immediate action; promotion of safety culture; and mindful allocation of people, responsibilities, and resources to reduce risks. We propose that these principles provide sound foundations for improving successful risk management. © 2014 Society for Risk Analysis.

  15. Implementation of renal key performance indicators: promoting improved clinical practice.

    Science.gov (United States)

    Toussaint, Nigel D; McMahon, Lawrence P; Dowling, Gregory; Soding, Jenny; Safe, Maria; Knight, Richard; Fair, Kathleen; Linehan, Leanne; Walker, Rowan G; Power, David A

    2015-03-01

    In the Australian state of Victoria, the Renal Health Clinical Network (RHCN) of the Department of Health Victoria established a Renal Key Performance Indicator (KPI) Working Group in 2011. The group developed four KPIs related to chronic kidney disease and dialysis. A transplant working group of the RHCN developed two additional KPIs. The aim was to develop clinical indicators to measure performance of renal services to drive service improvement. A data collection and benchmarking programme was established, with data provided monthly to the Department using a purpose-designed website portal. The KPI Working Group is responsible for analysing data each quarter and ensuring indicators remain accurate and relevant. Each indicator has clear definitions and targets, and assess (i) patient education, (ii) timely creation of vascular access for haemodialysis, (iii) proportion of patients dialysing at home, (iv) incidence of dialysis-related peritonitis, (v) incidence of pre-emptive renal transplantation, and (vi) timely listing of patients for deceased donor transplantation. Most KPIs have demonstrated improved performance over time with limited gains notably in two: the proportion of patients dialysing at home (KPI 3) and timely listing patients for transplantation (KPI 6). KPI implementation has been established in Victoria for 2 years, providing performance data without additional funding. The six Victorian KPIs are measurable, relevant and modifiable, and implementation relies on enthusiasm and goodwill of physicians and nurses involved in collecting data. The KPIs require further evaluation, but adoption of a similar programme by other jurisdictions could lead to improved national outcomes. © 2014 Asian Pacific Society of Nephrology.

  16. Improving statistical reasoning theoretical models and practical implications

    CERN Document Server

    Sedlmeier, Peter

    1999-01-01

    This book focuses on how statistical reasoning works and on training programs that can exploit people''s natural cognitive capabilities to improve their statistical reasoning. Training programs that take into account findings from evolutionary psychology and instructional theory are shown to have substantially larger effects that are more stable over time than previous training regimens. The theoretical implications are traced in a neural network model of human performance on statistical reasoning problems. This book apppeals to judgment and decision making researchers and other cognitive scientists, as well as to teachers of statistics and probabilistic reasoning.

  17. Learning leadership skills in practice through quality improvement.

    Science.gov (United States)

    Gamble, James; Vaux, Emma

    2014-02-01

    The development of leadership skills in doctors in training is essential to support both their professional development and the future supply of clinical leaders the NHS so desperately needs. There is, however, limited opportunity in current training programmes for trainees to learn and develop these skills, and what opportunity there is has often focused on management rather than leadership skills. Involvement in trainee-led supported quality improvement projects can teach these skills. We summarise the current limitations in leadership training and discuss how the College's 'Learning To Make a Difference' programme, and others like it, are helping to teach leadership.

  18. Application of quality-improvement methods in a community practice: the Sandhills Pediatrics Asthma Initiative.

    Science.gov (United States)

    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

  19. Practice of contemporary dance improves cognitive flexibility in aging

    Directory of Open Access Journals (Sweden)

    Olivier A. Coubard

    2011-09-01

    Full Text Available As society ages and frequency of dementia increases exponentially, counteracting cognitive aging decline is a challenging issue for countries of the developed world. Previous studies have suggested that physical fitness based on cardiovascular and strength training helps to improve attentional control in normal aging. However, how motor activity based on motor-skill learning can also benefit attentional control with age has been hitherto a neglected issue. This study examined the impact of contemporary dance (CD improvisation on attentional control of older adults, as compared to two other motor training programs, fall prevention and Tai Chi Chuan. Participants performed setting, suppressing, and switching attention tasks before and after 5.7-month training in either CD or fall prevention or Tai Chi Chuan. Results indicated that CD improved switching but not setting or suppressing attention. In contrast, neither fall prevention nor Tai Chi Chuan showed any effect. We suggest that CD improvisation works as a training for change, inducing plasticity in flexible attention.

  20. Improving Group Work Practices in Teaching Life Sciences: Trialogical Learning

    Science.gov (United States)

    Tammeorg, Priit; Mykkänen, Anna; Rantamäki, Tomi; Lakkala, Minna; Muukkonen, Hanni

    2017-08-01

    Trialogical learning, a collaborative and iterative knowledge creation process using real-life artefacts or problems, familiarizes students with working life environments and aims to teach skills required in the professional world. We target one of the major limitation factors for optimal trialogical learning in university settings, inefficient group work. We propose a course design combining effective group working practices with trialogical learning principles in life sciences. We assess the usability of our design in (a) a case study on crop science education and (b) a questionnaire for university teachers in life science fields. Our approach was considered useful and supportive of the learning process by all the participants in the case study: the students, the stakeholders and the facilitator. Correspondingly, a group of university teachers expressed that the trialogical approach and the involvement of stakeholders could promote efficient learning. In our case in life sciences, we identified the key issues in facilitating effective group work to be the design of meaningful tasks and the allowance of sufficient time to take action based on formative feedback. Even though trialogical courses can be time consuming, the experience of applying knowledge in real-life cases justifies using the approach, particularly for students just about to enter their professional careers.

  1. Do pressure ulcer risk assessment scales improve clinical practice?

    Directory of Open Access Journals (Sweden)

    Jan Kottner

    2010-07-01

    Full Text Available Jan Kottner1, Katrin Balzer21Department of Nursing Science, Charité-Universitätsmedizin Berlin, Germany; 2Nursing Research Group, Institute for Social Medicine, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyAbstract: Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulness. From a measurement point of view pressure ulcer (PU risk assessment scales have serious limitations. Empirical evidence supporting the validity of PU risk assessment scale scores is weak and obtained scores contain varying amounts of measurement error. The concept of pressure ulcer risk is strongly related to the general health status and severity of illness. A clinical impact due do the application of these scales could also not be demonstrated. It is questionable whether completion of standardized pressure ulcer risk scales in clinical practice is really needed.Keywords: Braden pressure ulcer, prevention, risk assessment, nursing assessment, predictive value, clinical effectiveness, review

  2. Quality improvement educational practices in pediatric residency programs: survey of pediatric program directors.

    Science.gov (United States)

    Mann, Keith J; Craig, Mark S; Moses, James M

    2014-01-01

    The Accreditation Council for Graduate Medical Education requires residents to learn quality improvement (QI) methods to analyze, change, and improve their practice. Little is known about how pediatric residency programs design, implement, and evaluate QI curricula to achieve this goal. We sought to describe current QI educational practices, evaluation methods, and program director perceptions through a national survey. A survey of QI curricula was developed, pilot tested, approved by the Association of Pediatric Program Directors (APPD), and distributed to pediatric program directors. Descriptive statistics were used to analyze the data. The response rate was 53% (104 of 197). Most respondents reported presence of a QI curriculum (85%, 88 of 104), including didactic sessions (83%) and resident QI projects (88%). Continuous process improvement was the most common methodology addressed (65%). The most frequent topics taught were "Making a Case for QI" (68%), "PDSA [plan-do-study-act] Cycles" (66%), and "Measurement in QI" (60%). Projects were most frequently designed to improve clinical care (90%), hospital operations (65%), and the residency (61%). Only 35% evaluated patient outcomes, and 17% had no formal evaluation. Programs had a mean of 6 faculty members (standard deviation 4.4, range 2-20) involved in teaching residents QI. Programs with more faculty involved were more likely to have had a resident submit an abstract to a professional meeting about their QI project (9, 92%; P = .003). Barriers to teaching QI included time (66%), funding constraints (39%), and absent local QI expertise (33%). Most PPDs (65%) believed that resident input in hospital QI was important, but only 24% reported resident involvement. Critical factors for success included an experiential component (56%) and faculty with QI expertise (50%). QI curricular practices vary greatly across pediatric residency programs. Although pediatric residency programs commit a fair number of resources to

  3. Effectiveness of a short-course in improving knowledge and skills on evidence-based practice.

    Science.gov (United States)

    Argimon-Pallàs, Josep M; Flores-Mateo, Gemma; Jiménez-Villa, Josep; Pujol-Ribera, Enriqueta

    2011-06-30

    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 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) 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 questions related to calculations such as sensitivity, specificity, the absolute risk reduction or the number needed to treat. A more modest increase was found in the residents' knowledge and skills in finding the best clinical evidence, and appraising the validity and applicability of an article. Finally, a weak and non-statistically significant improvement was found in formulating a clinical question. The study provides evidence for responsiveness to changes in knowledge and skills in EBP after an educational intervention.

  4. Cervical cancer screening in adolescents: an evidence-based internet education program for practice improvement among advanced practice nurses.

    Science.gov (United States)

    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.

  5. Improving blood transfusion practice by regular education in the United Arab Emirates.

    Science.gov (United States)

    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.

  6. Sensitivity-Improved Strain Sensor over a Large Range of Temperatures Using an Etched and Regenerated Fiber Bragg Grating

    Directory of Open Access Journals (Sweden)

    Yupeng Wang

    2014-10-01

    Full Text Available A sensitivity-improved fiber-optic strain sensor using an etched and regenerated fiber Bragg grating (ER-FBG suitable for a large range of temperature measurements has been proposed and experimentally demonstrated. The process of chemical etching (from 125 µm to 60 µm provides regenerated gratings (at a temperature of 680 °C with a stronger reflective intensity (from 43.7% to 69.8%, together with an improved and linear strain sensitivity (from 0.9 pm/με to 4.5 pm/με over a large temperature range (from room temperature to 800 °C, making it a useful strain sensor for high temperature environments.

  7. Practice improvement, part II: update on patient communication technologies.

    Science.gov (United States)

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support. 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.

  8. Retrieval practice: a simple strategy for improving memory after traumatic brain injury.

    Science.gov (United States)

    Sumowski, James F; Wood, Hali G; Chiaravalloti, Nancy; Wylie, Glenn R; Lengenfelder, Jeannie; DeLuca, John

    2010-11-01

    Memory impairment is common following traumatic brain injury (TBI), but interventions to improve memory in persons with TBI have been ineffective. Retrieval practice is a robust memory strategy among healthy undergraduates, whereby practice retrieving information shortly after it is presented leads to better delayed recall than simple restudy. In a verbal paired associate paradigm, we investigated the effect of retrieval practice relative to massed and spaced restudy on delayed recall in 14 persons with chronic memory impairment following a TBI and 14 age-matched healthy controls. A significant learning condition (massed restudy, spaced restudy, retrieval practice) by group (TBI, healthy) interaction emerged, whereby only healthy controls benefited from spaced restudy (i.e., distributed learning) over massed restudy, but both groups greatly benefited from retrieval practice over massed and spaced restudy. That is, retrieval practice greatly improves memory in persons with TBI, even when other mnemonic strategies (e.g., distributed learning) are less effective.

  9. Syncope Best Practices: A Syncope Clinical Practice Guideline to Improve Quality.

    Science.gov (United States)

    Phelps, Heather M; Sachdeva, Ritu; Mahle, William T; McCracken, Courtney E; Kelleman, Michael; McConnell, Michael; Fischbach, Peter S; Cardis, Brian M; Campbell, Robert M; Oster, Matthew E

    2016-05-01

    To determine whether implementation of a standardized clinical practice guideline (CPG) for the evaluation of syncope would decrease practice variability and resource utilization. A retrospective review of medical records of patients presenting to our practice for outpatient evaluation of syncope before and after implementation of the CPG. The guideline included elements of history, physical exam, electrocardiogram, and "red flags" for further testing. Outpatient pediatric cardiology offices of a large pediatric cardiology practice. All new patients between 3 and 21 years old, who presented to cardiology clinic with a chief complaint of syncope. The CPG for the evaluation of pediatric syncope was presented to the providers. Resource utilization was determined by the tests ordered by individual physicians before and after initiation of the CPG. Patient final diagnoses were recorded and the medical records were subsequently reviewed to determine if any patients, who presented again to the system, were ultimately diagnosed with cardiac disease. Of the 1496 patients with an initial visit for syncope, there was no significant difference in the diagnosis of cardiac disease before or after initiation of the CPG: (0.6% vs. 0.4%, P = .55). Electrocardiography provides the highest yield in the evaluation of pediatric syncope. Despite high compliance (86.9%), there were no overall changes in costs ($346.31 vs. $348.53, P = .85) or in resource utilization. There was, however, a decrease in the variability of ordering of echocardiograms among physicians, particularly among those at the extremes of utilization. Although the CPG did not decrease already low costs, it did decrease the wide variability in echo utilization. Evaluation beyond detailed history, physical exam, and electrocardiography provides no additional benefit in the evaluations of pediatric patients presenting with syncope. © 2015 Wiley Periodicals, Inc.

  10. Decreasing operating room environmental pathogen contamination through improved cleaning practice.

    Science.gov (United States)

    Munoz-Price, L Silvia; Birnbach, David J; Lubarsky, David A; Arheart, Kristopher L; Fajardo-Aquino, Yovanit; Rosalsky, Mara; Cleary, Timothy; Depascale, Dennise; Coro, Gabriel; Namias, Nicholas; Carling, Philip

    2012-09-01

    Potential transmission of organisms from the environment to patients is a concern, especially in enclosed settings, such as operating rooms, in which there are multiple and frequent contacts between patients, provider's hands, and environmental surfaces. Therefore, adequate disinfection of operating rooms is essential. We aimed to determine the change in both the thoroughness of environmental cleaning and the proportion of environmental surfaces within operating rooms from which pathogenic organisms were recovered. Prospective environmental study using feedback with UV markers and environmental cultures. A 1,500-bed county teaching hospital. Environmental service personnel, hospital administration, and medical and nursing leadership. The proportion of UV markers removed (cleaned) increased from 0.47 (284 of 600 markers; 95% confidence interval [CI], 0.42-0.53) at baseline to 0.82 (634 of 777 markers; 95% CI, 0.77-0.85) during the last month of observations ([Formula: see text]). Nevertheless, the percentage of samples from which pathogenic organisms (gram-negative bacilli, Staphylococcus aureus, and Enterococcus species) were recovered did not change throughout our study. Pathogens were identified on 16.6% of surfaces at baseline and 12.5% of surfaces during the follow-up period ([Formula: see text]). However, the percentage of surfaces from which gram-negative bacilli were recovered decreased from 10.7% at baseline to 2.3% during the follow-up period ([Formula: see text]). Feedback using Gram staining of environmental cultures and UV markers was successful at improving the degree of cleaning in our operating rooms.

  11. Organizational assessment in general practice: a systematic review and implications for quality improvement.

    NARCIS (Netherlands)

    Rhydderch, S.M.; Edwards, A.; Elwyn, G.; Marshall, M.; Engels, Y.M.P.; Hombergh, P. van den; Grol, R.P.T.M.

    2005-01-01

    BACKGROUND: Quality improvement of organizational aspects in general practice is receiving increasing attention. In particular, the impact of effective organization on preventative care has been recognized. Organizational assessments are typically used as part of professionally led accreditation

  12. Improving operational performance by influencing shopfloor behavior via performance management practices

    NARCIS (Netherlands)

    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

  13. Report: EPA Needs to Improve Management Practices to Ensure a Successful Customer Technology Solutions Project

    Science.gov (United States)

    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.

  14. The range of the Oxford Shoulder Score in the asymptomatic population: a marker for post-operative improvement.

    Science.gov (United States)

    Younis, F; Sultan, J; Dix, S; Hughes, P J

    2011-11-01

    The Oxford Shoulder Score (OSS) is a validated scoring system used to assess the degree of pain and disability caused by shoulder pathology. To date there is no knowledge of the range of the OSS in the healthy adult population. This study aimed to establish the range in asymptomatic individuals. The OSS of 100 asymptomatic volunteers was compared with the pre-operative OSS of 100 symptomatic individuals who had had elective shoulder surgery performed at the Royal Preston hospital. The difference in mean scores in the operated group (36.7) and the asymptomatic group (15.3) was statistically significant (pSymptom scores can only be used effectively when the range in the asymptomatic population is known. This is so that disease severity can be gauged in the context of the normal population and post-operative improvements can be forecast more accurately.

  15. Opportunities to improve domestic hygiene practices through new enabling products: a study of handwashing practices and equipment in rural Cambodia.

    Science.gov (United States)

    Jenkins, Marion W; Anand, Aprajita R; Revell, Geoff; Sobsey, Mark D

    2013-12-01

    Lack of a dedicated place and equipment for handwashing has been associated with poor practice of handwashing with soap in the home in developing communities where the practice is needed to reduce diarrhea diseases and respiratory infections. We conducted formative research on handwashing knowledge, attitudes, practices and equipment and investigated the need and demand for dedicated handwashing equipment to enable improved hygiene practices and enhance handwashing performance for health in rural Cambodian homes where water is collected and stored. Responses to closed and open-ended questions and structured observation of a demonstration of handwashing by the mother or another female adult child caretaker in 79 households were used to identify handwashing occasions, evaluate handwashing equipment and competency, investigate attitudes and structural barriers to handwashing with soap, and assess use of and interest in dedicated handwashing equipment. We found significant evidence of the need for handwashing enabling equipment to eliminate unsafe domestic water handling during handwashing and reduce structural barriers to routine handwashing with soap in Cambodian homes dependent on stored water supplies. Substantial interest in dedicated handwashing equipment and in specific equipment features was measured. Findings suggest household demand for and uptake of affordable household handwashing facilities incorporating desired features and functionality could be generated in Cambodia to support improved domestic hygiene practices.

  16. Greener on the Other Side: Cultivating Community and Improvement through Sustainability Practices

    Science.gov (United States)

    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…

  17. Practical Measurement and Productive Persistence: Strategies for Using Digital Learning System Data to Drive Improvement

    Science.gov (United States)

    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…

  18. Usage of Practices Promoted by School Improvement Grants. NCEE 2015-4019

    Science.gov (United States)

    Dragoset, Lisa; James-Burdumy, Susanne; Hallgren, Kristin; Perez-Johnson, Irma; Herrmann, Mariesa; Tuttle, Christina; Angus, Megan Hague; Herman, Rebecca; Murray, Matthew; Tanenbaum, Courtney; Graczewski, Cheryl

    2015-01-01

    The American Recovery and Reinvestment Act of 2009 injected $7 billion into two of the Obama administration's signature competitive education grant programs: Race to the Top (RTT) and School Improvement Grants (SIG). While RTT focused on state policies and SIG focused on school practices, both programs promoted related policies and practices,…

  19. Improving Primary School Practice and School-College Linkage in Ethiopia through Collaborative Action Research

    Science.gov (United States)

    Worku, Mulugeta Yayeh

    2017-01-01

    In Ethiopia, as elsewhere in the world, action research is recognized as a valuable and cost-effective form of inquiry to improve classroom and school practices. It has been given due consideration, both by the Ministry of Education and teacher education institutes of the country. Nevertheless, studies conducted on the practice of action research…

  20. Strengthening care teams to improve adherence in cystic fibrosis: a qualitative practice assessment and quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Gardner AJ

    2017-04-01

    Full Text Available Allison J Gardner,1 Alice L Gray,2 Staci Self,3 Jeffrey S Wagener4 1Med-IQ, LLC, Baltimore, MD, 2Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, 3Division of Pediatric Pulmonology, University of Alabama at Birmingham, Birmingham, AL, 4Department of Pediatrics, University of Colorado Medical School, Aurora, CO, USA Background: Treatment regimens for patients with cystic fibrosis (CF are complex, time consuming, and burdensome, and adherence to CF treatment is suboptimal. CF care teams play a critical role in supporting patients’ chronic self-management skills, but there is no uniform method for assessing patients’ adherence to treatment or standard interventions to help patients improve when necessary.Methods: Between May 2015 and March 2016, care team members from 10 CF centers in the USA participated in a practice assessment and quality improvement (QI initiative. The intervention included a baseline practice assessment survey, personalized continuing medical education (CME-certified Webconferences with expert study faculty, targeted reinforcement of key practice points, and follow-up online survey and telephone interviews to evaluate the benefits and limitations of the intervention.Results: Responses to the baseline practice assessment survey were received from 50 multidisciplinary care team members representing 10 CF centers. Primary barriers to adherence-related aspects of care in their clinics were motivating patients and caregivers to improve adherence and obtaining accurate information about adherence from patients. At the conclusion of the initiative, participants reported improvements in communication within their care team, implementation of new approaches to asking about adherence, and a renewed commitment to asking patients and caregivers about adherence at each clinic visit.Conclusion: Structured QI interventions that bring multidisciplinary care teams together to

  1. Who is afraid of Qualitative Research? A Compromise Accounting Research Failure in Improving accounting Practices

    OpenAIRE

    Theresia Woro Damayant

    2013-01-01

    The purpose of this research is to find a compromise over the failure of accounting research in improving accounting practices. Various debate occurred between the pros and cons between quantitative and qualitative research. Both depend on philosophical commitments of researchers. The failure of accounting research to improve accounting practices can be resolved through scientific qualitative research is scientific, the qualitative research that meet the elements of validity and r...

  2. Improving evidence based practice in postgraduate nursing programs: A systematic review: Bridging the evidence practice gap (BRIDGE project).

    Science.gov (United States)

    Hickman, Louise D; DiGiacomo, Michelle; Phillips, Jane; Rao, Angela; Newton, Phillip J; Jackson, Debra; Ferguson, Caleb

    2018-01-31

    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.

  3. Improving medication administration safety: using naïve observation to assess practice and guide improvements in process and outcomes.

    Science.gov (United States)

    Donaldson, Nancy; Aydin, Carolyn; Fridman, Moshe; Foley, Mary

    2014-01-01

    To present findings from the Collaborative Alliance for Nursing Outcomes' (CALNOC) hospital medication administration (MA) accuracy assessment in a sample of acute care hospitals. Aims were as follows: (1) to describe the CALNOC MA accuracy assessment, (2) to examine nurse adherence to six safe practices during MA, (3) to examine the prevalence of MA errors in adult acute care, and (4) to explore associations between safe practices and MA accuracy. Using a cross-sectional design, point in time, and convenience sample, direct observation data were collected by 43 hospitals participating in CALNOC's benchmarking registry. Data included 33,425 doses from 333 observation studies on 157 adult acute care units. Results reveal that the most common MA safe practice deviations were distraction/interruption (22.89%), not explaining medication to patients (13.90%), and not checking two forms of ID (12.47%). The most common MA errors were drug not available (0.76%) and wrong dose (0.45%). The overall percentage of safe practice deviations per encounter was 11.40%, whereas the overall percentage of MA errors was 0.32%. Findings predict that for 10,000 MA encounters, 27,630 safe practice deviations and 770 MA errors will occur. A 36% reduction in practice deviation per encounter prevents 4.4% MA errors. Ultimately, reliably performing safe practices improves MA accuracy. © 2014 National Association for Healthcare Quality.

  4. No longer simply a Practice-based Research Network (PBRN) health improvement networks.

    Science.gov (United States)

    Williams, Robert L; Rhyne, Robert L

    2011-01-01

    While primary care Practice-based Research Networks are best known for their original, research purpose, evidence accumulating over the last several years is demonstrating broader values of these collaborations. Studies have demonstrated their role in quality improvement and practice change, in continuing professional education, in clinician retention in medically underserved areas, and in facilitating transition of primary care organization. A role in informing and facilitating health policy development is also suggested. Taking into account this more robust potential, we propose a new title, the Health Improvement Network, and a new vision for Practice-based Research Networks.

  5. [Improvement of medical processes with Six Sigma - practicable zero-defect quality in preparation for surgery].

    Science.gov (United States)

    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

  6. Implementing practice management strategies to improve patient care: the EPIC project.

    Science.gov (United States)

    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.

  7. Seclusion and restraint in psychiatry: patients' experiences and practical suggestions on how to improve practices and use alternatives.

    Science.gov (United States)

    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.

  8. A randomised trial of the Flinders Program to improve patient self-management competencies in a range of chronic conditions: study rationale and protocol

    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.

  9. Changing classroom practices: the role of school-wide capacity for sustainable improvement

    NARCIS (Netherlands)

    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

  10. Changing classroom practices: the role of school-wide capacity for sustainable improvement

    NARCIS (Netherlands)

    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

  11. Sector-Led Improvement in Children's Services: A Lever for Evidence-Informed Practice?

    Science.gov (United States)

    Holmes, Dez; Brookes, Carole

    2014-01-01

    The drive for sector-led improvement within children's services has a more prominent place in improving outcomes for children and young people than ever before. Concurrently, the imperative to access and utilise evidence to inform practice has become increasingly important, enabling scarce resources to be allocated according to "what…

  12. The Superintendent's Leadership Role in School Improvement: Relationships between Authenticity and Best Practices

    Science.gov (United States)

    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…

  13. Conducting a Successful Practice Quality Improvement Project for American Board of Radiology Certification.

    Science.gov (United States)

    Lee, Cindy S; Wadhwa, Vibhor; Kruskal, Jonathan B; Larson, David B

    2015-10-01

    Practice quality improvement (PQI) is a required component of the American Board of Radiology (ABR) Maintenance of Certification (MOC) cycle, with the goal to "improve the quality of health care through diplomate-initiated learning and quality improvement." The essential requirements of PQI projects include relevance to one's practice, achievability in one's clinical setting, results suited for repeat measurements during an ABR MOC cycle, and reasonable expectation to result in quality improvement (QI). PQI projects can be performed by a group or an individual or as part of a participating institution. Given the interdisciplinary nature of radiology, teamwork is critical to ensure patient safety and the success of PQI projects. Additionally, successful QI requires considerable investment of time and resources, coordination, organizational support, and individual engagement. Group PQI projects offer many advantages, especially in larger practices and for processes that cross organizational boundaries, whereas individual projects may be preferred in small practices or for focused projects. In addition to the three-phase "plan, do, study, act" model advocated by the ABR, there are several other improvement models, which are based on continuous data collection and rapid simultaneous testing of multiple interventions. When properly planned, supported, and executed, group PQI projects can improve the value and viability of a radiology practice. © RSNA, 2015.

  14. Improving antimicrobial prescribing practice for sore throat symptoms in a general practice setting.

    Science.gov (United States)

    Razai, Mohammad; Hussain, Kamal

    2017-01-01

    Acute sore throat is a common presentation in primary care settings. We aimed to improve our compliance with national antibiotic guidelines for sore throat symptoms to 90% in 3 months' time period. The national guidelines are based on Centor criteria. A retrospective audit of 102 patient records with sore throat symptoms presenting between 1 January to 30 December 2015 showed that over 50% were given antibiotics. Those who were prescribed antibiotics, 27% did not meet NICE criteria and 85% of patients were given immediate antibiotic prescription. Centor criteria was documented in just 2% of cases. Compliance with correct antibiotic course length was 15%. Antibiotic choice and dose was correct in 94% and 92% of cases respectively. Antibiotic frequency was correctly prescribed in 100% of patients. We introduced interventions that included oral and poster presentations to multidisciplinary team, dissemination of guidelines through internal e-mail and systemic changes to GP electronic patient record system EMIS. This involved creating an automated sore throat template and information page. On re-auditing of 71 patients, after two PDSA cycles, compliance with NICE criteria was 87% with a significant reduction in immediate prescribing (66%). Centor criteria documentation was 42%. Correct antibiotic course length was prescribed in over 30% of cases. Other antibiotic regimen parameters (choice, dose and frequency) were correct in 100% of cases. The initial results demonstrated that significant changes were needed. In particular, reducing the amount of antibiotics prescribed by increasing compliance with NICE criteria and ensuring all parameters of antibiotic prescription were correct. We showed that significant sustainable improvement is achievable through carefully devised automated systemic changes that provides critical information in readily accessible format, and does not solely rely on prescribers' knowledge and initiative. The outcome of these interventions are a

  15. Improvement of Performance Range of Centrifugal Compressors Gas by Surge Line Modification Using Active Controller Based on Fuzzy Logic

    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.

  16. Determination of background, signal-to-noise, and dynamic range of a flow cytometer: A novel practical method for instrument characterization and standardization.

    Science.gov (United States)

    Giesecke, Claudia; Feher, Kristen; von Volkmann, Konrad; Kirsch, Jenny; Radbruch, Andreas; Kaiser, Toralf

    2017-09-27

    A well-defined scale calibration in flow cytometry can improve many aspects of data acquisition such as cytometer setup, instrument comparison and sample comparison. The theory for scale calibration was proposed by Steen over two decades ago, but it has never been put into regular use due to the lack of a widely available precision light source. The introduction of such a light source, the quantiFlash(TM) , gave this possibility. Here, we describe how this light source can be used to characterize a cytometer's PMT performance. We, therefore, characterized the instrument's response over the entire PMT voltage range. As a consequence, we propose a practical method to characterize a cytometer's signal-to-noise ratio (SNR) and dynamic range (DNR). This allows the selection of a voltage/gain corresponding to a PMT's maximum efficiency and hence the lowest electronic noise, which can help with experiment design. We further introduced a decibel (dB) scale for the presentation of SNR and DNR values. SNR and DNR are stand-alone values that allow the direct comparison of different instruments. Finally, with this method, it becomes clear that increased SNR comes at the expense of DNR and thus the limiting factor of modern cytometers is the DNR. © 2017 International Society for Advancement of Cytometry. © 2017 International Society for Advancement of Cytometry.

  17. Improving newborn care practices through home visits: lessons from Malawi, Nepal, Bangladesh, and Uganda

    Science.gov (United States)

    Sitrin, Deborah; Guenther, Tanya; Waiswa, Peter; Namutamba, Sarah; Namazzi, Gertrude; Sharma, Srijana; Ashish, KC; Rubayet, Sayed; Bhadra, Subrata; Ligowe, Reuben; Chimbalanga, Emmanuel; Sewell, Elizabeth; Kerber, Kate; Moran, Allisyn

    2015-01-01

    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 increasing facility

  18. Utilizing best practice methods to improve labour management in a partnership of five hospitals.

    Science.gov (United States)

    Walker, David E

    2003-12-01

    To assess the use of "Best Practice" methods as a means of improving obstetrical care pertaining to labour management and Caesarean birth in a partnership group of 5 hospitals, 4 with birthing rates of 50 to 175 women a year, and the fifth with a birthing rate of approximately 1000 women a year. The Labour Management module of the Advances in Labour and Risk Management (ALARM) Best Practice course of the Society of Obstetricians and Gynaecologists of Canada (SOGC) was tested on the 4 Level I rural hospitals and 1 modified Level II hospital in a small city in the Huron Perth Hospitals. The outcomes assessed were the module's effectiveness as a Continuing Medical Education (CME) tool; its effectiveness at promoting common practice guidelines; and its effectiveness at improving communication and co-operation. From the 5 participating partnership hospitals, 3 obstetricians, 28 family physicians, and 5 midwives were eligible to participate. Of these 36 clinicians, 80% completed the Pre-study Phase, which included auditing their practice for Labour Management; 94% attended the workshops; and 67% completed the Post-study Audit. Common practice changes were identified through the workshops and post-study results showed success in their implementation. A Post-study Questionnaire indicated improved co-operation and communication in the partnership hospitals. The Management of Labour module of the SOGC ALARM Best Practice course was successful in improving obstetrical practice in the partnership group of hospitals tested. This method promoted the use of common practice guidelines at the bedside and also improved communication and co-operation in the hospital partnership.

  19. Practice leaders programme: entrusting and enabling general practitioners to lead change to improve patient experience.

    Science.gov (United States)

    Lynch, Marion; McFetridge, Nigel

    2011-01-01

    This program focused on practice-level service change as a means of improving patient care and developing leadership skills of 19 general practitioners (GPs) and aimed to: promote and support change in leadership thinking and practice, facilitate practice-led service improvement, support career development, support continuing professional development, and contribute to the development of extended GP specialty training. Nineteen GPs, in Milton Keynes, United Kingdom, both new and experienced, volunteered to participate. Milton Keynes was selected on the basis of it being an area of relative social deprivation and underperformance in national quality indicators. New and experienced GPs took part in biweekly Action Learning Sets, individual coaching, and placements with the national and local health organizations. Each participant completed a project to improve the quality of patient care. The learning sets supported the process and 11 of the GPs chose to complete a postgraduate certificate in General Practice. Evaluation consisted of analysis of development of leadership competencies recorded through Medical Leadership Competency Framework pre- and postintervention assessment, analysis of learning recorded in participants' reflective diaries, analysis of learning process recorded through participant focus groups, and analysis of learning and project outcomes recorded in project reports. Outcomes showed statistically significant increases in leadership competencies, changes in services and care, improved confidence and changed culture. GPs expressed increased confidence to "have a go" and motivation to "make a difference." This innovative narrative, complex, neuroleadership-based program continues to inform educational policy and practice, increasing leadership competencies, and to improve the quality of patient care.

  20. Standardised procedures can improve the validity of susceptibility testing of uropathogenic bacteria in general practice.

    Science.gov (United States)

    Bjerrum, L; Grinsted, P; Petersen, P H; Søgaard, P

    2000-12-01

    To investigate whether the validity of susceptibility testing in general practice would improve when preceded by an intervention. Instruction in standardised susceptibility testing procedures given by laboratory instructors. Urine specimens containing monocultures of typical uropathogenic bacteria were sent to 23 general practices before and after the intervention. Practices performed susceptibility testing by the Sensicult and the Iso-Res agar methods and the validity of the results before and after the intervention was compared. Results from susceptibility testing at the bacteriological laboratory, Odense University Hospital, were used as gold standard. The median frequency of correct results increased from 82% to 98% for susceptibility testing based on Sensicult (p = 0.001) and from 90% to 96% based on Iso-Res agar (p = 0.05). The validity of susceptibility testing in general practice improves when preceded by instruction in standardised procedures.

  1. Improving the dependability of research in personality and social psychology: recommendations for research and educational practice.

    Science.gov (United States)

    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."

  2. Improving the catalytic activity of hyperthermophilic Pyrococcus prolidases for detoxification of organophosphorus nerve agents over a broad range of temperatures.

    Science.gov (United States)

    Theriot, Casey M; Du, Xuelian; Tove, Sherry R; Grunden, Amy M

    2010-08-01

    Prolidase isolated from the hyperthermophilic archaeon Pyrococcus furiosus has potential for application for decontamination of organophosphorus compounds in certain pesticides and chemical warfare agents under harsh conditions. However, current applications that use an enzyme-based cocktail are limited by poor long-term enzyme stability and low reactivity over a broad range of temperatures. To obtain a better enzyme for OP nerve agent decontamination and to investigate structural factors that influence protein thermostability and thermoactivity, randomly mutated P. furiosus prolidases were prepared by using XL1-red-based mutagenesis and error-prone PCR. An Escherichia coli strain JD1 (lambdaDE3) (auxotrophic for proline [DeltaproA] and having deletions in pepQ and pepP dipeptidases with specificity for proline-containing dipeptides) was constructed for screening mutant P. furiosus prolidase expression plasmids. JD1 (lambdaDE3) cells were transformed with mutated prolidase expression plasmids and plated on minimal media supplemented with 50 muM Leu-Pro as the only source of proline. By using this positive selection, Pyrococcus prolidase mutants with improved activity over a broader range of temperatures were isolated. The activities of the mutants over a broad temperature range were measured for both Xaa-Pro dipeptides and OP nerve agents, and the thermoactivity and thermostability of the mutants were determined.

  3. [Medical practice and clinical research: keys to generate knowledge and improve care].

    Science.gov (United States)

    Martínez Castuera-Gómez, Carla; Talavera, Juan O

    2013-01-01

    The increased quality in medical care may be immediately accomplished if clinical research is integrated into daily clinical practice. In the generation of medical knowledge are four steps: an unanswered question awakened from clinical practice, the critical analysis of specialized literature, the development of a research protocol, and, finally, the publication of outcomes. Decision making and continuous training are becoming part of an effective strategy of medical attention improvement.

  4. Environmental and Quality Improvement Practices: Their Analysis as Components of the Value Added in Horticultural Firms

    OpenAIRE

    Gomez, Emilio Galdeano; Lorente, Jose Cespedes; Rodriguez, Manuel Rodriguez

    2002-01-01

    This paper analyses the effect of environmental and quality improvement practices on the value added of the fruit and vegetable sector. These practices form part of the incentive-based programmes established by the Common Agricultural Policy. Taking the investment in quality-environmental activities as knowledge capital, we propose a specific analysis that evaluates the effect of the factors of the production function and of the current subsidies over the value added. In general, the share of...

  5. Implementing simulated learning modules to improve students’ pharmacy practice skills and professionalism

    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

  6. Future improvements and implementation of animal care practices within the animal testing regulatory environment.

    Science.gov (United States)

    Guittin, Pierre; Decelle, Thierry

    2002-01-01

    Animal welfare is an increasingly important concern when considering biomedical experimentation. Many of the emerging regulations and guidelines specifically address animal welfare in laboratory animal care and use. The current revision of the appendix of the European Convention, ETS123 (Council of Europe), updates and improves on the current animal care standardization in Europe. New guidelines from the Organisation for Economic Co-operation and Development and the European Federation of Pharmaceutical Industries Association focus specifically on safety testing. These guidelines will affect the way toxicity studies are conducted and therefore the global drug development process. With the 3Rs principles taken into account, consideration regarding animal welfare will demand changes in animal care practices in regulatory safety testing. The most significant future improvements in animal care and use practices are likely to be environmental enrichment, management of animal pain and distress, and improved application of the humane endpoints. Our challenge is to implement respective guidelines based on scientific data and animal welfare, through a complex interplay of regulatory objective and public opinion. The current goal is to work toward solutions that continue to provide relevant animal models for risk assessment in drug development and that are science based. In this way, future improvements in animal care and use practices can be founded on facts, scientific results, and analysis. Some of these improvements become common practice in some countries. International harmonization can facilitate the development and practical application of "best scientific practices" by the consensus development process that harmonization requires. Since the implementation of good laboratory practices (GLP) standards in safety testing, these new regulations and recommendations represent a new way forward for animal safety studies.

  7. Evaluation of a practice-development initiative to improve breastfeeding rates.

    Science.gov (United States)

    Barnes, Margaret; Cox, Julie; Doyle, Bronwyn; Reed, Rachel

    2010-01-01

    The benefits of breastfeeding for infant, mother, family, and community are well recognized, and increasing breastfeeding rates is considered an important health-promotion strategy. Improving breastfeeding knowledge and practice among individuals caring for breastfeeding women is considered an important aspect of this strategy. The practice-development initiative described in this article aimed to improve hospital-based breastfeeding rates through the implementation of The Ten Steps to Successful Breastfeeding. The initiative included the development and implementation of an education program aimed at changing and improving breastfeeding practices. The program was evaluated in three ways: changes in breastfeeding rates at hospital discharge; client preparation for breastfeeding and satisfaction during the postnatal period; and staff knowledge and skills.

  8. Sustaining health in faith community nursing practice: emerging processes that support the development of a middle-range theory.

    Science.gov (United States)

    Dyess, Susan MacLeod; Chase, Susan K

    2012-01-01

    This article reveals processes that support theoretical development for holistic nursing in the context of a faith community. The emerging processes enhance the articulation of the holistically focused practice, add clarity to faith community nursing activities and outcomes, and contribute to theoretical clarification and development. Theoretical clarity is essential to guide faith community nursing practice, research, and education because there is tremendous potential for the specialty practice to contribute to the health of a community across the continuum of caring and because to date there has been no unifying model for this practice proposed. A lack of a theoretical basis can result in disparate and disconnected approaches to studying, testing, and promoting the practice.

  9. [Quality assurance and quality improvement in medical practice. Part 1. Definition and importance of quality in medical practice].

    Science.gov (United States)

    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.

  10. 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.

  11. Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players.

    Science.gov (United States)

    Laudner, Kevin; Compton, Bryce D; McLoda, Todd A; Walters, Chris M

    2014-02-01

    Due to the repetitive rotational and distractive forces exerted onto the posterior shoulder during the deceleration phase of the overhead throwing motion, limited glenohumeral (GH) range of motion (ROM) is a common trait found among baseball players, making them prone to a wide variety of shoulder injuries. Although utilization of instrument-assisted soft tissue mobilization (IASTM), such as the Graston® Technique, has proven effective for various injuries and disorders, there is currently no empirical data regarding the effectiveness of this treatment on posterior shoulder tightness. To determine the effectiveness of IASTM in improving acute passive GH horizontal adduction and internal rotation ROM in collegiate baseball players. Thirty-five asymptomatic collegiate baseball players were randomly assigned to one of two groups. Seventeen participants received one application of IASTM to the posterior shoulder in between pretest and posttest measurements of passive GH horizontal adduction and internal rotation ROM. The remaining 18 participants did not receive a treatment intervention between tests, serving as the controls. Data were analyzed using separate 2× 2 mixed-model analysis of variance, with treatment group as the between-subjects variable and time as the within-subjects variable. A significant group-by-time interaction was present for GH horizontal adduction ROM with the IASTM group showing greater improvements in ROM (11.1°) compared to the control group (-0.12°) (p <0.001). A significant group-by-time interaction was also present for GH internal rotation ROM with the IASTM group having greater improvements (4.8°) compared to the control group (-0.14°) (p < 0.001). The results of this study indicate that an application of IASTM to the posterior shoulder provides acute improvements in both GH horizontal adduction ROM and internal rotation ROM among baseball players. 2b.

  12. Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement.

    Science.gov (United States)

    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

  13. Improving pharmacy staff knowledge and practice on childhood diarrhea management in Vietnam: are educational interventions effective?

    Science.gov (United States)

    Pham, Duc Minh; Byrkit, Mona; Pham, Hoang Van; Pham, Trung; Nguyen, Chien Thang

    2013-01-01

    In many developing countries, private pharmacies play an important role in providing health information and services to local communities for common health issues. The aim of this study was to ascertain medium-term impact of educational interventions on knowledge and practice of pharmacy staff regarding management of childhood diarrhea in Vietnam. This was a pre- and post-intervention study with 32 and 44 months difference from the time of the baseline survey to the conclusion of trainings and the time of the end-line survey, respectively. Interventions included in-class training for pharmacy staff, printed materials at the pharmacy, and supportive supervision. Knowledge/reported practice and actual practice of pharmacy staff were measured before and after interventions. After interventions, significant improvements (ppharmacy staff's knowledge about childhood diarrhea; for instance, 31% and 60% of surveyed staff asked about weight of the child and accompanying symptoms of childhood diarrhea, respectively, an increase from 11% and 45% at the baseline. Oral rehydration solution (ORS) was the most frequently reported product recommended (97% to 99%), but probiotics and antidiarrheals were the products most frequently prescribed at pharmacies. Public health facilities remained the preferred choice for referrals from pharmacies, but the use of private clinics was increasing. Consultations and advice provided to caregivers also improved, but considerable gaps between knowledge and actual practice of staff in real pharmacy settings remained. Educational interventions were effective in improving pharmacy staff knowledge and practice regarding management of childhood diarrhea. Knowledge and actual practice of staff in real pharmacy settings did not always correlate; there is need for a stronger regulatory and law enforcement system. Interventions to improve pharmacy practice in developing countries should be focused, comprehensive, and evidence-based.

  14. Study on the resolution improvement of a range finder using the chaotic frequency characteristics of a laser diode

    Science.gov (United States)

    Saito, Takahiro; Maehara, Shinya; Doi, Kohei; Sato, Takashi; Ohdaira, Yasuo; Sakamoto, Shuichi; Ohkawa, Masashi

    2017-06-01

    An optical range finder system that relies on laser diodes' frequency noise, instead of intensity or frequency modulations, and its improvement in resolution are reported. The distance to the target is measured by calculating the cross-correlation of two signals reflected from the target and reference mirrors. These two signals are converted from the laser diodes' frequency noise signals by frequency/intensity converters, such as a Fabry-Perot etalon. We obtained the distance to the target by checking time lags between the target and reference beams at the highest correlation coefficient. We also measured the change in the correlation coefficient around the peak sampling point by adjusting the reference-path length, achieving a resolving power of ±3 mm.

  15. Practices for Improving Secondary School Climate: A Systematic Review of the Research Literature.

    Science.gov (United States)

    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.

  16. Optimizing Taq polymerase concentration for improved signal-to-noise in the broad range detection of low abundance bacteria.

    Directory of Open Access Journals (Sweden)

    Rudolph Spangler

    Full Text Available BACKGROUND: PCR in principle can detect a single target molecule in a reaction mixture. Contaminating bacterial DNA in reagents creates a practical limit on the use of PCR to detect dilute bacterial DNA in environmental or public health samples. The most pernicious source of contamination is microbial DNA in DNA polymerase preparations. Importantly, all commercial Taq polymerase preparations inevitably contain contaminating microbial DNA. Removal of DNA from an enzyme preparation is problematical. METHODOLOGY/PRINCIPAL FINDINGS: This report demonstrates that the background of contaminating DNA detected by quantitative PCR with broad host range primers can be decreased greater than 10-fold through the simple expedient of Taq enzyme dilution, without altering detection of target microbes in samples. The general method is: For any thermostable polymerase used for high-sensitivity detection, do a dilution series of the polymerase crossed with a dilution series of DNA or bacteria that work well with the test primers. For further work use the concentration of polymerase that gave the least signal in its negative control (H(2O while also not changing the threshold cycle for dilutions of spiked DNA or bacteria compared to higher concentrations of Taq polymerase. CONCLUSIONS/SIGNIFICANCE: It is clear from the studies shown in this report that a straightforward procedure of optimizing the Taq polymerase concentration achieved "treatment-free" attenuation of interference by contaminating bacterial DNA in Taq polymerase preparations. This procedure should facilitate detection and quantification with broad host range primers of a small number of bona fide bacteria (as few as one in a sample.

  17. Does warm-up using mental practice improve crisis resource management performance? A simulation study.

    Science.gov (United States)

    Hayter, M A; Bould, M D; Afsari, M; Riem, N; Chiu, M; Boet, S

    2013-02-01

    Mental practice (MP) is defined as the 'symbolic rehearsal of a physical activity in the absence of any gross-muscular movements' and has been used in sport and music to enhance performance. In healthcare, MP has been demonstrated to improve technical skill performance of surgical residents. However, its effect on crisis resource management (CRM) skills has yet to be determined. We aimed to investigate the effect of warm-up with MP on CRM skill performance during a simulated crisis scenario. Following ethics board approval, 40 anaesthesia residents were randomized. The intervention group performed 20 min of MP of a script based on CRM principles. The control group received a 20 min didactic teaching session on an unrelated topic. Each subject then managed a simulated cardiac arrest. Two CRM experts rated the video recordings of each performance using the previously validated Ottawa GRS. The time to start chest compressions, administer epinephrine, and give blood was recorded. There was no significant difference between the intervention and control groups: total Ottawa GRS score was 24.50 (18.63-28.88 [6.50-34.50]) (median (inter-quartile range [range]) vs 20.50 (13.00-29.13 [6.50-34.50]) (P=0.53); the time to start chest compressions 146.0 s (138.0-231.0 [115.0-323.0]) vs 162.5 s (138.0-231.0 [100.0-460.0]) (P=0.27), the time to epinephrine administration 163.0 s (151.0-187.0 [111.0-337.0]) vs 187.0 s (164.0-244.0 [115.0-310.0]) (P=0.09), and the time to blood administration 220.5 s (130.8-309.0 [92.0-485.0]) vs 252.5 (174.5-398.8 [65.0-527.0]) (P=0.48). Unlike technical skills, warm-up with MP does not seem to improve CRM skills in simulated crisis scenarios.

  18. Building of the Partnership for the University Lecture Improvements : Through the practice of "Child Nutriton"

    OpenAIRE

    橋川, 喜美代; 石井, 弘子

    2003-01-01

    The purpose of this paper is to build the partnership between practicers and university reseachers by discussing the contents of the lecture looked for "Child Nutrition", and the method of the university lecture improvements from the point of view of the training curriculum for the nursery teachers. It is important for university students to understand the significance that a suitable meal corresponding to the development process of the child's food activities is provided and the improvement ...

  19. Development and participant assessment of a practical quality improvement educational initiative for surgical residents.

    Science.gov (United States)

    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.

  20. Constraints to adoption of improved hatchery management practices among catfish farmers in Lagos State

    OpenAIRE

    Oghenetejiri DIGUN-AWETO; Ademuyiwa OLADELE

    2017-01-01

    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 i...

  1. Comparison of Physical Therapy with Energy Healing for Improving Range of Motion in Subjects with Restricted Shoulder Mobility

    Directory of Open Access Journals (Sweden)

    Ann Linda Baldwin

    2013-01-01

    Full Text Available Two forms of energy healing, Reconnective Healing (RH and Reiki, which involve light or no touch, were tested for efficacy against physical therapy (PT for increasing limited range of motion (ROM of arm elevation in the scapular plane. Participants were assigned to one of 5 groups: PT, Reiki, RH, Sham Healing, or no treatment. Except for no treatment, participants were blinded as to grouping. Range of Motion, self-reported pain, and heart rate variability (HRV were assessed before and after a 10-minute session. On average, for PT, Reiki, RH, Sham Healing, and no treatment, respectively, ROM increased by 12°, 20°, 26°, 0.6°, and 3° and pain score decreased by 11.5%, 10.1%, 23.9%, 15.4%, and 0%. Physical therapy, Reiki, and RH were more effective than Sham Healing for increasing ROM (PT: , ; Reiki: , ; RH: , . It is possible that this improvement was not mediated by myofascial release because the subjects’ HRV did not change, suggesting no significant increase in vagal activity. Sham treatment significantly reduced pain compared to no treatment (, and was just as effective as PT, Reiki, and RH. It is the authors’ opinion that the accompanying pain relief is a placebo effect.

  2. Satellite range scheduling with the priority constraint: An improved genetic algorithm using a station ID encoding method

    Directory of Open Access Journals (Sweden)

    Li Yuqing

    2015-06-01

    Full Text Available Satellite range scheduling with the priority constraint is one of the most important problems in the field of satellite operation. This paper proposes a station coding based genetic algorithm to solve this problem, which adopts a new chromosome encoding method that arranges tasks according to the ground station ID. The new encoding method contributes to reducing the complexity in conflict checking and resolving, and helps to improve the ability to find optimal resolutions. Three different selection operators are designed to match the new encoding strategy, namely random selection, greedy selection, and roulette selection. To demonstrate the benefits of the improved genetic algorithm, a basic genetic algorithm is designed in which two cross operators are presented, a single-point crossover and a multi-point crossover. For the purpose of algorithm test and analysis, a problem-generating program is designed, which can simulate problems by modeling features encountered in real-world problems. Based on the problem generator, computational results and analysis are made and illustrated for the scheduling of multiple ground stations.

  3. Improvement of Surface Temperature Prediction Using SVR with MOGREPS Data for Short and Medium range over South Korea

    Science.gov (United States)

    Lim, S. J.; Choi, R. K.; Ahn, K. D.; Ha, J. C.; Cho, C. H.

    2014-12-01

    As the Korea Meteorology Administration (KMA) has operated Met Office Global and Regional Ensemble Prediction System (MOGREPS) with introduction of Unified Model (UM), many attempts have been made to improve predictability in temperature forecast in last years. In this study, post-processing method of MOGREPS for surface temperature prediction is developed with machine learning over 52 locations in South Korea. Past 60-day lag time was used as a training phase of Support Vector Regression (SVR) method for surface temperature forecast model. The selected inputs for SVR are followings: date and surface temperatures from Numerical Weather prediction (NWP), such as GDAPS, individual 24 ensemble members, mean and median of ensemble members for every 3hours for 12 days.To verify the reliability of SVR-based ensemble prediction (SVR-EP), 93 days are used (from March 1 to May 31, 2014). The result yielded improvement of SVR-EP by RMSE value of 16 % throughout entire prediction period against conventional ensemble prediction (EP). In particular, short range predictability of SVR-EP resulted in 18.7% better RMSE for 1~3 day forecast. The mean temperature bias between SVR-EP and EP at all test locations showed around 0.36°C and 1.36°C, respectively. SVR-EP is currently extending for more vigorous sensitivity test, such as increasing training phase and optimizing machine learning model.

  4. Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services.

    Science.gov (United States)

    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

  5. 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

  6. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices.

    Science.gov (United States)

    Kennelly, S; Kennedy, N P; Corish, C A; Flanagan-Rughoobur, G; Glennon-Slattery, C; Sugrue, S

    2011-10-01

    Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later. The intervention involved general practitioners (GPs), practice nurses, nurses in local nursing homes and community nurses. It comprised an education programme together with the provision of a new community dietetics service. Changes in health care professionals' nutrition care practices were determined by examining community dietetics records. ONS prescribing volume and expenditure on ONS were assessed using data from the Primary Care Reimbursement Service of the Irish Health Service Executive. Seven out of 10 principal GPs participated in the nutrition education programme. One year later, screening for malnutrition risk was better, dietary advice was provided more often, referral to the community dietetics service improved and ONS were prescribed for a greater proportion of patients at 'high risk' of malnutrition than before (88% versus 37%; P dietetics intervention improved ONS prescribing practices by GPs and nurses, in accordance with best practice guidelines, without increasing expenditure on ONS during the year after intervention. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

  7. Kinesio taping improves pain, range of motion, and proprioception in older patients with knee osteoarthritis: a randomized controlled trial.

    Science.gov (United States)

    Cho, Hwi-young; Kim, Eun-Hye; Kim, Junesun; Yoon, Young Wook

    2015-03-01

    This study investigated the short-term effects of Kinesio taping (KT) on various types of pain, active range of motion (AROM), and proprioception in patients with knee osteoarthritis. Forty-six older participants (mean [SD], 57.9 [4.4] yrs) with osteoarthritis were randomly allocated to two groups: the KT group or the placebo-KT group. Taping with tension (KT application) or without tension (placebo-KT application) was applied to the quadriceps of the participants in both groups. Before and after intervention, pain intensity was measured using a visual analog scale at rest and during walking, and pressure pain thresholds (PPTs) were assessed using an algometer in the quadriceps and the tibialis anterior. In addition, pain-free AROM and proprioception were measured. The KT group showed attenuation of pain during walking (effect size [ES], 1.97), PPT in the quadriceps (ES, 2.58), and PPT in the tibialis anterior (ES, 2.45). This group also showed significantly improved AROM (ES, 2.01) and proprioception (ES, 1.73-1.89; P proprioception. There were significant differences between the two groups in pain during walking and PPT. In addition, pain during walking showed a significant correlation with AROM and proprioception, and a significant correlation was found between PPT and AROM. These results demonstrated that KT application with proper tension to the quadriceps effectively attenuates various types of pain and improves AROM and proprioception in osteoarthritis patients. Thus, KT may be a suitable intervention to improve pain, AROM, and proprioception in patients with osteoarthritis in clinics.

  8. Does radiography advanced practice improve patient outcomes and health service quality? A systematic review.

    Science.gov (United States)

    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.

  9. Improving farming practices reduces the carbon footprint of spring wheat production.

    Science.gov (United States)

    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.

  10. A Practical Guide for Improving Transparency and Reproducibility in Neuroimaging Research.

    Directory of Open Access Journals (Sweden)

    Krzysztof J Gorgolewski

    2016-07-01

    Full Text Available Recent years have seen an increase in alarming signals regarding the lack of replicability in neuroscience, psychology, and other related fields. To avoid a widespread crisis in neuroimaging research and consequent loss of credibility in the public eye, we need to improve how we do science. This article aims to be a practical guide for researchers at any stage of their careers that will help them make their research more reproducible and transparent while minimizing the additional effort that this might require. The guide covers three major topics in open science (data, code, and publications and offers practical advice as well as highlighting advantages of adopting more open research practices that go beyond improved transparency and reproducibility.

  11. Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

    Science.gov (United States)

    Montano, Maria F; Mehdi, Harshal; Nash, David B

    2016-11-01

    The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting. © The Author(s) 2016.

  12. Practical Recommendations to Improve the Quality of Training and Methodical Support of Professional Teacher Education

    Science.gov (United States)

    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…

  13. A Community of Practice among Educators, Researchers and Scientists for Improving Science Teaching in Southern Mexico

    Science.gov (United States)

    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…

  14. Collaboration in Pennsylvania: Rapidly Spreading Improved Chronic Care for Patients to Practices

    Science.gov (United States)

    Bricker, Patricia L.; Baron, Richard J.; Scheirer, Jorge J.; DeWalt, Darren A.; Derrickson, John; Yunghans, Suzanne; Gabbay, Robert A.

    2010-01-01

    Introduction: Pennsylvania's Improving Performance in Practice (IPIP) program is administered by the Pennsylvania (PA) chapters of the American Academy of Family Physicians, American College of Physicians, and American Academy of Pediatrics. The project has provided coaching, monthly measurement, and patient registry support for 155 primary-care…

  15. Practical measures for improving the ecological state of lake Marken using in depth system knowledge

    NARCIS (Netherlands)

    M. Genseberger (Menno); R. Noordhuis; C.X.O. Thiange; P.M.A. Boderie

    2015-01-01

    htmlabstractFor Lake Marken in the Netherlands, high suspended sediment concentrations result in reduced ecological values and prevent goals and standards from being met (Water Framework Directive, Natura 2000). A practical measure to improve the ecology that is currently studied is the construction

  16. E-learning to Improve Healthcare Professionals' Attitudes and Practices on Breastfeeding.

    Science.gov (United States)

    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.

  17. Use of Mobile Applications for Hospital Discharge Letters - Improving Handover at Point of Practice

    NARCIS (Netherlands)

    Maher, Bridget; Drachsler, Hendrik; Kalz, Marco; Hoare, Cathal; Sorensen, Humphrey; Lezcano, Leonardo; Henn, Pat; Specht, Marcus

    2013-01-01

    Maher, B., Drachsler, H., Kalz, M., Hoare, C., Sorensen, H., Lezcano, L., Henn, P., & Specht, M. (2013). Use of Mobile Applications for Hospital Discharge Letters - Improving Handover at Point of Practice. International Journal of Mobile and Blended Learning, 5(4), 29. IGI Global.

  18. How can I improve my students' ability in doing laboratory practical ...

    African Journals Online (AJOL)

    This action research was aimed at improving students' ability in doing the practical laboratory work and exercising of science process skills. This was because these students show lack of experience in specially handling laboratory materials, chemicals and following scientific processes like observation, data record, ...

  19. Continuous improvement in The Netherlands: a survey-based study into current practices

    NARCIS (Netherlands)

    Middel, H.G.A.; op de Weegh, S.; Gieskes, J.F.B.

    2007-01-01

    Continuous Improvement (CI) is a well-known and consolidated concept in management literature and practice, and is considered vital in today's business environment. In 2003, a survey, which is part of the international CINet survey, was conducted in The Netherlands in order to gain insight into

  20. Improving Professional Development System through Quality Assurance Practices in the Universities of Pakistan

    Science.gov (United States)

    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…

  1. Record of Assessment Moderation Practice (RAMP): Survey Software as a Mechanism of Continuous Quality Improvement

    Science.gov (United States)

    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…

  2. Learning from Local Practices : Improving Student Performance in West Bank and Gaza

    OpenAIRE

    Yarrow, Noah; Abdul-Hamid, Husein; Quota, Manal; Cuadra, Ernesto

    2014-01-01

    The motivation for this study is to contribute to the preparation of the new Palestinian Education Strategy by shedding light on the school and classroom level factors that influence student learning, and to identify good practices that can be generalized from high-performing classrooms to those that need improvement. While most Palestinian children are in school, performance on assessment...

  3. Improvement of best practice in early breast cancer : Actionable surgeon and hospital factors

    NARCIS (Netherlands)

    Gort, Marjan; Broekhuis, Manda; Otter, Rene; Klazinga, Niek S.

    To identify actionable elements for improving best practice, this study examined the relative effects of patient, surgeon and hospital factors on surgical treatment variation of 2,929 early breast cancer patients, diagnosed from January 1998 to January 2002 in the region of the Comprehensive Cancer

  4. Improving EFL Learners' Pronunciation of English through Quiz-Demonstration-Practice-Revision (QDPR)

    Science.gov (United States)

    Moedjito

    2018-01-01

    This study investigates the effectiveness of Quiz-Demonstration-Practice-Revision (QDPR) in improving EFL learners' pronunciation of English. To achieve the goal, the present researcher conducted a one-group pretest-posttest design. The experimental group was selected using a random sampling technique with consideration of the inclusion criteria.…

  5. Practice development plans to improve the primary care management of acute asthma: randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Price David

    2007-04-01

    Full Text Available Abstract Background Our professional development plan aimed to improve the primary care management of acute asthma, which is known to be suboptimal. Methods We invited 59 general practices in Grampian, Scotland to participate. Consenting practices were randomised to early and delayed intervention groups. Practices undertook audits of their management of all acute attacks (excluding children under 5 years occurring in the 3 months preceding baseline, 6-months and 12-months study time-points. The educational programme [including feedback of audit results, attendance at a multidisciplinary interactive workshop, and formulation of development plan by practice teams] was delivered to the early group at baseline and to the delayed group at 6 months. Primary outcome measure was recording of peak flow compared to best/predicted at 6 months. Analyses are presented both with, and without adjustment for clustering. Results 23 consenting practices were randomised: 11 to early intervention. Baseline practice demography was similar. Six early intervention practices withdraw before completing the baseline audit. There was no significant improvement in our primary outcome measure (the proportion with peak flow compared to best/predicted at either the 6 or 12 month time points after adjustment for baseline and practice effects. However, the between group difference in the adjusted combined assessment score, whilst non-significant at 6 months (Early: 2.48 (SE 0.43 vs. Delayed 2.26 (SE 0.33 p = 0.69 reached significance at 12 m (Early:3.60 (SE 0.35 vs. Delayed 2.30 (SE 0.28 p = 0.02. Conclusion We demonstrated no significant benefit at the a priori 6-month assessment point, though improvement in the objective assessment of attacks was shown after 12 months. Our practice development programme, incorporating audit, feedback and a workshop, successfully engaged the healthcare team of participating practices, though future randomised trials of educational

  6. Principles and practices for the restoration of ponderosa pine and dry mixed-conifer forests of the Colorado Front Range

    Science.gov (United States)

    Robert N. Addington; Gregory H. Aplet; Mike A. Battaglia; Jennifer S. Briggs; Peter M. Brown; Antony S. Cheng; Yvette Dickinson; Jonas A. Feinstein; Kristen A. Pelz; Claudia M. Regan; Jim Thinnes; Rick Truex; Paula J. Fornwalt; Benjamin Gannon; Chad W. Julian; Jeffrey L. Underhill; Brett Wolk

    2018-01-01

    Wildfires have become larger and more severe over the past several decades on Colorado’s Front Range, catalyzing greater investments in forest management intended to mitigate wildfire risks. The complex ecological, social, and political context of the Front Range, however, makes forest management challenging, especially where multiple management goals including forest...

  7. Perioperative care map improves compliance with best practices for the morbidly obese.

    Science.gov (United States)

    Solsky, Ian; Edelstein, Alex; Brodman, Michael; Kaleya, Ronald; Rosenblatt, Meg; Santana, Calie; Feldman, David L; Kischak, Patricia; Somerville, Donna; Mudiraj, Santosh; Leitman, I Michael; Shamamian, Peter

    2016-12-01

    Morbid obesity can complicate perioperative management. Best practice guidelines have been published but are typically followed only in bariatric patients. Little is known regarding physician awareness of and compliance with these clinical recommendations for nonbariatric operations. Our study evaluated if an educational intervention could improve physician recognition of and compliance with established best practices for all morbidly obese operatively treated patients. A care map outlining best practices for morbidly obese patients was distributed to all surgeons and anesthesiologists at 4 teaching hospitals in 2013. Pre- and postintervention surveys were sent to participants in 2012 and in 2015 to evaluate changes in clinical practice. A chart audit performed postintervention determined physician compliance with distributed guidelines. In the study, 567 physicians completed the survey in 2012 and 375 physicians completed the survey in 2015. Postintervention, statistically significant improvements were seen in the percentage of surgeons and anesthesiologists combined who reported changing their management of morbidly obese, operatively treated patients to comply with best practices preoperatively (89% vs 59%), intraoperatively (71% vs 54%), postoperatively (80% vs 57%), and overall (88% vs 72%). Results were similar when surgeons and anesthesiologists were analyzed separately. A chart audit of 170 cases from the 4 hospitals found that 167 (98%) cases were compliant with best practices. After care map distribution, the percentage of physicians who reported changing their management to match best practices significantly improved. These findings highlight the beneficial impact this educational intervention can have on physician behavior. Continued investigation is needed to evaluate the influence of this intervention on clinical outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Sustainable practice improvements: impact of the Comprehensive Advanced Palliative Care Education (CAPCE) program.

    Science.gov (United States)

    Harris, Diane; Hillier, Loretta M; Keat, Nancy

    2007-01-01

    This paper describes an education program designed to improve palliative care practice through the development of workplace hospice palliative care resources (PCRs), and its impact on knowledge transfer and longer-term changes to clinical practice. Evaluation methods included pre- and post-program questionnaires, and a survey of learners' (n=301) perceptions of program learning strategies. Interviews (n=21) were conducted with a purposeful sample of PCRs and representatives from their work sites. Ratings of the sessions indicated that they were relevant to learners' clinical practice. At follow up, the majority of learners (83%) continued to serve as PCRs. Many positive effects were identified, including enhanced pain and symptom management, staff education, and development of care policies and guidelines. Management support, particularly the prioritization of palliative care and staff development, were factors facilitating sustained implementation. These findings highlight the importance of multimodal learning strategies and supportive work environments in the development of PCRs to enhance palliative care practice.

  9. Do visits help improve the quality of teaching within undergraduate teaching practices?

    Science.gov (United States)

    Elam, Paul; Scales, Michael; Pearson, David

    2009-11-01

    The Academic Unit of Primary Care (AUPC) at the University of Leeds is responsible for the quality assurance of 79 teaching practices, who contribute 14% of the MBChB clinical placements. We wanted to analyse the effects of visiting undergraduate teaching practices as part of an approach to quality assurance. A survey of 79 practices in Yorkshire revealed a high level of tutor satisfaction with the process and 41% showed evidence of change following the visit. Some qualitative information was elicited from the survey and is used to illustrate examples of change. Our paper looks at the role of practice visits as part of a system of quality assurance and makes further recommendations to improve their focus and effectiveness. The paper is timely given the large increase in primary care placements and the recent discussions about the development of quality criteria for undergraduate medical teaching in the community.

  10. Experiences of practice facilitators working on the Improved Delivery of Cardiovascular Care project: Retrospective case study.

    Science.gov (United States)

    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.

  11. Checklist Model to Improve Work Practices in Small-Scale Demolition Operations with Silica Dust Exposures

    Directory of Open Access Journals (Sweden)

    Paul Succop

    2012-01-01

    Full Text Available A systematic approach was developed to review, revise and adapt existing exposure control guidance used in developed countries for use in developing countries. One-page employee and multiple-page supervisor guidance sheets were adapted from existing documents using a logic framework and workers were trained to use the information to improve work practices. Interactive, hands-on training was delivered to 26 workers at five small-scale demolition projects in Maputo City, Mozambique, and evaluated. A pre-and-post walkthrough survey used by trained observers documented work practice changes. Worker feedback indicated that the training was effective and useful. Workers acquired knowledge (84% increase, p < 0.01 and applied the work practice guidance. The difference of proportions between use of work practice components before and after the intervention was statistically significant (p < 0.05. Changes in work practices following training included preplanning, use of wet methods and natural ventilation and end-of-task review. Respirable dust measurements indicated a reduction in exposure following training. Consistency in observer ratings and observations support the reliability and validity of the instruments. This approach demonstrated the short-term benefit of training in changing work practices; follow-up is required to determine the long-term impact on changes in work practices, and to evaluate the need for refresher training.

  12. Best Practices for Chemotherapy Administration in Pediatric Oncology: Quality and Safety Process Improvements (2015).

    Science.gov (United States)

    Looper, Karen; Winchester, Kari; Robinson, Deborah; Price, Andrea; Langley, Rachel; Martin, Gina; Jones, Sally; Holloway, Jodi; Rosenberg, Susanne; Flake, Susan

    2016-01-01

    The administration of chemotherapy to children with cancer is a high-risk process that must be performed in a safe and consistent manner with high reliability. Clinical trials play a major role in the treatment of children with cancer; conformance to chemotherapy protocol requirements and accurate documentation in the medical record are critical. Inconsistencies in the administration and documentation of chemotherapy were identified as opportunities for errors to occur. A major process improvement was initiated to establish best practices for nurses who administer chemotherapy to children. An interdisciplinary team was formed to evaluate the current process and to develop best practices based on current evidence, protocol requirements, available resources, and safety requirements. The process improvement focused on the establishment of standardized and safe administration techniques, exact administration times, and consistent electronic documentation that could easily be retrieved in medical record audits. Quality improvement tools including SBAR (Situation, Background, Assessment, Recommendation), process mapping, PDSA (Plan, Do. Study, Act) cycles, and quality metrics were used with this process improvement. The team established best practices in chemotherapy administration to children that have proven to be safe and reliable. Follow-up data have demonstrated that the project was highly successful and improved accuracy, patient and nurse safety, and effectiveness of chemotherapy administration. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

  13. Water Governance in England: Improving Understandings and Practices through Systemic Co-Inquiry

    Directory of Open Access Journals (Sweden)

    Natalie Foster

    2016-11-01

    Full Text Available In 2015, water governance in England finds itself part way through perhaps the most significant changes since the privatisation of the water industry in 1989. Each of the changes is a response to the specific challenges that fall within the realm of improving water governance. However, they also raise many questions: How will the changes play out in practice? Will they work together to form a coherent ’whole’? Can collaborative and competitive approaches really co-exist? This research aims to engage researchers, policy-makers and practitioners in a systemic co-inquiry in order to improve understandings and practices in relation to water governance in England. The two workshops undertaken as part of the research focused on the current and future water governance situation in England, respectively. The findings from the workshops demonstrate that the systemic co-inquiry process generally proved very successful and useful for this group of stakeholders. The workshops provided the opportunity for participants to share, explore and challenge their ideas, knowledge and experiences in water governance; and in doing so, they brought about shared understandings, revealed new insights and identified concerted actions to improve (transform water governance. However, it is recognised that whilst significant progress has been made towards improving understanding and practices in relation to water governance in England, there is still further work required in order to implement these improvements on a local, national or global scale.

  14. Deliberate practice improves pediatric residents' skills and team behaviors during simulated neonatal resuscitation.

    Science.gov (United States)

    Cordero, Leandro; Hart, Brandon J; Hardin, Rene; Mahan, John D; Nankervis, Craig A

    2013-08-01

    To evaluate the skills and team behavior of pediatric residents during resuscitation with a high-fidelity mannequin before and after a deliberate practice intervention. Each month residents participate in two 90-minute videorecorded sessions (2-3 weeks apart) in an "off-site" delivery room during their neonatal ICU rotation. Teams responded to a scenario that required 5 skills (positive pressure ventilation, chest compressions, endotracheal intubation, umbilical vein catheterization, and epinephrine administration). Skills were scored for technique and timeliness and team behaviors for communication, management, and leadership. A 2-hour focused intervention was given between sessions. In all, 33 residents (11 teams) completed the sessions. Gaps in procedural skills noted during the first session were corrected. Timeliness for completion of skills remained below expectations. Improvements in team behaviors were noted. Deliberate practice improved procedural skills and team performance. Lack of improvement in timeliness suggests that a different educational paradigm is required.

  15. Convergent evolution toward an improved growth rate and a reduced resistance range in Prochlorococcus strains resistant to phage.

    Science.gov (United States)

    Avrani, Sarit; Lindell, Debbie

    2015-04-28

    Prochlorococcus is an abundant marine cyanobacterium that grows rapidly in the environment and contributes significantly to global primary production. This cyanobacterium coexists with many cyanophages in the oceans, likely aided by resistance to numerous co-occurring phages. Spontaneous resistance occurs frequently in Prochlorococcus and is often accompanied by a pleiotropic fitness cost manifested as either a reduced growth rate or enhanced infection by other phages. Here, we assessed the fate of a number of phage-resistant Prochlorococcus strains, focusing on those with a high fitness cost. We found that phage-resistant strains continued evolving toward an improved growth rate and a narrower resistance range, resulting in lineages with phenotypes intermediate between those of ancestral susceptible wild-type and initial resistant substrains. Changes in growth rate and resistance range often occurred in independent events, leading to a decoupling of the selection pressures acting on these phenotypes. These changes were largely the result of additional, compensatory mutations in noncore genes located in genomic islands, although genetic reversions were also observed. Additionally, a mutator strain was identified. The similarity of the evolutionary pathway followed by multiple independent resistant cultures and clones suggests they undergo a predictable evolutionary pathway. This process serves to increase both genetic diversity and infection permutations in Prochlorococcus populations, further augmenting the complexity of the interaction network between Prochlorococcus and its phages in nature. Last, our findings provide an explanation for the apparent paradox of a multitude of resistant Prochlorococcus cells in nature that are growing close to their maximal intrinsic growth rates.

  16. Nursing clinical practice changes to improve self-management in chronic obstructive pulmonary disease.

    Science.gov (United States)

    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.

  17. Overcoming early barriers to PCMH practice improvement in family medicine residencies.

    Science.gov (United States)

    Fernald, Douglas H; Deaner, Nicole; O'Neill, Caitlin; Jortberg, Bonnie T; degruy, Frank Verloin; Dickinson, W Perry

    2011-01-01

    Residency programs face inevitable challenges as they redesign their practices for higher quality care and resident training. Identifying and addressing early barriers can help align priorities and thereby augment the capacity to change. Evaluation of the Colorado Family Medicine Residency PCMH Project included iterative qualitative analysis of field notes, interviews, and documents to identify early barriers to change and strategies to overcome them. Nine common but not universal barriers were identified: (1) a practice's history reflected some negative past experiences with quality improvement or routines incompatible with transformative change, (2) leadership gaps were evident in unprepared practice leaders or hierarchical leadership, (3) resistance and skepticism about change were expressed through cynicism aimed at change or ability to change, (4) unproductive team processes were reflected in patterns of canceled meetings, absentee leaders, or lack of accountability, (5) knowledge gaps about the Patient-centered Medical Home (PCMH) were apparent from incomplete dissemination about the project or planned changes, (6) EHR implementation distracted focus or stalled improvement activity, (7) sponsoring organizations' constraints emerged from staffing rules and differing priorities, (8) insufficient staff participation resulted from traditional role expectations and structures, and (9) communication was hampered by ineffective methods and part-time faculty and residents. Early barriers responded to varying degrees to specific interventions by practice coaches. Some barriers that interfere with practices getting started with cultural and structural transformation can be addressed with persistent attention and reflection from on-site coaches and by realigning the talents, leaders, and priorities already in these residency programs.

  18. A collaborative approach to standards, practices. Setting the stage for continuous quality improvement.

    Science.gov (United States)

    Krueger, N E; Mazuzan, J E

    1993-02-01

    In retrospect, the most important thing we did was work together. We analyzed, refined, and validated our philosophical approach to patient care. We provided an information data base that is readily available for on-the-job reference and serves as a starting point for CQI activities. The very act of joint documentation of practices encourages open discussions about improvements to patient care. One physician states, We know that flaws in the process through which we produce care are everywhere--waste, duplication of effort, unnecessary complexity, and unpredictability . . . I believe that modern total quality management offers enormous hope to a medical care field that is rather desperate. . . . Collaborative practice and CQI activities are one hope. The scope of what nurses and physicians traditionally consider when discussing standards and practices must widen. We should no longer look only at patient care. We must simultaneously focus on how the management of total systems influences quality care for all patients. The CQI process, a proactive method, requires an accurate data base of information that is easily retrieved when looking for systems and individual patient care improvements. Our Computerized Collaborative Standards and Practices Manual is the reservoir for documenting practice plans developed and approved by all the disciplines involved. The process described here began with two closely knit operating room disciplines; this framework, however, offers the potential for expansion into a hospital-wide system of information organization and use.

  19. Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review.

    Science.gov (United States)

    Solomons, Nan M; Spross, Judith A

    2011-01-01

    The purpose of the present study is to examine the barriers and facilitators to evidence-based practice (EBP) using Shortell's framework for continuous quality improvement (CQI). EBP is typically undertaken to improve practice. Although there have been many studies focused on the barriers and facilitators to adopting EBP, these have not been tied explicitly to CQI frameworks. CINAHL, Academic Search Premier, Medline, Psych Info, ABI/Inform and LISTA databases were searched using the keywords: nurses, information literacy, access to information, sources of knowledge, decision making, research utilization, information seeking behaviour and nursing practice, evidence-based practice. Shortell's framework was used to organize the barriers and facilitators. Across the articles, the most common barriers were lack of time and lack of autonomy to change practice which falls within the strategic and cultural dimensions in Shortell's framework. Barriers and facilitators to EBP adoption occur at the individual and institutional levels. Solutions to the barriers need to be directed to the dimension where the barrier occurs, while recognizing that multidimensional approaches are essential to the success of overcoming these barriers. The findings of the present study can help nurses identify barriers and implement strategies to promote EBP as part of CQI. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

  20. Framework and implementation for improving physics essential skills via computer-based practice: Vector math

    Science.gov (United States)

    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.

  1. More black box to explore: how quality improvement collaboratives shape practice change.

    Science.gov (United States)

    Shaw, Eric K; Chase, Sabrina M; Howard, Jenna; Nutting, Paul A; Crabtree, Benjamin F

    2012-01-01

    Quality improvement collaboratives (QICs) are used extensively to promote quality improvement in health care. Evidence of their effectiveness is limited, prompting calls to "open up the black box" to better understand how and why such collaboratives work. We selected a cohort of 5 primary care practices that participated in a 6-month intervention study aimed at improving colorectal cancer screening rates. Using an immersion/crystallization technique, we analyzed qualitative data that included audio recordings and field notes of QICs and practice-based team meetings. Three themes emerged from our analysis: (1) practice staff became empowered through and drew on the QICs to advance change efforts in the face of leader/physician resistance; (2) a mix of content and media in the QIC program was important for reaching all participants; (3) resources offered at the QIC did little to spur practice change efforts. QICs offer a potentially powerful way of disseminating health care innovations through enhanced strategies for learning and change. Creating collaborative environments in which diverse participants learn, listen, reflect, and share together can enable them to take back to their own organizations key messages and change strategies that benefit them the most.

  2. More Black Box to Explore: How Quality Improvement Collaboratives Shape Practice Change

    Science.gov (United States)

    Shaw, Eric K.; Chase, Sabrina M.; Howard, Jenna; Nutting, Paul; Crabtree, Benjamin F.

    2012-01-01

    Background Quality improvement collaboratives (QICs) are used extensively to promote quality improvement in healthcare. Evidence of their effectiveness is limited, prompting calls to open up the ‘black box’ to better understand how and why such collaboratives work. Methods We selected a cohort of five primary care practices that participated in a six-month intervention study aimed at improving colorectal cancer screening rates. Using an immersion/crystallization technique, we analyzed qualitative data which included audio-recordings and fieldnotes of QICs and practice-based team meetings. Results Three themes emerged from our analysis. 1) Practice staff became empowered through and drew on the QICs to advance change efforts in the face of leader/physician resistance. 2) A mix of content and media in a QIC program was important for reaching all participants. 3) Resources offered at the QIC did little to spur practice change efforts. Discussion QICs offer a potentially powerful way of disseminating healthcare innovations through enhanced strategies for learning and change. Creating collaborative environments where diverse participants learn, listen, reflect, and share together can enable them to take key messages and change strategies back to their own organizations that benefit them the most. PMID:22403195

  3. Demographics and practices of semi-intensive free-range farming systems in Australia with an outdoor stocking density of ≤1500 hens/hectare.

    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.

  4. Empowering European communities to improve natural resource management for human well-being: the OPPLA web portal & communities of practice

    Science.gov (United States)

    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.

  5. Cluster randomized, controlled trial on patient safety improvement in general practice: a study protocol

    Science.gov (United States)

    2013-01-01

    Background An open, constructive safety culture is key in healthcare since it is seen as a main condition for patient safety. Studies have examined culture improvement strategies in hospitals. In primary care, however, not much is known about effective strategies to improve the safety culture yet. The purpose of this study is to examine the effect of two patient safety culture interventions: a patient safety culture questionnaire solely, the SCOPE, or the SCOPE questionnaire combined with a patient safety workshop. The purpose of this paper is to describe the rationale and design of this trial. Methods/design The SCOPE Intervention Study is a cluster randomized, three-armed controlled trial, that will be conducted in 30 general practices in the Netherlands. Ten practices in the first intervention arm will complete the SCOPE questionnaire and are expected to draw and implement their own improvement initiatives based on a computerised feedback report. In the second intervention arm, staff of the ten practices also will be asked to complete the SCOPE questionnaire and in addition will be given a complementary workshop. This workshop is theoretical and interactive, educating staff and facilitating discussion, leading to a practice specific action plan for patient safety improvement. The results of the SCOPE questionnaire are incorporated in the workshop. The ten practices in the control arm continue care as usual. Baseline and follow-up measurements will be conducted with an implementation period of one year. The primary outcome will include the number of incidents reported and secondary several quality and safety indicators and the patient safety culture. Moreover, interviews will be conducted at follow-up to evaluate the implementation process of the intervention. Discussion Results of this study will give insight in the effect of administering a culture questionnaire or the questionnaire with a complementary workshop. This knowledge will aid implementation of

  6. Cholera vaccination campaign contributes to improved knowledge regarding cholera and improved practice relevant to waterborne disease in rural Haiti.

    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.

  7. Cholera vaccination campaign contributes to improved knowledge regarding cholera and improved practice relevant to waterborne disease in rural Haiti.

    Science.gov (United States)

    Aibana, Omowunmi; Franke, Molly F; Franke, Molly; Teng, Jessica E; Teng, Jessica; Hilaire, Johanne; Raymond, Max; Ivers, Louise C

    2013-11-01

    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.

  8. Cholera Vaccination Campaign Contributes to Improved Knowledge Regarding Cholera and Improved Practice Relevant to Waterborne Disease in Rural Haiti

    Science.gov (United States)

    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

  9. Improving personal voice in academic writing: an action inquiry using self-reflective practice

    OpenAIRE

    Logan, Anna

    2012-01-01

    This paper describes the author’s experience of using self-reflective practice within an action inquiry in order to improve both her personal practice in engaging in academic writing and her work as a teacher educator. As such, the study could be viewed as an example of simultaneous first- and second-person action inquiry. The focus is on the expression of the author’s voice in academic writing with speciflc reference to the use of the passive and active voice and the first person pronoun ‘I’...

  10. 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.

  11. IMPROVING ENGLISH IMPLICIT GRAMMAR KNOWLEDGE USING SEMANTICO-SYNTACTIC TRANSLATION PRACTICE

    Directory of Open Access Journals (Sweden)

    Futuh Handoyo

    2010-08-01

    Full Text Available The present was to respond to the students’ low implicit grammar knowledge and, therefore, was concerned with its improvement. The subjects of the study were twenty six students of the first semester accounting students of State Polytechnic of Malang. The strategy used was semantico-syntactic translation practice, which proceeded through three main stages: upgrading their explicit grammar knowledge followed by internalizing the knowledge into explicit grammar knowledge, and testing the result. The result showed that the determined goal was reached in fifteen meetings within one cycle with some extra meetings for oral internalization practice.

  12. Improving low-wage, midsized employers' health promotion practices: a randomized controlled trial.

    Science.gov (United States)

    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

  13. Current Practices of Measuring and Reference Range Reporting of Free and Total Testosterone in the United States.

    Science.gov (United States)

    Le, Margaret; Flores, David; May, Danica; Gourley, Eric; Nangia, Ajay K

    2016-05-01

    The evaluation and management of male hypogonadism should be based on symptoms and on serum testosterone levels. Diagnostically this relies on accurate testing and reference values. Our objective was to define the distribution of reference values and assays for free and total testosterone by clinical laboratories in the United States. Upper and lower reference values, assay methodology and source of published reference ranges were obtained from laboratories across the country. A standardized survey was reviewed with laboratory staff via telephone. Descriptive statistics were used to tabulate results. We surveyed a total of 120 laboratories in 47 states. Total testosterone was measured in house at 73% of laboratories. At the remaining laboratories studies were sent to larger centralized reference facilities. The mean ± SD lower reference value of total testosterone was 231 ± 46 ng/dl (range 160 to 300) and the mean upper limit was 850 ± 141 ng/dl (range 726 to 1,130). Only 9% of laboratories where in-house total testosterone testing was performed created a reference range unique to their region. Others validated the instrument recommended reference values in a small number of internal test samples. For free testosterone 82% of laboratories sent testing to larger centralized reference laboratories where equilibrium dialysis and/or liquid chromatography with mass spectrometry was done. The remaining laboratories used published algorithms to calculate serum free testosterone. Reference ranges for testosterone assays vary significantly among laboratories. The ranges are predominantly defined by limited population studies of men with unknown medical and reproductive histories. These poorly defined and variable reference values, especially the lower limit, affect how clinicians determine treatment. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  14. Practice makes perfect: familiarity of task determines success in solvable tasks for free-ranging dogs (Canis lupus familiaris).

    Science.gov (United States)

    Bhattacharjee, Debottam; Dasgupta, Sandipan; Biswas, Arpita; Deheria, Jayshree; Gupta, Shreya; Nikhil Dev, N; Udell, Monique; Bhadra, Anindita

    2017-07-01

    Domestic dogs' (Canis lupus familiaris) socio-cognitive faculties have made them highly sensitive to human social cues. While dogs often excel at understanding human communicative gestures, they perform comparatively poorly in problem-solving and physical reasoning tasks. This difference in their behaviour could be due to the lifestyle and intense socialization, where problem solving and physical cognition are less important than social cognition. Free-ranging dogs live in human-dominated environments, not under human supervision and are less socialized. Being scavengers, they often encounter challenges where problem solving is required in order to get access to food. We tested Indian street dogs in familiar and unfamiliar independent solvable tasks and quantified their persistence and dependence on a novel human experimenter, in addition to their success in solving a task. Our results indicate that free-ranging dogs succeeded and persisted more in the familiar task as compared to the unfamiliar one. They showed negligible amount of human dependence in the familiar task, but showed prolonged gazing and considerable begging behaviour to the human experimenter in the context of the unfamiliar task. Cognitive abilities of free-ranging dogs thus play a pivotal role in determining task-associated behaviours based on familiarity. In addition to that, these dogs inherently tend to socialize with and depend on humans, even if they are strangers. Our results also illustrate free-ranging dogs' low competence at physical cognitive tasks.

  15. Practical Wide-speed-range Sensorless Control System for Permanent Magnet Reluctance Synchronous Motor Drives via Active Flux Model

    DEFF Research Database (Denmark)

    Ancuti, Mihaela Codruta; Tutelea, Lucian; Andreescu, Gheorghe-Daniel

    2014-01-01

    This article introduces a control strategy to obtain near-maximum available torque in a wide speed range with sensorless operation via the active flux concept for permanent magnet-reluctance synchronous motor drives. A new torque dq current reference calculator is proposed, with reference torque...

  16. Learning to teach: how a formal teaching qualification improved our practice.

    Science.gov (United States)

    Lipczynska, Sonya; Crowley, Clare

    2015-09-01

    In this article, guest writers Sonya Lipczynska and Clare Crowley from King's College London discuss the learning that occurred when they undertook a Postgraduate Certificate in Academic Practice in Higher Education (PGCAPHE). In particular, they identify how their exploration of relevant learning and teaching theory on the course helped them to evaluate their library instruction teaching practice with medical and dental students. They highlight how they made changes and improvements to the delivery of these sessions based on greater consideration of inclusivity and the characteristics of both individuals and broader student groups. They also discuss the successes of new teaching practices that they experimented with, and reflect on how they have developed as educators as a result of this. H.S. © 2015 Health Libraries Group.

  17. Improving ethical and participatory practice for marginalized populations in biomedical HIV prevention trials: lessons from Thailand.

    Science.gov (United States)

    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

  18. Improving ethical and participatory practice for marginalized populations in biomedical HIV prevention trials: lessons from Thailand.

    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

  19. 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.

  20. Using Statistical Process Control to Drive Improvement in Neonatal Care: A Practical Introduction to Control Charts.

    Science.gov (United States)

    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.

  1. Retrieval practice improves memory in survivors of severe traumatic brain injury.

    Science.gov (United States)

    Sumowski, James F; Coyne, Julia; Cohen, Amanda; Deluca, John

    2014-02-01

    To investigate whether retrieval practice (RP) improves delayed recall after short and long delays in survivors of severe traumatic brain injury (TBI) relative to massed restudy (MR) and spaced restudy (SR). 3(learning condition: MR, SR, RP)×2(delayed recall: 30min, 1wk) within-subject experiment. Nonprofit medical rehabilitation research center. Memory-impaired (memory impairment engenders confidence that this strategy would work outside the laboratory to improve memory in real-life settings. Future randomized controlled trials of RP training are needed. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  2. 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.

  3. 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.

  4. Direct mail improves knowledge of basic life support guidelines in general practice: a randomised study.

    Science.gov (United States)

    Secher, Niels; Mikkelsen, Mette Marie; Adelborg, Kasper; Mikkelsen, Ronni; Grove, Erik Lerkevang; Rubak, Jens Mørch; Vedsted, Peter; Løfgren, Bo

    2012-10-14

    Implementation of new guidelines into clinical practice is often incomplete. Direct mail is a simple way of providing information to physicians and may improve implementation of new guidelines on basic life support (BLS). The aim of this study was to describe knowledge of the most recent European Resuscitation Council (ERC) Guidelines for BLS among general practitioners (GPs) and investigate whether direct mail improves theoretical knowledge of these guidelines. All general practice clinics (n=351) in Central Denmark Region were randomised to receive either direct mail (intervention) or no direct mail (control). The direct mail consisted of the official ERC BLS/AED poster and a cover letter outlining changes in compression depth and frequency in the new guidelines. In general practice clinics randomised to intervention, every GP received a direct mail addressed personally to him/her. Two weeks later, a multiple-choice questionnaire on demographics and BLS guidelines were mailed to GPs in both groups. In total, 830 GPs were included in this study (direct mail, n=408; control, n=422). The response rate was 58%. The majority (91%) of GPs receiving direct mail were familiar with BLS Guidelines 2010 compared to 72% in the control group (Pguidelines and thus facilitated the implementation of this knowledge into clinical practice. Resuscitation councils and medical societies may consider using direct mail as a simple strategy to facilitate implementation of changes in clinical guidelines.

  5. Art Educational Practices: Fostering Self-Control and Improving Focus for Students Coping with Anxiety

    Science.gov (United States)

    Ogle, Alexandra

    2013-01-01

    This action research study served to help students suffering from anxiety or anxiety related issues by using Art as a means of improving focus and fostering self control. The student participants in this study were a group of 25 sophomore and junior high school students, both male and female, ranging between the ages of 15-17. The participants…

  6. Can Applying Organic and Industry Best Practices Improve Foreign Military Sales Supportability

    Science.gov (United States)

    2009-10-01

    Publication of the Defense Acquisition University www.dau.mil and using Federal Express, United Parcel Service, or DHL International as a source for...the FMS customer , this could create a cyclical process where the FMS customer returns to request either an increase of systems or other available...by the international customer ; 2) take advantage of potential initiatives and existing best business practices; and 3) improve life cycle support

  7. Walking Exercise in Water Improving Practical Ambulation in a Patient with Chronic Cerebellar Ataxia

    OpenAIRE

    池永, 康規; 豊田, 多喜子; 八幡, 徹太郎; 染矢, 富士子; 立野, 勝彦

    2002-01-01

    The specific effect of general dynamic water exercise in 41 year-old woman with chronic cerebellar ataxia induced by meningitis was observed. She was conservatively treated and took bed rest for two weeks, and she suffered from severe dynamic and static ataxia. And exercise under weight-bearing and bandage pressure and Frenkel exercise was applied for nine months. However her disability was not improved. And then she took a 30-minute walking practice in water twice weekly. After that training...

  8. American Organization of Nurse Executives Care Innovation and Transformation program: improving care and practice environments.

    Science.gov (United States)

    Oberlies, Amanda Stefancyk

    2014-09-01

    The American Organization of Nurse Executives conducted an evaluation of the hospitals participating in the Care Innovation and Transformation (CIT) program. A total of 24 hospitals participated in the 2-year CIT program from 2012 to 2013. Reported outcomes include increased patient satisfaction, decreased falls, and reductions in nurse turnover and overtime. Nurses reported statistically significant improvements in 4 domains of the principles and elements of a healthful practice environment developed by the Nursing Organizations Alliance.

  9. Probabilistic Requirements (Partial) Verification Methods Best Practices Improvement. Variables Acceptance Sampling Calculators: Empirical Testing. Volume 2

    Science.gov (United States)

    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.

  10. Standardized practice design with electronic support mechanisms for surgical process improvement: reducing mechanical ventilation time.

    Science.gov (United States)

    Cook, David J; Pulido, Juan N; Thompson, Jeffrey E; Dearani, Joseph A; Ritter, Matthew J; Hanson, Andrew C; Borah, Bijan J; Habermann, Elizabeth B

    2014-12-01

    Hospital surgical care is complex and subject to unwarranted variation. As part of a multiyear effort, we sought to reduce variability in intraoperative care and management of mechanical ventilation in cardiac surgery. We identified a patient population whose care could be standardized and implemented a protocol-based practice model reinforced by electronic mechanisms. In a large cardiac surgery practice, we built a standardized practice model between 2009 and 2011. We compared mechanical ventilation time before (2008) and after (2012) implementation. To ensure groups were comparable, propensity analysis matched patients from the 2 operative years. In 2012, more than 50% of all cardiac surgical patients were managed with our standardized care model; of those, 769 were one-to-one matched with patients undergoing surgery in 2008. Patients had a mix of coronary artery bypass grafting, valve surgery, and combined procedures. Our practice model reduced median mechanical ventilation duration from 9.3 to 6.3 hours (2008 and 2012) (P Variability in ventilation time was also reduced. We demonstrate that in more than 50% of all cardiac surgical patients, a standardized practice model can be used to achieve better results. Clinical outcomes are improved and unwarranted variability is reduced. Success is driven by clear patient identification and well-defined protocols that are clearly communicated both by electronic tools and by empowerment of bedside providers to advance care when clinical criteria are met.

  11. Nurses Improving Care for Healthsystem Elders – a model for optimising the geriatric nursing practice environment

    Science.gov (United States)

    Capezuti, Elizabeth; Boltz, Marie; Cline, Daniel; Dickson, Victoria Vaughn; Rosenberg, Marie-Claire; Wagner, Laura; Shuluk, Joseph; Nigolian, Cindy

    2012-01-01

    Aims and objectives To explain the relationship between a positive nurse practice environment (NPE) and implementation of evidence-based practices. To describe the components of NICHE (Nurses Improving Care for Healthsystem Elders) programmes that contribute to a positive geriatric nursing practice environment. Background The NPE is a system-level intervention for promoting quality and patient safety; however, there are population-specific factors that influence the nurses’ perception of their practice and its’ relationship with patient outcomes. Favourable perceptions of the geriatric-specific NPE are associated with better perceptions of geriatric care quality. Designs Discursive paper. Method In this selective critical analysis of the descriptive and empirical literature, we present the implementation of geriatric models in relation to the NPE and components of the NICHE programme that support hospitals’ systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice. Results Although there are several geriatric models and chronic care models available, NICHE has been the most successful in recruiting hospital membership as well as contributing to the depth of geriatric hospital programming. Conclusions Although all geriatric care models require significant nursing input, only NICHE focuses on the nursing staff’s perception of the care environment for geriatric practice. Studies in NICHE hospitals demonstrate that quality geriatric care requires a NPE in which the structure and processes of hospital services focus on specific patient care needs. Relevance to clinical practice The implementation of evidence-based models addressing the unique needs of hospitalised older adults requires programmes such as NICHE that serve as technical resources centre and a catalyst for networking among facilities committed to quality geriatric care. Unprecedented international growth in the ageing population compels us to examine how

  12. Participative leadership practice in junior high schools and actions to improve the practice : a case study of Sekyere south district, Ghana

    OpenAIRE

    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...

  13. Managing boundaries in primary care service improvement: a developmental approach to communities of practice.

    Science.gov (United States)

    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

  14. Managing boundaries in primary care service improvement: A developmental approach to communities of practice

    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

  15. Critique and Contribute: A Practice-Based Framework for Improving Critical Data Studies and Data Science.

    Science.gov (United States)

    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

  16. Deliberate Learning in Health Care: The Effect of Importing Best Practices and Creative Problem Solving on Hospital Performance Improvement

    Science.gov (United States)

    Nembhard, Ingrid M.; Cherian, Praseetha; Bradley, Elizabeth H.

    2015-01-01

    This article examines the effect on quality improvement of two common but distinct approaches to organizational learning: importing best practices (an externally oriented approach rooted in learning by imitating others’ best practices) and internal creative problem solving (an internally oriented approach rooted in learning by experimenting with self-generated solutions). We propose that independent and interaction effects of these approaches depend on where organizations are in their improvement journey – initial push or later phase. We examine this contingency in hospitals focused on improving treatment time for patients with heart attacks. Our results show that importing best practices helps hospitals achieve initial phase but not later phase improvement. Once hospitals enter the later phase of their efforts, however, significant improvement requires creative problem solving as well. Together, our results suggest that importing best practices delivers greater short-term improvement, but continued improvement depends on creative problem solving. PMID:24876100

  17. Improving skills development in residency using a deliberate-practice and learner-centered model.

    Science.gov (United States)

    Bhatti, Nasir I; Ahmed, Aadil

    2015-10-01

    Work-hour restrictions, increased workload, and subjective assessment of competency are major threats to the efficacy of the traditional apprenticeship model of surgical training in modern surgical practice. In response, medical educators are developing time- and resource-efficient competency-based models of surgical training. The purpose of our project was to develop, implement, and measure the outcomes of such objective and structured programs in otolaryngology. We also investigated factors affecting the learning curve, especially deliberate practice, formative feedback, and learners' autonomy. Prospective, longitudinal study. To measure the surgical skills of residents, we first developed and tested objective tools for otolaryngology procedures. Based on these instruments, we identified milestones of the procedures. Training on a virtual-reality simulator was validated to shorten the learning curve. We also studied a learner-centered approach of training, factors affecting the learning curve, and barriers to a competency-based model. The objective tools were found to be a feasible, reliable, and valid opportunity for measuring competency in both the laboratory and operating room. With the formative assessment from these tools, residents had a remediation target to be achieved by deliberate practice. The milestones helped identify the threshold of competency, and deliberate practice on the simulator gave an opportunity for improving skills. The learner-centered approach allowed flexibility and personalized learning by shifting the responsibility of the learning process to the learners. The competency-based model of residency, based on the principles of deliberate practice and a learner-centered approach, is a feasible model of residency training that allows development of competent surgeons and hence improves patient outcomes. Despite these advantages, challenges to this model require a concerted effort to overcome and fully implement these principles of training

  18. Continous quality improvement of perfusion practice: the role of electronic data collection and statistical control charts.

    Science.gov (United States)

    Baker, R A; Newland, R F

    2008-01-01

    In-hospital data collection may be used to improve the selection, operative techniques, and process of care for cardiac surgical patients. The aim of this report is to demonstrate the influence of the automated generation of quality indicators (QI) for cardiopulmonary bypass (CPB) and the implementation of a continuous quality improvement (CQI) programme on the CPB process of care. Adult patients undergoing CPB were divided into three consecutive groups: Group 1 (n = 363); no QI data feedback, Group 2 (n = 253); automated QI data feedback alone, and Group 3 (n = 363) data feedback and implementation of CQI. There were no significant differences in demographic, procedural or clinical outcomes for each group. Significant improvement, as determined by adherence to practice protocols and reduction in practice variation, was observed for cardiac index 37.5 degrees C (min), minimum pCO2 (mmHg), maximum pCO2 (mmHg), and minimum pO2 (mmHg). There was no change in the minimum haemoglobin (g/dl) on bypass. Automated generation of QI resulted in improved adherence to process of care guidelines, highlighting the potential of electronic data collection. This technique is optimised in a CQI programme, utilising statistical control charts for data interpretation.

  19. Improving care for advanced COPD through practice change: Experiences of participation in a Canadian spread collaborative.

    Science.gov (United States)

    Verma, Jennifer Y; Amar, Claudia; Sibbald, Shannon; Rocker, Graeme M

    2017-01-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of death, morbidity, and health-care spending. The Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ has proved highly beneficial for patients and the health-care system. With direct investment of ratings, and open-ended questions. The qualitative evaluation entailed key informant interviews and focus groups undertaken between February and April 2016 post-collaborative. Teams reported that the year-long QIC helped bring focus to a needed, though often overlooked area of improvement, facilitating innovation spread. They report examples of new work practices as well as unanticipated cultural change (given the short QIC time frame). Most teams gained new skills in quality improvement (QI) and evidence-based medicine, showing progress in their ability to measure and implement COPD care improvements. Teams felt networking with other teams across the country toward a common solution as well as learning from a team of clinical innovators and evidence-based innovation were critical to their success. Factors affecting sustainability included local leadership support, involvement of frontline clinicians, and sharing milestones to motivate continued QI. The INSPIRED QIC enabled teams across Canada to adapt and implement a new COPD care model for high users of health-care with rapid improvements to work practices, cultural change, and skill sets, and at relatively low cost.

  20. Childhood obesity: Can electronic medical records customized with clinical practice guidelines improve screening and diagnosis?

    Science.gov (United States)

    Saviñon, Carla; Taylor, Julie Smith; Canty-Mitchell, Janie; Blood-Siegfried, Jane

    2012-08-01

    The purpose of this project was to determine if customization of the electronic medical record (EMR) using evidence-based practice guidelines developed by the National Association of Pediatric Nurse Practitioners and the Expert Panel recommendations for the prevention, screening, and treatment of childhood and adolescent overweight and obesity would improve the rate of screening and diagnosis of obesity in children, 7 to 18 years of age. A retrospective review of encounters before and after implementation of customized EMR was conducted in a community health center. Data collected were compared for documentation of body mass index (BMI), completion of growth charts, scoring of risk questionnaire, and diagnosis of overweight or obesity. There was a clear increase in the frequency of recording BMI, completing BMI growth charts, and scoring questionnaires between written and electronic medical records. The number of children diagnosed with overweight or obesity increased with customized EMR but still remains well below the rates of obesity for this community. Customizing EMR with clinical practice guidelines improved adherence to recommendations for screening and identification of childhood overweight and obesity. Increased recognition and diagnosis will lead to improved interventions and improve outcomes for childhood obesity. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

  1. Electro- and Heat Transfer in Cd_{0.22}Hg_{0.78} Te Single Crystals in the Temperature Range of Their Practical Applications

    Science.gov (United States)

    Bessmolniy, Yu. V.; Khadzhaj, G. Ya.; Beletskii, V. I.; Rokhmistrov, D. V.; Vovk, R. V.; Goulatis, I. L.; Chroneos, A.

    2018-01-01

    The thermal and electrical conductivity of a single-crystal Cd_{0.22}Hg_{0.78}Te was studied in the temperature range of practical applications (77-300 K). The sample has impurity conductivity, which is limited by the scattering of charge carriers by phonons. Heat in the sample is transferred by phonons and thermal conductivity is limited by phonon-phonon scattering. The electron contribution to the thermal conductivity can be neglected.

  2. Regular, brief mindfulness meditation practice improves electrophysiological markers of attentional control

    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

  3. Improving surgical site infection prevention practices through a multifaceted educational intervention.

    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.

  4. Quality improvement practices to institutionalize supply chain best practices for iCCM: Evidence from Rwanda and Malawi.

    Science.gov (United States)

    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.

  5. 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.

  6. Is the ecosystem service concept improving impact assessment? Evidence from recent international practice

    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.

  7. Adoption of JMM practices - A key to performance improvement of a local automotive industry

    Science.gov (United States)

    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.

  8. Demographics and practices of semi-intensive free-range farming systems in Australia with an outdoor stocking density of ≤1500 hens/hectare.

    Science.gov (United States)

    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 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.

  9. Improving farming practices reduces the carbon footprint of spring wheat production

    Science.gov (United States)

    Gan, Yantai; Liang, Chang; Chai, Qiang; Lemke, Reynald L.; Campbell, Con A.; Zentner, Robert P.

    2014-01-01

    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. PMID:25405548

  10. Impact of Company Size on Manufacturing Improvement Practices: An empirical study

    Science.gov (United States)

    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.

  11. Improving farming practices reduces the carbon footprint of spring wheat production

    Science.gov (United States)

    Gan, Yantai; Liang, Chang; Chai, Qiang; Lemke, Reynald L.; Campbell, Con A.; Zentner, Robert P.

    2014-11-01

    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.

  12. Development of a plan for improved recruitment and retention of Hispanic practical nursing students.

    Science.gov (United States)

    Healey, Carol

    2013-01-01

    In 2007, Hispanic Americans represented 14% of the US population, but only 5.8% of licensed practical nurses (US Dept. of Labor Bureau of Labor Statistics, 2007). The lack of diversity in the nursing workforce results in disparities in healthcare delivery. Nursing educators are challenged to develop strategies to recruit and retain a more diverse student population. This article focuses on the development of a plan to improve recruitment and retention of Hispanic practical nursing students at an urban community college in Northern New Jersey. The first step of the project was to complete a needs assessment to understand the disproportionately low numbers of Hispanic students enrolled in the practical nursing program as compared with other majors. Phase two of the project was to identify best practices nationally that have proven to be successful in recruiting and retaining Hispanic students. Data obtained from phases one and two were used in phase three of the project to develop specific recruitment and retention strategies. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. An improved scheme for Flip-OFDM based on Hartley transform in short-range IM/DD systems.

    Science.gov (United States)

    Zhou, Ji; Qiao, Yaojun; Cai, Zhuo; Ji, Yuefeng

    2014-08-25

    In this paper, an improved Flip-OFDM scheme is proposed for IM/DD optical systems, where the modulation/demodulation processing takes advantage of the fast Hartley transform (FHT) algorithm. We realize the improved scheme in one symbol period while conventional Flip-OFDM scheme based on fast Fourier transform (FFT) in two consecutive symbol periods. So the complexity of many operations in improved scheme is half of that in conventional scheme, such as CP operation, polarity inversion and symbol delay. Compared to FFT with complex input constellation, the complexity of FHT with real input constellation is halved. The transmission experiment over 50-km SSMF has been realized to verify the feasibility of improved scheme. In conclusion, the improved scheme has the same BER performance with conventional scheme, but great superiority on complexity.

  14. Improved Models and Tools for Prediction of Radiation Effects on Space Electronics in Wide Temperature Range Project

    Data.gov (United States)

    National Aeronautics and Space Administration — All NASA exploration systems operate in the extreme environments of space and require reliable electronics capable of handling a wide temperature range (-180:C to...

  15. Factors affecting adoption of improved management practices in the pastoral industry in Great Barrier Reef catchments.

    Science.gov (United States)

    Rolfe, John; Gregg, Daniel

    2015-07-01

    Substantial efforts are being made by industry and government in Australia to reduce adverse impacts of pastoral operations on water quality draining to the Great Barrier Reef. A key target is to achieve rapid adoption of better management practices by landholders, but current theoretical frameworks provide limited guidance about priorities for improving adoption. In this study information from direct surveys with landholders in the two largest catchments draining into the Great Barrier Reef has been collected and analysed. Study outcomes have important implications for policy settings, because they confirm that substantial variations in adoption drivers exist across landholders, enterprises and practices. The results confirm that the three broad barriers to adoption of information gaps, financial incentives and risk perceptions are relevant. This implies that different policy mechanisms, including extension and incentive programs, remain important, although financial incentives were only identified as important to meet capital and transformational costs rather than recurrent costs. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Challenges in recruiting minority-serving private practice primary care physicians to a quality improvement project.

    Science.gov (United States)

    Meehan, Thomas P; Van Hoof, Thomas J; Galusha, Deron; Barr, Judith K; Curry, Maureen; Kelvey-Albert, Michele; Meehan, Thomas P

    2011-01-01

    The objectives of this study were the following: (1) describe one organization's experience with recruiting minority-serving private practice primary care physicians to an ambulatory quality improvement (QI) project; (2) compare and contrast physicians who agreed to participate with those who declined; and (3) list incentives and barriers to participation. The authors identified eligible physicians by analyzing Medicare Part B claims data, a publicly available physician database, and office staff responses to telephone inquiries. The recruitment team had difficulty identifying, contacting, and recruiting eligible physicians. Solo practitioners and physicians who had lower scores on certain quality measures were more likely to participate. Barriers to participation were similar in all practices and included concerns about extra work, difficulty of change, and impact on office work flow. Commonly used incentives were offered but were not universally embraced. Additional work is required to refine the process of physician recruitment and to find more compelling incentives for QI.

  17. Role of courtyard counselling meeting in improving household food safety knowledge and practices in Munshiganj district of Bangladesh.

    Science.gov (United States)

    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; P<0.001). However, hand washing after use of toilet was unchanged after the intervention (75% vs.76%). Knowledge about safe food 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.

  18. Role of courtyard counselling meeting in improving household food safety knowledge and practices in Munshiganj district of Bangladesh

    Science.gov (United States)

    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

    2016-01-01

    ABSTRACT 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; P<0.001). However, hand washing after use of toilet was unchanged after the intervention (75% vs.76%). Knowledge about safe food 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. PMID:28008194

  19. Improvement in asthma management practices in child care services: an evaluation of a staff education program.

    Science.gov (United States)

    Hazell, Juliana; Henry, Richard L; Francis, J Lynn

    2006-04-01

    The aim of this study was to identify the strengths and weaknesses of asthma management in child care services in the Hunter region and to develop, implement and evaluate a health education program to address the deficiencies. A questionnaire was sent to the 190 child care services in the Hunter region in 1997 to assess their asthma management practices. Results of the survey were used to develop a two-hour training workshop for child care staff in the management of asthma. District-based workshops were conducted for 535 child care staff (representing 140 services) over two years. Participants completed pre- and post-workshop knowledge and confidence questionnaires. The survey was repeated in 2000. The baseline survey identified potential for substantial improvement in the management of asthma in child care services and in the training of staff. Training workshops significantly improved asthma knowledge and confidence in managing asthma (pmanagement practices. The program was effective in achieving vast improvements in the knowledge and confidence that child care staff require to manage asthma and has led to the broad dissemination and adoption of the appropriate policies and procedures for the management of asthma in child care services.

  20. Behavioural informatics for improving water hygiene practice based on IoT environment.

    Science.gov (United States)

    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.

  1. Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy.

    Science.gov (United States)

    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 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.

  2. A parallel guideline development and formalization strategy to improve the quality of clinical practice guidelines.

    Science.gov (United States)

    Goud, Rick; Hasman, Arie; Strijbis, Anne-Margreet; Peek, Niels

    2009-08-01

    Clinical practice guidelines often contain ambiguities, inconsistencies, and logical errors that hamper implementation of these guidelines in practice. As guideline formalization is useful to verify the logical structure, consistency, and completeness of guidelines, several authors have argued that the formalization of guidelines concurrent with their development may improve their quality. However, experiences with such a parallel guideline development and formalization approach have not yet been reported. The goal of this study was to develop such a strategy and evaluate its application in practice. Existing methodologies for guideline development and guideline formalization were analyzed and used as a basis to develop a strategy in which guideline formalization is performed concurrently with guideline development. The developed strategy was applied in the development of a clinical practice guideline for cardiac rehabilitation. A parallel guideline development and formalization strategy was developed that intertwines the processes of guideline development and guideline formalization. Central assets are early involvement of guideline formalization specialists and formalization tools, cooperation between guideline authors and guideline formalization specialists in the development of clinical algorithms, access to domain knowledge when formalization identifies inconsistencies or omissions, and formal verification of the guideline model prior to guideline dissemination. This strategy was applied in the development of a guideline for cardiac rehabilitation and helped to identify several vague and inconsistent recommendations and impracticabilities in the narrative guidelines that could be resolved before publication. In addition, the strategy ensured consistency between the narrative and formalized guideline. Based on our experience, formalizing a guideline concurrent with its development is feasible in practice and we recommend applying such a strategy as it can be

  3. Advanced Energy Retrofit Guide: Practical Ways to Improve Energy Performance; Grocery Stores (Revised) (Book)

    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.

  4. Advanced Energy Retrofit Guide: Practical Ways to Improve Energy Performance, K-12 Schools (Book)

    Energy Technology Data Exchange (ETDEWEB)

    2013-02-01

    The U.S. Department of Energy developed the K-12 Advanced Energy Retrofit Guide to provide specific methodologies, information, and guidance to help energy managers and other stakeholders plan and execute energy efficiency improvements. We emphasize actionable information, practical methodologies, diverse case studies, and unbiased evaluation of the most promising retrofit measure for each building type. 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.

  5. Improving the user experience through practical data analytics gain meaningful insight and increase your bottom line

    CERN Document Server

    Fritz, Mike

    2015-01-01

    Improving the User Experience through Practical Data Analytics is your must-have resource for making UX design decisions based on data, rather than hunches. Authors Fritz and Berger help the UX professional recognize and understand the enormous potential of the ever-increasing user data that is often accumulated as a by-product of routine UX tasks, such as conducting usability tests, launching surveys, or reviewing clickstream information. Then, step-by-step, they explain how to utilize both descriptive and predictive statistical techniques to gain meaningful insight with that data. You'll be

  6. Maintaining Perioperative Normothermia: Sustaining an Evidence-Based Practice Improvement Project.

    Science.gov (United States)

    Levin, Rona F; Wright, Fay; Pecoraro, Kathleen; Kopec, Wendy

    2016-02-01

    Unintentional perioperative hypothermia has been shown to cause serious patient complications and, thus, to increase health care costs. In 2009, an evidence-based practice improvement project produced a significant decrease in unintentional perioperative hypothermia in colorectal surgical patients through monitoring of OR ambient room temperature. Project leaders engaged all interdisciplinary stakeholders in the original project, which facilitated the sustainability of the intervention method. An important aspect of sustainability is ongoing monitoring and evaluation of a new intervention method. Therefore, continued evaluation of outcomes of the protocol developed in 2009 was scheduled at specific time points after the initial small test of change with colorectal patients. This article focuses on how attention to sustainability factors during implementation of an improvement project led to the sustainability of a protocol for monitoring OR ambient room temperature with all types of surgical patients five years after the initial project. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  7. Improving prescribing practices: A pharmacist-led educational intervention for nurse practitioner students.

    Science.gov (United States)

    Sabatino, Jennifer A; Pruchnicki, Maria C; Sevin, Alexa M; Barker, Elizabeth; Green, Christopher G; Porter, Kyle

    2017-05-01

    To assess impact of a pharmacist-led educational intervention on family nurse practitioner (FNP) students' prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator. Prospective pre-post assessment of a 14-week educational intervention in an FNP program in the spring semester of 2014. Students participated in an online module of weekly patient cases and prescriptions emphasizing legal requirements, prescription accuracy, and appropriate therapy. A pharmacist facilitator provided formative feedback on students' submissions. Participants completed a matched assessment on prescription writing before and after the module, and a retrospective postsurvey then presurvey to collect perceptions. There was significant improvement in performance on error identification and demonstration of prescription elements from preassessment to postassessment (+17%, p medication use with improved recognition and avoidance of prescribing errors, although it did not result in competency. Exposure to pharmacist expertise in this area may encourage collaboration in practice. ©2017 American Association of Nurse Practitioners.

  8. 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.

  9. Direct milling and casting of polymer-based optical waveguides for improved transparency in the visible range

    DEFF Research Database (Denmark)

    Snakenborg, Detlef; Perozziello, Gerardo; Klank, Henning

    2006-01-01

    properties. Direct micromilling enabled us to fabricate 100 mu m wide optical waveguides. Propagation losses of less than 1 dB cm(-1) could be achieved throughout the entire visual range down to a wavelength of 400 nm. A casting process amenable to high number production of such devices was furthermore...

  10. Time-of-flight neutron rejection to improve prompt gamma imaging for proton range verification : a simulation study

    NARCIS (Netherlands)

    Biegun, Aleksandra K.; Seravalli, Enrica; Lopes, Patricia Cambraia; Rinaldi, Ilaria; Pinto, Marco; Oxley, David C.; Dendooven, Peter; Verhaegen, Frank; Parodi, Katia; Crespo, Paulo; Schaart, Dennis R.

    2012-01-01

    Therapeutic proton and heavier ion beams generate prompt gamma photons that may escape from the patient. In principle, this allows for real-time, in situ monitoring of the treatment delivery, in particular, the hadron range within the patient, by imaging the emitted prompt gamma rays. Unfortunately,

  11. Incorporating nutrition into pediatric practice: physicians and dietitians working together to improve children's health.

    Science.gov (United States)

    Lasswell, A B

    1992-10-01

    Clinicians are needed to include nutrition in the routine care of infants and children in office practice. Physicians play an important role in assessing nutritional status, diagnosing nutritional problems, providing a rationale for treatment, prescribing, performing brief counseling, referring to other resources if needed, and following up on the progress of their patients. Registered dietitians are the consultants of choice to assist pediatricians in the care of patients with nutrition-related disorders and are skilled in providing pediatric health promotion and disease prevention information. Consultant dietitians in the community can be found through contacting the local department of health or local hospital outpatient department. The American Dietetic Association also maintains a list of consulting dietitians throughout the United States. Funding mechanisms for engaging dietetic services vary from contracting with dietitians in private practice, local health departments, or hospital outpatient clinics, to employing dietitians on-site to provide counseling services in the office. Availability for third party payment for nutrition services varies with insurance carriers, individual policies, and region of the country. Incorporating nutrition into pediatric practice is important. Together, physicians and dietitians can work together to improve children's health.

  12. Measuring practice capacity for change: a tool for guiding quality improvement in primary care settings.

    Science.gov (United States)

    Bobiak, Sarah N; Zyzanski, Stephen J; Ruhe, Mary C; Carter, Caroline A; Ragan, Brian; Flocke, Susan A; Litaker, David; Stange, Kurt C

    2009-01-01

    Capacity for change, or the ability and willingness to undertake change, is an organizational characteristic with potential to foster quality management in health care. We report on the development and psychometric properties of a quantitative measure of capacity for change for use in primary care settings. Following review of previous conceptual and empirical studies, we generated 117 items that assessed organizational structure, climate, and culture. Using information from direct observation and key informant interviews, a research team member rated these items for 15 primary care practices engaged in a quality improvement intervention. Distributional statistics, pairwise correlation analysis, Rasch modeling, and item content review guided item reduction and instrument finalization. Reliability and convergent validity were assessed. Ninety-two items were removed because of limited response distributions and redundancy or because of poor Rasch model fit. The final instrument comprising 25 items had excellent reliability (alpha = .94). A Rasch model-derived capacity for change score correlated well with an independently determined, qualitatively derived summary assessment of each practice's capacity for change (rhoS = 0.82), suggesting good convergent validity. We describe a new instrument for quantifying organizational capacity for change in primary care settings. The ability to quantify capacity for change may enable better recognition of practices likely to be successful in their change efforts and those first requiring capacity building prior to change interventions.

  13. Interprofessional Oral Health Education Improves Knowledge, Confidence, and Practice for Pediatric Healthcare Providers.

    Science.gov (United States)

    Cooper, Devon; Kim, JungSoo; Duderstadt, Karen; Stewart, Ray; Lin, Brent; Alkon, Abbey

    2017-01-01

    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 evaluation showed that

  14. Interprofessional Oral Health Education Improves Knowledge, Confidence, and Practice for Pediatric Healthcare Providers

    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

  15. Analysis of the nutritional management practices in intensive care: Identification of needs for improvement.

    Science.gov (United States)

    Lázaro-Martín, N I; Catalán-González, M; García-Fuentes, C; Terceros-Almanza, L; Montejo-González, J C

    2015-12-01

    To analyze the nutritional management practices in Intensive Care (ICU) to detect the need for improvement actions. Re-evaluate the process after implementation of improvement actions. Prospective observational study in 3 phases: 1) observation; 2) analysis, proposal development and dissemination; 3) analysis of the implementation. ICU of a hospital of high complexity. Adult ICU forecast more than 48h of artificial nutrition. Parenteral nutrition (PN), enteral nutrition (EN) (type, average effective volume, complications) and average nutritional ratio. A total of 229 patients (phase 1: 110, phase 3: 119). After analyzing the initial results, were proposed: increased use and precocity of EN, increased protein intake, nutritional monitoring effectiveness and increased supplementary indication NP. The measures were broadcast at specific meetings. During phase 3 more patients received EN (55.5 vs. 78.2%, P=.001), with no significant difference in the start time (1.66 vs. 2.33 days), duration (6.82 vs. 10,12 days) or complications (37,7 vs. 47,3%).Use of hyperproteic diets was higher in phase 3 (0 vs. 13.01%, Pnutritional ratio (0.56±0.28 vs. 0.61±0.27, P=.56). The use of EN and the protein intake increased, without appreciating effects on other improvement measures. Other methods appear to be necessary for the proper implementation of improvement measures. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  16. Evaluation of pig production practices, constraints and opportunities for improvement in smallholder production systems in Kenya.

    Science.gov (United States)

    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.

  17. Repeating Knowledge Application Practice to Improve Student Performance in a Large, Introductory Science Course

    Science.gov (United States)

    Fujinuma, Ryosuke; Wendling, Laura A.

    2015-11-01

    There is a tendency for lecture-based instruction in large introductory science courses to strongly focus on the delivery of discipline-specific technical terminology and fundamental concepts, sometimes to the detriment of opportunities for application of learned knowledge in evidence-based critical-thinking activities. We sought to improve student performance on evidence-based critical-thinking tasks through the implementation of peer learning and problem-based learning tutorial activities. Small-group discussions and associated learning activities were used to facilitate deeper learning through the application of new knowledge. Student performance was assessed using critical-thinking essay assignments and a final course exam, and student satisfaction with tutorial activities was monitored using online surveys. Overall, students expressed satisfaction with the small-group-discussion-based tutorial activities (mean score 7.5/10). Improved critical thinking was evidenced by improved student performance on essay assignments during the semester, as well as a 25% increase in mean student scores on the final course exam compared to previous years. These results demonstrate that repeated knowledge application practice can improve student learning in large introductory-level science courses.

  18. 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.

  19. Understanding the Epidemiology of Heart Failure to Improve Management Practices: An Asia-Pacific Perspective.

    Science.gov (United States)

    Rajadurai, Jeyamalar; Tse, Hung-Fat; Wang, Chao-Hung; Yang, Ning-I; Zhou, Jingmin; Sim, David

    2017-04-01

    Heart failure (HF) is a major global healthcare problem with an estimated prevalence of approximately 26 million. In Asia-Pacific regions, HF is associated with a significant socioeconomic burden and high rates of hospital admission. Epidemiological data that could help to improve management approaches to address this burden in Asia-Pacific regions are limited, but suggest patients with HF in the Asia-Pacific are younger and have more severe signs and symptoms of HF than those of Western countries. However, local guidelines are based largely on the European Society of Cardiology and American College of Cardiology Foundation/American Heart Association guidelines, which draw their evidence from studies where Western patients form the major demographic and patients from the Asia-Pacific region are underrepresented. Furthermore, regional differences in treatment practices likely affect patient outcomes. In the following review, we examine epidemiological data from existing regional registries, which indicate that these patients represent a distinct subpopulation of patients with HF. In addition, we highlight that patients with HF are under-treated in the region despite the existence of local guidelines. Finally, we provide suggestions on how data can be enriched throughout the region, which may positively affect local guidelines and improve management practices. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  20. How to improve mental health competency in general practice training?--a SWOT analysis.

    Science.gov (United States)

    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.

  1. An educational intervention to improve nurses’ knowledge, attitude, and practice toward reporting of adverse drug reactions

    Science.gov (United States)

    Hanafi, Somayeh; Torkamandi, Hassan; Hayatshahi, Alireza; Gholami, Kheirollah; Shahmirzadi, Nikinaz Ashrafi; Javadi, Mohammad Reza

    2014-01-01

    Background: The reporting of adverse drug reactions (ADRs) by nurses in hospitals is very important. Aims: This study was aimed at investigating the impact of an educational intervention to improve ADR reporting and whether trained nurses had better knowledge, attitude, and practice toward ADR reporting. Materials and Methods: A total of 300 nurses in a tertiary care teaching hospital in Tehran, Iran were evaluated with a knowledge, attitude, and practice (KAP) questionnaire regarding ADR reporting in March 2010. After this, an educational program about ADR was provided to nurses. Then the nurses were re-evaluated by the same questionnaire. Comparisons were made of the attitude and knowledge within nurses, before and after education. Data were analyzed using SPSS software. P nurses before the intervention was significantly less than the knowledge after the intervention (P = 0.001). Also, there was a significant effect on attitude (P = 0.002). During the follow-up period of 4 months after the intervention, 26 spontaneous reports were received. Conclusion: Continuous ADR educational program, training, and integration of ADRs’ reporting into the activities of the nurses would likely improve ADR reporting. PMID:24554968

  2. A pilot programme of clinical practice improvement for future consultant doctors.

    Science.gov (United States)

    Oates, Kim; Vinters, Cathy; Cass-Verco, John; Fletcher, Mandy; Kaur, Narinder; Mherekumombe, Martha; Tang, Alice

    2017-04-01

    To provide junior doctors with tools to improve patient care in their workplace, a partnership was developed between the Clinical Excellence Commission (CEC) and the Royal Australasian College of Physicians (RACP) to help trainee consultants carry out clinical practice improvement (CPI) projects during clinical work. Based on a patient-care problem they wished to resolve, trainee consultants attended a 2-day face-to-face workshop to learn quality-improvement methods, describe their proposals and refine them using CPI methodology. They were provided with continuing supervision, participated in a mid-point review and were responsible for driving their projects. Trainee consultants attended a 2-day face-to-face workshop to learn quality-improvement methods RESULTS: Examples of five projects are: reducing mislabelled specimens leaving an emergency department, from 82 in the baseline period to 18 following the intervention; creating a multidisciplinary team to reduce hypoglycaemic episodes on a diabetic ward, from 23 episodes at baseline to three episodes over the same time period after the intervention; establishing an acute paediatric review clinic that reduced avoidable admissions of pneumonia by 74 per cent; providing 100 per cent of patients in a palliative care unit with an effective pain-management plan; developing an education package to increase staff confidence in recognising and responding to anaphylaxis in children, producing an increase in confidence from 51 per cent at baseline to 100 per cent after the intervention. Involving a learned college such as the RACP in patient-care improvement, with educational input from a partner organisation, shows how junior staff can become effective leaders in improving patient care. © 2016 John Wiley & Sons Ltd.

  3. Infant feeding practices in the Peruvian Amazon: implications for programs to improve feeding

    Directory of Open Access Journals (Sweden)

    Gwenyth Lee

    2014-09-01

    Full Text Available OBJECTIVE: To characterize feeding practices in a community in the Peruvian Amazon and to consider how this information could be used to strengthen programs and policies designed to improve nutrition and reduce child malnutrition in vulnerable communities METHODS: Data from three structured questionnaires were combined to produce a comprehensive depiction of feeding in a sample of 246 infants from birth through 8 months of life in the community of Santa Clara de Nanay near Iquitos, Peru. Breastfeeding initiation practices, exclusive breastfeeding in the first 180 days of life, the introduction of solids, and complementary feeding practices from 6-8 months, were described and related to maternal, infant, and household characteristics, including food insecurity RESULTS: The median duration of exclusive breastfeeding was 19 days. However, over the first 180 days of life, children were exclusively breastfed on 46.1% of days. Overall, 68.3% of infants received some semi-solid or solid food between 0-6 months and all had received semi-solids by the end of 8 months of age. The proportion of infants consuming a minimally acceptable (frequent and diverse complementary diet was 2.9%, 7.9%, and 16.1% at 6, 7, and 8 months respectively CONCLUSIONS: Although breastfeeding is nearly universal, promotion programs are needed in Santa Clara to 1 delay the introduction of plain water, other non-breast milk liquids, and semi-solid foods; 2 extend the period of exclusive breastfeeding; and 3 increase food diversity and the frequency of feeding during the period of complementary feeding. These results can be used to guide programs and policies to improve nutrition and reduce child malnutrition.

  4. Conservation Agriculture Practices in Rainfed Uplands of India Improve Maize-Based System Productivity and Profitability.

    Science.gov (United States)

    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.

  5. Conservation agriculture practices in rainfed uplands of India improve maize-based system productivity and profitability

    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.

  6. Science museums, centers and professional development: Teachers' self reflection on improving their practice

    Science.gov (United States)

    Ogbomo, Queen O.

    The purpose of this qualitative case study research was to ascertain the significance of the professional development programs workshops organized by a science museum and a science center in two Midwestern cities. The research investigated the effect the workshops had on the instructional practice of the participating elementary science teachers. More specifically, this study was guided by the following research question: How do the professional development programs at museums help teachers change the way they teach and consider science in their classroom? The core of this study consists of case studies of six elementary school teachers who were identified as a result of their participation in the museum and science center workshops and an instructor from the museum and another instructor from the science center. Teachers' self-efficacy regarding the teaching of science was sought through a Likert-style survey and triangulated with classroom observations and interviews of individual teachers. The findings of this study revealed two overarching themes: one, that the workshops were beneficial and two, that it did not improve instructional practice. The following are the factors identified as reasons for the workshops being beneficial: (1) the opportunity to build their content knowledge, (2) opportunity to experience and discuss the materials: (3) opportunity to collaborate with colleagues: (4) workshop materials and resources are linked to state goals: and (5) that they promote teacher confidence. The teachers who thought the workshops did not improve their instructional practice gave the following reasons: (1) they already had a strong background in science: (2) there was no follow-up activity: (3) the loss of a full day of teaching: and (4) the time constraint to implement what was learned. Though this study utilized a small sample of teachers, those involved in this study felt they acquired knowledge that would be either beneficial to them or to their students

  7. Eye tracking as a debriefing mechanism in the simulated setting improves patient safety practices.

    Science.gov (United States)

    Henneman, Elizabeth A; Cunningham, Helene; Fisher, Donald L; Plotkin, Karen; Nathanson, Brian H; Roche, Joan P; Marquard, Jenna L; Reilly, Cheryl A; Henneman, Philip L

    2014-01-01

    Human patient simulation has been widely adopted in healthcare education despite little research supporting its efficacy. The debriefing process is central to simulation education, yet alternative evaluation methods to support providing optimal feedback to students have not been well explored. Eye tracking technology is an innovative method for providing objective evaluative feedback to students after a simulation experience. The purpose of this study was to compare 3 forms of simulation-based student feedback (verbal debrief only, eye tracking only, and combined verbal debrief and eye tracking) to determine the most effective method for improving student knowledge and performance. An experimental study using a pretest-posttest design was used to compare the effectiveness of 3 types of feedback. The subjects were senior baccalaureate nursing students in their final semester enrolled at a large university in the northeast United States. Students were randomly assigned to 1 of the 3 intervention groups. All groups performed better in the posttest evaluation than in the pretest. Certain safety practices improved significantly in the eye tracking-only group. These criteria were those that required an auditory and visual comparison of 2 artifacts such as "Compares patient stated name with name on ID band." Eye tracking offers a unique opportunity to provide students with objective data about their behaviors during simulation experiences, particularly related to safety practices that involve the comparison of patient stated data to an artifact such as an ID band. Despite the limitations of current eye tracking technology, there is significant potential for the use of this technology as a method for the study and evaluation of patient safety practices.

  8. Conservation Agriculture Practices in Rainfed Uplands of India Improve Maize-Based System Productivity and Profitability

    Science.gov (United States)

    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

  9. Improving incidence estimation in practice-based sentinel surveillance networks using spatial variation in general practitioner density

    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.

  10. Quality improvement training for core medical and general practice trainees: a pilot study of project participation, completion and journal publication.

    Science.gov (United States)

    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

  11. Patient-Specific Tailored Intervention Improves INR Time in Therapeutic Range and INR Variability in Heart Failure Patients.

    Science.gov (United States)

    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 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 failure. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Varying the item format improved the range of measurement in patient-reported outcome measures assessing physical function

    DEFF Research Database (Denmark)

    Liegl, Gregor; Gandek, Barbara; Fischer, H. Felix

    2017-01-01

    Background: Physical function (PF) is a core patient-reported outcome domain in clinical trials in rheumatic diseases. Frequently used PF measures have ceiling effects, leading to large sample size requirements and low sensitivity to change. In most of these instruments, the response category...... easy, increases the range of precise measurement of self-reported PF. Methods: Three five-item PF short forms were constructed from the Patient-Reported Outcomes Measurement Information System (PROMIS®) wave 1 data. All forms included the same physical activities but varied in item stem and response...... precision between the short forms using different item formats. Results: Sufficient unidimensionality of all short-form items and the original PF item bank was supported. Compared to formats A and B, format C increased the range of reliable measurement by about 0.5 standard deviations on the positive side...

  13. Personalized Video Feedback and Repeated Task Practice Improve Laparoscopic Knot-Tying Skills: Two Controlled Trials.

    Science.gov (United States)

    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.

  14. From Guide to Practice: Improving Your After School Science Program to Increase Student Academic Achievement

    Science.gov (United States)

    Taylor, J.

    2013-12-01

    Numerous science organizations, such as NASA, offer educational outreach activities geared towards after school. For some programs, the primary goal is to grow students' love of science. For others, the programs are also intended to increase academic achievement. For those programs looking to support student learning in out-of-school time environments, aligning the program with learning during the classroom day can be a challenge. The Institute for Education Sciences, What Works Clearinghouse, put together a 'Practice Guide' for maximizing learning time beyond the regular school day. These practice guides provide concrete recommendations for educators supported by research. While this guide is not specific to any content or subject-area, the recommendations provided align very well with science education. After school science is often viewed as a fun, dynamic environment for students. Indeed, one of the recommendations to ensure time is structured according to students' needs is to provide relevant and interesting experiences. Given that our after school programs provide such creative environments for students, what other components are needed to promote increased academic achievement? The recommendations provided to academic achievement, include: 1. Align Instruction, 2. Maximize Attendance and Participation, 3. Adapt Instruction, 4. Provide Engaging Experiences, and 5. Evaluate Program. In this session we will examine these five recommendations presented in the Practice Guide, discuss how these strategies align with science programs, and examine what questions each program should address in order to provide experiences that lend themselves to maximizing instruction. Roadblocks and solutions for overcoming challenges in each of the five areas will be presented. Jessica Taylor will present this research based on her role as an author on the Practice Guide, 'Improving Academic Achievement in Out-of-School Time' and her experience working in various informal science

  15. Oral Health Care in the Future: Expansion of the Scope of Dental Practice to Improve Health.

    Science.gov (United States)

    Lamster, Ira B; Myers-Wright, Noreen

    2017-09-01

    The health care environment in the U.S. is changing. The population is aging, the prevalence of non-communicable diseases (NCDs) is increasing, edentulism is decreasing, and periodontal infection/inflammation has been identified as a risk factor for NCDs. These trends offer an opportunity for oral health care providers to broaden the scope of traditional dental practice, specifically becoming more involved in the management of the general health of patients. This new practice paradigm will promote a closer integration with the larger health care system. This change is based on the realization that a healthy mouth is essential for a healthy life, including proper mastication, communication, esthetics, and comfort. Two types of primary care are proposed: screenings for medical conditions that are directly affected by oral disease (and may modify the provision of dental care), and a broader emphasis on prevention that focuses on lifestyle behaviors. Included in the former category are screenings for NCDs (e.g., the risk of cardiovascular disease and identification of patients with undiagnosed dysglycemia or poorly managed diabetes mellitus), as well as identification of infectious diseases, such as HIV or hepatitis C. Reducing the risk of disease can be accomplished by an emphasis on smoking cessation and dietary intake and the prevention of obesity. These activities will promote interprofessional health care education and practice. While change is always challenging, this new practice paradigm could improve both oral health and health outcomes of patients seen in the dental office. This article was written as part of the project "Advancing Dental Education in the 21st Century."

  16. Reflection as a strategy to improve management practice: Insights from management education

    Directory of Open Access Journals (Sweden)

    Linda Ronnie

    2016-03-01

    Full Text Available Orientation: This study examines the role of reflection as a learning strategy for management students and how this process can contribute to developing a cadre of useful and effective managers.Research purpose: Using data from MBA student work, the aim of the study was to explore reflection as a pedagogical strategy to enhance management practice within an emerging market context.Motivation for the study: The development of more rigorous, thoughtful and decision-focussed management is among the challenges facing organisations in South Africa. Within management education, reflection is seen as a potential strategy to address this issue.Research approach, design and method: This qualitative study sampled 513 students’ reflective assignments. Students were given an individual task as a deliberate strategy to reflect on their own learning and provide insight on the benefits and challenges of the process. Coding was conducted along thematic lines.Main findings: The findings showed that students gained self-awareness and insight into their own management and organisational practices. Their application of concepts, tools and techniques was also enhanced, as was their understanding of working with others.Practical implications: Personal growth, transformation and development in terms of current and future management roles were all outcomes of the reflective process. Skills such as probing, analysing and synthesis – all essential to managers – are encouraged through a reflective mindset.Contribution: The findings of this study indicated that a deeper understanding and improved clarity of management and organisational practices ensued as an outcome of the reflective process.

  17. Improving access to yoga: barriers to and motivators for practice among health professions students.

    Science.gov (United States)

    Brems, Christiane; Justice, Lauren; Sulenes, Kari; Girasa, Lisa; Ray, Julia; Davis, Madison; Freitas, Jillian; Shean, Margaret; Colgan, Dharmakaya

    2015-01-01

    promotion, and emotional well-being as well as the seeking of pain relief and a sense of community. A referral by health care providers was the least-frequently cited motivator. The findings have implications for strategies that may help motivate health professionals toward a yoga practice, because having done yoga personally may be related to a willingness to perceive the benefits of and to refer patients to yoga as a viable integrative treatment for patients. Improved access can be developed in 3 ways: (1) integration of yoga research into health curricula to acquaint care providers with yoga's benefits to patients and care givers; (2) have yoga available as close to the workplace as possible to obviate some of the larger access barriers; and (3) societally, project yoga as a healing art and science, not simply as a weight loss strategy or athletic endeavor.

  18. Improving Chronic Pain Management Processes in Primary Care Using Practice Facilitation and Quality Improvement: The Central Appalachia Inter-Professional Pain Education Collaborative

    Directory of Open Access Journals (Sweden)

    Roberto Cardarelli

    2017-11-01

    Full Text Available Purpose: With the increasing burden of chronic pain and opioid use, provider shortages in Eastern Kentucky and West Virginia have experienced many challenges related to chronic pain management. This study tested a practice facilitator model in both academic and community clinics that selected and implemented best practice processes to better assist patients with chronic pain and increase the use of interdisciplinary health care services. Methods: Using a quasi-experimental design, a practice facilitator was assigned to each state’s clinics and trained clinic teams in quality improvement methods to implement chronic pain tool(s and workflow processes. Charts for 695 patients with chronic pain using opioids, from 8 randomly selected clinics in eastern Appalachia, were reviewed to assess for changes in clinic processes. Results: Statistically significant improvements were found in 10 out of 16 chronic pain best practice process measures. These included improved workflow implementation (P < 0.001, increased urine drug screen test orders (P = 0.001 and increased utilization of controlled medication agreements (P = 0.004. In total, 7 of 8 clinics significantly improved in at least one, if not all, selected and implemented process measures. Conclusions: Our findings indicate that practice facilitation, standardization of workflows and formation of structured clinical teams can improve processes of care in chronic pain management and facilitate the use of interdisciplinary services. Future studies are needed to assess long-term patient-centered outcomes that may result from improved processes of chronic pain care.

  19. Use of narrow-range peptide IEF to improve detection of lung adenocarcinoma markers in plasma and pleural effusion.

    Science.gov (United States)

    Pernemalm, Maria; De Petris, Luigi; Eriksson, Hanna; Brandén, Eva; Koyi, Hirsh; Kanter, Lena; Lewensohn, Rolf; Lehtiö, Janne

    2009-07-01

    In this study we applied narrow-range peptide IEF to plasma or pleural effusion prior to LC/MS/MS. Two methods for narrow-range IEF were run; IPG strips and free-flow electrophoresis. Data from this study was compared with cell line data to evaluate the method performance in body fluids. To test the methods potential in quantitative biomarker discovery studies, plasma and pleural effusion from patients with lung adenocarcinoma (n=3) were compared with inflammatory pleuritis (n=3) using iTRAQ quantification. Using narrow-range IEF on the peptide level we were able to identify and quantify 282 proteins in plasma and 300 proteins in pleural effusion. These body fluid proteomes demonstrated high degree of overlap; however, more proteins significantly differently altered levels related to adenenocarcinoma were found in pleural effusion compared with plasma, suggesting enrichment of lung tissue-related proteins in pleural effusion. Nine proteins were chosen for initial validation with Western blot, and one protein (NPC2) was chosen for further validation using imunohistochemistry. Overall, the quantitative results from IEF/LC/MS/MS showed good correlation with the results from Western blot and imunohistochemistry, showing the potential of this methodology in quantitative biomarker discovery studies.

  20. TB tracer teams in South Africa: knowledge, practices and challenges of tracing TB patients to improve adherence.

    Science.gov (United States)

    Bristow, Claire C; Podewils, Laura Jean; Bronner, Liza Ellen; Bantubani, Nonkqubela; Walt, Martie van der; Peters, Annatjie; Mametja, David

    2013-09-04

    In 2008-2009 the South African National Tuberculosis (TB) Program (NTP) implemented a national pilot project, the TB Tracer Project, aiming to decrease default rates and improve patient outcomes. The current study aimed to inform the NTP by describing the knowledge, attitudes, and practices of TB program personnel involved with tracing activities. A self-administered written questionnaire was sent to TB staff, managers and tracer team leaders to assess basic TB knowledge, attitudes and practices. Descriptive statistics were used to summarize results and the chi-squared statistic was used to compare responses of staff at facilities that participated in the TB Tracer Project (tracer) and those that followed standard NTP care (non-tracer). Of 560 total questionnaires distributed, 270 were completed and returned (response rate 48%). Total TB knowledge ranged from 70.8-86.3% correct across all response groups. However, just over half (range 50-59.3%) of each respondent group was able to correctly identify the four components of a DOT encounter. A patient no longer feeling sick was cited by 72.1% of respondents as the reason patients fail to adhere to treatment. Tracer teams were viewed as an effective means to get patients to return to treatment by 96.3% of health facility level respondents. Tracer team leaders reported concerns including lack of logistical support (41.7%), insufficient physical safety precautions (41.7%), and inadequate protection from contracting TB (39.1%). Upon patients returning to treatment at the clinic, facilities included in the TB Tracer Project were significantly more likely to discuss alternate DOTS arrangements than non-tracer facilities (79.2 vs. 66.4%, p = 0.03). This study identified key components of knowledge, attitudes, and practices regarding TB patient tracing activities in South Africa. Educating patients on the essential need to complete treatment irrespective of clinical symptoms may help improve treatment adherence. Future

  1. Effectiveness of an Online Educational Module in Improving Evidence-Based Practice Skills of Practicing Registered Nurses.

    Science.gov (United States)

    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.

  2. [How to improve practices and interventions for work integration of people with schizophrenia in France?].

    Science.gov (United States)

    Pachoud, B; Llorca, P M; Azorin, J M; Dubertret, C; de Pierrefeu, I; Gaillard, R; Franck, N

    2015-12-01

    Getting and keeping a job are not only one of the criteria of recovery from schizophrenia, but are also one of its main means. Indeed, recovery is partly defined by the ability to work. Despite the lack of data in France about employment of people with schizophrenia, it is widely acknowledged that the employment rate of people with schizophrenia remains quite low, and frequently it is only an employment in sheltered workshops, not on the regular work market. International research data show that it is possible to improve significantly this employment rate, with an appropriate support, that is precisely defined by the current researches, and that is quickly spreading in most developed countries. The aim of this paper is to present, on the basis of a broad current literature review, the key predictive factors of the return to work for people with schizophrenia, and the strategies to optimize vocational services. It will appear that there are several ways to improve practices and interventions in France to support work integration. To begin with individual factors of work integration, dependant on each person, the clinical state and the cognitive skills (in a broad sense, including social cognition and metacognition) are to be taken into account, and optimized by means of the association of a finely tuned pharmacological treatment and psychosocial interventions such as cognitive remediation adjusted to the person's specific needs. The other main kind of factors is environmental factors, particularly the kind of vocational support, which turns out to have a major impact not only on job acquisition, but importantly also on job tenure. The most effective vocational services are based on the "Place and train" model, and even more precisely on the Individual Placement and Support (IPS) model, that allows to the majority of people with a severe mental illness (more than 50%) to obtain a competitive employment after 6 to 18 months of individualized support. This approach

  3. Improving the off-axis spatial resolution and dynamic range of the NIF X-ray streak cameras (invited).

    Science.gov (United States)

    MacPhee, A G; Dymoke-Bradshaw, A K L; Hares, J D; Hassett, J; Hatch, B W; Meadowcroft, A L; Bell, P M; Bradley, D K; Datte, P S; Landen, O L; Palmer, N E; Piston, K W; Rekow, V V; Hilsabeck, T J; Kilkenny, J D

    2016-11-01

    We report simulations and experiments that demonstrate an increase in spatial resolution of the NIF core diagnostic x-ray streak cameras by at least a factor of two, especially off axis. A design was achieved by using a corrector electron optic to flatten the field curvature at the detector plane and corroborated by measurement. In addition, particle in cell simulations were performed to identify the regions in the streak camera that contribute the most to space charge blurring. These simulations provide a tool for convolving synthetic pre-shot spectra with the instrument function so signal levels can be set to maximize dynamic range for the relevant part of the streak record.

  4. Improving the off-axis spatial resolution and dynamic range of the NIF X-ray streak cameras (invited)

    Science.gov (United States)

    MacPhee, A. G.; Dymoke-Bradshaw, A. K. L.; Hares, J. D.; Hassett, J.; Hatch, B. W.; Meadowcroft, A. L.; Bell, P. M.; Bradley, D. K.; Datte, P. S.; Landen, O. L.; Palmer, N. E.; Piston, K. W.; Rekow, V. V.; Hilsabeck, T. J.; Kilkenny, J. D.

    2016-11-01

    We report simulations and experiments that demonstrate an increase in spatial resolution of the NIF core diagnostic x-ray streak cameras by at least a factor of two, especially off axis. A design was achieved by using a corrector electron optic to flatten the field curvature at the detector plane and corroborated by measurement. In addition, particle in cell simulations were performed to identify the regions in the streak camera that contribute the most to space charge blurring. These simulations provide a tool for convolving synthetic pre-shot spectra with the instrument function so signal levels can be set to maximize dynamic range for the relevant part of the streak record.

  5. Preliminary evidence that yoga practice progressively improves mood and decreases stress in a sample of UK prisoners

    NARCIS (Netherlands)

    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

  6. Improving quality of care in general practices by self-audit, benchmarking and quality circles.

    Science.gov (United States)

    Mahlknecht, Angelika; Abuzahra, Muna E; Piccoliori, Giuliano; Enthaler, Nina; Engl, Adolf; Sönnichsen, Andreas

    2016-10-01

    Guideline adherence of general practitioners (GP) regarding treatment of chronic conditions shows room for improvement. Thus, concepts have to be designed to promote quality of care. The aim of the interventional study "Improvement of Quality by Benchmarking" was to assess whether quality can be improved by self-auditing, benchmarking and quality circles in Salzburg (Austria) and South Tyrol (Italy). In this publication we present the Austrian results. Quality indicators were developed in a consensus process for eight chronic diseases based on pre-existing quality management systems. A quality score consisting of 35 indicators was calculated (0-5 points per indicator depending on fulfilment, maximum 175 points). Data were extracted from the electronic health records of participating practices in 2012, 2013 and 2014. A statistical pre-post analysis was performed using Wilcoxon signed-rank tests. A total of 20 GPs participated in the project. The mean quality score increased from 62.0 at baseline to 84.0 at the second follow-up (p = 0.003). Regarding the individual quality indicators, strong improvements were achieved between baseline and first follow-up, especially in process indicators concerning documentation. Between the first and second follow-up, quality remained in most cases at the same level. The validity of results is limited because of structural and technical problems. Due to the uncontrolled pre-post design we cannot exclude external influences on the results. Nevertheless, the intervention was able to improve measured quality of care. Barriers were detected that should be considered in a possible implementation of quality control programs.

  7. Good practice or positive action? Using Q methodology to identify competing views on improving gender equality in academic medicine.

    Science.gov (United States)

    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.

  8. Sustained improvement in clinical preventive service delivery among independent primary care practices after implementing electronic health record systems.

    Science.gov (United States)

    Wang, Jason J; Sebek, Kimberly M; McCullough, Colleen M; Amirfar, Sam J; Parsons, Amanda S; Singer, Jesse; Shih, Sarah C

    2013-08-01

    Studies showing sustained improvements in the delivery of clinical preventive services are limited. Fewer studies demonstrate sustained improvements among independent practices that are not affiliated with hospitals or integrated health systems. This study examines the continued improvement in clinical quality measures for a group of independent primary care practices using electronic health records (EHRs) and receiving technical support from a local public health agency. We analyzed clinical quality measure performance data from a cohort of primary care practices that implemented an EHR at least 3 months before October 2009, the study baseline. We assessed trends for 4 key quality measures: antithrombotic therapy, blood pressure control, smoking cessation intervention, and hemoglobin A1c (HbA1c) testing based on monthly summary data transmitted by the practices. Of the 151 practices, 140 were small practices and 11 were community health centers; average time using an EHR was 13.7 months at baseline. From October 2009 through October 2011, average rates increased for antithrombotic therapy (from 58.4% to 74.8%), blood pressure control (from 55.3% to 64.1%), HbA1c testing (from 46.4% to 57.7%), and smoking cessation intervention (from 29.3% to 46.2%). All improvements were significant. During 2 years, practices showed significant improvement in the delivery of several key clinical preventive services after implementing EHRs and receiving support services from a public health agency.

  9. Effectiveness of a practice-based, multimodal quality improvement intervention for gastroenteritis within a Medicaid managed care network.

    Science.gov (United States)

    Zolotor, Adam J; Randolph, Greg D; Johnson, Julie K; Wegner, Steven; Edwards, Lori; Powell, Carol; Esporas, Megan H

    2007-09-01

    Acute gastroenteritis results in 220,000 hospitalizations yearly in the United States. The substantial geographic variation in gastroenteritis care, coupled with the evidence of effective treatment of dehydration in nonhospital settings, suggests that the majority of these hospitalizations are avoidable. We sought to decrease hospitalizations for gastroenteritis by using practice-based, multimodal quality improvement methods that target multiple care processes to make them consistent with evidence-based guidelines. We used a controlled before/after study design to evaluate a quality improvement intervention in a 20-practice Medicaid network. All 20 practices participated in continuing education sessions; received free oral rehydration solution, patient education materials, and performance feedback; and participated in a follow-up conference call. Three practices were chosen to develop and pilot office-process changes. These practices formed interdisciplinary teams to develop and test changes and collaborated with project faculty and each other. They shared their learning with the other 17 practices via a conference call and toolkit. We compared before/after gastroenteritis hospital admissions for children <5 years old covered by Medicaid in the intervention practices with all other Medicaid recipients in North Carolina using claims data from 2000-2002. The 3 high-intensity practices all made numerous changes to care processes. Most of the 17 low-intensity practices reported changes in their gastroenteritis care processes. Gastroenteritis admission rates declined 45% in high-intensity practices and 44% in low-intensity practices during the study compared with 11% in the control practices. A practice-based, multimodal quality improvement intervention that targets multiple care processes on the basis of evidence-based guidelines lowered rates of gastroenteritis hospitalization in a Medicaid network. This approach could lower costs attributable to gastroenteritis for

  10. Comparison of Physical Therapy with Energy Healing for Improving Range of Motion in Subjects with Restricted Shoulder Mobility

    Science.gov (United States)

    Linda Baldwin, Ann; Schwartz, Gary E.

    2013-01-01

    Two forms of energy healing, Reconnective Healing (RH) and Reiki, which involve light or no touch, were tested for efficacy against physical therapy (PT) for increasing limited range of motion (ROM) of arm elevation in the scapular plane. Participants were assigned to one of 5 groups: PT, Reiki, RH, Sham Healing, or no treatment. Except for no treatment, participants were blinded as to grouping. Range of Motion, self-reported pain, and heart rate variability (HRV) were assessed before and after a 10-minute session. On average, for PT, Reiki, RH, Sham Healing, and no treatment, respectively, ROM increased by 12°, 20°, 26°, 0.6°, and 3° and pain score decreased by 11.5%, 10.1%, 23.9%, 15.4%, and 0%. Physical therapy, Reiki, and RH were more effective than Sham Healing for increasing ROM (PT: F = 8.05, P = 0.008; Reiki: F = 10.48, P = 0.003; RH: F = 30.19, P Reiki, and RH. It is the authors' opinion that the accompanying pain relief is a placebo effect. PMID:24327820

  11. Interventions to improve question formulation in professional practice and self-directed learning.

    Science.gov (United States)

    Horsley, Tanya; O'Neill, Jennifer; McGowan, Jessie; Perrier, Laure; Kane, Gabrielle; Campbell, Craig

    2010-05-12

    Formulating questions is fundamental to the daily life of a healthcare worker and is a defining characteristic of professional competence and meaningful learning. With high expectations for healthcare providers to remain up-to-date with current evidence and the movement towards formalizing reflective practice as part of physician revalidation, it is important that curricula developed for improving the ability to formulate well-constructed questions are based on the best evidence. To assess the effectiveness of interventions for increasing the frequency and quality of questions formulated by healthcare providers in practice and the context of self-directed learning. We obtained studies from searches of electronic bibliographic databases, and supplemented these with handsearching, checking reference lists, and consultation with experts. We considered published and unpublished randomized controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time-series (ITS), and controlled before-after (CBA) studies of any language examining interventions for increasing the quality and frequency of questions formulated by health professionals involved with direct patient care. Two review authors independently undertook all relevancy screening and 'Risk of bias' assessment in duplicate. Intervention characteristics, follow-up intervals, and measurement outcomes were diverse and precluded quantitative analysis. We have summarized data descriptively. Searches identified four studies examining interventions to improve question formulation in healthcare professionals. Interventions were mostly multi-component, limited within the context of EBM and primarily in physician and resident populations. We did not identify studies examining changes in frequency of questions formulated or those within the context of reflection. Risk of bias was generally rated to be 'high risk'. Three of the four studies showed improvements in question formulation in physicians, residents, or

  12. Improved Fuzzy Logic based DTC of Induction machine for wide range of speed control using AI based controllers

    Directory of Open Access Journals (Sweden)

    H. Sudheer

    2016-06-01

    Full Text Available This paper presents improvements in Direct Torque control of induction motor using Fuzzy logic switching controller (FDTC. The conventional DTC (CDTC and FDTC drive performance is compared using Conventional PI, Fuzzy controller and Neural Network controllers. The major disadvantages of CDTC are high torque and flux ripples in steady state operation of the drive, inferior performance at low speed operation and variable switching frequency. The presence of hysteresis bands is the major reason for high torque and flux ripples in CDTC. In FDTC the hysteresis band and switching table are replaced by Fuzzy logic switching controller. Using fuzzy logic torque, stator flux space are divided into smaller subsections which results in precise and optimal selection of switching state to meet load torque. In high performance drives accurate tuning of PI speed controller is required. The conventional PI controller cannot adapt to the variation in model parameters. Artificial intelligence based fuzzy controller and neural network controller are compared with PI controller for both CDTC and FDTC of Induction machine. The proposed schemes are developed in Matlab/Simulink environment. Simulation results shows reduction in torque and flux ripples in FDTC and dynamic performance of the drive at low speeds and sudden change in load torque can be improved using Fuzzy logic controller compared to PI and neural network controller.

  13. A High-Voltage class-D power amplifier with switching frequency regulation for improved high-efficiency output power range

    NARCIS (Netherlands)

    Ma, H.; van der Zee, Ronan A.R.; Nauta, Bram

    2015-01-01

    This paper describes the power dissipation analysis and the design of an efficiency-improved high-voltage class-D power amplifier. The amplifier adaptively regulates its switching frequency for optimal power efficiency across the full output power range. This is based on detecting the switching

  14. Improvement of trans-sialylation versus hydrolysis activity of an engineered sialidase from Trypanosoma rangeli by use of co-solvents

    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...

  15. Improve the Robustness of Range-Free Localization Methods on Wireless Sensor Networks using Recursive Position Estimation Algorithms

    Directory of Open Access Journals (Sweden)

    Gamantyo Hendrantoro

    2011-12-01

    Full Text Available The position of a sensor node at wireless sensor networks determines the received data sensing accuracy. By the knowledge of sensor positioning, the location of target sensed can be estimated. Localization techniques used to find out the position of sensor node by considering the distance of this sensor from the vicinity reference nodes. Centroid Algorithm is a robust, simple and low cost localization technique without dependence on hardware requirement. We propose Recursive Position Estimation Algorithm to obtain the more accurate node positioning on range-free localization technique. The simulation result shows that this algorithm has the ability on increasing position accuracy up to 50%. The trade off factor shows the smaller the number of reference nodes the higher the computational time required. The new method on the availability on sensor power controlled is proposed to optimize the estimated position.

  16. Improve the Robustness of Range-Free Localization Methods on Wireless Sensor Networks using Recursive Position Estimation Algorithm

    Directory of Open Access Journals (Sweden)

    Prima Kristalina

    2013-09-01

    Full Text Available The position of a sensor node at wireless sensor networks determines the received data sensing accuracy. By the knowledge of sensor positioning, the location of target sensed can be estimated. Localization techniques used to find out the position of sensor node by considering the distance of this sensor from the vicinity reference nodes.  Centroid Algorithm is a robust, simple and low cost localization technique without dependence on hardware requirement. We propose Recursive Position Estimation Algorithm to obtain the more accurate node positioning on range-free localization technique. The simulation result shows that this algorithm has the ability on increasing position accuracy up to 50%.  The trade off factor shows the smaller the number of reference nodes the higher the computational time required. The new method on the availability on sensor power controlled is proposed to optimize the estimated position.

  17. Examination of the scientific review process: Ten best practice suggestions for an improved process

    CERN Document Server

    Harrus, Ilana

    2015-01-01

    In this article we wish to provide a common set of best practice approaches that should be considered for all effective research grant proposal reviews. The federal government performs a critical role in American competitiveness and security by supporting basic research funded with taxpayer dollars. Effectively managing their allocation to scientists and researchers is a noble and crucial mission for advancing fundamental knowledge and deserves a heightened attention. Ensuring that proposals submitted are treated fairly and transparently is essential to both the health of any research program and also a duty to the public who ultimately funds the research. The paper describes the general requirements of a review process and at each step underlines the issues and suggests potential improvements and some fundamental requirements that should be included in any scientific review. We also included a series of tips geared to the scientific community. Our goals in this paper are 1) to demystify the process for every...

  18. [Improvement of management of hypertension by implementation of alcohol screening and subsequent interventions in primary practice].

    Science.gov (United States)

    Rehm, Jürgen; Gmel, G; Kiefer, F; Kreutz, R; Kugler, J; Müller-Walther, M; Sandow, P; Weisser, B

    2014-11-01

    Hypertension and alcohol use are both part of the five most important risk factors for burden of disease in Western Europe, mainly because of their impact on non-communicable diseases (NCD). Both risk factors are prevalent with high overlap among patients in primary care. Implementation of a screening for alcohol among patients of hypertension in primary care followed by brief intervention for problem alcohol use or formal treatment for people with alcohol dependence could constitute an important step to reach the goals of the Global WHO Action Plan for Prevention and Control of NCD. In addition, such an intervention could improve the management of hypertension. In a working group of experts from clinical practice and research the rationale and potential barriers for this intervention were discussed and steps for implementation in primary care were developed. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Broadening End-of-Life Comfort to Improve Palliative Care Practices in Long Term Care.

    Science.gov (United States)

    Sussman, Tamara; Kaasalainen, Sharon; Mintzberg, Susan; Sinclair, Shane; Young, Laurel; Ploeg, Jenny; Bourgeois-Guérin, Valérie; Thompson, Genevieve; Venturato, Lorraine; Earl, Marie; Strachan, Patricia; You, John J; Bonifas, Robin; McKee, Margaret

    2017-09-01

    This study aimed to (1) explore how palliative care in long-term care (LTC) addresses the tensions associated with caring for the living and dying within one care community, and (2) to inform how palliative care practices may be improved to better address the needs of all residents living and dying in LTC as well as those of the families and support staff. This article reports findings from 19 focus groups and 117 participants. Study findings reveal that LTC home staff, resident, and family perspectives of end-of-life comfort applied to those who were actively dying and to their families. Our findings further suggest that eliciting residents' perceptions of end-of-life comfort, sharing information about a fellow resident's death more personally, and ensuring that residents, families, and staff can constructively participate in providing comfort care to dying residents could extend the purview of end-of-life comfort and support expanded integration of palliative principles within LTC.

  20. The sustainability of improvements from continuing professional development in pharmacy practice and learning behaviors.

    Science.gov (United States)

    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.

  1. Evaluating, understanding and improving the quality of clinical placements for undergraduate nurses: A practice development approach.

    Science.gov (United States)

    Courtney-Pratt, Helen; Ford, Karen; Marlow, Annette

    2015-11-01

    Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners. Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings. Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Measuring and improving physician compliance with clinical practice guidelines. A controlled interventional trial.

    Science.gov (United States)

    Ellrodt, A G; Conner, L; Riedinger, M; Weingarten, S

    1995-02-15

    To determine factors that may lead physicians not to comply with clinical practice guidelines. Retrospective analysis of patients whose physicians were not compliant with discharge recommendations from a prospective, controlled interventional trial of a guideline to reduce hospital length of stay for patients admitted for chest pain. A large community teaching hospital. Patients admitted with chest pain who were not discharged according to a practice guideline. 79 (34%) of 230 patients with chest pain classified as being at low risk by concurrent or retrospective review were not discharged by day 3 (the guideline recommendation). Of these 79 patients, 33 (42%) were misclassified at concurrent review (10 were falsely classified as being at high risk and 23 were falsely classified as being at low risk). Of 46 correctly classified patients, 11 (14%) were classified as having noncompliant physicians because of health care system inefficiencies. The status of 7 (9%) patients was changed to high risk between initial classification and potential discharge. For 15 patients (19%), no obvious reason for delayed discharge was found, but they had a higher severity of illness than did low-risk patients discharged according to the guideline as measured by mean time-insensitive predictive instrument scores (41.3% +/- [SD] 14.1% compared with 31.5% +/- 14.3%; P = 0.017). In 13 patients (16%), physicians refused to follow the guideline recommendations. In measuring and attempting to improve physician compliance with a length-of-stay guideline, physician refusal accounts for a small percentage (16%) of noncompliance. Implementation issues, health care system inefficiency, and severity of illness were the predominant reasons why physicians did not comply with guidelines. Our study further supports the principle that clinical practice guidelines should complement rather than be a substitute for physician judgment.

  3. Hatha Yoga practice decreases menopause symptoms and improves quality of life: A randomized controlled trial.

    Science.gov (United States)

    Jorge, Márcia P; Santaella, Danilo F; Pontes, Isabella M O; Shiramizu, Victor K M; Nascimento, Ezequiel B; Cabral, Alícia; Lemos, Telma M A M; Silva, Regina H; Ribeiro, Alessandra M

    2016-06-01

    Yoga practice includes a group of specific psychophysical techniques. Although previous studies showed beneficial effects of yoga for health and rehabilitation, improving quality of life, there are few studies on the possible therapeutic application of yoga during the climacteric period. The purpose of this study was to investigate the psychophysiological effects of Hatha Yoga regular practice in post-menopausal women. Eighty-eight post-menopausal women volunteered for this 12-week trial. They were randomly assigned to one of three groups: control (no intervention), exercise, and yoga. Questionnaires were applied in order to evaluate climacteric syndrome (Menopause Rating Scale), stress (Lipp Stress Symptom Inventory), quality of life (Brief World Health Organization Quality of Life), depression (Beck Depression Inventory) and anxiety (State/Trait Anxiety Inventories). Physiological changes were evaluated through hormone levels (cortisol, FSH, LH, progesterone and estradiol). At 12 weeks, yoga practitioners showed statistically lower scores for menopausal symptoms, stress levels and depression symptoms, as well as significantly higher scores in quality of life when compared to control and exercise groups. Only control group presented a significant increase in cortisol levels. The yoga and exercise groups showed decreased levels of FSH and LH when compared to control group. These results suggest that yoga promotes positive psychophysiological changes in post-menopausal women and may be applied as a complementary therapy towards this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. MICRO FINANCING SCHEME BASED ON OPTIMIZATION OF NETWORK (MFS-ON: APROPOSED IMPROVEMENT ON CURRENT PRACTICES

    Directory of Open Access Journals (Sweden)

    Soenartomo Soepomo

    2017-03-01

    Full Text Available One important method in reducing poverty was through finance.The poor were lack of qualification andcapacity to borrow from formal financial sector. Therefore they should resort their financing needs to informalsources albeit very high cost implication.This dependency in turn would disrupt their productive capacitysincethe interest was very high. We focus on special segment of theproductive poor. We reviewed various financingscheme that widely practiced both domestically and globally. We perceived that existing schemes were inadequatefrom several perspectives: (1 partial nature, (2 substandard business practices, (3 lack of cooperationand (4 limited coverage. We proposed an alternative financing scheme.The spirit of the approach emphasizedthe critical role of self-sufficiency of Microfinance Institution (MFI. Through self sufficiency, MFI coulddevelop a healthy business with reasonable rate of return. In addition to self sufficiency, first, the proposal alsoincluded financing from private sector through mobilization of Corporate Social Responsibility (CSR funds.The funding sources became broad and economics scale could be achieved. Second, the proposal improved risksharing mechanism by introducing the regional government banks as well as insurers. Third, the proposalmade the distribution channel optimum by involvement of society elements

  5. Three-Dimensional Modeling May Improve Surgical Education and Clinical Practice.

    Science.gov (United States)

    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.

  6. Integrating Health Promotion Into Physical Therapy Practice to Improve Brain Health and Prevent Alzheimer Disease.

    Science.gov (United States)

    McGough, Ellen; Kirk-Sanchez, Neva; Liu-Ambrose, Teresa

    2017-07-01

    Alzheimer disease is the most common cause of dementia, and brain pathology appears years before symptoms are evident. Primary prevention through health promotion can incorporate lifestyle improvement across the lifespan. Risk factor assessment and identifying markers of disease might also trigger preventive measures needed for high-risk individuals and groups. Many potential risk factors are modifiable through exercise, and may be responsive to early intervention strategies to reduce the downward slope toward disability. Through the use of common clinical tests to identify cognitive and noncognitive functional markers of disease, detection and intervention can occur at earlier stages, including preclinical stages of disease. Physical activity and exercise interventions to address modifiable risk factors and impairments can play a pivotal role in the prevention and delay of functional decline, ultimately reducing the incidence of dementia. This article discusses prevention, prediction, plasticity, and participation in the context of preserving brain health and preventing Alzheimer disease and related dementias in aging adults. Rehabilitation professionals have opportunities to slow disease progression through research, practice, and education initiatives. From a clinical perspective, interventions that target brain health through lifestyle changes and exercise interventions show promise for preventing stroke and associated neurovascular diseases in addition to dementia. Physical therapists are well positioned to integrate primary health promotion into practice for the prevention of dementia and other neurological conditions in older adults.

  7. 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.

  8. Improving healthcare practice behaviors: an exploratory study identifying effective and ineffective behaviors in healthcare.

    Science.gov (United States)

    Van Fleet, David D; Peterson, Tim O

    2016-01-01

    The purpose of this paper is to present the results of exploratory research designed to develop an awareness of healthcare behaviors, with a view toward improving the customer satisfaction with healthcare services. It examines the relationship between healthcare providers and their consumers/patients/clients. The study uses a critical incident methodology, with both effective and ineffective behavioral specimens examined across different provider groups. The effects of these different behaviors on what Berry (1999) identified as the common core values of service organizations are examined, as those values are required to build a lasting service relationship. Also examined are categories of healthcare practice based on the National Quality Strategy priorities. The most obvious is the retrospective nature of the method used. How accurate are patient or consumer memories? Are they capable of making valid judgments of healthcare experiences (Berry and Bendapudi, 2003)? While an obvious limitation, such recollections are clearly important as they may be paramount in following the healthcare practitioners' instructions, loyalty for repeat business, making recommendations to others and the like. Further, studies have shown retrospective reports to be accurate and useful (Miller et al., 1997). With this information, healthcare educators should be in a better position to improve the training offered in their programs and practitioners to better serve their customers. The findings would indicate that the human values of excellence, innovation, joy, respect and integrity play a significant role in building a strong service relationship between consumer and healthcare provider. Berry (1999) has argued that the overriding importance in building a lasting service business is human values. This exploratory study has shown how critical incident analysis can be used to determine both effective and ineffective practices of different medical providers. It also provides guidelines as

  9. Improving the phenotypic expression of rice genotypes: Rethinking “intensification” for production systems and selection practices for rice breeding

    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.

  10. Data and material of the Safe-Range-Inventory: An assistance tool helping to improve the charging infrastructure for electric vehicles.

    Science.gov (United States)

    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; Mage=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].

  11. Improvement of antioxidant activity of peptides with molecular weights ranging from 1 to 10 kDa by PEF technology.

    Science.gov (United States)

    Wang, Jia; Wang, Ke; Lin, Songyi; Zhao, Ping; Jones, Gregory; Trang, Hung; Liu, Jingbo; Ye, Haiqing

    2012-10-01

    Egg white protein powder was hydrolyzed with Alcalase to produce antioxidant peptides. Then, the peptides were fractionated with ultrafiltration membranes. The peptides (1-10 kDa) were further treated by pulsed electric field (PEF) to investigate its effect on the antioxidant activity of the peptides. Antioxidant activity was evaluated using a 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical inhibition assay. The results indicated that optimal electric field intensity and standing times of PEF can enhance the antioxidant activity of the peptides. Therefore, a Box-Behnken design (BBD) with three independent variables including concentration, electric field intensity and pulse frequency was used to establish the regression equation of second-order response surface. The optimal conditions were as follows: concentration 8 mg/ml, electric field intensity 10 kV/cm and pulse frequency 2400 Hz. Under these conditions, the peptides antioxidant activity was 62.64% ± 0.98%. The present study demonstrated that the antioxidant activity of peptides (1-10 kDa) could be improved using PEF. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. Promising Practices and Strategies for Using Trauma-Informed Child Welfare Practice to Improve Foster Care Placement Stability: A Breakthrough Series Collaborative

    Science.gov (United States)

    Conradi, Lisa; Agosti, Jen; Tullberg, Erika; Richardson, Lisa; Langan, Heather; Ko, Susan; Wilson, Charles

    2011-01-01

    This paper will provide information on a recent Breakthrough Series Collaborative (BSC) conducted by the National Child Traumatic Stress Network on Using Trauma-Informed Child Welfare Practice to Improve Foster Care Placement Stability. Information on this particular BSC will be provided, followed by initial findings gathered from an evaluation of…

  13. Working with Primary Care Practices to Improve Service Delivery for People with Learning Disabilities--A Pilot Study

    Science.gov (United States)

    Webb, Jenny; Stanton, Melanie

    2009-01-01

    The relatively poor health of people with learning disability reflects the failure of primary care practitioners to improve the accessibility of the service they offer. This North Essex study involved evaluation of a project to work with three primary care practices to raise staff awareness, improve their training, and adapt their working…

  14. Continuous improvement in the Netherlands: current practices and experiences in Dutch manufacturing industry (awarded with ANBAR Citation of excellence)

    NARCIS (Netherlands)

    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

  15. Using Data to Improve Student Outcomes: Learning from Leading Colleges. Education Trust Higher Education Practice Guide #2

    Science.gov (United States)

    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"…

  16. Teacher Progress Monitoring of Instructional and Behavioral Management Practices: An Evidence-Based Approach to Improving Classroom Practices

    Science.gov (United States)

    Reddy, Linda A.; Dudek, Christopher M.

    2014-01-01

    In the era of teacher evaluation and effectiveness, assessment tools that identify and monitor educators' instruction and behavioral management practices are in high demand. The Classroom Strategies Scale (CSS) Observer Form is a multidimensional teacher progress monitoring tool designed to assess teachers' usage of instructional and behavioral…

  17. Systematic comparisons of various spectrophotometric and colorimetric methods to measure concentrations of protein, peptide and amino acid: detectable limits, linear dynamic ranges, interferences, practicality and unit costs.

    Science.gov (United States)

    Chutipongtanate, Somchai; Watcharatanyatip, Kamolwan; Homvises, Teerada; Jaturongkakul, Kewalee; Thongboonkerd, Visith

    2012-08-30

    There is limited and inconclusive information regarding detectable limits and linear dynamic ranges of various quantitative protein assays. We thus performed systematic comparisons of seven commonly used methods, including direct spectrophotometric quantitation at λ205 and λ280 nm (A205 and A280, respectively), bicinchoninic acid (BCA), Biuret, Bradford, Lowry and Ninhydrin methods. Purified BSA, porcine kidney extract, tryptic digested peptides derived from purified BSA, and glycine, were used as representative purified protein, complex protein mixture, peptide and amino acid, respectively. Bradford method was the most sensitive assay (LOD=0.006 mg/ml) and had the widest range of detectability (LOD-UOD=0.006-100mg/ml) for purified protein and complex protein mixture. For peptide, A205, A280, Lowry and Ninhydrin methods had a comparable LOD (0.006 mg/ml), but Ninhydrin method had the widest detectability range (LOD-UOD=0.006-100mg/ml). For amino acid, A205 and Ninhydrin methods had a comparable LOD (0.006 mg/ml), but A205 had a wider detectability range (LOD-UOD=0.006-6.250 mg/ml). Biuret method offered the widest linear dynamic range for purified protein and complex protein mixture (0.391-100mg/ml), A280 offered the widest linear dynamic range for peptide (0.024-6.250 mg/ml), and Ninhydrin method offered the widest linear dynamic range for amino acid (0.024-0.195 mg/ml). Both Laemmli's and 2-D lysis buffers had dramatic interfering effects on all assays. Concerning the practicality and unit costs, A205 and A280 were the most favorable. Among the colorimetric methods, Bradford method consumed the least amount of samples and shortest analytical time with the lowest unit cost. These are the most extensive comparative data of commonly used quantitative protein assays that will be useful for selecting the most suitable method for each study. Copyright © 2012 Elsevier B.V. All rights reserved.

  18. Practical Implications for an Effective Radiology Residency Quality Improvement Program for Milestone Assessment.

    Science.gov (United States)

    Leddy, Rebecca; Lewis, Madelene; Ackerman, Susan; Hill, Jeanne; Thacker, Paul; Matheus, Maria; Tipnis, Sameer; Gordon, Leonie

    2017-01-01

    Utilization of a radiology resident-specific quality improvement (QI) program and curriculum based on the Accreditation Council for Graduate Medical Education (ACGME) milestones can enable a program's assessment of the systems-based practice component and prepare residents for QI implementation post graduation. This article outlines the development process, curriculum, QI committee formation, and resident QI project requirements of one institution's designated radiology resident QI program. A method of mapping the curriculum to the ACGME milestones and assessment of resident competence by postgraduate year level is provided. Sample projects, challenges to success, and lessons learned are also described. Survey data of current trainees and alumni about the program reveal that the majority of residents and alumni responders valued the QI curriculum and felt comfortable with principles and understanding of QI. The most highly valued aspect of the program was the utilization of a resident education committee. The majority of alumni responders felt the residency quality curriculum improved understanding of QI, assisted with preparation for the American Board of Radiology examination, and prepared them for QI in their careers. In addition to the survey results, outcomes of resident project completion and resident scholarly activity in QI are evidence of the success of this program. It is hoped that this description of our experiences with a radiology resident QI program, in accordance with the ACGME milestones, may facilitate the development of successful QI programs in other diagnostic radiology residencies. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  19. Anal Pap Screening for HIV-infected Men Who Have Sex With Men: Practice Improvement.

    Science.gov (United States)

    Welbeck, Monique

    2016-01-01

    HIV-infected men who have sex with men (MSM) have the highest rates of anal dysplasia and anal cancer when compared to HIV-uninfected MSM and when compared to HIV-infected heterosexual men and women. Despite significantly increasing rates of anal dysplasia and anal cancer in HIV-infected MSM, in many settings, no standard protocol is in place to screen for anal dysplasia in this high-risk group. A practice improvement project was conducted at a primary care health center to educate the HIV health care team about anal Pap screening in an effort to increase provider knowledge and rates of anal Pap screening performed as part of primary comprehensive care for HIV-infected MSM. Increased health care provider knowledge of anal Pap screening within this setting resulted in increased anal Pap screening for HIV-infected MSM. Routine screening leads to improved surveillance and treatment of precancerous lesions, decreasing morbidity and mortality in HIV-infected MSM. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  20. An improved proposal on the practical quantum key distribution with biased basis

    Science.gov (United States)

    Mao, Chen-Chen; Li, Jian; Zhu, Jian-Rong; Zhang, Chun-Mei; Wang, Qin

    2017-10-01

    In this manuscript, we propose an improved scheme on the decoy-state quantum key distribution (QKD) under practical experimental conditions with biased basis. Compared with the standard decoy-state method with biased basis (prepare signal pulses in both X and Z basis with certain probabilities, and weak decoy pulses as well), the difference here is, we prepare signal pulses in both X and Z basis, but the weak decoy state in only X basis. In the follow-up, we adopt this scheme to conducting numerical simulations on the QKD with the mostly often used source, i.e., weak coherent source by taking statistical fluctuations into account. Furthermore, we carry out full parameter optimization on it. Numerical simulation results demonstrate that our new scheme can present a higher key generation rate and a longer transmission distance compared with standard three-intensity decoy-state method with biased basis. Moreover, it shows drastically improved performance by conducting full parameter optimization in our new scheme compared with partial optimization.

  1. Improvement of nuclear power plants within the perspective of applications of lean manufacturing practices

    Science.gov (United States)

    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.

  2. Integrating Theory and Practice: Applying the Quality Improvement Paradigm to Product Line Engineering

    Science.gov (United States)

    Stark, Michael; Hennessy, Joseph F. (Technical Monitor)

    2002-01-01

    My assertion is that not only are product lines a relevant research topic, but that the tools used by empirical software engineering researchers can address observed practical problems. Our experience at NASA has been there are often externally proposed solutions available, but that we have had difficulties applying them in our particular context. We have also focused on return on investment issues when evaluating product lines, and while these are important, one can not attain objective data on success or failure until several applications from a product family have been deployed. The use of the Quality Improvement Paradigm (QIP) can address these issues: (1) Planning an adoption path from an organization's current state to a product line approach; (2) Constructing a development process to fit the organization's adoption path; (3) Evaluation of product line development processes as the project is being developed. The QIP consists of the following six steps: (1) Characterize the project and its environment; (2) Set quantifiable goals for successful project performance; (3) Choose the appropriate process models, supporting methods, and tools for the project; (4) Execute the process, analyze interim results, and provide real-time feedback for corrective action; (5) Analyze the results of completed projects and recommend improvements; and (6) Package the lessons learned as updated and refined process models. A figure shows the QIP in detail. The iterative nature of the QIP supports an incremental development approach to product lines, and the project learning and feedback provide the necessary early evaluations.

  3. Acquisition and improvement of human motor skills: Learning through observation and practice

    Science.gov (United States)

    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.

  4. Practical solution for improving the mechanical behaviour of the composite materials reinforced with flax woven fabric

    Directory of Open Access Journals (Sweden)

    Camelia Cerbu

    2015-04-01

    Full Text Available This article focuses on finding a practical solution for improving the mechanical behaviour especially in bending in case of the composite materials reinforced with flax fabric. For this purpose, two kinds of composites having the same number of layers are mechanically tested: the flax/epoxy composite and the flax/glass/epoxy composite (hybrid composite. The mechanical tests used were tensile test and bending test (three-point method. Different results corresponding to the weft or warp directions were remarked in case of the hybrid composite: for example, the maximum values of the tensile strength and the flexural strength measured in the weft direction are 40.63% and 34.61% greater, respectively, than the values corresponding to the warp direction. This article reports the improvement of the mechanical properties by replacing the flax reinforcement with glass reinforcement in the two upper and lower layers of the flax composite materials: increasing with 35.19% in terms of Young’s modulus E recorded in the tensile test, with 79.86% of the maximum value of the tensile stress and with 91.08% of the maximum value of the flexural stress. Composite beam theory was considered and theoretical approaches were validated by the experimental results.

  5. Do "High-Performance" Work Practices Improve Establishment-Level Outcomes?

    Science.gov (United States)

    Cappelli, Peter; Neumark, David

    2001-01-01

    Links between organizational performance and high-performance work practices were studied using data from the National Employment Survey, measures of work practices comparable across organizations, and a longitudinal design incorporating data predating use of high-performance practices. Practices raise employee compensation without necessarily…

  6. A case study of translating ACGME practice-based learning and improvement requirements into reality: systems quality improvement projects as the key component to a comprehensive curriculum.

    Science.gov (United States)

    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.

  7. Evaluate the ability of clinical decision support systems (CDSSs) to improve clinical practice.

    Science.gov (United States)

    Ajami, Sima; Amini, Fatemeh

    2013-01-01

    Prevalence of new diseases, medical science promotion and increase of referring to health care centers, provide a good situation for medical errors growth. Errors can involve medicines, surgery, diagnosis, equipment, or lab reports. Medical errors can occur anywhere in the health care system: In hospitals, clinics, surgery centers, doctors' offices, nursing homes, pharmacies, and patients' homes. According to the Institute of Medicine (IOM), 98,000 people die every year from preventable medical errors. In 2010 from all referred medical error records to Iran Legal Medicine Organization, 46/5% physician and medical team members were known as delinquent. One of new technologies that can reduce medical errors is clinical decision support systems (CDSSs). This study was unsystematic-review study. The literature was searched on evaluate the "ability of clinical decision support systems to improve clinical practice" with the help of library, books, conference proceedings, data bank, and also searches engines available at Google, Google scholar. For our searches, we employed the following keywords and their combinations: medical error, clinical decision support systems, Computer-Based Clinical Decision Support Systems, information technology, information system, health care quality, computer systems in the searching areas of title, keywords, abstract, and full text. In this study, more than 100 articles and reports were collected and 38 of them were selected based on their relevancy. The CDSSs are computer programs, designed for help to health care careers. These systems as a knowledge-based tool could help health care manager in analyze evaluation, improvement and selection of effective solutions in clinical decisions. Therefore, it has a main role in medical errors reduction. The aim of this study was to express ability of the CDSSs to improve

  8. Measuring and Improving Value of Care in Oncology Practices: ASCO Programs from Quality Oncology Practice Initiative to the Rapid Learning System.

    Science.gov (United States)

    Jacobson, Joseph O; Neuss, Michael N; Hauser, Robert

    2012-01-01

    Rising cancer care costs are no longer sustainable. Medical oncologists must focus on providing the maximum value to their patients; improving short-term, intermediate and long-term outcomes; and managing overall costs. Accurate measurement of outcomes and overall cost is essential to informing providers and institutions and in the quest for continuous improvement in value. The ASCO Quality Oncology Practice Initiative (QOPI) is an excellent tool for sampling processes of care in medical oncology practices. To achieve the larger goal of improving the value of cancer care, ASCO is investing in the development of a Rapid Learning System, which will leverage emerging information technologies to more accurately measure outcomes (including those reported by the patient) and costs, resulting in highly efficient, effective, and safe cancer care.

  9. Treadmill training with an incline reduces ankle joint stiffness and improves active range of movement during gait in adults with cerebral palsy

    DEFF Research Database (Denmark)

    Lorentzen, Jakob; Kirk, Henrik; Fernandez-Lago, Helena

    2017-01-01

    PURPOSE: We investigated if 30 min of daily treadmill training with an incline for 6 weeks would reduce ankle joint stiffness and improve active range of movement in adults with cerebral palsy (CP). METHODS: The study was designed as a randomized controlled clinical trial including 32 adults...... with CP (GMFCS 1-3) aged 38.1 SD 12 years. The training group (n = 16) performed uphill treadmill training at home daily for 30 min for 6 weeks in addition to their usual activities. Passive and reflex mediated stiffness and range of motion (ROM) of the ankle joint, kinematic and functional measures...

  10. Observational practice benefits are limited to perceptual improvements in the acquisition of a novel coordination skill.

    Science.gov (United States)

    Maslovat, Dana; Hodges, Nicola J; Krigolson, Olav E; Handy, Todd C

    2010-07-01

    There is disagreement about the effectiveness of observational practice for the acquisition of novel coordination skills and the type of processes involved in observation of novel movements. In this study, we examined learning of a bimanual 90 degrees phase offset through comparisons of three groups; physical practice, observational practice and no practice (n = 12/group). Groups were compared before and after practice on perception and production scans of the practised pattern. The observation group was yoked to the physical group such that observers watched repeated demonstrations of a learning model. Although there were no positive effects of observational practice for physical performance measures, the observation group did not differ from the physical practice group and was more accurate than controls on perceptual discrimination measures after practice. We concluded that observation of a novel bimanual movement can aid perception but that physical practice is necessary for immediate physical performance benefits. These results are discussed in terms of cognitive mediation models of motor skill learning.

  11. Improving practices in nanomedicine through near real-time pharmacokinetic analysis

    Science.gov (United States)

    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.

  12. Rural domestic waste management in Zhejiang Province, China: Characteristics, current practices, and an improved strategy.

    Science.gov (United States)

    Guan, Yidong; Zhang, Yuan; Zhao, Dongye; Huang, Xiaofeng; Li, Haini

    2015-06-01

    Lack of access to adequate sanitation facilities has serious health implications for rural dwellers and can degrade the ecosystems. This study offers a systemantic and quantitative overview of historical data on rural domestic waste (RDW) production and past and current management practices in a prototype region in China, where rural areas are undergoing rapid urbanization and are confronted with great environmental challenges associated with poor RDW management practices. The results indicate that RDW is characterized with a large fraction of kitchen waste (42.9%) and high water content (53.4%). The RDW generation (RDWG) per capita between 2012 and 2020 is estimated to increase from 0.68 to 1.01 kg/d-cap. The Hill 1 model is able to adequately simulate/project the population growth in a rural area from 1993 to 2020. The annual RDWG in the region is estimated to double from 6,033,000 tons/year in 2008 to 12,030,000 tons/year by 2020. By comparing three RDW management scenarios based on the life-cycle inventory approach and cost-benefit analysis, it is strongly recommended that the present Scenario 2 (sanitary landfill treatment) be upgraded to Scenario 3 (source separation followed by composting and landfill of RDW) to significantly reduce the ecological footprint and to improve the cost-effectiveness and long-term sustainability. Rural domestic waste (RDW) is affecting 720 million people in China and more than 3221 million people worldwide. Consequently, handling and disposal of RDW have serious health implications to rural dwellers and the ecosystems. This study offers a systemantic and quantitative overview and analysis of historical data on RDW production and management practices in a prototype region in China, which is confronted with great environmental challenges associated with RDW. Then we predict future production of RDW and propose a sustainable RDW management strategy, which holds the promise of greatly mitigating the mounting environmental pressure

  13. The Escherichia coli glucuronylsynthase promoted synthesis of steroid glucuronides: improved practicality and broader scope.

    Science.gov (United States)

    Ma, Paul; Kanizaj, Nicholas; Chan, Shu-Ann; Ollis, David L; McLeod, Malcolm D

    2014-08-28

    A library of steroid glucuronides was prepared using the glucuronylsynthase derived from Escherichia coliβ-glucuronidase, followed by purification using solid-phase extraction. A representative range of steroid substrates were screened for synthesis on the milligram scale under optimised conditions with conversions dependent on steroid substitution and stereochemistry. Epiandrosterone (3β-hydroxy-5α-androstan-17-one) provided the highest conversion of 90% (84% isolated yield). The previously unreported glucuronide conjugates of methandriol (17α-methylandrost-5-ene-3β,17β-diol), cholest-5-ene-3β,25-diol and the designer steroid trenazone (17β-hydroxyestra-4,9-dien-3-one) were prepared on a multi-milligram scale suitable for characterisation by (1)H and (13)C NMR spectroscopy. The glucuronide conjugate of d5-etiocholanolone (2,2,3,4,4-d5-3α-hydroxy-5β-androstan-17-one), a target developed by the World Anti-Doping Agency as a certified reference material, was also prepared on a milligram scale. The improved E. coli glucuronylsynthase method provides for the rapid synthesis and purification of steroid glucuronides on a scale suitable for a range of analytical applications.

  14. Integrated double mulching practices optimizes soil temperature and improves soil water utilization in arid environments

    Science.gov (United States)

    Yin, Wen; Feng, Fuxue; Zhao, Cai; Yu, Aizhong; Hu, Falong; Chai, Qiang; Gan, Yantai; Guo, Yao

    2016-09-01

    Water shortage threatens agricultural sustainability in many arid and semiarid areas of the world. It is unknown whether improved water conservation practices can be developed to alleviate this issue while increasing crop productivity. In this study, we developed a "double mulching" system, i.e., plastic film coupled with straw mulch, integrated together with intensified strip intercropping. We determined (i) the responses of soil evaporation and moisture conservation to the integrated double mulching system and (ii) the change of soil temperature during key plant growth stages under the integrated systems. Experiments were carried out in northwest China in 2009 to 2011. Results show that wheat-maize strip intercropping in combination with plastic film and straw covering on the soil surface increased soil moisture (mm) by an average of 3.8 % before sowing, 5.3 % during the wheat and maize co-growth period, 4.4 % after wheat harvest, and 4.9 % after maize harvest, compared to conventional practice (control). The double mulching decreased total evapotranspiration of the two intercrops by an average of 4.6 % ( P < 0.05), compared to control. An added feature was that the double mulching system decreased soil temperature in the top 10-cm depth by 1.26 to 1.31 °C in the strips of the cool-season wheat, and by 1.31 to 1.51 °C in the strips of the warm-season maize through the 2 years. Soil temperature of maize strips higher as 1.25 to 1.94 °C than that of wheat strips in the top 10-cm soil depth under intercropping with the double mulching system; especially higher as 1.58 to 2.11 °C under intercropping with the conventional tillage; this allows the two intercrops to grow in a well "collaborative" status under the double mulching system during their co-growth period. The improvement of soil moisture and the optimization of soil temperature for the two intercrops allow us to conclude that wheat-maize intensification with the double mulching system can be used as an

  15. Improving of type 2 diabetic patients' knowledge, attitude and practice towards diabetes self-care by implementing Community-Based Interactive Approach-diabetes mellitus strategy.

    Science.gov (United States)

    Hartayu, Titien Siwi; Mi, Mohamed Izham; Suryawati, Sri

    2012-06-21

    Community Based Interactive Approach-diabetes mellitus (CBIA-DM) is an active self-learning method. This study is aimed at improving type 2 diabetic patients' knowledge, attitude and practice on diabetes self-care by implementing the CBIA-DM strategy. Time series, pre and post quasi-experimental design, Intervention group underwent CBIA-DM, DM-club and Normal-care group acted as control. Data were collected in pre-intervention, immediately, one, three and six months post intervention. Ranging scores for pre and post test questionnaires were: knowledge (0-18) and attitude (9-45); categorizing as rational scales of the scores in good, fair and poor. Practicing in diabetes self-care was assessed using 12 questionnaires, and categorized as adhere and not adhere to DM self-care. Effectiveness of CBIA-DM was evaluated based on the increasing number of participants in good knowledge and attitude levels, and adherence in practicing diabetes self-care. CBIA-DM group shows increasing number of participants in good level of knowledge from 40 % (n = 30) up to 80 % at M + 3 with scores significantly improved from 13.1 ± 2.4 up to 15.4 ± 2.0 (Wilcoxon test, p attitude from 20 % up to 50 % at M + 3, with scores significantly improved from 33.5 ± 4.1 up to 34.9 ± 6.2 (p = 0.031) and increasing number of participants' adherence to all variables of DM self-care at M + 6 post intervention. CBIA-DM strategy is effective to improve diabetic patients' knowledge, attitude and practice on diabetes self-care. Repeating and improving the strategy program is needed to sustain the impact.

  16. Range management visual impacts

    Science.gov (United States)

    Bruce R. Brown; David Kissel

    1979-01-01

    Historical overgrazing of western public rangelands has resulted in the passage of the Public Rangeland Improvement Act of 1978. The main purpose of this Act is to improve unsatisfactory range conditions. A contributing factor to unfavorable range conditions is adverse visual impacts. These visual impacts can be identified in three categories of range management: range...

  17. A parallel guideline development and formalization strategy to improve the quality of clinical practice guidelines

    NARCIS (Netherlands)

    Goud, Rick; Hasman, Arie; Strijbis, Anne-Margreet; Peek, Niels

    2009-01-01

    Purpose: Clinical practice guidelines often contain ambiguities, inconsistencies, and logical errors that hamper implementation of these guidelines in practice. As guideline formalization is useful to verify the logical structure, consistency, and completeness of guidelines, several authors have

  18. Improving population-based cervical cancer screening in general practice : effects of a national strategy

    NARCIS (Netherlands)

    Hermens, R P; Hak, E; Hulscher, M E; Mulder, J; Tacken, M A; Braspenning, J C; Grol, R P

    OBJECTIVE: To assess the effects of a Dutch national prevention programme, aimed at general practitioners (GPs), on the adherence to organizational guidelines for effective cervical cancer screening in general practice. To identify the characteristics of general practices determining success.

  19. Use of a structured template to facilitate practice-based learning and improvement projects.

    Science.gov (United States)

    McClain, Elizabeth K; Babbott, Stewart F; Tsue, Terance T; Girod, Douglas A; Clements, Debora; Gilmer, Lisa; Persons, Diane; Unruh, Greg

    2012-06-01

    The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents' competency in practice-based learning and improvement (PBLI) is particularly challenging. We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning. We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008-2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure. An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template. The development of the tool generated program leaders' support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level.

  20. Bayesian Network Modeling to Improve Water Pricing Practices in Northwest China

    Directory of Open Access Journals (Sweden)

    Yusuyunjiang Mamitimin

    2015-10-01

    Full Text Available Water pricing is regarded as the most important and simplest economic instrument to encourage more efficient use of irrigation water in crop production. In the extremely water-scarce Tarim River basin in northwest China, improving water use efficiency has high relevance for research and policy. A Bayesian network modeling approach was applied, which is especially suitable under data-scarce conditions and the complex geo-hydrological, socioeconomic, and institutional settings of the study region, as it allows the integration of data from various types of sources. The transdisciplinary approach aimed at understanding the actual water pricing practices, the shortcomings of the current system, and possible ways of improvement. In an iterative procedure of expert interviews and group workshops, the key factors related to water pricing and water use efficiency were identified. The interactions among specific factors were defined by the respective experts, generating a causal network, which describes all relevant aspects of the investigated system. This network was finally populated with probabilistic relationships through a second round of expert interviews and group discussions. The Bayesian modeling exercise was then conducted using Netica software. The modeling results show that the mere increase of water price does not lead to significant increases in water use efficiency in crop production. Additionally, the model suggests a shift to volumetric water pricing, subsidization of water saving irrigation technology, and advancing agricultural extension to enable the farmer to efficiently react to increased costs for water. The applied participatory modeling approach helped to stimulate communication among relevant stakeholders from different domains in the region, which is necessary to create mutual understanding and joint targeted action. Finally, the challenges related to the applied transdisciplinary Bayesian modeling approach are discussed in the