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...... and Rosenberg's theorem), are also hard for dynamic range searching in the group model. This theorem allows us to reuse decades of research on range reporting lower bounds to immediately obtain a range of new group model lower bounds. Amongst others, this includes an improved lower bound for the fundamental...

  2. Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices.

    Science.gov (United States)

    Byrnes, Matthew C; Schuerer, Douglas J E; Schallom, Marilyn E; Sona, Carrie S; Mazuski, John E; Taylor, Beth E; McKenzie, Wendi; Thomas, James M; Emerson, Jeffrey S; Nemeth, Jennifer L; Bailey, Ruth A; Boyle, Walter A; Buchman, Timothy G; Coopersmith, Craig M

    2009-10-01

    To determine a) if a checklist covering a diverse group of intensive care unit protocols and objectives would improve clinician consideration of these domains and b) if improved consideration would change practice patterns. Pre- and post observational study. A 24-bed surgical/burn/trauma intensive care unit in a teaching hospital. A total of 1399 patients admitted between June 2006 and May 2007. The first component of the study evaluated whether mandating verbal review of a checklist covering 14 intensive care unit best practices altered verbal consideration of these domains. Evaluation was performed using real-time bedside audits on morning rounds. The second component evaluated whether the checklist altered implementation of these domains by changing practice patterns. Evaluation was performed by analyzing data from the Project IMPACT database after patients left the intensive care unit. Verbal consideration of evaluable domains improved from 90.9% (530/583) to 99.7% (669/671, p < .0001) after verbal review of the checklist was mandated. Bedside consideration improved on the use of deep venous thrombosis prophylaxis (p < .05), stress ulcer prophylaxis (p < .01), oral care for ventilated patients (p < 0.01), electrolyte repletion (p < .01), initiation of physical therapy (p < .05), and documentation of restraint orders (p < .0001). Mandatory verbal review of the checklist resulted in a greater than two-fold increase in transferring patients out of the intensive care unit on telemetry (16% vs. 35%, p < .0001) and initiation of physical therapy (28% vs. 42%, p < .0001) compared with baseline practice. A mandatory verbal review of a checklist covering a wide range of objectives and goals at each patient's bedside is an effective method to improve both consideration and implementation of intensive care unit best practices. A bedside checklist is a simple, cost-effective method to prevent errors of omission in basic domains of intensive care unit management that might

  3. Improving Corporate Governance Practices

    OpenAIRE

    M. Huse; J. Gabrielsson; A. Minichilli

    2009-01-01

    Peak performing organizations may benefit from active value creating boards. Suggestions to improve board behaviour and corporate governance practices are presented in this article. The suggestions result from findings in the “Valued Creating Board” research programme. However, active boards working in a shareholder activism framework may destroy rather than support value creation processes within firms. In peak performing organizations corporate governance practices should be designed and de...

  4. Improving Practice through Research.

    Science.gov (United States)

    Rose, Terry L.

    1989-01-01

    The article discusses the need for communication of research findings involving exceptional individuals, the need for resolution of the research-practice dichotomy, and the types of papers which will appear in the new column. (JDD)

  5. 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...

  6. Practice management companies improve practices' financial position.

    Science.gov (United States)

    Dupell, T

    1997-11-01

    To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.

  7. Improving practical atmospheric dispersion models

    International Nuclear Information System (INIS)

    Hunt, J.C.R.; Hudson, B.; Thomson, D.J.

    1992-01-01

    The new generation of practical atmospheric dispersion model (for short range ≤ 30 km) are based on dispersion science and boundary layer meteorology which have widespread international acceptance. In addition, recent improvements in computer skills and the widespread availability of small powerful computers make it possible to have new regulatory models which are more complex than the previous generation which were based on charts and simple formulae. This paper describes the basis of these models and how they have developed. Such models are needed to satisfy the urgent public demand for sound, justifiable and consistent environmental decisions. For example, it is preferable that the same models are used to simulate dispersion in different industries; in many countries at present different models are used for emissions from nuclear and fossil fuel power stations. The models should not be so simple as to be suspect but neither should they be too complex for widespread use; for example, at public inquiries in Germany, where simple models are mandatory, it is becoming usual to cite the results from highly complex computational models because the simple models are not credible. This paper is written in a schematic style with an emphasis on tables and diagrams. (au) (22 refs.)

  8. Problems in implementing improved range management on ...

    African Journals Online (AJOL)

    Keywords: Africa; Australia; Livestock development; Pastoral communities; Rangeland development; Rangeland systems; Sustainability; development; ecology; holism; pastoralism; range management; strategies; environment; water; health; crop production; rangelands; resource management; north africa; holistic approach ...

  9. 36 CFR 222.9 - Range improvements.

    Science.gov (United States)

    2010-07-01

    ... performed by a cooperator or permittee on National Forest System lands shall not confer the exclusive right..., to maintain improvements to specified standards. (d) Grazing fees or the number of animal months...

  10. 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.

  11. middle range theory evaluation: bridging the theory-practice gap

    African Journals Online (AJOL)

    The importance underlying the practice of nursing education must continue ... describes selected middle range theory evaluation as a tool for bridging ... engaging in innovative ways of acquiring competency. ..... performances, that guides learners attitudes towards ... Reference knowledge acquired by work experience.

  12. Pattern of optometry practice and range of services in India.

    Science.gov (United States)

    Thite, Nilesh; Jaggernath, Jyoti; Chinanayi, Farai; Bharadwaj, Shrikant; Kunjeer, Gauri

    2015-05-01

    This study was conducted to evaluate the range of services provided by optometrists in various modes of optometric practice in India. An online questionnaire was administered to 1674 optometrists to collect information on the range of optometric services offered. Data were analyzed based on variables including sex, educational qualification, and modes of practice. Two-sample Wilcoxon rank sum tests, χ tests, and Fisher exact text were used to conduct inferential statistics. A total of 563 valid and completed survey questionnaires were received from graduates of 41 optometry institutes working across 23 states of India. Of these, 225 (40.0%) were female, 288 (51.2%) had completed postgraduate education, and 340 (60.5%) were involved in more than one mode of practice. The top three modes of practice were hospital-based practice (44.8%), academia (42.8%), and optical retail (33.0%). Of the 441, out of 563 (78.3%) respondents involved in patient care, the majority (98.4%) performed refraction and routine eye examination, 70.3% dispensed contact lenses, and 66.9% practiced optical dispensing. Lower involvement was seen in providing binocular-vision (45.1%) and low-vision services (30.2%). Higher education was associated with advanced level of practice (p < 0.05) except clinical investigative procedures. There was a significant association between postgraduate studies and involvement in academics and research (p < 0.01). Most optometrists are engaged in multiple modes of practice, with optical practice, hospital-based practice, and academia being the leading modes. Optometrists need to be more involved in providing the core optometric services of binocular vision and low vision. Higher education has an impact on the level of optometric practice.

  13. Quality Improvement Practices and Trends

    DEFF Research Database (Denmark)

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

    1998-01-01

    professor, as well as key individuals from various industries. In addition to the above activities, Rick will be working with the European Foundation for Quality Management on their "European Master's Programme in Total Quality Management." That program involves a consortium of European universities. Rick......The following article, "Quality Improvement Practices and Trends in Denmark," is the first in a series of papers arranged for and co-authored by Dr. Rick L. Edgeman. Rick is a member of QE's Editorial Board and is on sabbatical from Colorado State University. During the year, Rick and his family...... has begun the process of developing a comparable consortium of American universities for the same purpose-- an activity which is cosponsored by the Education Division of the American Society for Quality (ASQ)....

  14. Continuous Improvement in Schools: Understanding the Practice

    Science.gov (United States)

    Anderson, Stephen; Kumari, Roshni

    2009-01-01

    This article investigates conceptually and practically what it means for schools to engage in the practice of continuous improvement. The analysis draws upon prior research and discussion to predict core elements of the practice of continuous improvement in schools. The predictions are then applied to a case study of continuous improvement efforts…

  15. Improving practical reasoning and argumentation

    OpenAIRE

    Baumtrog, Michael David

    2015-01-01

    This thesis justifies the need for and develops a new integrated model of practical reasoning and argumentation. After framing the work in terms of what is reasonable rather than what is rational (chapter 1), I apply the model for practical argumentation analysis and evaluation provided by Fairclough and Fairclough (2012) to a paradigm case of unreasonable individual practical argumentation provided by mass murderer Anders Behring Breivik (chapter 2). The application shows that by following t...

  16. Scientific considerations on the improvement of the range of ...

    African Journals Online (AJOL)

    This article provides the results of the investigation of biological effectiveness and the development of the regulations on the use of new agents for the improvement and expansion of the range of herbicides for the protection of sunflower crops. Keywords: range of pesticides, herbicides, sunflower, weeds, biological ...

  17. Practical Approaches to Quality Improvement for Radiologists.

    Science.gov (United States)

    Kelly, Aine Marie; Cronin, Paul

    2015-10-01

    Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

  18. Improvement of the severe accident practice tool

    International Nuclear Information System (INIS)

    Kawasaki, Ikuo; Takahashi, Shunsuke

    2016-01-01

    We developed the severe accident (SA) practice tool based on lessons learned in the accident at the Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Station. We utilized the developed SA practice tool and carried out the SA training for some employees of Kansai Electric Power Co., Inc. Afterwards, we examined the opinions given by trainees attending the training lecture and improved the SA practice tool to achieve a better educational effect. The main changes we made were improvement of the practice scenario for EAL judgments and addition of functions to the practice tool such as the EAL explanation document indication. As a result of having carried out the SA education using this practice tool, we determined the tool users could make the right EAL judgment and report the communication vote. Finally, we confirmed that the knowledge necessary for SA correspondence could be given satisfactorily by this practice tool. (author)

  19. Improved optical ranging for space based gravitational wave detection

    International Nuclear Information System (INIS)

    Sutton, Andrew J; Shaddock, Daniel A; McKenzie, Kirk; Ware, Brent; De Vine, Glenn; Spero, Robert E; Klipstein, W

    2013-01-01

    The operation of 10 6  km scale laser interferometers in space will permit the detection of gravitational waves at previously unaccessible frequency regions. Multi-spacecraft missions, such as the Laser Interferometer Space Antenna (LISA), will use time delay interferometry to suppress the otherwise dominant laser frequency noise from their measurements. This is accomplished by performing sub-sample interpolation of the optical phase measurements recorded at each spacecraft for synchronization and cancellation of the otherwise dominant laser frequency noise. These sub-sample interpolation time shifts are dependent upon the inter-spacecraft range and will be measured using a pseudo-random noise ranging modulation upon the science laser. One limit to the ranging performance is mutual interference between the outgoing and incoming ranging signals upon each spacecraft. This paper reports on the demonstration of a noise cancellation algorithm which is shown to providing a factor of ∼8 suppression of the mutual interference noise. Demonstration of the algorithm in an optical test bed showed an rms ranging error of 0.06 m, improved from 0.19 m in previous results, surpassing the 1 m RMS LISA specification and potentially improving the cancellation of laser frequency noise. (paper)

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

    African Journals Online (AJOL)

    Nurse education is being challenged to maintain quality in light of shortage of practice professionals, societal demands and rapid changes in health care delivery. The importance underlying the practice of nursing education must continue to be explored through theories to bring about refinement of educational strategies for ...

  1. Do Clinical Practice Guidelines Improve Quality?

    Science.gov (United States)

    Baldassari, Cristina M

    2017-07-01

    Controversy exists surrounding how to best define and assess quality in the health care setting. Clinical practice guidelines (CPGs) have been developed to improve the quality of medical care by highlighting key clinical recommendations based on recent evidence. However, data linking CPGs to improvements in outcomes in otolaryngology are lacking. Numerous barriers contribute to difficulties in translating CPGs to improvements in quality. Future initiatives are needed to improve CPG adherence and define the impact of CPG recommendations on the quality of otolaryngologic care provided to our patients.

  2. Using Data to Improve Educational Practice

    Directory of Open Access Journals (Sweden)

    Matthijs Koopmans

    2017-04-01

    Full Text Available Review of the book “Action Research in the Classroom: Helping Teachers Assess and Improve their Work” by Sr. Mary Ann Jacobs and Bruce S. Cooper There are many ways in which research can contribute to the improvement of educational practice, and action research is one of them. Action research bridges the gap that typically separates research from practice by having practitioners conduct specific projects to address their own questions and improve their effectiveness based on the answers they obtain. One of the advantages of this type of research is that results are often immediately accessible and have actionable implications. Thus, action research is a good tool for making improvements to the field based on evidence.

  3. 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 ...

  4. 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.

  5. Production Practice During Language Learning Improves Comprehension.

    Science.gov (United States)

    Hopman, Elise W M; MacDonald, Maryellen C

    2018-04-01

    Language learners often spend more time comprehending than producing a new language. However, memory research suggests reasons to suspect that production practice might provide a stronger learning experience than comprehension practice. We tested the benefits of production during language learning and the degree to which this learning transfers to comprehension skill. We taught participants an artificial language containing multiple linguistic dependencies. Participants were randomly assigned to either a production- or a comprehension-learning condition, with conditions designed to balance attention demands and other known production-comprehension differences. After training, production-learning participants outperformed comprehension-learning participants on vocabulary comprehension and on comprehension tests of grammatical dependencies, even when we controlled for individual differences in vocabulary learning. This result shows that producing a language during learning can improve subsequent comprehension, which has implications for theories of memory and learning, language representations, and educational practices.

  6. Improving coding accuracy in an academic practice.

    Science.gov (United States)

    Nguyen, Dana; O'Mara, Heather; Powell, Robert

    2017-01-01

    Practice management has become an increasingly important component of graduate medical education. This applies to every practice environment; private, academic, and military. One of the most critical aspects of practice management is documentation and coding for physician services, as they directly affect the financial success of any practice. Our quality improvement project aimed to implement a new and innovative method for teaching billing and coding in a longitudinal fashion in a family medicine residency. We hypothesized that implementation of a new teaching strategy would increase coding accuracy rates among residents and faculty. Design: single group, pretest-posttest. military family medicine residency clinic. Study populations: 7 faculty physicians and 18 resident physicians participated as learners in the project. Educational intervention: monthly structured coding learning sessions in the academic curriculum that involved learner-presented cases, small group case review, and large group discussion. overall coding accuracy (compliance) percentage and coding accuracy per year group for the subjects that were able to participate longitudinally. Statistical tests used: average coding accuracy for population; paired t test to assess improvement between 2 intervention periods, both aggregate and by year group. Overall coding accuracy rates remained stable over the course of time regardless of the modality of the educational intervention. A paired t test was conducted to compare coding accuracy rates at baseline (mean (M)=26.4%, SD=10%) to accuracy rates after all educational interventions were complete (M=26.8%, SD=12%); t24=-0.127, P=.90. Didactic teaching and small group discussion sessions did not improve overall coding accuracy in a residency practice. Future interventions could focus on educating providers at the individual level.

  7. 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.

  8. How improving practice relationships among clinicians and nonclinicians can improve quality in primary care.

    Science.gov (United States)

    Lanham, Holly J; McDaniel, Reuben R; Crabtree, Benjamin F; Miller, William L; Stange, Kurt C; Tallia, Alfred F; Nutting, Paula

    2009-09-01

    Understanding the role of relationships health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed. Data were drawn from four large National Institutes of Health (NIH)-funded studies, and an iterative analytic strategy and a grounded theory approach were used to understand the characteristics of relationships within primary care practices. This multimethod approach amassed rich and comparable data sets in all four studies, which were all aimed at primary care practice improvement. The broad range of data included direct observation of practices during work activities and of patient-clinician interactions, in-depth interviews with physicians and other key staff members, surveys, structured checklists of office environments, and chart reviews. Analyses focused on characteristics of relationships in practices that exhibited a range of success in achieving practice improvement. Complex adaptive systems theory informed these analyses. Trust, mindfulness, heedfulness, respectful interaction, diversity, social/task relatedness, and rich/lean communication were identified as important in practice improvement. A model of practice relationships was developed to describe how these characteristics work together and interact with reflection, sensemaking, and learning to influence practice-level quality outcomes. Although this model of practice relationships was developed from data collected in primary care practices, which differ from other HCOs in some important ways, the ideas that quality is emergent and that relationships influence quality of care are universally important for all HCOs and all medical specialties.

  9. 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

  10. Improvements in medium range weather forecasting system of India

    Indian Academy of Sciences (India)

    system is based on the latest Grid Statistical Interpolation (GSI) scheme and it has the provision to use most of .... ified Simplified-Arakawa Scheme (SAS) (Han and. Pan 2010). ..... Kim Y-J and Arakawa A 1995 Improvement of orographic gravity wave ... Yang F, Mitchell K, Hou Y-T, Dai Y, Deng X, Wang Z and. Liang X-Z ...

  11. Pitch range variations improve cognitive processing of audio messages

    OpenAIRE

    Rodero Antón, Emma; Potter, Rob F.; Prieto Vives, Pilar, 1965-

    2017-01-01

    This study explores the effect of different speaker intonation strategies in audio messages on attention, autonomic arousal, and memory. An experiment was conducted in which participants listened to 16 radio commercials produced to vary in pitch range across sentences. Dependent variables were self-reported effectiveness and adequacy, psychophysiological arousal and attention, immediate word recall and recognition of information. Results showed that messages conveyed with pitch variations ach...

  12. Objectives for next generation of practical short-range atmospheric dispersion models

    International Nuclear Information System (INIS)

    Olesen, H.R.; Mikkelsen, T.

    1992-01-01

    The proceedings contains papers from the workshop ''Objectives for Next Generation of Practical Short-Range Atmospheric Dispersion Models''. They deal with two types of models, namely models for regulatory purposes and models for real-time applications. The workshop was the result of an action started in 1991 for increased cooperation and harmonization within atmospheric dispersion modelling. The focus of the workshop was on the management of model development and the definition of model objectives, rather than on detailed model contents. It was the intention to identify actions that can be taken in order to improve the development and use of atmospheric dispersion models. The papers in the proceedings deal with various topics within the broad spectrum of matters related to up-to-date practical models, such as their scientific basis, requirements for model input and output, meteorological preprocessing, standardisation within modelling, electronic information exchange as a potentially useful tool, model evaluation and data bases for model evaluation. In addition to the papers, the proceedings contain summaries of the discussions at the workshop. These summaries point to a number of recommended actions which can be taken in order to improve ''modelling culture''. (AB)

  13. Making perceptual learning practical to improve visual functions.

    Science.gov (United States)

    Polat, Uri

    2009-10-01

    Task-specific improvement in performance after training is well established. The finding that learning is stimulus-specific and does not transfer well between different stimuli, between stimulus locations in the visual field, or between the two eyes has been used to support the notion that neurons or assemblies of neurons are modified at the earliest stage of cortical processing. However, a debate regarding the proposed mechanism underlying perceptual learning is an ongoing issue. Nevertheless, generalization of a trained task to other functions is an important key, for both understanding the neural mechanisms and the practical value of the training. This manuscript describes a structured perceptual learning method that previously used (amblyopia, myopia) and a novel technique and results that were applied for presbyopia. In general, subjects were trained for contrast detection of Gabor targets under lateral masking conditions. Training improved contrast sensitivity and diminished the lateral suppression when it existed (amblyopia). The improvement was transferred to unrelated functions such as visual acuity. The new results of presbyopia show substantial improvement of the spatial and temporal contrast sensitivity, leading to improved processing speed of target detection as well as reaction time. Consequently, the subjects, who were able to eliminate the need for reading glasses, benefited. Thus, here we show that the transfer of functions indicates that the specificity of improvement in the trained task can be generalized by repetitive practice of target detection, covering a sufficient range of spatial frequencies and orientations, leading to an improvement in unrelated visual functions. Thus, perceptual learning can be a practical method to improve visual functions in people with impaired or blurred vision.

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

    African Journals Online (AJOL)

    Osondu

    This study assessed management practices on ... technological methods adopted and huge ... Ethiopian Journal of Environmental Studies and Management EJESM Vol. 5 No. .... perspectives. .... specifications, cost data, programmes, plus.

  15. Interrogating Your Wisdom of Practice to Improve Classroom Practices

    Science.gov (United States)

    Chappell, Philip

    2017-01-01

    This article presents a heuristic for language teachers to articulate and explore their fundamental theories of and philosophical stances towards language, language learning, and language teaching. It includes tools with which teachers can interrogate those theories, weighing them up against their actual classroom practices. Through presenting…

  16. Practice improvement, part II: trends in employment versus private practice.

    Science.gov (United States)

    Coleman, Mary Thoesen; Roett, Michelle A

    2013-11-01

    A growing percentage of physicians are selecting employment over solo practice, and fewer family physicians have hospital admission privileges. Results from surveys of recent medical school graduates indicate a high value placed on free time. Factors to consider when choosing a practice opportunity include desire for independence, decision-making authority, work-life balance, administrative responsibilities, financial risk, and access to resources. Compensation models are evolving from the simple fee-for-service model to include metrics that reward panel size, patient access, coordination of care, chronic disease management, achievement of patient-centered medical home status, and supervision of midlevel clinicians. When a practice is sold, tangible personal property and assets in excess of liabilities, patient accounts receivable, office building, and goodwill (ie, expected earnings) determine its value. The sale of a practice includes a broad legal review, addressing billing and coding deficiencies, noncompliant contractual arrangements, and potential litigations as well as ensuring that all employment agreements, leases, service agreements, and contracts are current, have been executed appropriately, and meet regulatory requirements. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  17. Improved linearity using harmonic error rejection in a full-field range imaging system

    Science.gov (United States)

    Payne, Andrew D.; Dorrington, Adrian A.; Cree, Michael J.; Carnegie, Dale A.

    2008-02-01

    Full field range imaging cameras are used to simultaneously measure the distance for every pixel in a given scene using an intensity modulated illumination source and a gain modulated receiver array. The light is reflected from an object in the scene, and the modulation envelope experiences a phase shift proportional to the target distance. Ideally the waveforms are sinusoidal, allowing the phase, and hence object range, to be determined from four measurements using an arctangent function. In practice these waveforms are often not perfectly sinusoidal, and in some cases square waveforms are instead used to simplify the electronic drive requirements. The waveforms therefore commonly contain odd harmonics which contribute a nonlinear error to the phase determination, and therefore an error in the range measurement. We have developed a unique sampling method to cancel the effect of these harmonics, with the results showing an order of magnitude improvement in the measurement linearity without the need for calibration or lookup tables, while the acquisition time remains unchanged. The technique can be applied to existing range imaging systems without having to change or modify the complex illumination or sensor systems, instead only requiring a change to the signal generation and timing electronics.

  18. 78 FR 18954 - Incentives To Adopt Improved Cybersecurity Practices

    Science.gov (United States)

    2013-03-28

    ... [Docket Number 130206115-3115-01] Incentives To Adopt Improved Cybersecurity Practices AGENCY: U.S... best practices and standards, once adopted, are updated in the light of changing threats and new...

  19. Developer Stories: Improving Architecture in Agile Practice

    DEFF Research Database (Denmark)

    Tjørnehøj, Gitte; Jensen, Rolf Njor; Platz, Niels

    2007-01-01

    of viable architectures. To strengthen XP in this regard a new practice: Developer Stories ([2]) was introduced in 2006 - mainly based on a theoretical argumentation. This paper reports from extensive experimentation with, and elaboration of the new practice. Results from this experimentation shows...... that using Developer Stories increases the likelihood of developing a viable architecture through a series of deliberate choices, through creating disciplined and recurring activities that: 1) Facilitate sharing and embodying of knowledge about architectural issues, and 2) heighten visibility of refactorings...

  20. Quality assessment and improvements in pathology practice

    NARCIS (Netherlands)

    Kuijpers, C.C.H.J.

    2016-01-01

    Every patient has the right to receive optimal quality health care. With regard to pathology practice, a small (interpretational) difference can have major impact for the patient, because prognosis and treatment selection are often based on the pathology report. Unfortunately, it is inevitable that

  1. Performance improvement of professional printing systems : from theory to practice

    NARCIS (Netherlands)

    Ezzeldin Mahdy Abdelmonem, M.

    2012-01-01

    Performance Improvement of Professional Printing Systems: from theory to practice Markets demand continuously for higher quality, higher speed, and more energy-efficient professional printers. In this thesis, control strategies have been developed to improve the performance of both professional

  2. 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

  3. Practical solution of plastic deformation problems in elastic-plastic range

    Science.gov (United States)

    Mendelson, A; Manson, S

    1957-01-01

    A practical method for solving plastic deformation problems in the elastic-plastic range is presented. The method is one of successive approximations and is illustrated by four examples which include a flat plate with temperature distribution across the width, a thin shell with axial temperature distribution, a solid cylinder with radial temperature distribution, and a rotating disk with radial temperature distribution.

  4. 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

  5. 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...... districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure...

  6. 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.

  7. How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

    Science.gov (United States)

    OʼRourke, Hannah M; Fraser, Kimberly D

    2016-01-01

    Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.

  8. 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 (soil, migration of Pb within shooting ranges and offsite has been reported in literature. Best management practices to reduce mobility of Pb in shooting ranges involve an integrated Pb management program which has been described in the paper. The adoption of the non-toxic "green bullet" which has been developed to replace Pb bullets may reduce or prevent environmental pollution at shooting ranges. However, the contaminated soil resulting from decades of operation of several shooting ranges still needs to be restored to its natural state. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. 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 J; Weyer, Sharon M; Werner, James J; Fry, Ronald E; Stange, Kurt C

    2011-01-01

    To test the effect of an Appreciative Inquiry (AI) quality improvement strategy on clinical quality management and practice development outcomes. Appreciative inquiry enables the discovery of shared motivations, envisioning a transformed future, and learning around the implementation of a change process. Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical-record review assessed change in PSD rates. Ethnographic field notes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. The PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives, and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited 1 or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective.

  10. Information Technology Management: Social Security Administration Practices Can Be Improved

    National Research Council Canada - National Science Library

    Shaw, Clay

    2001-01-01

    To improve SSAs IT management practices, we recommend that the Acting Commissioner of Social Security direct the Chief Information Officer and the Deputy Commissioner for Systems to complete the following actions...

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

    African Journals Online (AJOL)

    STORAGESEVER

    2008-12-29

    Dec 29, 2008 ... the annual income of the PFs and NPFs, respectively. ... Key words: Adoption, improved vegetable, production practices, farmers and national fadama ..... so, fixed cost components such as depreciation, insurance, repairs,.

  12. Programme evaluation: Can it improve human resource management practice?

    Directory of Open Access Journals (Sweden)

    Johann Louw

    2012-07-01

    Full Text Available Orientation: This is the final article in the special edition on human resource (HR programmes and evaluation. Its starting point is that programme evaluation is the application of a wide range of social science research methods that provide credible information about the need, use, planning, effectiveness and cost of a programme. Research purpose: The purpose of this article is to review the other articles in this volume, and to draw out general conclusions about their contributions to knowledge in the field. Motivation for the study: If evaluations are undertaken in the HR domain in South Africa, they remain mostly unpublished, and thus cannot contribute to a knowledge base for the field. Research design, approach and method: This article provides a theory-based approach to programme evaluation. The seven articles were analysed in terms of two major functions of programme evaluation, namely to ask ‘How does a programme work?’, and ‘Does it work?‘ Main findings: Eight overarching themes are identified in the articles included in this volume. Practical/managerial implications: The evidence discussed here can be used to make better decisions, promote organisational learning, improve practice, and enhance employee wellbeing. Contribution/value-add: The main contribution of this concluding article is its argument that research and theory in this field can enhance the work of HR professionals, by providing evidence about how ‘good’ a programme is, and why it is good. This adds substantial value in a world characterised by accountability and evidence-based practice.

  13. Evidence-based care: an innovation to improve nursing practice ...

    African Journals Online (AJOL)

    Evidence-based care: an innovation to improve nursing practice globally. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... best available evidence from research findings, expert ideas from specialists in the various health ... need to be addressed to enhance utilization of the best available evidence in nursing practice.

  14. Practice-level quality improvement interventions in primary care: a review of systematic reviews.

    Science.gov (United States)

    Irwin, Ryan; Stokes, Tim; Marshall, Tom

    2015-11-01

    To present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews. Quality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care--the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting. A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions. Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions. A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions. Audit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions. Evidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality

  15. Using a standards committee to design practical procedure system improvements

    International Nuclear Information System (INIS)

    Grider, D.A.; Plung, D.

    1993-01-01

    In the post-Three Mile Island (TMI) environment, numerous reports have been issued on how to improve the quality of procedures used at government and commercial nuclear facilities. The studies tend to be long on what is wrong with existing procedures and short on practical directions on how to fix those faults. Few of these studies have been conducted by practitioners with full-time procedure-managing or procedure writing experience. None of these studies go into detail on how to improve the procedure system itself. Over the last 10 yr, various nuclear facilities within the US Department of Energy (DOE) have carried out individual programs to develop procedures that meet post-TMI standards. However, ∼2 yr ago, DOE formed a Procedures Standards Committee to advise DOE in developing a set of post-TMI guidelines that could be consistently applied throughout all DOE nuclear facilities. The committee has achieved not only its original mission by producing a series of integrated guidance documents but has also evolved a systems approach to procedures management that sets new standards for procedure quality and efficiency. As members of this committee, the authors want to describe what has made the group's approach so successful. The lessons learned may be translatable to a wide range of government and commercial industry procedure programs

  16. Effectiveness of a quality-improvement program in improving management of primary care practices

    Science.gov (United States)

    Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

    2011-01-01

    Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the

  17. Beyond "implementation strategies": classifying the full range of strategies used in implementation science and practice.

    Science.gov (United States)

    Leeman, Jennifer; Birken, Sarah A; Powell, Byron J; Rohweder, Catherine; Shea, Christopher M

    2017-11-03

    Strategies are central to the National Institutes of Health's definition of implementation research as "the study of strategies to integrate evidence-based interventions into specific settings." Multiple scholars have proposed lists of the strategies used in implementation research and practice, which they increasingly are classifying under the single term "implementation strategies." We contend that classifying all strategies under a single term leads to confusion, impedes synthesis across studies, and limits advancement of the full range of strategies of importance to implementation. To address this concern, we offer a system for classifying implementation strategies that builds on Proctor and colleagues' (2013) reporting guidelines, which recommend that authors not only name and define their implementation strategies but also specify who enacted the strategy (i.e., the actor) and the level and determinants that were targeted (i.e., the action targets). We build on Wandersman and colleagues' Interactive Systems Framework to distinguish strategies based on whether they are enacted by actors functioning as part of a Delivery, Support, or Synthesis and Translation System. We build on Damschroder and colleague's Consolidated Framework for Implementation Research to distinguish the levels that strategies target (intervention, inner setting, outer setting, individual, and process). We then draw on numerous resources to identify determinants, which are conceptualized as modifiable factors that prevent or enable the adoption and implementation of evidence-based interventions. Identifying actors and targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up. In our descriptions of each class, we identify the level of the Interactive System Framework at which the strategy is enacted (actors), level and determinants targeted (action targets), and outcomes used to

  18. Practical Forward-Secure Range and Sort Queries with Update-Oblivious Linked Lists

    Directory of Open Access Journals (Sweden)

    Blass Erik-Oliver

    2015-06-01

    Full Text Available We revisit the problem of privacy-preserving range search and sort queries on encrypted data in the face of an untrusted data store. Our new protocol RASP has several advantages over existing work. First, RASP strengthens privacy by ensuring forward security: after a query for range [a, b], any new record added to the data store is indistinguishable from random, even if the new record falls within range [a, b]. We are able to accomplish this using only traditional hash and block cipher operations, abstaining from expensive asymmetric cryptography and bilinear pairings. Consequently, RASP is highly practical, even for large database sizes. Additionally, we require only cloud storage and not a computational cloud like related works, which can reduce monetary costs significantly. At the heart of RASP, we develop a new update-oblivious bucket-based data structure. We allow for data to be added to buckets without leaking into which bucket it has been added. As long as a bucket is not explicitly queried, the data store does not learn anything about bucket contents. Furthermore, no information is leaked about data additions following a query. Besides formally proving RASP’s privacy, we also present a practical evaluation of RASP on Amazon Dynamo, demonstrating its efficiency and real world applicability.

  19. Rescue dose orders as an alternative to range orders: an evidence-based practice project.

    Science.gov (United States)

    Yi, Cassia

    2015-06-01

    Relief of pain is a fundamental aspect of optimal patient care. However, pain management in the inpatient setting is often constrained by concerns related to regulatory oversight, particularly with regard to the use of opioid dose range orders. These concerns can inadvertently result in the development of policies and practices that can negatively impact the health care team's ability to deliver optimal and individualized pain management. An evidence-based practice project was undertaken to address concerns about regulatory oversight of pain management processes by changing the way pain was managed in a large academic hospital setting. A novel pain management approach using rescue dose medications was established as an alternative to opioid dose range orders. The use of the rescue dose protocol was successfully implemented. Outcomes included an overall reduction in the administration of inappropriate intravenous opioids and opioid-acetaminophen combination medications, with a subsequent increase in single-entity first-line opioid analgesics. Rescue dose protocols may offer an alternative to opioid dose range orders as a means of effectively managing pain. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  20. Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

    Science.gov (United States)

    Fagnan, Lyle J; Walunas, Theresa L; Parchman, Michael L; Dickinson, Caitlin L; Murphy, Katrina M; Howell, Ross; Jackson, Kathryn L; Madden, Margaret B; Ciesla, James R; Mazurek, Kathryn D; Kho, Abel N; Solberg, Leif I

    2018-04-01

    The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. We developed a cost-of-recruitment template and used it to record personnel time and associated costs of travel and communication materials. A total of 3,669 practices were contacted during the 14- to 18-month recruitment period, resulting in 484 enrolled practices across the 6 states served by the 2 cooperatives. The average number of interactions per enrolled practice was 7, with a total of 29,100 hours and a total cost of $2.675 million, or $5,529 per enrolled practice. Prior partnerships predicted recruiting almost 1 in 3 of these practices as contrasted to 1 in 20 practices without a previous relationship or warm hand-off. Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more. © 2018 Annals of Family Medicine, Inc.

  1. Role of storms and forest practices in sedimentation of an Oregon Coast Range lake

    Science.gov (United States)

    Richardson, K.; Hatten, J. A.; Wheatcroft, R. A.; Guerrero, F. J.

    2014-12-01

    The design of better management practices in forested watersheds to face climate change and the associated increase in the frequency of extreme events requires a better understanding of watershed responses to extreme events in the past and also under management regimes. One of the most sensitive watershed processes affected is sediment yield. Lake sediments record events which occur in a watershed and provide an opportunity to examine the interaction of storms and forest management practices in the layers of the stratigraphy. We hypothesize that timber harvesting and road building since the 1900s has resulted in increases in sedimentation; however, the passage of the Oregon Forest Practices Act (OFPA) in 1972 has led to a decrease in sedimentation. Sediment cores were taken at Loon Lake in the Oregon Coast Range. The 32-m deep lake captures sediment from a catchment highly impacted by recent land use and episodic Pacific storms. We can use sedimentological tools to measure changes in sediment production as motivated by extreme floods before settlement, during a major timber harvesting period, and after installation of forestry Best Management Practices. Quantification of changes in particle size and elemental composition (C, N, C/N) throughout the cores can elucidate changes in watershed response to extreme events, as can changes in layer thickness. Age control in the cores is being established by Cesium-137 and radiocarbon dating. Given the instrumental meteorological data and decadal climate reconstructions, we will disentangle climate driven signals from changes in land use practices. The sediment shows distinct laminations and varying thickness of layers throughout the cores. Background deposition is composed of thin layers (events to determine if the OFPA is having an effect on reducing sedimentation rates as a result of extreme magnitude storm events.

  2. Target recognition of ladar range images using slice image: comparison of four improved algorithms

    Science.gov (United States)

    Xia, Wenze; Han, Shaokun; Cao, Jingya; Wang, Liang; Zhai, Yu; Cheng, Yang

    2017-07-01

    Compared with traditional 3-D shape data, ladar range images possess properties of strong noise, shape degeneracy, and sparsity, which make feature extraction and representation difficult. The slice image is an effective feature descriptor to resolve this problem. We propose four improved algorithms on target recognition of ladar range images using slice image. In order to improve resolution invariance of the slice image, mean value detection instead of maximum value detection is applied in these four improved algorithms. In order to improve rotation invariance of the slice image, three new improved feature descriptors-which are feature slice image, slice-Zernike moments, and slice-Fourier moments-are applied to the last three improved algorithms, respectively. Backpropagation neural networks are used as feature classifiers in the last two improved algorithms. The performance of these four improved recognition systems is analyzed comprehensively in the aspects of the three invariances, recognition rate, and execution time. The final experiment results show that the improvements for these four algorithms reach the desired effect, the three invariances of feature descriptors are not directly related to the final recognition performance of recognition systems, and these four improved recognition systems have different performances under different conditions.

  3. Performance analysis of dedicated short range communications technology and overview of the practicability for developing countries

    Directory of Open Access Journals (Sweden)

    Vandana Bassoo

    2015-12-01

    Full Text Available Vehicular communication is a widely researched field and aims at developing technologies that may complement systems such as the advanced driver assistance systems. It is therefore important to analyse and infer on the performance of vehicular technologies for different driving and on-road criteria. This study considers the dedicated short range communications technology and more precisely the IEEE 802.11p standard for a performance and practicability analysis. There is also the proposal of a new classification scheme for typical driving conditions, which includes the main categories of Emergency and Safety scenarios while sub-classifications of Critical and Preventive Safety also exist. The scheme is used to build up scenarios as well as related equations relevant to developing countries for practical network simulation. The results obtained indicate that the relative speed of nodes is a determining factor in the overall performance and effectiveness of wireless vehicular communication systems. Moreover, delay values of low order were observed while an effective communication range of about 800 m was calculated for highway scenarios. The research thus indicates suitability of the system for an active use in collision avoidance even though independent factors such as climatic conditions and driver behaviour may affect its effectiveness in critical situations.

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

    Science.gov (United States)

    2017-09-01

    MODELING TO IMPROVE HUMAN DECISION-MAKING DURING TEST AND EVALUATION RANGE CONTROL by William Carlson September 2017 Thesis Advisor...the Office of Management and Budget, Paperwork Reduction Project (0704-0188) Washington, DC 20503. 1. AGENCY USE ONLY (Leave blank) 2. REPORT...MAKING DURING TEST AND EVALUATION RANGE CONTROL 5. FUNDING NUMBERS 6. AUTHOR(S) William Carlson 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES

  5. On the use of small integrating spheres to improve the linearity range of RASNIKS systems

    International Nuclear Information System (INIS)

    Alberdi, J.; Burgos, C.; Ferrando, A.; Molinero, A.; Schvachkin, V.; Figueroa, C.F.; Matorras, F.; Rodrigo, T.; Ruiz, A.; Vila, I.

    1997-10-01

    Rasniks elements will be used in the CMS alignment system. The large displacements of the different sub detectors expected in the CMS experiment demands large linearity response of this system. By the use of a small integrating sphere we have optimized the source definition such that a factor three improvement in the linearity range with respect to conventional Rasniks configurations is obtained. The response range reached coincides with the maximum one can get with the components used in the test

  6. 33 CFR 334.20 - Gulf of Maine off Cape Small, Maine; naval aircraft practice mining range area.

    Science.gov (United States)

    2010-07-01

    ... REGULATIONS § 334.20 Gulf of Maine off Cape Small, Maine; naval aircraft practice mining range area. (a) The... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Gulf of Maine off Cape Small, Maine; naval aircraft practice mining range area. 334.20 Section 334.20 Navigation and Navigable Waters...

  7. Practice Facilitator Strategies for Addressing Electronic Health Record Data Challenges for Quality Improvement: EvidenceNOW.

    Science.gov (United States)

    Hemler, Jennifer R; Hall, Jennifer D; Cholan, Raja A; Crabtree, Benjamin F; Damschroder, Laura J; Solberg, Leif I; Ono, Sarah S; Cohen, Deborah J

    2018-01-01

    Practice facilitators ("facilitators") can play an important role in supporting primary care practices in performing quality improvement (QI), but they need complete and accurate clinical performance data from practices' electronic health records (EHR) to help them set improvement priorities, guide clinical change, and monitor progress. Here, we describe the strategies facilitators use to help practices perform QI when complete or accurate performance data are not available. Seven regional cooperatives enrolled approximately 1500 small-to-medium-sized primary care practices and 136 facilitators in EvidenceNOW, the Agency for Healthcare Research and Quality's initiative to improve cardiovascular preventive services. The national evaluation team analyzed qualitative data from online diaries, site visit field notes, and interviews to discover how facilitators worked with practices on EHR data challenges to obtain and use data for QI. We found facilitators faced practice-level EHR data challenges, such as a lack of clinical performance data, partial or incomplete clinical performance data, and inaccurate clinical performance data. We found that facilitators responded to these challenges, respectively, by using other data sources or tools to fill in for missing data, approximating performance reports and generating patient lists, and teaching practices how to document care and confirm performance measures. In addition, facilitators helped practices communicate with EHR vendors or health systems in requesting data they needed. Overall, facilitators tailored strategies to fit the individual practice and helped build data skills and trust. Facilitators can use a range of strategies to help practices perform data-driven QI when performance data are inaccurate, incomplete, or missing. Support is necessary to help practices, particularly those with EHR data challenges, build their capacity for conducting data-driven QI that is required of them for participating in practice

  8. 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.

  9. Performance improvement planning : developing effective billing and collection practices

    OpenAIRE

    anonymous

    2008-01-01

    Effective billing and collection systems are a critical component for ensuring the viability of a service provider. Improving billing and collection activities has an immediate impact on the revenue streams of a service provider that can, in turn, help the service provider in improving services. However, while effective billing and collection practices depend on many internal factors (including customer databases, the extent of metered and unmetered service provision, tariff and billing struc...

  10. A Pilot Feasibility Study to Improve Food Parenting Practices.

    Science.gov (United States)

    Moore, Amy M; Clair-Michaud, Mary; Melanson, Kathleen J; Tovar, Alison

    2018-03-01

    We examined the feasibility and acceptability of a novel home-based intervention to improve the food parenting practices of low-income mothers with preschool-aged children. Mother-child dyads (N = 15) were recruited from WIC in southern Rhode Island. A non-experimental, pretest-posttest design was used to assess changes in maternal food parenting practices. Dyads participated in 3 home-based sessions that included baseline measures and an evening meal video recording at session 1, a motivational interviewing (MI) intervention that included feedback on the evening meal video recording at session 2, and a satisfaction ques- tionnaire at session 3. Pretest-posttest measures included 5 subscales of the Comprehensive Feeding Practices Questionnaire. Fifteen mother-child dyads (mothers: 32.3, SD = 4.6 years, 86.7% white; children: 3.2, SD = 0.9 years, male = 73.3%, 66.7% white) completed the study. Mothers reported improvements in food parenting practices following the home-based MI intervention. Overall, 93% of mothers 'strongly agreed' that it was worth their effort to participate in the study. A home-based MI intervention may be an effective strategy for improving maternal food parenting practices in low-income populations. Most mothers found that watching themselves was informative and applicable to their own lives.

  11. IMPROVING WOMEN'S LIVES Practical support for women gives ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    IMPROVING WOMEN'S LIVES Practical support for women gives communities a better future. October 26 ... Organized into small cooperatives, the women produce and market argan oil using a mix of traditional and modern methods. At the same time ... arts and craft. Technology helps Asian women balance family and work.

  12. 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

  13. Improving School Leadership. Volume 1: Policy and Practice

    Science.gov (United States)

    OECD Publishing (NJ3), 2008

    2008-01-01

    As countries strive to reform education systems and improve student results, school leadership is high on education policy agendas. But in many countries, the men and women who run schools are overburdened, underpaid and near retirement. And few people are lining up for their jobs. Based on an OECD study of school leadership practices and policies…

  14. What interventions can improve the mental health nursing practice environment?

    Science.gov (United States)

    Redknap, Robina; Twigg, Di; Towell, Amanda

    2016-02-01

    The nursing practice environment is an important factor for services to consider in the attraction and retention of a skilled workforce during future nursing shortages. Despite the significant number of international studies undertaken to understand the influence of the practice environment on nurse satisfaction and retention, few have been undertaken within the mental health setting. This paper reports on results from a survey conducted in a large Australian public mental health hospital to examine nurses' perceptions of their practice environment, and identifies interventions that could be implemented to improve the practice environment. The hospital is the only remaining, standalone public mental health hospital in Western Australia. © 2016 Australian College of Mental Health Nurses Inc.

  15. Practice of building production planning system of company with a wide range of products - case study

    Directory of Open Access Journals (Sweden)

    Łukasz Hadaś

    2012-09-01

    Full Text Available Background: The complexity of the manufacturing environments of today's mechanical engineering companies and the number of both internal and external restrictions affecting to need of building tailored production planning and control systems. This statement is particularly important in conditions of companies with a wide range of products and different customer service strategies (different locations of the logistics decoupling point otherwise called "order penetration point". Streams of materials in these conditions require different management what is the main reason for carrying out research in business conditions by the authors. Material and methods: The research was carried out in industrial engineering in complex environmental conditions of production. This was a specializing in technology, multi-departments environment, with multiple streams of values and a wide range of products (about 500 items. The work was carried out under the transformation of the production system from the "push" logic of flow to "pull" logic of flow and building a dedicated system based on the best practice approach. Results: The paper describes the process of building tailored hybrid systems in the area of planning and shop flow control of production. The authors present the theoretical considerations on the issue and practical experiences. The authors present factors of selection of the transformation path and its road map. The article describes the part of the authors' own experience in the work on the methodology of transformation of Polish companies in the running business condition. Conclusions: Establishing the methodology of transformation of the production system is not a simple task. This paper presents only selected aspects of complex decision-making process. However, the authors presented work shows the important aspect of the transformation of production systems for these organizational conditions.

  16. 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).

  17. Precision improvement of frequency-modulated continuous-wave laser ranging system with two auxiliary interferometers

    Science.gov (United States)

    Shi, Guang; Wang, Wen; Zhang, Fumin

    2018-03-01

    The measurement precision of frequency-modulated continuous-wave (FMCW) laser distance measurement should be proportional to the scanning range of the tunable laser. However, the commercial external cavity diode laser (ECDL) is not an ideal tunable laser source in practical applications. Due to the unavoidable mode hopping and scanning nonlinearity of the ECDL, the measurement precision of FMCW laser distance measurements can be substantially affected. Therefore, an FMCW laser ranging system with two auxiliary interferometers is proposed in this paper. Moreover, to eliminate the effects of ECDL, the frequency-sampling method and mode hopping influence suppression method are employed. Compared with a fringe counting interferometer, this FMCW laser ranging system has a measuring error of ± 20 μm at the distance of 5.8 m.

  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. [Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

    Science.gov (United States)

    Godény, Sándor

    2012-02-05

    The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

  1. 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.

  2. NOAA's Strategy to Improve Operational Weather Prediction Outlooks at Subseasonal Time Range

    Science.gov (United States)

    Schneider, T.; Toepfer, F.; Stajner, I.; DeWitt, D.

    2017-12-01

    NOAA is planning to extend operational global numerical weather prediction to sub-seasonal time range under the auspices of its Next Generation Global Prediction System (NGGPS) and Extended Range Outlook Programs. A unification of numerical prediction capabilities for weather and subseasonal to seasonal (S2S) timescales is underway at NOAA using the Finite Volume Cubed Sphere (FV3) dynamical core as the basis for the emerging unified system. This presentation will overview NOAA's strategic planning and current activities to improve prediction at S2S time-scales that are ongoing in response to the Weather Research and Forecasting Innovation Act of 2017, Section 201. Over the short-term, NOAA seeks to improve the operational capability through improvements to its ensemble forecast system to extend its range to 30 days using the new FV3 Global Forecast System model, and by using this system to provide reforecast and re-analyses. In parallel, work is ongoing to improve NOAA's operational product suite for 30 day outlooks for temperature, precipitation and extreme weather phenomena.

  3. Improvement of linear reactivity methods and application to long range fuel management

    International Nuclear Information System (INIS)

    Woehlke, R.A.; Quan, B.L.

    1982-01-01

    The original development of the linear reactivity theory assumes flat burnup, batch by batch. The validity of this assumption is explored using multicycle burnup data generated with a detailed 3-D SIMULATE model. The results show that the linear reactivity method can be improved by correcting for batchwise power sharing. The application of linear reactivity to long range fuel management is demonstrated in several examples. Correcting for batchwise power sharing improves the accuracy of the analysis. However, with regard to the sensitivity of fuel cost to changes in various parameters, the corrected and uncorrected linear reactivity theories give remarkably similar results

  4. Improved measurement linearity and precision for AMCW time-of-flight range imaging cameras.

    Science.gov (United States)

    Payne, Andrew D; Dorrington, Adrian A; Cree, Michael J; Carnegie, Dale A

    2010-08-10

    Time-of-flight range imaging systems utilizing the amplitude modulated continuous wave (AMCW) technique often suffer from measurement nonlinearity due to the presence of aliased harmonics within the amplitude modulation signals. Typically a calibration is performed to correct these errors. We demonstrate an alternative phase encoding approach that attenuates the harmonics during the sampling process, thereby improving measurement linearity in the raw measurements. This mitigates the need to measure the system's response or calibrate for environmental changes. In conjunction with improved linearity, we demonstrate that measurement precision can also be increased by reducing the duty cycle of the amplitude modulated illumination source (while maintaining overall illumination power).

  5. 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 improvement methods were not adopted by most participating practices. Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate. © 2010 Blackwell Publishing Ltd.

  6. Ultra-low-pressure sputtering to improve exchange bias and tune linear ranges in spin valves

    Energy Technology Data Exchange (ETDEWEB)

    Tang, XiaoLi, E-mail: tangtang1227@163.com; Yu, You; Liu, Ru; Su, Hua; Zhang, HuaiWu; Zhong, ZhiYong; Jing, YuLan

    2017-05-01

    A series of CoFe/IrMn exchange bilayers was grown by DC-sputtering at different ultra-low argon pressures ranging from 0.008 to 0.1 Pa. This pressure range was one to two orders lower than the normal sputtering pressure. Results revealed that the exchange bias increased from 140 to 250 Oe in CoFe(10 nm)/IrMn (15 nm) bilayers of fixed thickness because of the improved crystalline structure and morphological uniformity of films. Since ferromagnetic /antiferromagnetic (FM/AF) bilayers are always used in linear magnetic sensors as detection layers, the varying exchange bias can successfully achieve tunable linear range in a crossed pinning spin valve. The linear range could be adjustable from −80 Oe – +80 Oe to −150 Oe – +150 Oe on the basis of giant magnetoresistance responses. Therefore, this method provides a simple method to tune the operating range of magnetic field sensors. - Highlights: • Increasing exchange bias was achieved in bilayer at ultra-low-pressure sputtering. • The low void density and smooth surface were achieved in low pressure. • Varying exchange bias achieved tunable linear range in spin valve.

  7. Improving product development practice: An action-research based approach

    DEFF Research Database (Denmark)

    Harmsen, Hanne

    In studies of new product development it has often been concluded that to a large extent new product suc-cess is tunder the influence of companies and long lists of direct norma-tive guide-lines have been formulated. Nevertheless descriptive studi that deve-lopment practice is still far from...... studies both purely descriptive and studies identifying success and failure factors, but almost no studies of how companies actually undertake improve-ments, which problems they encounter,, and how/whether they overcome these problems. Action research is proposed as a suitable method for studying...

  8. Work management practices that reduce dose and improve efficiency

    International Nuclear Information System (INIS)

    Miller, D.W.; Hulin, M.

    1998-01-01

    Work management practices at nuclear power plants can dramatically affect the outcome of annual site dose goals and outage costs. This presentation discusses global work management practices that contribute to dose reduction including work philosophy, work selection, work planning, work scheduling, worker training, work implementation and worker feedback. The presentation is based on a two-year international effort (sponsored by NEA/IAEA ISOE) to study effective work practices that reduce dose. Experts in this area believe that effective work selection and planning practices can substantially reduce occupational dose during refueling outages. For example, some plants represented in the expert group complete refueling outages in 12-18 days (Finland) with doses below 0,90 person-Sv. Other plants typically have 50-75 day outages with substantially higher site doses. The fundamental reasons for longer outages and higher occupational doses are examined. Good work management principles that have a proven track record of reducing occupational dose are summarized. Practical methods to reduce work duration and dose are explained. For example, scheduling at nuclear power plants can be improved by not only sequencing jobs on a time line but also including zone and resource-based considerations to avoid zone congestion and manpower delays. An ongoing, global, benchmarking effort is described which provides current duration and dose information for repetitive jobs to participating utilities world-wide. (author)

  9. 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.

  10. Audit and feedback by medical students to improve the preventive care practices of general practice supervisors.

    Science.gov (United States)

    Gilkes, Lucy A; Liira, Helena; Emery, Jon

    Medical students benefit from their contact with clinicians and patients in the clinical setting. However, little is known about whether patients and clinicians also benefit from medical students. We developed an audit and feedback intervention activity to be delivered by medical students to their general practice supervisors. We tested whether the repeated cycle of audit had an effect on the preventive care practices of general practitioners (GPs). The students performed an audit on topics of preventive medicine and gave feedback to their supervisors. Each supervisor in the study had more than one student performing the audit over the academic year. After repetitive cycles of audit and feedback, the recording of social history items by GPs improved. For example, recording alcohol history increased from 24% to 36%. This study shows that medical students can be effective auditors, and their repeated audits may improve their general practice supervisors' recording of some aspects of social history.

  11. Integrated Practice Improvement Solutions-Practical Steps to Operating Room Management.

    Science.gov (United States)

    Chernov, Mikhail; Pullockaran, Janet; Vick, Angela; Leyvi, Galina; Delphin, Ellise

    2016-10-01

    Perioperative productivity is a vital concern for surgeons, anesthesiologists, and administrators as the OR is a major source of hospital elective admissions and revenue. Based on elements of existing Practice Improvement Methodologies (PIMs), "Integrated Practice Improvement Solutions" (IPIS) is a practical and simple solution incorporating aspects of multiple management approaches into a single open source framework to increase OR efficiency and productivity by better utilization of existing resources. OR efficiency was measured both before and after IPIS implementation using the total number of cases versus room utilization, OR/anesthesia revenue and staff overtime (OT) costs. Other parameters of efficiency, such as the first case on-time start and the turnover time (TOT) were measured in parallel. IPIS implementation resulted in increased numbers of surgical procedures performed by an average of 10.7%, and OR and anesthesia revenue increases of 18.5% and 6.9%, respectively, with a simultaneous decrease in TOT (15%) and OT for anesthesia staff (26%). The number of perioperative adverse events was stable during the two-year study period which involved a total of 20,378 patients. IPIS, an effective and flexible practice improvement model, was designed to quickly, significantly, and sustainably improve OR efficiency by better utilization of existing resources. Success of its implementation directly correlates with the involvement of and acceptance by the entire OR team and hospital administration.

  12. Teacher coaching supported by formative assessment for improving classroom practices.

    Science.gov (United States)

    Fabiano, Gregory A; Reddy, Linda A; Dudek, Christopher M

    2018-06-01

    The present study is a wait-list controlled, randomized study investigating a teacher coaching approach that emphasizes formative assessment and visual performance feedback to enhance elementary school teachers' classroom practices. The coaching model targeted instructional and behavioral management practices as measured by the Classroom Strategies Assessment System (CSAS) Observer and Teacher Forms. The sample included 89 general education teachers, stratified by grade level, and randomly assigned to 1 of 2 conditions: (a) immediate coaching, or (b) waitlist control. Results indicated that, relative to the waitlist control, teachers in immediate coaching demonstrated significantly greater improvements in observations of behavior management strategy use but not for observations of instructional strategy use. Observer- and teacher-completed ratings of behavioral management strategy use at postassessment were significantly improved by both raters; ratings of instructional strategy use were significantly improved for teacher but not observer ratings. A brief coaching intervention improved teachers' use of observed behavior management strategies and self-reported use of behavior management and instructional strategies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  13. 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.

  14. Avoiding never events: Improving nasogastric intubation practice and standards

    International Nuclear Information System (INIS)

    Law, Robert L.; Pullyblank, Ann M.; Eveleigh, Mark; Slack, Nicola

    2013-01-01

    Aim: To identify and rectify weaknesses in nasogastric (NG) intubation practice in the North Bristol NHS Trust that resulted in the occurrence of a National patient Safety Agency defined “never event”. Material and methods: Root-cause analysis identified that a change in culture was required. Recommendations divided into four categories: documentation, intubation, interpretation training, and radiology. A 6 month prospective audit covering all aspects of NG intubation practice preceded implementation of the recommendations. All patients whose tubes were mis-sited formed the cohort of the study. A re-audit was undertaken 12 months after the implementation of the recommended changes. Results: Re-audit suggested significant improvements had occurred in all categories, particularly junior doctor check image interpretation errors, which in the study group were reduced from seven to one, and documentation, which has so far improved by 22%. Protocols and guidelines associated with NG tube check imaging have now been developed for radiologists and radiographers with check imaging and image interpretation being made a priority and respiratory tract intubation treated as an emergency. Conclusion: The service is still not perfect, but there is a focal awareness of patient safety associated with intubation practice, and image interpretation by junior doctors significantly improved with the introduction of the e-learning package. However, it is considered that the responsibility for developing safe practice with respect to NG tube check image interpretation ultimately lies with the department of radiology, which should take the lead on reducing the risk of never events being caused by the misinterpretation of these images

  15. MRI-Based Computed Tomography Metal Artifact Correction Method for Improving Proton Range Calculation Accuracy

    International Nuclear Information System (INIS)

    Park, Peter C.; Schreibmann, Eduard; Roper, Justin; Elder, Eric; Crocker, Ian; Fox, Tim; Zhu, X. Ronald; Dong, Lei; Dhabaan, Anees

    2015-01-01

    Purpose: Computed tomography (CT) artifacts can severely degrade dose calculation accuracy in proton therapy. Prompted by the recently increased popularity of magnetic resonance imaging (MRI) in the radiation therapy clinic, we developed an MRI-based CT artifact correction method for improving the accuracy of proton range calculations. Methods and Materials: The proposed method replaces corrupted CT data by mapping CT Hounsfield units (HU number) from a nearby artifact-free slice, using a coregistered MRI. MRI and CT volumetric images were registered with use of 3-dimensional (3D) deformable image registration (DIR). The registration was fine-tuned on a slice-by-slice basis by using 2D DIR. Based on the intensity of paired MRI pixel values and HU from an artifact-free slice, we performed a comprehensive analysis to predict the correct HU for the corrupted region. For a proof-of-concept validation, metal artifacts were simulated on a reference data set. Proton range was calculated using reference, artifactual, and corrected images to quantify the reduction in proton range error. The correction method was applied to 4 unique clinical cases. Results: The correction method resulted in substantial artifact reduction, both quantitatively and qualitatively. On respective simulated brain and head and neck CT images, the mean error was reduced from 495 and 370 HU to 108 and 92 HU after correction. Correspondingly, the absolute mean proton range errors of 2.4 cm and 1.7 cm were reduced to less than 2 mm in both cases. Conclusions: Our MRI-based CT artifact correction method can improve CT image quality and proton range calculation accuracy for patients with severe CT artifacts

  16. Operational practices of lean manufacturing: Potentiating environmental improvements

    Energy Technology Data Exchange (ETDEWEB)

    Pinto, Marcos José Alves Junior; Mendes, Juliana Veiga

    2017-07-01

    Purpose: The objective of this paper is to investigate how environmental improvements can be achieved through operational practices of Lean Manufacturing. Design/methodology/approach: A literature review was conducted to analyze the relationship between operational practices of Lean and reduction of environmental impact in organizational contexts. Verified theoretically, this relationship was observed in a company of the electronics industry, through an exploratory research which contemplated a mixed approach. The adopted research method consisted of a single case study, by providing greater depth and detail of the study. Utilized a research protocol, validated test pilot. The instruments for data collection were semi-structured interviews, direct observation and document analysis. The information was examined qualitatively considering the technique for content analysis. Findings: As a result of the study, it was found that there is evidence for the existence of relationship between the practices of Lean, for example, Kaizen, PDCA (plan, do, check, act), Ishikawa Diagram, Poka-Yoke, Standardized Work and Value Stream Mapping, with the reduction of environmental impacts of an organization. This reduction was observed after application of these practices that resulted in the reduction of energy consumption, water and waste generation. These results were accounted for financially, contributing to a reduction of annual costs by about US$ 20,900. Originality/value: The study presents in detail, the application of operational practices of Lean Manufacturing, with an effective view to reducing the environmental impact and cost reduction. The literature review, a detailed description of the application process and financial results are important information that contributes to the scientific studies that address traditional operating practices and the search for better environmental performance.

  17. 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.

  18. Operational practices of lean manufacturing: Potentiating environmental improvements

    International Nuclear Information System (INIS)

    Pinto, Marcos José Alves Junior; Mendes, Juliana Veiga

    2017-01-01

    Purpose: The objective of this paper is to investigate how environmental improvements can be achieved through operational practices of Lean Manufacturing. Design/methodology/approach: A literature review was conducted to analyze the relationship between operational practices of Lean and reduction of environmental impact in organizational contexts. Verified theoretically, this relationship was observed in a company of the electronics industry, through an exploratory research which contemplated a mixed approach. The adopted research method consisted of a single case study, by providing greater depth and detail of the study. Utilized a research protocol, validated test pilot. The instruments for data collection were semi-structured interviews, direct observation and document analysis. The information was examined qualitatively considering the technique for content analysis. Findings: As a result of the study, it was found that there is evidence for the existence of relationship between the practices of Lean, for example, Kaizen, PDCA (plan, do, check, act), Ishikawa Diagram, Poka-Yoke, Standardized Work and Value Stream Mapping, with the reduction of environmental impacts of an organization. This reduction was observed after application of these practices that resulted in the reduction of energy consumption, water and waste generation. These results were accounted for financially, contributing to a reduction of annual costs by about US$ 20,900. Originality/value: The study presents in detail, the application of operational practices of Lean Manufacturing, with an effective view to reducing the environmental impact and cost reduction. The literature review, a detailed description of the application process and financial results are important information that contributes to the scientific studies that address traditional operating practices and the search for better environmental performance.

  19. 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

  20. Practical recommendations for the evaluation of improvement initiatives

    Science.gov (United States)

    Parry, Gareth; Coly, Astou; Goldmann, Don; Rowe, Alexander K; Chattu, Vijay; Logiudice, Deneil; Rabrenovic, Mihajlo; Nambiar, Bejoy

    2018-01-01

    Abstract A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution. PMID:29447410

  1. Figures in clinical trial reports: current practice & scope for improvement.

    Science.gov (United States)

    Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

    2007-11-19

    Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

  2. 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.

  3. Improvements in cross-infection control in general dental practice.

    Science.gov (United States)

    Bentley, E M; Sarll, D W

    1995-07-08

    A questionnaire about cross-infection control was sent to all GDPs in five FHSAs in the North Western Region. Replies came from 312 dentists, a response rate of 74%. They worked in 185 practices, a response rate of 85%. Gloves were worn routinely by 86% of dentists and 80% of DSAs. Handpieces were autoclaved between patients in 77% of practices. Much however, remains to be improved. DSAs could be better protected if more ultrasonic cleaners were used, eye protection encouraged and heavy duty gloves were available for cleaning instruments. BDA guidelines were reported as being the most influential factor, though it would appear that the media did persuade many practitioners to use autoclavable handpieces and sterilise them after each use.

  4. Improving prescribing practices with rapid diagnostic tests (RDTs)

    DEFF Research Database (Denmark)

    Burchett, Helen E D; Leurent, Baptiste; Baiden, Frank

    2017-01-01

    OBJECTIVES: The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts...... packages, supervision, supplies and community sensitisation. OUTCOME MEASURES: Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider...... characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for m...

  5. Improving rapeseed production practices in the southeastern United States

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, D.L.; Breve, M.A.; Raymer, P.L.; Minton, N.A.; Sumner, D.R. (Georgia Univ., Tifton, GA (USA). Georgia Coastal Plain Experiment Station)

    1990-04-01

    Oilseed rape or rapeseed is a crop which offers a potential for double-cropping in the southeastern United States. This final project report describes the results from a three year study aimed at evaluating the effect of different planting and harvesting practices on establishment and yield of three rape cultivars, and the double cropping potential of rapeseed in the southeastern United States. The project was conducted on two yield sites in Tifton, Georgia during 1986--87, 1987--88 and 1988--89. The general objective of this research is to improve the seed and biomass yield of winter rapeseed in the southeastern United States by developing appropriate agronomic practices for the region. The primary constraint is to grow rapeseed within the allowable period for double cropping with an economically desirable crop, such as peanut or soybean. Planting and harvesting are the most critical steps in this process. Therefore, the specific objectives of this research were: evaluate and improve the emergence of rapeseed by developing planting techniques that enhance the soil, water and seed regimes for winter rapeseed in the southeast, and evaluate and improve the yields of harvested rapeseed by developing techniques for determining the optimum timing of harvest and efficient methods for harvesting winter rapeseed in the southeast. 6 refs., 12 figs., 9 tabs.

  6. Improvement in Visual Search with Practice : Mapping Learning-Related Changes in Neurocognitive Stages of Processing

    NARCIS (Netherlands)

    Clark, Kait; Appelbaum, L. Gregory; van den Berg, Berry; Mitroff, Stephen R.; Woldorff, Marty G.

    2015-01-01

    Practice can improve performance on visual search tasks; the neural mechanisms underlying such improvements, however, are not clear. Response time typically shortens with practice, but which components of the stimulus-response processing chain facilitate this behavioral change? Improved search

  7. 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

  8. Good practices for improved nuclear power plant performance

    International Nuclear Information System (INIS)

    1989-04-01

    This report provides an overview of operational principles, practice and improvements which have contributed to good performance of eight selected world nuclear power stations. The IAEA Power Reactor Information System (PRIS) was used to identify a population of good performers. It is recognized that there are many other good performing nuclear power stations not included in this report. Specific criteria described in the introduction were used in selecting these eight stations. The information contained in this report was obtained by the staff from IAEA, Division of Nuclear Power. This was accomplished by visits to the stations and visits to a number of utility support groups and three independent organizations which provide support to more than one utility. The information in this report is intended as an aid for operating organizations to identify possible improvement initiatives to enhance plant performance. Figs and tabs

  9. 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.

  10. Test results for triple-modulation radar electronics with improved range disambiguation

    Energy Technology Data Exchange (ETDEWEB)

    Pollastrone, Fabio, E-mail: fabio.pollastrone@enea.it; Neri, Carlo

    2015-10-15

    Highlights: • A new digital radar electronic system based on triple-modulation has been developed. • The triple-modulation system uses an improved algorithm for the range-disambiguation. • The new radar electronics has been applied in the IVVS optical radar prototype for ITER. • The performances obtained with IVVS double and triple-modulation were compared. - Abstract: The In Vessel Viewing System (IVVS) is an optical radar with sub milimetrical resolution that will be used for imaging and metrology pourposes in ITER. The electronics of the system is based on a Digital Radar Electronics developed in ENEA Frascati laboratories during the past years. Until the present study, the system was based on amplitude modulation technique having double-modulation frequency. The power of the laser is sinusoidally modulated and the distance of the points scanned by the laser beam is obtained measuring the phase difference between outgoing and echo signals. Recently a triple-modulation radar electronics version and an algorithm able to solve the range disambiguation were developed. The aim of the upgrade was the increase of the robustness in the range disambiguation. The paper briefly describes the updates carried out on the Digital Radar Electronics and extensively the test results obtained by comparing the performance of the triple modulation versus the double modulation techniques.

  11. Using Relational Reasoning Strategies to Help Improve Clinical Reasoning Practice.

    Science.gov (United States)

    Dumas, Denis; Torre, Dario M; Durning, Steven J

    2018-05-01

    Clinical reasoning-the steps up to and including establishing a diagnosis and/or therapy-is a fundamentally important mental process for physicians. Unfortunately, mounting evidence suggests that errors in clinical reasoning lead to substantial problems for medical professionals and patients alike, including suboptimal care, malpractice claims, and rising health care costs. For this reason, cognitive strategies by which clinical reasoning may be improved-and that many expert clinicians are already using-are highly relevant for all medical professionals, educators, and learners.In this Perspective, the authors introduce one group of cognitive strategies-termed relational reasoning strategies-that have been empirically shown, through limited educational and psychological research, to improve the accuracy of learners' reasoning both within and outside of the medical disciplines. The authors contend that relational reasoning strategies may help clinicians to be metacognitive about their own clinical reasoning; such strategies may also be particularly well suited for explicitly organizing clinical reasoning instruction for learners. Because the particular curricular efforts that may improve the relational reasoning of medical students are not known at this point, the authors describe the nature of previous research on relational reasoning strategies to encourage the future design, implementation, and evaluation of instructional interventions for relational reasoning within the medical education literature. The authors also call for continued research on using relational reasoning strategies and their role in clinical practice and medical education, with the long-term goal of improving diagnostic accuracy.

  12. Practice and documentation of palliative sedation: a quality improvement initiative

    Science.gov (United States)

    McKinnon, M.; Azevedo, C.; Bush, S.H.; Lawlor, P.; Pereira, J.

    2014-01-01

    Background Palliative sedation (ps), the continuous use of sedating doses of medication to intentionally reduce consciousness and relieve refractory symptoms at end of life, is ethically acceptable if administered according to standards of best practice. Procedural guidelines outlining the appropriate use of ps and the need for rigorous documentation have been developed. As a quality improvement strategy, we audited the practice and documentation of ps on our palliative care unit (pcu). Methods A pharmacy database search of admissions in 2008 identified, for a subsequent chart review, patients who had received either a continuous infusion of midazolam (≥10 mg/24 h), regular parenteral dosing of methotrimeprazine (≥75 mg daily), or regular phenobarbital. Documentation of the decision-making process, consent, and medication use was collected using a data extraction form based on current international ps standards. Results Interpretation and comparison of data were difficult because of an apparent lack of a consistent operational definition of ps. Patient records had no specific documentation in relation to ps initiation, to clearly identified refractory symptoms, and to informed consent in 60 (64.5%), 43 (46.2%), and 38 (40.9%) charts respectively. Variation in the medications used was marked: 54 patients (58%) were started on a single agent and 39 (42%), on multiple agents. The 40 patients (43%) started on midazolam alone received a mean daily dose of 21.4 mg (standard deviation: 24.6 mg). Conclusions The lack of documentation and standardized practice of ps on our pcu has resulted in a quality improvement program to address those gaps. They also highlight the importance of conducting research and developing clinical guidelines in this area. PMID:24764700

  13. 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.

  14. Passive Back Support Exoskeleton Improves Range of Motion Using Flexible Beams

    Directory of Open Access Journals (Sweden)

    Matthias B. Näf

    2018-06-01

    Full Text Available In the EU, lower back pain affects more than 40% of the working population. Mechanical loading of the lower back has been shown to be an important risk factor. Peak mechanical load can be reduced by ergonomic interventions, the use of cranes and, more recently, by the use of exoskeletons. Despite recent advances in the development of exoskeletons for industrial applications, they are not widely adopted by industry yet. Some of the challenges, which have to be overcome are a reduced range of motion, misalignment between the human anatomy and kinematics of the exoskeleton as well as discomfort. A body of research exists on how an exoskeleton can be designed to compensate for misalignment and thereby improve comfort. However, how to design an exoskeleton that achieves a similar range of motion as a human lumbar spine of up to 60° in the sagittal plane, has not been extensively investigated. We addressed this need by developing and testing a novel passive back support exoskeleton, including a mechanism comprised of flexible beams, which run in parallel to the spine, providing a large range of motion and lowering the peak torque requirements around the lumbo-sacral (L5/S1 joint. Furthermore, we ran a pilot study to test the biomechanical (N = 2 and functional (N = 3 impact on subjects while wearing the exoskeleton. The biomechanical testing was once performed with flexible beams as a back interface and once with a rigid structure. An increase of more than 25% range of motion of the trunk in the sagittal plane was observed by using the flexible beams. The pilot functional tests, which are compared to results from a previous study with the Laevo device, suggest, that the novel exoskeleton is perceived as less hindering in almost all tested tasks.

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

    Science.gov (United States)

    Scott, Angela Bullanday; Singh, Mini; Toribio, Jenny-Ann; Hernandez-Jover, Marta; Barnes, Belinda; Glass, Kathryn; Moloney, Barbara; Lee, Amanda; Groves, Peter

    2017-01-01

    There are few published studies describing the unique management practices, farm design and housing characteristics of commercial meat chicken and layer farms in Australia. In particular, there has been a large expansion of free range poultry production in Australia in recent years, but limited information about this enterprise exists. This study aimed to describe features of Australian commercial chicken farms, with particular interest in free range farms, by conducting on-farm interviews of 25 free range layer farms, nine cage layer farms, nine barn layer farms, six free range meat chicken farms and 15 barn meat chicken farms in the Sydney basin bioregion and South East Queensland. Comparisons between the different enterprises (cage, barn and free range) were explored, including stocking densities, depopulation procedures, environmental control methods and sources of information for farmers. Additional information collected for free range farms include range size, range characteristics and range access. The median number of chickens per shed was greatest in free range meat chicken farms (31,058), followed by barn meat chicken (20,817), free range layer (10,713), barn layer (9,300) and cage layer farms (9,000). Sheds had cooling pads and tunnel ventilation in just over half of both barn and free range meat chicken farms (53%, n = 8) and was least common in free range layer farms (16%, n = 4). Range access in free range meat chicken farms was from sunrise to dark in the majority (93%, n = 14) of free range meat chicken farms. Over half of free range layer farms (56%, n = 14) granted range access at a set time each morning; most commonly between 9:00 to 10.00am (86%, n = 12), and chickens were placed back inside sheds when it was dusk.

  16. Determinants of the range of drugs prescribed in general practice: a cross-sectional analysis.

    NARCIS (Netherlands)

    Bakker, D.H. de; Coffie, D.S.V.; Heerdink, E.R.; Dijk, L. van; Groenewegen, P.P.

    2007-01-01

    BACKGROUND: Current health policies assume that prescribing is more efficient and rational when general practitioners (GPs) work with a formulary or restricted drugs lists and thus with a limited range of drugs. Therefore we studied determinants of the range of drugs prescribed by general

  17. An exploration of cultural beliefs and practices across the Southern Ground-Hornbill's range in Africa.

    Science.gov (United States)

    Coetzee, Hendri; Nell, Werner; van Rensburg, Leon

    2014-03-26

    This article explores cultural beliefs and practices related to the Southern Ground-Hornbill (SGH) (Bucorvus leadbeateri) in nine southern and east-African countries. A qualitative, thematic content-analysis approach was followed. Ninety-eight participants took part in the study. Interviews and group discussions were used as the main data gathering methods. Each interview was digitally recorded and transcribed. Data were analysed by means of thematic content analysis. The main themes that emerged from the data analysis indicated that beliefs and practices relate to the SGH as being (a) a bringer or signifier of death/destruction/loss/ deprivation, with the bird commonly being regarded as a bad omen of evil spirits and announcer of calamities; (b) a protector against evil spirits, against lightning and against drought; (c) an enabler/causer of altered perceptions, which include remote viewing, foreseeing the future, and creating an illusion; and (d) a timekeeper that announces the beginning and end of a working day and of seasonal changes. Knowledge about the use of the SGH in cultural practices can contribute to conservation efforts in at least two significant ways: Firstly, beliefs and practices that were identified in this study as having potentially protective consequences for the SGH can now be specifically targeted and strengthened in future interventions. Secondly, destructive beliefs and practices that were identified can now be changed by means of the implementation of an intervention programme in countries where it is needed.

  18. Range resolution improvement in passive bistatic radars using nested FM channels and least squares approach

    Science.gov (United States)

    Arslan, Musa T.; Tofighi, Mohammad; Sevimli, Rasim A.; ćetin, Ahmet E.

    2015-05-01

    One of the main disadvantages of using commercial broadcasts in a Passive Bistatic Radar (PBR) system is the range resolution. Using multiple broadcast channels to improve the radar performance is offered as a solution to this problem. However, it suffers from detection performance due to the side-lobes that matched filter creates for using multiple channels. In this article, we introduce a deconvolution algorithm to suppress the side-lobes. The two-dimensional matched filter output of a PBR is further analyzed as a deconvolution problem. The deconvolution algorithm is based on making successive projections onto the hyperplanes representing the time delay of a target. Resulting iterative deconvolution algorithm is globally convergent because all constraint sets are closed and convex. Simulation results in an FM based PBR system are presented.

  19. A Fourier Transform Spectrometer Based on an Electrothermal MEMS Mirror with Improved Linear Scan Range

    Directory of Open Access Journals (Sweden)

    Wei Wang

    2016-09-01

    Full Text Available A Fourier transform spectrometer (FTS that incorporates a closed-loop controlled, electrothermally actuated microelectromechanical systems (MEMS micromirror is proposed and experimentally verified. The scan range and the tilting angle of the mirror plate are the two critical parameters for MEMS-based FTS. In this work, the MEMS mirror with a footprint of 4.3 mm × 3.1 mm is based on a modified lateral-shift-free (LSF bimorph actuator design with large piston and reduced tilting. Combined with a position-sensitive device (PSD for tilt angle sensing, the feedback controlled MEMS mirror generates a 430 µm stable linear piston scan with the mirror plate tilting angle less than ±0.002°. The usable piston scan range is increased to 78% of the MEMS mirror’s full scan capability, and a spectral resolution of 0.55 nm at 531.9 nm wavelength, has been achieved. It is a significant improvement compared to the prior work.

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

    Directory of Open Access Journals (Sweden)

    Christian Nyffenegger

    Full Text Available A sialidase (EC 3.2.1.18 from the non-pathogenic Trypanosoma rangeli, TrSA, has been shown to exert trans-sialidase activity after mutation of five specific amino acids in the active site (M96V, A98P, S120Y, G249Y, Q284P to form the so-called TrSA5mut enzyme. By computational and hypothesis driven approaches additional mutations enhancing the trans-sialidase activity have been suggested. In the present work, we made a systematic combination of these mutations leading to seven new variants of the T. rangeli sialidase, having 6-16 targeted amino acid mutations. The resulting enzyme variants were analyzed via kinetics for their ability to carry out trans-sialidase reaction using CGMP and D-lactose as substrates. The sialidase variants with 15 and 16 mutations, respectively, exhibited significantly improved trans-sialidase activity for D-lactose sialylation. Our results corroborate, that computational studies of trans-glycosylation can be a valuable input in the design of novel trans-glycosidases, but also highlight the importance of experimental validation in order to assess the performance. In conclusion, two of the seven mutants displayed a dramatic switch in specificity from hydrolysis towards trans-sialylation and constitute the most potent trans-sialidase mutants of TrSA described in literature to date.

  1. An improved method to estimate reflectance parameters for high dynamic range imaging

    Science.gov (United States)

    Li, Shiying; Deguchi, Koichiro; Li, Renfa; Manabe, Yoshitsugu; Chihara, Kunihiro

    2008-01-01

    Two methods are described to accurately estimate diffuse and specular reflectance parameters for colors, gloss intensity and surface roughness, over the dynamic range of the camera used to capture input images. Neither method needs to segment color areas on an image, or to reconstruct a high dynamic range (HDR) image. The second method improves on the first, bypassing the requirement for specific separation of diffuse and specular reflection components. For the latter method, diffuse and specular reflectance parameters are estimated separately, using the least squares method. Reflection values are initially assumed to be diffuse-only reflection components, and are subjected to the least squares method to estimate diffuse reflectance parameters. Specular reflection components, obtained by subtracting the computed diffuse reflection components from reflection values, are then subjected to a logarithmically transformed equation of the Torrance-Sparrow reflection model, and specular reflectance parameters for gloss intensity and surface roughness are finally estimated using the least squares method. Experiments were carried out using both methods, with simulation data at different saturation levels, generated according to the Lambert and Torrance-Sparrow reflection models, and the second method, with spectral images captured by an imaging spectrograph and a moving light source. Our results show that the second method can estimate the diffuse and specular reflectance parameters for colors, gloss intensity and surface roughness more accurately and faster than the first one, so that colors and gloss can be reproduced more efficiently for HDR imaging.

  2. Perioperative hair removal: A review of best practice and a practice improvement opportunity.

    Science.gov (United States)

    Spencer, Maureen; Barnden, Marsha; Johnson, Helen Boehm; Fauerbach, Loretta Litz; Graham, Denise; Edmiston, Charles E

    2018-06-01

    The current practice of perioperative hair removal reflects research-driven changes designed to minimize the risk of surgical wound infection. An aspect of the practice which has received less scrutiny is the clean-up of the clipped hair. This process is critical. The loose fibers represent a potential infection risk because of the micro-organisms they can carry, but their clean-up can pose a logistical problem because of the time required to remove them. Research has demonstrated that the most commonly employed means of clean-up, the use of adhesive tape or sticky mitts, can be both ineffective and time-consuming in addition to posing an infection risk from cross-contamination. Recently published research evaluating surgical clippers fitted with a vacuum-assisted hair collection device highlights the potential for significant practice improvement in the perioperative hair removal clean-up process. These improvements include not only further mitigation of potential infection risk but also substantial OR time and cost savings.

  3. Linearity improvement on wide-range log signal of neutron measurement system for HANARO

    International Nuclear Information System (INIS)

    Kim, Young-Ki; Tuetken, Jeffrey S.

    1998-01-01

    This paper discusses engineering activities for improving the linearity characteristics of the Log Power signal from the neutron measurement system for HANARO. This neutron measurement system uses a fission chamber based detector which covers 10.3 decade-wide range from 10 -8 % full power(FP) up to 200%FP, The Log Power signal is designed to control the reactor at low power levels where most of the reactor physics tests are carried out. Therefore, the linearity characteristics of the Log Power signal is the major factor for accurate reactor power control. During the commissioning of the neutron measurement system, it was found that the linearity characteristics of the Log Power signal, especially near 10 -2 %FP, were not accurate enough for controlling the reactor during physics testing. Analysis of the system linearity data directly measured with reactor operating determined that the system was not operating per the design characteristics established from previous installations. The linearity data, which were taken as the reactor was increased in power, were sent to manufacturer's engineering group and a follow-up measures based on the analysis were then fed back to the field. Through step by step trouble-shooting activities, which included minor circuit modifications and alignment procedure changes, the linearity characteristics have been successfully improved and now exceed minimum performance requirements. This paper discusses the trouble-shooting techniques applied, the changes in the linearity characteristics, special circumstances in the HANARO application and the final resolution. (author)

  4. Use of hyaluronidase to improve chemical immobilization of free-ranging polar bears (Ursus maritimus).

    Science.gov (United States)

    Cattet, Marc R L; Obbard, Martyn E

    2010-01-01

    We assessed the efficacy and safety of hyaluronidase to improve chemical immobilization of free-ranging polar bears (Ursus maritimus) captured from helicopter by remote drug delivery along the Ontario coast line of northwestern James Bay and southern Hudson Bay during September 2005 and October 2007. We used a single blind study design in which one person prepared and loaded all darts without the shooter knowing whether hyaluronidase (150 IU per dart) or sterile water was added to the immobilizing drug mixture of xylazine and zolazepam-tiletamine (XZT). We found that we often required more than one dart to immobilize bears in the control group (XZT+sterile water; >1 dart for 15 of 28 captures) versus the treatment group (XZT+hyaluronidase; >1 dart for seven of 26 captures). As a consequence, treatment bears were generally immobilized with smaller XZT dosages (7.9 vs. 9.4 mg/kg; P = 0.08) and shorter induction (10 vs. 15 min; P = 0.004) than control bears. We found no differences in vital rates and serum biochemistry results between control and treatment bears. We did find, however, that induction times correlated directly with rectal temperature at polar bears. Overall we found hyaluronidase to be effective and safe for capture of polar bears. We recommend further study to determine whether effects of hyaluronidase are dose dependent and recommend that others involved with capture of seasonally fat species such as polar bears consider use of hyaluronidase to improve chemical immobilization.

  5. 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.

  6. Listening to parents to improve health visiting practice.

    Science.gov (United States)

    Morton, Alison; Hargreaves, Sharon; Taylor, Liz

    2015-05-01

    Listening to the "voice" of the service user is now widely accepted as central to the delivery of high quality healthcare. This paper presents an overview of the importance of service user engagement and personalised care in health visiting with a brief review of recent policy and research. A personalised approach to health visiting practice is recommended to improve service user experience and uptake of the health visiting service offer and this is considered most significant when engaging "hard to reach" groups. A project report on a service user experience strategy within the 0-19 service of a NHS Trust in England is presented which describes initiatives to develop a health visiting and school nursing service that listens to service users. A cyclical service user engagement model which incorporates continuous reviews and service reconfiguration is described with examples of service changes in response to expressed local needs.

  7. 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

  8. 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

  9. Using Patient-Reported Information to Improve Clinical Practice.

    Science.gov (United States)

    Schlesinger, Mark; Grob, Rachel; Shaller, Dale

    2015-12-01

    To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries. We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians. First, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the

  10. 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

  11. Errors in laboratory medicine: practical lessons to improve patient safety.

    Science.gov (United States)

    Howanitz, Peter J

    2005-10-01

    Patient safety is influenced by the frequency and seriousness of errors that occur in the health care system. Error rates in laboratory practices are collected routinely for a variety of performance measures in all clinical pathology laboratories in the United States, but a list of critical performance measures has not yet been recommended. The most extensive databases describing error rates in pathology were developed and are maintained by the College of American Pathologists (CAP). These databases include the CAP's Q-Probes and Q-Tracks programs, which provide information on error rates from more than 130 interlaboratory studies. To define critical performance measures in laboratory medicine, describe error rates of these measures, and provide suggestions to decrease these errors, thereby ultimately improving patient safety. A review of experiences from Q-Probes and Q-Tracks studies supplemented with other studies cited in the literature. Q-Probes studies are carried out as time-limited studies lasting 1 to 4 months and have been conducted since 1989. In contrast, Q-Tracks investigations are ongoing studies performed on a yearly basis and have been conducted only since 1998. Participants from institutions throughout the world simultaneously conducted these studies according to specified scientific designs. The CAP has collected and summarized data for participants about these performance measures, including the significance of errors, the magnitude of error rates, tactics for error reduction, and willingness to implement each of these performance measures. A list of recommended performance measures, the frequency of errors when these performance measures were studied, and suggestions to improve patient safety by reducing these errors. Error rates for preanalytic and postanalytic performance measures were higher than for analytic measures. Eight performance measures were identified, including customer satisfaction, test turnaround times, patient identification

  12. Improving the global efficiency in small hydropower practice

    Science.gov (United States)

    Razurel, P.; Gorla, L.; Crouzy, B.; Perona, P.

    2015-12-01

    The global increase in energy production from renewable sources has seen river exploitation for small hydropower plants to also grow considerably in the last decade. River intakes used to divert water from the main course to the power plant are at the base of such practice. A key issue concern with finding innovative concepts to both design and manage such structures in order to improve classic operational rules. Among these, the Minimal Flow Release (MFR) concept has long been used in spite of its environmental inconsistency.In this work, we show that the economical and ecological efficiency of diverting water for energy production in small hydropower plants can be improved towards sustainability by engineering a novel class of flow-redistribution policies. We use the mathematical form of the Fermi-Dirac statistical distribution to define non-proportional dynamic flow-redistribution rules, which broadens the spectrum of dynamic flow releases based on proportional redistribution. The theoretical background as well as the economic interpretation is presented and applied to three case studies in order to systematically test the global performance of such policies. Out of numerical simulations, a Pareto frontier emerges in the economic vs environmental efficiency plot, which show that non-proportional distribution policies improve both efficiencies with respect to those obtained from some traditional MFR and proportional policies. This picture is shown also for long term climatic scenarios affecting water availability and the natural flow regime.In a time of intense and increasing exploitation close to resource saturation, preserving natural river reaches requires to abandon inappropriate static release policies in favor of non-proportional ones towards a sustainable use of the water resource.

  13. Measures to Improve Diagnostic Safety in Clinical Practice.

    Science.gov (United States)

    Singh, Hardeep; Graber, Mark L; Hofer, Timothy P

    2016-10-20

    Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health-care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  14. 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…

  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. 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

  17. 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.

  18. Infrastructure for large-scale quality-improvement projects: early lessons from North Carolina Improving Performance in Practice.

    Science.gov (United States)

    Newton, Warren P; Lefebvre, Ann; Donahue, Katrina E; Bacon, Thomas; Dobson, Allen

    2010-01-01

    Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3) quality-improvement consultants (QICs), or practice facilitators; (4) learning networks; and (5) alignment of incentives. We emphasized a community-based strategy and developing a statewide infrastructure. Results are reported from the first 2 years of the North Carolina Improving Performance in Practice (IPIP) project. A coalition was formed to include professional societies, North Carolina AHEC, Community Care of North Carolina, insurers, and other organizations. Wave One started with 18 practices in 2 of 9 regions of the state. Quality-improvement consultants recruited practices. Over 80 percent of practices attended all quarterly regional meetings. In 9 months, almost all diabetes measures improved, and a bundled asthma measure improved from 33 to 58 percent. Overall, the magnitude of improvement was clinically and statistically significant (P = .001). Quality improvements were maintained on review 1 year later. Wave Two has spread to 103 practices in all 9 regions of the state, with 42 additional practices beginning the enrollment process. Large-scale health care quality improvement is feasible, when broadly supported by statewide leadership and community infrastructure. Practice-collected data and lack of a control group are limitations of the study design. Future priorities include maintaining improved sustainability for practices and communities. Our long-term goal is to transform all 2000 primary-care practices in our state.

  19. 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.

  20. 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

  1. Meeting physicians' needs: a bottom-up approach for improving the implementation of medical knowledge into practice.

    Science.gov (United States)

    Vaucher, Carla; Bovet, Emilie; Bengough, Theresa; Pidoux, Vincent; Grossen, Michèle; Panese, Francesco; Burnand, Bernard

    2016-07-18

    Multiple barriers to knowledge translation in medicine have been identified (ranging from information overload to abstraction of models), leading to important implementation gaps. This study aimed at assessing the suggestions of practicing physicians for possible improvements of knowledge translation (KT) effectiveness into clinical practice. We used a mixed methods design. French- German- and Italian-speaking general practitioners, psychiatrists, orthopaedic surgeons, cardiologists, and diabetologists practicing in Switzerland were interrogated through semi-structured interviews, focus group discussions, and an online survey. A total of 985 physicians from three regions of Switzerland participated in the online survey, whereas 39 participated in focus group discussions and 14 in face-to-face interviews. Physicians expressed limitations and difficulties related to KT into their daily practice. Several barriers were identified, including influence and pressure of pharmaceutical companies, non-publication of negative results, mismatch between guidelines and practice, education gaps, and insufficient collaboration between research and practice. Suggestions to overcome barriers were improving education concerning the evaluation of scientific publications, expanding applicability of guidelines, having free and easy access to independent journals, developing collaborations between research and practice, and creating tools to facilitate access to medical information. Our study provides suggestions for improving KT into daily medical practice, matching the views, needs and preferences of practicing physicians. Responding to suggestions for improvements brought up by physicians may lead to better knowledge translation, higher professional satisfaction, and better healthcare outcomes.

  2. 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.

  3. Natura 2000 appropriate assessment: Shortcomings and improvements in Finnish practice

    International Nuclear Information System (INIS)

    Soederman, Tara

    2009-01-01

    The EU Habitats Directive 92/43/EEC requires impact assessments called Appropriate Assessments (AA) for plans and projects probably having adverse effects on the sites of European ecological importance, Natura 2000 sites. Seventy-three Appropriate Assessment reports and seventy official opinions given on them by regional environmental authorities from 1997 to 2005 were reviewed. The findings of the study demonstrate typical shortcomings of ecological impact assessment: a weak information basis for assessment outcomes and lack of proper cumulative impact assessment with respect to ecological structures and processes. The quality of reporting has improved over time with respect to direct impacts on individual habitat types and species and detailed mitigation measures. Regional environment centres considered one fifth of the AA reports to be inadequate because of lacking data. In most cases the regional environment centres demanded a change of plan or project, added mitigation measures, choice of only one alternative for further planning or a new completed assessment with additional information in order to be able to evaluate the significance of the effects. The study underlines the need for iterative planning practices in which the preparation of a plan or project with alternative options goes hand in hand with the impact assessment equipped with sufficient data

  4. Protein alignment using cellulose nanocrystals: practical considerations and range of application

    International Nuclear Information System (INIS)

    Denisov, Alexey Y.; Kloser, Elisabeth; Gray, Derek G.; Mittermaier, Anthony K.

    2010-01-01

    Cellulose nanocrystals (CNCs) form liquid crystals in aqueous solution that confer alignment to macromolecules and permit the measurement of residual dipolar couplings. CNCs possess many attractive features as an alignment medium. They are inexpensive, non-toxic, chemically inert, and robust to denaturants and temperature. Despite these advantages, CNCs are seldom employed as an alignment medium and the range of their applicability has not yet been explored. We have re-examined the use of CNCs in biomolecular NMR by analyzing the effects concentration, ionic strength, and temperature on molecular alignment. Stable alignment was obtained over wide ranges of temperature (10-70 o C) and pH (2.5-8.0), which makes CNCs potentially very useful in studies of thermophilic proteins and acid-stabilized molecules. Notably, we find that CNC suspensions are very sensitive to the concentrations of biological buffers, which must be taken into account when they are used in NMR analyses. These results have led us to develop a general procedure for preparing aligned samples with CNCs. Using the SH3 domain from the Fyn tyrosine kinase as a model system, we find that CNCs produce an alignment frame collinear with that of the commonly used Pf1 bacteriophage alignment medium, but of opposite magnitude.

  5. Practical target location and accuracy indicator in digital close range photogrammetry using consumer grade cameras

    Science.gov (United States)

    Moriya, Gentaro; Chikatsu, Hirofumi

    2011-07-01

    Recently, pixel numbers and functions of consumer grade digital camera are amazingly increasing by modern semiconductor and digital technology, and there are many low-priced consumer grade digital cameras which have more than 10 mega pixels on the market in Japan. In these circumstances, digital photogrammetry using consumer grade cameras is enormously expected in various application fields. There is a large body of literature on calibration of consumer grade digital cameras and circular target location. Target location with subpixel accuracy had been investigated as a star tracker issue, and many target location algorithms have been carried out. It is widely accepted that the least squares models with ellipse fitting is the most accurate algorithm. However, there are still problems for efficient digital close range photogrammetry. These problems are reconfirmation of the target location algorithms with subpixel accuracy for consumer grade digital cameras, relationship between number of edge points along target boundary and accuracy, and an indicator for estimating the accuracy of normal digital close range photogrammetry using consumer grade cameras. With this motive, an empirical testing of several algorithms for target location with subpixel accuracy and an indicator for estimating the accuracy are investigated in this paper using real data which were acquired indoors using 7 consumer grade digital cameras which have 7.2 mega pixels to 14.7 mega pixels.

  6. An improved broadband method to evaluate effective parameters of slab metamaterials in the microwave frequency range

    International Nuclear Information System (INIS)

    Rybin, O.; Nawaz, T.; Abbasi, T.

    2007-01-01

    An improved broadband method for determining complex effective refractive index, permittivity and permeability of an arbitrary passive metamaterial in microwave frequency range has been proposed. Evaluation of the effective parameters is realized using the reflection-transmission S-parameters obtained by simulation or experimental measurements and analytically evaluated interface reflection coefficient of the slab. Formulas for evaluation of effective permittivity and permeability which contain the square root of complex functions of S-parameters have been proposed in (1-2). But this method does not propose a way to avoid an ambiguity arising in choosing the square root branch of product of effective permittivity and permeability. Moreover the above calculation procedure requires evaluating the square root branch of function of S-parameters. Proposed way to choose the square root branch gives sometimes mistaken results. Our method is much simple as compared with the above mentioned formulas and it does not require making a choice of square root branch of complex functions of S-parameters in order to evaluate any of the parameters (refractive index, permittivity or permeability). Instead we obtain a formula for complex refractive index which is simple. On the basis of proposed model effective permittivity and permeability for rod meta-materials can be evaluated with enhanced precision and accuracy. Proposed method is easy to be implemented in engineering problems and does not require using complicated mathematical calculations. Comparison of precision of the presented method with the Nicolson-Ross techniques (1-2) has been made using the simulations for different configurations of rod meta-materials. Some discussion concerning the sensitivity of the effective parameters of meta-materials for the accuracy of the frequency dependent S -parameters is also presented in this paper. (author)

  7. Arbuscular Mycorrhiza Improves Substrate Hydraulic Conductivity in the Plant Available Moisture Range Under Root Growth Exclusion.

    Science.gov (United States)

    Bitterlich, Michael; Franken, Philipp; Graefe, Jan

    2018-01-01

    Arbuscular mycorrhizal fungi (AMF) proliferate in soils and are known to affect soil structure. Although their contribution to structure is extensively investigated, the consequences of those processes for soil water extractability and transport has, so far, gained surprisingly little attention. Therefore we asked, whether AMF can affect water retention and unsaturated hydraulic conductivity under exclusion of root ingrowth, in order to minimize plant driven effects. We carried out experiments with tomato inoculated with Rhizoglomus irregulare in a soil substrate with sand and vermiculite that created variation in colonization by mixed pots with wild type (WT) plants and mycorrhiza resistant (RMC) mutants. Sampling cores were introduced and used to assess substrate moisture retention dynamics and modeling of substrate water retention and hydraulic conductivity. AMF reduced the saturated water content and total porosity, but maintained air filled porosity in soil spheres that excluded root ingrowth. The water content between field capacity and the permanent wilting point (6-1500 kPa) was only reduced in mycorrhizal substrates that contained at least one RMC mutant. Plant available water contents correlated positively with soil protein contents. Soil protein contents were highest in pots that possessed the strongest hyphal colonization, but not significantly affected. Substrate conductivity increased up to 50% in colonized substrates in the physiologically important water potential range between 6 and 10 kPa. The improvements in hydraulic conductivity are restricted to substrates where at least one WT plant was available for the fungus, indicating a necessity of a functional symbiosis for this effect. We conclude that functional mycorrhiza alleviates the resistance to water movement through the substrate in substrate areas outside of the root zone.

  8. Development of test practice requirements for a standard method on fracture toughness testing in the transition range

    International Nuclear Information System (INIS)

    McCabe, D.E.; Zerbst, U.; Heerens, J.

    1993-01-01

    This report covers the resolution of several issues that are relevant to the ductile to brittle transition range of structural steels. One of this issues was to compare a statistical-based weakest-link method to constraint data adjustment methods for modeling the specimen size effects on fracture toughness. Another was to explore the concept of a universal transition temperature curve shape (Master Curve). Data from a Materials Properties Council round robin activity were used to test the proposals empirically. The findings of this study are inclosed in an activity for the development of a draft standard test procedure ''Test Practice for Fracture Toughness in the Transition Range''. (orig.) [de

  9. PNRA: Practically Improving Safety Culture within the Regulatory Body

    International Nuclear Information System (INIS)

    Bhatti, S.A.N.; Habib, M.A.

    2016-01-01

    The prevalence of a good safety culture is equally important for all kind of organizations involved in nuclear business including operating organizations, designers, regulator, etc., and this should be reflected through the processes and activities of these organizations. The need for inculcating safety culture into regulatory processes and practices is gradually increasing since the major nuclear accident of Fukushima, Japan. Accordingly, several international fora in last few years repeatedly highlighted the importance of prevalence of safety culture in regulatory bodies as well. The utilisation of concept of safety culture remained applicable in regulatory activities of PNRA in the form of core values. After the Fukushima accident, PNRA considered it important to check the extent of utilisation of safety culture concept in organizational activities and decided to conduct its “Safety Culture Self-Assessment (SCSA)” for presenting itself as role model in-order to endorse the fact that safety culture at regulatory authority plays an important role to influence safety culture at licenced facilities. Considering the complexity of cultural assessment starting from visual manifestations to the basic assumptions at the deeper level, PNRA decided to utilise IAEA emerging methodology for assessment of culture and then used modified IAEA normative framework (made it applicable for regulatory body) for assessing safety culture at a regulatory body. PNRA SCSA team utilised safety culture assessment tools (observations, focus groups, surveys, interviews and document analysis) for collecting cultural facts by including all level of personnel involved in different activities and functions in the organization. Different challenges were encountered during implementation of these tools which were tackled with the background of training on SCSA and with the help of experts during support missions arranged by IAEA. Before formally starting the SCSA process, pre-launch activities

  10. Global NDE Best Practice for Technology Improvement, Outage Management, Foreign Material Exclusion and Dose Control

    International Nuclear Information System (INIS)

    Glass, S. W.; Mohr, F.

    2010-01-01

    Non Destructive Examination (NDE) is a critical element of both Boiling Water and Pressurized Water Reactor outages. Frequently this includes critical path activity so both the utility and the inspection vendor are under intense pressure to perform the work quickly. Concurrent with AREVA's new global organization of NDE resources, AREVA NDE SOLUTIONS, efforts have intensified for global application of lessons learned and best practices. These best practices include new developments as well as continuous improvements to well established tools and NDE techniques. Advancements range from steam generator robots, advanced steam generator deposit characterization sensors and method, new phased array approaches for PWR and BWR reactor vessel examination, new sensors and approaches for RPV head examinations, plus advanced internals examination robots and methods. In addition to specialized tools and techniques, best practice includes numerous management innovations. AREVA's multi-disciplined integrated nuclear worker strategy helps to minimize the total number of personnel deployed to multi-task outages. Specific design and on-site practice has been implemented to minimize or eliminate foreign material from the reactor system and vigorous pursuit of dose management practices keeps our nuclear worker dose as low as reasonably achievable. The industry is moving to much more conservative nuclear worker dose limits. While this is proving to be an issue with many vendors, AREVA has had an internal policy of <2R since 2006. Globalizing the organization also helps AREVA manage peaks and unplanned emergency inspections from an enlarged pool of globally qualified inspection personnel and tools. (Author)

  11. 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.

  12. Infrastructure for Large-Scale Quality-Improvement Projects: Early Lessons from North Carolina Improving Performance in Practice

    Science.gov (United States)

    Newton, Warren P.; Lefebvre, Ann; Donahue, Katrina E.; Bacon, Thomas; Dobson, Allen

    2010-01-01

    Introduction: Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods: Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3)…

  13. 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.

  14. 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

  15. Internet research: improving traditional community analysis before launching a practice.

    Science.gov (United States)

    Barresi, B; Scott, C

    2000-01-01

    Optometric practice management experts have always recommended that optometrists thoroughly research the communities in which they are considering practicing. Until the Internet came along, demographic research was possible but often daunting. Today, say these authors, it's becoming quite a bit easier ... and they show us how.

  16. Practice Facilitators' and Leaders' Perspectives on a Facilitated Quality Improvement Program.

    Science.gov (United States)

    McHugh, Megan; Brown, Tiffany; Liss, David T; Walunas, Theresa L; Persell, Stephen D

    2018-04-01

    Practice facilitation is a promising approach to helping practices implement quality improvements. Our purpose was to describe practice facilitators' and practice leaders' perspectives on implementation of a practice facilitator-supported quality improvement program and describe where their perspectives aligned and diverged. We conducted interviews with practice leaders and practice facilitators who participated in a program that included 35 improvement strategies aimed at the ABCS of heart health (aspirin use in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation). Rapid qualitative analysis was used to collect, organize, and analyze the data. We interviewed 17 of the 33 eligible practice leaders, and the 10 practice facilitators assigned to those practices. Practice leaders and practice facilitators both reported value in the program's ability to bring needed, high-quality resources to practices. Practice leaders appreciated being able to set the schedule for facilitation and select among the 35 interventions. According to practice facilitators, however, relying on practice leaders to set the pace of the intervention resulted in a lower level of program intensity than intended. Practice leaders preferred targeted assistance, particularly electronic health record documentation guidance and linkages to state smoking cessation programs. Practice facilitators reported that the easiest interventions were those that did not alter care practices. The dual perspectives of practice leaders and practice facilitators provide a more holistic picture of enablers and barriers to program implementation. There may be greater opportunities to assist small practices through simple, targeted practice facilitator-supported efforts rather than larger, comprehensive quality improvement projects. © 2018 Annals of Family Medicine, Inc.

  17. 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.

  18. Long-Range Planning Can Improve the Efficiency of Agricultural Research and Development.

    Science.gov (United States)

    1981-07-24

    planning is not done » Conclusions Recommendat ion Agency comments ADVISORY BODIES HAVE HAD MIXED SUCCESS IN AFFECTING LONG-RANGE PLANNING... kfc r Their efforts have more impact on determining priorities for the short-range budgeting cycle rather than influencing development of long...cultural products, (2) developing an efficient marketing and processing system, (3) conserving natural resources, and (4) im- proving the well-being of

  19. Improving transfusion practice in transfusion dependent thalassaemia patients

    Directory of Open Access Journals (Sweden)

    Chathupa Wickremaarachchi

    2017-10-01

    Full Text Available The aim of this study was to improve current transfusion practice in transfusiondependent thalassaemia patients by determining whether safe transition from triplewashed red cells (TWRC to leucodepleted red cells (LDRC, increasing transfusion rates, reducing the use of frusemide and creating uniform practice across patients is possible. In patients receiving regular transfusions (50, triple-washed red blood cells were changed to LDRC, transfusion rates were increased to 5 mL/kg/h (in line with the Cooley’s Foundation guidelines to a maximum of 300 mL/h and frusemide was ceased. Medical review occurred at completion of the transfusion. Of the 20 patients on TWRC, 18 were transitioned to leucodepleted red cells (90%. Recurrent allergic reactions in 2 patients required re-institution of TWRC. 7 of the 8 patients on regular frusemide ceased this practice with no documented transfusion-related fluid overload. One patient refused. Of the eligible 50 patients, 20 patients (40% were increased to the maximum transfusion rate of 300 mLs/h; 6 (12% increased rate but refused to go to the maximum; 9 (18% refused a change in practice and 15 (30% were already at the maximum rate. There was only one documented transfusion reaction (palpitations however this patient was able to tolerate a higher transfusion rate on subsequent transfusions. Thalassemia patients on TWRC were safely transitioned to LDRC. Transfusion rates were safely increased, with a calculated reduction in day-stay bed time of 17.45 h per month. This confirms a guideline of 5 mL/kg/h for transfusion-dependant thalassaemia patients with preserved cardiac function is well tolerated and may be translated to other centres worldwide.   本研究的目的是通过确定是否有可能进行从三洗红细胞(TWRC)到去白细胞红细胞(LDRC)的安全过渡,提高输血速率,减少速尿的使用,并在患者中实施统一规则,从而改进输血依赖型地中海贫血患者中

  20. Test of the Practicality and Feasibility of EDoF-Empowered Image Sensors for Long-Range Biometrics.

    Science.gov (United States)

    Hsieh, Sheng-Hsun; Li, Yung-Hui; Tien, Chung-Hao

    2016-11-25

    For many practical applications of image sensors, how to extend the depth-of-field (DoF) is an important research topic; if successfully implemented, it could be beneficial in various applications, from photography to biometrics. In this work, we want to examine the feasibility and practicability of a well-known "extended DoF" (EDoF) technique, or "wavefront coding," by building real-time long-range iris recognition and performing large-scale iris recognition. The key to the success of long-range iris recognition includes long DoF and image quality invariance toward various object distance, which is strict and harsh enough to test the practicality and feasibility of EDoF-empowered image sensors. Besides image sensor modification, we also explored the possibility of varying enrollment/testing pairs. With 512 iris images from 32 Asian people as the database, 400-mm focal length and F/6.3 optics over 3 m working distance, our results prove that a sophisticated coding design scheme plus homogeneous enrollment/testing setups can effectively overcome the blurring caused by phase modulation and omit Wiener-based restoration. In our experiments, which are based on 3328 iris images in total, the EDoF factor can achieve a result 3.71 times better than the original system without a loss of recognition accuracy.

  1. 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.

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. Health Psychology Bulletin : Improving Publication Practices to Accelerate Scientific Progress

    NARCIS (Netherlands)

    Peters, Gjalt-jorn Ygram; Kok, Gerjo; Crutzen, Rik; Sanderman, Robbert

    2017-01-01

    The instrument of scientific publishing, originally a necessary tool to enable development of a global science, has evolved relatively little in response to technological advances. Current scientific publishing practices incentivize a number of harmful approaches to research. Health Psychology

  7. Best practices and strategies for improving rail energy efficiency

    Science.gov (United States)

    2014-01-28

    In support of the FRA Energy, Environment, and Engine (E3) program, this study reviews and evaluates technology development opportunities, equipment upgrades, and best practices (BPs) of international and U.S. passenger and freight rail industry segm...

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

    African Journals Online (AJOL)

    user

    2014-10-13

    Oct 13, 2014 ... of skills for critical thinking and reflective practice as well as promotion of ... consideration of the nature of such evidence. ... nursing has a strong tradition of focusing on various .... Cost/Benefit ratio (Tanner, 1987) taking into.

  9. 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.

  10. 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…

  11. The History and State of Neonatal Nursing Quality Improvement Practice and Education.

    Science.gov (United States)

    Kukla, Aniko; Dowling, Donna A; Dolansky, Mary A

    2018-03-01

    Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.

  12. Exploring the effectiveness of engagement in a broad range of disciplinary practices on learning of Turkish high-school chemistry students

    Science.gov (United States)

    Seda Cetin, Pinar; Eymur, Guluzar; Southerland, Sherry A.; Walker, Joi; Whittington, Kirby

    2018-03-01

    This study examines the influence of laboratory instruction that engages students in a wide range of the practices of science on Turkish high-school students' chemistry learning. In this mixed methods study, student learning in two different laboratory settings was compared, one that featured an instruction that engaged students in a wide range of disciplinary practices (through Argument-driven Inquiry - ADI) and similar laboratories in which a more traditional Structured Inquiry (SI) approach was employed. The data sources included a Chemistry Concept test, an Argumentative Writing Assessment, and Semi-structured interviews. After seven weeks of chemistry instruction, students experiencing ADI instruction scored higher on the Chemistry Concept test and the Argumentative Writing Assessment than students experiencing SI instruction. Furthermore, girls who experienced ADI instruction scored higher on the assessments than their majority peers in the same class. The results suggest that Turkish students can substantially improve their chemistry proficiency if they have an opportunity to engage in instruction featuring a broad array of the practices of science.

  13. Hydrothermal germination models: Improving experimental efficiency by limiting data collection to the relevant hydrothermal range

    Science.gov (United States)

    Hydrothermal models used to predict germination response in the field are usually parameterized with data from laboratory experiments that examine the full range of germination response to temperature and water potential. Inclusion of low water potential and high and low-temperature treatments, how...

  14. Opportunities for Improving Army Modeling and Simulation Development: Making Fundamental Adjustments and Borrowing Commercial Business Practices

    National Research Council Canada - National Science Library

    Lee, John

    2000-01-01

    .... This paper briefly explores project management principles, leadership theory, and commercial business practices, suggesting improvements to the Army's modeling and simulation development process...

  15. 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.

  16. CONTINUOUS IMPROVEMENT PRACTICE IN LARGE ENTERPRISES: STUDY RESULTS

    Directory of Open Access Journals (Sweden)

    Dorota Stadnicka

    2015-03-01

    Full Text Available Continuous improvement is indispensable for ensuring the company's development and its survival on the constantly changing global market. Continuous improvement is particularly important in the quality and production management systems. A company should deliver a product compliant with a client's requirements in a specified time and at an appropriate price. That is why, continuous improvement refers to different areas of an organization's functioning and it is an integral part of Lean Manufacturing. This article presents the results of the study conducted in production enterprises on a limited area. The aim of the study was the assessment of the implementation of continuous improvement in Lean Manufacturing, and, in particular, employees' involvement in the problem identification and in reporting improvements as well as the way of motivating employees to involve themselves. The authors also tried to identify the factors influencing the elements of a continuous improvement system.

  17. Collaborative Practice Model: Improving the Delivery of Bad News.

    Science.gov (United States)

    Bowman, Pamela N; Slusser, Kim; Allen, Deborah

    2018-02-01

    Ideal bad news delivery requires skilled communication and team support. The literature has primarily focused on patient preferences, impact on care decisions, healthcare roles, and communication styles, without addressing systematic implementation. This article describes how an interdisciplinary team, led by advanced practice nurses, developed and implemented a collaborative practice model to deliver bad news on a unit that had struggled with inconsistencies. Using evidence-based practices, the authors explored current processes, role perceptions and expectations, and perceived barriers to developing the model, which is now the standard of care and an example of interprofessional team collaboration across the healthcare system. This model for delivering bad news can be easily adapted to meet the needs of other clinical units.
.

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

    Science.gov (United States)

    2010-09-01

    limitation of the simplistic model and adaptation of the higher fidelity model is the catalyst of the material in Chapters V and VI. In order to...characterization has been done previously in fields such as heterodyne Light Detection and Ranging (LiDAR), RADAR, and positron emisson tomography (PET) [20...Figure 6.13(b). These values for pt are consistent with the values from the previous section. Considering all the above optimal pulse-width studies

  19. 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...... the widely published normative advice. While there may be several reasons for discrepancies between research results and prac-tice this paper focuses on problems of implementation of the identified success factors. Within the research area of NPD-management there has been numerous surveys as well as case...

  20. Smothering in UK free-range flocks. Part 2: investigating correlations between disease, housing and management practices.

    Science.gov (United States)

    Rayner, A C; Gill, R; Brass, D; Willings, T H; Bright, A

    2016-09-10

    Smothering, when birds group together in a way that results in death from suffocation, is a welfare and economic concern for the egg industry. This questionnaire-based study explored correlations between disease, housing, management practices and smothering on free-range farms. A binomial logistic regression approach was used to test whether question responses predicted occurrence of nest box smothers (NBS) and panic and recurring smothers (PSRS) on farms. Breed (P=0.008) and nest box manufacturer (P=0.014) predicted NBS. Breed and nest box design have been previously reported to affect nesting behaviour. The affect of nest box manufacturer found in this study may illustrate the effect of nest box design features or house layouts. Nest box manufacturer (P=0.009), feeding oyster grit or grain on the litter (Prange use on a sunny day (Pranging) may contribute to smothering, whereas some management practices such as those aimed at occupying birds may be beneficial, illustrating the delicate balance of factors involved in free-range egg production. It is hoped that these results will stimulate further work exploring the suitability of housing design and management of laying hens in light of smothering. British Veterinary Association.

  1. Partnering through Training and Practice to Achieve Performance Improvement

    Science.gov (United States)

    Lyons, Paul R.

    2010-01-01

    This article presents a partnership effort among managers, trainers, and employees to spring to life performance improvement using the performance templates (P-T) approach. P-T represents a process model as well as a method of training leading to performance improvement. Not only does it add to our repertoire of training and performance management…

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

    African Journals Online (AJOL)

    Esem

    reducing mortality, but also on improving quality of life. ... Heart Failure in Zambia: Evidence for Improving ... likely to be a result of “informed guess work” with ... balance. The study reported that a high serum urea and high creatinine were ...

  3. Practical methods to improve the development of computational software

    International Nuclear Information System (INIS)

    Osborne, A. G.; Harding, D. W.; Deinert, M. R.

    2013-01-01

    The use of computation has become ubiquitous in science and engineering. As the complexity of computer codes has increased, so has the need for robust methods to minimize errors. Past work has show that the number of functional errors is related the number of commands that a code executes. Since the late 1960's, major participants in the field of computation have encouraged the development of best practices for programming to help reduce coder induced error, and this has lead to the emergence of 'software engineering' as a field of study. Best practices for coding and software production have now evolved and become common in the development of commercial software. These same techniques, however, are largely absent from the development of computational codes by research groups. Many of the best practice techniques from the professional software community would be easy for research groups in nuclear science and engineering to adopt. This paper outlines the history of software engineering, as well as issues in modern scientific computation, and recommends practices that should be adopted by individual scientific programmers and university research groups. (authors)

  4. Seven unconfirmed ideas to improve future ICU practice

    NARCIS (Netherlands)

    Marini, John J.; de Backer, Daniel; Ince, Can; Singer, Mervyn; van Haren, Frank; Westphal, Martin; Wischmeyer, Paul

    2017-01-01

    With imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or overturned by

  5. Handling Practicalities in Agricultural Policy Optimization for Water Quality Improvements

    Science.gov (United States)

    Bilevel and multi-objective optimization methods are often useful to spatially target agri-environmental policy throughout a watershed. This type of problem is complex and is comprised of a number of practicalities: (i) a large number of decision variables, (ii) at least two inte...

  6. 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 ...

  7. Seven unconfirmed ideas to improve future ICU practice

    NARCIS (Netherlands)

    Marini, J.J. (John J.); D. de Backer (Daniel); C. Ince (Can); Singer, M. (Mervyn); F.M.P. Van Haren; M. Westphal (Manfred); Wischmeyer, P. (Paul)

    2017-01-01

    textabstractWith imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or

  8. 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

  9. 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…

  10. Under surveillance: using cameras to improve care home practice.

    Science.gov (United States)

    Pearce, Lynne

    2017-05-03

    When the owner of Bramley Court in Birmingham mooted the idea of installing surveillance cameras inside the care home, manager and nurse Ann Willey was unenthusiastic. 'It felt like Big Brother was watching you,' she says. But then she considered how cameras might reduce the risk of poor practice and the potential benefits for vulnerable residents.

  11. School Policies and Practices that Improve Indoor Air Quality

    Science.gov (United States)

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

    2010-01-01

    Background: 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. Methods: This study analyzed school-level data from the 2006 School Health Policies and Programs Study, a national study of…

  12. 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.

  13. 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

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

    NARCIS (Netherlands)

    Joosen, Margot C. W.; van Beurden, Karlijn M.; Terluin, Berend; van Weeghel, Jaap; Brouwers, Evelien P. M.; van der Klink, Jac J. L.

    2015-01-01

    Background: Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived

  15. LIDAR pulse coding for high resolution range imaging at improved refresh rate.

    Science.gov (United States)

    Kim, Gunzung; Park, Yongwan

    2016-10-17

    In this study, a light detection and ranging system (LIDAR) was designed that codes pixel location information in its laser pulses using the direct- sequence optical code division multiple access (DS-OCDMA) method in conjunction with a scanning-based microelectromechanical system (MEMS) mirror. This LIDAR can constantly measure the distance without idle listening time for the return of reflected waves because its laser pulses include pixel location information encoded by applying the DS-OCDMA. Therefore, this emits in each bearing direction without waiting for the reflected wave to return. The MEMS mirror is used to deflect and steer the coded laser pulses in the desired bearing direction. The receiver digitizes the received reflected pulses using a low-temperature-grown (LTG) indium gallium arsenide (InGaAs) based photoconductive antenna (PCA) and the time-to-digital converter (TDC) and demodulates them using the DS-OCDMA. When all of the reflected waves corresponding to the pixels forming a range image are received, the proposed LIDAR generates a point cloud based on the time-of-flight (ToF) of each reflected wave. The results of simulations performed on the proposed LIDAR are compared with simulations of existing LIDARs.

  16. Energy savings and increased electric vehicle range through improved battery thermal management

    International Nuclear Information System (INIS)

    Smith, Joshua; Hinterberger, Michael; Schneider, Christoph; Koehler, Juergen

    2016-01-01

    Lithium-ion cells are temperature sensitive: operation outside the optimal operating range causes premature aging and correspondingly reduces vehicle range and battery system lifetime. In order to meet consumer demands for electric and hybrid-electric vehicle performance, especially in adverse climates, a battery thermal management system (BTMS) is often required. This work presents a novel experimental method for analyzing BTMS using three sample cooling plate concepts. For each concept, the input parameters (ambient temperature, coolant temperature and coolant flow rate) are varied and the resulting effect on the average temperature and temperature distribution across and between cells is compared. Additionally, the pressure loss along the coolant path is utilized as an indicator of energy efficiency. Using the presented methodology, various cooling plate layouts optimized for production alternative techniques are compared to the state of the art. It is shown that these production-optimized cooling plates provide sufficient thermal performance with the additional benefit of mechanical integration within the battery and/or vehicle system. It is also shown that the coolant flow influences battery cell thermal behavior more than the solid material and that pressure drop is more sensitive to geometrical changes in the cooling plate than temperature changes at the module.

  17. Modified expansive open-door laminoplasty technique improved postoperative neck pain and cervical range of motion.

    Science.gov (United States)

    Yeh, Kuang-Ting; Chen, Ing-Ho; Yu, Tzai-Chiu; Liu, Kuan-Lin; Peng, Cheng-Huan; Wang, Jen-Hung; Lee, Ru-Ping; Wu, Wen-Tien

    2015-12-01

    Expansive open-door laminoplasty (EOLP) is a useful technique for multiple-level cervical spondylotic myelopathy. The common postoperative complications of EOLP include moderate to severe neck pain, loss of cervical lordosis, decrease of cervical range of motion, and C5 palsy. We modified the surgical technique to lessen these complications. This study is aimed to elucidate the efficacy of modified techniques to lessen the complications of traditional procedures. We collected data from 126 consecutive patients treated at our institution between August 2008 and December 2012. Of these, 66 patients underwent conventional EOLP (CEOLP) and the other 60 patients underwent modified EOLP (MEOLP). The demographic and preoperative data, axial pain visual analog scale scores at 2 weeks and 3 months postoperatively, clinical outcomes evaluated using Nurick score and Japanese Orthopedic Association recovery rate at 12 months postoperatively, and radiographic results assessed using plain films at 3 months and 12 months postoperatively for both groups were compared and analyzed. There were no significant differences regarding the preoperative condition between the CEOLP and MEOLP groups (p > 0.05). The Japanese Orthopedic Association recovery rate of the MEOLP group was 70.3%, comparable to the result of the other group (70.2%). Postoperative axial neck pain, loss of range of motion, and loss of lordosis of cervical curvature decreased significantly in the MEOLP group (p cervical spondylotic myelopathy, which decreases postoperative complications effectively. Copyright © 2014. Published by Elsevier B.V.

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

    OpenAIRE

    Mazzocato, Pamela; Stenfors-Hayes, Terese; von Thiele Schwarz, Ulrica; Hasson, Henna; Nystr?m, Monica Elisabeth

    2016-01-01

    OBJECTIVES: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. METHODS: We analysed 186 structured kaizen documents containing improvement suggest...

  19. 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

    were analyzed via kinetics for their ability to carry out trans-sialidase reaction using CGMP and D-lactose as substrates. The sialidase variants with 15 and 16 mutations, respectively, exhibited significantly improved trans-sialidase activity for D-lactose sialylation. Our results corroborate......, that computational studies of trans-glycosylation can be a valuable input in the design of novel trans-glycosidases, but also highlight the importance of experimental validation in order to assess the performance. In conclusion, two of the seven mutants displayed a dramatic switch in specificity from hydrolysis...

  20. Opportunities for practical improvements in the management of plant transients

    International Nuclear Information System (INIS)

    Zebroski, E.L.

    1984-01-01

    This chapter attempts to provide some perspectives on the steps involved in analyzing, evaluating, and implementing remedies for transients and for potentially severe events. The importance of improved response and control of plant transients is stressed. The main steps involved in the attainment of improved control of plant transients are listed. Topics considered include the acquisition of plant data, sensitivity and risk analysis, the options for improvements, the managerial role, and some priorities for data, analysis, and evaluation. The ten most frequent types of transients for pressurized water reactors (PWRs) and boiling water reactors (BWRs) are listed according to frequency of occurrence. It is concluded that the two main needs of transient management are to avoid preoccupation with end-of-spectrum accidents and to improve the rate of technology transfer from best-available analysis and implementation

  1. Improvement of practical Countermeasures: Preventive medication. Post-Chernobyl action

    International Nuclear Information System (INIS)

    Gerber, G.

    1991-01-01

    The Chernobyl accident, which occurred on 26 April 1986, presented major challenges to the European Community with respect to the practical and regulatory aspects of radiation protection, public information, trade, particularly in food, and international politics. The Chernobyl accident was also a major challenge to the international scientific community which had to evaluate rapidly the radiological consequences of the accident and advise on the introduction of any countermeasures. Prior to the accident at Chernobyl, countermeasures to reduce the consequences of radioactive contamination had been conceived largely in the context of relatively small accidental releases and for application over relatively small areas. Less consideration had been given to the practical implications of applying such measures in case of a large source term and a spread over a very large area

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

    KAUST Repository

    Altaf, Muhammad; Butler, T.; Luo, X.; Dawson, C.; Mayo, T.; Hoteit, Ibrahim

    2013-01-01

    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.

  4. 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.

  5. Practitioner-informed improvements to early childhood intervention performance checklists and practice guides

    Directory of Open Access Journals (Sweden)

    Carl J. Dunst

    2017-08-01

    Full Text Available Results from four early childhood practitioner field tests of performance checklists and early intervention practice guides are reported. Findings from the first field test were used to make changes and improvements in the checklists and practice guides evaluated in the second and third field tests, and findings from the latter two field tests were used to improve the checklist and practice guide evaluated in the fourth field test. Results indicated that changes made in response to practitioners’ suggestions and feedback were associated with (1 progressive increases in the practitioners’ social validity judgments of the checklists, practice guides, and checklist-practice guide correspondence, and (2 progressive decreases in the number of practitioner suggestions and feedback for improving the early intervention materials. The field-test research demonstrates the importance of practitioner input, suggestions, and feedback for improving the usefulness of early childhood intervention practices.

  6. An improved energy-range relationship for high-energy electron beams based on multiple accurate experimental and Monte Carlo data sets

    International Nuclear Information System (INIS)

    Sorcini, B.B.; Andreo, P.; Hyoedynmaa, S.; Brahme, A.; Bielajew, A.F.

    1995-01-01

    A theoretically based analytical energy-range relationship has been developed and calibrated against well established experimental and Monte Carlo calculated energy-range data. Only published experimental data with a clear statement of accuracy and method of evaluation have been used. Besides published experimental range data for different uniform media, new accurate experimental data on the practical range of high-energy electron beams in water for the energy range 10-50 MeV from accurately calibrated racetrack microtrons have been used. Largely due to the simultaneous pooling of accurate experimental and Monte Carlo data for different materials, the fit has resulted in an increased accuracy of the resultant energy-range relationship, particularly at high energies. Up to date Monte Carlo data from the latest versions of the codes ITS3 and EGS4 for absorbers of atomic numbers between four and 92 (Be, C, H 2 O, PMMA, Al, Cu, Ag, Pb and U) and incident electron energies between 1 and 100 MeV have been used as a complement where experimental data are sparse or missing. The standard deviation of the experimental data relative to the new relation is slightly larger than that of the Monte Carlo data. This is partly due to the fact that theoretically based stopping and scattering cross-sections are used both to account for the material dependence of the analytical energy-range formula and to calculate ranges with the Monte Carlo programs. For water the deviation from the traditional energy-range relation of ICRU Report 35 is only 0.5% at 20 MeV but as high as - 2.2% at 50 MeV. An improved method for divergence and ionization correction in high-energy electron beams has also been developed to enable use of a wider range of experimental results. (Author)

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

    International Nuclear Information System (INIS)

    Jeong, YeonJoo; Kim, Sungho; Lu, Wei D.

    2015-01-01

    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

  8. Use of safety management practices for improving project performance.

    Science.gov (United States)

    Cheng, Eddie W L; Kelly, Stephen; Ryan, Neal

    2015-01-01

    Although site safety has long been a key research topic in the construction field, there is a lack of literature studying safety management practices (SMPs). The current research, therefore, aims to test the effect of SMPs on project performance. An empirical study was conducted in Hong Kong and the data collected were analysed with multiple regression analysis. Results suggest that 3 of the 15 SMPs, which were 'safety committee at project/site level', 'written safety policy', and 'safety training scheme' explained the variance in project performance significantly. Discussion about the impact of these three SMPs on construction was provided. Assuring safe construction should be an integral part of a construction project plan.

  9. Cultivation of zebra mussels (Dreissena polymorpha) within their invaded range to improve water quality in reservoirs.

    Science.gov (United States)

    McLaughlan, C; Aldridge, D C

    2013-09-01

    of spread to other locations. This may render some reservoir systems, such as dammed rivers which have outflows to downstream watercourses, unsuitable for cultivation. Such reservoirs are especially common in North America. We consider the practicalities of putting a zebra mussel cultivation system into place and identify gaps in knowledge. We conclude that zebra mussel cultivation offers an attractive tool for managing nutrient-enriched reservoirs, but that the benefits and costs must be balanced on a site-by-site basis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. 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 ...

  11. adoption of improved aquaculture practices by shrimp farmers

    African Journals Online (AJOL)

    Dr.Adesope

    use of check trays and adjustment of feed accordingly (95.0%), formation of ... Key words: adoption, improved aquaculture, shrimp farmers ... Brackish water shrimp farming is getting more attention because of high profitability ..... water and pond water whereas 52.5% of farmers did not observe the actual acclimatisation.

  12. 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

  13. 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,…

  14. Improving Teacher Practice: Experimental Evidence on Individualized Teacher Coaching

    Science.gov (United States)

    Kraft, Matthew A.; Blazar, David L.

    2013-01-01

    For over a century, school systems in the U.S. have attempted to improve instructional quality by investing in the education and training of their teachers. Today, over 90% of teachers report participating in some form of professional development (PD). Practitioners have responded to critiques of PD by re-envisioning it in the form of…

  15. 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…

  16. Using data to improve medical practice by measuring processes and outcomes of care.

    Science.gov (United States)

    Nelson, E C; Splaine, M E; Godfrey, M M; Kahn, V; Hess, A; Batalden, P; Plume, S K

    2000-12-01

    The purpose of this article is to help clinicians expand their use of data to improve medical practice performance and to do improvement research. Clinical practices can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly improved by embedding measurement into the flow of daily work in the practice. WHY DO IT?: Four good reasons to build measures into daily medical practice are to (1) diagnose strengths and weaknesses in practice performance; (2) improve and innovate in providing care and services using improvement research; (3) manage patients and the practice; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical practice to analyze the practice, to manage it, and to improve it. One model views clinical practices as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based practice might look like if it were using front-line measurement to improve care and services most of the time and to conduct clinical improvement research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO IMPROVE PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and improve practice. HOW CAN A PRACTICE START TO USE DATA TO IMPROVE CARE AND CONDUCT IMPROVEMENT RESEARCH?: Practical challenges are involved in starting to use data for enhancing care and improvement research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not

  17. Can a Community of Practice Improve Physical Therapists' Self-Perceived Practice in Developmental Coordination Disorder?

    Science.gov (United States)

    Camden, Chantal; Rivard, Lisa M; Hurtubise, Karen; Héguy, Léa; Berbari, Jade

    2017-07-01

    Communities of practice (CoPs) are useful knowledge translation (KT) strategies, but little is known about their impact on physical therapists' self-perceived practice. The impact of a CoP on physical therapists' self-perceived practice was evaluated, and factors influencing changes in self-perceived knowledge, skills, and practice related to developmental coordination disorder (DCD) were explored. An explanatory sequential mixed-methods design was used, guided by the Theory of Reasoned Action and Theory of Planned Behavior. Physical therapists participated in a DCD physical therapist CoP, which included 2 full-day, face-to-face workshops, with access to a 5-month online forum between the workshops, and completed questionnaires at 3 time-points: before the first workshop, before accessing the online forum, and following the second workshop. Measures completed before and after the CoP included closed-ended questions providing global scores on therapists' self-perceived knowledge, skills, and practice. Physical therapists' sociodemographic characteristics, information-seeking style, use of the online forum, and behavioral change goals were also collected. Paired t-tests, ANCOVAs, and linear regression models were used to analyze the data. Forty-one physical therapists completed all questionnaires. Their self-perceived knowledge, skills, and practice change scores were significantly higher (+0.47, +1.23, and +2.61, respectively; P behavioral changes influence patient outcomes. © 2017 American Physical Therapy Association

  18. SU-F-T-221: An Assessment of the Potential for Improved Local Control of Skull- Base Chordomas Via Reduction of the Proton Beam Range Uncertainty

    Energy Technology Data Exchange (ETDEWEB)

    Muller, L; Soldner, A; Kirk, M; Fager, M; Solberg, T; Robert, L; Dolney, D [University of Pennsylvania, Philadelphia, PA (United States)

    2016-06-15

    Purpose: The beam range uncertainty presents a special challenge for proton therapy. Novel technologies currently under development offer strategies to reduce the range uncertainty [1,2]. This work quantifies the potential advantages that could be realized by such a reduction for dosimetrically challenging chordomas at the base of skull. Therapeutic improvement was assessed by evaluating tumor control probabilities (TCP) and normal tissue complication probabilities (NTCP). Methods: Treatment plans were made for a modulated-scanned proton delivery technique using the Eclipse treatment planning system. The prescription dose was 7920 cGy to the CTV. Three different range uncertainty scenarios were considered: 5 mm (3.5% of the beam range + 1 mm, representing current clinical practice, “Curr”), 2 mm (1.3%), and 1 mm (0.7%). For each of 4 patients, 3 different PTVs were defined via uniform expansion of the CTV by the value of the range uncertainty. Tumor control probability (TCP) and normal tissue complication probabilities (NTCPs) for organs-at-risk (OARs) were calculated using the Lyman-Kutcher-Burman[3] formalism and published model parameters [ref Terahara[4], quantec S10, Burman Red Journal v21 pp 123]. Our plan optimization strategy was to achieve PTV close to prescription while maintaining OAR NTCP values at or better than the Curr plan. Results: The average TCP values for the 5, 2, and 1 mm range uncertainty scenarios are 51%, 55% and 65%. The improvement in TCP for patients was between 4 and 30%, depending primarily on the proximity of the GTV to OAR. The average NTCPs for the brainstem and cord were about 4% and 1%, respectively, for all target margins. Conclusion: For base of skull chordomas, reduced target margins can substantially increase the TCP without increasing the NTCP. This work demonstrates the potential significance of a reduction in the range uncertainty for proton beams.

  19. How do technical improvements change radiographers' practice – A practice theory perspective

    International Nuclear Information System (INIS)

    Lundvall, L.-L.; Abrandt-Dahlgren, M.; Wirell, S.

    2015-01-01

    Introduction: The two plane imaging techniques are gradually being replaced by multidimensional imaging. How it affects radiographers' professional practice has not been investigated. Aim: To explore how technical development affects the relations between different actors and their actions in the practice of Computer Tomography. Method: A qualitative design with data collection by open interviews (n = 8) and open observations (n = 10) of radiographers during their work with Computer Tomography. Data was first analyzed inductively resulting in seven codes. Secondly abduction was carried out by interpreting the content in the codes with a practice theory. This resulted in four themes. Result: First theme: Changed materiality makes the practical action easier. The actual image production has become practically easier. Second theme: Changed machines cause conflict between the arrangements of the work and the patients' needs. The time for the machine to carry out image production is easy to foresee, but information about the patient's individual status and needs is missing and this leads to difficulties in giving individual planned care. Third theme: Changing materiality prefigure learning. The different apparatus in use and the continuously changing methods of image production is co-constitutive of the practitioners' activities and learning. Fourth theme: Radiography is arranged for patient safety in relation to radiation doses and medical security risks. But the radiographers, who meet the patients, have to check the accuracy of the planned examination in relation to the clinical observed information about patient safety risks with the examination. - Highlights: • The arrangements of CT practice make it difficult to achieve individual planned care. • Continuously learning has become an essential part of radiographers' practice. • Radiographers' planning of each examination is important for secure patient safety

  20. The practical problem of improving quality in multicenter dialysis facilities.

    Science.gov (United States)

    Balter, Paul

    2003-01-01

    Multifacility dialysis groups are frequently interested in improving overall quality and find that there are major differences between individual units. Upper management must consider what strategy is needed for the whole company and what strategy must be formulated by individual facilities. To make substantive changes, management must decide to adopt a new culture of true teamwork, drive out fear, and emphasize leadership and education both at the management level and in the individual unit. Both at the corporate and unit levels, leaders must be chosen who are able to recognize people who have the ability, the educational background, the enthusiasm, and the time to direct change. Empowering the individual units and individual employees to make changes and be enthusiastic about improvement is the key to success.

  1. 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...

  2. Improvement of Pediatric Drug Development: Regulatory and Practical Frameworks.

    Science.gov (United States)

    Tsukamoto, Katusra; Carroll, Kelly A; Onishi, Taku; Matsumaru, Naoki; Brasseur, Daniel; Nakamura, Hidefumi

    2016-03-01

    A dearth in pediatric drug development often leaves pediatricians with no alternative but to prescribe unlicensed or off-label drugs with a resultant increased risk of adverse events. We present the current status of pediatric drug development and, based on our data analysis, clarify the problems in this area. Further action is proposed to improve the drug development that has pediatric therapeutic orphan status. We analyzed all Phase II/III and Phase III trials in ClinicalTrials.gov that only included pediatric participants (Performance index, an indicator of pediatric drug development, was calculated by dividing the annual number of pediatric clinical trials by million pediatric populations acquired from Census.gov. Effects of the 2 Japanese premiums introduced in 2010, for the enhancement of pediatric drug development, were analyzed by comparing mean performance index prepremiums (2006-2009) and postpremiums (2010-2014) among Japan, the European Union, and the United States. The European Union Clinical Trials Register and published reports from the European Medicines Agency were also surveyed to investigate the Paediatric Committee effect on pediatric clinical trials in the European Union. Mean difference of the performance index in prepremiums and postpremiums between Japan and the European Union were 0.296 (P 15% after 2008. Recruitment and ethical obstacles make conducting pediatric clinical trials challenging. An improved operational framework for conducting clinical trials should mirror the ever-improving regulatory framework that incentivizes investment in pediatric clinical trials. Technological approaches, enhancements in electronic medical record systems, and community approaches that actively incorporate input from physicians, researchers, and patients could offer a sustainable solution to recruitment of pediatric study participants. The key therefore is to improve pediatric pharmacotherapy collaboration among industry, government, academia, and

  3. Factors influencing change in clinical practice: A qualitative evaluation of the implementation of the quality improvement in colonoscopy study.

    Science.gov (United States)

    Rajasekhar, Praveen T; Rees, Colin J; Nixon, Catherine; East, James E; Brown, Sally

    2016-01-01

    The quality improvement in colonoscopy study was a region wide service improvement study to improve adenoma detection rate at colonoscopy by implementing evidence into routine colonoscopy practice. Implementing evidence into clinical practice can be challenging. The purpose of this paper is to perform a qualitative interview study to evaluate factors that influenced implementation within the study. Semi-structured interviews were conducted with staff in endoscopy units taking part in the quality improvement in colonoscopy study, after study completion. Units and interviewees were purposefully sampled to ensure a range of experiences was represented. Interviews were conducted with 11 participants. Key themes influencing uptake of the quality improvement in colonoscopy evidence bundle included time, study promotion, training, engagement, positive outcomes and modifications. Areas within themes were increased awareness of quality in colonoscopy (QIC), emphasis on withdrawal time and empowerment of endoscopy nurses to encourage the use of quality measures were positive outcomes of the study. The simple, visible study posters were reported as useful in aiding study promotion. Feedback sessions improved engagement. Challenges included difficulty arranging set-up meetings and engaging certain speciality groups. This evaluation suggests that methods to implement evidence into clinical practice should include identification and empowerment of team members who can positively influence engagement, simple, visible reminders and feedback. Emphasis on timing of meetings and strategies to engage speciality groups should also be given consideration. Qualitative evaluations can provide important insights into why quality improvement initiatives are successful or not, across different sites.

  4. Promoting Physicians' Self-Assessment and Quality Improvement: The ABIM Diabetes Practice Improvement Module

    Science.gov (United States)

    Holmboe, Eric S.; Meehan, Thomas P.; Lynn, Lorna; Doyle, Paula; Sherwin, Tierney; Duffy, F. Daniel

    2006-01-01

    Introduction: The American Board of Internal Medicine (ABIM) recognized that certification and recertification must be based on an assessment of performance in practice as well as an examination of medical knowledge. Physician self-assessment of practice performance is proposed as one method that certification boards may use to evaluate competence…

  5. Improving the rate and quality of medicaid well child care exams in primary care practices.

    Science.gov (United States)

    Smith, Katy Duncan; Merchen, Eileen; Turner, Crystal D; Vaught, Cara; Fritz, Terrie; Mold, Jim

    2010-07-01

    Providing recommended well child care to children insured bythe Medicaid Program can be challenging. Members of the Department of Family and Preventive Medicine (DFPM) at the University of Oklahoma Health Sciences Center contracted to help practices improve the rates and quality of well child care visits within the Oklahoma Medicaid Program. Sixteen pediatric and family medicine practices in three Oklahoma counties chose to participate in this quality improvement initiative. The records of Sooner Care-insured children age 0-20 were reviewed for both rate and quality of well child care visits made during the previous twelve months. Performance feedback was provided. Practice guidelines, Sooner Care requirements, and tips from exemplary practices were provided. In two of the counties, a case manager helped practices with challenging patients. Practice Enhancement Assistants (PEAs) then helped practices implement a variety of strategies to increase visit rates and improve the quality of early and periodic screening, diagnosis, and treatment (EPSDT) visits. Information technology (IT) support was provided when needed. The average rates of visits, for all counties combined, increased. Visit rates increased more in the younger age groups (birth to two years). There was significant improvement in quality of visits. Rates and quality improved much more in some practices than in others. A combination of academic detailing, performance feedback, practice facilitation, case management, and IT support produced increases in the quality and rates of EPSDT exams.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Improving water management practices to reduce nutrient export from rice paddy fields.

    Science.gov (United States)

    Zhang, Zhi-Jian; Yao, Ju-Xiang; Wang, Zhao-De; Xu, Xin; Lin, Xian-Yong; Czapar, George F; Zhang, Jian-Ying

    2011-01-01

    Nitrogen (N) and phosphorus (P) loss from rice paddy fields represents a significant threat to water quality in China. In this project, three irrigation-drainage regimes were compared, including one conventional irrigation-drainage regime, i.e. continuous submergence regime (CSR), and two improved regimes, i.e. the alternating submergence-nonsubmergence regime (ASNR) and the zero-drainage irrigation technology (ZDIT), to seek cost-effective practices for reducing nutrient loss. The data from these comparisons showed that, excluding the nutrient input from irrigation, the net exports of total N and total P via surface field drainage ranged from -3.93 to 2.39 kg ha and 0.17 to 0.95 g ha(-1) under the CSR operation, respectively, while N loss was -2.46 to -2.23 kg ha(-1) and P export was -0.65 to 0.31 kg ha(-1) under the improved regimes. The intensity of P export was positively correlated to the rate of P application. Reducing the draining frequency or postponing the draining operation would shift the ecological role of the paddy field from a nutrient export source to an interception sink when ASNR or the zero-drainage water management was used. In addition, since the rice yields are being guaranteed at no additional cost, the improved irrigation-drainage operations would have economic as well as environmental benefits.

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

    Directory of Open Access Journals (Sweden)

    Oghenetejiri DIGUN-AWETO

    2017-11-01

    Full Text Available Aquaculture has shown capacities to serve as means of livelihood, improve living standards, provide employment and generate foreign exchange in many countries. Recent investment in Nigerian aquaculture has been target towards catfish farming. However, small quantity and poor quality fish seeds are one of the problems limiting production. Consequently, Lagos State government introduced improved breeding and hatchery management practices as a package to fish hatchery operators with the aim of improving fish seed quantity and quality in the state. Nevertheless, the dissemination of the package has not yielded the desired result. This study assessed the constraints to adoption of improved hatchery management practices among catfish farmers in Lagos State. With structured questionnaire, 150 catfish farmers, randomly selected from 12 local government areas spread across Lagos State were interviewed. Despite that majority of the respondents strongly agreed or agreed to the fact that improved hatchery management practices have positive impacts on breeding, hatching, and survival of fish fry, majority of them affirmed that high cost of acquisition, high technicality in using the improved management practices as well as inadequate information about the improved management practices are primary reasons for non-adoption of some of the improved practices. Some of the limitations faced by the respondents include insufficient capital, lack of technical expertise to use the methods adequately, non-availability of inputs, expensive cost of facility maintenance, poor information dissemination and insufficient technical support from the extension agents and the state government. Although the adoption of improved practices has not been total, due to these constraints, the farmers’ knowledge of the improved hatchery management practices is broad. There is a need for the state government to subsidize the improved hatchery technologies and inputs, in addition to

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. Motivational Interviewing: An Evidence-Based Practice for Improving Student Practice Skills

    Science.gov (United States)

    Hohman, Melinda; Pierce, Paloma; Barnett, Elizabeth

    2015-01-01

    Motivational interviewing (MI) is an evidence-based communication method to assist clients in resolving their ambivalence regarding change. With a school emphasis on evidence-based practice and learning outcomes, a social work department implemented a semester-long course on MI. The purpose of this study was to determine baseline skills and…

  17. 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

  18. Understanding Seasonal Changes to Improve Good Practices in Livestock Management

    Directory of Open Access Journals (Sweden)

    Francesco Martelli

    2018-06-01

    Full Text Available Background and Aim: Food quality control techniques based on process control methods are increasingly adopted in livestock production systems to fulfill increasing market's expectations toward competitiveness and issues linked to One Health pillars (environment, animal, and human health. Control Charts allow monitoring and systematic investigation of sources of variability in dairy production parameters. These parameters, however, may be affected by seasonal variations that render impractical, biased or ineffective the use statistical control charts. A possible approach to this problem is to adapt seasonal adjustment methods used for the analysis of economic and demographic seasonal time series. The aim of the present work is to evaluate a seasonal decomposition technique called X-11 on milk parameters routinely collected also in small farms (fat, protein, and lactose content, solids-not-fat, freezing point, somatic cell count, total bacterial count and to test the efficacy of different seasonal removal methods to improve the effectiveness of statistical control charting.Method: Data collection was carried out for 3 years on routinely monitored bulk tank milk parameters of a small farm. Seasonality presence was statistically assessed on milk parameters and, for those parameters showing seasonality, control charts for individuals were applied on raw data, on X-11 seasonally adjusted data, and on data smoothed with a symmetric moving average filter. Correlation of seasonally influenced parameters with daily mean temperature was investigated.Results: Presence of seasonality in milk parameters was statistically assessed for fat, protein, and solids-non-fat components. The X-11 seasonally-adjusted control charts showed a reduced number of violations (false alarms with respect to non-seasonally adjusted control chart (from 5 to 1 violation for fat, from 17 to 1 violation for protein, and from 9 to none violation for solids-non-fat.. This result was

  19. 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.

  20. 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.

  1. Evaluating the implementation of a quality improvement process in General Practice using a realist evaluation framework.

    Science.gov (United States)

    Moule, Pam; Clompus, Susan; Fieldhouse, Jon; Ellis-Jones, Julie; Barker, Jacqueline

    2018-05-25

    Underuse of anticoagulants in atrial fibrillation is known to increase the risk of stroke and is an international problem. The National Institute for Health Care and Excellence guidance CG180 seeks to reduce atrial fibrillation related strokes through prescriptions of Non-vitamin K antagonist Oral Anticoagulants. A quality improvement programme was established by the West of England Academic Health Science Network (West of England AHSN) to implement this guidance into General Practice. A realist evaluation identified whether the quality improvement programme worked, determining how and in what circumstances. Six General Practices in 1 region, became the case study sites. Quality improvement team, doctor, and pharmacist meetings within each of the General Practices were recorded at 3 stages: initial planning, review, and final. Additionally, 15 interviews conducted with the practice leads explored experiences of the quality improvement process. Observation and interview data were analysed and compared against the initial programme theory. The quality improvement resources available were used variably, with the training being valued by all. The initial programme theories were refined. In particular, local workload pressures and individual General Practitioner experiences and pre-conceived ideas were acknowledged. Where key motivators were in place, such as prior experience, the programme achieved optimal outcomes and secured a lasting quality improvement legacy. The employment of a quality improvement programme can deliver practice change and improvement legacy outcomes when particular mechanisms are employed and in contexts where there is a commitment to improve service. © 2018 John Wiley & Sons, Ltd.

  2. 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.

  3. The public health nutrition intervention management bi-cycle: a model for training and practice improvement.

    Science.gov (United States)

    Hughes, Roger; Margetts, Barrie

    2012-11-01

    The present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development. The bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices. Education and practice settings. This model will have applications for educators and practitioners. Modifications to existing models have been informed by the authors' observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice. Public health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.

  4. 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

  5. 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.

  6. Study on improving rail energy efficiency (E2) : best practices and strategies

    Science.gov (United States)

    2015-03-23

    A recent Volpe Center report [1] for the Federal Railroad Administrations (FRA) Rail Energy, Environment, and Engine (E3) Technology research and development program reviewed rail industry best practices (BPs) and strategies for improving energy e...

  7. Changing Current Practice in Urology: Improving Guideline Development and Implementation Through Stakeholder Engagement.

    Science.gov (United States)

    MacLennan, Sara J; MacLennan, Steven; Bex, Axel; Catto, James W F; De Santis, Maria; Glaser, Adam W; Ljungberg, Borje; N'Dow, James; Plass, Karin; Trapero-Bertran, Marta; Van Poppel, Hendrik; Wright, Penny; Giles, Rachel H

    2017-08-01

    Effective stakeholder integration for guideline development should improve outcomes and adherence to clinical practice guidelines. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  8. Recommended Feeding and Dietary Practices To Improve Infant and Maternal Nutrition.

    Science.gov (United States)

    Academy for Educational Development, Washington, DC.

    The LINKAGES Project is intended to improve breastfeeding and related complementary feeding and maternal dietary practices. The project, in consultation with technical experts and program managers, identified a set of recommended feeding and dietary practices intended to break the cycle of poor health and nutrition that passes from generation to…

  9. 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…

  10. Leadership for School Improvement: Exploring Factors and Practices in the Process of Curriculum Change

    Science.gov (United States)

    Ho, Dora Choi Wa

    2010-01-01

    Research Findings: This article describes research into leadership practice for school improvement in Hong Kong preschools at a time when there was a move toward increased accountability. Two schools were selected for study, both of which were rated as excellent in the quality assurance inspections of the Education Bureau. Leadership practice for…

  11. 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…

  12. 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

    2018-04-01

    The nursing profession has a significant evidence to practice gap in an increasingly complex and dynamic health care environment. To evaluate effectiveness of teaching and learning strategies related to a capstone project within a Masters of Nursing program that encourage the development of evidence based practice capabilities. Systematic review that conforms to the PRISMA statement. Master's Nursing programs that include elements of a capstone project within a university setting. MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, ERIC and PsycInfo were used to search for RCT's or quasi experimental studies conducted between 1979 and 9 June 2017, published in a peer reviewed journal in English. Of 1592 studies, no RCT's specifically addressed the development of evidence based practice capabilities within the university teaching environment. Five quasi-experimental studies integrated blended learning, guided design processes, small group work, role play and structured debate into Masters of Nursing research courses. All five studies demonstrated some improvements in evidence based practice skills and/or research knowledge translation, with three out of five studies demonstrating significant improvements. There is a paucity of empirical evidence supporting the best strategies to use in developing evidence based practice skills and/or research knowledge translation skills for Master's Nursing students. As a profession, nursing requires methodologically robust studies that are discipline specific to identify the best approaches for developing evidence-based practice skills and/or research knowledge translation skills within the university teaching environment. Provision of these strategies will enable the nursing profession to integrate the best empirical evidence into nursing practice. Copyright © 2018. Published by Elsevier Ltd.

  13. A framework of quality improvement interventions to implement evidence-based practices for pressure ulcer prevention.

    Science.gov (United States)

    Padula, William V; Mishra, Manish K; Makic, Mary Beth F; Valuck, Robert J

    2014-06-01

    To enhance the learner's competence with knowledge about a framework of quality improvement (QI) interventions to implement evidence-based practices for pressure ulcer (PrU) prevention. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Summarize the process of creating and initiating the best-practice framework of QI for PrU prevention.2. Identify the domains and QI interventions for the best-practice framework of QI for PrU prevention. Pressure ulcer (PrU) prevention is a priority issue in US hospitals. The National Pressure Ulcer Advisory Panel endorses an evidence-based practice (EBP) protocol to help prevent PrUs. Effective implementation of EBPs requires systematic change of existing care units. Quality improvement interventions offer a mechanism of change to existing structures in order to effectively implement EBPs for PrU prevention. The best-practice framework developed by Nelson et al is a useful model of quality improvement interventions that targets process improvement in 4 domains: leadership, staff, information and information technology, and performance and improvement. At 2 academic medical centers, the best-practice framework was shown to physicians, nurses, and health services researchers. Their insight was used to modify the best-practice framework as a reference tool for quality improvement interventions in PrU prevention. The revised framework includes 25 elements across 4 domains. Many of these elements support EBPs for PrU prevention, such as updates in PrU staging and risk assessment. The best-practice framework offers a reference point to initiating a bundle of quality improvement interventions in support of EBPs. Hospitals and clinicians tasked with quality improvement efforts can use this framework to problem-solve PrU prevention and other critical issues.

  14. An approach to improving transporting velocity in the long-range ultrasonic transportation of micro-particles

    International Nuclear Information System (INIS)

    Meng, Jianxin; Mei, Deqing; Yang, Keji; Fan, Zongwei

    2014-01-01

    In existing ultrasonic transportation methods, the long-range transportation of micro-particles is always realized in step-by-step way. Due to the substantial decrease of the driving force in each step, the transportation is lower-speed and stair-stepping. To improve the transporting velocity, a non-stepping ultrasonic transportation approach is proposed. By quantitatively analyzing the acoustic potential well, an optimal region is defined as the position, where the largest driving force is provided under the condition that the driving force is simultaneously the major component of an acoustic radiation force. To keep the micro-particle trapped in the optimal region during the whole transportation process, an approach of optimizing the phase-shifting velocity and phase-shifting step is adopted. Due to the stable and large driving force, the displacement of the micro-particle is an approximately linear function of time, instead of a stair-stepping function of time as in the existing step-by-step methods. An experimental setup is also developed to validate this approach. Long-range ultrasonic transportations of zirconium beads with high transporting velocity were realized. The experimental results demonstrated that this approach is an effective way to improve transporting velocity in the long-range ultrasonic transportation of micro-particles

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

    Science.gov (United States)

    Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

    2002-12-01

    Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.

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

    Science.gov (United States)

    Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

    2002-01-01

    BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children. PMID:12528583

  17. 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.

  18. 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.

  19. Practice on an augmented reality/haptic simulator and library of virtual brains improves residents' ability to perform a ventriculostomy.

    Science.gov (United States)

    Yudkowsky, Rachel; Luciano, Cristian; Banerjee, Pat; Schwartz, Alan; Alaraj, Ali; Lemole, G Michael; Charbel, Fady; Smith, Kelly; Rizzi, Silvio; Byrne, Richard; Bendok, Bernard; Frim, David

    2013-02-01

    Ventriculostomy is a neurosurgical procedure for providing therapeutic cerebrospinal fluid drainage. Complications may arise during repeated attempts at placing the catheter in the ventricle. We studied the impact of simulation-based practice with a library of virtual brains on neurosurgery residents' performance in simulated and live surgical ventriculostomies. Using computed tomographic scans of actual patients, we developed a library of 15 virtual brains for the ImmersiveTouch system, a head- and hand-tracked augmented reality and haptic simulator. The virtual brains represent a range of anatomies including normal, shifted, and compressed ventricles. Neurosurgery residents participated in individual simulator practice on the library of brains including visualizing the 3-dimensional location of the catheter within the brain immediately after each insertion. Performance of participants on novel brains in the simulator and during actual surgery before and after intervention was analyzed using generalized linear mixed models. Simulator cannulation success rates increased after intervention, and live procedure outcomes showed improvement in the rate of successful cannulation on the first pass. However, the incidence of deeper, contralateral (simulator) and third-ventricle (live) placements increased after intervention. Residents reported that simulations were realistic and helpful in improving procedural skills such as aiming the probe, sensing the pressure change when entering the ventricle, and estimating how far the catheter should be advanced within the ventricle. Simulator practice with a library of virtual brains representing a range of anatomies and difficulty levels may improve performance, potentially decreasing complications due to inexpert technique.

  20. Benchmarking, benchmarks, or best practices? Applying quality improvement principles to decrease surgical turnaround time.

    Science.gov (United States)

    Mitchell, L

    1996-01-01

    The processes of benchmarking, benchmark data comparative analysis, and study of best practices are distinctly different. The study of best practices is explained with an example based on the Arthur Andersen & Co. 1992 "Study of Best Practices in Ambulatory Surgery". The results of a national best practices study in ambulatory surgery were used to provide our quality improvement team with the goal of improving the turnaround time between surgical cases. The team used a seven-step quality improvement problem-solving process to improve the surgical turnaround time. The national benchmark for turnaround times between surgical cases in 1992 was 13.5 minutes. The initial turnaround time at St. Joseph's Medical Center was 19.9 minutes. After the team implemented solutions, the time was reduced to an average of 16.3 minutes, an 18% improvement. Cost-benefit analysis showed a potential enhanced revenue of approximately $300,000, or a potential savings of $10,119. Applying quality improvement principles to benchmarking, benchmarks, or best practices can improve process performance. Understanding which form of benchmarking the institution wishes to embark on will help focus a team and use appropriate resources. Communicating with professional organizations that have experience in benchmarking will save time and money and help achieve the desired results.

  1. Improving and ensuring best practice continence management in residential aged care.

    Science.gov (United States)

    Heckenberg, Gayle

    2008-06-01

    Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness

  2. Exploring the Effectiveness of Engagement in a Broad Range of Disciplinary Practices on Learning of Turkish High-School Chemistry Students

    Science.gov (United States)

    Seda Cetin, Pinar; Eymur, Guluzar; Southerland, Sherry A.; Walker, Joi; Whittington, Kirby

    2018-01-01

    This study examines the influence of laboratory instruction that engages students in a wide range of the practices of science on Turkish high-school students' chemistry learning. In this mixed methods study, student learning in two different laboratory settings was compared, one that featured an instruction that engaged students in a wide range of…

  3. [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

  4. 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.

  5. 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.

  6. Collaborative Practice Improvement for Childhood Obesity in Rural Clinics: The Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP)

    OpenAIRE

    Shaikh, U; Nettiksimmons, J; Joseph, JG; Tancredi, D; Romano, PS

    2014-01-01

    © 2013 by the American College of Medical Quality. This study assessed the impact of participation in a virtual quality improvement (QI) learning network on adherence to clinical guidelines for childhood obesity prevention in rural clinics. A total of 7 primary care clinics in rural California included in the Healthy Eating Active Living TeleHealth Community of Practice and 288 children seen in these clinics for well-child care participated in this prospective observational pre-post study. Cl...

  7. Examining Ratings on the VAL-ED Evaluation Instrument of Principals to Improve Instructional Leadership Practices

    Science.gov (United States)

    Babin, Erin Pevey

    2017-01-01

    The biggest challenge facing American public schools today is increasing student achievement, and this depends on the educational system's ability to improve the quality of instruction. Principals play a key role in improving the quality of instruction on their campus through the instructional leadership practices they engage in on a daily basis.…

  8. Evaluating an Art-Based Intervention to Improve Practicing Nurses' Observation, Description, and Problem Identification Skills.

    Science.gov (United States)

    Nease, Beth M; Haney, Tina S

    Astute observation, description, and problem identification skills provide the underpinning for nursing assessment, surveillance, and prevention of failure to rescue events. Art-based education has been effective in nursing schools for improving observation, description, and problem identification. The authors describe a randomized controlled pilot study testing the effectiveness of an art-based educational intervention aimed at improving these skills in practicing nurses.

  9. 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

  10. 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…

  11. How Positive Practices Can Accelerate Transformation To a Lean Improvement Culture

    DEFF Research Database (Denmark)

    Jørgensen, Rasmus; Hansen, David; Lilja, Johan

    2016-01-01

    With increasing pressure on creating more value with fewer resources, many organizations pursue continuous improvement culture and practices in daily operations.In operations management Lean and the Toyota Way have been continuous improvement role models for describing tools and culture. However...

  12. 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

  13. Integrating Quality and Safety Competencies to Improve Outcomes: Application in Infusion Therapy Practice.

    Science.gov (United States)

    Sherwood, Gwen; Nickel, Barbara

    Despite intense scrutiny and process improvement initiatives, patient harm continues to occur in health care with alarming frequency. The Quality and Safety Education for Nursing (QSEN) project provides a roadmap to transform nursing by integrating 6 competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. As front-line caregivers, nurses encounter inherent risks in their daily work. Infusion therapy is high risk with multiple potential risks for patient harm. This study examines individual and system application of the QSEN competencies and the Infusion Nurses Society's 2016 Infusion Therapy Standards of Practice in the improvement of patient outcomes.

  14. Free Dietary Choice and Free-Range Rearing Improve the Product Quality, Gait Score, and Microbial Richness of Chickens

    Directory of Open Access Journals (Sweden)

    Siyu Chen

    2018-06-01

    Full Text Available Poultry welfare has been extensively studied; however, there is a lack of rigorous scientific knowledge relating to the different aspects of welfare factors and how this may contribute to the production quantity and product quality as well as the welfare of chickens. Therefore, we conducted an integrated study to compare welfare factors in chickens by providing free dietary choice under cage rearing, and further comparing cage rearing with free-range rearing. One hundred chickens each were allocated to a cage rearing group with conventional feeding (CC, a cage rearing group with free dietary choice of mealworms (FDM, a cage rearing group with free dietary choice of mealworms and fresh grass (FDMG, and a free-range rearing system group with free dietary choice of mealworms and fresh grass (FRMG. Results showed that under cage rearing, free dietary choice contributed to better meat quality and gait score, higher values of blood platelets, and a richer gut microbial composition, but poorer egg production than CC chickens. As compared to FDMG, FRMG chickens showed better meat quality, gait score, and feather conditions, as well as a richer gut microbial composition; however, they had poorer egg production and a poorer foot pad and foot feather condition. We conclude that free dietary choice and free-range rearing systems improve the product quality, gait score, and microbial richness of chickens.

  15. 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 range, thereby increasing the risk of complications. This study aimed to evaluate the effect of a patient-specific tailored intervention on anticoagulation control in patients with heart failure. Patients with heart failure taking warfarin therapy (n = 145) were randomized to either standard care or a 1-time intervention assessing potential risk factors for lability of INR, in which they received patient-specific instructions. Time in therapeutic range (TTR) using Rosendaal's linear model was assessed 3 months before and after the intervention. The patient-tailored intervention significantly increased anticoagulation control. The median TTR levels before intervention were suboptimal in the interventional and control groups (53% vs 45%, P = .14). After intervention the median TTR increased significantly in the interventional group compared with the control group (80% [interquartile range, 62%-93%] vs 44% [29%-61%], P <.0001). The intervention resulted in a significant improvement in the interventional group before versus after intervention (53% vs 80%, P <.0001) but not in the control group (45% vs 44%, P = .95). The percentage of patients with a TTR ≥60%, considered therapeutic, was substantially higher in the interventional group: 79% versus 25% (P <.0001). The INR variability (standard deviation of each patient's INR measurements) decreased significantly in the interventional group, from 0.53 to 0.32 (P <.0001) after intervention but not in the control group. Patient-specific tailored intervention significantly improves anticoagulation therapy in patients with heart failure. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Improving the fundamentals of care for older people in the acute hospital setting: facilitating practice improvement using a Knowledge Translation Toolkit.

    Science.gov (United States)

    Wiechula, Rick; Kitson, Alison; Marcoionni, Danni; Page, Tammy; Zeitz, Kathryn; Silverston, Heidi

    2009-12-01

    This paper reports on a structured facilitation program where seven interdisciplinary teams conducted projects aimed at improving the care of the older person in the acute sector. Aims  To develop and implement a structured intervention known as the Knowledge Translation (KT) Toolkit to improve the fundamentals of care for the older person in the acute care sector. Three hypotheses were tested: (i) frontline staff can be facilitated to use existing quality improvement tools and techniques and other resources (the KT Toolkit) in order to improve care of older people in the acute hospital setting; (ii) fundamental aspects of care for older people in the acute hospital setting can be improved through the introduction and use of specific evidence-based guidelines by frontline staff; and (iii) innovations can be introduced and improvements made to care within a 12-month cycle/timeframe with appropriate facilitation. Methods  Using realistic evaluation methodology the impact of a structured facilitation program (the KT Toolkit) was assessed with the aim of providing a deeper understanding of how a range of tools, techniques and strategies may be used by clinicians to improve care. The intervention comprised three elements: the facilitation team recruited for specific knowledge, skills and expertise in KT, evidence-based practice and quality and safety; the facilitation, including a structured program of education, ongoing support and communication; and finally the components of the toolkit including elements already used within the study organisation. Results  Small improvements in care were shown. The results for the individual projects varied from clarifying issues of concern and planning ongoing activities, to changing existing practices, to improving actual patient outcomes such as reducing functional decline. More importantly the study described how teams of clinicians can be facilitated using a structured program to conduct practice improvement activities

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

    Directory of Open Access Journals (Sweden)

    Deborah Sitrin

    2015-03-01

    Full Text Available Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective: This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design: Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW during pregnancy (0, 1–2, 3+ – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results: There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion: Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of

  18. A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice

    NARCIS (Netherlands)

    Flottorp, S.A.; Oxman, A.D.; Krause, J.; Musila, N.R.; Wensing, M.; Godycki-Cwirko, M.; Baker, R.; Eccles, M.P.

    2013-01-01

    BACKGROUND: Determinants of practice are factors that might prevent or enable improvements. Several checklists, frameworks, taxonomies, and classifications of determinants of healthcare professional practice have been published. In this paper, we describe the development of a comprehensive,

  19. Improving outcomes for patients with type 2 diabetes using general practice networks: a quality improvement project in east London.

    Science.gov (United States)

    Hull, Sally; Chowdhury, Tahseen A; Mathur, Rohini; Robson, John

    2014-02-01

    Structured diabetes care can improve outcomes and reduce risk of complications, but improving care in a deprived, ethnically diverse area can prove challenging. This report evaluates a system change to enhance diabetes care delivery in a primary care setting. All 35 practices in one inner London Primary Care Trust were geographically grouped into eight networks of four to five practices, each supported by a network manager, clerical staff and an educational budget. A multidisciplinary team developed a 'care package' for type 2 diabetes management, with financial incentives based on network achievement of targets. Monthly electronic performance dashboards enabled networks to track and improve performance. Network multidisciplinary team meetings including the diabetic specialist team supported case management and education. Key measures for improvement included the number of diabetes care plans completed, proportion of patients attending for digital retinal screen and proportions of patients achieving a number of biomedical indices (blood pressure, cholesterol, glycated haemoglobin). Between 2009 and 2012, completed care plans rose from 10% to 88%. The proportion of patients attending for digital retinal screen rose from 72% to 82.8%. The proportion of patients achieving a combination of blood pressure ≤ 140/80 mm Hg and cholesterol ≤ 4 mmol/L rose from 35.3% to 46.1%. Mean glycated haemoglobin dropped from 7.80% to 7.66% (62-60 mmol/mol). Investment of financial, organisational and education resources into primary care practice networks can achieve clinically important improvements in diabetes care in deprived, ethnically diverse communities. This success is predicated on collaborative working between practices, purposively designed high-quality information on network performance and engagement between primary and secondary care clinicians.

  20. Nursing unit leaders' influence on the long-term sustainability of evidence-based practice improvements.

    Science.gov (United States)

    Fleiszer, Andrea R; Semenic, Sonia E; Ritchie, Judith A; Richer, Marie-Claire; Denis, Jean-Louis

    2016-04-01

    To describe how actions of nursing unit leaders influenced the long-term sustainability of a best practice guidelines (BPG) program on inpatient units. Several factors influence the initial implementation of evidence-based practice improvements in nursing, with leadership recognized as essential. However, there is limited knowledge about enduring change, including how frontline nursing leaders influence the sustainability of practice improvements over the long term. A qualitative descriptive case study included 39 in-depth interviews, observations, and document reviews. Four embedded nursing unit subcases had differing levels of program sustainability at 7 years (average) following implementation. Higher levels of BPG sustainability occurred on units where formal leadership teams used an integrated set of strategies and activities. Two key strategies were maintaining priorities and reinforcing expectations. The coordinated use of six activities (e.g., discussing, evaluating, integrating) promoted the continuation of BPG practices among staff. These leadership processes, fostering exchange and learning, contributed to sustainability-promoting environments characterized by teamwork and accountability. Unit leaders are required to strategically orchestrate several overlapping and synergistic efforts to achieve long-term sustainability of BPG-based practice improvements. As part of managing overall unit performance, unit leaders may influence practice improvement sustainability by aligning vision, strategies, and activities. © 2015 John Wiley & Sons Ltd.

  1. MAP as a model for practice-based learning and improvement in child psychiatry training.

    Science.gov (United States)

    Kataoka, Sheryl H; Podell, Jennifer L; Zima, Bonnie T; Best, Karin; Sidhu, Shawn; Jura, Martha Bates

    2014-01-01

    Not only is there a growing literature demonstrating the positive outcomes that result from implementing evidence based treatments (EBTs) but also studies that suggest a lack of delivery of these EBTs in "usual care" practices. One way to address this deficit is to improve the quality of psychotherapy teaching for clinicians-in-training. The Accreditation Council for Graduate Medical Education (ACGME) requires all training programs to assess residents in a number of competencies including Practice-Based Learning and Improvements (PBLI). This article describes the piloting of Managing and Adapting Practice (MAP) for child psychiatry fellows, to teach them both EBT and PBLI skills. Eight child psychiatry trainees received 5 full days of MAP training and are delivering MAP in a year-long outpatient teaching clinic. In this setting, MAP is applied to the complex, multiply diagnosed psychiatric patients that present to this clinic. This article describes how MAP tools and resources assist in teaching trainees each of the eight required competency components of PBLI, including identifying deficits in expertise, setting learning goals, performing learning activities, conducting quality improvement methods in practice, incorporating formative feedback, using scientific studies to inform practice, using technology for learning, and participating in patient education. A case example illustrates the use of MAP in teaching PBLI. MAP provides a unique way to teach important quality improvement and practice-based learning skills to trainees while training them in important psychotherapy competence.

  2. An Improved Continuous-Time Model Predictive Control of Permanent Magnetic Synchronous Motors for a Wide-Speed Range

    Directory of Open Access Journals (Sweden)

    Dandan Su

    2017-12-01

    Full Text Available This paper proposes an improved continuous-time model predictive control (CTMPC of permanent magnetic synchronous motors (PMSMs for a wide-speed range, including the constant torque region and the flux-weakening (FW region. In the constant torque region, the mathematic models of PMSMs in dq-axes are decoupled without the limitation of DC-link voltage. However, in the FW region, the mathematic models of PMSMs in dq-axes are cross-coupled together with the limitation of DC-link voltage. A nonlinear PMSMs mathematic model in the FW region is presented based on the voltage angle. The solving of the nonlinear mathematic model of PMSMs in FW region will lead to heavy computation load for digital signal processing (DSP. To overcome such a problem, a linearization method of the voltage angle is also proposed to reduce the computation load. The selection of transiting points between the constant torque region and FW regions is researched to improve the performance of the driven system. Compared with the proportional integral (PI controller, the proposed CTMPC has obvious advantages in dealing with systems’ nonlinear constraints and improving system performance by restraining overshoot current under step torque changing. Both simulation and experimental results confirm the effectiveness of the proposed method in achieving good steady-state performance and smooth switching between the constant torque and FW regions.

  3. Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services.

    Science.gov (United States)

    Stoneman, Alice; Atkinson, David; Davey, Maureen; Marley, Julia V

    2014-10-07

    Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia. Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI. A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change. Well

  4. 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."

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

    OpenAIRE

    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...

  6. Improving long-range dispersion predictions with ETEX real-time and a-posteriori model evaluations

    International Nuclear Information System (INIS)

    Desiato, F.

    1997-01-01

    The Italian environmental Protection Agency (ANPA), which is responsible for the evaluation of the consequences of accidental releases into the atmosphere, has participated to both the real-time (phase-1) and a-posteriori (phase-2) ETEX model evaluations. The double benchmark actually constituted an invaluable experience for better understanding the skill and limits of the present long-range dispersion modelling capabilities. In particular, the strong difference between phase-1 and phase-2 model performance emphasised the opportunity to modify, improve or tune a number of specific aspects of the overall simulation. ETEX model runs were carried out with the Lagrangian particle model APOLLO. The meteorological input was constituted by ECMWF fields. Three-hourly average concentrations paired in space and time and time-integrated concentrations were used in the evaluation of the results, based on a set of statistical indexes and concentration contour lines and scatter diagrams

  7. Underwater Ranging

    OpenAIRE

    S. P. Gaba

    1984-01-01

    The paper deals with underwater laser ranging system, its principle of operation and maximum depth capability. The sources of external noise and methods to improve signal-to-noise ratio are also discussed.

  8. 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

  9. Talking about the elephant in the room: Improving fundamental assessment practices

    Directory of Open Access Journals (Sweden)

    Betty Gill

    2015-08-01

    Full Text Available This paper reports on an institution-wide strategy to improve first year assessment practices. Assessment is central to the student experience and to informing their developing conceptions of themselves as students. Despite this central importance, much national and international literature raises questions about the fitness-for-purpose of assessment practices in higher education. The reported strategy was developed in response to analysis of student feedback, which suggested, like the literature, substantial opportunity for improvement. Student feedback on their assessment experience was validated by an audit of first session assessment and used to inform the strategy. A significant improvement in quantitative and qualitative measures of student satisfaction across routine data sources is provided to demonstrate impact. This supports a conclusion that the first year student experience can be impacted by the systemic application of a small number of fundamental good practice assessment strategies which are outlined.

  10. [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.

  11. 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.

  12. Practice and quality improvement: successful implementation of TeamSTEPPS tools into an academic interventional ultrasound practice.

    Science.gov (United States)

    Gupta, Rajan T; Sexton, J Bryan; Milne, Judy; Frush, Donald P

    2015-01-01

    The goal of this study was to implement an evidence-based teamwork system to improve communication and teamwork skills among health care professionals (TeamSTEPPS) into an academic interventional ultrasound program and to assess safety and team-work climate across team members both before and after implementation. Members of a change team (including master trainers) selected specific tools available within TeamSTEPPS to implement into an academic interventional ultrasound service. Tools selected were based on preimplementation survey data obtained from team members (n = 64: 11 attending faculty physicians, 12 clinical abdominal imaging fellows or residents, 17 sonographers, 19 nurses, and five technologist aides or administrative personnel). The survey included teamwork climate and safety climate domains from the Safety Attitudes Questionnaire. Four months after implementation, respondents were resurveyed and post-implementation data were collected. Teamwork climate scores improved from a mean of 67.9 (SD, 12.8) before implementation to a mean of 87.8 (SD, 14.1) after implementation (t = -7.6; p ultrasound practice. The most notable improvements were seen in communication among team members and role clarification. We think that this model, which has been successfully implemented in many nonradiologic areas in medical care, is also applicable in imaging practice.

  13. 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.

  14. Improved atomic data for electron-transport predictions by the codes TIGER and TIGERP: II. Electron stopping and range data

    International Nuclear Information System (INIS)

    Peek, J.M.; Halbleib, J.A.

    1983-04-01

    The electron stopping and range data now used in the TIGER and TIGERP electron-transport codes are extracted and compared with other data for these processes. At the smallest collision energies treated by these codes, E approx. 1 keV, the stopping-power is estimated to be accurate for small-Z targets, to be about 25 percent too small for Z near 36 and to be a factor of three too small for Z > 79. These errors decrease with increasing E and the largest error for any target is roughly 20 percent for E = 10 keV. The closely related continuous-slowing-down range is estimated, at 1 keV, to be about 25 percent too small for small-Z targets and a factor of 2 too large for large-Z targets. The electron-transport problem of reflection from planer surfaces is re-investigated with improved stopping-power data. The effects of this change for the examples considered were about the size of the statistical uncertainties in the calculation, 1 to 2 percent

  15. 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.

  16. A Novel Realization of Low-Power and Low-Distortion Multiplier Circuit with Improved Dynamic Range

    Directory of Open Access Journals (Sweden)

    Ali Naderi Saatlo

    2017-01-01

    Full Text Available A novel topology of four-quadrant analog multiplier circuit is presented in this paper. The voltage mode technique is employed to design the circuit in CMOS technology. The dynamic input and output ranges of the circuit are improved owing to the fact that the circuit works in the saturation region not in weak inversion. Also the proposed multiplier is suitable for low voltage operation and its power consumption is relatively low. In order to verify the performance of the proposed circuit, performance of the circuit affected by second order effects including transistor mismatch and mobility reduction is analyzed in detail. It will be shown that any conceivable mismatch in the transistor parameters leads to second harmonic distortion. Additionally, the effect of mobility reduction in the third harmonic distortion will be computed. In order to simulate the circuit, Cadence and HSPICE software are used with TSMC level 49 (BSIM3v3 parameters for 0.18 μm CMOS technology, where under supply voltage of 1.5 V, total power consumption is 44 µW, the corresponding average nonlinearity remains as low as 1 %, and the input range of the circuit is ± 400 mV.

  17. Electro-encephalogram based brain-computer interface: improved performance by mental practice and concentration skills.

    Science.gov (United States)

    Mahmoudi, Babak; Erfanian, Abbas

    2006-11-01

    Mental imagination is the essential part of the most EEG-based communication systems. Thus, the quality of mental rehearsal, the degree of imagined effort, and mind controllability should have a major effect on the performance of electro-encephalogram (EEG) based brain-computer interface (BCI). It is now well established that mental practice using motor imagery improves motor skills. The effects of mental practice on motor skill learning are the result of practice on central motor programming. According to this view, it seems logical that mental practice should modify the neuronal activity in the primary sensorimotor areas and consequently change the performance of EEG-based BCI. For developing a practical BCI system, recognizing the resting state with eyes opened and the imagined voluntary movement is important. For this purpose, the mind should be able to focus on a single goal for a period of time, without deviation to another context. In this work, we are going to examine the role of mental practice and concentration skills on the EEG control during imaginative hand movements. The results show that the mental practice and concentration can generally improve the classification accuracy of the EEG patterns. It is found that mental training has a significant effect on the classification accuracy over the primary motor cortex and frontal area.

  18. 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...

  19. Improvement of quality of radiation indicators used for food irradiation in dose range of 3-10 kGy

    International Nuclear Information System (INIS)

    Hoang Hoa Mai; Pham Duy Duong; Nguyen Dinh Duong

    2007-01-01

    A sensitive indicators based on the polyvinyl butyral dyed with leuco-malachite green and methyl orange were made for use as devices for discriminating and monitoring radiation treatment in food irradiation. The sensitivity and stability of the indicator have been improved by using several additives such as CCl 4 in combination with di(nonylphenyl) isophthalate [dinonyl phthalate -C 6 H 4 (COOC 9 H 19 ) 2 ]. The dosimeters change their color from orange to greenish when irradiated with gamma rays or electrons to dose just about 2 kGy. The greenish continue to develop to deep-green upon the increase of dose to 7 kGy. This makes the indicators useful for the dose range of food irradiation application, especially in treatment of frozen meat and sea products for elimination of micro-organism. The quality of indicators are also improved by adjusting of factors and procedures during preparation of film and dosimeters. The indicators were produced in a stick-on label type showing attractive characteristics in use. The orange color before irradiation keep well stable for as long as 20 months under normal conditions in laboratory. The green after irradiation was maintained up to 12 months in piratical conditions of products. The indicator can be produced in big amount to supply to the irradiation facilities in Vietnam instead of imported devices. (author)

  20. 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.

  1. An exploration of cultural beliefs and practices across the Southern Ground-Hornbill’s range in Africa

    Science.gov (United States)

    2014-01-01

    Background This article explores cultural beliefs and practices related to the Southern Ground-Hornbill (SGH) (Bucorvus leadbeateri) in nine southern and east-African countries. Methods A qualitative, thematic content-analysis approach was followed. Ninety-eight participants took part in the study. Interviews and group discussions were used as the main data gathering methods. Each interview was digitally recorded and transcribed. Data were analysed by means of thematic content analysis. Results The main themes that emerged from the data analysis indicated that beliefs and practices relate to the SGH as being (a) a bringer or signifier of death/destruction/loss/ deprivation, with the bird commonly being regarded as a bad omen of evil spirits and announcer of calamities; (b) a protector against evil spirits, against lightning and against drought; (c) an enabler/causer of altered perceptions, which include remote viewing, foreseeing the future, and creating an illusion; and (d) a timekeeper that announces the beginning and end of a working day and of seasonal changes. Conclusions Knowledge about the use of the SGH in cultural practices can contribute to conservation efforts in at least two significant ways: Firstly, beliefs and practices that were identified in this study as having potentially protective consequences for the SGH can now be specifically targeted and strengthened in future interventions. Secondly, destructive beliefs and practices that were identified can now be changed by means of the implementation of an intervention programme in countries where it is needed. PMID:24670253

  2. 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

  3. 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

    2016-01-01

    Objectives Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. Methods We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated. Results 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions. Conclusions There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results. PMID:27473953

  4. [ISMP-Spain questionnaire and strategy for improving good medication practices in the Andalusian health system].

    Science.gov (United States)

    Padilla-Marín, V; Corral-Baena, S; Domínguez-Guerrero, F; Santos-Rubio, M D; Santana-López, V; Moreno-Campoy, E

    2012-01-01

    To describe the strategy employed by Andalusian public health service hospitals to foster safe medication use. The self-evaluation questionnaire on drug system safety in hospitals, adapted by the Spanish Institute for Safe Medication Practices was used as a fundamental tool to that end. The strategy is developed in several phases. We analyse the report evaluating drug system safety in Andalusian public hospitals published by the Spanish Ministry of Health and Consumption in 2008 and establish a grading system to assess safe medication practices in Andalusian hospitals and prioritise areas needing improvement. We developed a catalogue of best practices available in the web environment belonging to the Andalusian health care quality agency's patient safety observatory. We publicised the strategy through training seminars and implemented a system allowing hospitals to evaluate the degree of compliance for each of the best practices, and based on that system, we were able to draw up a map of centres of reference. We found areas for improvement among several of the questionnaire's fundamental criteria. These areas for improvement were related to normal medication procedures in daily clinical practice. We therefore wrote 7 best practice guides that provide a cross-section of the assessment components of the questionnaire related to the clinical process needing improvement. The self-evaluation questionnaire adapted by ISMP-Spain is a good tool for designing a systematic, rational intervention to promote safe medication practices and intended for a group of hospitals that share the same values. Copyright © 2011 SEFH. Published by Elsevier Espana. All rights reserved.

  5. 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.

  6. 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.

  7. 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

  8. A Practice Indexes for Improving Facial Movements of Brass Instrument Players

    Science.gov (United States)

    Ito, Kyoko; Hirano, Takeshi; Noto, Kazufumi; Nishida, Shogo; Ohtsuki, Tatsuyuki

    Two experimental studies have been conducted in order to propose practice indexes for the improvement of the embouchure of French horn players, two experimental studies have been conducted. In both studies, the same task was performed by advanced and amateur French horn players. The first study investigated the activity, while performing the above-mentioned task, of the 5 facial muscles (levator labii superioris, zygomaticus major, depressor anguli oris, depressor labii inferioris, and risorius muscles) on the right side of the face by surface electromyography, and the facial movement on the left side of the face by attaching two markers above each muscle and using two high-speed cameras simultaneously. The results of the study showed that it is possible for the four markers around the lower lip to practice indexes. The second study evaluated whether the above-mentioned markers are appropriate as practice indexes using a 3-D tracking system and questionnaires. The results showed that both the advanced and the amateur players assessed that the markers were suitable as practice indexes for improving the embouchure. This set of approaches could be useful for selecting practice indexes and developing scientific practice methods not only for the French horn but also for other instruments and other fields.

  9. 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.

  10. 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

  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

    2014-11-18

    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.

  12. 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…

  13. 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…

  14. 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…

  15. 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…

  16. System Leadership for School Improvement: A Developing Concept and Set of Practices

    Science.gov (United States)

    Dimmock, Clive

    2016-01-01

    System leadership is a developing concept and practice increasingly seen as a tool for school improvement, as policymakers switch from traditional top-down reform to professional models of schools working collaboratively. System leadership is being championed by the Scottish College for Educational Leadership (SCEL), but is still in its infancy in…

  17. The New Product Development Improvement Motives and Practices of Miles and Snow's Prospectors, Analysers and Defenders

    DEFF Research Database (Denmark)

    Laugen, Bjørge Timenes; Boer, Harry; Acur, Nuran

    2006-01-01

    , twenty-seven analysers and seven defenders (Miles and Snow, 1978) suggests that the NPD improvement motives and practices of these three types of strategies are less different than we expected. Our explanation for this finding is that the three strategic types are growing towards each other, forced...

  18. Improving Student Achievement and Teacher Effectiveness through Scientifically Based Practices. NCREL Viewpoints, Number 11

    Science.gov (United States)

    Schuch, Linda, Ed.

    2004-01-01

    "Viewpoints" is a multimedia package containing two audio CDs and a short, informative booklet. This volume of "Viewpoints" focuses on using scientifically based practices to improve student achievement and teacher effectiveness. The audio CDs provide the voices, or viewpoints, of various leaders from the education field who have worked closely…

  19. 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.

  20. Performance measures for improving the prevention of venous thromboembolism: achievement in clinical practice.

    Science.gov (United States)

    Wilson, Kenneth C; Merli, Geno J

    2011-10-01

    Venous thromboembolism (VTE) is a common complication during and after hospitalization for acute medical illness or surgery. Despite the existence of evidence-based guidelines for VTE prevention, real-world prescribing practices are frequently suboptimal. Specific performance measures relating to VTE prevention and treatment have been developed by US health care organizations to increase adherence with best-practice recommendations and ultimately reduce the number of preventable VTE events. Two measures developed by the Surgical Care Improvement Project have been endorsed by the National Quality Forum (NQF) and focus on VTE prevention. In addition, six measures have been developed recently by The Joint Commission in collaboration with the NQF; three measures relate to VTE prevention and three focus on treatment. To attain widespread achievement of these performance goals, it is essential to raise awareness of their existence and specifications. It is also imperative that hospitals develop and implement effective VTE protocols. The use of multiple, active strategies, such as computer decision support systems with regular audit and feedback, may be particularly valuable approaches to improve current practices within an integrated quality improvement program. During practical implementation of VTE protocols at Norton Healthcare (Kentucky's largest healthcare system), strong leadership, physician engagement, and caregiver accountability were identified as key factors influencing the process. As such, more hospitals may be able to increase adherence with guidelines, improve achievement of quality goals, and help to reduce the substantial burden associated with avoidable VTE.

  1. Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion.

    Science.gov (United States)

    Stanek, Justin; Sullivan, Taylor; Davis, Samantha

    2018-02-01

      Restricted dorsiflexion (DF) at the ankle joint can cause acute and chronic injuries at the ankle and knee. Myofascial release and instrument-assisted soft tissue mobilization (IASTM) techniques have been used to increase range of motion (ROM); however, evidence directly comparing their effectiveness is limited.   To compare the effects of a single session of compressive myofascial release (CMR) or IASTM using the Graston Technique (GT) on closed chain ankle-DF ROM.   Randomized controlled trial.   Laboratory.   Participants were 44 physically active people (53 limbs) with less than 30° of DF.   Limbs were randomly assigned to 1 of 3 groups: control, CMR, or GT. Both treatment groups received one 5-minute treatment that included scanning the area and treating specific restrictions. The control group sat for 5 minutes before measurements were retaken.   Standing and kneeling ankle DF were measured before and immediately after treatment. Change scores were calculated for both positions, and two 1-way analyses of variance were conducted.   A difference between groups was found in the standing ( F 2,52 = 13.78, P = .001) and kneeling ( F 2,52 = 5.85, P = .01) positions. Post hoc testing showed DF improvements in the standing position after CMR compared with the GT and control groups (both P = .001). In the kneeling position, DF improved after CMR compared with the control group ( P = .005).   Compressive myofascial release increased ankle DF after a single treatment in participants with DF ROM deficits. Clinicians should consider adding CMR as a treatment intervention for patients with DF deficits.

  2. 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 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.

  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. Highly Adoptable Improvement: A Practical Model and Toolkit to Address Adoptability and Sustainability of Quality Improvement Initiatives.

    Science.gov (United States)

    Hayes, Christopher William; Goldmann, Don

    2018-03-01

    Failure to consider the impact of change on health care providers is a barrier to success. Initiatives that increase workload and have low perceived value are less likely to be adopted. A practical model and supporting tools were developed on the basis of existing theories to help quality improvement (QI) programs design more adoptable approaches. Models and theories from the diffusion of innovation and work stress literature were reviewed, and key-informant interviews and site visits were conducted to develop a draft Highly Adoptable Improvement (HAI) Model. A list of candidate factors considered for inclusion in the draft model was presented to an expert panel. A modified Delphi process was used to narrow the list of factors into main themes and refine the model. The resulting model and supporting tools were pilot tested by 16 improvement advisors for face validity and usability. The HAI Model depicts how workload and perceived value influence adoptability of QI initiatives. The supporting tools include an assessment guide and suggested actions that QI programs can use to help design interventions that are likely to be adopted. Improvement advisors reported good face validity and usability and found that the model and the supporting tools helped address key issues related to adoption and reported that they would continue to use them. The HAI Model addresses important issues regarding workload and perceived value of improvement initiatives. Pilot testing suggests that the model and supporting tools are helpful and practical in guiding design and implementation of adoptable and sustainable QI interventions. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  5. 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.

  6. 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.

  7. Improving the implementation of responsible alcohol management practices by community sporting clubs: A randomised controlled trial.

    Science.gov (United States)

    Kingsland, Melanie; Wolfenden, Luke; Tindall, Jennifer; Rowland, Bosco; Sidey, Maree; McElduff, Patrick; Wiggers, John H

    2015-07-01

    Despite an increased prevalence of risky alcohol consumption and alcohol-related harm among members of sporting groups and at sporting venues, sporting clubs frequently fail to implement alcohol management practices consistent with liquor legislation and best practice guidelines. The aim of this study was to assess the impact of a multi-strategy intervention in improving the implementation of responsible alcohol management practices by sports clubs. A randomised controlled trial was conducted with 87 football clubs, with half randomised to receive a multi-strategy intervention to support clubs to implement responsible alcohol management practices. The 2-year intervention, which was based on implementation and capacity building theory and frameworks, included project officer support, funding, accreditation rewards, printed resources, observational audit feedback, newsletters, training and support from state sporting organisations. Interviews were undertaken with club presidents at baseline and post-intervention to assess alcohol management practice implementation. Post-intervention, 88% of intervention clubs reported implementing '13 or more' of 16 responsible alcohol management practices, which was significantly greater than the proportion of control groups reporting this level of implementation (65%) [odds ratio: 3.7 (95% confidence interval: 1.1-13.2); P = 0.04]. All intervention components were considered highly useful and three-quarters or more of clubs rated the amount of implementation support to be sufficient. The multi-strategy intervention was successful in improving alcohol management practices in community sports clubs. Further research is required to better understand implementation barriers and to assess the long-term sustainability of the change in club alcohol management practices. © 2015 Australasian Professional Society on Alcohol and other Drugs.

  8. Thermal conductivity of a wide range of alternative refrigerants measured with an improved guarded hot-plate apparatus

    International Nuclear Information System (INIS)

    Hammerschmidt, U.

    1995-01-01

    The thermal conductivity of the refrigerants R22, R123, R134a, R142b, R143a, and R152a has been determined as a function of temperature in the range from 300 to 460 K. Measurements were carried out at atmospheric pressure with an improved guarded hot-plate apparatus. The width of the instrument's gas layer and the temperature difference across the metering section were varied to detect any stray heat transfer. Radiation correction factors were derived from IR absorption spectra. The uncertainty of the measurements is estimated to be 2% at a standard deviation of less than 0.1%. Our data sets are compared with corresponding hot wire results. In contrast to the generally preferred hot wire technique, with its possible electrical and chemical interactions between the wire and the polar refrigerant, there are no such difficulties using a guarded hot-plate apparatus. Our data sets may thus contribute to the discussions on discrepancies in thermal conductivity values from various authors using hot wire as one particular method

  9. 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.

  10. 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...

  11. Managing railcar maintenance : a primer on practices and improvement opportunities for the U.S. transit industry.

    Science.gov (United States)

    2013-09-01

    This report surveys the state-of-practice of transit railcar maintenance management and fleet management practices. It emphasizes a lifecycle management approach to fleet management. It also emphasizes the role of performance improvement programs and...

  12. 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; Pfood and the necessity of thorough cooking were significantly increased after the intervention (88% from 64% and 34% from 21%, respectively). Mean scores of knowledge and practice on food safety were significantly increased by 1.9 and 1.6, respectively after the one month intervention. Thus this food safety education in rural communities should be scaled up and, indeed, strengthened using the courtyard counselling meetings in Bangladesh.

  13. 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.

  14. Surface-water hydrology of the Little Black River basin, Missouri and Arkansas, before water-land improvement practices

    Science.gov (United States)

    Berkas, W.R.; Femmer, Suzanne R.; Mesko, T.O.; Thompson, B.W.

    1987-01-01

    The U. S. Department of Agriculture, Soil Conservation Service, in accordance with Public Law 566, is implementing various types of water-land improvement practices in the Little Black River basin in southeastern Missouri. These practices are designed, in part, to decrease the suspended sediment (SS) transport in the basin, decrease flood damage in the basin, and improve drainage in the agricultural area. The general features of the basin, such as geology, groundwater hydrology, soils, land use, water use, and precipitation are described; surface water quantity, quality, and suspended sediment discharge are also described. The aquifers are the Mississippi River valley alluvial aquifer, which can yield about 3,500 gal/min to properly constructed wells, and the Ozark and St. Francois aquifers, which can yield from about 30 to 500 gal/min to properly constructed wells. Soils in the area have formed in loess and cherty residuum in the uplands or have formed in alluvial sediment in the lowlands. About 93% of the estimated 3 billion gal/year of water used in the basin is for crop irrigation. The average monthly precipitation varies slightly throughout the year, with an average annual precipitation of about 47 inches. Water quality data were collected at seven stations. Specific conductance values ranged from 50 to 400 microsiemens/cm at 25 C. Water temperatures ranged from 0.0 C in the winter to 33.5 C in summer. pH values ranged from 6.4 to 8.5 units. Dissolved oxygen concentrations ranged from 2.2 to 12.8 ml/l. Total nitrogen concentrations ranged from 0.13 to 2.20 ml/l as nitrogen, with organic nitrogen as the most abundant form. Phosphorus concentrations ranged from zero to 0.29 ml/l as phosphorus. Bacterial counts were largest during storm runoff in the basin with livestock waste as the significant contributor. For the period from October 1, 1980, to September 30, 1984, the average annual SS discharge ranged from 2,230 tons/yr in the headwater areas to 27,800 tons

  15. 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.

  16. 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.

  17. 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

  18. 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.

  19. 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.

  20. 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

  1. Mass-density compensation can improve the performance of a range of different detectors under non-equilibrium conditions

    International Nuclear Information System (INIS)

    Underwood, T S A; Hill, M A; Winter, H C; Fenwick, J D

    2013-01-01

    Dosimeters often consist of several components whose mass densities differ substantially from water. These components cause small-field correction factors to vary significantly as lateral electronic equilibrium breaks down. Even amongst instruments designed for small-field dosimetry, inter-detector variation in the correction factors associated with very small (∼0.5 cm) fields can amount to tens of per cent. For a given dosimeter, small-field correction factors vary not only with field size but also with detector azimuthal angle and position within the field. Furthermore the accurate determination of these factors typically requires time-intensive Monte Carlo simulations. Thus, if achievable, ‘correction factor free’ small-field dosimetry would be highly desirable. This study demonstrates that a new generation of mass-density compensated detectors could take us towards this goal. Using a 6 MV beam model, it shows that ‘mass-density compensation’ can be utilized to improve the performance of a range of different detectors under small-field conditions. Non-sensitive material of appropriate mass-density is incorporated into detector designs in order to make the instruments behave as if consisting only of water. The dosimeter perturbative effects are then reduced to those associated with volume averaging. An even better solution—which modifies detectors to obtain profiles that look like those measured by a point-like water structure—is also considered. Provided that adequate sensitivity can be achieved for a small measurement volume, this study shows that it may be possible to use mass-density compensation (and Monte Carlo-driven design) to produce a solid-state dosimeter/ionization chamber with a near-perfect non-equilibrium response. (paper)

  2. [Use of PubMed to improve evidence-based medicine in routine urological practice].

    Science.gov (United States)

    Rink, M; Kluth, L A; Shariat, S F; Chun, F K; Fisch, M; Dahm, P

    2013-03-01

    Applying evidence-based medicine in daily clinical practice is the basis of patient-centered medicine and knowledge of accurate literature acquisition skills is necessary for informed clinical decision-making. PubMed is an easy accessible, free bibliographic database comprising over 21 million citations from the medical field, life-science journals and online books. The article summarizes the effective use of PubMed in routine urological clinical practice based on a common case scenario. This article explains the simple use of PubMed to obtain the best search results with the highest evidence. Accurate knowledge about the use of PubMed in routine clinical practice can improve evidence-based medicine and also patient treatment.

  3. Readability of Patient Education Materials in Hand Surgery and Health Literacy Best Practices for Improvement.

    Science.gov (United States)

    Hadden, Kristie; Prince, Latrina Y; Schnaekel, Asa; Couch, Cory G; Stephenson, John M; Wyrick, Theresa O

    2016-08-01

    This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement. A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources. The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices. Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons. Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Determination of significance in Ecological Impact Assessment: Past change, current practice and future improvements

    Energy Technology Data Exchange (ETDEWEB)

    Briggs, Sam; Hudson, Malcolm D., E-mail: mdh@soton.ac.uk

    2013-01-15

    Ecological Impact Assessment (EcIA) is an important tool for conservation and achieving sustainable development. 'Significant' impacts are those which disturb or alter the environment to a measurable degree. Significance is a crucial part of EcIA, our understanding of the concept in practice is vital if it is to be effective as a tool. This study employed three methods to assess how the determination of significance has changed through time, what current practice is, and what would lead to future improvements. Three data streams were collected: interviews with expert stakeholders, a review of 30 Environmental Statements and a broad-scale survey of the United Kingdom Institute of Ecology and Environmental Management (IEEM) members. The approach taken in the determination of significance has become more standardised and subjectivity has become constrained through a transparent framework. This has largely been driven by a set of guidelines produced by IEEM in 2006. The significance of impacts is now more clearly justified and the accuracy with which it is determined has improved. However, there are limitations to accuracy and effectiveness of the determination of significance. These are the quality of baseline survey data, our scientific understanding of ecological processes and the lack of monitoring and feedback of results. These in turn are restricted by the limited resources available in consultancies. The most notable recommendations for future practice are the implementation of monitoring and the publication of feedback, the creation of a central database for baseline survey data and the streamlining of guidance. - Highlights: Black-Right-Pointing-Pointer The assessment of significance has changed markedly through time. Black-Right-Pointing-Pointer The IEEM guidelines have driven a standardisation of practice. Black-Right-Pointing-Pointer Currently limited by quality of baseline data and scientific understanding. Black-Right-Pointing-Pointer Monitoring

  5. 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

  6. 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

  7. Advanced Practice Nursing Committee on Process Improvement in Trauma: An Innovative Application of the Strong Model.

    Science.gov (United States)

    West, Sarah Katherine

    2016-01-01

    This article aims to summarize the successes and future implications for a nurse practitioner-driven committee on process improvement in trauma. The trauma nurse practitioner is uniquely positioned to recognize the need for clinical process improvement and enact change within the clinical setting. Application of the Strong Model of Advanced Practice proves to actively engage the trauma nurse practitioner in process improvement initiatives. Through enhancing nurse practitioner professional engagement, the committee aims to improve health care delivery to the traumatically injured patient. A retrospective review of the committee's first year reveals trauma nurse practitioner success in the domains of direct comprehensive care, support of systems, education, and leadership. The need for increased trauma nurse practitioner involvement has been identified for the domains of research and publication.

  8. 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.

  9. DOE program for improvement practices for shallow burial of radioactive waste

    International Nuclear Information System (INIS)

    Dieckhoner, J.E.

    1978-01-01

    The practice of burying solid radioactive waste in relatively shallow pits or trenches at government nuclear sites dates back to the Manhattan Project. In some cases, where local conditions were considered unfavorable, intersite shipment of waste has been required. This general concept was later used at commercially-operated sites under Federal or state regulation. The purpose, scope, and results of a DOE program begun several years ago for improvements of burial ground disposal methods are reviewed. The program includes the re-evaluation of the original siting and of operating practices at existing burial grounds (including monitoring for migration of activity); the development of improved criteria for siting of new grounds that might be required as the defense site operations continue; and development of corrective measures such as diking and better draining for possible unsatisfactory conditions that might be detected. The possible applications of these findings to commercial burial grounds is discussed

  10. Launching a Laboratory Testing Process Quality Improvement Toolkit: From the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP).

    Science.gov (United States)

    Fernald, Douglas; Hamer, Mika; James, Kathy; Tutt, Brandon; West, David

    2015-01-01

    Family medicine and internal medicine physicians order diagnostic laboratory tests for nearly one-third of patient encounters in an average week, yet among medical errors in primary care, an estimated 15% to 54% are attributed to laboratory testing processes. From a practice improvement perspective, we (1) describe the need for laboratory testing process quality improvements from the perspective of primary care practices, and (2) describe the approaches and resources needed to implement laboratory testing process quality improvements in practice. We applied practice observations, process mapping, and interviews with primary care practices in the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)-affiliated practice-based research networks that field-tested in 2013 a laboratory testing process improvement toolkit. From the data collected in each of the 22 participating practices, common testing quality issues included, but were not limited to, 3 main testing process steps: laboratory test preparation, test tracking, and patient notification. Three overarching qualitative themes emerged: practices readily acknowledge multiple laboratory testing process problems; practices know that they need help addressing the issues; and practices face challenges with finding patient-centered solutions compatible with practice priorities and available resources. While practices were able to get started with guidance and a toolkit to improve laboratory testing processes, most did not seem able to achieve their quality improvement aims unassisted. Providing specific guidance tools with practice facilitation or other rapid-cycle quality improvement support may be an effective approach to improve common laboratory testing issues in primary care. © Copyright 2015 by the American Board of Family Medicine.

  11. Lay health educators within primary care practices to improve cancer screening uptake for South Asian patients: challenges in quality improvement

    Directory of Open Access Journals (Sweden)

    Lofters AK

    2017-03-01

    Full Text Available AK Lofters,1–4 M Vahabi,5 V Prakash,6 L Banerjee,7 P Bansal,8 S Goel,7,8 S Dunn1,2,9 1Department of Family and Community Medicine, 2Dalla Lana School of Public Health, University of Toronto, 3Department of Family and Community Medicine, 4Centre for Urban Health Solutions, St Michael’s Hospital, 5Daphne Cockwell School of Nursing, Ryerson University, Toronto, 6Screening Saves Lives Program, Canadian Cancer Society, Mississauga, 7Wise Elephant Family Health Team, Brampton, 8Mississauga Halton Central West Regional Cancer Program, Mississauga, 9Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada Background: Cancer screening uptake is known to be low among South Asian residents of Ontario. The objective of this pilot study was to determine if lay health educators embedded within the practices of primary care providers could improve willingness to screen and cancer screening uptake for South Asian patients taking a quality improvement approach.Materials and methods: Participating physicians selected quality improvement initiatives to use within their offices that they felt could increase willingness to screen and cancer screening uptake. They implemented initiatives, adapting as necessary, for six months.Results: Four primary care physicians participated in the study. All approximated that at least 60% of their patients were of South Asian ethnicity. All physicians chose to work with a preexisting lay health educator program geared toward South Asians. Health ambassadors spoke to patients in the office and telephoned patients. For all physicians, ~60% of South Asian patients who were overdue for cancer screening and who spoke directly to health ambassadors stated they were willing to be screened. One physician was able to track actual screening among contacted patients and found that screening uptake was relatively high: from 29.2% (colorectal cancer to 44.6% (breast cancer of patients came in for screening

  12. 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.

  13. 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.

  14. 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.

  15. Improving the Identification, Dissemination and Implementation of Deactivation and Decommissioning Lessons Learned and Best Practices

    International Nuclear Information System (INIS)

    Waisley, Sandra L.; Lackey, Michael B.; Dusek, Lansing G.

    2008-01-01

    Approximately $150 billion of work currently remains in the United States Department of Energy's (DoE's) Office of Environmental Management (EM) life cycle budget for U.S. projects. Contractors who manage facilities for the DOE have been challenged to identify transformational changes to reduce the life cycle costs and to develop a knowledge-management system that identifies, disseminates, and tracks the implementation of lessons learned and best practices. This paper discusses DoE's rationale for using lessons learned and best practices to improve safety and performance while reducing life cycle costs for Deactivation and Decommissioning (D and D) projects. It also provides an update on the Energy Facility Contractors Group's (EFCOG's) progress in supporting DoE's efforts. At this juncture the best practice efforts described are in developmental stages; however, the commitment to and the concrete nature of the work thus far is noteworthy in regard to improving the way D and D lessons learned and best practices are identified, disseminated and implemented across the DOE Complex

  16. Simulation-Based Mastery Learning with Deliberate Practice Improves Clinical Performance in Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Ankeet D. Udani

    2014-01-01

    Full Text Available Introduction. Properly performing a subarachnoid block (SAB is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents’ next three patients were evaluated in the operating room (OR. Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P<0.02. The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P<0.03. The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

  17. Simulation-based mastery learning with deliberate practice improves clinical performance in spinal anesthesia.

    Science.gov (United States)

    Udani, Ankeet D; Macario, Alex; Nandagopal, Kiruthiga; Tanaka, Maria A; Tanaka, Pedro P

    2014-01-01

    Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents' next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P < 0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P < 0.03). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

  18. The Role of Work-Life Balance Practices in Order to Improve Organizational Performance

    OpenAIRE

    IOAN LAZAR; CODRUTA OSOIAN; PATRICIA RATIU

    2010-01-01

    Well known in the literature as work life balance, the quality relationship between paid work and unpaid responsibilities is critical for success in today’s competitive business world. The issue of work-life balance has been developed in response to demographic, economic and cultural changes. The purpose of this paper is to establish whether work-life balance initiatives and practices can be considered as strategic human resource management decisions that can translate into improved individua...

  19. Incorrect results in software engineering experiments: How to improve research practices

    OpenAIRE

    Jørgensen, Magne; Dybå, Tore; Liestøl, Knut; Sjøberg, Dag

    2016-01-01

    Context The trustworthiness of research results is a growing concern in many empirical disciplines. Aim The goals of this paper are to assess how much the trustworthiness of results reported in software engineering experiments is affected by researcher and publication bias, given typical statistical power and significance levels, and to suggest improved research practices. Method First, we conducted a small-scale survey to document the presence of researcher and publication biases in software...

  20. 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.

  1. From theory to practice: improving the impact of health services research

    Directory of Open Access Journals (Sweden)

    Levine Robert

    2005-01-01

    Full Text Available Abstract Background While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers. Discussion Recognizing the importance of theory calls for new expectations in the practice of health services research. These include: the formation of interdisciplinary research teams; broadening the training for those who will practice health services research; and supportive organizational conditions that promote collaboration between researchers and decision makers. Further, funding bodies can provide a significant role in guiding and supporting the use of theory in the practice of health services research. Summary Institutions and researchers should incorporate the use of theory if health services research is to fulfill its potential for improving the delivery of health care.

  2. Primary Care Practices' Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement.

    Science.gov (United States)

    Cohen, Deborah J; Dorr, David A; Knierim, Kyle; DuBard, C Annette; Hemler, Jennifer R; Hall, Jennifer D; Marino, Miguel; Solberg, Leif I; McConnell, K John; Nichols, Len M; Nease, Donald E; Edwards, Samuel T; Wu, Winfred Y; Pham-Singer, Hang; Kho, Abel N; Phillips, Robert L; Rasmussen, Luke V; Duffy, F Daniel; Balasubramanian, Bijal A

    2018-04-01

    Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports-but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.

  3. Chiroptical methods in a wide wavelength range for obtaining Ln3+ complexes with circularly polarized luminescence of practical interest.

    Science.gov (United States)

    Górecki, Marcin; Carpita, Luca; Arrico, Lorenzo; Zinna, Francesco; Di Bari, Lorenzo

    2018-05-29

    We studied enantiopure chiral trivalent lanthanide (Ln3+ = La3+, Sm3+, Eu3+, Gd3+, Tm3+, and Yb3+) complexes with two fluorinated achiral tris(β-diketonate) ligands (HFA = hexafluoroacetylacetonate and TTA = 2-thenoyltrifluoroacetonate), incorporating a chiral bis(oxazolinyl)pyridine (PyBox) unit as a neutral ancillary ligand, by the combined use of optical and chiroptical methods, ranging from UV to IR both in absorption and circular dichroism (CD), and including circularly polarized luminescence (CPL). Ultimately, all the spectroscopic information is integrated into a total and a chiroptical super-spectrum, which allows one to characterize a multidimensional chemical space, spanned by the different Ln3+ ions, the acidity and steric demand of the diketone and the chirality of the PyBox ligand. In all cases, the Ln3+ ions endow the systems with peculiar chiroptical properties, either allied to f-f transitions or induced by the metal onto the ligand. In more detail, we found that Sm3+ complexes display interesting CPL features, which partly superimpose and partly integrate the more common Eu3+ properties. Especially, in the context of security tags, the pair Sm/Eu may be a winning choice for chiroptical barcoding.

  4. Education in Quality Improvement for Pediatric Practice: an online program to teach clinicians QI.

    Science.gov (United States)

    Bundy, David G; Morawski, Lori F; Lazorick, Suzanne; Bradbury, Scott; Kamachi, Karen; Suresh, Gautham K

    2014-01-01

    Education in Quality Improvement for Pediatric Practice (EQIPP) is an online program designed to improve evidence-based care delivery by teaching front-line clinicians quality improvement (QI) skills. Our objective was to evaluate EQIPP data to characterize 1) participant enrollment, use patterns, and demographics; 2) changes in performance in clinical QI measures from baseline to follow-up measurement; and 3) participant experience. We conducted an observational study of EQIPP participants utilizing 1 of 3 modules (asthma, immunizations, gastroesophageal reflux disease) from 2009 to 2013. Enrollment and use, demographic, and quality measure data were extracted directly from the EQIPP system; participant experience was assessed via an optional online survey. Study participants (n = 3501) were diverse in their gender, age, and race; most were board certified. Significant quality gaps were observed across many of the quality measures at baseline; sizable improvements were observed across most quality measures at follow-up. Participants were generally satisfied with their experience. The most influential module elements were collecting and analyzing data, creating and implementing aim statements and improvement plans, and completing "QI Basics." Online educational programs, such as EQIPP, hold promise for front-line clinicians to learn QI. The sustainability of the observed improvements in care processes and their linkage to improvements in health outcomes are unknown and are an essential topic for future study. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  5. 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

  6. 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

  7. Improvement of input power dynamic range for 20 Gbit/s optical WDM switch nodes using an integrated Michelson wavelength converter

    DEFF Research Database (Denmark)

    Danielsen, Søren Lykke; Hansen, Peter Bukhave; Jørgensen, Carsten

    1997-01-01

    be improved compared to switch blocks without IWCs. This is especially important at high bit rates where the cascadability of the SOA gates decreases. Here, more than 15 dB improvement of the input power dynamic range is achieved at 20 Gbit/s using a high-speed Michelson interferometer wavelength converter...

  8. 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...

  9. 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

  10. Practical Ranges of Loudness Levels of Various Types of Environmental Noise, Including Traffic Noise, Aircraft Noise, and Industrial Noise

    Directory of Open Access Journals (Sweden)

    Sabine A. Janssen

    2011-05-01

    Full Text Available In environmental noise control one commonly employs the A-weighted sound level as an approximate measure of the effect of noise on people. A measure that is more closely related to direct human perception of noise is the loudness level. At constant A-weighted sound level, the loudness level of a noise signal varies considerably with the shape of the frequency spectrum of the noise signal. In particular the bandwidth of the spectrum has a large effect on the loudness level, due to the effect of critical bands in the human hearing system. The low-frequency content of the spectrum also has an effect on the loudness level. In this note the relation between loudness level and A-weighted sound level is analyzed for various environmental noise spectra, including spectra of traffic noise, aircraft noise, and industrial noise. From loudness levels calculated for these environmental noise spectra, diagrams are constructed that show the relation between loudness level, A‑weighted sound level, and shape of the spectrum. The diagrams show that the upper limits of the loudness level for broadband environmental noise spectra are about 20 to 40 phon higher than the lower limits for narrowband spectra, which correspond to the loudness levels of pure tones. The diagrams are useful for assessing limitations and potential improvements of environmental noise control methods and policy based on A-weighted sound levels.

  11. American Board of Radiology Maintenance of Certification-Part IV: Practice Quality Improvement for Radiation Oncology

    International Nuclear Information System (INIS)

    Kun, Larry E.; Haffty, Bruce G.; Bosma, Jennifer; Strife, Janet L.; Hattery, Robert R.

    2007-01-01

    Maintenance of Certification is a physician-based response to public concerns about the quality of medical care and physician competency in a rapidly evolving, technically demanding specialty. American Board of Radiology (ABR) has previously described the first three components of the Maintenance of Certification. The ABR is currently developing a program in practice performance, completing Part IV of the competencies. The Practice Quality Improvement (PQI) program is meant to critically evaluate meaningful aspects of a physician's practice in a simple manner, using identifiable metrics and self-assessment to include an action plan for quality improvement. Each diplomate will be expected to complete three PQI projects during a full 10-year Maintenance of Certification cycle. Current diplomates with time-limited certificates will find prorated requirements determined by their year of certification on the ABR Website. Diplomates will have the option of completing zero to two Type I PQI projects (assessing factors relevant to clinical practice by peer review and self-reporting) and one to three Type II projects (i.e., at least one Type II projects of the three required, assessing parameters of practice by comparison with evidence-based guidelines, consensus statements, or peer comparisons; Type II projects are initiated and managed by professional societies). Several examples of Type I projects that might be offered by societies or directly through the ABR are provided, as well as highlights of the two Type II projects that have sought ABR qualification: American Society for Therapeutic Radiology and Oncology's Performance Assessment for the Advancement of Radiation Oncology Treatment program and American College of Radiology's RO-PEER program. An additional objective of the PQI is to develop national databases for future reference using aggregate data from the PQI projects

  12. Improved Models and Tools for Prediction of Radiation Effects on Space Electronics in Wide Temperature Range, Phase II

    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 (-180ºC to...

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

    Science.gov (United States)

    Moore, Adam; Gruber, Thomas; Derose, Jennifer; Malinowski, Peter

    2012-01-01

    Mindfulness-based meditation practices involve various attentional skills, including the ability to sustain and focus ones attention. During a simple mindful breathing practice, sustained attention is required to maintain focus on the breath while cognitive control is required to detect mind wandering. We thus hypothesized that regular, brief mindfulness training would result in improvements in the self-regulation of attention and foster changes in neuronal activity related to attentional control. A longitudinal randomized control group EEG study was conducted. At baseline (T1), 40 meditation naïve participants were randomized into a wait list group and a meditation group, who received three hours mindfulness meditation training. Twenty-eight participants remained in the final analysis. At T1, after eight weeks (T2) and after 16 weeks (T3), all participants performed a computerized Stroop task (a measure of attentional control) while the 64-channel EEG was recorded. Between T1 and T3 the meditators were requested to meditate daily for 10 min. Event-related potential (ERP) analysis highlighted two between group effects that developed over the course of the 16-week mindfulness training. An early effect at left and right posterior sites 160–240 ms post-stimulus indicated that meditation practice improved the focusing of attentional resources. A second effect at central posterior sites 310–380 ms post-stimulus reflects that meditation practice reduced the recruitment of resources during object recognition processes, especially for incongruent stimuli. Scalp topographies and source analyses (Variable Resolution Electromagnetic Tomography, VARETA) indicate relevant changes in neural sources, pertaining to left medial and lateral occipitotemporal areas for the early effect and right lateral occipitotemporal and inferior temporal areas for the later effect. The results suggest that mindfulness meditation may alter the efficiency of allocating cognitive resources

  14. 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

  15. 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)

    Ruhnke, Isabelle; de Koning, Carolyn; Drake, Kelly; Skerman, Alan G.; Hinch, Geoff N.; Glatz, Philip C.

    2017-01-01

    Baseline information on demographics and practices on semi-intensive free-range egg farms with an outdoor stocking density of ≤1500 hens/hectare in Australia is presented. Free-range egg production is changing the structure of the egg industry in Australia and a broad variety and tiers of free-range systems have emerged due to lack of concrete legislative standards on outdoor stocking densities in the past. Information was extracted from a pre-existing online free-range poultry survey dataset, consisting of a total of 79 questions related to nutrition, pasture management, welfare and health, animal housing, environmental impact and economics. Forty-one free-range egg farms, with an outdoor stocking density of ≤1500 hens/hectare, were identified in the dataset from all major Australian states. Two types of semi-intensive free-range housing systems were documented: mobile (modified caravan/trailer) housing (56%), and fixed sheds (44%). Seventy-two percent of respondents reported >75% of the hens in the flock used the outdoor range. All respondents reported ingestion of range components by hens in the form of vegetation, insects, stones and grit. Up to 10% mortality was reported by 40% respondents with predation (34%), cannibalism (29%), heat stress (24%) and grass impaction (19.5%) as major causes. Biosecurity on farms was sub-optimal with 8 of the 10 actions implemented by farms. Applied research and communication of results to farmers is highly recommended to ensure optimum health and welfare of free-range laying hens and sustained egg production. PMID:29065169

  16. Group discussions with the health care team--a method of improving care of hypertension in general practice.

    Science.gov (United States)

    Adorian, D; Silverberg, D S; Tomer, D; Wamosher, Z

    1990-06-01

    A management-by-objective approach was used by the health care administration of the Kupat Holim Sick Fund to improve care of hypertension in 20 family practices in the city of Ashdod in central Israel. The doctor-nurse teams in these clinics met jointly on a regular basis with a physician-instructor, reviewed the results of their care of hypertension and discussed ways of improving it. Over a seven-year period, until 1988, the percentage of the population treated increased from 4.0% to 9.2% and percentage of treated patients who had diastolic pressure of 100 mmHg or more fell from 29.6% to 13.4%. Dropout rate ranged from 2.3% to 3.1% per year over the whole period. In 20 other practices in the Ashdod area in 1988 used for comparison, only 5.9% of the population was treated and the per cent treated was less than Ashdod for all age groups above 30. Dropout rate was higher, averaging 9.8% per year, and the percentage of patients with diastolic pressures of 100 mmHg or more was higher (18.1%). Thus the use of regular discussions with feedback to the health care team was associated with better detection, treatment and follow-up of hypertension.

  17. 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.

  18. 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.

  19. Role of Social Support in Improving Infant Feeding Practices in Western Kenya: A Quasi-Experimental Study.

    Science.gov (United States)

    Mukuria, Altrena G; Martin, Stephanie L; Egondi, Thaddeus; Bingham, Allison; Thuita, Faith M

    2016-03-01

    We designed and tested an intervention that used dialogue-based groups to engage infants' fathers and grandmothers to support optimal infant feeding practices. The study's aim was to test the effectiveness of increased social support by key household influencers on improving mothers' complementary feeding practices. Using a quasi-experimental design, we enrolled mothers, fathers, and grandmothers from households with infants 6-9 months old in 3 rural communities (1 intervention arm with fathers, 1 intervention arm with grandmothers, and 1 comparison arm) in western Kenya. We engaged 79 grandmothers and 85 fathers in separate dialogue groups for 6 months from January to July 2012. They received information on health and nutrition and were encouraged to provide social support to mothers (defined as specific physical actions in the past 2 weeks or material support actions in the past month). We conducted a baseline household survey in December 2011 in the 3 communities and returned to the same households in July 2012 for an endline survey. We used a difference-in-difference (DiD) approach and logistic regression to evaluate the intervention. We surveyed 554 people at baseline (258 mothers, 165 grandmothers, and 131 fathers) and 509 participants at endline. The percentage of mothers who reported receiving 5 or more social support actions (of a possible 12) ranged from 58% to 66% at baseline in the 3 groups. By endline, the percentage had increased by 25.8 percentage points (P=.002) and 32.7 percentage points (P=.001) more in the father and the grandmother intervention group, respectively, than in the comparison group. As the number of social support actions increased in the 3 groups, the likelihood of a mother reporting that she had fed her infant the minimum number of meals in the past 24 hours also increased between baseline and endline (odds ratio [OR], 1.14; confidence interval [CI], 1.00 to 1.30; P=.047). When taking into account the interaction effects of

  20. 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.

  1. Applying industrial process improvement techniques to increase efficiency in a surgical practice.

    Science.gov (United States)

    Reznick, David; Niazov, Lora; Holizna, Eric; Siperstein, Allan

    2014-10-01

    The goal of this study was to examine how industrial process improvement techniques could help streamline the preoperative workup. Lean process improvement was used to streamline patient workup at an endocrine surgery service at a tertiary medical center utilizing multidisciplinary collaboration. The program consisted of several major changes in how patients are processed in the department. The goal was to shorten the wait time between initial call and consult visit and between consult and surgery. We enrolled 1,438 patients enrolled in the program. The wait time from the initial call until consult was reduced from 18.3 ± 0.7 to 15.4 ± 0.9 days. Wait time from consult until operation was reduced from 39.9 ± 1.5 to 33.9 ± 1.3 days for the overall practice and to 15.0 ± 4.8 days for low-risk patients. Patient cancellations were reduced from 27.9 ± 2.4% to 17.3 ± 2.5%. Overall patient flow increased from 30.9 ± 5.1 to 52.4 ± 5.8 consults per month (all P process improvement methodology, surgery patients can benefit from an improved, streamlined process with significant reduction in wait time from call to initial consult and initial consult to surgery, with reduced cancellations. This generalized process has resulted in increased practice throughput and efficiency and is applicable to any surgery practice. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. 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.

  3. 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.

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

    International Nuclear Information System (INIS)

    Rosa, Josianne Claudia Sales; Sánchez, Luis E.

    2015-01-01

    Considering ecosystem services (ES) could foster innovation and improve environmental and social impact assessment (ESIA) practice, but is the potential being fulfilled? In order to investigate how ES have been treated in recent international practice, three questions are asked: (i) were the tasks of an ES analysis carried out? (ii) how is such analysis integrated with other analysis presented in the ESIA? (iii) does ES analysis result in additional or improved mitigation or enhancement measures? These research questions were unfolded into 15 auxiliary questions for reviewing five ESIA reports prepared for mining, hydroelectric and transportation infrastructure projects in Africa, Asia and South America. All cases incorporated ES into ESIA to meet a requirement of the International Finance Corporation's Performance Standards on Environmental and Social Sustainability. It was found that: (i) in only three cases most tasks recommended by current guidance were adopted (ii) all reports feature a dedicated ES chapter or section, but in three of them no evidence was found that the ES analysis was integrated within impact assessment (iii) in the two ESIAs that followed guidance, ES analysis resulted in specific mitigation measures. Few evidence was found that the ES concept is improving current ESIA practice. Key challenges are: (i) integrating ES analysis in such a way that it does not duplicate other analysis; (ii) adequately characterizing the beneficiaries of ES; and (iii) quantifying ES supply for impact prediction. - Highlights: • Incorporating ecosystem services analysis in impact assessment can improve results. • Additional impacts and mitigation were identified. • Challenges include developing appropriate indicators for impact prediction. • A key challenge is integrating the concept in such a way that it does not duplicate other analysis

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

    International Nuclear Information System (INIS)

    Syan, C S; Ramoutar, K

    2014-01-01

    There is a constant search for ways to achieve a competitive advantage through new manufacturing techniques. Best performing manufacturing companies tend to use world-class manufacturing (WCM) practices. Although the last few years have witnessed phenomenal growth in the use of WCM techniques, their effectiveness is not well understood specifically in the context of less developed countries. This paper presents an empirical study to investigate the impact of company size on improving manufacturing performance in manufacturing organizations based in Trinidad and Tobago (T and T). Empirical data were collected via a questionnaire survey which was send to 218 manufacturing firms in T and T. Five different company sizes and seven different industry sectors were studied. The analysis of survey data was performed with the aid of Statistical Package for Social Sciences (SPSS) software. The study signified facilitating and impeding factors towards improving manufacturing performance. Their relative impact/importance is dependent on varying company size and industry sectors. Findings indicate that T and T manufacturers are still practicing traditional approaches, when compared with world class manufacturers. In the majority of organizations, these practices were not 100% implemented even though they started the implementation process more than 5 years ago. The findings provided some insights in formulating more optimal operational strategies, and later develop action plans towards more effective implementation of WCM in T and T manufacturers

  6. 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.

  7. A Standardized Shift Handover Protocol: Improving Nurses’ Safe Practice in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Javad Malekzadeh

    2013-08-01

    Full Text Available Introduction: For maintaining the continuity of care and improving the quality of care, effective inter-shift information communication is necessary. Any handover error can endanger patient safety. Despite the importance of shift handover, there is no standard handover protocol in our healthcare settings. Methods In this one-group pretest-posttest quasi-experimental study conducted in spring and summer of 2011, we recruited a convenience sample of 56 ICU nurses. The Nurses’ Safe Practice Evaluation Checklist was used for data collection. The Content Validity Index and the inter-rater correlation coefficient of the checklist was 0.92 and 89, respectively. We employed the SPSS 11.5 software and the Mc Nemar and paired-samples t test for data analysis. Results: Study findings revealed that nurses’ mean score on the Safe Practice Evaluation Checklist increased significantly from 11.6 (2.7 to 17.0 (1.8 (P < 0.001. Conclusion: using a standard handover protocol for communicating patient’s needs and information improves nurses’ safe practice in the area of basic nursing care.

  8. Soil Bacterial and Fungal Community Structure Across a Range of Unimproved and Semi-Improved Upland Grasslands

    OpenAIRE

    Kennedy, Nabla; Edwards, Suzanne; Clipson, Nicholas

    2005-01-01

    Changes in soil microbial community structure due to improvement are often attributed to concurrent shifts in floristic community composition. The bacterial and fungal communities of unimproved and semi-improved (as determined by floristic classification) grassland soils were studied at five upland sites on similar geological substrata using both broad-scale (microbial activity and fungal biomass) and molecular [terminal restriction fragment length polymorphism (TRFLP)...

  9. Effects of a strategy to improve offender assessment practices: Staff perceptions of implementation outcomes.

    Science.gov (United States)

    Welsh, Wayne N; Lin, Hsiu-Ju; Peters, Roger H; Stahler, Gerald J; Lehman, Wayne E K; Stein, Lynda A R; Monico, Laura; Eggers, Michele; Abdel-Salam, Sami; Pierce, Joshua C; Hunt, Elizabeth; Gallagher, Colleen; Frisman, Linda K

    2015-07-01

    This implementation study examined the impact of an organizational process improvement intervention (OPII) on a continuum of evidence based practices related to assessment and community reentry of drug-involved offenders: Measurement/Instrumentation, Case Plan Integration, Conveyance/Utility, and Service Activation/Delivery. To assess implementation outcomes (staff perceptions of evidence-based assessment practices), a survey was administered to correctional and treatment staff (n=1509) at 21 sites randomly assigned to an Early- or Delayed-Start condition. Hierarchical linear models with repeated measures were used to examine changes in evidence-based assessment practices over time, and organizational characteristics were examined as covariates to control for differences across the 21 research sites. Results demonstrated significant intervention and sustainability effects for three of the four assessment domains examined, although stronger effects were obtained for intra- than inter-agency outcomes. No significant effects were found for Conveyance/Utility. Implementation interventions such as the OPII represent an important tool to enhance the use of evidence-based assessment practices in large and diverse correctional systems. Intra-agency assessment activities that were more directly under the control of correctional agencies were implemented most effectively. Activities in domains that required cross-systems collaboration were not as successfully implemented, although longer follow-up periods might afford detection of stronger effects. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

    Science.gov (United States)

    Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L

    2018-03-31

    To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.

  11. Improvement in Cuba of the regulatory mark in the industrial X-ray practice

    International Nuclear Information System (INIS)

    Lopez Forteza; Yamil; Quevedo Garcia, Jose R.; Jerez Vegueria, Pablo F.; Dumenigo Gonzalez, Cruz; De la Fuente Puch, Andres; Diaz Guerra, Pedro

    2003-01-01

    The Cuban regulatory mark as regards nuclear and radiological security until the year 2002 had not had a Guide of Security linked to the practice of Industrial X-ray. The improvement of the national regulatory mark, by the light of the international recommendations and the national experience of the inspection and licensing regulatory activity of this practice took to necessity of the existence of a Guide of Security that allowed in an effective way to make complete the established approaches of security in the Basic Norms of Security (NBS), during the operation of the teams of Industrial X-ray. The present work exposes and they expose the main aspects that are included in this document that they constitute from an or another way precision to that settled down in the NBS

  12. 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.

  13. 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...

  14. 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

    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...

  15. Wrong, but useful: regional species distribution models may not be improved by range-wide data under biased sampling.

    Science.gov (United States)

    El-Gabbas, Ahmed; Dormann, Carsten F

    2018-02-01

    Species distribution modeling (SDM) is an essential method in ecology and conservation. SDMs are often calibrated within one country's borders, typically along a limited environmental gradient with biased and incomplete data, making the quality of these models questionable. In this study, we evaluated how adequate are national presence-only data for calibrating regional SDMs. We trained SDMs for Egyptian bat species at two different scales: only within Egypt and at a species-specific global extent. We used two modeling algorithms: Maxent and elastic net, both under the point-process modeling framework. For each modeling algorithm, we measured the congruence of the predictions of global and regional models for Egypt, assuming that the lower the congruence, the lower the appropriateness of the Egyptian dataset to describe the species' niche. We inspected the effect of incorporating predictions from global models as additional predictor ("prior") to regional models, and quantified the improvement in terms of AUC and the congruence between regional models run with and without priors. Moreover, we analyzed predictive performance improvements after correction for sampling bias at both scales. On average, predictions from global and regional models in Egypt only weakly concur. Collectively, the use of priors did not lead to much improvement: similar AUC and high congruence between regional models calibrated with and without priors. Correction for sampling bias led to higher model performance, whatever prior used, making the use of priors less pronounced. Under biased and incomplete sampling, the use of global bats data did not improve regional model performance. Without enough bias-free regional data, we cannot objectively identify the actual improvement of regional models after incorporating information from the global niche. However, we still believe in great potential for global model predictions to guide future surveys and improve regional sampling in data

  16. 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 implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.

  17. Improving the Accuracy of NMR Structures of Large Proteins Using Pseudocontact Shifts as Long-Range Restraints

    Energy Technology Data Exchange (ETDEWEB)

    Gaponenko, Vadim [National Cancer Institute, Structural Biophysics Laboratory (United States); Sarma, Siddhartha P. [Indian Institute of Science, Molecular Biophysics Unit (India); Altieri, Amanda S. [National Cancer Institute, Structural Biophysics Laboratory (United States); Horita, David A. [Wake Forest University School of Medicine, Department of Biochemistry (United States); Li, Jess; Byrd, R. Andrew [National Cancer Institute, Structural Biophysics Laboratory (United States)], E-mail: rabyrd@ncifcrf.gov

    2004-03-15

    We demonstrate improved accuracy in protein structure determination for large ({>=}30 kDa), deuterated proteins (e.g. STAT4{sub NT}) via the combination of pseudocontact shifts for amide and methyl protons with the available NOEs in methyl-protonated proteins. The improved accuracy is cross validated by Q-factors determined from residual dipolar couplings measured as a result of magnetic susceptibility alignment. The paramagnet is introduced via binding to thiol-reactive EDTA, and multiple sites can be serially engineered to obtain data from alternative orientations of the paramagnetic anisotropic susceptibility tensor. The technique is advantageous for systems where the target protein has strong interactions with known alignment media.

  18. 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.

  19. 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

  20. Therapy by electromagnetic wave of millimeter energy range (EFH-therapy, MRT, IWT). Scientific and practical materials on the use of physical factors in clinical and health resort practice

    International Nuclear Information System (INIS)

    Samosyuk, I.Z.; Fisenko, L.I.; Kolesnik, K.Eh.; Chukhraev, N.V.; Shimkov, G.E.

    1998-01-01

    Problems of extremely high frequency (EHF) therapy, microwave resonance therapy (MRT) and information-wave therapy (IWT) are considered. Possibilities of electromagnetic waves in millimeter energy range use in clinical and health resort practice are systematized. Recommendations on their use in treatment of different diseases are given. The main principles of selection of zones for meridian correction with the help of electromagnetic waves in millimeter energy range are exposed. The results of EFH-therapy clinical use indicate the possibility of its application practically in all cases, since positive results were obtained in most cases. The recommendations are prepared with account of possibilities and parameters of the apparatus ''MIT-1'' for reflexotherapy which was designed and produced by the Medical Innovative Centre in Kiev

  1. Constraining the range of Yukawa gravity interaction from S2 star orbits III: improvement expectations for graviton mass bounds

    Science.gov (United States)

    Zakharov, A. F.; Jovanović, P.; Borka, D.; Borka Jovanović, V.

    2018-04-01

    Recently, the LIGO-Virgo collaboration discovered gravitational waves and in their first publication on the subject the authors also presented a graviton mass constraint as mg advance for general relativity and Yukawa potential are different functions on eccentricity and semimajor axis, it gives an opportunity to improve current estimates of graviton mass with future observational facilities. In our considerations of an improvement potential for a graviton mass estimate we adopt a conservative strategy and assume that trajectories of bright stars and their apocenter advance will be described with general relativity expressions and it gives opportunities to improve graviton mass constraints. In contrast with our previous studies, where we present current constraints on parameters of Yukawa gravity [5] and graviton mass [6] from observations of S2 star, in the paper we express expectations to improve current constraints for graviton mass, assuming the GR predictions about apocenter shifts will be confirmed with future observations. We concluded that if future observations of bright star orbits during around fifty years will confirm GR predictions about apocenter shifts of bright star orbits it give an opportunity to constrain a graviton mass at a level around 5 × 10‑23 eV or slightly better than current estimates obtained with LIGO observations.

  2. Improving the scanning speed of atomic force microscopy at the scanning range of several tens of micrometers

    International Nuclear Information System (INIS)

    Wang, Yanyan; Hu, Xiaodong; Xu, Linyan; Hu, Xiaotang

    2013-01-01

    The atomic force microscope (AFM) is a powerful instrument which can measure the surface of samples at the nanoscale. The resonance of the scanner in xy directions, and the feedback control in the z direction are two major sources of image distortion at high scan speed. In order to improve the scanning speed of the AFM, a low-cost and easy method, which includes sinusoidal scans in the fast scan direction, and an intelligent fuzzy controller in the z direction, is proposed in this paper. The use of a single-frequency driving signal in the fast scan direction allows the scanner to move at a higher speed without exciting its mechanical resonance. The intelligent fuzzy controller automatically selects appropriate PI parameters through the analysis of the tracking errors, thus improving the dynamic tracking performance of the z scanner. The development and functioning of the sinusoidal fast scans and the intelligent fuzzy controller are demonstrated, as well as how this approach significantly achieves faster scans and a higher resolution AFM imaging. -- Highlights: ► The sinusoidal scan and the intelligent controller are used to improve AFM's rate. ► A new method is raised to overcome the nonlinearity caused by the sinusoidal scan. ► A new controller is proposed to improve the performance of the vertical direction.

  3. Therapy by electromagnetic wave of millimeter energy range (EFH-therapy, MRT, IWT). Scientific and practical materials on the use of physical factors in clinical and health resort practice

    International Nuclear Information System (INIS)

    Samosyuk, I.Z.; Chukhraev, N.V.; Shimkov, G.E.; Bitson, A.V.

    1999-01-01

    EHF-therapy method is a principally new method of treatment which is based on the peculiarities in perception by human organism the magnetic radiation of millimeter energy range. Practical use of this method has shown its high therapeutic efficiency at influencing on acupuncture points. This monography is completely devoted to description of EHF-therapy effects on acupuncture points with account of the Chinese reflexotherapy. Apparats of 'MIT' and 'Eleknronika-EHF' series do not provoke any damages in biological structures and refer to the safe class. The proposed scientific and practical materials on the use of physical factors in clinical and health resort practice are edited in addition to the previous monograph under the same title. These materials are of use for physicians of different specializations and listeners of medical advanced courses

  4. Design and Implementation of a Thermal Load Reduction System for a Hyundai Sonata PHEV for Improved Range

    Energy Technology Data Exchange (ETDEWEB)

    Rugh, John P [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Kreutzer, Cory J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Scott, Matthew [Hyundai America Technical Center Inc.; Gallagher, James [Gentherm Incoporated

    2018-04-03

    Increased adoption of electric-drive vehicles requires overcoming hurdles including limited vehicle range. Vehicle cabin heating and cooling demand for occupant climate control requires energy from the main battery and has been shown to significantly degrade vehicle range. During peak cooling and heating conditions, climate control can require as much as or more energy than propulsion. As part of an ongoing project, the National Renewable Energy Laboratory and project partners Hyundai America Technical Center, Inc., Gentherm, Pittsburgh Glass Works, PPG Industries, Sekisui, 3 M, and Hanon Systems developed a thermal load reduction system to reduce the range penalty associated with electric vehicle climate control. Solar reflective paint, solar control glass, heated and cooled/ventilated seats, heated surfaces, and a heated windshield with door demisters were integrated into a Hyundai Sonata plug-in hybrid electric vehicle. Cold weather field-testing was conducted in Fairbanks, Alaska, and warm weather testing was conducted in Death Valley, California, to assess the system performance in comparison to the baseline production vehicle. In addition, environmental chamber testing at peak heating and cooling conditions was performed to assess the performance of the system in standardized conditions compared to the baseline. Experimental results are presented in this paper, providing quantitative data to automobile manufacturers on the impact of climate control thermal load reduction technologies to increase the advanced thermal technology adoption and market penetration of electric drive vehicles.

  5. Outcomes management: incorporating and sustaining processes critical to using outcome data to guide practice improvement.

    Science.gov (United States)

    Hodges, Kay; Wotring, James R

    2012-04-01

    An outcomes management system (OMS) greatly facilitates an organization or state achieving requirements regarding accountability and use of empirically based interventions. A case example of the authors' experience with a successful and enduring OMS is presented, followed by a review of the literature and a proposed model delineating the key components and benefits of an OMS. Building capacity to measure performance requires embedding utilization of youth-specific, clinically meaningful outcome data into the organization's processes and structures. An OMS measures outcomes associated with services, facilitates implementation of evidence-based practices, informs case decision making, enables better and more efficient clinical management, and provides aggregated information used to improve services. A case-specific supervisory model based on instantaneously available information, including progress to date, helps maximize consumer outcomes. Continuous quality improvement activities, which are databased and goal-oriented, become a positive change management tool. This paper describes organizational processes that facilitate the development of a highly functional OMS.

  6. R and D proposals to improve outages operation. Methods, practices and tools

    International Nuclear Information System (INIS)

    Dionis, Francois

    2014-01-01

    This paper deals with outage operation improvement. It offers a number of tracks on the interactions between the operation activities and maintenance, with a methodological perspective and proposals concerning the Information System. On the methodological point of view, a clever plant systems modeling may allow representing the needed characteristics in order to optimize tagouts, alignment procedures and the schedule. Tools must be taken n into account for new tagout practices such as tags sharing. It is possible to take advantage of 2D drawings integrated into the information system in order to improve the data controls and to visualize operation activities. An integrated set of mobile applications should allow field operators to join the information system for a better and safer performance. (author)

  7. Evaluating online continuing medical education seminars: evidence for improving clinical practices.

    Science.gov (United States)

    Weston, Christine M; Sciamanna, Christopher N; Nash, David B

    2008-01-01

    The purpose of this study was to evaluate the potential for online continuing medical education (CME) seminars to improve quality of care. Primary care physicians (113) participated in a randomized controlled trial to evaluate an online CME series. Physicians were randomized to view either a seminar about type 2 diabetes or a seminar about systolic heart failure. Following the seminar, physicians were presented with 4 clinical vignettes and asked to describe what tests, treatments, counseling, or referrals they would recommend. Physicians who viewed the seminars were significantly more likely to recommend guideline-consistent care to patients in the vignettes. For example, physicians who viewed the diabetes seminar were significantly more likely to order an eye exam for diabetes patients (63%) compared with physicians in the control group (27%). For some guidelines there were no group differences. These results provide early evidence of the effectiveness of online CME programs to improve physician clinical practice.

  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. Transition to the improved confinement mode in torsatron U-3M in range of rare collision frequencies

    International Nuclear Information System (INIS)

    Pashnev, V.K.; Sorokovov, E.L.; Berezhnyj, V.L. and others

    2010-01-01

    Transition to the mode of improved plasma confinement in U-3M facility earlier was discussed in works [1-3]. In these studies discussed the various processes in the confinement volume and in the peripheral plasma that accompany the transition process. Study of plasma confinement and process of transition into the mode of improved confinement just at rare collisions between plasma particles is very important because future fusion reactor based on a toroidal magnetic trap will operate under plasma parameters with rare collision frequencies ('banana' mode). The peculiarity of experiments on torsatron U-3M is that they are conducted at small density n-bar e ≤ 2 lover case x 10 12 cm -3 and, thereby, the frequency of collisions in the confinement area is in the 'banana' mode [4]. And herewith, time of collisions is essentially smaller (up to several orders for electrons and up to the order for ions) than the lifetime of plasma particles. It ensures maxwellization of distribution function and possibility to compare the obtained results with data from other experiments. The objective of this work is to study the main regularity of transition into the mode of improved confinement. Also it is interesting to compare the results with data from other facilities.

  10. Does the Texas First Dental Home Program Improve Parental Oral Care Knowledge and Practices?

    Science.gov (United States)

    Thompson, Charmaine L; McCann, Ann L; Schneiderman, Emet D

    2017-03-15

    This study evaluated the effectiveness of the Texas Medicaid First Dental Home (FDH) by comparing the oral health knowledge, practices, and opinions of participating vs. non-participating parents. A 29-question survey (English & Spanish) was developed and administered to 165 parents of children under three years old (FDH=49, Non-FDH=116) who visited qualifying Medicaid clinics in Texas. Mann Whitney U tests showed that FDH parents scored higher on overall knowledge (P=0.001) and practice scores (Pparents responded correctly more often than non-FDH about the recommended amount of toothpaste for toddlers (Pparents knew tap water was a potential source of fluoride (Pparents scored marginally higher about when a child should have the first dental visit (P=0.051). More Non-FDH parents let their child go to sleep with a bottle, sippy cup or pacifier (Pparents by increasing their oral healthcare knowledge and practices. This is the first step towards improving the oral health of children.

  11. Improving the off-axis spatial resolution and dynamic range of the NIF X-ray streak cameras (invited)

    Energy Technology Data Exchange (ETDEWEB)

    MacPhee, A. G., E-mail: macphee2@llnl.gov; Hatch, B. W.; Bell, P. M.; Bradley, D. K.; Datte, P. S.; Landen, O. L.; Palmer, N. E.; Piston, K. W.; Rekow, V. V. [Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808 (United States); Dymoke-Bradshaw, A. K. L.; Hares, J. D. [Kentech Instruments Ltd., Isis Building, Howbery Park, Wallingford, Oxfordshire OX10 8BD (United Kingdom); Hassett, J. [Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808 (United States); Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York 14627 (United States); Meadowcroft, A. L. [AWE Aldermaston, Reading, Berkshire RG7 4PR (United Kingdom); Hilsabeck, T. J.; Kilkenny, J. D. [General Atomics, P.O. Box 85608, San Diego, California 92186-5608 (United States)

    2016-11-15

    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.

  12. 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.

  13. A therapist-focused knowledge translation intervention for improving patient adherence in musculoskeletal physiotherapy practice.

    Science.gov (United States)

    Babatunde, Folarin Omoniyi; MacDermid, Joy Christine; MacIntyre, Norma

    2017-01-01

    Nonadherence to treatment remains high among patients with musculoskeletal conditions with negative impact on the treatment outcomes, use of personal and cost of care. An active knowledge translation (KT) strategy may be an effective strategy to support practice change. The purpose of this study was to deliver a brief, interactive, multifaceted and targeted KT program to improve physiotherapist knowledge and confidence in performing adherence enhancing activities related to risk, barriers, assessment and interventions. We utilised a 2-phase approach in this KT project. Phase 1 involved the development of an adherence tool kit following a synthesis of the literature and an iterative process involving 47 end-users. Clinicians treating patients with musculoskeletal conditions were recruited from two Physiotherapy and Occupational therapy national conferences in Canada. The intervention, based on the acronym SIMPLE TIPS was tested on 51 physiotherapists in phase 2. A pre- and post-repeated measures design was used in Phase 2. Graham's knowledge-to-action cycle was used as the conceptual framework. Participants completed a pre-intervention assessment, took part in a 1-h educational session and completed a post-intervention assessment. A questionnaire was used to measure knowledge of evidence-based treatment adherence barriers, interventions and measures and confidence to perform evidence-based adherence practice activities. Data was analysed using descriptive statistics (frequency and percentage), Fisher's exact test and Wilcoxon Sign-Ranked tests. Barriers and facilitators of adherence were identified under three domains (therapist, patient, health system) in phase 1. Seventy percent of the participants completed the questionnaire. Results indicated that 46.8% of respondents explored barriers including the use of behaviour change strategies and 45.7% reported that they measured adherence but none reported the use of validated outcomes. A significant improvement in

  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. 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.

  16. Improvement of environmental health and hygiene practices--case study in the Northern Province.

    Science.gov (United States)

    Mathekgana, M A; Chauke, L K; Otieno, F A

    2001-01-01

    The primary purpose of an improved water supply and sanitation is the achievement of acceptable health and hygiene standards as well as the sustainable improvement of the environment. Many governments recognize this and so they budget for large sums of money to improve these services to the communities. The purpose of this study was to investigate the different gaps in environmental health and hygiene practices with the aim of suggesting a strategy of improving this in the Northern Province of South Africa. To do this, 231 households and 30 schools were surveyed. Workshops and visits to different government departments were also used. This paper reports the results from this study which indicate that the situation in schools was not any better than that in households, with more than 90% of the villages still dependent on the unimproved pit latrines and 56,6% relying on standpipes which were (70% of the time) non-operational. The main problems identified seem to those associated with implementation and maintenance. The study concludes that with proper training of the water committees and their active involvement with the government and NGOs, environmental health and hygiene problems can be minimized or eliminated.

  17. Stakeholder-Driven Quality Improvement: A Compelling Force for Clinical Practice Guidelines.

    Science.gov (United States)

    Rosenfeld, Richard M; Wyer, Peter C

    2018-01-01

    Clinical practice guideline development should be driven by rigorous methodology, but what is less clear is where quality improvement enters the process: should it be a priority-guiding force, or should it enter only after recommendations are formulated? We argue for a stakeholder-driven approach to guideline development, with an overriding goal of quality improvement based on stakeholder perceptions of needs, uncertainties, and knowledge gaps. In contrast, the widely used topic-driven approach, which often makes recommendations based only on randomized controlled trials, is driven by epidemiologic purity and evidence rigor, with quality improvement a downstream consideration. The advantages of a stakeholder-driven versus a topic-driven approach are highlighted by comparisons of guidelines for otitis media with effusion, thyroid nodules, sepsis, and acute bacterial rhinosinusitis. These comparisons show that stakeholder-driven guidelines are more likely to address the quality improvement needs and pressing concerns of clinicians and patients, including understudied populations and patients with multiple chronic conditions. Conversely, a topic-driven approach often addresses "typical" patients, based on research that may not reflect the needs of high-risk groups excluded from studies because of ethical issues or a desire for purity of research design.

  18. MO-F-211-01: Methods for Completing Practice Quality Improvement (PQI).

    Science.gov (United States)

    Johnson, J; Brown, K; Ibbott, G; Pawlicki, T

    2012-06-01

    Practice Quality Improvement (PQI) is becoming an expected part of routine practice in healthcare as an approach to provide more efficient, effective and high quality care. Additionally, as part of the ABR's Maintenance of Certification (MOC) pathway, medical physicists are now expected to complete a PQI project. This session will describe the history behind and benefits of the ABR's MOC program, provide details of quality improvement methods and how to successfully complete a PQI project. PQI methods include various commonly used engineering and management tools. The Plan-Do-Study-Act (PDSA) cycle will be presented as one project planning and implementation tool. Other PQI analysis instruments such as flowcharts, Pareto charts, process control charts and fishbone diagrams will also be explained with examples. Cause analysis, solution development and implementation, and post-implementation measurement will be presented. Project identification and definition as well as appropriate measurement tool selection will be offered. Methods to choose key quality metrics (key quality indicators) will also be addressed. Several sample PQI projects and templates available through the AAPM and other organizations will be described. At least three examples of completed PQI projects will be shared. 1. Identify and define a PQI project 2. Identify and select measurement methods/techniques for use with the PQI project 3. Describe example(s) of completed projects. © 2012 American Association of Physicists in Medicine.

  19. 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.

  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. Exploring nurses' perceptions of collecting and using HOBIC measures to guide clinical practice and improve care.

    Science.gov (United States)

    Jeffs, Lianne; Wilson, Gail; Ferris, Ella; Cardiff, Brenda; Ng, San; Lanceta, Mary; White, Peggy; Pringle, Dorothy

    2012-03-01

    Ontario's Health Outcomes for Better Information and Care (HOBIC) is designed to help organizations and nurses plan and evaluate care by comparing patient outcomes with historical data on similar cases. Yet, fewer than 15% of patients in a 2010 study were found to have complete admission and discharge data sets. This low utilization rate of HOBIC measures prompted the current qualitative study, in which nurses from three clinical settings in an academic teaching hospital were interviewed to gain their perceptions related to collecting and using HOBIC measures in practice. The objective was to identify factors that promote or impede the collection and use of HOBIC data in clinical practice to improve patient care and outcomes. Analysis of interview results produced four key themes related to (a) use of HOBIC measures to inform patient care, (b) collecting and documenting HOBIC measures, (c) HOBIC as an afterthought and "black hole" and (d) impediments to assessing and documenting HOBIC measures because of language barriers, patients' cognitive status and lack of time. Recommendations to improve uptake include developing, implementing and evaluating a communication and learning plan that promotes HOBIC's values and benefits, and determining how managers and administrators perceive utilization of HOBIC at the clinical unit and organizational levels.

  2. Improvement of Lambert-Beer law dynamic range by the use of temporal gates on transmitted light pulse through a scattering medium

    International Nuclear Information System (INIS)

    Yoshino, Hironori; Wada, Kenji; Horinaka, Hiromichi; Cho, Yoshio; Umeda, Tokuo; Osawa, Masahiko.

    1995-01-01

    The Lambert-Beer law holding for pulsed lights transmitted through a scattering medium was examined using a streak camera. The Lambert-Beer law dynamic range is found to be limited by floor levels that are caused by scattered photons and are controllable by the use of a temporal gate on the transmitted pulse. The dynamic range improvement obtained for a scattering medium of 2.8 cm -1 scattering coefficient of a thickness of 80 mm by a temporal gate of 60 ps was as much as 50 dB and the Lambert-Beer law dynamic rang reached to 140 dB. (author)

  3. 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.

  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. PMID:27471508

  5. 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.

  6. Simulated rat intestinal fluid improves oral exposure prediction for poorly soluble compounds over a wide dose range

    Directory of Open Access Journals (Sweden)

    Joerg Berghausen

    2016-03-01

    Full Text Available Solubility can be the absorption limiting factor for drug candidates and is therefore a very important input parameter for oral exposure prediction of compounds with limited solubility. Biorelevant media of the fasted and fed state have been published for humans, as well as for dogs in the fasted state. In a drug discovery environment, rodents are the most common animal model to assess the oral exposure of drug candidates. In this study a rat simulated intestinal fluid (rSIF is proposed as a more physiologically relevant media to describe drug solubility in rats. Equilibrium solubility in this medium was tested as input parameter for physiologically-based pharmacokinetics (PBPK simulations of oral pharmacokinetics in the rat. Simulations were compared to those obtained using other solubility values as input parameters, like buffer at pH 6.8, human simulated intestinal fluid and a comprehensive dissolution assay based on rSIF. Our study on nine different compounds demonstrates that the incorporation of rSIF equilibrium solubility values into PBPK models of oral drug exposure can significantly improve the reliability of simulations in rats for doses up to 300 mg/kg compared to other media. The comprehensive dissolution assay may help to improve further simulation outcome, but the greater experimental effort as compared to equilibrium solubility may limit its use in a drug discovery environment. Overall, PBPK simulations based on solubility in the proposed rSIF medium can improve prioritizing compounds in drug discovery as well as planning dose escalation studies, e.g. during toxicological investigations.

  7. 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.

  8. 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 21 st Century."

  9. Do longer consultations improve the management of psychological problems in general practice? A systematic literature review

    Directory of Open Access Journals (Sweden)

    Hutton Catherine

    2007-05-01

    Full Text Available Abstract Background Psychological problems present a huge burden of illness in our community and GPs are the main providers of care. There is evidence that longer consultations in general practice are associated with improved quality of care; but this needs to be balanced against the fact that doctor time is a limited resource and longer consultations may lead to reduced access to health care. The aim of this research was to conduct a systematic literature review to determine whether management of psychological problems in general practice is associated with an increased consultation length and to explore whether longer consultations are associated with better health outcomes for patients with psychological problems. Methods A search was conducted on Medline (Ovid databases up to7 June 2006. The following search terms, were used: general practice or primary health care (free text or family practice (MeSH AND consultation length or duration (free text or time factors (MeSH AND depression or psychological problems or depressed (free text. A similar search was done in Web of Science, Pubmed, Google Scholar, and Cochrane Library and no other papers were found. Studies were included if they contained data comparing consultation length and management or detection of psychological problems in a general practice or primary health care setting. The studies were read and categories developed to enable systematic data extraction and synthesis. Results 29 papers met the inclusion criteria. Consultations with a recorded diagnosis of a psychological problem were reported to be longer than those with no recorded psychological diagnosis. It is not clear if this is related to the extra time or the consultation style. GPs reported that time pressure is a major barrier to treating depression. There was some evidence that increased consultation length is associated with more accurate diagnosis of psychological problems. Conclusion Further research is needed to

  10. 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.

  11. 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.

  12. 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.

  13. Varying the item format improved the range of measurement in patient-reported outcome measures assessing physical function.

    Science.gov (United States)

    Liegl, Gregor; Gandek, Barbara; Fischer, H Felix; Bjorner, Jakob B; Ware, John E; Rose, Matthias; Fries, James F; Nolte, Sandra

    2017-03-21

    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 that indicates the highest PF level is the statement that one is able to perform a given physical activity without any limitations or difficulty. This study investigates whether using an item format with an extended response scale, allowing respondents to state that the performance of an activity is easy or very easy, increases the range of precise measurement of self-reported PF. 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 scale: format A ("Are you able to …"; "without any difficulty"/"unable to do"); format B ("Does your health now limit you …"; "not at all"/"cannot do"); format C ("How difficult is it for you to …"; "very easy"/"impossible"). Each short-form item was answered by 2217-2835 subjects. We evaluated unidimensionality and estimated a graded response model for the 15 short-form items and remaining 119 items of the PROMIS PF bank to compare item and test information for the short forms along the PF continuum. We then used simulated data for five groups with different PF levels to illustrate differences in scoring precision between the short forms using different item formats. 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 of the PF continuum of the sample, provided more item information, and was more useful in distinguishing known groups with above-average functioning. Using an item format with an extended

  14. 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

  15. 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.

  16. Assessing potential modifications to the activated sludge process to improve simultaneous removal of a diverse range of micropollutants.

    Science.gov (United States)

    Petrie, Bruce; McAdam, Ewan J; Lester, John N; Cartmell, Elise

    2014-10-01

    It is proposed that wastewater treatment facilities meet legislated discharge limits for a range of micropollutants. However, the heterogeneity of these micropollutants in wastewaters make removal difficult to predict since their chemistry is so diverse. In this study, a range of organic and inorganic micropollutants known to be preferentially removed via different mechanisms were selected to challenge the activated sludge process (ASP) and determine its potential to achieve simultaneous micropollutant removal. At a fixed hydraulic retention time (HRT) of 8 h, the influence of an increase in solids retention time (SRT) on removal was evaluated. Maximum achievable micropollutant removal was recorded for all chemicals (estrogens, nonylphenolics and metals) at the highest SRT studied (27 days). Also, optimisation of HRT by extension to 24 h further augmented organic biodegradation. Most notable was the enhancement in removal of the considerably recalcitrant synthetic estrogen 17α-ethinylestradiol which increased to 65 ± 19%. Regression analysis indicates that this enhanced micropollutant behaviour is ostensibly related to the concomitant reduction in food: microorganism ratio. Interestingly, extended HRT also initiated nonylphenol biodegradation which has not been consistently observed previously in real wastewaters. However, extending HRT increased the solubilisation of particulate bound metals, increasing effluent aqueous metals concentrations (i.e., 0.45 μm filtered) by >100%. This is significant as only the aqueous metal phase is to be considered for environmental compliance. Consequently, identification of an optimum process condition for generic micropollutant removal is expected to favour a more integrated approach where upstream process unit optimisation (i.e., primary sedimentation) is demanded to reduce loading of the particle bound metal phase onto the ASP, thereby enabling longer HRT in the ASP to be considered for optimum removal of organic

  17. 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.

  18. 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

  19. Corticospinal tract integrity and lesion volume play different roles in chronic hemiparesis and its improvement through motor practice.

    Science.gov (United States)

    Sterr, Annette; Dean, Phil J A; Szameitat, Andre J; Conforto, Adriana Bastos; Shen, Shan

    2014-05-01

    Initial evidence suggests that the integrity of the ipsilesional corticospinal tract (CST) after stroke is strongly related to motor function in the chronic state but not the treatment gain induced by motor rehabilitation. We examined the association of motor status and treatment benefit by testing patients with a wide range of severity of hemiparesis of the left and right upper extremity. Diffusion tensor imaging was performed in 22 patients beyond 12 months after onset of stroke with severe to moderate hemiparesis. Motor function was tested before and after 2 weeks of modified constraint-induced movement therapy. CST integrity, but not lesion volume, correlated with the motor ability measures of the Wolf Motor Function Test and the Motor Activity Log. No differences were found between left and right hemiparesis. Motor performance improved significantly with the treatment regime, and did so equally for patients with left and right arm paresis. However, treatment benefit was not associated with either CST integrity or lesion volume. CST integrity correlated best in this small trial with chronic long-term status but not treatment-induced improvements. The CST may play a different role in the mechanisms mediating long-term outcome compared to those underlying practice-induced gains after a chronic plateau in motor function.

  20. Does an electronic continuum correction improve effective short-range ion-ion interactions in aqueous solution?

    Science.gov (United States)

    Bruce, Ellen E.; van der Vegt, Nico F. A.

    2018-06-01

    Non-polarizable force fields for hydrated ions not always accurately describe short-range ion-ion interactions, frequently leading to artificial ion clustering in bulk aqueous solutions. This can be avoided by adjusting the nonbonded anion-cation or cation-water Lennard-Jones parameters. This approach has been successfully applied to different systems, but the parameterization is demanding owing to the necessity of separate investigations of each ion pair. Alternatively, polarization effects may effectively be accounted for using the electronic continuum correction (ECC) of Leontyev et al. [J. Chem. Phys. 119, 8024 (2003)], which involves scaling the ionic charges with the inverse square-root of the water high-frequency dielectric permittivity. ECC has proven to perform well for monovalent salts as well as for divalent salts in water. Its performance, however, for multivalent salts with higher valency remains unexplored. The present work illustrates the applicability of the ECC model to trivalent K3PO4 and divalent K2HPO4 in water. We demonstrate that the ECC models, without additional tuning of force field parameters, provide an accurate description of water-mediated interactions between salt ions. This results in predictions of the osmotic coefficients of aqueous K3PO4 and K2HPO4 solutions in good agreement with experimental data. Analysis of ion pairing thermodynamics in terms of contact ion pair (CIP), solvent-separated ion pair, and double solvent-separated ion pair contributions shows that potassium-phosphate CIP formation is stronger with trivalent than with divalent phosphate ions.

  1. 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; M age =46.3 years, SD =12.1) were recruited to participate in the experimental design. Statistical analyses were conducted using ANOVA for repeated measures to test for interaction effects of available charging stations and remaining range with the dependent variable range anxiety . The full data set is publicly available via https://osf.io/bveyw/ (Carbon and Gebauer, 2017) [2].

  2. Walkrounds in practice: corrupting or enhancing a quality improvement intervention? A qualitative study.

    Science.gov (United States)

    Martin, Graham; Ozieranski, Piotr; Willars, Janet; Charles, Kathryn; Minion, Joel; McKee, Lorna; Dixon-Woods, Mary

    2014-07-01

    Walkrounds, introduced as Leadership (or Executive) WalkRounds, are a widely advocated model for increasing leadership engagement in patient safety to improve safety culture, but evidence for their effectiveness is mixed. In the English National Health Service (NHS), hospitals have been strongly encouraged to make use of methods closely based on the walkrounds approach. A study was conducted to explore how walkrounds are used in practice and to identify variations in implementation that might mediate their impact on safety and culture. The data, collected from 82 semistructured interviews in the English NHS, were drawn from two components of a wider study of culture and behavior around quality and safety in the English system. Analysis was based on the constant comparative method. Our analysis highlights how local, pragmatic adjustments to the walkrounds approach could radically alter its character and the way in which it is received by those at the front line. The modification and expansion of walkrounds to increase the scope of knowledge produced could increase the value that executives draw from them. However, it risks replacing the main objectives of walkrounds--specific, actionable knowledge about safety issues, and a more positive safety culture and relationship between ward and board--with a form of surveillance that could alienate frontline staff and produce fallible insights. The studys findings suggest some plausible explanations for the mixed evidence for walkrounds' effectiveness in creating a safety culture. On a practical level, they point to critical questions that executives must ask themselves in practicing interventions of this nature to ensure that adaptations align rather than conflict with the intervention's model of change.

  3. 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.

  4. Echocardiography Practice: Insights into Appropriate Clinical Use, Technical Competence and Quality Improvement Program

    Science.gov (United States)

    Kossaify, Antoine; Grollier, Gilles

    2014-01-01

    Echocardiography accounts for nearly half of all cardiac imaging techniques. It is a widely available and adaptable tool, as well as being a cost-effective and mainly a non-invasive test. In addition, echocardiography provides extensive clinical data, which is related to the presence or advent of different modalities (tissue Doppler imaging, speckle tracking imaging, three-dimensional mode, contrast echo, etc.), different approaches (transesophageal, intravascular, etc.), and different applications (ie, heart failure/resynchronization studies, ischemia/stress echo, etc.). In view of this, it is essential to conform to criteria of appropriate use and to keep standards of competence. In this study, we sought to review and discuss clinical practice of echocardiography in light of the criteria of appropriate clinical use, also we present an insight into echocardiographic technical competence and quality improvement project. PMID:24516342

  5. An interprofessional diabetes experience to improve pharmacy and nursing students' competency in collaborative practice.

    Science.gov (United States)

    Pittenger, Amy L; Westberg, Sarah; Rowan, Mary; Schweiss, Sarah

    2013-11-12

    To improve pharmacy and nursing students' competency in collaborative practice by having them participate in an interprofessional diabetes experience involving social networking. An existing elective course on diabetes management was modified to include interprofessional content based on Interprofessional Education Collaborative (IPEC) competency domains. Web-based collaborative tools (social networking and video chat) were used to allow nursing and pharmacy students located on 2 different campuses to apply diabetes management content as an interprofessional team. Mixed-method analyses demonstrated an increase in students' knowledge of the roles and responsibilities of the other profession and developed an understanding of interprofessional communication strategies and their central role in effective teamwork. Interprofessional content and activities can be effectively integrated into an existing course and offered successfully to students from other professional programs and on remote campuses.

  6. Contribution of the ARCAL XX/IAEA project to improvement of radiation safety in medical practices

    International Nuclear Information System (INIS)

    Medina Gironzini, E.

    2001-01-01

    The objectives of the ARCAL XX Project: 'Guidelines on Control of Radiation Sources' (1997-2000) are to promote an effective control of the radiation sources used in medicine, industrial and research applications, harmonising and updating existing procedures within Latin American, adopting the International Basic Safety Standards, in order to avoid unnecessary expositions limiting the probability of accidents occurrence. Nine countries participate with experts in the development of guidelines based in the regional experience. The guidelines contain Radiological Safety Requirements, Guide for Authorisation Application and Inspections Procedures. At this moment, there are guidelines for Radiotherapy, Nuclear Medicine and Diagnostic Radiology. The implementation of these guidelines will improve the effectiveness of regulatory control of radiation sources in Latin American and the radiological protection in aspects of occupational, medical, public and potential exposure. This document presents the experience in the development of these guidelines and their contribution for elaborating national regulations in medical practices. (author) [es

  7. Phase transformation based pyroelectric waste heat energy harvesting with improved practicality

    International Nuclear Information System (INIS)

    Jo, Hwan Ryul; Lynch, Christopher S

    2016-01-01

    In 2014, almost 60% of thermal energy produced in the United States was lost to the environment as waste heat. Ferroelectric based pyroelectric devices can be used to convert some of this waste heat into usable electrical energy using the Olsen cycle, an ideal thermodynamic cycle, but there are a number of barriers to its realization in a practical device. This study uses the Olsen cycle to benchmark a less efficient thermodynamic cycle that is more easily implemented in devices. The ferroelectric pyroelectric material used was (Pb 0.97 La 0.02 )(Zr 0.55 Sn 0.32 Ti 0.13 )O 3 ceramic, a ferroelectric material that undergoes a temperature driven phase transformation. A net energy density of 0.27 J cm −3 per cycle was obtained from the ferroelectric material using the modified cycle with a temperature change between 25°C and 180°C. This is 15.5% of the Olsen cycle result with the same temperature range and 1–8 MV m −1 applied electric field range. The power density was estimated to 13.5 mW cm −3 with given experimental conditions. A model is presented that quantitatively describes the effect of several parameters on output energy density and can be used to design ferroelectric based pyroelectric energy converters. The model indicates that optimization of material geometry and heating conditions can increase the output power by an order or magnitude. (paper)

  8. 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.

  9. Leveraging Employer Practices in Global Regulatory Frameworks to Improve Employment Outcomes for People with Disabilities

    Directory of Open Access Journals (Sweden)

    Matthew C. Saleh

    2018-03-01

    Full Text Available Work is an important part of life, providing both economic security and a forum to contribute one’s talents and skills to society, thereby anchoring the individual in a social role. However, access to work is not equally available to people with disabilities globally. Regulatory environments that prohibit discrimination and support vocational training and educational opportunities constitute a critical first step toward economic independence. However, they have not proven sufficient in themselves. In this article, we aim to infuse deeper consideration of employer practice and demand-side policy reforms into global policy discussions of the right to work for people with disabilities. We begin by documenting the employment and economic disparities existing for people with disabilities globally, followed by a description of the international, regional, and local regulatory contexts aiming to improve labor market outcomes for people with disabilities. Next, we examine how policies can leverage employer interests to further address inequalities. We discuss employer policies and practices demonstrated in the research to facilitate recruitment, hiring, career development, retention, and meaningful workplace inclusion. The goal of the article is to synthesize existing international literature on employment rights for people with disabilities with the employer perspective.

  10. Improving needle tip identification during ultrasound-guided procedures in anaesthetic practice.

    Science.gov (United States)

    Scholten, H J; Pourtaherian, A; Mihajlovic, N; Korsten, H H M; A Bouwman, R

    2017-07-01

    Ultrasound guidance is becoming standard practice for needle-based interventions in anaesthetic practice, such as vascular access and peripheral nerve blocks. However, difficulties in aligning the needle and the transducer can lead to incorrect identification of the needle tip, possibly damaging structures not visible on the ultrasound screen. Additional techniques specifically developed to aid alignment of needle and probe or identification of the needle tip are now available. In this scoping review, advantages and limitations of the following categories of those solutions are presented: needle guides; alterations to needle or needle tip; three- and four-dimensional ultrasound; magnetism, electromagnetic or GPS systems; optical tracking; augmented (virtual) reality; robotic assistance; and automated (computerised) needle detection. Most evidence originates from phantom studies, case reports and series, with few randomised clinical trials. Improved first-pass success and reduced performance time are the most frequently cited benefits, whereas the need for additional and often expensive hardware is the greatest limitation to widespread adoption. Novice ultrasound users seem to benefit most and great potential lies in education. Future research should focus on reporting relevant clinical parameters to learn which technique will benefit patients most in terms of success and safety. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  11. 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

  12. Improving Public Engagement With Climate Change: Five "Best Practice" Insights From Psychological Science.

    Science.gov (United States)

    van der Linden, Sander; Maibach, Edward; Leiserowitz, Anthony

    2015-11-01

    Despite being one of the most important societal challenges of the 21st century, public engagement with climate change currently remains low in the United States. Mounting evidence from across the behavioral sciences has found that most people regard climate change as a nonurgent and psychologically distant risk-spatially, temporally, and socially-which has led to deferred public decision making about mitigation and adaptation responses. In this article, we advance five simple but important "best practice" insights from psychological science that can help governments improve public policymaking about climate change. Particularly, instead of a future, distant, global, nonpersonal, and analytical risk that is often framed as an overt loss for society, we argue that policymakers should (a) emphasize climate change as a present, local, and personal risk; (b) facilitate more affective and experiential engagement; (c) leverage relevant social group norms; (d) frame policy solutions in terms of what can be gained from immediate action; and (e) appeal to intrinsically valued long-term environmental goals and outcomes. With practical examples we illustrate how these key psychological principles can be applied to support societal engagement and climate change policymaking. © The Author(s) 2015.

  13. 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%, P<.05). The use of NP was similar (48.2 vs. 48,7%) with a tendency to a later onset in phase 3 (1.25±1.25 vs. 2.45±3.22 days). There were no significant differences in the average nutritional 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.

  14. Improved horticultural practices against leaf wilting, root rot and nutrient uptake in mango (mangiferaindica l.)

    International Nuclear Information System (INIS)

    Nafees, M.; Ahmad, I.; Ahmad, S.; Anwar, R.; Maryyam, A.; Hussnain, R.R.

    2013-01-01

    Poor plant health condition due to various known biotic and abiotic stresses; becoming a disaster in each mango growing country of the world including Pakistan. On the basis of previous researches on the identification of pathogen and several abiotic factors; Soil drenching and foliar spray of various concentrations of Topsin M (TMIC), Aliette (ATP) and Ridomil Gold (ACE) in combination with CuSO/sub 4/(Copper sulphate) was done on mango plants of cv. S.B. (Samar Bahist) Chaunsa showing wilting of leaves and shoots. Foliar application of micro-nutrients (Fe, B and Zn) (Iron, Boron and Zinc) was also practiced to improve general health of experimental plants Month-wise emergence of flushes was significantly higher in all treated plants compared with control. Percentage of wilted leaves and root rot in plants, which received drenching and foliar treatments, was significantly reduced (50%) compared with untreated plants. Nitrogen, phosphorus and potassium (N, P and K) levels in leaves were significantly improved in treated plants compared with control. Sigmoid relatioship was observed between fungicides and copper sulphate concentrations and uptake of N, P and K in treated plants. Application of 250g ATP fungicide by foliar spray plus 125g by soil drench, each along with 50g CuSO/sub 4/proved to be the best against leaf wilting and it improved the N and P level in leaves. While, application of 250g TMIC by foliar spray and 125g by soil drench, each with 50g CuSO/sub 4/, was found to be the best to reduce the spread of root rot in experimental plants. Preliminary spray of TMIC along with Copper sulphate is effective to improve plant health of mango cv. S.B. Chounsa. (author)

  15. A practical 3D printed simulator for endoscopic endonasal transsphenoidal surgery to improve basic operational skills.

    Science.gov (United States)

    Wen, Guodao; Cong, ZiXiang; Liu, KaiDong; Tang, Chao; Zhong, Chunyu; Li, Liwen; Dai, XuJie; Ma, Chiyuan

    2016-06-01

    We aimed to present a practical three-dimensional (3D) printed simulator to comprehensively and effectively accelerate the learning curve of endoscopic endonasal transsphenoidal surgery (EETS). The 3D printed simulator consists of three parts: (1) skull frame, (2) the nasal passage and the nasal alar of the face, and (3) a modified sella turcica. We aimed to improve three basic operational skills of surgeons: drilling, curetting, and aspirating. Eighteen neurosurgeons and five post-graduates were recruited and consented for the training. For trainees, (1) as the training progressed, the scores increased gradually, (2) a significant increase in the average scores was observed in the tenth training compared to the first training, and (3) there is a significant decrease in trainee variability in the shortening of the gap. The 18 neurosurgeons were divided into three groups: experts, assistants, and observers. For all three basic operations, (1) the average score of experts was obviously higher than that of the assistants, observers, and trainees' tenth training and (2) the average scores of assistants and observers were obviously higher than that of trainees' first training. A significant high in the average score between the assistants and the observers was seen for aspirating, but not for drilling or curetting. For curetting and aspirating, the tenth training average score of trainees was obviously higher than that of assistants and observers. This 3D printed simulator allows different endoscopic basic operations to be simulated and improves the EETS techniques of surgeons. We believed it to be a practical, simple, and low-cost simulator.

  16. 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

  17. 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.

  18. 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.

  19. 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…

  20. Optimization Strategy for Improving the Energy Efficiency of Irrigation Systems by Micro Hydropower: Practical Application

    Directory of Open Access Journals (Sweden)

    Modesto Pérez-Sánchez

    2017-10-01

    Full Text Available Analyses of possible synergies between energy recovery and water management are essential for achieving sustainable advances in the performance of pressurized irrigation networks. Nowadays, the use of micro hydropower in water systems is being analysed to improve the overall energy efficiency. In this line, the present research is focused on the proposal and development of a novel optimization strategy for increasing the energy efficiency in pressurized irrigation networks by energy recovering. The recovered energy is maximized considering different objective functions, including feasibility index: the best energy converter must be selected, operating in its best efficiency conditions by variation of its rotational speed, providing the required flow in each moment. These flows (previously estimated through farmers’ habits are compared with registered values of flow in the main line with very suitable calibration results, getting a Nash–Sutcliffe value above 0.6 for different time intervals, and a PBIAS index below 10% in all time interval range. The methodology was applied to a Vallada network obtaining a maximum recovered energy of 58.18 MWh/year (41.66% of the available energy, improving the recovered energy values between 141 and 184% when comparing to energy recovery considering a constant rotational speed. The proposal of this strategy shows the real possibility of installing micro hydropower machines to improve the water–energy nexus management in pressurized systems.

  1. The Relationship of Engagement in Improvement Practices to Outcome Measures in Large-Scale Quality Improvement Initiatives.

    Science.gov (United States)

    Foster, Gregory L; Kenward, Kevin; Hines, Stephen; Joshi, Maulik S

    Hospital engagement networks (HENs) are part of the largest health care improvement initiative ever undertaken. This article explores whether engagement in improvement activities within a HEN affected quality measures. Data were drawn from 1174 acute care hospitals. A composite quality score was created from 10 targeted topic area measures multiplied by the number of qualifying topics. Scores improved from 5.4 (SD = 6.8) at baseline to 4.6 (5.9) at remeasurement; P improvement ( P improvement, whereas hospitals in the West ( P = .0009) did not improve as much as hospitals in other regions. After adjusting for hospital characteristics, hospitals with improvement champions ( P = .008), a higher level of engagement with their state association ( P = .001), and more leadership involvement ( P = .005) in HEN demonstrated greater improvement.

  2. Improving management of patients with autism spectrum disorder having scheduled surgery: optimizing practice.

    Science.gov (United States)

    Thompson, Debbie Gearner; Tielsch-Goddard, Anna

    2014-01-01

    Surgical preparation for children with autism spectrum disorders can be a challenge to perioperative staff because of the unique individual needs and behaviors in this population. Most children with autism function best in predictable, routine environments, and being in the hospital and other health care settings can create a stressful situation. This prospective, descriptive, quality improvement project was conducted to optimize best practices for perioperative staff and better individualize the plan of care for the autistic child and his or her family. Forty-three patients with a diagnosis of autism or autistic spectrum disorder were seen over 6 months at a suburban pediatric hospital affiliated with a major urban pediatric hospital and had an upcoming scheduled surgery or procedure requiring anesthesia. Caregivers were interviewed before and after surgery to collect information to better help their child cope with their hospital visit. In an evaluation of project outcomes, data were tabulated and summarized and interview data were qualitatively coded for emerging themes to improve the perioperative process for the child. Findings showed that staff members were able to recognize potential and actual stressors and help identify individual needs of surgical patients with autism. The families were pleased and appreciative of the individual attention and focus on their child's special needs. Investigators also found increased staff interest in optimizing the surgical experience for autistic children. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

  3. 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.

  4. 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.

  5. [Security of hospital infusion practices: From an a priori risk analysis to an improvement action plan].

    Science.gov (United States)

    Pignard, J; Cosserant, S; Traore, O; Souweine, B; Sautou, V

    2016-03-01

    Infusion in care units, and all the more in intensive care units, is a complex process which can be the source of many risks for the patient. Under cover of an institutional approach for the improvement of the quality and safety of patient healthcare, a risk mapping infusion practices was performed. The analysis was focused on intravenous infusion situations in adults, the a priori risk assessment methodology was applied and a multidisciplinary work group established. Forty-three risks were identified for the infusion process (prescription, preparation and administration). The risks' assessment and the existing means of control showed that 48% of them would have a highly critical patient security impact. Recommendations were developed for 20 risks considered to be most critical, to limit their occurrence and severity, and improve their control level. An institutional action plan was developed and validated in the Drug and Sterile Medical Devices Commission. This mapping allowed the realization of an exhaustive inventory of potential risks associated with the infusion. At the end of this work, multidisciplinary groups were set up to work on different themes and regular quarterly meetings were established to follow the progress of various projects. Risk mapping will be performed in pediatric and oncology unit where the risks associated with the handling of toxic products is omnipresent. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

  6. 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.

  7. Quality Oncology Practice Initiative Can Guide and Improve Oncology Providers’ Training in Brazil

    Directory of Open Access Journals (Sweden)

    Cristiane Decat Bergerot

    2017-06-01

    Full Text Available Purpose: It has become crucial to translate scientific findings and to find ways by which to mobilize local resources to improve the quality and accessibility of cancer care in developing countries. This study seeks to provide insight into challenge through examining differences in clinician documentation of patients with cancer treated at a Brazilian Public University Hospital. Methods: ASCO Quality Oncology Practice Initiative (QOPI measures were used to examine the care provided in the departments of breast, colorectal, lymphoma, gynecology, and lung cancers. For this study, data from a representative sample of patients receiving chemotherapy in the previous month were extracted and quality of cancer care indicators examined. Results: Certain elements of medical care were consistently and appropriately documented, including cancer diagnosis and stage, chemotherapy planning, administration, and summary. In general, considering the specific cancer management measures, patients received recommended care in accordance with recognized guidelines. Despite this, a number of important gaps in care were identified, including the assessment and treatment of pain, documentation of chemotherapy intention, symptom and toxicity management, patients’ psychosocial status, and provision of a treatment summary at care completion. Conclusion: These findings are encouraging in terms of adherence to core treatment guidelines in cancer care in Brazil. However, results suggest important opportunities for improving care across a number of domains, many of which represent a challenge throughout both developing and developed countries. This study may also provide preliminary guidance for enhancing educational and training programs for professionals and students alike, to implement high-quality, comprehensive cancer care.

  8. 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.

  9. 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

  10. 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"…

  11. ["Practical clinical competence" - a joint programme to improve training in surgery].

    Science.gov (United States)

    Ruesseler, M; Schill, A; Stibane, T; Damanakis, A; Schleicher, I; Menzler, S; Braunbeck, A; Walcher, F

    2013-12-01

    Practical clinical competence is, as a result of the complexity of the required skills and the immediate consequences of their insufficient mastery, fundamentally important for undergraduate medical education. However, in the daily clinical routine, undergraduate training competes with patient care and experimental research, mostly to the disadvantage of the training of clinical skills and competencies. All students have to spend long periods in compulsory surgical training courses during their undergraduate studies. Thus, surgical undergraduate training is predestined to exemplarily develop, analyse and implement a training concept comprising defined learning objectives, elaborated teaching materials, analysed teaching methods, as well as objective and reliable assessment methods. The aim of this project is to improve and strengthen undergraduate training in practical clinical skills and competencies. The project is funded by the German Federal Ministry of Education and Research with almost two million Euro as a joint research project of the medical faculties of the universities of Frankfurt/Main, Gießen and Marburg, in collaboration with the German Society of Surgery, the German Society of Medical Education and the German Medical Students' Association. Nine packages in three pillars are combined in order to improve undergraduate medical training on a methodical, didactic and curricular level in a nation-wide network. Each partner of this network provides a systematic contribution to the project based on individual experience and competence. Based on the learning objectives, which were defined by the working group "Education" of the German Society of Surgery, teaching contents will be analysed with respect to their quality and will be available for both teachers and students as mobile learning tool (first pillar). The existing surgical curricula at the cooperating medical faculties will be analysed and teaching methods as well as assessment methods for clinical

  12. Cardiac autonomic function in patients with diabetes improves with practice of comprehensive yogic breathing program

    Directory of Open Access Journals (Sweden)

    Viveka P Jyotsna

    2013-01-01

    Full Text Available Background: The aim of this study was to observe the effect comprehensive yogic breathing (Sudarshan Kriya Yoga [SKY] and Pranayam had on cardiac autonomic functions in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 64 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes and the other group receiving standard therapy for diabetes and comprehensive yogic breathing program. Standard therapy included dietary advice, brisk walking for 45 min daily, and administration of oral antidiabetic drugs. Comprehensive yogic breathing program was introduced to the participants through a course of 12 h spread over 3 days. It was an interactive session in which SKY, a rhythmic cyclical breathing, preceded by Pranayam is taught under the guidance of a certified teacher. Cardiac autonomic function tests were done before and after 6 months of intervention. Results: In the intervention group, after practicing the breathing techniques for 6 months, the improvement in sympathetic functions was statistically significant (P 0.04. The change in sympathetic functions in the standard therapy group was not significant (P 0.75.Parasympathetic functions did not show any significant change in either group. When both parasympathetic and sympathetic cardiac autonomic functions were considered, there was a trend toward improvement in patients following comprehensive yogic breathing program (P 0.06. In the standard therapy group, no change in cardiac autonomic functions was noted (P 0.99. Conclusion: Cardiac autonomic functions improved in patients with diabetes on standard treatment who followed the comprehensive yogic breathing program compared to patients who were on standard therapy alone.

  13. 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.

  14. Moving improvement research closer to practice: the Researcher-in-Residence model

    Science.gov (United States)

    Marshall, Martin; Pagel, Christina; French, Catherine; Utley, Martin; Allwood, Dominique; Fulop, Naomi; Pope, Catherine; Banks, Victoria; Goldmann, Allan

    2014-01-01

    The traditional separation of the producers of research evidence in academia from the users of that evidence in healthcare organisations has not succeeded in closing the gap between what is known about the organisation and delivery of health services and what is actually done in practice. As a consequence, there is growing interest in alternative models of knowledge creation and mobilisation, ones which emphasise collaboration, active participation of all stakeholders, and a commitment to shared learning. Such models have robust historical, philosophical and methodological foundations but have not yet been embraced by many of the people working in the health sector. This paper presents an emerging model of participation, the Researcher-in-Residence. The model positions the researcher as a core member of a delivery team, actively negotiating a body of expertise which is different from, but complementary to, the expertise of managers and clinicians. Three examples of in-residence models are presented: an anthropologist working as a member of an executive team, operational researchers working in a front-line delivery team, and a Health Services Researcher working across an integrated care organisation. Each of these examples illustrates the contribution that an embedded researcher can make to a service-based team. They also highlight a number of unanswered questions about the model, including the required level of experience of the researcher and their areas of expertise, the institutional facilitators and barriers to embedding the model, and the risk that the independence of an embedded researcher might be compromised. The Researcher-in-Residence model has the potential to engage both academics and practitioners in the promotion of evidence-informed service improvement, but further evaluation is required before the model should be routinely used in practice. PMID:24894592

  15. 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.

  16. Optimal implementation of best management practices to improve agricultural hydrology and water quality

    Science.gov (United States)

    Liu, Y.; Engel, B.; Collingsworth, P.; Pijanowski, B. C.

    2017-12-01

    Nutrient loading from the Maumee River watershed is a significant reason for the harmful algal blooms (HABs) problem in Lake Erie. Strategies to reduce nutrient loading from agricultural areas in the Maumee River watershed need to be explored. Best management practices (BMPs) are popular approaches for improving hydrology and water quality. Various scenarios of BMP implementation were simulated in the AXL watershed (an agricultural watershed in Maumee River watershed) using Soil and Water Assessment Tool (SWAT) and a new BMP cost tool to explore the cost-effectiveness of the practices. BMPs of interest included vegetative filter strips, grassed waterways, blind inlets, grade stabilization structures, wetlands, no-till, nutrient management, residue management, and cover crops. The following environmental concerns were considered: streamflow, Total Phosphorous (TP), Dissolved Reactive Phosphorus (DRP), Total Kjeldahl Nitrogen (TKN), and Nitrate+Nitrite (NOx). To obtain maximum hydrological and water quality benefits with minimum cost, an optimization tool was developed to optimally select and place BMPs by connecting SWAT, the BMP cost tool, and optimization algorithms. The optimization tool was then applied in AXL watershed to explore optimization focusing on critical areas (top 25% of areas with highest runoff volume/pollutant loads per area) vs. all areas of the watershed, optimization using weather data for spring (March to July, due to the goal of reducing spring phosphorus in watershed management plan) vs. full year, and optimization results of implementing BMPs to achieve the watershed management plan goal (reducing 2008 TP levels by 40%). The optimization tool and BMP optimization results can be used by watershed groups and communities to solve hydrology and water quality problems.

  17. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty Executive Summary.

    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

    knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are intended to include the caregiver if the patient is 24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery. The panel group made the following statement an option: (1) The surgeon, or the surgeon's designee, may administer perioperative systemic steroids to the rhinoplasty patient.

  18. 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

  19. Codifying knowledge to improve patient safety: a qualitative study of practice-based interventions.

    Science.gov (United States)

    Turner, Simon; Higginson, Juliet; Oborne, C Alice; Thomas, Rebecca E; Ramsay, Angus I G; Fulop, Naomi J

    2014-07-01

    Although it is well established that health care professionals use tacit and codified knowledge to provide front-line care, less is known about how these two forms of knowledge can be combined to support improvement related to patient safety. Patient safety interventions involving the codification of knowledge were co-designed by university and hospital-based staff in two English National Health Service (NHS) hospitals to support the governance of medication safety and mortality and morbidity (M&M) meetings. At hospital A, a structured mortality review process was introduced into three clinical specialities from January to December 2010. A qualitative approach of observing M&M meetings (n = 30) and conducting interviews (n = 40) was used to examine the impact on meetings and on front-line clinicians and hospital managers. At hospital B, a medication safety 'scorecard' was administered on a general medicine and elderly care ward from September to November 2011. Weekly feedback meetings were observed (n = 18) and interviews with front-line staff conducted (n = 10) to examine how knowledge codification influenced behaviour. Codification was shown to support learning related to patient safety at the micro (front-line service) level by structuring the sharing of tacit knowledge, but the presence of professional and managerial boundaries at the organisational level affected the codification initiatives' implementation. The findings suggest that codifying knowledge to support improvement presents distinct challenges at the group and organisational level; translating knowledge across these levels is contingent on the presence of enabling organisational factors, including the alignment of learning from clinical practice with its governance. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. Community intervention to improve knowledge and practices on commonly used drugs.

    Science.gov (United States)

    Kafle, K K; Karkee, S B; Shrestha, N; Prasad, R R; Bhuju, G B; Das, P L; Chataut, B D

    2010-01-01

    action. The key messages have effectively reached the households, and the knowledge and practices of the community members in drug use have improved.

  1. 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.

  2. Can Bayesian Theories of Autism Spectrum Disorder Help Improve Clinical Practice?

    Science.gov (United States)

    Haker, Helene; Schneebeli, Maya; Stephan, Klaas Enno

    2016-01-01

    Diagnosis and individualized treatment of autism spectrum disorder (ASD) represent major problems for contemporary psychiatry. Tackling these problems requires guidance by a pathophysiological theory. In this paper, we consider recent theories that re-conceptualize ASD from a "Bayesian brain" perspective, which posit that the core abnormality of ASD resides in perceptual aberrations due to a disbalance in the precision of prediction errors (sensory noise) relative to the precision of predictions (prior beliefs). This results in percepts that are dominated by sensory inputs and less guided by top-down regularization and shifts the perceptual focus to detailed aspects of the environment with difficulties in extracting meaning. While these Bayesian theories have inspired ongoing empirical studies, their clinical implications have not yet been carved out. Here, we consider how this Bayesian perspective on disease mechanisms in ASD might contribute to improving clinical care for affected individuals. Specifically, we describe a computational strategy, based on generative (e.g., hierarchical Bayesian) models of behavioral and functional neuroimaging data, for establishing diagnostic tests. These tests could provide estimates of specific cognitive processes underlying ASD and delineate pathophysiological mechanisms with concrete treatment targets. Written with a clinical audience in mind, this article outlines how the development of computational diagnostics applicable to behavioral and functional neuroimaging data in routine clinical practice could not only fundamentally alter our concept of ASD but eventually also transform the clinical management of this disorder.

  3. Advanced Energy Retrofit Guide (AERG): Practical Ways to Improve Energy Performance; Healthcare Facilities (Book)

    Energy Technology Data Exchange (ETDEWEB)

    Hendron, R.; Leach, M.; Bonnema, E.; Shekhar, D.; Pless, S.

    2013-09-01

    The Advanced Energy Retrofit Guide for Healthcare Facilities is part of a series of retrofit guides commissioned by the U.S. Department of Energy. By presenting general project planning guidance as well as detailed descriptions and financial payback metrics for the most important and relevant energy efficiency measures (EEMs), the guides provide a practical roadmap for effectively planning and implementing performance improvements in existing buildings. The Advanced Energy Retrofit Guides (AERGs) are intended to address key segments of the U.S. commercial building stock: retail stores, office buildings, K-12 schools, grocery stores, and healthcare facilities. The guides' general project planning considerations are applicable nationwide; the energy and cost savings estimates for recommended EEMs were developed based on energy simulations and cost estimates for an example hospital tailored to five distinct climate regions. These results can be extrapolated to other U.S. climate zones. Analysis is presented for individual EEMs, and for packages of recommended EEMs for two project types: existing building commissioning projects that apply low-cost and no-cost measures, and whole-building retrofits involving more capital-intensive measures.

  4. Why invest, and what it will take to improve breastfeeding practices?

    Science.gov (United States)

    Rollins, Nigel C; Bhandari, Nita; Hajeebhoy, Nemat; Horton, Susan; Lutter, Chessa K; Martines, Jose C; Piwoz, Ellen G; Richter, Linda M; Victora, Cesar G

    2016-01-30

    Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women's work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. The marketing of breastmilk substitutes negatively affects breastfeeding: global sales in 2014 of US$44·8 billion show the industry's large, competitive claim on infant feeding. Not breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0·49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women, and society. To realise these gains, political support and financial investment are needed to protect, promote, and support breastfeeding. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices.

    Science.gov (United States)

    Kano, Miria; Silva-Bañuelos, Alma Rosa; Sturm, Robert; Willging, Cathleen E

    2016-01-01

    Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities. We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps. Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents. This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented. © Copyright 2016 by the American Board of Family Medicine.

  6. TH-C-BRD-06: A Novel MRI Based CT Artifact Correction Method for Improving Proton Range Calculation in the Presence of Severe CT Artifacts

    International Nuclear Information System (INIS)

    Park, P; Schreibmann, E; Fox, T; Roper, J; Elder, E; Tejani, M; Crocker, I; Curran, W; Dhabaan, A

    2014-01-01

    Purpose: Severe CT artifacts can impair our ability to accurately calculate proton range thereby resulting in a clinically unacceptable treatment plan. In this work, we investigated a novel CT artifact correction method based on a coregistered MRI and investigated its ability to estimate CT HU and proton range in the presence of severe CT artifacts. Methods: The proposed method corrects corrupted CT data using a coregistered MRI to guide the mapping of CT values from a nearby artifact-free region. First patient MRI and CT images were registered using 3D deformable image registration software based on B-spline and mutual information. The CT slice with severe artifacts was selected as well as a nearby slice free of artifacts (e.g. 1cm away from the artifact). The two sets of paired MRI and CT images at different slice locations were further registered by applying 2D deformable image registration. Based on the artifact free paired MRI and CT images, a comprehensive geospatial analysis was performed to predict the correct CT HU of the CT image with severe artifact. For a proof of concept, a known artifact was introduced that changed the ground truth CT HU value up to 30% and up to 5cm error in proton range. The ability of the proposed method to recover the ground truth was quantified using a selected head and neck case. Results: A significant improvement in image quality was observed visually. Our proof of concept study showed that 90% of area that had 30% errors in CT HU was corrected to 3% of its ground truth value. Furthermore, the maximum proton range error up to 5cm was reduced to 4mm error. Conclusion: MRI based CT artifact correction method can improve CT image quality and proton range calculation for patients with severe CT artifacts

  7. Improving Nutrition and Physical Activity Policies and Practices in Early Care and Education in Three States, 2014-2016.

    Science.gov (United States)

    Smith, Teresa M; Blaser, Casey; Geno-Rasmussen, Cristy; Shuell, Julie; Plumlee, Catherine; Gargano, Tony; Yaroch, Amy L

    2017-08-31

    The National Early Care and Education Learning Collaboratives (ECELC) project aims to facilitate best practices in nutrition, physical activity, screen time, and breastfeeding support and infant feeding among early care and education (ECE) programs across multiple states. The project uses a train-the-trainer approach with 5, in-person learning-collaborative sessions, technical assistance, and action planning. We describe the longitudinal practice-based evaluation of the project and assess whether ECE programs evaluated (n = 104) sustained changes in policies and practices 1 year after completing the project. The number of best practices increased from pre-assessment to post-assessment (P professional development and training focused on improving best practices for environment-level child nutrition and physical activity, which is one strategy among many that are warranted for obesity prevention in young children.

  8. Harnessing and blending the power of two research networks to improve prevention science and public health practice

    Science.gov (United States)

    Vanderpool, Robin C.; Brownson, Ross C.; Mays, Glen P.; Crosby, Richard A.; Wyatt, Stephen W.

    2015-01-01

    Strategic collaborations are essential in moving public health research and practice forward1, particularly in light of escalating fiscal and environmental challenges facing the public health community. This commentary provides background and context for an emerging partnership between two national networks, Prevention Research Centers (PRCs) and Public Health Practice-Based Research Networks (PBRNs), to impact public health practice. Supported by CDC, PRCs are celebrating over 25 years of transdisciplinary applied prevention research grounded in community and stakeholder engagement. Public Health PBRNs, funded by the Robert Wood Johnson Foundation, conduct innovative public health services and systems research with public health agencies and community partners to improve public health decision-making. By utilizing each of the networks’ respective strengths and resources, collaborative ventures between PRCs and Public Health PBRNs can enhance the translation of applied prevention research to evidence-based practice and empirically investigate novel public health practices developed in the field. Three current PRC-Public Health PBRNs projects are highlighted and future research directions are discussed. Improving the interconnectedness of prevention research and public health practice is essential to improve the health of the Nation. PMID:24237918

  9. CDC's Prevention Status Reports: Monitoring the Status of Public Health Policies and Practices for Improved Performance and Accountability.

    Science.gov (United States)

    Young, Andrea C; Lowry, Garry; Mumford, Karen; Graaf, Christine

    Increasing the adoption and implementation of evidence-based policies and practices is a key strategy for improving public health. Although there is widespread agreement about the importance of implementing evidence-based public health policies and practices, there are gaps between what has been shown to be effective and what is implemented at the state level. The Centers for Disease Control and Prevention (CDC) developed the Prevention Status Reports (PSRs), a performance measurement system, to highlight evidence-based public health policies and practices and catalyze state performance and quality improvement efforts across the nation. CDC selected a set of 10 topics representing some of the most important public health challenges in the nation. Stakeholders, including state health departments and other partners, helped conceptualize the PSRs and informed the development of the PSR framework, which provides an organizational structure for the system. CDC subject matter experts developed criteria for selecting policies and practices, indicators for each policy and practice, and a criteria-based rating system for each indicator. The PSRs were developed for all 50 states and the District of Columbia. The PSRs were developed and serve as a performance measurement system for monitoring the adoption, reach, and implementation fidelity of evidence-based public health policies and practices nationwide. The PSRs include 33 policy and practice indicators across the 10 health topics. They use a simple 3-level rating system-green, yellow, and red-to report the extent to which each state (and the District of Columbia) has implemented the policy or practice in accordance with supporting evidence or expert recommendations. Results from aggregate analyses show positive change or improvement. The PSRs are a unique part of CDC's work to improve the performance and accountability of the public health system, serving as both a monitoring tool and a call to action to improve health

  10. Variable wide range of lens power and its improvement in a liquid-crystal lens using highly resistive films divided into two regions with different diameters

    Science.gov (United States)

    Kawamura, Marenori; Sato, Susumu

    2018-05-01

    The variable range of lens power of a liquid-crystal (LC) lens driven by two voltages is discussed on the basis of calculated and experimental results. The LC lens has two electrodes, which are a circularly hole-patterned electrode and a circular electrode, in addition to a common electrode, and highly resistive transparent films. The variable range of lens power increases with increasing driving voltage applied across the circularly hole-patterned electrode and the common electrode, and with decreasing diameter of highly resistive films. However, the optical-phase retardation profile tends to deviate from a parabolic curve in these cases. As a method to improve the trade-off properties, the highly resistive film is divided into two regions with different diameters, where the sheet resistance of an outer film is larger than that of an inner one. The improved LC lens has a lens power that varies in a wide range, and it exhibits a good parabolic phase retardation profile.