Qi Liu - Bulletin of Materials Science | Indian Academy of Sciences

Indian Academy of Sciences (India)

Home; Journals; Bulletin of Materials Science. QI LIU. Articles written in Bulletin of Materials Science. Volume 34 Issue 2 April 2011 pp 183-189. Study of structural transformations and phases formation upon calcination of Zn–Ni–Al hydrotalcite nanosheets · Zhanshuang Li Yanchao Song Jun Wang Qi Liu Piaoping Yang ...

[Brief discussion on acupuncture technique "controlling Qihai to regulate blood pressure" proposed by academician SHI Xuemin].

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Yu, Liang; Xu, Xifa; Liu, Jian; Fan, Xiaonong

2017-08-12

According to Qihai theory, academician SHI Xuemin established the acupuncture technique "controlling Qihai to regulate blood pressure" which focused on Renying (ST 9), and achieved favorable effects in clinical application. In this paper, based on the Qihai theory, from aspects of Yuan qi , Zong qi , Ying qi and Wei qi and relations among qi , blood and veins in TCM, and cardiac output, sympathetic nerve activity and blood vessels in modern medicine, the understanding on hypertension was explained. As a result, both TCM and modern medicine had consistency in the understanding of hypertension, reflecting the scientificity and practicability of this acupuncture technique. Besides, according to Qihai theory and "wind leading to vertigo" theory, academician SHI Xuemin brought forward the key pathogenesis of hypertension was "dysfunction of Qihai ", and the acupoint selected Renying (ST 9), Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36) and Taichong (LR 3). At the same time, the operation specification of each acupoint was mainly discussed, and the references of acupoint selection was explained based on TCM theory and modern clinical research.

[Professor GAO Yuchun's experience on "sequential acupuncture leads to smooth movement of qi"].

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Wang, Yanjun; Xing, Xiao; Cui, Linhua

2016-01-01

Professor GAO Yuchun is considered as the key successor of GAO's academic school of acupuncture and moxibustion in Yanzhao region. Professor GAO's clinical experience of, "sequential acupuncture" is introduced in details in this article. In Professor GAO's opinions, appropriate acupuncture sequence is the key to satisfactory clinical effects during treatment. Based on different acupoints, sequential acupuncture can achieve the aim of qi following needles and needles leading qi; based on different symptoms, sequential acupuncture can regulate qi movement; based on different body positions, sequential acupuncture can harmonize qi-blood and reinforcing deficiency and reducing excess. In all, according to the differences of disease condition and constitution, based on the accurate acupoint selection and appropriate manipulation, it is essential to capture the nature of diseases and make the order of acupuncture, which can achieve the aim of regulating qi movement and reinforcing deficiency and reducing excess.

Qing-Qi Rickshaw : A Boon Or Bane For Public Transportation? A Study Of Road Traffic Injury Patterns Involving Qing-Qi Rickshaws In Karachi Pakistan.

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Muzzammil, Muhammad; Minhas, Muhammad Saeed; Effendi, Jahanzeb; Jahanzeb, Syed; Mughal, Ayesha; Qadir, Abdul

2017-01-01

The three-wheeler Qing-qi and Compressed Natural Gas (CNG) auto-rickshaws were introduced in Karachi to meet the transportation demand of the growing population. These vehicles have directly or indirectly been implicated in a number of road traffic violations as well as road accidents. This study aims to describe the crash characteristics and injury patterns for Qing-qi rickshaw occupants and other road users hit by Qing-qi rickshaw in Karachi, Pakistan. An Observational/ Descriptive study was conducted at Accident & Emergency and Orthopaedic Surgery Department, Jinnah Post Graduate Medical Centre, Karachi Pakistan from July 2014 to June 2015.All patients who came with Qing-qi rickshaw accident in Accident & Emergency (A&E) of JPMC were included. Crash characteristics, details of injuries, injury severity parameters and outcome were documented in detailed interviews. Four hundred and eighty-six rickshaw related injuries were noted in road traffic accidents by Qing-gi rickshaw. Age range was 2-85 (43.5±58.68). 350 injured victims were males and 136 were females. By occupation most victims were laborers and daily wage workers (45%) and students (21%). Overloading of vehicle with more than two passengers was found in (28.5%). The most common cause of injury was collision with a moving vehicle (56%), followed by fall from rickshaw. The most common contributing factor was the overloading of rickshaw and roll over on turning (61%). Injury severity on arrival were mild (49%), moderate were (32%), and severe were (19%). Injuries related to head and neck (26%), face (14%), thorax and abdomen (5%), lower extremity and pelvic girdle (31%) and upper extremity (23%) were observed. Qing-qi rickshaw injuries are common and these vehicles are vulnerable to road traffic accidents. Occupants and road users are both at risk of injuries.

Relationship between endogenous hydrogen sulfide and blood stasis syndrome based on the Qi-blood theory of Chinese medicine.

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Li, Wei-wei; Guo, Hao; Wang, Xue-mei

2013-09-01

"Qi" and "blood" are two essential concepts in Chinese medicine (CM). As qi is intangible, the concept of qi is still controversial between CM and Western medicine. However, the endogenous hydrogen sulfide (H2S) and other gaseous signaling molecules provides a new approach for understanding the essence of qi in CM. Blood stasis syndrome is a common syndrome in CM. According to the CM theory, the incidence of blood stasis syndrome is closely correlated to the reckless movement of qi, as qi and blood are inseparable in regulating physiological functions. In recent years, more and more evidences suggest a close correlation between blood stasis syndrome and microcirculation dysfunction. In this paper, we discuss the relationship between endogenous H2S and blood stasis syndrome based on qi-blood theory of CM. We found that endogenous H2S maybe a material basis in concept of qi in CM, while dysfunctional microcirculation is the pathological basis of the blood stasis syndrome. As qi is closely associated with incidence and progression of blood stasis syndrome, endogenous H2S may play an important role in preventing and treating the blood stasis syndrome by improving the function of microcirculation.

Traditional Chinese medicine formula Bi-Qi capsule alleviates rheumatoid arthritis-induced inflammation, synovial hyperplasia, and cartilage destruction in rats.

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Wang, Kai; Zhang, Dongmei; Liu, Yan; Wang, Xuan; Zhao, Jiantong; Sun, Tingting; Jin, Tingting; Li, Baoli; Pathak, Janak L

2018-03-14

Traditional Chinese medicine (TCM) formula Bi-Qi capsule (Bi-Qi) is a commonly prescribed drug to treat rheumatoid arthritis (RA). However, the mechanism of Bi-Qi-mediated amelioration of RA pathogenesis is still a mystery. Collagen induced arthritis (CIA) in rats is an established model that shares many similarities with RA in humans. In this study we investigated the effect of Bi-Qi on the pathogenesis of CIA in rats. CIA was developed in Sprague-Dawley (S.D) rats (n = 60, female) and used as a model resembling RA in humans. Rats were treated with a high or moderate dose of Bi-Qi, or methotrexate (MTX). Effects of the treatment on local joint and systemic inflammation, synovial hyperplasia, cartilage destruction, and other main features in the pathogenesis of CIA were analyzed. Inflamed and swollen ankles and joints were observed in arthritic rats, while Bi-Qi or MTX treatment alleviated these symptoms. Only the Bi-Qi moderate dose decreased RA-induced serum levels of tumor necrosis factor-alpha (TNF-α). Both Bi-Qi and MTX reduced the interleukin (IL)-18 serum level. Protein levels of cartilage oligomeric matrix protein and osteopontin in serum, synovium, and cartilage were elevated in arthritic rats, while Bi-Qi alleviated these effects. Synovial hyperplasia, inflammatory cell infiltration in synovium and a high degree of cartilage degradation was observed in RA, and Bi-Qi or MTX alleviated this effect. Bi-Qi at the moderate dose was the most effective in mitigating CIA-related clinical complications. Our findings showed that Bi-Qi alleviates CIA-induced inflammation, synovial hyperplasia, cartilage destruction, and the other main features in the pathogenesis of CIA. This provides fundamental evidence for the anti-arthritic properties of Bi-Qi and corroborates the use of Bi-Qi TCM formula for the treatment of RA.

Influence of de qi on the immediate analgesic effect of SP6 acupuncture in patients with primary dysmenorrhoea and cold and dampness stagnation: a multicentre randomised controlled trial.

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Zhao, Min-Yi; Zhang, Peng; Li, Jing; Wang, Lin-Peng; Zhou, Wei; Wang, Yan-Xia; She, Yan-Fen; Ma, Liang-Xiao; Wang, Pei; Hu, Ni-Juan; Lin, Chi; Hu, Shang-Qin; Wu, Gui-Wen; Wang, Ya-Feng; Sun, Jun-Jun; Jiang, Si-Zhu; Zhu, Jiang

2017-10-01

The aim of this multicentre randomised controlled trial was to investigate the contribution of de qi to the immediate analgesic effect of acupuncture in patients with primary dysmenorrhoea and the specific traditional Chinese medicine diagnosis cold and dampness stagnation . Eighty-eight patients with primary dysmenorrhoea and cold and dampness stagnation were randomly assigned to de qi (n=43) or no de qi (n=45) groups and underwent 30 min of SP6 acupuncture. The de qi group received deep needling at SP6 with manipulation using thick needles; the no de qi group received shallow needling with no manipulation using thin needles. In both groups the pain scores and actual de qi sensation were evaluated using a visual analogue scale for pain (VAS-P) and the acupuncture de qi clinical assessment scale (ADCAS), respectively. Both groups showed reductions in VAS-P, with no signficant differences between groups. ADCAS scores showed 43/43 and 25/45 patients in de qi and no de qi groups, respectively, actually experienced de qi sensation. Independent of original group allocation, VAS-P reductions associated with actual de qi (n=68) were greater than those without (28.4±18.19 mm vs 14.6±12.28 mm, p=0.008). This study showed no significant difference in VAS-P scores in patients with primary dysmenorrhoea and cold and dampness stagnation immediately after SP6 acupuncture designed to induce or avoid de qi sensation. Both treatments significantly reduced VAS-P relative to baseline. Irrespective of group allocation, patients experiencing actual de qi sensation demonstrated larger reductions in pain score relative to those without, suggesting greater analgesic effects. Chinese Clinical Trial Registry (ChiCTR-TRC-13003086); Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Efficacy of an integrated continuing medical education (CME) and quality improvement (QI) program on radiation oncologist (RO) clinical practice

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Leong, Cheng Nang; Shakespeare, Thomas Philip; Mukherjee, Rahul K.; Back, Michael F.; Lee, Khai Mun; Lu, Jiade Jay; Wynne, Christopher J.; Lim, Keith; Tang, Johann; Zhang Xiaojian

2006-01-01

Purpose: There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. Methods and Materials: The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. Results: Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. Conclusion: An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence

Effect of Qi Ming Granule on the choroidal circulation in diabetic patients

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Ke-Jun Li

2016-03-01

Full Text Available AIM:To investigate the effect of a Chinese medicine(Qi Ming granuleon the retinal and choroidal circulation in diabetes patients. METHODS: According to the results of fundus fluorescein angiography(FFA, all the 45 diabetes patients were divided into no diabetic retinopathy(NDRgroup and nonproliferative diabetic retinopathy(NPDRgroup. All subjects were examined by FFA and indocyanine green angiography(ICGAat the same time. After taken Qi Ming granule for 3mo, all subjects were examined by the same method. FFA and ICGA were used to evaluate the retinal and choroidal circulation and their features. The key points were filling time for the retinal and choroidal circulation before and after treatments. The accuracy data was used to evaluate the effect.RESULTS: After taken Qi Ming granule for 3mo, there were significant decrease of the retina and the choroid filling time in NDR and NPDR groups. The occurrence rate of various abnormal angiographic features were significantly decreased. CONCLUSION: Qi Ming granule can accelerate the blood flow of retina and choroid, improve the blood circulation in diabetes patients, and delay the occurrence and development of diabetic retinopathy.

Weaker cognitive control abilities of Pi (Spleen) qi-deficient individuals supported Chinese medicine diagnosis.

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Lin, Hui-Yan; Zhao, Yan-Ping; Xu, Gui-Ping; Li, Yun-Si; Xie, Wei-Yun; Bai, Li-Hua; Jin, Hua

2017-07-28

To investigate whether Pi (Spleen) qi-deficiency affected psychological and neural responses in relevance to cognitive control. Pi qi-deficient and balanced participants were asked to perform the Stroop task, a classical cognitive control paradigm. In this paradigm, participants had to judge the color of the prompted word. The word's meaning indicated the color (the consistent condition) or not (the inconsistent condition), or were unrelated to the color (the neutral condition). Electroencephalograph (EEG) was recorded during the task. Event-related potential (ERP) results showed that Pi qi-deficient individuals failed to exhibit a normal Stroop effect as Balanced individuals did, such as the accuracy differences between the consistent and the inconsistent conditions as well as the N450 effect (P>0.05). Meanwhile, Pi qi-deficient individuals displayed larger P2 and P3 amplitudes than balanced individuals did during performing the cognitive control task (Pcognitive control aspect.

Impact of Qi-invigorating traditional Chinese medicines on intestinal flora: A basis for rational choice of prebiotics.

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Wang, Xiao-Meng; Li, Xiao-Bo; Peng, Ying

2017-04-01

According to the theory of traditional Chinese medicine (TCM), Qi (vital energy) is regarded as a driving force of biological activities in human body, including both nutrient substances and organ functions. Qi-invigorating TCMs are widely used to treat various symptoms and disorders, such as fatigue, obesity, immunosuppression, intestinal flora imbalance, and gastrointestinal diseases, in which Qi is considered to be reduced or depleted. Interestingly, abundant clinical evidences suggest that these disorders are associated with the alternation of intestinal flora, which directly affects disease status. Herein we review the interaction between gut microbiota and Qi-invigorating TCMs under healthy and disease conditions and discuss the mechanisms of action and applications of Qi-invigorating TCMs in enhancing health status through microbial alternation. A better understanding of the role of Qi-invigorating TCMs in modulating microbial composition and the association between intestinal microbiota and diseases would help reveal the clinical consequences of microbiota alteration and explore opportunities to harness this symbiotic relationship to improve public health. Copyright © 2017 China Pharmaceutical University. Published by Elsevier B.V. All rights reserved.

Brain areas involved in acupuncture needling sensation of de qi: a single-photon emission computed tomography (SPECT) study.

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Chen, Jia-Rong; Li, Gan-Long; Zhang, Gui-Feng; Huang, Yong; Wang, Shu-Xia; Lu, Na

2012-12-01

De qi is a sensory response elicited by acupuncture stimulation. According to traditional Chinese medicine (TCM), de qi is essential for clinical efficacy. However, the understanding of the neurobiological basis of de qi is still limited. To investigate the relationship between brain activation and de qi by taking a single-photon emission computed tomography (SPECT) scan while applying acupuncture at TE5. A total of 24 volunteers were randomly divided into 4 groups, and received verum or sham acupuncture at true acupuncture point TE5 or a nearby sham point according to grouping. All subjects then received a (99m)Tc-ethylcysteinate dimer (ECD) SPECT scan. All six subjects in the verum acupuncture at true acupuncture point group experienced de qi sensation; in contrast, all six subjects in the sham acupuncture at the sham point group responded with nothing other than non-sensation. Compared to the scan results from subjects who experienced non-sensation, SPECT scans from subjects with de qi sensation demonstrated significant activated points mainly located in brodmann areas 6, 8, 19, 21, 28, 33, 35, 37, 47, the parahippocampal gyrus, lentiform nucleus, claustrum and red nucleus; deactivated points were seen in brodmann areas 9 and 25. Verum acupuncture at true acupuncture points is more likely to elicit de qi sensation. De qi sensations mainly resulted in brain area activations, but not deactivations. These brain areas are related to the curative effect of Te5. The acupuncture needle sensations of de qi and sharp pain are associated with different patterns of activations and deactivations in the brain.

QiShenYiQi Pills, a Compound Chinese Medicine, Prevented Cisplatin Induced Acute Kidney Injury via Regulating Mitochondrial Function

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Li Zhou

2017-12-01

Full Text Available Nephrotoxicity is a serious adverse effect of cisplatin chemotherapy that limits its clinical application, to deal with which no effective management is available so far. The present study was to investigate the potential protective effect of QiShenYiQi Pills (QSYQ, a compound Chinese medicine, against cisplatin induced nephrotoxicity in mice. Pretreatment with QSYQ significantly attenuated the cisplatin induced increase in plasma urea and creatinine, along with the histological damage, such as tubular necrosis, protein cast, and desquamation of epithelial cells, improved the renal microcirculation disturbance as indicated by renal blood flow, microvascular flow velocity, and the number of adherent leukocytes. Additionally, QSYQ prevented mitochondrial dysfunction by preventing the cisplatin induced downregulation of mitochondrial complex activity and the expression of NDUFA10, ATP5D, and Sirt3. Meanwhile, the cisplatin-increased renal thiobarbituric acid-reactive substances, caspase9, cleaved-caspase9, and cleaved-caspase3 were all diminished by QSYQ pretreatment. In summary, the pretreatment with QSYQ remarkably ameliorated the cisplatin induced nephrotoxicity in mice, possibly via the regulation of mitochondrial function, oxidative stress, and apoptosis.

Feasibility of a virtual learning collaborative to implement an obesity QI project in 29 pediatric practices.

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John, Tamara; Morton, Michaela; Weissman, Mark; O'Brien, Ellen; Hamburger, Ellen; Hancock, Yolandra; Moon, Rachel Y

2014-04-01

Quality improvement (QI) activities are required to maintain board certification in pediatrics. However, because of lack of training and resources, pediatricians may feel overwhelmed by the need to implement QI activities. Pediatricians also face challenges when caring for overweight and obese children. To create a virtual (online) QI learning collaborative through which pediatric practices could easily develop and implement a continuous QI process. Prospective cohort. Pediatric practices that were part of the Children's National Health Network were invited to participate, with the option to receive continuing medical education and maintenance of certification credits. s) Practices conducted baseline and monthly chart audits, participated in educational webinars and selected monthly practice changes, using Plan-Do-Study-Act cycles. Practices reported activities monthly and periodic feedback was provided to practices about their performance. s) Improvement in (i) body mass index (BMI) percentile documentation, (ii) appropriate nutritional and activity counseling and (iii) follow-up management for high-risk patients. Twenty-nine practices (120 providers) participated, and 24 practices completed all program activities. Monthly chart audits demonstrated continuous improvement in documentation of BMI, abnormal weight diagnosis, nutrition and activity screening and counseling, weight-related health messages and follow-up management of overweight and obese patients. Impact of QI activities on visit duration and practice efficiency was minimal. A virtual learning collaborative was successful in providing a framework for pediatricians to implement a continuous QI process and achieve practice improvements. This format can be utilized to address multiple health issues.

Some properties of the Catalan-Qi function related to the Catalan numbers.

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Qi, Feng; Mahmoud, Mansour; Shi, Xiao-Ting; Liu, Fang-Fang

2016-01-01

In the paper, the authors find some properties of the Catalan numbers, the Catalan function, and the Catalan-Qi function which is a generalization of the Catalan numbers. Concretely speaking, the authors present a new expression, asymptotic expansions, integral representations, logarithmic convexity, complete monotonicity, minimality, logarithmically complete monotonicity, a generating function, and inequalities of the Catalan numbers, the Catalan function, and the Catalan-Qi function. As by-products, an exponential expansion and a double inequality for the ratio of two gamma functions are derived.

The Chinese Herb Yi-Qi-Huo-Xue Protects Cardiomyocyte Function in Diabetic Cardiomyopathy

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Xiangsheng Wang

2018-01-01

Full Text Available Aims. To study the effect of the Chinese herb Yi-qi-huo-xue on cardiomyopathy in diabetic rats. Methods. Rats were fed a high fat and high glucose diet and injected with 50 ml/kg streptozotocin (STZ to induce diabetic cardiomyopathy (DCM, followed by treatment with Yi-qi-huo-xue for 4 weeks. We measured the rats’ heart weight index, observed the myocardial morphology using hematoxylin eosin (HE staining, and determined the content of collagen types I and III in the myocardium using enzyme-linked immunosorbent assay (ELISA. We determined Bcl-2, Bax, and P53 protein expression by Western blot analysis and the cardiomyocyte apoptosis rate via a flow cytometry assay. Results. Compared with the rats in the control group, the diabetic rats gained weight and had increased blood sugar levels, an enhanced heart weight index, and increased myocardial pathophysiological damage. There was a decrease in their Bcl-2 expression, and their Bax and P53 expression increased. The Bcl-2/Bax ratio was enhanced, and there was an increase in the content of collagen types I and III in the myocardium. After treatment with Yi-qi-huo-xue, all levels listed above returned to normal. Conclusion. The Chinese herb Yi-qi-huo-xue degraded the myocardial interstitial collagen types I and III to protect the myocardium of the diabetic rats, thus delaying the role of myocardial fibrosis. Yi-qi-huo-xue could play an important role in protecting the myocardium of DCM rats by enhancing the expression of the Bcl-2 protein, inhibiting the expression of the Bax and P53 proteins, increasing the ratio of Bcl-2/Bax, and inhibiting the apoptosis of cardiomyocytes.

Gene Expression Profiles of HIV/AIDS Patients with Qi-Yin Deficiency and Dampness-Heat Retention.

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Liu, Sa; Chen, Yulong; Xie, Shiping; Xu, Qianlei; Chen, Jianshe; Wang, Changhai; Wang, Zhao; Ma, Suna; Wu, Xingwei; Zhang, Ning

2016-11-01

Traditional Chinese Medicine (TCM) applied in the clinic as a complementary and alternative therapy has helped improve immunity and reduce side effects and symptomatic treatment in patients with HIV/AIDS. However, the mechanisms of TCM syndromes are not clear. Transcriptomics enables the study of such TCM syndromes. This study compared the messenger RNA (mRNA) expressions of healthy persons and patients with HIV/AIDS who had two common TCM syndromes, qi-yin deficiency and dampness-heat retention, to find the difference in HIV/AIDS with TCM syndromes. Comparison with healthy persons identified 113 mRNAs-41 enhanced and 72 decreased-in the qi-yin deficiency group. Additionally, 76 mRNAs were found in the dampness-heat retention group: 14 increased and 62 decreased. Functional genetic analysis of the mRNAs indicated that two TCM syndromes were correlated with cell apoptosis, immunoinflammatory responses, and lymphocyte activation. Differentially expressed mRNAs in the qi-yin deficiency group were obviously associated with cellular activity, communication, protein localization, cellular ion homeostasis, and regulation of cell motion, whereas mRNAs in the dampness-heat retention group were associated with sequence-specific DNA binding, cellular response to stress, and hemopoietic or lymphoid organ development. These results suggest that the formation of different TCM syndromes in patients with HIV/AIDS were founded on biological transcriptomics, which reveal mechanisms of the formation of these syndromes in HIV/AIDS. Differentially expressed mRNAs in two TCM syndrome groups tended to normalize after TCM intervention, which indicates that TCM might remit symptoms by changing genetic expression.

Specific radiography technique

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Abdul Nassir Ibrahim; Azali Muhammad; Ab. Razak Hamzah; Abd. Aziz Mohamed; Mohamad Pauzi Ismail

2008-01-01

Beside radiography testing using x-ray machine and gamma source, there are several technique that developed specifically to complete the testing that cannot be done with the two earlier. This technique was specific based on several factor, for the example, the advantages of neutron and electron using to show the image was unique compare to x-ray and gamma. Besides that, these special radiography techniques maybe differ in how to detect the radiation get through the object. These technique can used to inspect thin or specimen that contained radioactive material. There are several technique will discussed in this chapter such as neutron radiography, electron radiography, fluoroscopy and also autoradiography.

[Mechanism of tonifying Qi traditional Chinese medicines contained in Yiqi Qingwen Jiedu mixture against influenza immune inflammatory injury].

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Xu, Hong-Ri; Wang, Cheng-Xiang; Wang, Lan; Zhou, Ping-An; Yin, Ren-Yi; Jiang, Liang-Duo; Wang, Hui-Fang

2014-10-01

To observe the impact of tonifying Qi traditional Chinese medicines contained in Yiqi Qingwen Jiedu mixture on mRNA expression of lung inflammatory cytokines and pulmonary pathological injury of mice infected by influenza virus, in order to discuss the mechanism of tonifying Qi traditional Chinese medicines against pulmonary immune inflammatory injury of infected mice. In different time phases after mice were infected with influenza virus FM1, the RT-PCR method was adopted to observe the impact of tonifying Qi traditional Chinese medicines contained in Yiqi Qingwen Jiedu mixture on five inflammatory cytokines TNF-α, IL-1, IL-6, IL-10 and IFN-γ, and the changes in pulmonary pathological injury of mice with viral pneumonia after intervention with tonifying qi traditional Chinese medicines. (1) Tonifying Qi traditional Chinese medicines significantly reduced the mRNA expression of TNF-α at 1-5 d and IL-1 mRNA expression at 7 d, may increase IL-1 mRNA expression in mouse lung at 3 d, significantly reduced IL-6 mRNA expression in mouse lung and increased IL-10 mRNA expression at 3-7 d, and significantly increased IFN-γ mRNA expression at 1 d. (2) Tonifying Qi traditional Chinese medicines could significantly inhibited and repaired pulmonary immune inflammatory injury of mice infected by FM1, which was most remarkable at 3-7 d after the infection with influenza virus FM1. Tonifying Qi traditional Chinese medicines contained in Yiqi Qingwen Jiedu mixture could resist pulmonary immune inflammatory injury and repair inflammatory injury by regulating the mRNA expression of imbalance inflammatory cytokines of organisms infected with influenza virus.

The Role of Rumination and Stressful Life Events in the Relationship between the Qi Stagnation Constitution and Depression in Women: A Moderated Mediation Model

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Liu, Qiaosheng

2017-01-01

The qi stagnation constitution is associated with depression in traditional Chinese medicine. It is unclear how rumination and stressful life events affect the relationship between the qi stagnation constitution and depression. The Qi Stagnation Constitution Scale, Ruminative Response Scale, Center for Epidemiologic Studies Depression Scale, and Adolescent Self-Rating Life Events Checklist were used to assess this association in 1200 female college students. The results revealed that the qi stagnation constitution was positively associated with depression. Furthermore, rumination was a partial mediator of the relationship between the qi stagnation constitution and depression. In addition, stressful life events moderated the direct effect and mediating effect of the qi stagnation constitution on depression. These findings indicate that rumination and stressful life events may affect the relationship between the qi stagnation constitution and depression in women. PMID:28757889

Tai Chi and Qi Gong for Health and Well-Being

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Full Text Available ... tool that features tai chi and qi gong as an activity to enhance wellness. These exercise therapies ... care approaches used to promote a healthy lifestyle. As always, talk to your health care provider if ...

Efficacy and Safety of the TCM Qi-Supplementing Therapy in Patients with Myasthenia Gravis: A Systematic Review and Meta-Analysis

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Xi-qian Yang

2017-01-01

Full Text Available Background. The Traditional Chinese Medicine (TCM Qi-supplementing therapy has been used widely for treating myasthenia gravis (MG in China. The purpose of this meta-analysis was to evaluate the efficacy and safety of Qi-supplementing therapy as an adjunctive therapy in MG patients. Methods. Seven electronic databases were searched through June 2016. Randomized controlled trials (RCTs evaluating the add-on effect of Qi-supplementing therapy in MG patients were included. The outcome measures were the total effective rate, relapse rate, and adverse events. Results. Twenty-three RCTs involving 1,691 MG patients were included. The included studies were of low-to-moderate quality. Meta-analysis showed that Qi-supplementing therapy combined with Western medicine (WM significantly improved the total response rate and reduced the relapse risk during 6–24 months of follow-up. Subgroup analysis showed that Qi-supplementing therapy only affected the total response rate within the first 6 months of treatment. Moreover, the rate of adverse events was lower with the addition of Qi-supplementing therapy to WM than with WM only. Conclusions. Short-term Qi-supplementing therapy combined with WM appears to be superior to WM for improving the total response rate and reducing the relapse rate. However, more high-quality RCTs are warranted owing to methodological flaws of previous trials.

Tai Chi and Qi Gong for Health and Well-Being

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Full Text Available ... Legislation Advisory Council Job Opportunities All About NCCIH Health Topics A-Z # A B C D E ... Y Z Tai Chi and Qi Gong for Health and Well-Being Share: © Mariann Seriff The following ...

Validation of the qi blood yin yang deficiency questionnaire on chronic fatigue.

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Kim, Jihye; Ku, Boncho; Kim, Keun Ho

2016-01-01

Chronic fatigue (CF) reflects an imbalance of inter-organ functions or of the four essential physiological components qi, blood (xue), yin, and yang. CF can be subdivided into different patterns. However, there are no diagnostic methods for CF. This study aimed to clinically validate a pattern identification method by identifying correlations between CF and responses to the qi blood yin yang deficiency questionnaire (QBYY-Q). Participants were recruited between May and June 2014 through the Kyung Hee University Korean Medicine hospital website and via posters and comprised 129 CF patients diagnosed with the United States Centers for Disease Control and Prevention (1994) criteria. Participants who had organic diseases that explained the CF were excluded. A total of 159 participants were asked to complete the QBYY-Q, the fatigue severity scale, and the Chalder fatigue scale. The latter two questionnaires were used to assess convergent validity with the QBYY-Q. Among the 129 CF participants, 70 and 59 had chronic fatigue syndrome and idiopathic chronic fatigue, respectively. Two Korean medical doctors independently assessed participants' qi, blood, yin, and yang deficiency patterns using QBYY deficiency pattern identification guidelines. Based on the results of a preliminary study of the QBYY-Q, we selected 32 reliable items for symptoms corresponding to each deficiency pattern. The items were used to estimate internal consistency and construct validity. Multinomial logistic regression analysis was performed for scores on each deficiency pattern. The data were means and standard deviations or numbers of participants and proportions for continuous and categorical variables, respectively. A statistical significance level of P yin, and yang deficiency were 45.1, 58.0, 52.2, and 63.4 %, respectively. Each QBYY-Q deficiency score was positively associated with each corresponding deficiency pattern. Qi deficiency was used as a reference category. Odds ratios of blood, yin

The Role of Rumination and Stressful Life Events in the Relationship between the Qi Stagnation Constitution and Depression in Women: A Moderated Mediation Model

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Mingfan Liu

2017-01-01

Full Text Available The qi stagnation constitution is associated with depression in traditional Chinese medicine. It is unclear how rumination and stressful life events affect the relationship between the qi stagnation constitution and depression. The Qi Stagnation Constitution Scale, Ruminative Response Scale, Center for Epidemiologic Studies Depression Scale, and Adolescent Self-Rating Life Events Checklist were used to assess this association in 1200 female college students. The results revealed that the qi stagnation constitution was positively associated with depression. Furthermore, rumination was a partial mediator of the relationship between the qi stagnation constitution and depression. In addition, stressful life events moderated the direct effect and mediating effect of the qi stagnation constitution on depression. These findings indicate that rumination and stressful life events may affect the relationship between the qi stagnation constitution and depression in women.

Qi Gong exercises and Feldenkrais method from the perspective of Gestalt concept and humanistic psychology.

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Posadzki, Paul; Stöckl, Andrea; Mucha, Dariusz

2010-07-01

This study describes two similar approaches to human movement: Qi Gong exercises and the Feldenkrais method. These systems are investigated in terms of Gestalt concepts and humanistic psychology. Moshe Feldenkrais created the concept known as Awareness Through Movement. This concept assumes that by becoming more aware of one's movements, one functions at a higher level. In similar ways to those using the Feldenkrais method, individuals may become more aware of their own movements by performing Qi Gong exercises: A therapeutic modality that facilitates mind-body integration. Qi Gong exercises commonly lead to increased personal awareness accompained by enhanced quality, fluency and smoothness of movement. These two methods of movement therapies are explored in terms of their relations with Gestalt concept and humanistic psychology. (c) 2008. Published by Elsevier Ltd. All rights reserved.

Requirement of histidine 217 for ubiquinone reductase activity (Qi site) in the cytochrome bc1 complex.

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Gray, K A; Dutton, P L; Daldal, F

1994-01-25

Folding models suggest that the highly conserved histidine 217 of the cytochrome b subunit from the cytochrome bc1 complex is close to the quinone reductase (Qi) site. This histidine (bH217) in the cytochrome b polypeptide of the photosynthetic bacterium Rhodobacter capsulatus has been replaced with three other residues, aspartate (D), arginine (R), and leucine (L). bH217D and bH217R are able to grow photoheterotrophically and contain active cytochrome bc1 complexes (60% of wild-type activity), whereas the bH217L mutant is photosynthetically incompetent and contains a cytochrome bc1 complex that has only 10% of the wild-type activity. Single-turnover flash-activated electron transfer experiments show that cytochrome bH is reduced via the Qo site with near native rates in the mutant strains but that electron transfer between cytochrome bH and quinone bound at the Qi site is greatly slowed. These results are consistent with redox midpoint potential (Em) measurements of the cytochrome b subunit hemes and the Qi site quinone. The Em values of cyt bL and bH are approximately the same in the mutants and wild type, although the mutant strains have a larger relative concentration of what may be the high-potential form of cytochrome bH, called cytochrome b150. However, the redox properties of the semiquinone at the Qi site are altered significantly. The Qi site semiquinone stability constant of bH217R is 10 times higher than in the wild type, while in the other two strains (bH217D and bH217L) the stability constant is much lower than in the wild type. Thus H217 appears to have major effects on the redox properties of the quinone bound at the Qi site. These data are incorporated into a suggestion that H217 forms part of the binding pocket of the Qi site in a manner reminiscent of the interaction between quinone bound at the Qb site and H190 of the L subunit of the bacterial photosynthetic reaction center.

External Qi therapy to treat symptoms of Agent Orange Sequelae in Korean combat veterans of the Vietnam War.

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Lee, Myeong Soo; Woo, Won-Hong; Lim, Hyun-Ja; Hong, Sung-Soo; Kim, Hye-Jung; Moon, Sun-Rock

2004-01-01

We investigated the efficacy of Qi therapy as a non-pharmacological treatment for various symptoms presented by Korean combat veterans of the Vietnam War with Agent Orange Sequelae. Nine subjects volunteered to receive 30 minutes of Qi therapy, twice per day for 7 days. There was marked improvement in 89% of the patients with impaired physical activity, 86% of those with psychological disorder, 78% of those with heavy drug use, and 67% of those with fatigue, indigestion and high blood glucose levels. This data suggests that Qi therapy combined with conventional treatment has positive effects in reducing and managing the pain, psychosomatic disorders, and substance abuse in patients with Agent Orange Sequelae. We cannot completely discount the possible influence of the placebo effect, and more objective, clinical measures are needed to study the long-term effects of Qi therapy.

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

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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.

The effectiveness of a multidisciplinary QI activity for accidental fall prevention: Staff compliance is critical

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Ohde Sachiko

2012-07-01

Full Text Available Abstract Background Accidental falls among inpatients are a substantial cause of hospital injury. A number of successful experimental studies on fall prevention have shown the importance and efficacy of multifactorial intervention, though success rates vary. However, the importance of staff compliance with these effective, but often time-consuming, multifactorial interventions has not been fully investigated in a routine clinical setting. The purpose of this observational study was to describe the effectiveness of a multidisciplinary quality improvement (QI activity for accidental fall prevention, with particular focus on staff compliance in a non-experimental clinical setting. Methods This observational study was conducted from July 2004 through December 2010 at St. Luke’s International Hospital in Tokyo, Japan. The QI activity for in-patient falls prevention consisted of: 1 the fall risk assessment tool, 2 an intervention protocol to prevent in-patient falls, 3 specific environmental safety interventions, 4 staff education, and 5 multidisciplinary healthcare staff compliance monitoring and feedback mechanisms. Results The overall fall rate was 2.13 falls per 1000 patient days (350/164331 in 2004 versus 1.53 falls per 1000 patient days (263/172325 in 2010, representing a significant decrease (p = 0.039. In the first 6 months, compliance with use of the falling risk assessment tool at admission was 91.5% in 2007 (3998/4368, increasing to 97.6% in 2010 (10564/10828. The staff compliance rate of implementing an appropriate intervention plan was 85.9% in 2007, increasing to 95.3% in 2010. Conclusion In our study we observed a substantial decrease in patient fall rates and an increase of staff compliance with a newly implemented falls prevention program. A systematized QI approach that closely involves, encourages, and educates healthcare staff at multiple levels is effective.

78 FR 43857 - Order Relating to Yaming Nina Qi Hanson

Science.gov (United States)

2013-07-22

... Hanson shall not take any action or make or permit to be made any public statement, directly or... intention to initiate an administrative proceeding against Qi Hanson pursuant to Section 766.3 of the Export..., delivering, storing, disposing of, forwarding, transporting, financing, or otherwise servicing in any way...

Protocol for the evaluation and validation of Qi Blood Yin Yang deficiency pattern questionnaire: prospective observational study.

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Kim, Jihye; Kim, Keun Ho

2015-12-01

The aim of this study is to validate the pattern identification standard of qi, blood, yin, and yang deficiency patterns diagnosis. The current study will investigate the usefulness of the Qi Blood Yin Yang deficiency pattern questionnaire as a diagnostic tool for qi, blood, yin, and yang deficiencies by assessing the agreement between the scores and a gold standard established by assessors. This protocol is for a single center, prospective, observational study. A total of 248 eligible patients with unexplained chronic fatigue will be assigned to four groups in a 1:1:1:1 ratio as the qi deficiency group, blood deficiency group, yin deficiency group, and yang deficiency group. The primary outcome will be measured using the score of the Qi Blood Yin Yang deficiency pattern questionnaire and the secondary outcomes will be measured using the fatigue severity scale, Korean-translated chalder fatigue scale, computerized tongue image analysis system, and three types of pattern identification questionnaires (cold-heat, food accumulation, and seven emotions patterns). The safety of the clinical study will be assessed after measurements at every visit. All statistical analysis will be performed using the R Statistics program. Statistics experts will analyze the relationship between clinical data using the Pearson's Chi-squared test and independent t -test. This study will provide reference data and good evidence that are applicable to future studies. Furthermore, the results of the present study are useful to improve the care of patients with unexplained chronic fatigue and unexplained chronic fatigue-related disorders.

Tai Chi and Qi Gong for Health and Well-Being

Medline Plus

Full Text Available ... The following video is intended to be an educational tool that features tai chi and qi gong as an activity to enhance wellness. These exercise therapies are generally considered safe, self-care approaches used to promote a healthy lifestyle. As always, talk to your health care provider if you are ...

[Guiding-qi acupuncture for dry eye syndrome].

Science.gov (United States)

Xie, Wenzhang; Zeng, Liang; Tao, Ying; Zhou, Yingfan; Zhao, Ran; Huang, Xinyun; Hou, Wenguang; Zhang, Ren; Zong, Lei

2018-02-12

To observe the clinical efficacy differences between different needling methods for dry eye syndrome. Sixty patients of dry eye syndrome were randomly divided into an observation group and a control group, 30 cases (60 eyes) in each group. Shangjingming (Extra), Xiajingming (Extra), Tongziliao (GB 1), Cuanzhu (BL 2), Fengchi (GB 20), Hegu (LI 4), Sanyinjiao (SP 6), Taixi (KI 3) and Taichong (LR 3) were selected in the two groups. The control group was treated with conventional acupuncture, while the observation group was treated with guiding- qi acupuncture. Electroacupuncture (EA) was used at bilateral Tongziliao (GB1) and Cuanzhu (BL 2), 30 min per treatment. The treatment was given three times per week. Totally 1-month treatment (12 treatments) was given. The eye symptom score, breakup time of tear film (BUT), Schirmer Ⅰ test (SⅠT) and visual analogue scale (VAS) score were compared before and after treatment in the two groups. The clinical efficacy was compared between the two groups. Compared before treatment, the eye symptom score, BUT, SⅠT and VAS score were improved after treatment in the two groups (all P eye symptom score and SⅠT in the observation group were superior to those in the control group (both P 0.05). The total effective rate was 86.7% (52/60) in the observation group, which was superior to 73.3% (44/60) in the control group ( P dry eye syndrome, and the efficacy of guiding- qi acupuncture combined with EA is superior to that of conventional EA.

Logarithmically complete monotonicity of a function related to the Catalan-Qi function

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Qi Feng

2016-08-01

Full Text Available In the paper, the authors find necessary and sufficient conditions such that a function related to the Catalan-Qi function, which is an alternative generalization of the Catalan numbers, is logarithmically complete monotonic.

The Contribution of Different Components in QiShenYiQi Pills® to Its Potential to Modulate Energy Metabolism in Protection of Ischemic Myocardial Injury

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Yuan-Chen Cui

2018-04-01

Full Text Available Ischemic heart diseases remain a challenge for clinicians. QiShenYiQi pills® (QSYQ has been reported to be curative during coronary heart diseases with modulation of energy metabolism as one of the underlying mechanisms. In this study, we detected the effect of QSYQ and its components on rat myocardial structure, mitochondrial respiratory chain complexes activity and energy metabolism, and heart function after 30 min of cardiac ischemia, with focusing on the contribution of each component to its potential to regulate energy metabolism. Results showed that treatment with QSYQ and all its five components protected myocardial structure from damage by ischemia. QSYQ also attenuated release of myocardial cTnI, and restored the production of ATP after cardiac ischemia. AS-IV and Rb1, but not Rg1, R1, and DLA, had similar effect as QSYQ in regulation of energy metabolism. These results indicate that QSYQ may prevent ischemia-induced cardiac injury via regulation of energy metabolism, to which each of its components contributes differently.

[Analysis in pulmonary ventilatory function from 100 patients with ano-rectal diseases caused by deficiency of qi].

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Wang, W

1999-03-01

To explore the pathogenesis of ano-rectal diseases caused by deficiency of Qi, which is correlated with obstruction of pulmonary ventilation. The pulmonary ventilatory function was measured in 100 patients with the internal piles, the interno-external hemorrhoid and prolapse of rectum, the prolapse of anus was the principal symptom of them. Data from the 100 patients showed that 67% of them were diagnosed with the obstruction of pulmonary ventilation, the ratio was far less in the health control group. FEV 1.0 (mean +/- s) (2011.65 +/- 875) ml, MMF (1.84 +/- 1.24) L/s and PEF (2.34 +/- 1.51) L/s in male patients, (1551.54 +/- 514) ml, (1.57 +/- 0.62) L/s and (1.85 +/- 0.92) L/s in female patients, but those values were higher in the control than in the patients. The statistical analysis was performed and the difference was significant between patients and the control group (P < 0.01). The patients with ano-rectal diseases caused by deficiency of Qi accompanied with obstruction of pulmonary ventilation in different degree and varied sorts, it confirmed that the pathogenesis of ano-rectal diseases caused by deficiency of Qi is related with "sinking of pectoral Qi".

Craniometric examination of Longxian and Qi Li Cun archaeological sites to assess population continuity in ancient northern China.

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Gibbon, Victoria E; Porter, Tarun A; Wu, Xiujie; Liu, Wu

2016-10-01

In this paper, population continuity and discontinuity in northern China are explored using craniometric analyses from two archaeological sites, Longxian (Warring States) and Qi Li Cun (Han Dynasty). Neither population has been previously studied. Artefactual evidence shows the individuals from Qi Li Cun were Xianbei, descendants from Mongolia. Longxian is from further south in the central plains at an earlier time, thus, we expect to observe variability between these groups. In total, 24 cranial measurements were obtained on 66 crania from these sites. Howells's cranial measurements on Anyang (42 crania) and Hainan (83 crania) Chinese samples were included for comparative purposes. Less variability is expected between Longxian and Howells's Chinese data due to geographic and temporal similarity. With closer geographic and temporal affinity with Anyang, the expectation is for Longxian and Anyang to be similar. Few statistical differences exist between Longxian and Qi Li Cun; this was supported by the similarity found through principal components analysis (PCA). Regardless of sex, canonical discriminant analysis shows clustering of Longxian and Qi Li Cun separate from those of Anyang and Hainan. Their similarity indicates the people from Longxian and Qi Li Cun likely share Mongolian ancestry. Our results, supported by other studies, suggest that despite temporal differences, Mongolians living in China during the Warring States and Han dynasty retained their cultural and genetic Mongolian identity. These data add valuable bioarchaeological information regarding the peopling of northern China during a crucial period of cultural and political change in the Early Bronze Age and Iron Age. Copyright © 2016 Elsevier GmbH. All rights reserved.

Cardioprotection against ischemia/reperfusion injury by QiShenYiQi Pill® via ameliorate of multiple mitochondrial dysfunctions

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Chen JR

2015-06-01

Full Text Available Jing Rui Chen,1–3 Jing Wei,1–3 Ling Yan Wang,1–3 Yan Zhu,1–3 Lan Li,1–3 Mary Akinyi Olunga,1–3 Xiu Mei Gao,1–3 Guan Wei Fan1–31Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin, People’s Republic of China; 2Key Laboratory of Pharmacology of Traditional Chinese Medicine Formulae, Ministry of Education, 3Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of ChinaAim: To investigate the potential cardioprotective effects of QiShenYiQi Pill® (QSYQ on myocardial ischemia/reperfusion (I/R injury through antioxidative stress and mitochondrial protection.Methods and results: Sprague Dawley rats were pretreated with QSYQ or saline for 7 days and subjected to ischemia (30 minutes occlusion of the left anterior descending coronary artery and reperfusion (120 minutes. Cardiac functions were evaluated by echocardiogram and hemodynamics. Myocardial mitochondria were obtained to evaluate changes in mitochondrial structure and function, immediately after 120 minutes reperfusion. Pretreatment with QSYQ protected against I/R-induced myocardial structural injury and improved cardiac hemodynamics, as demonstrated by normalized serum creatine kinase and suppressed oxidative stress. Moreover, the impaired myocardial mitochondrial structure and function decreased level of ATP (accompanied by reduction of ATP5D and increase in the expression of cytochrome C. Myocardial fiber rupture, interstitial edema, and infiltrated leukocytes were all significantly ameliorated by pretreatment with QSYQ.Conclusion: Pretreatment of QSYQ in Sprague Dawley rats improves ventricular function and energy metabolism and reduces oxidative stress via ameliorating multiple mitochondrial dysfunctions during I/R injury.Keywords: QSYQ, ischemia/reperfusion injury, energy metabolism, mitochondria

A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures.

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Lyons, Todd W; Stack, Anne M; Monuteaux, Michael C; Parver, Stephanie L; Gordon, Catherine R; Gordon, Caroline D; Proctor, Mark R; Nigrovic, Lise E

2016-06-01

Although children with isolated skull fractures rarely require acute interventions, most are hospitalized. Our aim was to safely decrease the hospitalization rate for children with isolated skull fractures. We designed and executed this multifaceted quality improvement (QI) initiative between January 2008 and July 2015 to reduce hospitalization rates for children ≤21 years old with isolated skull fractures at a single tertiary care pediatric institution. We defined an isolated skull fracture as a skull fracture without intracranial injury. The QI intervention consisted of 2 steps: (1) development and implementation of an evidence-based guideline, and (2) dissemination of a provider survey designed to reinforce guideline awareness and adherence. Our primary outcome was hospitalization rate and our balancing measure was hospital readmission within 72 hours. We used standard statistical process control methodology to assess change over time. To assess for secular trends, we examined admission rates for children with an isolated skull fracture in the Pediatric Health Information System administrative database. We identified 321 children with an isolated skull fracture with a median age of 11 months (interquartile range 5-16 months). The baseline admission rate was 71% (179/249, 95% confidence interval, 66%-77%) and decreased to 46% (34/72, 95% confidence interval, 35%-60%) after implementation of our QI initiative. No child was readmitted after discharge. The admission rate in our secular trend control group remained unchanged at 78%. We safely reduced the hospitalization rate for children with isolated skull fractures without an increase in the readmissions. Copyright © 2016 by the American Academy of Pediatrics.

Efficacy of integrative medicine in deficiency of both qi and yin in the rat model of type 2 diabetes

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Jing Zhao

2015-10-01

Conclusions: A rat model of T2DM with both qi and yin deficiency was successfully replicated. CHF appeared to be more efficacious than IM and PIO in the rat model of qi and yin deficiency pattern of T2DM, though IM and PIO were each found to have their merits and drawbacks in attenuating T2DM indicators in the rat model.

Switched modified function projective synchronization of hyperchaotic Qi system with uncertain parameters

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Sebastian Sudheer, K.; Sabir, M.

2010-12-01

This work is involved with switched modified function projective synchronization of two identical Qi hyperchaotic systems using adaptive control method. Switched synchronization of chaotic systems in which a state variable of the drive system synchronize with a different state variable of the response system is a promising type of synchronization as it provides greater security in secure communication. Modified function projective synchronization with the unpredictability of scaling functions can enhance security. Recently formulated hyperchaotic Qi system in the hyperchaotic mode has an extremely broad frequency bandwidth of high magnitudes, verifying its unusual random nature and indicating its great potential for some relevant engineering applications such as secure communications. By Lyapunove stability theory, the adaptive control law and the parameter update law are derived to make the state of two chaotic systems modified function projective synchronized. Synchronization under the effect of noise is also considered. Numerical simulations are presented to demonstrate the effectiveness of the proposed adaptive controllers.

Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability-An Emerging Framework.

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Holve, Erin

2013-01-01

Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four "pillars" of sustainability are discussed based on the experiences of EDM Forum grantees and other research and QI networks. These include trust and value, governance, management, and financial and administrative support. Two "foundational considerations," adaptive capacity and policy levers, are also discussed.

VizieR Online Data Catalog: Follow-up of probable young star ASASSN-15qi (Herczeg+, 2016)

Science.gov (United States)

Herczeg, G. J.; Dong, S.; Shappee, B. J.; Chen, P.; Hillenbrand, L. A.; Jose, J.; Kochanek, C. S.; Prieto, J. L.; Stanek, K. Z.; Kaplan, K.; Holoien, T.-S.; Mairs, S.; Johnstone, D.; Gully-Santiago, M.; Zhu, Z.; Smith, M. C.; Bersier, D.; Mulders, G. D.; Filippenko, A. V.; Ayani, K.; Brimacombe, J.; Brown, J. S.; Connelley, M.; Harmanen, J.; Itoh, R.; Kawabata, K. S.; Maehara, H.; Takata, K.; Yuk, H.; Zheng, W.

2017-02-01

The outburst of ASASSN-15qi (2MASS J22560882+5831040) occurred on JD2457298 (2015 October 2; UTC dates are used herein). The All-Sky Automated Survey for Supernovae (ASAS-SN) is an all-sky V-band transient survey with a limiting magnitude of ~17. ASAS-SN photometry of ASASSN-15qi was obtained from two different telescopes on Haleakala, Hawaii with intervals of one to three days. ASAS-SN photometry is listed in Table 2. Archival photometry, ground-based optical photometry with Las Cumbres Observatory Global Telescope Network (LCOGT) 1m telescope at McDonald Observatory between 2015 October 23 and December 23 and at the Liverpool Telescope on 2016 April 26 and June 11, Swift/UVOT photometry on 2015 October 12 (ID 00034098001) and 2015 December 27 (ID 00034098002), NIR photometry with the NOTCam camera at the Nordic Optical Telescope (NOT) on 2015 December 22 and Spitzer/IRAC MIR photometry on 2006 December 29 (Program ID 30734, PI Donald Figer) and James Clerk Maxwell Telescope (JCMT) SCUBA2 submillimeter observations of ASASSN-15qi on 2015 November 5 and optical and NIR spectroscopy observations are also described in section 2. (1 data file).

Cardioprotective Effects of QiShenYiQi Dripping Pills on Transverse Aortic Constriction-Induced Heart Failure in Mice.

Science.gov (United States)

Ruan, Guoran; Ren, Haojin; Zhang, Chi; Zhu, Xiaogang; Xu, Chao; Wang, Liyue

2018-01-01

QiShenYiQi dripping pills (QSYQ), a traditional Chinese medicine, are commonly used to treat coronary heart disease, and QSYQ was recently approved as a complementary treatment for ischemic heart failure in China. However, only few studies reported on whether QSYQ exerts a protective effect on heart failure induced by pressure overload. In this study, we explored the role of QSYQ in a mouse model of heart failure induced by transverse aortic constriction (TAC). Twenty-eight C57BL/6J mice were divided into four groups: Sham + NS group, Sham + QSYQ group, TAC + NS group, and TAC + QSYQ group. QSYQ dissolved in normal saline (NS) was administered intragastrically (3.5 mg/100 g/day) in the Sham + QSYQ and TAC + QSYQ groups. In the Sham + NS and TAC + NS groups, NS was provided every day intragastrically. Eight weeks after TAC, echocardiography, and cardiac catheterization were performed to evaluate the cardiac function, and immunofluorescent staining with anti-actinin2 antibody was performed to determine the structure of the myocardial fibers. Moreover, TUNEL staining and Masson trichrome staining were employed to assess the effects of QSYQ on cardiac apoptosis and cardiac fibrosis. Western blots and real-time polymerase chain reaction (PCR) were used to measure the expression levels of vascular endothelial growth factor (VEGF) in the heart, and immunohistochemical staining with anti-CD31 antibody was performed to explore the role of QSYQ in cardiac angiogenesis. Results showed that TAC-induced cardiac dysfunction and disrupted structure of myocardial fibers significantly improved after QSYQ treatment. Moreover, QSYQ treatment also significantly improved cardiac apoptosis and cardiac fibrosis in TAC-induced heart failure, which was accompanied by an increase in VEGF expression levels and maintenance of microvessel density in the heart. In conclusion, QSYQ exerts a protective effect on TAC-induced heart failure, which could be attributed to enhanced cardiac angiogenesis

Improving lung cancer prognosis assessment by incorporating synthetic minority oversampling technique and score fusion method

Energy Technology Data Exchange (ETDEWEB)

Yan, Shiju [School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China and School of Electrical and Computer Engineering, University of Oklahoma, Norman, Oklahoma 73019 (United States); Qian, Wei [Department of Electrical and Computer Engineering, University of Texas, El Paso, Texas 79968 and Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang 110819 (China); Guan, Yubao [Department of Radiology, Guangzhou Medical University, Guangzhou 510182 (China); Zheng, Bin, E-mail: Bin.Zheng-1@ou.edu [School of Electrical and Computer Engineering, University of Oklahoma, Norman, Oklahoma 73019 (United States)

2016-06-15

Purpose: This study aims to investigate the potential to improve lung cancer recurrence risk prediction performance for stage I NSCLS patients by integrating oversampling, feature selection, and score fusion techniques and develop an optimal prediction model. Methods: A dataset involving 94 early stage lung cancer patients was retrospectively assembled, which includes CT images, nine clinical and biological (CB) markers, and outcome of 3-yr disease-free survival (DFS) after surgery. Among the 94 patients, 74 remained DFS and 20 had cancer recurrence. Applying a computer-aided detection scheme, tumors were segmented from the CT images and 35 quantitative image (QI) features were initially computed. Two normalized Gaussian radial basis function network (RBFN) based classifiers were built based on QI features and CB markers separately. To improve prediction performance, the authors applied a synthetic minority oversampling technique (SMOTE) and a BestFirst based feature selection method to optimize the classifiers and also tested fusion methods to combine QI and CB based prediction results. Results: Using a leave-one-case-out cross-validation (K-fold cross-validation) method, the computed areas under a receiver operating characteristic curve (AUCs) were 0.716 ± 0.071 and 0.642 ± 0.061, when using the QI and CB based classifiers, respectively. By fusion of the scores generated by the two classifiers, AUC significantly increased to 0.859 ± 0.052 (p < 0.05) with an overall prediction accuracy of 89.4%. Conclusions: This study demonstrated the feasibility of improving prediction performance by integrating SMOTE, feature selection, and score fusion techniques. Combining QI features and CB markers and performing SMOTE prior to feature selection in classifier training enabled RBFN based classifier to yield improved prediction accuracy.

Improving lung cancer prognosis assessment by incorporating synthetic minority oversampling technique and score fusion method

International Nuclear Information System (INIS)

Yan, Shiju; Qian, Wei; Guan, Yubao; Zheng, Bin

2016-01-01

Purpose: This study aims to investigate the potential to improve lung cancer recurrence risk prediction performance for stage I NSCLS patients by integrating oversampling, feature selection, and score fusion techniques and develop an optimal prediction model. Methods: A dataset involving 94 early stage lung cancer patients was retrospectively assembled, which includes CT images, nine clinical and biological (CB) markers, and outcome of 3-yr disease-free survival (DFS) after surgery. Among the 94 patients, 74 remained DFS and 20 had cancer recurrence. Applying a computer-aided detection scheme, tumors were segmented from the CT images and 35 quantitative image (QI) features were initially computed. Two normalized Gaussian radial basis function network (RBFN) based classifiers were built based on QI features and CB markers separately. To improve prediction performance, the authors applied a synthetic minority oversampling technique (SMOTE) and a BestFirst based feature selection method to optimize the classifiers and also tested fusion methods to combine QI and CB based prediction results. Results: Using a leave-one-case-out cross-validation (K-fold cross-validation) method, the computed areas under a receiver operating characteristic curve (AUCs) were 0.716 ± 0.071 and 0.642 ± 0.061, when using the QI and CB based classifiers, respectively. By fusion of the scores generated by the two classifiers, AUC significantly increased to 0.859 ± 0.052 (p < 0.05) with an overall prediction accuracy of 89.4%. Conclusions: This study demonstrated the feasibility of improving prediction performance by integrating SMOTE, feature selection, and score fusion techniques. Combining QI features and CB markers and performing SMOTE prior to feature selection in classifier training enabled RBFN based classifier to yield improved prediction accuracy.

On Chinese-English Translation of Tourist Attraction in Cross-cultural Perspective--Taking Qi Culture as An Example

Institute of Scientific and Technical Information of China (English)

张滕龙

2014-01-01

Tourist textsfeature vividness and distinctiveness and its translation is a typical cross-cultural activity.By applying cross-cultural consciousness to the tourist material's translation, foreigners can understand the cultural connotation easily. Therefore, cross-cultural consciousness plays an important role in the translation of tourist materials.This thesis, taking Qi culture as an exam-ple, explores some typical tourist attractions from perspectives of historical allusions and legend as well as traditional customs. The analysis of Qi cultural connotation concludes business culture, Pu culture and filial piety culture. So, in order to transmit the cul-tural information to foreign tourists accurately, it is necessary to apply inter-cultural consciousness to the translation of tourist texts.

Theory of sinking of qi in treating chronic disease and its clinical application%从大气下陷论治慢性病经验举隅

Institute of Scientific and Technical Information of China (English)

范逸品

2012-01-01

Chronic diseases are usually occult in onset, complicated, recur repeatedly and long-term, treatment-resistant and so on. With the development of the society, environmental and social changes, chronic diseases has been the most dangerous threats to human health. This paper detailed the concept about qi and sinking of qi and pathogenesis, and holds that sinking of qi is closely related to chronic disease. Through the successful case in the treatment of sequela of myocarditis and progressive muscular dystrophy(PMD), we demonstrate the curative effect about theory of sinking of qi in treating chronic diseases, and analysis the advantages about therapy of invigorating qi and ascending qi collapse.%慢性病具有起病隐匿、病因复杂、反复发作、迁延难愈等特点.随着社会发展、环境因素及生活方式的变化,慢性病已逐渐成为威胁人类健康的首要原因.文章叙述了大气和大气下陷概念及病机特点,提出大气下陷与慢性病密切相关,以病毒性心肌炎后遗症与进行性肌营养不良治疗为例,证实了从大气下陷论治慢性病的疗效并分析了益气升陷法的优势作用.

[Profound meaning of acupuncture taboos in Internal Classic based on the fault of reinforcing and reducing technique by mind conduction of acupuncture therapy].

Science.gov (United States)

Qin, Yuge; Wang, Feng; Qin, Yuheng; Li, Li; Li, Mei

2016-05-01

By analyzing the acupuncture taboos in Neijing (Internal Classic) on clinical application of mind conduction of acupuncture therapy in going against the actual situation, astronomy and others, it is found that the relevant acupuncture taboo implies many subtle mysteries of human body, qi, mind and astronomy, which have not been discovered yet in modern science and are very significant in qi protection. In Neijing, the acupuncture physicians have been highly required in the mind treatment, in which, accurately regulating qi circulation is the target in the treatment. The mind conduction is used for qi circulation to accomplish accurately the reinforcing or reducing in the deficiency or excess condition. All of the taboos are provided to normalize the accuracy of reinforcing and reducing technique of acupuncture therapy and avoid the damage of qi in human body. Hence, those taboos must be obeyed so as to prevent from serious consequence and ensure the safety of this acupuncture therapy.

[Learning experience of acupuncture technique from professor ZHANG Jin].

Science.gov (United States)

Xue, Hongsheng; Zhang, Jin

2017-08-12

As a famous acupuncturist in the world, professor ZHANG Jin believes the key of acupuncture technique is the use of force, and the understanding of the "concentrating the force into needle body" is essential to understand the essence of acupuncture technique. With deep study of Huangdi Neijing ( The Inner Canon of Huangdi ) and Zhenjiu Dacheng ( Compendium of Acupuncture and Moxibustion ), the author further learned professor ZHANG Jin 's theory and operation specification of "concentrating force into needle body, so the force arriving before and together with needle". The whole-body force should be subtly focused on the tip of needle, and gentle force at tip of needle could get significant reinforcing and reducing effect. In addition, proper timing at tip of needle could start reinforcing and reducing effect, lead qi to disease location, and achieve superior clinical efficacy.

[Needling technique of Professor Li Yan-Fang].

Science.gov (United States)

Li, Li-Jun

2014-01-01

Experiences of needling techniques of Professor LI Ya- fang is introduced in this article. Gentle and superficial insertion is adopted by Professor LI in clinic. Emphases are put on the qi regulation function, needling sensation to the affected region and insertion with both hands, especially the function of the left hand as pressing hand. The gentle and superficial insertion should be done as the follows: hold the needle with the right hand, press gently along the running course of meridians with the left hand to promote qi circulation, hard pressing should be applied at acupoints to disperse the local qi and blood, insert the needle gently and quickly into the subcutaneous region with the right hand, and stop the insertion when patient has the needling sensation. While the fast needling is characterized with shallow insertion and swift manipulation: the left hand of the manipulator should press first along the running course of the meridian, and fix the local skin, hold the needle with the right hand and insert the needle quickly into the acupoint. Withdrawal of the needle should be done immediately after the reinforcing and reducing manipulations. Professor LI is accomplished in qi regulation. It is held by him that regulating qi circulation is essence of acupuncture, letting the patient get the needling sensation is the most important task of needling. Lifting, thrusting and rotation manipulations should be applied to do reinforcing or reducing. The tissue around the tip of the needle should not be too contracted or too relaxed, and the resistance should not be too strong or too weak. The feeling of the insertion hand of the practitioner should not be too smooth or too hesitant. Needle should be inserted into the skin quickly at the moment of hard pressing by the left hand. And then, slow rotation and gentle lifting and thrusting can be applied to promote the needling sensation like electric current pass through and to reach the affected region along the

[Correlation between spirit-qi acupuncture and lifting-thrusting twirling method for spirit in Huangdi Neijing].

Science.gov (United States)

Wang, Feng; Qin, Yuge; Qin, Yuheng; Li, Li; Li, Mei

2016-03-01

By analyzing the articles in Huangdi Neijing (Inner Canon of Yellow Emperor), combined with the verification of consciousness in vitro in clinic and modern science, it is found Huangdi Neijing has made special requirements of treating spirit for physicians using spirit-qi acupuncture. The physicians consciously use different methods to motivate the spirit of physician and patients, especially patients, to transform it to the physiological effect of patients, which could minimize the psychological factors that make negative influence on treatment; also the psychotherapy is considered as the most important principle of treating spirit. The reinforcing and reducing methods in later generations, mainly lifting-thrusting twirling method, unintentionally lead patients into a basic or strong status of treating spirit or keeping spirit during the process of achieving stimulation and needle sensation. To partially perform the special role of treating spirit for physicians in Huangdi Neijing on patients could cause the chages including patient-based using spirit to move qi. It not only inspires the body's natural resistance to disease and self-healing, but also motivates the self-protection mechanism of keeping spirit.

On the qi deficiency in traditional Chinese medicine.

Science.gov (United States)

Chiang, Hui-Chu; Chang, Hen-Hong; Huang, Po-Yu; Hsu, Mutsu

2014-09-01

Qi deficiency (QD), one of the most common disorders in Traditional Chinese medicine (TCM), is relevant to many disorders in obstetrics and gynecology. This study aimed to identify the common processes and criteria for diagnosing QD among contemporary proficient TCM practitioners. Steps of decision tree analysis and modified Delphi method were merged together into four-round postal questionnaires to collect qualitative and quantitative data. Open-ended questions and content analysis were used to explore the proficient TCM practitioners' cognitive activities used for diagnosis. The statements obtained from the qualitative responses were used to develop the items for subsequent questionnaires. Based on the TCM practitioners' responses, the diagnostic processes and criteria for making diagnosis were generated. Twenty-eight out of the 30 participants completed all four questionnaires from June 2007 to January 2010. The 11 diagnostic procedures identified in the returned first round of questionnaires were used as the alternatives to select and rank for all the steps to diagnose QD. After three more rounds of postal surveys, an algorithm with a five-stage diagnostic process as well as sets of decision criteria were identified. Although the priorities of procedures and descriptions of reasoning were varied, the content revealed the major themes in the model. The criteria to differentiate signs and symptoms (S/S) included five principles for correlating S/S with QD, and 17 S/S should be differentiated carefully. The results demonstrate that the TCM practitioners precisely diagnosed QD using a number of specific procedures and criteria that could be used as a reference to understand women complaining of S/S that could be similar to QD. Copyright © 2014. Published by Elsevier B.V.

[Efficacy of Qilin Pills combined with sertraline in the treatment of secondary non-consolidated kidney qi premature ejaculation].

Science.gov (United States)

Li, Jian-xin; Lu, Qing-ge

2015-05-01

To observe the clinical effectiveness of Qilin Pills combined with sertraline in the treatment of secondary non-consolidated kidney qi premature ejaculation (PE). A total of 120 patients with secondary non-consolidated kidney qi PE were randomly assigned to groups A (aged [35.5 ± 5.4] yr), B (aged [36.2 ± 5.7] yr), and C (aged [35.2 ± 5.3] yr) in the ratio of 1:1:1 to receive Qilin Pills (once 6 g, bid), sertraline (once 50 mg, qd), and Qilin Pills plus sertraline, respectively, all for 4 weeks. The intravaginal ejaculatory latency time (IELT) and PE diagnostic tool (PEDT) scores were obtained before and after medication and at 1 month after drug withdrawal, and comparative analyses were made among the three groups of patients. The IELT was dramatically prolonged in groups A, B, and C after treatment ([3.23 ± 1.84], [3.87 ± 2.43], and [5.92 ± 3.11] min) and at 1 month after drug withdrawal ([1.85 ± 1.27], [1.52 ± 1.06], and [ 4.26 ± 1.88 ] min) as compared with the baseline ([0.88 ± 0.45], [0.84 ± 0.47], and [0.85 ± 0.50] min) (P Pills combined with sertraline has a definite efficacy in the treatment of secondary non-consolidated kidney qi PE and therefore deserves wide clinical application.

The Effects of Yin, Yang and Qi in the Skin on Pain.

Science.gov (United States)

Adams, James David

2016-01-29

The most effective and safe treatment site for pain is in the skin. This chapter discusses the reasons to treat pain in the skin. Pain is sensed in the skin through transient receptor potential cation channels and other receptors. These receptors have endogenous agonists (yang) and antagonists (yin) that help the body control pain. Acupuncture works through modulation of these receptor activities (qi) in the skin; as do moxibustion and liniments. The treatment of pain in the skin has the potential to save many lives and improve pain therapy in most patients.

The Effects of Yin, Yang and Qi in the Skin on Pain

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James David Adams

2016-01-01

Full Text Available The most effective and safe treatment site for pain is in the skin. This chapter discusses the reasons to treat pain in the skin. Pain is sensed in the skin through transient receptor potential cation channels and other receptors. These receptors have endogenous agonists (yang and antagonists (yin that help the body control pain. Acupuncture works through modulation of these receptor activities (qi in the skin; as do moxibustion and liniments. The treatment of pain in the skin has the potential to save many lives and improve pain therapy in most patients.

[Professor LAI Xinsheng's clinical experience in the treatment of premature ovarian failure with tongyuan acupuncture technique and Chinese herbal medicine].

Science.gov (United States)

Li, Xiaozhe; Zhang, Sujuan

2017-03-12

In the treatment of premature ovarian failure (POF), professor LAI Xinsheng focuses on the determination of syndrome to seek for etiology, associating with the differentiation of meridian and collateral and that of zangfu organs. Professor LAI believes that POF is mainly manifested as amenorrhea and infertility, localized in the kidney, with the dysfunction of liver, spleen and heart. It is impacted by many pathological factors, such as cold blockage, qi stagnation, blood stagnation, blood deficiency, yin deficiency, etc., which leads to the damage of the thoroughfare vessel and the conception vessel and the blockage of menstrual flow. On the basis of four diagnostic Methods and syndrome differentiation, there are four common syndromes of POF, named qi and blood deficiency, qi and blood stagnation, liver and kidney deficiency and yang deficiency of spleen and kidney. Tongyuan acupuncture technique is summarized by Professor LAI Xinsheng on the basis of yinyang theory. It is an effective and scientific method for acupoint selection along the meridians. The acupoints on the back, communicating with the governor vessel and mind regulation, acting on the brain are selected to promote yang qi of the governor vessel. The back- shu points of five zang organs are selected to regulate the functions of internal organs. The acupoints on the abdomen and the conception vessel are selected to conduce qi to the primary so as to improve reproductive function. In the guidance of tongyuan acupuncture technique, the acupoint prescription is formed and the Chinese herbal medicines are selected in combination to improve ovarian function and regulate menstruation. Hence, the satisfactory therapeutic effects have been achieved.

78 FR 56264 - Big Bear Mining Corp., Four Rivers BioEnergy, Inc., Mainland Resources, Inc., QI Systems Inc...

Science.gov (United States)

2013-09-12

... SECURITIES AND EXCHANGE COMMISSION [File No. 500-1] Big Bear Mining Corp., Four Rivers BioEnergy, Inc., Mainland Resources, Inc., QI Systems Inc., South Texas Oil Co., and Synova Healthcare Group, Inc... that there is a lack of current and accurate information concerning the securities of Big Bear Mining...

ANALYSIS OF RELATIONS BETWEEN JUDO TECHNIQUES AND SPECIFIC MOTOR ABILITIES

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Patrik Drid

2006-06-01

Full Text Available Specific physical preparation affects the development of motor abilities required for execution of specific movements in judo. When selecting proper specific exercises for judo for a target motor ability, it is necessary to precede it with the study of the structure of specific judo techniques and activities of individual muscle groups engaged for execution of the technique. On the basis of this, one can understand which muscles are most engaged during realization of individual techniques, which serves as a standpoint for selection of a particular complex of specific exercises to produce the highest effects. In addition to the development of particular muscle groups, the means of specific preparation will take effect on the development of those motor abilities which are evaluated as the indispensable for the development of particular qualities which are characteristic for judo. This paper analyses the relationship between judo techniques field and specific motor abilities.

Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability?An Emerging Framework

OpenAIRE

Holve, Erin

2013-01-01

Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four ?pillars? of sustainability are discussed based on the experiences of...

[Effect of protein intervention on amino acid metabolism spectrum of Qi and Yin deficiency type 2 diabetic rats].

Science.gov (United States)

Ma, Li-Na; Mao, Xin-Min; Ma, Xiao-Li; Li, Lin-Lin; Wang, Ye; Tao, Yi-Cun; Wang, Jing-Wei; Guo, Jia-Jia; Lan, Yi

2016-11-01

To study the effect of plant protein and animal protein on amino acid metabolism spectrum of Qi and Yin deficiency type 2 diabetic rats. 110 male SD rats were randomly divided into blank group (n=10), diabetic model group (n=20), disease-symptoms group (n=80). The rats of blank group received ordinary feeding, while other groups were fed with high sugar and fat diets. During the whole process of feeding, rats of disease-symptoms group were given with Qingpi-Fuzi (15.75 g•kg⁻¹) once a day through oral administration. Five weeks later, the rats were given with a low dose of STZ (40 mg•kg⁻¹) by intraperitoneal injection to establish experimental diabetic models. Then the models were randomly divided into disease-symptoms group 1 (Qi and Yin deficiency diabetic group, 15.75 g•kg⁻¹), disease-symptoms group 2 (plant protein group, 0.5 g•kg⁻¹), disease-symptoms group 3 (animal protein group, 0.5 g•kg⁻¹), disease-symptoms group 4 (berberine group, 0.1 g•kg⁻¹). The drugs were given for 4 weeks by gavage administration. After 4 weeks of protein intervention, the abdominal aortic blood was collected and serum was isolated to analyze its free amino acid by using AQC pre-column derivatization HPLC and fluorescence detector. Four weeks after the protein intervention, plant protein, animal protein and berberine had no obvious effect on body weight and blood sugar in type 2 diabetic rats. As compared with animal protein group, histidine and proline（PYin deficiency type 2 diabetic SD rats. Symbolic differential compounds could be found through metabonomics technology, providing experimental basis for early warning of type 2 diabetes and diagnosis of Qi and Yin deficiency syndrome. Copyright© by the Chinese Pharmaceutical Association.

MO-C-12A-01: Quantitative Imaging Initiatives: Why, Who, What, and How?

Energy Technology Data Exchange (ETDEWEB)

Sullivan, D [Duke University, Durham, NC (United States); Jackson, E; Clarke, L; Petrick, N; Russek, S [University of Wisconsin, Madison, WI (United States)

2014-06-15

Over the past decade, there has been an increasing focus on quantitative imaging (QI), which, according to one definition, is “the extraction of quantifiable features from medical images for the assessment of normal or the severity, degree of change, or status of a disease, injury, or chronic condition relative to normal” ( www.rsna.org/QIBA ). To achieve the goals of QI requires the development and standardization of data acquisition, data analysis, and data display techniques, as well as appropriate reporting structures. As such, successful implementation of QI relies heavily on expertise from the fields of medical physics, radiology, statistics, and informatics as well as collaboration from vendors of imaging acquisition, analysis, and reporting systems. When successfully implemented, QI techniques will provide image-derived metrics with known bias and variance that can be validated with anatomically and physiologically relevant measures, including treatment response, and the heterogeneity of that response, and outcome. Such non-invasive measures can then be used effectively in clinical and translational research as well as patient care. In addition to modality-specific QI efforts implemented by individual scientific organizations, national and international organizations, including the NCI, RSNA, FDA, and NIST, appreciating the tremendous potential of QI but also understanding the associated challenges, have become increasingly involved. This symposium session will focus on 1) introducing QI and illustrating why it is important, even though challenging, in both research and clinical applications, and 2) providing overviews of QI efforts from national and international organizations, including the RSNA, NCI, FDA, and NIST. Learning Objectives: Understand the importance and potential of QI in research and clinical applications. Understand key challenges of QI and current barriers to implementation. Understand the current QI efforts of several national and

MO-C-12A-01: Quantitative Imaging Initiatives: Why, Who, What, and How?

International Nuclear Information System (INIS)

Sullivan, D; Jackson, E; Clarke, L; Petrick, N; Russek, S

2014-01-01

Over the past decade, there has been an increasing focus on quantitative imaging (QI), which, according to one definition, is “the extraction of quantifiable features from medical images for the assessment of normal or the severity, degree of change, or status of a disease, injury, or chronic condition relative to normal” ( www.rsna.org/QIBA ). To achieve the goals of QI requires the development and standardization of data acquisition, data analysis, and data display techniques, as well as appropriate reporting structures. As such, successful implementation of QI relies heavily on expertise from the fields of medical physics, radiology, statistics, and informatics as well as collaboration from vendors of imaging acquisition, analysis, and reporting systems. When successfully implemented, QI techniques will provide image-derived metrics with known bias and variance that can be validated with anatomically and physiologically relevant measures, including treatment response, and the heterogeneity of that response, and outcome. Such non-invasive measures can then be used effectively in clinical and translational research as well as patient care. In addition to modality-specific QI efforts implemented by individual scientific organizations, national and international organizations, including the NCI, RSNA, FDA, and NIST, appreciating the tremendous potential of QI but also understanding the associated challenges, have become increasingly involved. This symposium session will focus on 1) introducing QI and illustrating why it is important, even though challenging, in both research and clinical applications, and 2) providing overviews of QI efforts from national and international organizations, including the RSNA, NCI, FDA, and NIST. Learning Objectives: Understand the importance and potential of QI in research and clinical applications. Understand key challenges of QI and current barriers to implementation. Understand the current QI efforts of several national and

"Warming yang and invigorating qi" acupuncture alters acetylcholine receptor expression in the neuromuscular junction of rats with experimental autoimmune myasthenia gravis

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Hai-peng Huang

2016-01-01

Full Text Available Myasthenia gravis is an autoimmune disorder in which antibodies have been shown to form against the nicotinic acetylcholine nicotinic postsynaptic receptors located at the neuromuscular junction. "Warming yang and invigorating qi" acupuncture treatment has been shown to reduce serum inflammatory cytokine expression and increase transforming growth factor beta expression in rats with experimental autoimmune myasthenia gravis. However, few studies have addressed the effects of this type of acupuncture on the acetylcholine receptors at the neuromuscular junction. Here, we used confocal laser scanning microscopy to examine the area and density of immunoreactivity for an antibody to the nicotinic acetylcholine receptor at the neuromuscular junction in the phrenic nerve of rats with experimental autoimmune myasthenia gravis following "warming yang and invigorating qi" acupuncture therapy. Needles were inserted at acupressure points Shousanli (LI10, Zusanli (ST36, Pishu (BL20, and Shenshu (BL23 once daily for 7 consecutive days. The treatment was repeated after 1 day of rest. We found that area and the integrated optical density of the immunoreactivity for the acetylcholine receptor at the neuromuscular junction of the phrenic nerve was significantly increased following acupuncture treatment. This outcome of the acupuncture therapy was similar to that of the cholinesterase inhibitor pyridostigmine bromide. These findings suggest that "warming yang and invigorating qi" acupuncture treatment increases acetylcholine receptor expression at the neuromuscular junction in a rat model of autoimmune myasthenia gravis.

Alteration of radiation-induced hematotoxicity by Bu-Zhong-Yi-Qi-Tang in mouse

International Nuclear Information System (INIS)

Jang, Jong Sik; Kim, Sung Ho

2008-01-01

The purpose of this study reported here was to investigate the ability of Bu-Zhong-Yi-Qi-Tang (BZYQT), known to elevate hematopoietic functions, to protect mice undergoing treatment with whole body single gamma-irradiation. BZYQT was given (25 mg/kg B.W.) intraperitoneally at 36 and 12 hours before irradiation and 30 minute and 24 hours after irradiation. Recovery of neutrophil and lymphocyte counts was significantly stimulated by extract of BZYQT. Stimulated recovery by the extract from the BZYQT was also observed in thrombocytes. However, the anti-radiation effect of erythrocyte, hemoglobin and hematocrit was not as significant as that of leukocyte. Further studies are needed to better characterize the protective nature of BZYQT extract and its ingredients

Alteration of radiation-induced hematotoxicity by Bu-Zhong-Yi-Qi-Tang in mouse

Energy Technology Data Exchange (ETDEWEB)

Jang, Jong Sik [Kyungpook National University, Daegu (Korea, Republic of); Kim, Sung Ho [Chonnam National University, Gwangju (Korea, Republic of)

2008-09-15

The purpose of this study reported here was to investigate the ability of Bu-Zhong-Yi-Qi-Tang (BZYQT), known to elevate hematopoietic functions, to protect mice undergoing treatment with whole body single gamma-irradiation. BZYQT was given (25 mg/kg B.W.) intraperitoneally at 36 and 12 hours before irradiation and 30 minute and 24 hours after irradiation. Recovery of neutrophil and lymphocyte counts was significantly stimulated by extract of BZYQT. Stimulated recovery by the extract from the BZYQT was also observed in thrombocytes. However, the anti-radiation effect of erythrocyte, hemoglobin and hematocrit was not as significant as that of leukocyte. Further studies are needed to better characterize the protective nature of BZYQT extract and its ingredients.

Improving cachectic symptoms and immune strength of tumour-bearing mice in chemotherapy by a combination of Scutellaria baicalensis and Qing-Shu-Yi-Qi-Tang.

Science.gov (United States)

Wang, Hang; Chan, Yi-Lin; Li, Tsung-Lin; Wu, Chang-Jer

2012-05-01

Cancer cachexia is characterised by the loss of body mass and directly compromises immune response and the quality of life of cancer patients. In the present study, we set out to investigate the role of Chinese herbs as anticancer medicines and/or chemotherapeutic adjuvants to increase therapeutic efficacy and/or ameliorate given side-effects in animal model. Twelve kinds of herbs were chosen from the ingredients of major Chinese herbal medicines, and their effects on the antioxidant activity were investigated. To obtain the anticancer effects of 5-fluorouracil (5-FU) when consumed with minimal side-effects, we investigated the combination effect of Scutellaria baicalensis and Qing-Shu-Yi-Qi-Tang that may enhance the anticancer activity of 5-FU on subcutaneous tumour growth in C57BL/6 mice challenged with Lewis lung carcinoma cells. Qing-Shu-Yi-Qi-Tang, a multiple-component herbal extract, was shown to have high anti-oxidation activity, while S. baicalensis (Chinese skullcap) was demonstrated to have high tumour-growth inhibition activity. Thus, S. baicalensis and Qing-Shu-Yi-Qi-Tang were evaluated for their combinaton effects on the cancer-induced cachectic murine upon receiving 5-FU chemotherapy. As a result, tumour masses and losses of carcass and/or gastrocnemius muscle were found to be significantly decreased. This combination otherwise increased both Th1/Th2 ratio and NK cytotoxicity. In the mice receiving with or without 5-FU, the serum levels of monocyte chemoattractant protein-1 (MCP-1) increased by all means but otherwise decreased when the herbal combination was administrated. Additionally, the expressions of nuclear factor-kappa B (NF-κB) and muscle RING finger protein-1 (MuRF-1) decreased in the gastrocnemius muscle when the herbal combination was applied. Our results revealed that the combination of S. baicalensis and Qing-Shu-Yi-Qi-Tang is able to ameliorate cachectic symptoms and positively stimulate anti-tumour immunity while undergoing

Viabilidade da estimativa de QI a partir dos subtestes Vocabulário e Cubos da WAIS-III Viability of IQ estimates based on Vocabulary and Block Design WAIS-III subtests

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Flávia Wagner

2010-08-01

Full Text Available Objetivou-se avaliar a viabilidade de estimar o Quociente de Inteligência (QI de adultos por meio de duas estratégias que utilizam uma forma curta constituída pelos subtestes Vocabulário e Cubos da Escala Wechsler de Inteligência para Adultos (WAIS-III. Participaram do estudo 77 homens e mulheres, com idade média de 39,1 anos (dp=13,4. Foi aplicada a WAIS-III e questionários para cumprir os critérios de inclusão dos participantes sem prejuízos neurológicos e psiquiátricos. Para avaliar a concordância entre as duas estratégias de estimar o QI, utilizou-se o método estatístico proposto por Bland e Altman. Como resultado, encontrou-se que as estimativas de QI geradas pelas duas estratégias apresentam concordância com a medida do QI realizada pela aplicação da escala completa apenas em alguns dos casos avaliados. Sugere-se cautela na utilização dessas estratégias para estimar o QI de adultos.The aim of this study was to evaluate the feasibility of estimating the Intelligence Quotient (IQ in adults based on two strategies that use Vocabulary and Block Design subtests of Wechsler Adult Intelligence Scale (WAIS-III. Seventy-seven men and women participated of the study, with mean age of 39.1 (sd=13.4. WAIS-III subtests were administered and questionnaires were used to verify inclusion criteria for participants without neurological or psychiatric impairments. A statistical method proposed by Bland and Altman was used to evaluate the agreement between both strategies to estimate IQ. Results suggest that IQ estimates derived from both strategies only agree with the IQ derived from the full battery in a few cases of the sample. Considering these findings, caution is suggested when using these strategies to estimate adults' IQ.

Information Requirements Specification II: Brainstorming Collective Decision-Making Technique.

Science.gov (United States)

Telem, Moshe

1988-01-01

Information requirements specification (IRS) constitutes an Achilles heel in the system life cycle of management information systems. This article establishes a systematic overall IRS technique applicable to organizations of all types and sizes. The technique's integration of brainstorming and theory Z principles creates an effective, stimulating,…

Developing a taxonomy for the science of improvement in public health.

Science.gov (United States)

Riley, William; Lownik, Beth; Halverson, Paul; Parrotta, Carmen; Godsall, Jonathan R; Gyllstrom, Elizabeth; Gearin, Kimberly J; Mays, Glen

2012-11-01

Quality improvement (QI) methods have been used for almost a decade in public health departments to increase effectiveness and efficiency. Although results are rapidly accumulating, the evidence for the science of improvement is shallow and limited. To advance the use and effectiveness of QI in public health, it is important to develop a science of improvement using practice-based research to build an evidence base for QI projects. This purpose of this study is to advance the science of improvement in public health departments with 3 objectives: (1) establish a taxonomy of QI projects in public health, (2) categorize QI projects undertaken in health departments using the taxonomy, and (3) create an opportunity modes and effects analysis. This study is a qualitative analysis of archival data from 2 separate large databases consisting of 51 QI projects undertaken in public health departments over the last 5 years. The study involves 2 separate QI collaboratives. One includes Minnesota health departments; the other is a national collaborative. We propose a standardized case definition, common metrics, and a taxonomy of QI projects to begin building the evidence base for QI in public health and to advance the science of continuous quality improvement. All projects created an aim statement and used metrics while 53% used a specific QI model with an average of 3.25 QI techniques per project. Approximately 40% of the projects incorporated a process control methodology, and 60% of the projects identified the process from beginning to end, while 11 of 12 PHAB (Public Health Accreditation Board) domains were included. The findings provide a baseline for QI taxonomy to operationalize a science of improvement for public health departments.

A ginástica terapêutica e preventiva chinesa Lian Gong/Qi Gong como um dos instrumentos na prevenção e reabilitação da LER/DORT

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Gutembergue Livramento

Full Text Available Este ensaio traz elementos da medicina ocidental, da medicina tradicional chinesa e da sociologia do trabalho para reflexão sobre o Qi Gong - exercícios terapêuticos, um dos pilares da Medicina Tradicional Chinesa (MTC - como importante meio de prevenção da LER/DORT e recuperação da saúde. Considerando a natureza interdisciplinar e diversos níveis de prevenção, aborda aspectos sociológicos sobre as condições de trabalho frequentemente relacionadas com este tipo de adoecimento e categorias de trabalhadores mais acometidos. Focaliza aspectos médicos sobre a LER/DORT e as Síndromes de Bloqueio na MTC, estabelecendo canais de articulação e contribuição entre esses campos de conhecimento sobre a saúde humana. Ressalta o Qi Gong como importante prática terapêutica e preventiva na MTC e sua adequação à LER/DORT. No âmbito do Qi Gong, focaliza o Lian Gong Shi Ba Fa - Lian Gong em 18 Terapias, já amplamente experimentado na China e divulgado, inclusive no Brasil, para tratar e prevenir síndromes de dor em região cervical, ombros, membros superiores, membros inferiores e região lombar. À guisa de conclusão, são apresentadas algumas reflexões sobre a propriedade e a importância do Qi Gong na reabilitação e na prevenção da LER/DORT.

Role of phosphatase and tensin homolog deleted on chromosome ten in a rat model of carbon tetrachloride-induced liver fibrosis and the effect of qi-tonifying and blood-activating prescription

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NIU Xuemin

2018-01-01

Full Text Available Objective To investigate the role of phosphatase and tensin homology deleted on chromosome ten (PTEN in a rat model of carbon tetrachloride (CCl4-induced liver fibrosis and the molecular mechanism of action of qi-tonifying and blood-activating prescription in regulating PTEN and inhibiting liver fibrosis. Methods A total of 27 male Wistar rats were randomly divided into three groups, with 9 rats in each group. The rats in liver fibrosis group were treated with CCl4 to establish a model of liver fibrosis, and those in qi-tonifying and blood-activating prescription group were also treated with CCl4 to establish a model and then given a self-made qi-tonifying and blood-activating prescription containing Astragalus membranaceus, Salvia miltiorrhiza, and poria. The rats in the control group were given intraperitoneally injected olive oil. HE staining, Masson staining, and immunohistochemical staining of collagen type I alpha 1 (Col1A1 and collagen type Ⅳ (Col4 were performed to observe the degree of liver fibrosis and collagen deposition; qRT-PCR, immunohistochemistry, and Western blot were used to measure the expression of transforming growth factor-β1 (TGF-β1, PTEN, and downstream genes AKT, mTOR, and p70S6K. A one-way analysis of variance was used for comparison of continuous data between multiple groups and the least significant difference t-test was used for further comparison between any two groups. Results In the liver fibrosis group, liver pathology showed perisinusoidal fibrosis and fibrous tissue proliferation, collagen deposition, and formation of fibrous septum in the portal area; compared with the control group, the liver fibrosis group had significant increases in the mRNA and protein expression of TGF-β1, a significant reduction in the expression of PTEN, and significant increases in the mRNA and phosphorylated protein expression of AKT, mTOR, and p70S6K (all P＜0.01. The qi-tonifying and blood-activating prescription group had a

SLAP: Specification logic of actions with probability

CSIR Research Space (South Africa)

Rens, G

2014-06-01

Full Text Available )|. Let W (Γ)# = (w1, w2, . . . , wn) be an ordering of the worlds in W (Γ). With each world wk ∈ W (Γ)#, we associate a rational variable prk ∈ Q[0,1]. One can generate ci,1pr1 + ci,2pr2 + · · ·+ ci,nprn = qi, for a formula (x, [α]qiϕi) ∈ Γ and ci,1pr1...

Statistical and Economic Techniques for Site-specific Nematode Management.

Science.gov (United States)

Liu, Zheng; Griffin, Terry; Kirkpatrick, Terrence L

2014-03-01

Recent advances in precision agriculture technologies and spatial statistics allow realistic, site-specific estimation of nematode damage to field crops and provide a platform for the site-specific delivery of nematicides within individual fields. This paper reviews the spatial statistical techniques that model correlations among neighboring observations and develop a spatial economic analysis to determine the potential of site-specific nematicide application. The spatial econometric methodology applied in the context of site-specific crop yield response contributes to closing the gap between data analysis and realistic site-specific nematicide recommendations and helps to provide a practical method of site-specifically controlling nematodes.

[The essence of Professor Wu Lian-Zhong's acupuncture manipulation].

Science.gov (United States)

Liu, Jing; Guo, Yi; Wu, Lian-Zhong

2014-05-01

The painless needle insertion technique, summarized by Professor WU Lian-zhong during his decades of acupuncture clinical practice is introduced in this article, which is characterized as soft, flexible, fast, plucking and activating antipathogenic qi. The Sancai (three layers) lifting and thrusting manipulation technique is adopted by Professor WU for getting the qi sensation. And features of 10 kinds of needling sensation such as soreness, numbness, heaviness, distension, pain, cold, hot, radiation, jumping and contracture are summarized. Finger force, amplitude, speed and time length are also taken as the basis of reinforcing and reducing manipulations. Moreover, examples are also given to explain the needling technique on some specific points which further embodies Professor WU's unique experiences and understandings on acupuncture.

The influence of intestine-based treatment using Xuan Bai Cheng Qi Tang on the concentration of trace elements in the main organs of COPD rats

Directory of Open Access Journals (Sweden)

Jiamin Yang

2017-01-01

Conclusion: This study showed that “treating from the intestine” using Xuan Bai Cheng Qi Tang and its modified formulae can regulate the concentration of trace elements in the main organs of COPD rats. This may be one of the mechanisms for intestine-based treatment for COPD.

[Experimental study on the treatment of serious soft tissue injuries with strengthening the spleen and replenishing qi].

Science.gov (United States)

Chen, Xun-wen; Zhu, Yong-zhan; Chen, Zhi-wei; Wu, Zheng-jie; He, Li-lei

2008-09-01

To study the effects of Chinese drugs based on strengthening the spleen and replenishing qi treatment rule on neoformative capillaries and fibroblast during the soft tissue repair after serious trauma in rats, so as to explore the biological basis of the TCM theory "the spleen dominate extremities and muscles" applied to the treatment of soft tissue injuries. The model rats were established by bleeding from femoral artery and lancing method, and the rats were randomly divided into the control group, strengthening the spleen group and activating blood and resolving stasis group. The samples were got from the tissue of the wounded area at the 5th, 10th and 15th days after oral administration of the traditional Chinese medicine. After fixation and section, the tissues were stained by CD31 and PCNA staining. The amount of the capillaries and fibroblasts in the tissue of the wounded area were observed through multi-purpose microscope (ZEISS Axioskop2). Quantitative analysis was carried out on Image-ProPlus image analyzer. The amount of the capillaries and fibroblasts in the wounded tissue in the strengthening the spleen group were larger than that in the control group at the 5th, 10th and 15th day. And the proliferation speed of capillaries and fibroblasts was faster than those in the control group or the activating blood and resolving stasis group. The Chinese drugs according to strengthening the spleen and replenishing qi treatment rule were effective to promote growth of the granulation tissue and facilitate healing of the wounded area. And it has better effect than the treatment of promoting blood circulation and removing stasis.

[Health assessment of Qi'ao Island mangrove wetland ecosystem in Pearl River Estuary].

Science.gov (United States)

Wang, Shu-Gong; Zheng, Yao-Hui; Peng, Yi-Sheng; Chen, Gui-Zhu

2010-02-01

Based on the theories of wetland ecosystem health and by using "Pressure-State-Response" model, a health assessment indicator system for Qi' ao Island mangrove wetland ecosystem in Pearl River Estuary was built, and the assessment indices, assessment criteria, indices weighted values, assessment grades, and assessment methods were established to assess the health state of this ecosystem. In 2008, the overall health index of this ecosystem was 0.6580, health level was of grade II (healthy), and the pressure, state, and response indices were 0.3469, 0.8718, and 0.7754, respectively, suggesting that this ecosystem was good in state and response, but still had definite pressure. As a provincial nature reserve, this ecosystem was to be further improved in its health level. However, the research on the health assessment of mangrove wetland ecosystem was still young. Further studies should be made on the selection of assessment indices, long-term oriented monitoring of these indices, and quantification of the relations between ecosystem health level and ecosystem services.

Specificity and sensitivity assessment of selected nasal provocation testing techniques

Directory of Open Access Journals (Sweden)

Edyta Krzych-Fałta

2016-12-01

Full Text Available Introduction: Nasal provocation testing involves an allergen-specific local reaction of the nasal mucosa to the administered allergen. Aim: To determine the most objective nasal occlusion assessment technique that could be used in nasal provocation testing. Material and methods : A total of 60 subjects, including 30 patients diagnosed with allergy to common environmental allergens and 30 healthy subjects were enrolled into the study. The method used in the study was a nasal provocation test with an allergen, with a standard dose of a control solution and an allergen (5,000 SBU/ml administered using a calibrated atomizer into both nostrils at room temperature. Early-phase nasal mucosa response in the early phase of the allergic reaction was assessed via acoustic rhinometry, optical rhinometry, nitric oxide in nasal air, and tryptase levels in the nasal lavage fluid. Results : In estimating the homogeneity of the average values, the Levene’s test was used and receiver operating characteristic curves were plotted for all the methods used for assessing the nasal provocation test with an allergen. Statistically significant results were defined for p < 0.05. Of all the objective assessment techniques, the most sensitive and characteristic ones were the optical rhinometry techniques (specificity = 1, sensitivity = 1, AUC = 1, PPV = 1, NPV = 1. Conclusions : The techniques used showed significant differences between the group of patients with allergic rhinitis and the control group. Of all the objective assessment techniques, those most sensitive and characteristic were the optical rhinometry.

Assessment of Electromagnetic Interference with Active Cardiovascular Implantable Electronic Devices (CIEDs) Caused by the Qi A13 Design Wireless Charging Board.

Science.gov (United States)

Seckler, Tobias; Jagielski, Kai; Stunder, Dominik

2015-05-27

Electromagnetic interference is a concern for people wearing cardiovascular implantable electronic devices (CIEDs). The aim of this study was to assess the electromagnetic compatibility between CIEDs and the magnetic field of a common wireless charging technology. To do so the voltage induced in CIEDs by Qi A13 design magnetic fields were measured and compared with the performance limits set by ISO 14117. In order to carry this out a measuring circuit was developed which can be connected with unipolar or bipolar pacemaker leads. The measuring system was positioned at the four most common implantation sites in a torso phantom filled with physiological saline solution. The phantom was exposed by using Helmholtz coils from 5 µT to 27 µT with 111 kHz sine‑bursts or by using a Qi A13 design wireless charging board (Qi‑A13‑Board) in two operating modes "power transfer" and "pinging". With the Helmholtz coils the lowest magnetic flux density at which the performance limit was exceeded is 11 µT. With the Qi‑A13‑Board in power transfer mode 10.8% and in pinging mode 45.7% (2.2% at 10 cm distance) of the performance limit were reached at maximum. In neither of the scrutinized cases, did the voltage induced by the Qi‑A13‑Board exceed the performance limits.

Strategies for addressing barriers to publishing pediatric quality improvement research.

Science.gov (United States)

Van Cleave, Jeanne; Dougherty, Denise; Perrin, James M

2011-09-01

Advancing the science of quality improvement (QI) requires dissemination of the results of QI. However, the results of few QI interventions reach publication. To identify barriers to publishing results of pediatric QI research and provide practical strategies that QI researchers can use to enhance publishability of their work. We reviewed and summarized a workshop conducted at the Pediatric Academic Societies 2007 meeting in Toronto, Ontario, Canada, on conducting and publishing QI research. We also interviewed 7 experts (QI researchers, administrators, journal editors, and health services researchers who have reviewed QI manuscripts) about common reasons that QI research fails to reach publication. We also reviewed recently published pediatric QI articles to find specific examples of tactics to enhance publishability, as identified in interviews and the workshop. We found barriers at all stages of the QI process, from identifying an appropriate quality issue to address to drafting the manuscript. Strategies for overcoming these barriers included collaborating with research methodologists, creating incentives to publish, choosing a study design to include a control group, increasing sample size through research networks, and choosing appropriate process and clinical quality measures. Several well-conducted, successfully published QI studies in pediatrics offer guidance to other researchers in implementing these strategies in their own work. Specific, feasible approaches can be used to improve opportunities for publication in pediatric, QI, and general medical journals.

Incidencia de Mindfulness y Qi Gong sobre el Estado de Salud, Bienestar Psicológico, Satisfacción Vital y Estrés Laboral

Directory of Open Access Journals (Sweden)

Luis Armando Oblitas Guadalupe

2017-02-01

Full Text Available El presente estudio se realizó a través de un abordaje metodológico pre-experimental con medidas de tipo pre-test y post-test. Participaron 52 trabajadores de la Universidad de la Costa (Barranquilla, Colombia, quienes asistieron por invitación al taller de ocho horas de mindfulness y qi gong para el mejoramiento de la salud, bienestar psicológico, satisfacción vital y reducción del estrés. Los instrumentos utilizados fueron el Cuestionario de Salud sf-11, Escala de Bienestar Psicológico (Ryff & Keyes, 1995, Escala de Satisfacción Vital (Cortés, 2013 y Escala Numérica de Estrés Laboral. La combinación de mindfulness y qi gong produjo una mejoría en el estado de salud de los trabajadores —salud general, energía, eficiencia, actividades domésticas y disminución del dolor—, cambios importantes en el bienestar psicológico —adaptación, confianza, claridad, apertura y autoestima—, y mejoramiento de la satisfacción vital —salud y productividad—. No se encontraron diferencias significativas en los niveles de estrés laboral.

[Retrospective analysis of risk factors in 900 patients with ischemic cerebral stroke of wind-phlegm collateral obstruction syndrome and qi deficiency blood stasis syndrome in Wuhan District].

Science.gov (United States)

Qiu, Xin; Wang, Kai-xin; Chen, Guo-hua

2011-11-01

To analyze the correlation between risk factors and ischemic cerebral stroke of wind-phlegm collateral obstruction syndrome and qi deficiency blood stasis syndrome. Totally 900 patients of the two syndrome types were recruited. Risk factors correlated to ischemic cerebral stroke such as gender, age, time of onset, site of infarction, tongue proper, tongue fur, pulse picture, hypertension, diabetes, past stroke history, hyperlipidemia, hematocrit, smoking, drinking, genetic factor, blood type, complications were analyzed using Chi-square test and non-conditional Logistic regression analysis. Statistical significance existed between the two syndrome types in age (X2 = 8.2392, P = 0.0413), hyperlipidemia (X2 = 4.8386, P = 0.0278), tongue proper (X2 = 7.9470, P = 0.0048), and tongue fur (X2 = 4.3298, P = 0.0375). Statistical significance existed between the two syndrome types in hyperlipidemia, tongue proper, and tongue fur, and their OR value was 0.699 (P = 0.0282), 0.332 (P =0.0071), and 0.667 (P = 0.0382) respectively. The OR value of the past stroke history was 3.226 (P = 0.0314), that of complications 0.203 (P = 0.0705), and that of anterior circulation infarction 0.214 (P = 0.0098). Among different ages groups, the constituent ratio of qi deficiency blood stasis syndrome was obviously higher than that of wind-phlegm collateral obstruction syndrome. Besides, patients of qi deficiency blood stasis syndrome were liable to suffer from hyperlipidemia, anterior circulation infarction, and complications. The age, blood lipid levels, site of infarction, complications are closely correlated with Chinese syndrome types of ischemic cerebral stroke, which can provide objective indices for typing ischemic cerebral stroke.

Lipidomics study of plasma phospholipid metabolism in early type 2 diabetes rats with ancient prescription Huang-Qi-San intervention by UPLC/Q-TOF-MS and correlation coefficient.

Science.gov (United States)

Wu, Xia; Zhu, Jian-Cheng; Zhang, Yu; Li, Wei-Min; Rong, Xiang-Lu; Feng, Yi-Fan

2016-08-25

Potential impact of lipid research has been increasingly realized both in disease treatment and prevention. An effective metabolomics approach based on ultra-performance liquid chromatography/quadrupole-time-of-flight mass spectrometry (UPLC/Q-TOF-MS) along with multivariate statistic analysis has been applied for investigating the dynamic change of plasma phospholipids compositions in early type 2 diabetic rats after the treatment of an ancient prescription of Chinese Medicine Huang-Qi-San. The exported UPLC/Q-TOF-MS data of plasma samples were subjected to SIMCA-P and processed by bioMark, mixOmics, Rcomdr packages with R software. A clear score plots of plasma sample groups, including normal control group (NC), model group (MC), positive medicine control group (Flu) and Huang-Qi-San group (HQS), were achieved by principal-components analysis (PCA), partial least-squares discriminant analysis (PLS-DA) and orthogonal partial least-squares discriminant analysis (OPLS-DA). Biomarkers were screened out using student T test, principal component regression (PCR), partial least-squares regression (PLS) and important variable method (variable influence on projection, VIP). Structures of metabolites were identified and metabolic pathways were deduced by correlation coefficient. The relationship between compounds was explained by the correlation coefficient diagram, and the metabolic differences between similar compounds were illustrated. Based on KEGG database, the biological significances of identified biomarkers were described. The correlation coefficient was firstly applied to identify the structure and deduce the metabolic pathways of phospholipids metabolites, and the study provided a new methodological cue for further understanding the molecular mechanisms of metabolites in the process of regulating Huang-Qi-San for treating early type 2 diabetes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Treatment of Motor Neuron Disease with Qi-invigorating Herbs—— A Report of 31 Cases

Institute of Scientific and Technical Information of China (English)

覃小兰; 杨志敏; 何德平; 刘旭生; 陈红霞; 黄燕; 张文青

2002-01-01

@@ The motor neuron disease (MND) refers to a group of progressive diseases with unknown reasons, which attacks the cells of the anterior horn of the spinal cord, the motor nuclei of the brain stem cranial nerves and the pyramidal cells of the cerebral motor cortex. It is characterized in clinic by atrophy of the muscles, myasthenia and even death due to paralysis of the respiratory muscle. Currently, there is still no any effective cure for this illness. 50-70% of the victims will die in 3 to 5 years, and the survival time for those with brain stem injuries is no more than two years.1 Since 1996, the authors have treated 31 cases of motor neuron disease with large dosage of qi-invigorating drugs in accordance with Prof. Liu Mocai's experience, and obtained certain therapeutic effects. A report follows.

An introduction to Kundalini yoga meditation techniques that are specific for the treatment of psychiatric disorders.

Science.gov (United States)

Shannahoff-Khalsa, David S

2004-02-01

The ancient system of Kundalini yoga includes a vast array of meditation techniques and many were discovered to be specific for treating the psychiatric disorders as we know them today. One such technique was found to be specific for treating obsessive-compulsive disorder (OCD), the fourth most common psychiatric disorder, and the tenth most disabling disorder worldwide. Two published clinical trials are described here for treating OCD using a specific Kundalini yoga protocol. This OCD protocol also includes techniques that are useful for a wide range of anxiety disorders, as well as a technique specific for learning to manage fear, one for tranquilizing an angry mind, one for meeting mental challenges, and one for turning negative thoughts into positive thoughts. Part of that protocol is included here and published in detail elsewhere. In addition, a number of other disorder-specific meditation techniques are included here to help bring these tools to the attention of the medical and scientific community. These techniques are specific for phobias, addictive and substance abuse disorders, major depressive disorders, dyslexia, grief, insomnia and other sleep disorders.

Comparison of practice based research network based quality improvement technical assistance and evaluation to other ongoing quality improvement efforts for changes in agency culture.

Science.gov (United States)

Livingood, William C; Peden, Angela H; Shah, Gulzar H; Marshall, Nandi A; Gonzalez, Ketty M; Toal, Russell B; Alexander, Dayna S; Wright, Alesha R; Woodhouse, Lynn D

2015-07-31

Public health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance. Many of the functional and structural barriers to effective use of QI can be found in the organizational culture of public health agencies. The purpose of this study was to assess the impact of public health practice based research network (PBRN) evaluation and technical assistance for QI interventions on the organizational culture of public health agencies in Georgia, USA. An online survey of key informants in Georgia's districts and county health departments was used to compare perceptions of characteristics of organizational QI culture between PBRN supported QI districts and non-PBRN supported districts before and after the QI interventions. The primary outcomes of concern were number and percentage of reported increases in characteristics of QI culture as measured by key informant responses to items assessing organizational QI practices from a validated instrument on QI Collaboratives. Survey results were analyzed using Multi-level Mixed Effects Logistic Model, which accounts for clustering/nesting. Increases in QI organizational culture were consistent for all 10- items on a QI organizational culture survey related to: leadership support, use of data, on-going QI, and team collaboration. Statistically significant odds ratios were calculated for differences in increased QI organizational culture between PBRN-QI supported districts compared to Non-PBRN supported districts for 5 of the 10 items, after adjusting for District clustering of county health departments. Agency culture, considered by many QI experts as the main goal of QI, is different than use of specific QI methods, such as Plan-Do-Study-Act (PDSA) cycles or root-cause analyses. The specific use of a QI method does not necessarily reflect culture change. Attempts to measure QI culture are newly emerging. This study documented significant improvements in characteristics of

Just-in-Time Training: A Novel Approach to Quality Improvement Education.

Science.gov (United States)

Knutson, Allison; Park, Nesha D; Smith, Denise; Tracy, Kelly; Reed, Danielle J W; Olsen, Steven L

2015-01-01

Just-in-time training (JITT) is accepted in medical education as a training method for newer concepts or seldom-performed procedures. Providing JITT to a large nursing staff may be an effective method to teach quality improvement (QI) initiatives. We sought to determine if JITT could increase knowledge of a specific nutrition QI initiative. Members of the nutrition QI team interviewed staff using the Frontline Contextual Inquiry to assess knowledge regarding the specific QI project. The inquiry was completed pre- and post-JITT. A JITT educational cart was created, which allowed trainers to bring the educational information to the bedside for a short, small group educational session. The results demonstrated a marked improvement in the knowledge of the frontline staff regarding our Vermont Oxford Network involvement and the specifics of the nutrition QI project. Just-in-time training can be a valuable and effective method to disseminate QI principles to a large audience of staff members.

Task-specific singing dystonia: vocal instability that technique cannot fix.

Science.gov (United States)

Halstead, Lucinda A; McBroom, Deanna M; Bonilha, Heather Shaw

2015-01-01

Singer's dystonia is a rare variation of focal laryngeal dystonia presenting only during specific tasks in the singing voice. It is underdiagnosed since it is commonly attributed to technique problems including increased muscle tension, register transition, or wobble. Singer's dystonia differs from technique-related issues in that it is task- and/or pitch-specific, reproducible and occurs independently from the previously mentioned technical issues.This case series compares and contrasts profiles of four patients with singer's dystonia to increase our knowledge of this disorder. This retrospective case series includes a detailed case history, results of singing evaluations from individual voice teachers, review of singing voice samples by a singing voice specialist, evaluation by a laryngologist with endoscopy and laryngeal electromyography (LEMG), and spectral analysis of the voice samples by a speech-language pathologist. Results demonstrate the similarities and unique differences of individuals with singer's dystonia. Response to treatment and singing status varied from nearly complete relief of symptoms with botulinum toxin injections to minor relief of symptoms and discontinuation of singing. The following are the conclusions from this case series: (1) singer's dystonia exists as a separate entity from technique issues, (2) singer's dystonia is consistent with other focal task-specific dystonias found in musicians, (3) correctly diagnosing singer's dystonia allows singer's access to medical treatment of dystonia and an opportunity to modify their singing repertoire to continue singing with the voice they have, and (4) diagnosis of singer's dystonia requires careful sequential multidisciplinary evaluation to isolate the instability and confirm dystonia by LEMG and spectral voice analysis. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Development of a PCR technique specific for Demodex injai in biological specimens.

Science.gov (United States)

Sastre, N; Ravera, I; Ferreira, D; Altet, L; Sánchez, A; Bardagí, M; Francino, O; Ferrer, L

2013-09-01

The identification of Demodex injai as a second Demodex species of dog opened new questions and challenges in the understanding on the Demodex-host relationships. In this paper, we describe the development of a conventional PCR technique based on published genome sequences of D. injai from GenBank that specifically detects DNA from D. injai. This technique amplifies a 238-bp fragment corresponding to a region of the mitochondrial 16S rDNA of D. injai. The PCR was positive in DNA samples obtained from mites identified morphologically as D. injai, which served as positive controls, as well as in samples from three cases of demodicosis associated with proliferation of mites identified as D. injai. Furthermore, the PCR was positive in 2 out of 19 healthy dogs. Samples of Demodex canis and Demodex folliculorum were consistently negative. Skin samples from seven dogs with generalized demodicosis caused by D. canis were all negative in the D. injai-specific PCR, demonstrating that in generalized canine demodicosis, mite proliferation is species-specific. This technique can be a useful tool in the diagnosis and in epidemiologic and pathogenic studies.

To compare the efficacy of two kinds of Zhizhu pills in the treatment of functional dyspepsia of spleen-deficiency and qi-stagnation syndrome:a randomized group sequential comparative trial

Science.gov (United States)

2011-01-01

Background In Traditional Chinese Medicine (TCM) theory, functional dyspepsia (FD) can be divided into different syndromes according to different clinical symptoms and signs, and the most common one is spleen-deficiency and qi-stagnation syndrome that can be treated by Chinese traditional patent medicine ---- two kinds of Zhizhu pills, between which the primary difference in ingredients is that one contains immature orange fruit of Citrus aurantium L.(IFCA) and the other contains that of Citrus sinensis Osbeck (IFCS). The trial's objective was to compare the efficacy of two kinds of Zhizhu pills on symptom changes in patients with FD of spleen-deficiency and qi-stagnation syndrome. Methods A randomized, group sequential, double-blinded, multicenter trial was conducted in patients with FD of spleen-deficiency and qi-stagnation syndrome at 3 hospitals in Beijing between June 2003 and May 2005. Participants were randomly allocated into two groups (IFCA group and IFCS group) in a 1:1 ratio, and respectively took one of the two kinds of Zhizhu pills orally, 6 g each time, 3 times a day, for 4 weeks. Statistical analysis was performed with use of a group sequential method, the triangular test (TT). Results A total of 163 patients were randomized, and 3 patients were excluded from analysis because of early dropouts, leaving 160 patients (IFCA group: n = 82; IFCS group: n = 78) for statistical analysis. Three interim analyses were done after 62, 116, and 160 patients had completed their 4-week treatment, respectively. At the third interim analysis, the sample path crossed the upper boundary and the trial was stopped, the cure-markedly effective rates were 45% for IFCS group and 67% for IFCA group, respectively, the one-sided p-value was 0.0036, the median unbiased estimate of the odds ratio (OR) for the benefit of IFCA relative to IFCS was 2.91 with 95%CI: 1.40 to 6.06. No adverse events were observed in the two groups. Conclusions Zhizhu pills containing IFCA was superior

Development and fabrication of patient-specific knee implant using additive manufacturing techniques

Science.gov (United States)

Zammit, Robert; Rochman, Arif

2017-10-01

Total knee replacement is the most effective treatment to relief pain and restore normal function in a diseased knee joint. The aim of this research was to develop a patient-specific knee implant which can be fabricated using additive manufacturing techniques and has reduced wear rates using a highly wear resistant materials. The proposed design was chosen based on implant requirements, such as reduction in wear rates as well as strong fixation. The patient-specific knee implant improves on conventional knee implants by modifying the articulating surfaces and bone-implant interfaces. Moreover, tribological tests of different polymeric wear couples were carried out to determine the optimal materials to use for the articulating surfaces. Finite element analysis was utilized to evaluate the stresses sustained by the proposed design. Finally, the patient-specific knee implant was successfully built using additive manufacturing techniques.

THE ERUPTION OF THE CANDIDATE YOUNG STAR ASASSN-15QI

Energy Technology Data Exchange (ETDEWEB)

Herczeg, Gregory J.; Dong, Subo; Chen, Ping; Jose, Jessy; Gully-Santiago, Michael [Kavli Institute for Astronomy and Astrophysics, Peking University, Yi He Yuan Lu 5, Haidian Qu, 100871 Beijing (China); Shappee, Benjamin J. [Carnegie Observatories, 813 Santa Barbara Street, Pasadena, CA 91101 (United States); Hillenbrand, Lynne A. [Caltech, MC 105-24, 1200 E. California Boulevard, Pasadena, CA 91125 (United States); Kochanek, Christopher S.; Stanek, K. Z.; Holoien, Thomas W.-S. [Department of Astronomy, The Ohio State University, 140 West 18th Avenue, Columbus, OH 43210 (United States); Prieto, Jose L. [Núcleo de Astronomía de la Facultad de Ingeniería, Universidad Diego Portales, Av. Ejército 441, Santiago (Chile); Kaplan, Kyle [Department of Astronomy, The University of Texas at Austin, Austin, TX 78712 (United States); Mairs, Steve; Johnstone, Doug [Department of Physics and Astronomy, University of Victoria, Victoria, BC, V8P 1A1 (Canada); Zhu, Zhaohuan [Department of Astrophysical Sciences, 4 Ivy Lane, Peyton Hall, Princeton University, Princeton, NJ 08544 (United States); Smith, Martin C. [Key Laboratory for Research in Galaxies and Cosmology, Shanghai Astronomical Observatory, Chinese Academy of Sciences, 80 Nandan Road, Shanghai 200030 (China); Bersier, David [Astrophysics Research Institute, Liverpool Science Park, 146 Brownlow Hill, Liverpool L3 5RF (United Kingdom); Mulders, Gijs D. [Lunar and Planetary Laboratory, The University of Arizona, Tucson, AZ 85721 (United States); Filippenko, Alexei V. [Department of Astronomy, University of California, Berkeley, CA 94720-3411 (United States); Ayani, Kazuya, E-mail: gherczeg1@gmail.com [Bisei Astronomical Observatory, 1723-70 Okura, Bisei, Ibara, Okayama 714-1411 (Japan); and others

2016-11-10

Outbursts on young stars are usually interpreted as accretion bursts caused by instabilities in the disk or the star–disk connection. However, some protostellar outbursts may not fit into this framework. In this paper, we analyze optical and near-infrared spectra and photometry to characterize the 2015 outburst of the probable young star ASASSN-15qi. The ∼3.5 mag brightening in the V band was sudden, with an unresolved rise time of less than one day. The outburst decayed exponentially by 1 mag for 6 days and then gradually back to the pre-outburst level after 200 days. The outburst is dominated by emission from ∼10,000 K gas. An explosive release of energy accelerated matter from the star in all directions, seen in a spectacular cool, spherical wind with a maximum velocity of 1000 km s{sup −1}. The wind and hot gas both disappeared as the outburst faded and the source returned to its quiescent F-star spectrum. Nebulosity near the star brightened with a delay of 10–20 days. Fluorescent excitation of H{sub 2} is detected in emission from vibrational levels as high as v = 11, also with a possible time delay in flux increase. The mid-infrared spectral energy distribution does not indicate the presence of warm dust emission, though the optical photospheric absorption and CO overtone emission could be related to a gaseous disk. Archival photometry reveals a prior outburst in 1976. Although we speculate about possible causes for this outburst, none of the explanations are compelling.

Optimized Shielding and Fabrication Techniques for TiN and Al Microwave Resonators

Science.gov (United States)

Kreikebaum, John Mark; Kim, Eunseong; Livingston, William; Dove, Allison; Calusine, Gregory; Hover, David; Rosenberg, Danna; Oliver, William; Siddiqi, Irfan

We present a systematic study of the effects of shielding and packaging on the internal quality factor (Qi) of Al and TiN microwave resonators designed for use in qubit readout. Surprisingly, Qi =1.3x106 TiN samples investigated at 100 mK exhibited no significant changes in linewidth when operated without magnetic shielding and in an open cryo-package. In contrast, Al resonators showed systematic improvement in Qi with each successive shield. Measurements were performed in an adiabatic demagnetization refrigerator, where typical ambient fields of 0.2 mT are present at the sample stage. We discuss the effect of 100 mK and 500 mK Cu radiation shields and cryoperm magnetic shielding on resonator Q as a function of temperature and input power in samples prepared with a variety of surface treatments, fabrication recipes, and embedding circuits. This research was supported by the ARO and IARPA.

Effect of material strength on the relationship between the principal Hugoniot and quasi-isentrope of beryllium and 6061-T6 aluminum below 35 GPa

International Nuclear Information System (INIS)

Moss, W.C.

1985-01-01

Quasi-isentropic (QI) compression can be achieved by loading a specimen with a low strain rate, long rise time uniaxial strain wave. Recent experimental data show that the quasi-isentrope of 6061-T6 aluminum lies a few percent above the principal Hugoniot, that is, at a given specific volume, the QI stress exceeds the principal Hugoniot stress. It has been suggested that this effect is due to material strength. Using Hugoniot data, shock-reshock, and shock-unload data for beryllium and 6061-T6 aluminum, we have constructed the quasi-isentropes as functions of specific volume. Our results show that the QI stress exceeds the principal Hugoniot stress above a Hugoniot stress of 8.4 GPa in beryllium, and between Hugoniot stresses of 3.8 and 21.4 GPa in aluminum. The effect is due to strength and implies that the QI yield strength can be large. Our calculations show that the QI yield strength is 0.9 GPa in aluminum at a QI stress of 9 GPa, and 5.2 GPa in beryllium at a QI stress of 35 GPa

Measurements of VOC fluxes by Eddy-covariance with a PTR-Qi-TOF-MS over a mature wheat crop near Paris: Evaluation of data quality and uncertainties.

Science.gov (United States)

Buysse, Pauline; Loubet, Benjamin; Ciuraru, Raluca; Lafouge, Florence; Zurfluh, Olivier; Gonzaga-Gomez, Lais; Fanucci, Olivier; Gueudet, Jean-Christophe; Decuq, Céline; Gros, Valérie; Sarda, Roland; Zannoni, Nora

2017-04-01

The quantification of volatile organic compounds (VOC) fluxes exchanged by terrestrial ecosystems is of large interest because of their influence on the chemistry and composition of the atmosphere including aerosols and oxidants. Latest developments in the techniques for detecting, identifying and measuring VOC fluxes have considerably improved the abilities to get reliable estimates. Among these, the eddy-covariance (EC) methodology constitutes the most direct approach, and relies on both well-established principles (Aubinet et al. 2000) and a sound continuously worldwide improving experience. The combination of the EC methodology with the latest proton-transfer-reaction mass spectrometer (PTR-MS) device, the PTR-Qi-TOF-MS, which allows the identification and quantification of more than 500 VOC at high frequency, now provides a very powerful and precise tool for an accurate quantification of VOC fluxes on various types of terrestrial ecosystems. The complexity of the whole methodology however demands that several data quality requirements are fulfilled. VOC fluxes were measured by EC with a PTR-Qi-TOF-MS (national instrument within the ANAEE-France framework) for one month and a half over a mature wheat crop near Paris (FR-GRI ICOS site). Most important emissions (by descending order) were observed from detected compounds with mass-over-charge (m/z) ratios of 33.033 (methanol), 45.033 (acetaldehyde), 93.033 (not identified yet), 59.049 (acetone), and 63.026 (dimethyl sulfide or DMS). Emissions from higher-mass compounds, which might be due to pesticide applications at the beginning of our observation period, were also detected. Some compounds were also seen to deposit (e.g. m/z 47.013, 71.085, 75.044, 83.05) while others exhibited bidirectional fluxes (e.g. m/z 57.07, 69.07). Before analyzing VOC flux responses to meteorological and crop development drivers, a data quality check was performed which included (i) uncertainty analysis of mass and concentration

Technique of calculating specific capital investments in the fuel extracting sectors of industry

Energy Technology Data Exchange (ETDEWEB)

Bugrov, V.A.; Filey, I.A.

1980-01-01

An analysis is made of the existing methods of calculating specific capital investments in the fuel extracting sectors of industry. Their shortcomings are shown. It is suggested that specific capital investments for extraction of coal and gas be defined as the ratio of capital investments to the conditional increase in extraction. Coal extraction should take int consideration all the capital investments associated with the input of new facilities, and the maintenance of the attained level of extraction and reconstruction of the enterprise, as well as all the newly introduced facilities both at the new and at the active enterprises associated with an increase in coal extraction and with maintenance of the facilities. The suggested technique completely corresponds to the ''Standard Technique for Developing a Technical-Industrial-Financial Plan,'' which stipulates determination of specific capital investments per unit of introduced facilities with only the difference that it takes into consideration the specific features of the fuel extracting sectors of industry.

[metabonomics research on coronary heart disease patients of phlegm turbidity syndrome and qi deficiency syndrome].

Science.gov (United States)

Cheng, Peng; Chen, Ze-qi; Wang, Dong-sheng

2015-02-01

To study the correlation between Chinese medical types of coronary heart disease (CHD) [i.e., phlegm turbidity syndrome (PTS) and qi deficiency syndrome (QDS)] and their metabolites. Recruited were 65 CHD patients including 37 cases of PTS and 28 cases of QDS. Serum endogenous metabolites in the two syndrome types were determined by gas chromatograph-mass spectrometer-computer (GC/MS), and their differences between their metabolic profiles analyzed. More than 100 chromatographic peaks were totally scanned. Chromatograms obtained was matched with mass spectrum bank, and finally we got the category contribution value of 46 kinds of substances. Results of MCTree analysis showed patients of PTS and patients of QDS could be effectively distinguished. Compounds contributing to identify the two syndromes were sequenced as serine, valine, 2 hydroxy propionic acid. Comparison of metabolites showed contents of serine and 2 hydroxy propionic acid were higher in patients of PTS than in patients of QDS (Pmetabonomics of CHD TCM syndrome types could provide material bases for TCM syndrome differentiation of CHD, indicating that metabonomics technologies might become a new research method for TCM syndrome typing.

[Effects of Chinese herbal medicines for regulating liver qi on expression of 5-hydroxytryptamine 3B receptor in hypothalamic tissues of rats with anger emotion].

Science.gov (United States)

Ge, Qing-fang; Zhang, Hui-yun

2011-08-01

To explore the central mechanisms of anger emotion and the effects of Chinese herbal medicines for regulating liver qi on the anger emotion and the expression level of 5-hydroxytryptamine 3B receptor (5-HT3BR) in rat hypothalamus. Rat models of anger-in or anger-out emotions were prepared by the methods of resident intruder paradigm. There were five groups in this study: control, anger-in model, Jingqianshu Granule-treated anger-in, anger-out model and Jingqianping Granule-treated anger-out groups. The treatment groups were orally given Jingqianshu granules and Jingqianping granules respectively, and the model groups and the normal control group were given sterile water. Open-field test and sucrose preference test were used to evaluate behavioristics of the rats. Semi-quantitative reverse transcription-polymerase chain reaction and Western blot methods were used to detect the expression levels of 5-HT3BR mRNA and protein in the rat hypothalamus. The expression of 5-HT3BR in hypothalamus of anger-in model rats increased obviously (Pexpressions of 5-HT3BR in the treatment groups were significantly improved (Pexpression and the anger-out emotion can obviously reduce its expression. Chinese herbal medicines for regulating liver qi may treat anger emotion in rats by improving the hypothalamic 5-HT3BR protein and gene expression levels.

Tracer technique for measuring specific activity of 63 Ni, using 4πβ-γ

International Nuclear Information System (INIS)

Iwahara, A.

1979-01-01

The specific activity of a 6 3 Ni solution has been measured by an efficiency tracer technique using a 4 π β - γ coincidence system. 6 3 Ni was chosen. Because it's a very low energy pure beta emitter. Due to chemical compatibility and beta spectral shapes, 6 0 Co has been chosen as tracer. In the determination of 6 3 Ni, the specific activity. As the efficiency tracer techniques requires a previous knowledge of tracer activity, this has been measured by a conventional 4 π β -γ coincidence method. (author)

Effects of Qi-Fang-Xi-Bi-Granules on Cartilage Morphology and C/ebpα Promoter Methylation in Rats with Knee Osteoarthritis

Directory of Open Access Journals (Sweden)

Xinxin Wang

2018-01-01

Full Text Available Objective. To investigate the effects of Qi-Fang-Xi-Bi-Granules (QFXBGs on cartilage morphology and methylation of C/ebpα (CCAAT/enhancer binding proteinα at the promoter region. Methods. Knee osteoarthritis (KOA modeling was performed in rats in accordance with Hulth’s method, and control group received sham operation. Eight weeks after KOA modeling, the rats in the KOA modeling group were further divided into 6 groups. Each group was given the appropriate drug. After 8 weeks, half of the rats were used for Micro-CT scan, HE staining, ABH/OG staining, immunohistochemistry, and TUNNEL staining of the knee joint tissue, and the other half were used to examine C/ebpα promoter methylation. Results. The three dose groups of QFXBGs all showed lower degrees of surface fissures and flaking, thicker cartilage layer, and restored chondrocyte and subchondral bone morphology, compared with the KOA model group. C/ebpα-22 promoter methylation levels in the high- and low-dose groups were significantly higher than that in the KOA modeling group (p<0.05, while C/ebpα-2 promoter methylation level in the medium-dose group was significantly higher than that in the KOA modeling group (p<0.05. Conclusions. QFXBGs may alleviate articular cartilage degeneration through promoting C/ebpα-2 or C/ebpα-22 methylation at specific promoter sites.

Gas chromatographic isolation technique for compound-specific radiocarbon analysis

International Nuclear Information System (INIS)

Uchida, M.; Kumamoto, Y.; Shibata, Y.; Yoneda, M.; Morita, M.; Kawamura, K.

2002-01-01

Full text: We present here a gas chromatographic isolation technique for the compound-specific radiocarbon analysis of biomarkers from the marine sediments. The biomarkers of fatty acids, hydrocarbon and sterols were isolated with enough amount for radiocarbon analysis using a preparative capillary gas chromatograph (PCGC) system. The PCGC systems used here is composed of an HP 6890 GC with FID, a cooled injection system (CIS, Gerstel, Germany), a zero-dead-volume effluent splitter, and a cryogenic preparative collection device (PFC, Gerstel). For AMS analysis, we need to separate and recover sufficient quantity of target individual compounds (>50 μgC). Yields of target compounds from C 14 n-alkanes to C 40 to C 30 n-alkanes and approximately that of 80% for higher molecular weights compounds more than C 30 n-alkanes. Compound specific radiocarbon analysis of organic compounds, as well as compound-specific stable isotope analysis, provide valuable information on the origins and carbon cycling in marine system. Above PCGC conditions, we applied compound-specific radiocarbon analysis to the marine sediments from western north Pacific, which showed the possibility of a useful chronology tool for estimating the age of sediment using organic matter in paleoceanographic study, in the area where enough amounts of planktonic foraminifera for radiocarbon analysis by accelerator mass spectrometry (AMS) are difficult to obtain due to dissolution of calcium carbonate. (author)

Quality improvement primer part 1: Preparing for a quality improvement project in the emergency department.

Science.gov (United States)

Chartier, Lucas B; Cheng, Amy H Y; Stang, Antonia S; Vaillancourt, Samuel

2018-01-01

Emergency medicine (EM) providers work in a fast-paced and often hectic environment that has a high risk for patient safety incidents and gaps in the quality of care. These challenges have resulted in opportunities for frontline EM providers to play a role in quality improvement (QI) projects. QI has developed into a mature field with methodologies that can dramatically improve the odds of having a successful project with a sustainable impact. However, this expertise is not yet commonly taught during professional training. In this first of three articles meant as a QI primer for EM clinicians, we will introduce QI methodology and strategic planning using a fictional case study as an example. We will review how to identify a QI problem, define components of an effective problem statement, and identify stakeholders and core change team members. We will also describe three techniques used to perform root cause analyses-Ishikawa diagrams, Pareto charts and process mapping-and how they relate to preparing for a QI project. The next two papers in this series will focus on the execution of the QI project itself using rapid-cycle testing and on the evaluation and sustainability of QI projects.

Embedding organisational quality improvement through middle manager ownership.

Science.gov (United States)

Balding, Cathy

2005-01-01

To strengthen the middle manager role in a hospital quality improvement (QI) program, with a view to increasing and sustaining organisational QI implementation. Case study based action research project, combining pre- and post-action quantitative and qualitative data collection, relating to a QI program intervention in an Australian metropolitan specialist teaching hospital. A model for enhancing the middle manager role in QI was developed and then implemented as the action over a 12-month period. Middle manager understanding and ownership of the QI program and organisational QI implementation significantly increased, although their perceived enjoyment of being involved in QI decreased. This case-study based action research project was limited to one organisation of a specific type - a large specialist metropolitan teaching hospital. The composition of the middle manager group, therefore, is necessarily limited to particular specialties. It is acknowledged that findings from case study and action research methodologies are limited in their generalisability, but assist in the development of knowledge and principles that can be adapted to different settings. This QI implementation model can increase levels of organisational QI implementation by effecting a positive change in middle manager attitude to and involvement in QI. There are many theories regarding the importance of the middle manager role in QI, but little empirical research into exactly what this role may be and how it may be strengthened. This research adds to the knowledge base, and provides clear steps for achieving increased staff involvement and QI implementation.

6 June 2012 - Chinese Nanjing University President J.Chen in the ATLAS visitor centre with Member of the ATLAS Collaboration I. Wingerter and International Relations Office Adviser E. Tsesmelis. M. Qi, Nanjing University and ATLAS Collaboration, accompanies the delegation.

CERN Multimedia

Maximilien Brice

2012-01-01

6 June 2012 - Chinese Nanjing University President J.Chen in the ATLAS visitor centre with Member of the ATLAS Collaboration I. Wingerter and International Relations Office Adviser E. Tsesmelis. M. Qi, Nanjing University and ATLAS Collaboration, accompanies the delegation.

Courtship and mating of Scorpiops luridus Zhu Lourenço & Qi, 2005 (Scorpiones: Euscorpiidae from Xizang province, China

Directory of Open Access Journals (Sweden)

GB Jiao

2010-01-01

Full Text Available In the current work, the courtship and mating of Scorpiops luridus Zhu Lourenço & Qi, 2005 (Euscorpiidae from Xizang province (Tibet, China, were studied for the first time in the laboratory. Most of the mating behaviors in Scorpiops luridus are not remarkably different from those exhibited by other scorpions. However, for the first time a male pulling a female with its chelicerae to rapidly accomplish the sperm uptake was observed. Additionally, the sexual stinging behavior displayed by the male occurred in the initial stage, not during the promenade stage as previously described in several scorpion species. Through observation and analysis, we speculate that venom injection during sexual stinging is selective, possibly relying on the status shown by the stung scorpion (passive or aggressive. In order to clearly describe the process of courtship and mating, both sequences are represented in a flow chart, while the main behavior components of these processes were identified, analyzed and discussed.

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.

Key Characteristics of Rehabilitation Quality Improvement Publications: Scoping Review From 2010 to 2016.

Science.gov (United States)

Jesus, Tiago S; Papadimitriou, Christina; Pinho, Cátia S; Hoenig, Helen

2017-09-28

To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation. Five electronic databases were searched for English-language articles from 2010 to 2016. Keywords for QI and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (eg, references-list scanning) were also performed. Two reviewers independently selected articles using working definitions of rehabilitation and QI study types; of 1016 references, 112 full texts were assessed for eligibility. Reported study characteristics including study focus, study setting, use of inferential statistics, stated limitations, and use of improvement cycles and theoretical models were extracted by 1 reviewer, with a second reviewer consulted whenever inferences or interpretation were involved. Fifty-nine empirical rehabilitation QI studies were found: 43 reporting on local QI activities, 7 reporting on QI effectiveness research, 8 reporting on QI facilitators or barriers, and 1 systematic review of a specific topic. The number of publications had significant yearly growth between 2010 and 2016 (P=.03). Among the 43 reports on local QI activities, 23.3% did not explicitly report any study limitations; 39.5% did not used inferential statistics to measure the QI impact; 95.3% did not cite/mention the appropriate reporting guidelines; only 18.6% reported multiple QI cycles; just over 50% reported using a model to guide the QI activity; and only 7% reported the use of a particular theoretical model. Study sites and focuses were diverse; however, nearly a third (30.2%) examined early mobilization in intensive care units. The number of empirical, peer-reviewed rehabilitation QI publications is growing but remains a tiny fraction of rehabilitation research publications. Rehabilitation QI studies could be strengthened by greater use of extant models and theory to guide the QI work, consistent reporting of study limitations, and use of

RN-to-BSN Students' Quality Improvement Knowledge, Skills, Confidence, and Systems Thinking.

Science.gov (United States)

Trent, Peggy; Dolansky, Mary A; DeBrew, Jacqueline Kayler; Petty, Gayle M

2017-12-01

Little evidence demonstrates that RN-to-baccalaureate nursing (BSN) graduates have met The Essentials of Baccalaureate Education for Professional Nursing Practice-specifically, evidence of the graduates' organizational and systems leadership related to quality care and patient safety. This BSN Essentials reflects the QSEN quality improvement (QI) competency. The purpose of this pilot study was to develop and test an assessment strategy to measure RN-to BSN students' QI competence and their perception of QI knowledge and skills. Students (N = 59) from six RN-to-BSN programs participated in a Qualtrics survey e-mailed during the last semester of their program. The majority of students (60%) reported that they did not experience QI content in their program. Scores on QI knowledge, skills, and systems thinking were low, yet the students self-reported that they were confident in their ability to perform QI. This pilot study provides an assessment strategy to measure students' competence related to QI. Nursing education has an opportunity to integrate and measure QI competence to ensure that nurses have the knowledge and skills to continually improve patient care. [J Nurs Educ. 2017;56(12):737-740.]. Copyright 2017, SLACK Incorporated.

Educational gaps and solutions for early-career nurse managers' education and participation in quality improvement.

Science.gov (United States)

Djukic, Maja; Kovner, Christine T; Brewer, Carol S; Fatehi, Farida; Jun, Jin

2015-04-01

The objective of this study was to examine early-career frontline nurse managers' (FLNMs') reported educational preparedness and participation in quality improvement (QI). Frontline nurse managers are vitally important for leading QI. However, it is not well known if they have adequate knowledge and skills to lead this important function. We examined cross-sectional survey data from 42 FLNMs using descriptive statistics. About 30% of FLNMs reported being very prepared across 12 measured QI skills by schools or employers and 35% reported participating in a specific clinical effort to improve patient care on their unit more than once a month. More than 50% reported having good organizational support for QI, but only about 30% reported being rewarded for their contributions to QI. Our study highlights opportunities for development in QI for FLNMs and offers some solutions for nurse executives that can bridge the educational gaps.

Vitrification and Devitrification of Rigid Amorphous Fraction of PET during Quasi-isothermal Cooling and Heating

Science.gov (United States)

Cebe, Peggy; Chen, Huipeng

2009-03-01

Poly(ethylene terephthalate), PET, was studied by quasi-isothermal (QI) Temperature Modulated Differential Scanning Calorimetry (TMDSC). For the first time, both the temperature dependent crystalline fraction and rigid amorphous fraction (RAF) were quantitatively analyzed during QI cooling and reheating. Specific reversing heat capacity measurements show that most RAF vitrifies step by step during QI cooling after completion of crystallization. Upon subsequent QI reheating, the RAF devitrifies also step by step and only a small RAF of 0.04 remains at 470K, while melting starts above 473K. To obtain the exact temperature of the start of melting, heat capacity measurements were made using subsequent standard DSC heating, after QI cooling. By combining this method with the QI results, the temperature dependent phase fractions were obtained during standard DSC heating. We conclude that RAF completely devitrifies before the temperature reaches the crystal melting endotherm under the conditions used in this work.

Multimodal technique to eliminate humidity interference for specific detection of ethanol.

Science.gov (United States)

Jalal, Ahmed Hasnain; Umasankar, Yogeswaran; Gonzalez, Pablo J; Alfonso, Alejandro; Bhansali, Shekhar

2017-01-15

Multimodal electrochemical technique incorporating both open circuit potential (OCP) and amperometric techniques have been conceptualized and implemented to improve the detection of specific analyte in systems where more than one analyte is present. This approach has been demonstrated through the detection of ethanol while eliminating the contribution of water in a micro fuel cell sensor system. The sensor was interfaced with LMP91000 potentiostat, controlled through MSP430F5529LP microcontroller to implement an auto-calibration algorithm tailored to improve the detection of alcohol. The sensor was designed and fabricated as a three electrode system with Nafion as a proton exchange membrane (PEM). The electrochemical signal of the interfering phase (water) was eliminated by implementing the multimodal electrochemical detection technique. The results were validated by comparing sensor and potentiostat performances with a commercial sensor and potentiostat respectively. The results suggest that such a sensing system can detect ethanol at concentrations as low as 5ppm. The structure and properties such as low detection limit, selectivity and miniaturized size enables potential application of this device in wearable transdermal alcohol measurements. Copyright © 2016 Elsevier B.V. All rights reserved.

The Educational Toolbox: Kick Start Your Educational Program in Quality Improvement.

Science.gov (United States)

Hoffman, Rebecca L; Medbery, Rachel L; Vandermeer, Thomas J; Morris, Jon B; Kelz, Rachel R

2015-01-01

To disseminate materials and learning from the proceedings of the Association of Program Directors 2014 Annual Meeting workshop on the integration of quality improvement (QI) education into the existing educational infrastructure. Modern surgical practice demands an understanding of QI methodology. Yet, today׳s surgeons are not formally educated in QI methodology. Therefore, it is hard to follow the historical mantra of "see one, do one, teach one" in the quality realm. Participants were given a brief introduction to QI approaches. A number of concrete examples of how to incorporate QI education into training programs were presented, followed by a small group session focused on the identification of barriers to incorporation. Participants were provided with a worksheet to help navigate the initial incorporation of QI education in 3 steps. Participants were representative of all types of training programs, with differing levels of existing QI integration. Barriers to QI education included lack of resident interest/buy-in, concerns over the availability of educational resources (i.e., limited time to devote to QI), and a limited QI knowledge among surgical educators. The 3 steps to kick starting the educational process included (1) choosing a specific method of QI education, (2) incorporation via barrier, infrastructure, and stakeholder identification, and (3) implementation and ongoing assessment. Recent changes in the delivery of surgical care along with the new accreditation system have necessitated the development of QI education programs for use in surgical education. To continue to make surgery safer and ensure optimal patient outcomes, surgical educators must teach each resident to adopt quality science methodology in a meaningful way. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement.

Science.gov (United States)

Kaplan, Heather C; Provost, Lloyd P; Froehle, Craig M; Margolis, Peter A

2012-01-01

BACKGROUND Quality improvement (QI) efforts have become widespread in healthcare, however there is significant variability in their success. Differences in context are thought to be responsible for some of the variability seen. To develop a conceptual model that can be used by organisations and QI researchers to understand and optimise contextual factors affecting the success of a QI project. 10 QI experts were provided with the results of a systematic literature review and then participated in two rounds of opinion gathering to identify and define important contextual factors. The experts subsequently met in person to identify relationships among factors and to begin to build the model. The Model for Understanding Success in Quality (MUSIQ) is organised based on the level of the healthcare system and identifies 25 contextual factors likely to influence QI success. Contextual factors within microsystems and those related to the QI team are hypothesised to directly shape QI success, whereas factors within the organisation and external environment are believed to influence success indirectly. The MUSIQ framework has the potential to guide the application of QI methods in healthcare and focus research. The specificity of MUSIQ and the explicit delineation of relationships among factors allows a deeper understanding of the mechanism of action by which context influences QI success. MUSIQ also provides a foundation to support further studies to test and refine the theory and advance the field of QI science.

Application of quality improvement analytic methodology in emergency medicine research: A comparative evaluation.

Science.gov (United States)

Harries, Bruce; Filiatrault, Lyne; Abu-Laban, Riyad B

2018-05-30

Quality improvement (QI) analytic methodology is rarely encountered in the emergency medicine literature. We sought to comparatively apply QI design and analysis techniques to an existing data set, and discuss these techniques as an alternative to standard research methodology for evaluating a change in a process of care. We used data from a previously published randomized controlled trial on triage-nurse initiated radiography using the Ottawa ankle rules (OAR). QI analytic tools were applied to the data set from this study and evaluated comparatively against the original standard research methodology. The original study concluded that triage nurse-initiated radiographs led to a statistically significant decrease in mean emergency department length of stay. Using QI analytic methodology, we applied control charts and interpreted the results using established methods that preserved the time sequence of the data. This analysis found a compelling signal of a positive treatment effect that would have been identified after the enrolment of 58% of the original study sample, and in the 6th month of this 11-month study. Our comparative analysis demonstrates some of the potential benefits of QI analytic methodology. We found that had this approach been used in the original study, insights regarding the benefits of nurse-initiated radiography using the OAR would have been achieved earlier, and thus potentially at a lower cost. In situations where the overarching aim is to accelerate implementation of practice improvement to benefit future patients, we believe that increased consideration should be given to the use of QI analytic methodology.

Splintless orthognathic surgery: a novel technique using patient-specific implants (PSI).

Science.gov (United States)

Gander, Thomas; Bredell, Marius; Eliades, Theodore; Rücker, Martin; Essig, Harald

2015-04-01

In the past few years, advances in three-dimensional imaging have conducted to breakthrough in the diagnosis, treatment planning and result assessment in orthognathic surgery. Hereby error-prone and time-consuming planning steps, like model surgery and transfer of the face bow, can be eluded. Numerous positioning devices, in order to transfer the three-dimensional treatment plan to the intraoperative site, have been described. Nevertheless the use of positioning devices and intraoperative splints are failure-prone and time-consuming steps, which have to be performed during the operation and during general anesthesia of the patient. We describe a novel time-sparing and failsafe technique using patient-specific implants (PSI) as positioning guides and concurrently as rigid fixation of the maxilla in the planned position. This technique avoids elaborate positioning and removal of manufactured positioning devices and allows maxillary positioning without the use of occlusal splints. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Hospital accreditation: staff experiences and perceptions.

Science.gov (United States)

Bogh, Søren Bie; Blom, Ane; Raben, Ditte Caroline; Braithwaite, Jeffrey; Thude, Bettina; Hollnagel, Erik; Plessen, Christian von

2018-06-11

Purpose The purpose of this paper is to understand how staff at various levels perceive and understand hospital accreditation generally and in relation to quality improvement (QI) specifically. Design/methodology/approach In a newly accredited Danish hospital, the authors conducted semi-structured interviews to capture broad ranging experiences. Medical doctors, nurses, a quality coordinator and a quality department employee participated. Interviews were audio recorded and subjected to framework analysis. Findings Staff reported that The Danish Healthcare Quality Programme affected management priorities: office time and working on documentation, which reduced time with patients and on improvement activities. Organisational structures were improved during preparation for accreditation. Staff perceived that the hospital was better prepared for new QI initiatives after accreditation; staff found disease specific requirements unnecessary. Other areas benefited from accreditation. Interviewees expected that organisational changes, owing to accreditation, would be sustained and that the QI focus would continue. Practical implications Accreditation is a critical and complete hospital review, including areas that often are neglected. Accreditation dominates hospital agendas during preparation and surveyor visits, potentially reducing patient care and other QI initiatives. Improvements are less likely to occur in areas that other QI initiatives addressed. Yet, accreditation creates organisational foundations for future QI initiatives. Originality/value The authors study contributes new insights into how hospital staff at different organisational levels perceive and understand accreditation.

Quantitative Reasoning in Environmental Science: Rasch Measurement to Support QR Assessment

Directory of Open Access Journals (Sweden)

Robert L. Mayes

2015-07-01

Full Text Available The ability of middle and high school students to reason quantitatively within the context of environmental science was investigated. A quantitative reasoning (QR learning progression, with associated QR assessments in the content areas of biodiversity, water, and carbon, was developed based on three QR progress variables: quantification act, quantitative interpretation, and quantitative modeling. Diagnostic instruments were developed specifically for the progress variable quantitative interpretation (QI, each consisting of 96 Likert-scale items. Each content version of the instrument focused on three scale levels (macro scale, micro scale, and landscape scale and four elements of QI identified in prior research (trend, translation, prediction, and revision. The QI assessments were completed by 362, 6th to 12th grade students in three U.S. states. Rasch (1960/1980 measurement was used to determine item and person measures for the QI instruments, both to examine validity and reliability characteristics of the instrument administration and inform the evolution of the learning progression. Rasch methods allowed identification of several QI instrument revisions, including modification of specific items, reducing number of items to avoid cognitive fatigue, reconsidering proposed item difficulty levels, and reducing Likert scale to 4 levels. Rasch diagnostics also indicated favorable levels of instrument reliability and appropriate targeting of item abilities to student abilities for the majority of participants. A revised QI instrument is available for STEM researchers and educators.

辛弃疾的“事功派”思想及在稼轩词中的体现%Xin Qi-ji’s Utilitarianism Ethics Thought And influence on Jiaxuan Ci-poems

Institute of Scientific and Technical Information of China (English)

宋学达

2013-01-01

事功派哲学家陈亮与辛弃疾私交甚厚，其哲学思想必然会对辛弃疾产生影响，而历来对辛弃疾的研究中，似乎很少关注其思想哲学的相关问题。本文旨在论证辛弃疾的哲学思想乃是以陈亮为代表的事功派哲学一脉，并探讨事功派哲学对稼轩词艺术特质及词史地位所产生的深刻影响。%Chen Liang, the philosopher of Utilitarianism Ethics Thought, has a good relationship with Xin Qi-ji. So his philosophical thoughts certainly would have an influence on Xin Qiji. But in the past, on the study of Xin Qi-ji, we can seldom found researches concerning his thought of philosophy. This dissertation is aimed to argue that Xin's philosophical thoughts is a brunch of Chen’s Utilitarianism Ethics Thought and the latter had great influence on Jiaxuan Ci-Poems, including its artistic particularities and the status in Ci-poetry history.

Mixed-Methods Assessment of Trauma and Acute Care Surgical Quality Improvement Programs in Peru.

Science.gov (United States)

LaGrone, Lacey N; Fuhs, Amy K; Egoavil, Eduardo Huaman; Rodriguez Castro, Manuel J A; Valderrama, Roberto; Isquith-Dicker, Leah N; Herrera-Matta, Jaime; Mock, Charles N

2017-04-01

Evidence for the positive impact of quality improvement (QI) programs on morbidity, mortality, patient satisfaction, and cost is strong. Data regarding the status of QI programs in low- and middle-income countries, as well as in-depth examination of barriers and facilitators to their implementation, are limited. This cross-sectional, descriptive study employed a mixed-methods design, including distribution of an anonymous quantitative survey and individual interviews with healthcare providers who participate in the care of the injured at ten large hospitals in Lima, Peru. Key areas identified for improvement in morbidity and mortality (M&M) conferences were the standardization of case selection, incorporation of evidence from the medical literature into case presentation and discussion, case documentation, and the development of a clear plan for case follow-up. The key barriers to QI program implementation were a lack of prioritization of QI, lack of sufficient human and administrative resources, lack of political support, and lack of education on QI practices. A national program that makes QI a required part of all health providers' professional training and responsibilities would effectively address a majority of identified barriers to QI programs in Peru. Specifically, the presence of basic QI elements, such as M&M conferences, should be required at hospitals that train pre-graduate physicians. Alternatively, short of this national-level organization, efforts that capitalize on local examples through apprenticeships between institutions or integration of QI into continuing medical education would be expected to build on the facilitators for QI programs that exist in Peru.

Effect of ultrasonic specific energy on waste activated sludge ...

African Journals Online (AJOL)

USER

2010-03-22

Mar 22, 2010 ... Yuanyuan Yan, Leiyu Feng*, Chaojie Zhang, Hongguang Zhu and Qi Zhou. State Key ... soluble chemical oxygen demand; TCOD, total chemical oxygen demand ... studied as well as their effects on the characteristics of sludge. .... universal liquid module (ULM) which could detect particle size from. 0.04 up ...

Impact of a national QI programme on reducing electronic health record notifications to clinicians.

Science.gov (United States)

Shah, Tina; Patel-Teague, Shilpa; Kroupa, Laura; Meyer, Ashley N D; Singh, Hardeep

2018-03-05

Emerging evidence suggests electronic health record (EHR)-related information overload is a risk to patient safety. In the US Department of Veterans Affairs (VA), EHR-based 'inbox' notifications originally intended for communicating important clinical information are now cited by 70% of primary care practitioners (PCPs) to be of unmanageable volume. We evaluated the impact of a national, multicomponent, quality improvement (QI) programme to reduce low-value EHR notifications. The programme involved three steps: (1) accessing daily PCP notification load data at all 148 facilities operated nationally by the VA; (2) standardising and restricting mandatory notification types at all facilities to a recommended list; and (3) hands-on training for all PCPs on customising and processing notifications more effectively. Designated leaders at each of VA's 18 regional networks led programme implementation using a nationally developed toolkit. Each network supervised technical requirements and data collection, ensuring consistency. Coaching calls and emails allowed the national team to address implementation challenges and monitor effects. We analysed notification load and mandatory notifications preintervention (March 2017) and immediately postintervention (June-July 2017) to assess programme impact. Median number of mandatory notification types at each facility decreased significantly from 15 (IQR: 13-19) to 10 (IQR: 10-11) preintervention to postintervention, respectively (Pmanage them. Nevertheless, our project suggests feasibility of using large-scale 'de-implementation' interventions to reduce unintended safety or efficiency consequences of well-intended electronic communication systems. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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.

78 FR 5810 - AHRQ Standing Workgroup for Quality Indicator Measure Specification

Science.gov (United States)

2013-01-28

... collaboratively publish peer-reviewed journal articles or reports based on workgroup activities. However, this is..., quality alliances, medical or specialty societies, measure developers, accrediting organizations, and... topics include: (1) Strategic areas for AHRQ QI program development for the upcoming year, (2) measure...

The cost-effectiveness analysis of JinQi Jiangtang tablets for the treatment on prediabetes: a randomized, double-blind, placebo-controlled, multicenter design.

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Sun, Xiao; Guo, Liping; Shang, Hongcai; Ren, Ming; Wang, Yue; Huo, Da; Lei, Xiang; Wang, Hui; Zhai, Jingbo

2015-11-03

reduced the incidence of diabetes mellitus and enhanced reversion rate. compared with the control group (p 0.05); finally the compliance of participants between the two groups had no significant difference. The cost-effectiveness analysis outcomes:in the intervention period of 12 months,on the aspect of reversion rate, the treatment group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio;on the aspect of the incidence of diabetes, the control group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio; in the follow-up period of 24 months, on the aspect of reversion rate, the treatment group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio, on the aspect of the incidence of diabetes, the control group had better economic advantage by using cost-effectivenes ratio and the incremental cost-effectiveness ratio.At the same time, these outcomes remained the same by sensitivity analysis. Assuming that prices and resident incomes rose 5%, the sensitiveness analysis shows that the two group affected by the paremeters changed little. The importance and effectiveness of lifestyle education and JinQi Jiangtang tablets was proven. In both the intervention period and follow-up, JinQi Jiangtang tablets combined with lifestyle education had a greater cost advantage effect than the lifestyle education alone on the reversion rate; the lifestyle education had a greater cost advantage effect than the JinQi Jiangtang tablets combined with lifestyle education on the incidence of diabetes. Chinese Clinical Trials ChiCTR-TRC-09000401 ) , registered on 25 May 2009.

A ginástica terapêutica e preventiva chinesa Lian Gong/Qi Gong como um dos instrumentos na prevenção e reabilitação da LER/DORT

OpenAIRE

Livramento,Gutembergue; Franco,Tânia; Livramento,Alaíde

2010-01-01

Este ensaio traz elementos da medicina ocidental, da medicina tradicional chinesa e da sociologia do trabalho para reflexão sobre o Qi Gong - exercícios terapêuticos, um dos pilares da Medicina Tradicional Chinesa (MTC) - como importante meio de prevenção da LER/DORT e recuperação da saúde. Considerando a natureza interdisciplinar e diversos níveis de prevenção, aborda aspectos sociológicos sobre as condições de trabalho frequentemente relacionadas com este tipo de adoecimento e categorias de...

Uncovering category specificity of genital sexual arousal in women: The critical role of analytic technique.

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Pulverman, Carey S; Hixon, J Gregory; Meston, Cindy M

2015-10-01

Based on analytic techniques that collapse data into a single average value, it has been reported that women lack category specificity and show genital sexual arousal to a large range of sexual stimuli including those that both match and do not match their self-reported sexual interests. These findings may be a methodological artifact of the way in which data are analyzed. This study examined whether using an analytic technique that models data over time would yield different results. Across two studies, heterosexual (N = 19) and lesbian (N = 14) women viewed erotic films featuring heterosexual, lesbian, and gay male couples, respectively, as their physiological sexual arousal was assessed with vaginal photoplethysmography. Data analysis with traditional methods comparing average genital arousal between films failed to detect specificity of genital arousal for either group. When data were analyzed with smoothing regression splines and a within-subjects approach, both heterosexual and lesbian women demonstrated different patterns of genital sexual arousal to the different types of erotic films, suggesting that sophisticated statistical techniques may be necessary to more fully understand women's genital sexual arousal response. Heterosexual women showed category-specific genital sexual arousal. Lesbian women showed higher arousal to the heterosexual film than the other films. However, within subjects, lesbian women showed significantly different arousal responses suggesting that lesbian women's genital arousal discriminates between different categories of stimuli at the individual level. Implications for the future use of vaginal photoplethysmography as a diagnostic tool of sexual preferences in clinical and forensic settings are discussed. © 2015 Society for Psychophysiological Research.

Effect of Da-Cheng-Qi Decoction on Pancreatitis-Associated Intestinal Dysmotility in Patients and in Rat Models

Directory of Open Access Journals (Sweden)

Jianlei Zhao

2015-01-01

Full Text Available The impairment of intestinal motility and related infectious complications are the predominant clinical phenomenon in patients with severe acute pancreatitis (SAP. We aimed to investigate the effects of Da-Cheng-Qi decoction (DCQD on the gastrointestinal injury in SAP patients and the potential mechanism involved in rats. DCQD was enema administered to 70 patients for 7 days in West China Hospital. Mortality and organ failure during admission were observed and blood samples for laboratory analysis were collected. We also experimentally examined plasma inflammatory cytokines in rat serum and carried the morphometric studies of the gut. Intestinal propulsion index and serum and tissue vasoactive intestinal peptide (VIP were also detected. Though DCQD did not affect the overall incidence of organ failure, it shortened the average time of paralytic intestinal obstruction and decreased the morbidity of infectious complications in patients with SAP. Compared with untreated rats, the DCQD lowered the levels of proinflammatory cytokine and decreased the mean pathological intestinal lesion scores. The VIP level in intestinal tissue or serum in DCQD group was obviously lowered and intestinal propulsion index was significantly improved. In conclusion, DCQD has good effect on pancreatitis-associated intestinal dysmotility in patients and in rat models.

Treatment of Goiter with Traditional Chinese Medicine Regimen Xing Qi Hua Ying Tang: A Clinical Study on 72 Patients with Multinodular and Diffuse Goiter.

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Yang, Ming-Li; Lu, Bo

2018-04-01

The present work aimed to further explore the therapeutic potential of Xing Qi Hua Ying Tang (XQHYT) by conducting a systemic clinical study in patients with goiter. Seventy-two patients with either multinodular or diffuse goiter were enrolled and randomly assigned into treatment group receiving XQHYT (n = 36) and control group receiving Hai Zao Yu Hu Tang (n = 36). Traditional Chinese Medicine Hospital of Shanxi. Patients were diagnosed multinodular goiter or diffuse goiter resulting from Qi stagnation. All patients took the extract twice a day (100 mL each time) for two courses of treatment, of which a single course lasted for 3 months. Before the treatment was commenced and after the completion of the treatment, general body checks, thyroid function test, and goiter size examination were performed. Scoring of the clinical symptoms using Chinese medicine symptomatology was also done. The symptom score of the treatment group was significantly lower than that of the control group (treatment group, 8.26 ± 2.62; control group, 10.02 ± 2.62; p < 0.05). Substantial reduction in goiter size was seen in 82.3% of XQHYT-treated patients, whereas in the control group only 67.7% of patients exhibited constricted goiter. When assessed by both the Chinese medicine criteria and goiter size, the overall effective rate of the treatment group was 91.2%, whereas that of the control group was only 67.7%. The difference was statistically significant (p < 0.05). XQHYT did not affect the normal functions of liver, kidney, and heart. For both groups of patients, their levels of thyroid-stimulating hormone, free T4 and free T3 were normal before the treatment, and were not affected by the treatment. XQHYT was shown to be a promising therapeutic regimen for the treatment of goiter. The herbal regimen ameliorated clinical symptoms of patients that were accompanied with reduction in the size of goiter.

Increased Adoption of Quality Improvement Interventions to Implement Evidence-Based Practices for Pressure Ulcer Prevention in U.S. Academic Medical Centers.

Science.gov (United States)

Padula, William V; Mishra, Manish K; Makic, Mary Beth F; Wald, Heidi L; Campbell, Jonathan D; Nair, Kavita V; Valuck, Robert J

2015-12-01

In 2008, the U.S. Centers for Medicare and Medicaid Services enacted a nonpayment policy for stage III and IV hospital-acquired pressure ulcers (HAPUs), which incentivized hospitals to improve prevention efforts. In response, hospitals looked for ways to support implementation of evidence-based practices for HAPU prevention, such as adoption of quality improvement (QI) interventions. The objective of this study was to quantify adoption patterns of QI interventions for supporting evidence-based practices for HAPU prevention. This study surveyed wound care specialists working at hospitals within the University HealthSystem Consortium. A questionnaire was used to retrospectively describe QI adoption patterns according to 25 HAPU-specific QI interventions into four domains: leadership, staff, information technology (IT), and performance and improvement. Respondents indicated QI interventions implemented between 2007 and 2012 to the nearest quarter and year. Descriptive statistics defined patterns of QI adoption. A t-test and statistical process control chart established statistically significant increase in adoption following nonpayment policy enactment in October 2008. Increase are described in terms of scope (number of QI domains employed) and scale (number of QI interventions within domains). Fifty-three of the 55 hospitals surveyed reported implementing QI interventions for HAPU prevention. Leadership interventions were most frequent, increasing in scope from 40% to 63% between 2008 and 2012; "annual programs to promote pressure ulcer prevention" showed the greatest increase in scale. Staff interventions increased in scope from 32% to 53%; "frequent consult driven huddles" showed the greatest increase in scale. IT interventions increased in scope from 31% to 55%. Performance and improvement interventions increased in scope from 18% to 40%, with "new skin care products . . ." increasing the most. Academic medical centers increased adoption of QI interventions

Accelerating Best Care in Pennsylvania: adapting a large academic system's quality improvement process to rural community hospitals.

Science.gov (United States)

Haydar, Ziad; Gunderson, Julie; Ballard, David J; Skoufalos, Alexis; Berman, Bettina; Nash, David B

2008-01-01

Industrial quality improvement (QI) methods such as continuous quality improvement (CQI) may help bridge the gap between evidence-based "best care" and the quality of care provided. In 2006, Baylor Health Care System collaborated with Jefferson Medical College of Thomas Jefferson University to conduct a QI demonstration project in select Pennsylvania hospitals using CQI techniques developed by Baylor. The training was provided over a 6-month period and focused on methods for rapid-cycle improvement; data system design; data management; tools to improve patient outcomes, processes of care, and cost-effectiveness; use of clinical guidelines and protocols; leadership skills; and customer service skills. Participants successfully implemented a variety of QI projects. QI education programs developed and pioneered within large health care systems can be adapted and applied successfully to other settings, providing needed tools to smaller rural and community hospitals that lack the necessary resources to establish such programs independently.

Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales.

Science.gov (United States)

Cooper, Andrew; Gray, Jonathon; Willson, Alan; Lines, Chris; McCannon, Joe; McHardy, Karina

2015-03-01

Effective communication is critical to successful large-scale change. Yet, in our experience, communications strategies are not formally incorporated into quality improvement (QI) frameworks. The 1000 Lives Campaign ('Campaign') was a large-scale national QI collaborative that aimed to save an additional 1000 lives and prevent 50 000 episodes of harm in Welsh health care over a 2-year period. We use the Campaign as a case study to describe the development, application, and impact of a communications strategy embedded in a large-scale QI initiative. A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. We used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff. The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes. Systematic and structured communications can support and enhance QI initiatives. From our experience, we developed a 'communications bundle' consisting of six core components. We recommend that communications bundles be incorporated into existing QI

A site-specific slurry application technique on grassland and on arable crops.

Science.gov (United States)

Schellberg, Jürgen; Lock, Reiner

2009-01-01

There is evidence that unequal slurry application on agricultural land contributes to N losses to the environment. Heterogeneity within fields demands adequate response by means of variable rate application. A technique is presented which allows site-specific application of slurry on grassland and arable land based on pre-defined application maps. The system contains a valve controlling flow rate by an on-board PC. During operation, flow rate is measured and scaled against set point values given in the application map together with the geographic position of the site. The systems worked sufficiently precise at a flow rate between 0 and 25 l s(-1) and an offset of actual slurry flow from set point values between 0.33 and 0.67 l s(-1). Long-term experimentation is required to test if site-specific application de facto reduces N surplus within fields and so significantly contributes to the unloading of N in agricultural areas.

Rhinology-specific priority setting for quality improvement: a modified Delphi study from the Quality Improvement Committee of the American Rhinologic Society.

Science.gov (United States)

Rudmik, Luke; Mattos, Jose L; Stokken, Janalee K; Soler, Zachary M; Manes, R Peter; Higgins, Thomas S; Setzen, Michael; Lee, Jivianne; Schneider, John

2017-10-01

Improving the quality of healthcare is a complex and resource intensive process. To optimize the allocation of scarce resources, quality improvement (QI) should focus on high-value diseases that will produce the largest improvement in health system performance. Given the breadth and multidisciplinary nature of sinonasal disease management, the purpose of this study was to transparently develop a prioritized list of sinonasal diseases for QI from the perspective of the specialty of rhinology and the American Rhinologic Society (ARS). The RAND modified Delphi methodology was used to rank the priority of nine sinonasal disease categories from 1 (lowest priority) to 9 (highest priority). Two rounds of ranking along with a teleconference meeting was performed by a panel of 9 experts from the ARS Quality Improvement Committee. The final QI-prioritized list of sinonasal diseases are as follows: chronic rhinosinusitis (CRS) (mean score = 8.9), recurrent acute rhinosinusitis (RARS) (mean score = 7.9), sinonasal neoplasms (mean score = 7.0), anatomic nasal obstruction (mean score = 5.9), refractory epistaxis (mean score = 5.2), complicated acute rhinosinusitis (mean score = 5.2), chronic nonallergic rhinitis (mean score = 4.4), orbital disease (mean score = 4.3), uncomplicated acute rhinosinusitis (mean score = 4.1), and allergy/allergic rhinitis (mean score = 3.7). The three most important disease categories for QI from the perspective of the specialty of rhinology were CRS, RARS, and sinonasal neoplasms. Future studies need to define and validate quality metrics for each of these important disease categories in order to facilitate appropriate measurement and improvement initiatives. © 2017 ARS-AAOA, LLC.

The effect of the SQUIRE (Standards of QUality Improvement Reporting Excellence) guidelines on reporting standards in the quality improvement literature: a before-and-after study.

Science.gov (United States)

Howell, Victoria; Schwartz, Amanda Eva; O'Leary, James Daniel; Mc Donnell, Conor

2015-06-01

The SQUIRE (Standards of QUality Improvement Reporting Excellence) guidelines were developed to improve the reporting of quality improvement (QI) projects. The effect of the guidelines on the completeness of reporting in the QI literature is unknown. Our primary objective was to determine if the completeness of reporting in the QI literature has been improved[OUP_CE13] since the introduction of the SQUIRE guidelines. We performed a before-and-after evaluation of QI articles selected from four prominent journals of healthcare quality. Twenty-five articles published in each of two time periods (2006-2008 and 2010-2011) were confirmed to be QI projects using a standardised definition and were independently evaluated by two investigators as an interim evaluation of a planned larger sample. Articles were assessed using 50 statements of the SQUIRE guidelines, and the overall change in the completeness of reporting between the two groups was determined. The value of pimprovement observed in the completeness of reporting of QI projects after the publication of the SQUIRE guidelines, and the study was stopped early. There is potential for improvement in reporting standards, particularly for those guideline items or statements specific to QI projects. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Quality improvement "201": context-relevant quality improvement leadership training for the busy clinician-educator.

Science.gov (United States)

Stille, Christopher J; Savageau, Judith A; McBride, Jeanne; Alper, Eric J

2012-01-01

Development of quality improvement (QI) skills and leadership for busy clinician-educators in academic medical centers is increasingly necessary, although it is challenging given limited resources. In response, the authors developed the Quality Scholars program for primary care teaching faculty. They conducted a needs assessment, evaluated existing internal and national resources, and developed a 9-month, 20-session project-based curriculum that combines didactic and hands-on techniques with facilitated project discussion. They also conducted pre-post tests of knowledge and attitudes, and evaluations of each session, scholars' projects, and program sustainability and costs. In all, 10 scholars from all 3 generalist disciplines comprised the first class. A wide spectrum of previous experiences enhanced collaboration. QI knowledge increased slightly, and reported self-readiness to lead QI projects increased markedly. Protected time for project work and group discussion of QI topics was seen as essential. All 10 scholars completed projects and presented results. Institutional leadership agreed to sustain the program using institutional funds.

Evaluation of mesh morphing and mapping techniques in patient specific modeling of the human pelvis.

Science.gov (United States)

Salo, Zoryana; Beek, Maarten; Whyne, Cari Marisa

2013-01-01

Robust generation of pelvic finite element models is necessary to understand the variation in mechanical behaviour resulting from differences in gender, aging, disease and injury. The objective of this study was to apply and evaluate mesh morphing and mapping techniques to facilitate the creation and structural analysis of specimen-specific finite element (FE) models of the pelvis. A specimen-specific pelvic FE model (source mesh) was generated following a traditional user-intensive meshing scheme. The source mesh was morphed onto a computed tomography scan generated target surface of a second pelvis using a landmarked-based approach, in which exterior source nodes were shifted to target surface vertices, while constrained along a normal. A second copy of the morphed model was further refined through mesh mapping, in which surface nodes of the initial morphed model were selected in patches and remapped onto the surfaces of the target model. Computed tomography intensity based material properties were assigned to each model. The source, target, morphed and mapped models were analyzed under axial compression using linear static FE analysis and their strain distributions evaluated. Morphing and mapping techniques were effectively applied to generate good quality geometrically complex specimen-specific pelvic FE models. Mapping significantly improved strain concurrence with the target pelvis FE model. Copyright © 2012 John Wiley & Sons, Ltd.

Evaluation of mesh morphing and mapping techniques in patient specific modelling of the human pelvis.

Science.gov (United States)

Salo, Zoryana; Beek, Maarten; Whyne, Cari Marisa

2012-08-01

Robust generation of pelvic finite element models is necessary to understand variation in mechanical behaviour resulting from differences in gender, aging, disease and injury. The objective of this study was to apply and evaluate mesh morphing and mapping techniques to facilitate the creation and structural analysis of specimen-specific finite element (FE) models of the pelvis. A specimen-specific pelvic FE model (source mesh) was generated following a traditional user-intensive meshing scheme. The source mesh was morphed onto a computed tomography scan generated target surface of a second pelvis using a landmarked-based approach, in which exterior source nodes were shifted to target surface vertices, while constrained along a normal. A second copy of the morphed model was further refined through mesh mapping, in which surface nodes of the initial morphed model were selected in patches and remapped onto the surfaces of the target model. Computed tomography intensity-based material properties were assigned to each model. The source, target, morphed and mapped models were analyzed under axial compression using linear static FE analysis, and their strain distributions were evaluated. Morphing and mapping techniques were effectively applied to generate good quality and geometrically complex specimen-specific pelvic FE models. Mapping significantly improved strain concurrence with the target pelvis FE model. Copyright © 2012 John Wiley & Sons, Ltd.

Partnering health disparities research with quality improvement science in pediatrics.

Science.gov (United States)

Lion, K Casey; Raphael, Jean L

2015-02-01

Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. Copyright © 2015 by the American Academy of Pediatrics.

A Preliminary Investigation of General and Technique-specific Assessments for the Evaluation of Laparoscopic Technical Skills.

Science.gov (United States)

Vergis, Ashley; Steigerwald, Sarah

2017-10-07

Background  Both general and technique-specific assessments of technical skill have been validated in surgical education. The purpose of this study was to assess the correlation between the objective structured assessment of technical skills (OSATS) and the global operative assessment of laparoscopic skills (GOALS) rating scales using a high-fidelity porcine laparoscopic cholecystectomy model. Methods Post-graduate year-one general surgery and urology residents (n=14) performed a live laparoscopic porcine cholecystectomy. Trained surgeons rated their performance using OSATS and GOALS assessment scales. Results Pearson's correlation coefficient between OSATS and GOALS was 0.96 for overall scores. It ranged from 0.78 - 0.89 for domains that overlapped between the two scales. Conclusion There is a very high correlation between OSATS and GOALS. This implies that they likely measure similar constructs and that either may be used for summative-type assessments of trainee skill. However, further investigation is needed to determine if technique-specific assessments may provide more useful feedback in formative evaluation.

Aspergillus specific IgE estimation by radioallergosorbent technique (RAST) in obstructive airways disease at Agra

International Nuclear Information System (INIS)

Sharma, S.K.; Singh, R.; Mehrotra, M.P.; Patney, N.L.; Sachan, A.S.; Shiromany, A.

1986-01-01

The radioallergosorbent technique (RAST) was used to measure the levels of Aspergillus specific IgE in 25 normal controls, 25 cases of extrinsic bronchial asthma and 25 cases of allergic broncho-pulmonary aspergillosis with a view to study the clinical role and its correlation with sputum culture, skin sensitivity and severity of airways obstruction. The test was performed using Pharmacia diagnostic kits with antigen derived from Aspergillus fumigatus. Abnormal levels of Aspergillus specific IgE were observed in 84 per cent cases of bronchial asthma but none of the controls. 86.7 per cent of all cases with positive skin test had positive radioallergosorbent test and there was no false positive reaction. There was a positive correlation of Aspergillus specific IgE with skin test positivity and with FEV 1 /FVC per cent. (author)

A story of success: continuous quality improvement in cystic fibrosis care in the USA.

Science.gov (United States)

Quon, Bradley S; Goss, Christopher H

2011-12-01

Continuous quality improvement (CQI) in healthcare can be described as a reiterative approach to improving processes to reduce unexpected variation in health outcomes. CQI represents one model to achieve quality improvement (QI) and has long been recognized as a key to success in the manufacturing industry with companies like Toyota leading the way. Healthcare, and specifically pulmonary, critical care and sleep medicine represent ideal settings for the application of CQI. This opinion piece will describe QI and CQI initiatives in the US Cystic fibrosis (CF) population. QI in CF care in the United States has been ongoing since inception of the US CF Foundation (CFF) in 1955. This effort has included work to improve the quality of clinical care provided at CF centers and work to improve clinical outcomes in CF. More recently, QI methods have been applied to the conduct of clinical research. The CF community has become a leader in the area of QI and has pointed out the opportunities for others to follow in the area of lung diseases.

Using Medical Student Quality Improvement Projects to Promote Evidence-Based Care in the Emergency Department.

Science.gov (United States)

Manning, Michael W; Bean, Eric W; Miller, Andrew C; Templer, Suzanne J; Mackenzie, Richard S; Richardson, David M; Bresnan, Kristin A; Greenberg, Marna R

2018-01-01

The Association of American Medical Colleges' (AAMC) initiative for Core Entrustable Professional Activities for Entering Residency includes as an element of Entrustable Professional Activity 13 to "identify system failures and contribute to a culture of safety and improvement." We set out to determine the feasibility of using medical students' action learning projects (ALPs) to expedite implementation of evidence-based pathways for three common patient diagnoses in the emergency department (ED) setting (Atrial fibrillation, congestive heart failure, and pulmonary embolism). These prospective quality improvement (QI) initiatives were performed over six months in three Northeastern PA hospitals. Emergency physician mentors were recruited to facilitate a QI experience for third-year medical students for each project. Six students were assigned to each mentor and given class time and network infrastructure support (information technology, consultant experts in lean management) to work on their projects. Students had access to background network data that revealed potential for improvement in disposition (home) for patients. Under the leadership of their mentors, students accomplished standard QI processes such as performing the background literature search and assessing key stakeholders' positions that were involved in the respective patient's care. Students effectively developed flow diagrams, computer aids for clinicians and educational programs, and participated in recruiting champions for the new practice standard. They met with other departmental clinicians to determine barriers to implementation and used this feedback to help set specific parameters to make clinicians more comfortable with the changes in practice that were recommended. All three clinical practice guidelines were initiated at consummation of the students' projects. After implementation, 86% (38/44) of queried ED providers felt comfortable with medical students being a part of future ED QI

An extract of a formula used in the traditional chinese medicine (Buzhong Yi Qi Wan) alters the labeling of blood constituents with technetium-99m

International Nuclear Information System (INIS)

Giani, Tania Santos; Paoli, Severo de; Brandao-Neto, Jose; Medeiros, Aldo da Cunha; Presta, Giuseppe Antonio; Maiworm, Adalgisa Ieda; Santos Filho, Sebastiao David; Fonseca, Adenilson de Souza da; Bernardo-Filho, Mario

2007-01-01

Buzhong Yi Qi Wan (Buzhong) is a medicinal herb widely used in Traditional Chinese Medicine to treat the digestive and circulatory systems. Red blood cell and plasma proteins labeled with technetium-99m ( 99m Tc) are used in nuclear medicine. The aim of this work was to investigate the effects of an aqueous Buzhong extract on the labeling of blood constituents with 99m Tc. Heparinized blood (Wistar rats) was incubated in vitro with different Buzhong extract concentrations and 99m Tc-labeling was performed. Plasma (P) and blood cells (BC) were separated and soluble (SF-P, SF-BC) and insoluble (IF-P, IF-BC) fractions were isolated. The radioactivity on blood constituents was determined and the percentage of incorporated radioactivity (%ATI) was calculated. Buzhong extract at the highest concentrations used altered significantly (p 99 mTc. (author)

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.

Woman Survival in Chinese Feudal Patrilineal Society: An Analysis of Song Lian's Destiny in Qi Qie Chenqun By Su Tong

Directory of Open Access Journals (Sweden)

Xuc Lin

2009-05-01

Full Text Available Article depicted woman’s difficulties in maintaining her life as well as her aggressiveness in the patrilineal society in Chinese feudal time. Article analyzed Song Lian’s bad fate. She was the main character of qi qie chenqun novel, written by Su Tong. Article analysis consisted of three parts. The first part described Song Lian’s background of life and her becoming a mistress. The second part indicated Song Lian’s attacking behavior to other woman because of defending her life. His third part analyzed some causes that made Song Lian did not survive in life. It can be concluded that the fact, Song Lian is able to be survive but she decides to be a mistress caused by both personal and o social reasons. Song Lian’s attacking other woman is caused by her anger representing her unsuccessful life. Principally, Song Lian’s failure in the feudal life is caused by her unsuccessful in becoming a respected woman. If she had been a respected woman, she would have also competed with other women in achieving a better life.      

Using typing techniques in a specific outbreak: the ethical reflection of public health professionals.

Science.gov (United States)

Rump, B; Cornelis, C; Woonink, F; VAN Steenbergen, J; Verweij, M; Hulscher, M

2017-05-01

Typing techniques are laboratory methods used in outbreak management to investigate the degree to which microbes found within an outbreak are related. Knowledge about relational patterns between microbes benefits outbreak management, but inevitably also tells us something about the relational patterns of the people hosting them. Since the technique is often used without explicit consent of all individuals involved, this may raise ethical questions. The aim of this study was to unravel the complex ethical deliberation of professionals over the use of such techniques. We organised group discussions (n = 3) with Dutch outbreak managers (n = 23). The topic list was based on previously identified ethical issues and discussions were analysed for recurrent themes. We found that outbreak managers first and foremost reflect on the balance of individual harm with public health benefit. This key question was approached by way of discussing four more specific ethical themes: (1) justification of governmental intervention, (2) responsibility to prevent infections, (3) scientific uncertainty and (4) legal consequences. The themes found in this study, rephrased into accessible questions, represent the shared ethical understanding of professionals and can help to articulate the ethical dimensions of using molecular science in response to infectious disease outbreaks.

The immediate effect of a brief energy psychology intervention (Emotional Freedom Techniques) on specific phobias: a pilot study.

Science.gov (United States)

Salas, Martha M; Brooks, Audrey J; Rowe, Jack E

2011-01-01

Specific phobia is one of the most prevalent anxiety disorders. Emotional Freedom Techniques (EFT) has been shown to improve anxiety symptoms; however, their application to specific phobias has received limited attention. This pilot study examined whether EFT, a brief exposure therapy that combines cognitive and somatic elements, had an immediate effect on the reduction of anxiety and behavior associated with specific phobias. The study utilized a crossover design with participants randomly assigned to either diaphragmatic breathing or EFT as the first treatment. The study was conducted at a regional university in the Southwestern United States. Twenty-two students meeting criteria for a phobic response to a specific stimulus (≥8 on an 11-point subjective units of distress scale). Participants completed a total of five two-minute rounds in each treatment intervention. Study measures included a behavioral approach test (BAT), Subjective Units of Distress Scale (SUDS), and Beck Anxiety Inventory (BAI). Emotional Freedom Techniques significantly reduced phobia-related anxiety (BAI P = .042; SUDS P = .002) and ability to approach the feared stimulus (BAT P = .046) whether presented as an initial treatment or following diaphragmatic breathing. When presented as the initial treatment, the effects of EFT remained through the presentation of the comparison intervention. The efficacy of EFT in treating specific phobias demonstrated in several earlier studies is corroborated by the current investigation. Comparison studies between EFT and the most effective established therapies for treating specific phobias are recommended. Copyright © 2011 Elsevier Inc. All rights reserved.

An extract of a formula used in the traditional chinese medicine (Buzhong Yi Qi Wan alters the labeling of blood constituents with technetium-99m

Directory of Open Access Journals (Sweden)

Tania Santos Giani

2007-09-01

Full Text Available Buzhong Yi Qi Wan (Buzhong is a medicinal herb widely used in Traditional Chinese Medicine to treat the digestive and circulatory systems. Red blood cell and plasma proteins labeled with technetium-99m (99mTc are used in nuclear medicine. The aim of this work was to investigate the effects of an aqueous Buzhong extract on the labeling of blood constituents with 99mTc. Heparinized blood (Wistar rats was incubated in vitro with different Buzhong extract concentrations and 99mTc-labeling was performed. Plasma (P and blood cells (BC were separated and soluble (SF-P, SF-BC and insoluble (IF-P, IF-BC fractions were isolated. The radioactivity on blood constituents was determined and the percentage of incorporated radioactivity (%ATI was calculated. Buzhong extract at the highest concentrations used altered significantly (pBuzhong Yi Qi Wan (Buzhong é uma fórmula utilizada na Medicina Tradicional Chinesa para tratamento de distúrbios nos sistemas digestório e circulatório. Constituintes sangüíneos marcados com tecnécio-99m (99mTc são usados na medicina nuclear. O objetivo deste estudo foi investigar os efeitos do extrato de Buzhong na marcação de constituintes sangüíneos com 99mTc. Amostras de sangue de ratos Wistar foram incubadas com diferentes concentrações do extrato de Buzhong e a marcação de constituintes sangüíneos com 99mTc foi realizado. Plasma e células sangüíneas foram separados, frações solúveis e insolúveis do plasma e das células sangüíneas foram isoladas. A radioatividade nos constituintes sangüíneos foi contada e as porcentagens de radioatividade incorporada (%ATI, determinada. Extrato de Buzhong nas maiores concentrações utilizadas altera significativamente (p<0.05 a %ATI nos constituintes sangüíneos. Substâncias presentes no extrato de Buzhong poderiam alterar a membrana celular e/ou gerar radicais livres, que têm propriedades oxidantes, modificando a marcação dos constituintes sangüíneos com

Articular dysfunction patterns in patients with mechanical neck pain: a clinical algorithm to guide specific mobilization and manipulation techniques.

Science.gov (United States)

Dewitte, Vincent; Beernaert, Axel; Vanthillo, Bart; Barbe, Tom; Danneels, Lieven; Cagnie, Barbara

2014-02-01

In view of a didactical approach for teaching cervical mobilization and manipulation techniques to students as well as their use in daily practice, it is mandatory to acquire sound clinical reasoning to optimally apply advanced technical skills. The aim of this Masterclass is to present a clinical algorithm to guide (novice) therapists in their clinical reasoning to identify patients who are likely to respond to mobilization and/or manipulation. The presented clinical reasoning process is situated within the context of pain mechanisms and is narrowed to and applicable in patients with a dominant input pain mechanism. Based on key features in subjective and clinical examination, patients with mechanical nociceptive pain probably arising from articular structures can be categorized into specific articular dysfunction patterns. Pending on these patterns, specific mobilization and manipulation techniques are warranted. The proposed patterns are illustrated in 3 case studies. This clinical algorithm is the corollary of empirical expertise and is complemented by in-depth discussions and knowledge exchange with international colleagues. Consequently, it is intended that a carefully targeted approach contributes to an increase in specificity and safety in the use of cervical mobilizations and manipulation techniques as valuable adjuncts to other manual therapy modalities. Copyright © 2013 Elsevier Ltd. All rights reserved.

Lymphogammagraphy. An adaptive technique to specific clinical problems

International Nuclear Information System (INIS)

Rojas, Juan Carlos; Llamas, Augusto E; De los Reyes, Amelia; Martinez, Maria Cristina

2000-01-01

Lymphoscintigraphy (LS) is an accurate and safe procedure for the evaluation of lymph nodes, many of which remain occult to other imaging techniques. Not only lymphatic pathways, but also the functional condition of the lymphatic channels and the localization of lymphatic basins can be assessed with LS. We will illustrate the utility of the technique in different clinical settings, concerning two patients recently studied at the National Cancer Institute. In the first case a patient previously diagnosed with a testicular teratocarcinoma that presented with ascites. The LS showed a chyloperitoneum, leading the clinicians to with old further treatment given the lymphatic nature of the ascites as opposed to a malignant origin. In the second patient the LS illustrated the adaptability of the lymphatic system to a chronic insult (suture of Pecquet's cistem) by lymphatic flows diversion through paralumbar channels. In this patient LS was combined with a peritoneal scintigraphy to demonstrate permeability through a peritoneovenous bypass; incidentally, a peritoneopleural shunt was diagnosed. LS permit the visualization of lymphatic channels and their functional derangements in an easy, minimally invasive way, not routinely achievable by other imaging techniques |

Sediment Origin Determination in the Sub-Catchment of Mistelbach (Austria) using Fatty Acids Biomarkers and Compound-Specific Stable Isotope Techniques

International Nuclear Information System (INIS)

Mabit, L.; Chen, X.; Resch, C.; Toloza, A.; Meusburger, K.; Alewell, C.; Gibbs, M.; Klik, A.; Eder, A.; Strauss, P.

2016-01-01

Compound-specific stable isotope (CSSI) signatures of inherent soil organic biomarkers allow discriminating and apportioning the source of soil contribution from different land uses. Plant communities label the soil where they grow by exuding organic biomarkers. Although all plants produce the same biomarkers, the stable isotopic signature of those biomarkers is different for each plant species. For agri-environmental investigations, the CSSI technique is based on the measurement of carbon-13 ( 13 C) natural abundance signatures of specific organic compounds such as natural fatty acids (FAs) in the soil. By linking fingerprints of land use to the sediment in deposition zones, this approach has been shown to be a useful technique for determining the source of eroded soil and thereby identifying areas prone to soil degradation. The authors have used this innovative technique to investigate a 3 hectares sub-catchment of Mistelbach situated 60 km north of Vienna. Using the 137 Cs technique, Mabit et al. (2009) reported a local maximum sedimentation rate reaching 20 to 50 t ha -1 yr -1 in the lowest part of this Austrian catchment. To test the ability of the CSSI technique to discriminate different sediment sources of these deposited sediments, representative soil samples from four main agricultural fields of the site were analyzed

How Well Is Quality Improvement Described in the Perioperative Care Literature? A Systematic Review

Science.gov (United States)

Jones, Emma L.; Lees, Nicholas; Martin, Graham; Dixon-Woods, Mary

2016-01-01

Abstract Background Quality improvement (QI) approaches are widely used across health care, but how well they are reported in the academic literature is not clear. A systematic review was conducted to assess the completeness of reporting of QI interventions and techniques in the field of perioperative care. Methods Searches were conducted using Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organization of Care database, and PubMed. Two independent reviewers used the Template for Intervention Description and Replication (TIDieR) checklist, which identifies 12 features of interventions that studies should describe (for example, How: the interventions were delivered [e.g., face to face, internet]), When and how much: duration, dose, intensity), to assign scores for each included article. Articles were also scored against a small number of additional criteria relevant to QI. Results The search identified 16,103 abstracts from databases and 19 from other sources. Following review, full-text was obtained for 223 articles, 100 of which met the criteria for inclusion. Completeness of reporting of QI in the perioperative care literature was variable. Only one article was judged fully complete against the 11 TIDieR items used. The mean TIDieR score across the 100 included articles was 6.31 (of a maximum 11). More than a third (35%) of the articles scored 5 or lower. Particularly problematic was reporting of fidelity (absent in 74% of articles) and whether any modifications were made to the intervention (absent in 73% of articles). Conclusions The standard of reporting of quality interventions and QI techniques in surgery is often suboptimal, making it difficult to determine whether an intervention can be replicated and used to deliver a positive effect in another setting. This suggests a need to explore how reporting practices could be improved. PMID:27066922

Design and manufacturing of patient-specific orthodontic appliances by computer-aided engineering techniques.

Science.gov (United States)

Barone, Sandro; Neri, Paolo; Paoli, Alessandro; Razionale, Armando Viviano

2018-01-01

Orthodontic treatments are usually performed using fixed brackets or removable oral appliances, which are traditionally made from alginate impressions and wax registrations. Among removable devices, eruption guidance appliances are used for early orthodontic treatments in order to intercept and prevent malocclusion problems. Commercially available eruption guidance appliances, however, are symmetric devices produced using a few standard sizes. For this reason, they are not able to meet all the specific patient's needs since the actual dental anatomies present various geometries and asymmetric conditions. In this article, a computer-aided design-based methodology for the design and manufacturing of a patient-specific eruption guidance appliances is presented. The proposed approach is based on the digitalization of several steps of the overall process: from the digital reconstruction of patients' anatomies to the manufacturing of customized appliances. A finite element model has been developed to evaluate the temporomandibular joint disks stress level caused by using symmetric eruption guidance appliances with different teeth misalignment conditions. The developed model can then be used to guide the design of a patient-specific appliance with the aim at reducing the patient discomfort. At this purpose, two different customization levels are proposed in order to face both arches and single tooth misalignment issues. A low-cost manufacturing process, based on an additive manufacturing technique, is finally presented and discussed.

Pharmacist leadership in ICU quality improvement: coordinating spontaneous awakening and breathing trials.

Science.gov (United States)

Stollings, Joanna L; Foss, Julie J; Ely, E Wesley; Ambrose, Anna M; Rice, Todd W; Girard, Timothy D; Wheeler, Arthur P

2015-08-01

Coordinating efforts across disciplines in the intensive care unit is a key component of quality improvement (QI) efforts. Spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) are considered key components of guidelines, yet unfortunately are often not done or coordinated properly. To determine if a pharmacist-driven awakening and breathing coordination (ABC) QI program would improve compliance (ie, process measures) as compared with the previous protocol, which did not involve pharmacists. The QI program included pharmacist-led education, daily discussion on rounds, and weekly performance reports to staff. Using a pre-QI versus during-QI versus post-QI intervention design, we compared data from 500 control ventilator-days (pre-QI period) versus 580 prospective ventilator-days (during-QI period). We then evaluated the sustainability of the QI program in 216 ventilator-days in the post-QI period. SAT safety screens were performed on only 20% pre-QI patient-days versus 97% of during-QI patient-days (P improved process measures compliance, comparing the pre-QI versus during-QI rates of screening, performing, and coordinating SAT and SBTs, and these results were sustained in the 8-month follow-up period post-QI program. © The Author(s) 2015.

Quality improvement and accreditation readiness in state public health agencies.

Science.gov (United States)

Madamala, Kusuma; Sellers, Katie; Beitsch, Leslie M; Pearsol, Jim; Jarris, Paul

2012-01-01

There were 3 specific objectives of this study. The first objective was to examine the progress of state/territorial health assessment, health improvement planning, performance management, and quality improvement (QI) activities at state/territorial health agencies and compare findings to the 2007 findings when available. A second objective was to examine respondent interest and readiness for national voluntary accreditation. A final objective was to explore organizational factors (eg, leadership and capacity) that may influence QI or accreditation readiness. Cross-sectional study. State and Territorial Public Health Agencies. Survey respondents were organizational leaders at State and Territorial Public Health Agencies. Sixty-seven percent of respondents reported having a formal performance management process in place. Approximately 77% of respondents reported a QI process in place. Seventy-three percent of respondents agreed or strongly agreed that they would seek accreditation and 36% agreed or strongly agreed that they would seek accreditation in the first 2 years of the program. In terms of accreditation prerequisites, a strategic plan was most frequently developed, followed by a state/territorial health assessment and health improvement plan, respectively. Advancements in the practice and applied research of QI in state public health agencies are necessary steps for improving performance. In particular, strengthening the measurement of the QI construct is essential for meaningfully assessing current practice patterns and informing future programming and policy decisions. Continued QI training and technical assistance to agency staff and leadership is also critical. Accreditation may be the pivotal factor to strengthen both QI practice and research. Respondent interest in seeking accreditation may indicate the perceived value of accreditation to the agency.

Pediatrics Residents' Confidence and Performance Following a Longitudinal Quality Improvement Curriculum.

Science.gov (United States)

Courtlandt, Cheryl; Noonan, Laura; Koricke, Maureen Walsh; Zeskind, Philip Sanford; Mabus, Sarah; Feld, Leonard

2016-02-01

Quality improvement (QI) training is an integral part of residents' education. Understanding the educational value of a QI curriculum facilitates understanding of its impact. The purpose of this study was to evaluate the effects of a longitudinal QI curriculum on pediatrics residents' confidence and competence in the acquisition and application of QI knowledge and skills. Three successive cohorts of pediatrics residents (N = 36) participated in a longitudinal curriculum designed to increase resident confidence in QI knowledge and skills. Key components were a succession of progressive experiential projects, QI coaching, and resident team membership culminating in leadership of the project. Residents completed precurricular and postcurricular surveys and demonstrated QI competence by performance on the pediatric QI assessment scenario. Residents participating in the Center for Advancing Pediatric Excellence QI curriculum showed significant increases in pre-post measures of confidence in QI knowledge and skills. Coaching and team leadership were ranked by resident participants as having the most educational value among curriculum components. A pediatric QI assessment scenario, which correlated with resident-perceived confidence in acquisition of QI skills but not QI knowledge, is a tool available to test pediatrics residents' QI knowledge. A 3-year longitudinal, multimodal, experiential QI curriculum increased pediatrics residents' confidence in QI knowledge and skills, was feasible with faculty support, and was well-accepted by residents.

Vapor generation – atomic spectrometric techniques. Expanding frontiers through specific-species preconcentration. A review

International Nuclear Information System (INIS)

Gil, Raúl A.; Pacheco, Pablo H.; Cerutti, Soledad; Martinez, Luis D.

2015-01-01

This article reviews 120 articles found in SCOPUS and specific Journal cites corresponding to the terms ‘preconcentration’; ‘speciation’; ‘vapor generation techniques’ and ‘atomic spectrometry techniques’ in the last 5 years. - Highlights: • Recent advances in vapor generation and atomic spectrometry were reviewed. • Species-specific preconcentration strategies after and before VG were discussed. • New preconcentration and speciation analysis were evaluated within this framework. - Abstract: We review recent progress in preconcentration strategies associated to vapor generation techniques coupled to atomic spectrometric (VGT-AS) for specific chemical species detection. This discussion focuses on the central role of different preconcentration approaches, both before and after VG process. The former was based on the classical solid phase and liquid–liquid extraction procedures which, aided by automation and miniaturization strategies, have strengthened the role of VGT-AS in several research fields including environmental, clinical, and others. We then examine some of the new vapor trapping strategies (atom-trapping, hydride trapping, cryotrapping) that entail improvements in selectivity through interference elimination, but also they allow reaching ultra-low detection limits for a large number of chemical species generated in conventional VG systems, including complete separation of several species of the same element. This review covers more than 100 bibliographic references from 2009 up to date, found in SCOPUS database and in individual searches in specific journals. We finally conclude by giving some outlook on future directions of this field

Vapor generation – atomic spectrometric techniques. Expanding frontiers through specific-species preconcentration. A review

Energy Technology Data Exchange (ETDEWEB)

Gil, Raúl A.; Pacheco, Pablo H.; Cerutti, Soledad [Área de Química Analítica, Facultad de Química Bioquímica y Farmacia, Universidad Nacional de San Luis, Ciudad de San Luis 5700 (Argentina); Instituto de Química de San Luis, INQUISAL, Centro Científico-Tecnológico de San Luis (CCT-San Luis), Consejo Nacional de Investigaciones Científicas y Universidad Nacional de San Luis, Ciudad de San Luis 5700 (Argentina); Martinez, Luis D., E-mail: ldm@unsl.edu.ar [Área de Química Analítica, Facultad de Química Bioquímica y Farmacia, Universidad Nacional de San Luis, Ciudad de San Luis 5700 (Argentina); Instituto de Química de San Luis, INQUISAL, Centro Científico-Tecnológico de San Luis (CCT-San Luis), Consejo Nacional de Investigaciones Científicas y Universidad Nacional de San Luis, Ciudad de San Luis 5700 (Argentina)

2015-05-22

This article reviews 120 articles found in SCOPUS and specific Journal cites corresponding to the terms ‘preconcentration’; ‘speciation’; ‘vapor generation techniques’ and ‘atomic spectrometry techniques’ in the last 5 years. - Highlights: • Recent advances in vapor generation and atomic spectrometry were reviewed. • Species-specific preconcentration strategies after and before VG were discussed. • New preconcentration and speciation analysis were evaluated within this framework. - Abstract: We review recent progress in preconcentration strategies associated to vapor generation techniques coupled to atomic spectrometric (VGT-AS) for specific chemical species detection. This discussion focuses on the central role of different preconcentration approaches, both before and after VG process. The former was based on the classical solid phase and liquid–liquid extraction procedures which, aided by automation and miniaturization strategies, have strengthened the role of VGT-AS in several research fields including environmental, clinical, and others. We then examine some of the new vapor trapping strategies (atom-trapping, hydride trapping, cryotrapping) that entail improvements in selectivity through interference elimination, but also they allow reaching ultra-low detection limits for a large number of chemical species generated in conventional VG systems, including complete separation of several species of the same element. This review covers more than 100 bibliographic references from 2009 up to date, found in SCOPUS database and in individual searches in specific journals. We finally conclude by giving some outlook on future directions of this field.

Curling Edges: A Problem that Has Plagued Scrolls for Millennia

Science.gov (United States)

Chou, Ming-Han; Shen, Wei-Chao; Wang, Yi-Ping; Hung, Sun-Hsin; Hong, Tzay-Ming

2014-01-01

Qi-Wa refers to the up curl on the lengths of hand scrolls and hanging scrolls, which has troubled Chinese artisans and emperors for as long as the art of painting and calligraphy has existed. This warp is unwelcome not only for aesthetic reasons, but its potential damage to the fiber and ink. Although it is generally treated as a part of the cockling and curling due to moisture, consistency of paste, and defects from the mounting procedures, we demonstrate that the spontaneous extrinsic curvature incurred from the storage is in fact more essential to understanding and curing Qi-Wa. In contrast to the former factors whose effects are less predictable, the plastic deformation and strain distribution on a membrane are a well-defined mechanical problem. We study this phenomenon by experiments, theoretical models, and molecular dynamics simulation, and obtain consistent scaling relations for the Qi-Wa height. This knowledge enables us to propose modifications on the traditional mounting techniques that are tested on real mounted paper to be effective at mitigating Qi-Wa. By experimenting on polymer-based films, we demonstrate the possible relevance of our study to the modern development of flexible electronic paper.

Edge curling that has plagued scrolls for millenniums

Science.gov (United States)

Chou, Ming-Han; Shen, Wei-Chao; Wang, Yi-Ping; Hung, Sun-Hsin; Hong, Tzay-Ming; Department of Registration and Conservation, National Palace Museum Collaboration; Department of Physics, National Tsing Hua University Team

2014-03-01

Qi-Wa refers to the up curl on the lengths of handscrolls and hanging scrolls, which has troubled Chinese artisans and emperors for as long as the art of painting and calligraphy exists. This warp is unwelcome not only for aesthetic reasons, but its potential damage to the fiber and ink. Although it is generally treated as a part of the cockling and curling due to moisture, consistency of paste, and defects from the mounting procedures, we demonstrate that the spontaneous extrinsic curvature incurred from the storage is in fact more essential to understanding and curing Qi-Wa. In contrast to the former factors whose effects are less predictable, the plastic deformation and strain distribution on a membrane are a well-defined mechanical problem. We study this phenomenon by experiments, theoretical models, and Molecular Dynamics Simulation, and obtain consistent scaling relations for the Qi-Wa height. This knowledge enables us to propose modifications on the traditional mounting techniques, that are tested on real mounted paper to be effective at mitigating Qi-Wa. By experimenting on polymer-based films, we demonstrate possible relevance of our study to the modern development of flexible electronic paper.

The 'Nefertiti lift': a new technique for specific re-contouring of the jawline.

Science.gov (United States)

Levy, Phillip M

2007-12-01

Botulinum toxin type A (BoNTA) is now used extensively for rejuvenation of the forehead, glabellar and periocular regions and there is increasing focus on treatment of the lower face. Although there is well-documented evidence for the efficacy of botulinum toxin in the correction of platysmal bands, little work has been done to explore its potential role in rejuvenation of the jawline. To date, effects in this area have been reported as a consequence of platysmal banding treatment and are inconsistent. Hesitancy to explore treatment may be due to evidence of a greater, more durable response to the toxin in the lower facial muscles as well as reports of increased potential migration and subsequent side effects. This paper describes a new technique using BoNTA (Vistabel); Allergan, Irvine, CA, USA) to drape the skin of the jawline contour and provide the visual effect of a 'mini lift'. Experience with 130 patients with doses of BoNTA up to 20 U is described. Patient satisfaction is extremely high and the specificity of dosing and technique has led to a low incidence of adverse effects. The 'Nefertiti lift' is a minimally invasive, effective and acceptable alternative for those patients seeking an effective way to push back surgery.

Using Medical Student Quality Improvement Projects to Promote Evidence-Based Care in the Emergency Department

Directory of Open Access Journals (Sweden)

Michael W. Manning

2017-12-01

Full Text Available Introduction The Association of American Medical Colleges’ (AAMC initiative for Core Entrustable Professional Activities for Entering Residency includes as an element of Entrustable Professional Activity 13 to “identify system failures and contribute to a culture of safety and improvement.” We set out to determine the feasibility of using medical students’ action learning projects (ALPs to expedite implementation of evidence-based pathways for three common patient diagnoses in the emergency department (ED setting (Atrial fibrillation, congestive heart failure, and pulmonary embolism. Methods These prospective quality improvement (QI initiatives were performed over six months in three Northeastern PA hospitals. Emergency physician mentors were recruited to facilitate a QI experience for third-year medical students for each project. Six students were assigned to each mentor and given class time and network infrastructure support (information technology, consultant experts in lean management to work on their projects. Students had access to background network data that revealed potential for improvement in disposition (home for patients. Results Under the leadership of their mentors, students accomplished standard QI processes such as performing the background literature search and assessing key stakeholders’ positions that were involved in the respective patient’s care. Students effectively developed flow diagrams, computer aids for clinicians and educational programs, and participated in recruiting champions for the new practice standard. They met with other departmental clinicians to determine barriers to implementation and used this feedback to help set specific parameters to make clinicians more comfortable with the changes in practice that were recommended. All three clinical practice guidelines were initiated at consummation of the students’ projects. After implementation, 86% (38/44 of queried ED providers felt comfortable

Assessment of effects of a formula used in the traditional Chinese medicine (Buzhong Yi Qi Wan on the morphologic and osmotic fragility of red blood cells

Directory of Open Access Journals (Sweden)

Tania S. Giani

Full Text Available Buzhong Yi Qi Wan (BYQW is a combination of some medicinal herbs widely used in traditional Chinese medicine to treat blood, spleen and stomach disorders. Morphometric analysis and osmotic fragility assay have been used to evaluate changes on membrane integrity of red blood cells. The aim of this work was to evaluate the effect of an aqueous BYQW extract on the morphology and osmotic fragility of red blood cells. Blood samples were treated with BYQW extract, quantitative/qualitative morphological analysis and osmotic fragility assay were carried out against control groups treated with saline. The data obtained indicated no modification on morphology but osmotic fragility assay suggested a significant (p<0.05 increasing of hemolysis in red blood cells isolated from blood treated with aqueous BYQW extract. In conclusion, the aqueous BYQW extract could affect the membrane integrity decreasing the osmotic resistance but without altering the shape of red blood cells.

The technique for 3D printing patient-specific models for auricular reconstruction.

Science.gov (United States)

Flores, Roberto L; Liss, Hannah; Raffaelli, Samuel; Humayun, Aiza; Khouri, Kimberly S; Coelho, Paulo G; Witek, Lukasz

2017-06-01

Currently, surgeons approach autogenous microtia repair by creating a two-dimensional (2D) tracing of the unaffected ear to approximate a three-dimensional (3D) construct, a difficult process. To address these shortcomings, this study introduces the fabrication of patient-specific, sterilizable 3D printed auricular model for autogenous auricular reconstruction. A high-resolution 3D digital photograph was captured of the patient's unaffected ear and surrounding anatomic structures. The photographs were exported and uploaded into Amira, for transformation into a digital (.stl) model, which was imported into Blender, an open source software platform for digital modification of data. The unaffected auricle as digitally isolated and inverted to render a model for the contralateral side. The depths of the scapha, triangular fossa, and cymba were deepened to accentuate their contours. Extra relief was added to the helical root to further distinguish this structure. The ear was then digitally deconstructed and separated into its individual auricular components for reconstruction. The completed ear and its individual components were 3D printed using polylactic acid filament and sterilized following manufacturer specifications. The sterilized models were brought to the operating room to be utilized by the surgeon. The models allowed for more accurate anatomic measurements compared to 2D tracings, which reduced the degree of estimation required by surgeons. Approximately 20 g of the PLA filament were utilized for the construction of these models, yielding a total material cost of approximately $1. Using the methodology detailed in this report, as well as departmentally available resources (3D digital photography and 3D printing), a sterilizable, patient-specific, and inexpensive 3D auricular model was fabricated to be used intraoperatively. This technique of printing customized-to-patient models for surgeons to use as 'guides' shows great promise. Copyright © 2017 European

A Simple Ensemble Simulation Technique for Assessment of Future Variations in Specific High-Impact Weather Events

Science.gov (United States)

Taniguchi, Kenji

2018-04-01

To investigate future variations in high-impact weather events, numerous samples are required. For the detailed assessment in a specific region, a high spatial resolution is also required. A simple ensemble simulation technique is proposed in this paper. In the proposed technique, new ensemble members were generated from one basic state vector and two perturbation vectors, which were obtained by lagged average forecasting simulations. Sensitivity experiments with different numbers of ensemble members, different simulation lengths, and different perturbation magnitudes were performed. Experimental application to a global warming study was also implemented for a typhoon event. Ensemble-mean results and ensemble spreads of total precipitation, atmospheric conditions showed similar characteristics across the sensitivity experiments. The frequencies of the maximum total and hourly precipitation also showed similar distributions. These results indicate the robustness of the proposed technique. On the other hand, considerable ensemble spread was found in each ensemble experiment. In addition, the results of the application to a global warming study showed possible variations in the future. These results indicate that the proposed technique is useful for investigating various meteorological phenomena and the impacts of global warming. The results of the ensemble simulations also enable the stochastic evaluation of differences in high-impact weather events. In addition, the impacts of a spectral nudging technique were also examined. The tracks of a typhoon were quite different between cases with and without spectral nudging; however, the ranges of the tracks among ensemble members were comparable. It indicates that spectral nudging does not necessarily suppress ensemble spread.

Educational system factors that engage resident physicians in an integrated quality improvement curriculum at a VA hospital: a realist evaluation.

Science.gov (United States)

Ogrinc, Greg; Ercolano, Ellyn; Cohen, Emily S; Harwood, Beth; Baum, Karyn; van Aalst, Robertus; Jones, Anne C; Davies, Louise

2014-10-01

Learning about quality improvement (QI) in resident physician training is often relegated to elective or noncore clinical activities. The authors integrated teaching, learning, and doing QI into the routine clinical work of inpatient internal medicine teams at a Veterans Affairs (VA) hospital. This study describes the design factors that facilitated and inhibited the integration of a QI curriculum-including real QI work-into the routine work of inpatient internal medicine teams. A realist evaluation framework used three data sources: field notes from QI faculty; semistructured interviews with resident physicians; and a group interview with QI faculty and staff. From April 2011 to July 2012, resident physician teams at the White River Junction VA Medical Center used the Model for Improvement for their QI work and analyzed data using statistical process control charts. Three domains affected the delivery of the QI curriculum and engagement of residents in QI work: setting, learner, and teacher. The constant presence of the QI material on a public space in the team workroom was a facilitating mechanism in the setting. Explicit sign-out of QI work to the next resident team formalized the handoff in the learner domain. QI teachers who were respected clinical leaders with QI expertise provided role modeling and local system knowledge. Integrating QI teaching into the routine clinical and educational systems of an inpatient service is challenging. Identifiable, concrete strategies in the setting, learner, and teacher domains helped integrate QI into the clinical and educational systems.

Management and Long-Term Outcome of Acute Coronary Syndrome Patients Presenting with Heart Failure in a Contemporary New Zealand Cohort (ANZACS-QI 4).

Science.gov (United States)

Kueh, Shaw Hua Anthony; Devlin, Gerry; Lee, Mildred; Doughty, Rob N; Kerr, Andrew J

2016-08-01

Acute heart failure (HF) associated with an acute coronary syndrome (ACS) predicts adverse outcome. There have been important recent improvements in ACS management. Our aim was to describe the management and outcomes in those with and without HF in a contemporary ACS cohort. Consecutive patients presenting with ACS between 2007 and 2011 were enrolled in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. Outcomes and medication dispensing were obtained using anonymised linkage to national data sets. A summary pharmacotherapy measure of "quadruple therapy" was defined as dispensing of at least one agent from each of the four evidence-based classes - anti-platelet, statin, angiotensin converting enzyme inhibitor/angiotensin receptor blocker and beta blocker. Of 3743 ACS patients 14% had acute HF. Acute heart failure patients were older (69.2±12.6 vs 62.3±12.8 years, pcoronary angiography (66% vs 86%, pAcute heart failure complicating ACS is associated with heightened risk of short-term and long-term mortality. One in three ACS patients with HF did not have coronary angiography and less than half received quadruple therapy a year after presentation. Copyright © 2016. Published by Elsevier B.V.

Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU.

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Ewald, Dominik A; Huss, Gottfried; Auras, Silke; Caceres, Juan Ruiz-Canela; Hadjipanayis, Adamos; Geraedts, Max

2018-06-01

Paediatric ambulatory healthcare systems in Europe are, because of historical reasons, diverse and show strikingly different outcomes. All across Europe, the benchmarking of structures, processes and outcomes could reveal opportunities for improving Paediatric Primary Care (PPC). The aim of this study was to develop a set of Quality Indicators (QIs) to assess and monitor PPC in Europe. In a three-step process, we used the available external evidence and European expert consensus in a modified RAND/UCLA Appropriateness Method (RAM) to develop an indicator set. (1) A broad literature and online research of published QI and guidelines yielded an inventory of 1516 QI. (2) A collaborative panel of paediatric senior experts from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) from 15 European countries participated in a first consensus process to reduce the initial indicator inventory by eliminating not PPC-focused indicators and duplicates. (3) In a second consensus process, the panel rated the QI regarding validity and feasibility. The final QI set "COSI-PPC-EU" consists of 42 indicators in five categories of PPC: (A) health promotion/prevention/screening (13 QI), (B) acute care (9 QI), (C) chronic care (8 QI), (D) practice management (3 QI) and (E) patient safety (9 QI). COSI-PPC-EU represents a consented set of a limited number of valid quality indicators for the application in paediatric primary care in different healthcare systems throughout Europe. What is Known: • Paediatric ambulatory healthcare systems in Europe are diverse and show strikingly different outcomes. • There are known gaps in quality performance measures of paediatric primary care in Europe. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. What is New: • A set of 42 quality indicators for primary paediatric care in Europe was developed in a multi

Risk based technique for improving technical specifications

International Nuclear Information System (INIS)

Kim, I. S.; Jae, M. S.; Kim, B. S.; Hwang, S. W.; Kang, K. M.; Park, S. S.; Yu, Y. S.

2001-03-01

The objective of this study is to develop the systematic guidance for reviewing the documents associated with the changes of technical specifications. The work done in this fiscal year is the following : surveys in TS requirements, TS improvements and TS regulations in foreign countries as well as Korea, surveys on the state-of-the-art of RITSs and their use in Korea, development of a decision-making framework for both the licensee and the regulation agency, description of risk measures, assessment methodology on STI/AOT, and adverse effects caused by periodic maintenance, which are explained in appendix. The results of this study might contribute to enhancing the quality of the current technical specifications and contribute to preparing the risk informed regulation program using the decision-making framework developed in this study

How can we recognize continuous quality improvement?

Science.gov (United States)

Rubenstein, Lisa; Khodyakov, Dmitry; Hempel, Susanne; Danz, Margie; Salem-Schatz, Susanne; Foy, Robbie; O'Neill, Sean; Dalal, Siddhartha; Shekelle, Paul

2014-02-01

Continuous quality improvement (CQI) methods are foundational approaches to improving healthcare delivery. Publications using the term CQI, however, are methodologically heterogeneous, and labels other than CQI are used to signify relevant approaches. Standards for identifying the use of CQI based on its key methodological features could enable more effective learning across quality improvement (QI) efforts. The objective was to identify essential methodological features for recognizing CQI. Previous work with a 12-member international expert panel identified reliably abstracted CQI methodological features. We tested which features met rigorous a priori standards as essential features of CQI using a three-phase online modified-Delphi process. Primarily United States and Canada. 119 QI experts randomly assigned into four on-line panels. Participants rated CQI features and discussed their answers using online, anonymous and asynchronous discussion boards. We analyzed ratings quantitatively and discussion threads qualitatively. Main outcome measure(s) Panel consensus on definitional CQI features. /st> Seventy-nine (66%) panelists completed the process. Thirty-three completers self-identified as QI researchers, 18 as QI practitioners and 28 as both equally. The features 'systematic data guided activities,' 'designing with local conditions in mind' and 'iterative development and testing' met a priori standards as essential CQI features. Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI. We found consensus among a broad group of CQI researchers and practitioners on three features as essential for identifying QI work more specifically as 'CQI.' All three features are needed as a minimum standard for recognizing CQI methods.

An extract of a formula used in the traditional chinese medicine (Buzhong Yi Qi Wan) alters the labeling of blood constituents with technetium-99m

Energy Technology Data Exchange (ETDEWEB)

Giani, Tania Santos; Paoli, Severo de; Brandao-Neto, Jose; Medeiros, Aldo da Cunha [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Centro de Ciencias da Saude. Programa de Pos-graduacao em Ciencias da Saude]. E-mail: tgiani@gmail.com; Presta, Giuseppe Antonio; Maiworm, Adalgisa Ieda; Santos Filho, Sebastiao David; Fonseca, Adenilson de Souza da [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Inst. de Biologia Roberto Alcantara Gomes. Lab. de Radiofarmacia Experimental; Bernardo-Filho, Mario [Instituto Nacional de Cancer (INCa), Rio de Janeiro, RJ (Brazil). Centro de Pesquisa Basica

2007-09-15

Buzhong Yi Qi Wan (Buzhong) is a medicinal herb widely used in Traditional Chinese Medicine to treat the digestive and circulatory systems. Red blood cell and plasma proteins labeled with technetium-99m ({sup 99m}Tc) are used in nuclear medicine. The aim of this work was to investigate the effects of an aqueous Buzhong extract on the labeling of blood constituents with {sup 99m}Tc. Heparinized blood (Wistar rats) was incubated in vitro with different Buzhong extract concentrations and {sup 99m}Tc-labeling was performed. Plasma (P) and blood cells (BC) were separated and soluble (SF-P, SF-BC) and insoluble (IF-P, IF-BC) fractions were isolated. The radioactivity on blood constituents was determined and the percentage of incorporated radioactivity (%ATI) was calculated. Buzhong extract at the highest concentrations used altered significantly (p<0.05) the %ATI in blood constituents. Substances present in the Buzhong extract could alter the cellular membrane and/or generation of free radicals that have oxidant properties modifying the labeling of blood constituents with {sup 99}mTc. (author)

Quality Improvement in Athletic Health Care.

Science.gov (United States)

Lopes Sauers, Andrea D; Sauers, Eric L; Valier, Alison R Snyder

2017-11-01

  Quality improvement (QI) is a health care concept that ensures patients receive high-quality (safe, timely, effective, efficient, equitable, patient-centered) and affordable care. Despite its importance, the application of QI in athletic health care has been limited.   To describe the need for and define QI in health care, to describe how to measure quality in health care, and to present a QI case in athletic training.   As the athletic training profession continues to grow, a widespread engagement in QI efforts is necessary to establish the value of athletic training services for the patients that we serve. A review of the importance of QI in health care, historical perspectives of QI, tools to drive QI efforts, and examples of common QI initiatives is presented to assist clinicians in better understanding the value of QI for advancing athletic health care and the profession. Clinical and Research Advantages:  By engaging clinicians in strategies to measure outcomes and improve their patient care services, QI practice can help athletic trainers provide high-quality and affordable care to patients.

Application of Specific Theory of Constraints Technique for the Identification of Main Causes of Negative Consequences within Procurement Logistics

Directory of Open Access Journals (Sweden)

Kapustina Larisa M.

2017-05-01

Full Text Available The paper presents a concrete example of the selected Theory of Constraints (TOC technique implementation in order to identify the main causes of undesirable consequences in the context of supply logistics issues. Determining the undesirable consequences of supply logistics is primarily related to the adverse impact on costs, profitability and quality of outsourcing enterprise which provide services in supply chain field. Particularly, this implementation includes individual steps of the process related to the creation of the specific TOC technique. The outcome is to identify the main causes which have the most significant impact on the negative consequences.

Sustaining a quality improvement culture in local health departments applying for accreditation.

Science.gov (United States)

Verma, Pooja; Moran, John W

2014-01-01

This article focuses on local health departments (LHDs) that are advanced in accreditation and quality improvement (QI) efforts and the barriers and facilitators associated with sustaining improvements and building an organizational culture of QI. To understand the barriers and facilitators associated with building and sustaining progress toward a QI culture in LHDs. Quantitative data from a self-reporting survey and qualitative data from telephone interviews. Twenty-two LHDs across the United States responded to the survey. Ten of the 22 LHD respondents participated in telephone interviews. QI lead staff at LHDs that are advanced in accreditation preparation and QI. Self-reported LHD survey ratings against indicators for a QI culture, and the identified barriers and facilitators around sustaining QI initiatives. Of the 6 domains of a QI culture measured in the survey, the percentages of respondents that scored themselves highly to at least 1 indicator in each domain are as follows: leadership commitment (100%); employee empowerment (100%); teamwork and collaboration (100%); continuous process improvement (86%); customer focus (72%); and QI infrastructure (64%). Qualitative data from 10 telephone interviews revealed that key barriers to sustaining progress around QI included staff turnover, budget cuts, and major crises or events that arise as priority. Key facilitators included leadership commitment, accreditation, and dedication of resources and staff time to QI. When engaging in QI, LHDs should consider investing efforts in gaining leadership support and dedicating staff time early in the QI journey to ensure that QI efforts and initiatives are sustained. Local health departments interested in developing a QI culture should also consider pursuing accreditation, as it provides a structured framework for continuous improvement. They should also actively develop QI knowledge and skills among all staff members to minimize the negative impact of staff turnover.

Qi-Dong-Huo-Xue-Yin Inhibits Inflammation in Acute Lung Injury in Mice via Toll-Like Receptor 4/Caveolin-1 Signaling

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Li-Ying Xu

2018-01-01

Full Text Available Acute lung injury (ALI is a critical illness with no current effective treatment. Caveolin-1 indirectly activates inflammation-associated signaling pathways by inhibiting endothelial nitric oxide synthase (eNOS. This induces an imbalance between pro- and anti-inflammatory cytokine levels, which are involved in the pathogenesis of ALI. The compound Chinese prescription Qi-Dong-Huo-Xue-Yin (QDHXY is efficacious for ALI treatment via an anti-inflammatory effect; however, the exact underlying mechanism is unknown. Therefore, we explored the protective effect of QDHXY against lipopolysaccharide- (LPS- induced ALI in mice. Histopathological changes in mouse lung tissues were studied. Furthermore, alterations in the serum levels of pro- and anti-inflammatory cytokines were investigated. The levels of tumor necrosis factor- (TNF-α, interleukin- (IL- 6, IL-1β, and interferon-γ-induced protein 10 in bronchoalveolar lavage fluid were measured. Additionally, the expression levels of myeloid differentiation factor 88 (MyD88, caveolin-1, and eNOS were assessed. QDHXY significantly reduced lung infiltration with inflammatory cells and the production of serum pro- and anti-inflammatory cytokines and inhibited the expression of TNF-α, IL-1β, caveolin-1, and MyD88 but not eNOS. These indicate that QDHXY significantly improved the balance between pro- and anti-inflammatory cytokine levels, possibly by inhibiting the caveolin-1 signaling pathway. Therefore, QDHXY may be a potential treatment for ALI.

Yi Qi Qing Re Gao-containing serum inhibits lipopolysaccharide-induced rat mesangial cell proliferation by suppressing the Wnt pathway and TGF-β1 expression.

Science.gov (United States)

Yang, Liping; Sun, Xueyan; Zhan, Yongli; Liu, Huijie; Wen, Yumin; Mao, Huimin; Dong, X I; Li, Ping

2016-04-01

The aim of the present study was to investigate the effect of Yi Qi Qing Re Gao-containing serum (YQ-S) on rat mesangial cell (MC) proliferation and to investigate the underlying mechanism. MCs were divided into the control, lipopolysaccharide (LPS)-stimulated, YQ-S and fosinopril-containing serum (For-S) groups, and cultured for 48 h. An MTT assay was used to evaluate the proliferation of MCs. In addition, reverse transcription-quantitative polymerase chain reaction and western blot analysis were conducted to detect the expression levels of Wnt4, β-catenin and transforming growth factor (TGF)-β1 in MCs. The results indicated that YQ-S inhibited LPS-induced MC proliferation. The Wnt4 and TGF-β1 mRNA expression levels were reduced in the YQ-S group (P<0.01 or P<0.05). Furthermore, the Wnt4, β-catenin and TGF-β1 protein expression levels were suppressed in the YQ-S group (P<0.01 or P<0.05). Therefore, YQ-S appears to inhibit MC proliferation, and its mechanism may involve the inhibition of the Wnt signaling pathway and downregulation of TGF-β1 expression.

Articular dysfunction patterns in patients with mechanical low back pain: A clinical algorithm to guide specific mobilization and manipulation techniques.

Science.gov (United States)

Dewitte, V; Cagnie, B; Barbe, T; Beernaert, A; Vanthillo, B; Danneels, L

2015-06-01

Recent systematic reviews have demonstrated reasonable evidence that lumbar mobilization and manipulation techniques are beneficial. However, knowledge on optimal techniques and doses, and its clinical reasoning is currently lacking. To address this, a clinical algorithm is presented so as to guide therapists in their clinical reasoning to identify patients who are likely to respond to lumbar mobilization and/or manipulation and to direct appropriate technique selection. Key features in subjective and clinical examination suggestive of mechanical nociceptive pain probably arising from articular structures, can categorize patients into distinct articular dysfunction patterns. Based on these patterns, specific mobilization and manipulation techniques are suggested. This clinical algorithm is merely based on empirical clinical expertise and complemented through knowledge exchange between international colleagues. The added value of the proposed articular dysfunction patterns should be considered within a broader perspective. Copyright © 2014 Elsevier Ltd. All rights reserved.

Documentation of quality improvement exposure by internal medicine residency applicants.

Science.gov (United States)

Kolade, Victor O; Sethi, Anuradha

2016-01-01

Quality improvement (QI) has become an essential component of medical care in the United States. In residency programs, QI is a focus area of the Clinical Learning Environment Review visits conducted by the Accreditation Council for Graduate Medical Education. The readiness of applicants to internal medicine residency to engage in QI on day one is unknown. To document the reporting of QI training or experience in residency applications. Electronic Residency Application Service applications to a single internal medicine program were reviewed individually looking for reported QI involvement or actual projects in the curriculum vitae (CVs), personal statements (PSs), and letters of recommendation (LORs). CVs were also reviewed for evidence of education in QI such as completion of Institute for Healthcare Improvement (IHI) modules. Of 204 candidates shortlisted for interview, seven had QI items on their CVs, including one basic IHI certificate. Three discussed their QI work in their PSs, and four had recommendation letters describing their involvement in QI. One applicant had both CV and LOR evidence, so that 13 (6%) documented QI engagement. Practice of or instruction in QI is rarely mentioned in application documents of prospective internal medicine interns.

Team dynamics within quality improvement teams: a scoping review.

Science.gov (United States)

Rowland, Paula; Lising, Dean; Sinclair, Lynne; Baker, G Ross

2018-03-31

This scoping review examines what is known about the processes of quality improvement (QI) teams, particularly related to how teams impact outcomes. The aim is to provide research-informed guidance for QI leaders and to inform future research questions. Databases searched included: MedLINE, EMBASE, CINAHL, Web of Science and SCOPUS. Eligible publications were written in English, published between 1999 and 2016. Articles were included in the review if they examined processes of the QI team, were related to healthcare QI and were primary research studies. Studies were excluded if they had insufficient detail regarding QI team processes. Descriptive detail extracted included: authors, geographical region and health sector. The Integrated (Health Care) Team Effectiveness Model was used to synthesize findings of studies along domains of team effectiveness: task design, team process, psychosocial traits and organizational context. Over two stages of searching, 4813 citations were reviewed. Of those, 48 full-text articles are included in the synthesis. This review demonstrates that QI teams are not immune from dysfunction. Further, a dysfunctional QI team is not likely to influence practice. However, a functional QI team alone is unlikely to create change. A positive QI team dynamic may be a necessary but insufficient condition for implementing QI strategies. Areas for further research include: interactions between QI teams and clinical microsystems, understanding the role of interprofessional representation on QI teams and exploring interactions between QI team task, composition and process.

POLARIZED LINE FORMATION IN MULTI-DIMENSIONAL MEDIA. III. HANLE EFFECT WITH PARTIAL FREQUENCY REDISTRIBUTION

International Nuclear Information System (INIS)

Anusha, L. S.; Nagendra, K. N.

2011-01-01

In two previous papers, we solved the polarized radiative transfer (RT) equation in multi-dimensional (multi-D) geometries with partial frequency redistribution as the scattering mechanism. We assumed Rayleigh scattering as the only source of linear polarization (Q/I, U/I) in both these papers. In this paper, we extend these previous works to include the effect of weak oriented magnetic fields (Hanle effect) on line scattering. We generalize the technique of Stokes vector decomposition in terms of the irreducible spherical tensors T K Q , developed by Anusha and Nagendra, to the case of RT with Hanle effect. A fast iterative method of solution (based on the Stabilized Preconditioned Bi-Conjugate-Gradient technique), developed by Anusha et al., is now generalized to the case of RT in magnetized three-dimensional media. We use the efficient short-characteristics formal solution method for multi-D media, generalized appropriately to the present context. The main results of this paper are the following: (1) a comparison of emergent (I, Q/I, U/I) profiles formed in one-dimensional (1D) media, with the corresponding emergent, spatially averaged profiles formed in multi-D media, shows that in the spatially resolved structures, the assumption of 1D may lead to large errors in linear polarization, especially in the line wings. (2) The multi-D RT in semi-infinite non-magnetic media causes a strong spatial variation of the emergent (Q/I, U/I) profiles, which is more pronounced in the line wings. (3) The presence of a weak magnetic field modifies the spatial variation of the emergent (Q/I, U/I) profiles in the line core, by producing significant changes in their magnitudes.

Compilation Techniques Specific for a Hardware Cryptography-Embedded Multimedia Mobile Processor

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Masa-aki FUKASE

2007-12-01

Full Text Available The development of single chip VLSI processors is the key technology of ever growing pervasive computing to answer overall demands for usability, mobility, speed, security, etc. We have so far developed a hardware cryptography-embedded multimedia mobile processor architecture, HCgorilla. Since HCgorilla integrates a wide range of techniques from architectures to applications and languages, one-sided design approach is not always useful. HCgorilla needs more complicated strategy, that is, hardware/software (H/S codesign. Thus, we exploit the software support of HCgorilla composed of a Java interface and parallelizing compilers. They are assumed to be installed in servers in order to reduce the load and increase the performance of HCgorilla-embedded clients. Since compilers are the essence of software's responsibility, we focus in this article on our recent results about the design, specifications, and prototyping of parallelizing compilers for HCgorilla. The parallelizing compilers are composed of a multicore compiler and a LIW compiler. They are specified to abstract parallelism from executable serial codes or the Java interface output and output the codes executable in parallel by HCgorilla. The prototyping compilers are written in Java. The evaluation by using an arithmetic test program shows the reasonability of the prototyping compilers compared with hand compilers.

Quality Improvement Cycles that Reduced Waiting Times at ...

African Journals Online (AJOL)

It was decided to undertake quality improvement (QI) cycles to analyse and improve the situation, using waiting time as a measure of improvement. Methods: A QI team was chosen to conduct two QI cycles. The allocated time for QI cycle 1 was from May to August 2006 and for QI cycle 2 from September to December 2006.

Quality Improvement and Performance Management Benefits of Public Health Accreditation: National Evaluation Findings.

Science.gov (United States)

Siegfried, Alexa; Heffernan, Megan; Kennedy, Mallory; Meit, Michael

To identify the quality improvement (QI) and performance management benefits reported by public health departments as a result of participating in the national, voluntary program for public health accreditation implemented by the Public Health Accreditation Board (PHAB). We gathered quantitative data via Web-based surveys of all applicant and accredited public health departments when they completed 3 different milestones in the PHAB accreditation process. Leadership from 324 unique state, local, and tribal public health departments in the United States. Public health departments that have achieved PHAB accreditation reported the following QI and performance management benefits: improved awareness and focus on QI efforts; increased QI training among staff; perceived increases in QI knowledge among staff; implemented new QI strategies; implemented strategies to evaluate effectiveness and quality; used information from QI processes to inform decision making; and perceived achievement of a QI culture. The reported implementation of QI strategies and use of information from QI processes to inform decision making was greater among recently accredited health departments than among health departments that had registered their intent to apply but not yet undergone the PHAB accreditation process. Respondents from health departments that had been accredited for 1 year reported higher levels of staff QI training and perceived increases in QI knowledge than those that were recently accredited. PHAB accreditation has stimulated QI and performance management activities within public health departments. Health departments that pursue PHAB accreditation are likely to report immediate increases in QI and performance management activities as a result of undergoing the PHAB accreditation process, and these benefits are likely to be reported at a higher level, even 1 year after the accreditation decision.

Characterization of 3D printing techniques: Toward patient specific quality assurance spine-shaped phantom for stereotactic body radiation therapy.

Directory of Open Access Journals (Sweden)

Min-Joo Kim

Full Text Available Development and comparison of spine-shaped phantoms generated by two different 3D-printing technologies, digital light processing (DLP and Polyjet has been purposed to utilize in patient-specific quality assurance (QA of stereotactic body radiation treatment. The developed 3D-printed spine QA phantom consisted of an acrylic body phantom and a 3D-printed spine shaped object. DLP and Polyjet 3D printers using a high-density acrylic polymer were employed to produce spine-shaped phantoms based on CT images. Image fusion was performed to evaluate the reproducibility of our phantom, and the Hounsfield units (HUs were measured based on each CT image. Two different intensity-modulated radiotherapy plans based on both CT phantom image sets from the two printed spine-shaped phantoms with acrylic body phantoms were designed to deliver 16 Gy dose to the planning target volume (PTV and were compared for target coverage and normal organ-sparing. Image fusion demonstrated good reproducibility of the developed phantom. The HU values of the DLP- and Polyjet-printed spine vertebrae differed by 54.3 on average. The PTV Dmax dose for the DLP-generated phantom was about 1.488 Gy higher than that for the Polyjet-generated phantom. The organs at risk received a lower dose for the 3D printed spine-shaped phantom image using the DLP technique than for the phantom image using the Polyjet technique. Despite using the same material for printing the spine-shaped phantom, these phantoms generated by different 3D printing techniques, DLP and Polyjet, showed different HU values and these differently appearing HU values according to the printing technique could be an extra consideration for developing the 3D printed spine-shaped phantom depending on the patient's age and the density of the spinal bone. Therefore, the 3D printing technique and materials should be carefully chosen by taking into account the condition of the patient in order to accurately produce 3D printed

Characterization of 3D printing techniques: Toward patient specific quality assurance spine-shaped phantom for stereotactic body radiation therapy.

Science.gov (United States)

Kim, Min-Joo; Lee, Seu-Ran; Lee, Min-Young; Sohn, Jason W; Yun, Hyong Geon; Choi, Joon Yong; Jeon, Sang Won; Suh, Tae Suk

2017-01-01

Development and comparison of spine-shaped phantoms generated by two different 3D-printing technologies, digital light processing (DLP) and Polyjet has been purposed to utilize in patient-specific quality assurance (QA) of stereotactic body radiation treatment. The developed 3D-printed spine QA phantom consisted of an acrylic body phantom and a 3D-printed spine shaped object. DLP and Polyjet 3D printers using a high-density acrylic polymer were employed to produce spine-shaped phantoms based on CT images. Image fusion was performed to evaluate the reproducibility of our phantom, and the Hounsfield units (HUs) were measured based on each CT image. Two different intensity-modulated radiotherapy plans based on both CT phantom image sets from the two printed spine-shaped phantoms with acrylic body phantoms were designed to deliver 16 Gy dose to the planning target volume (PTV) and were compared for target coverage and normal organ-sparing. Image fusion demonstrated good reproducibility of the developed phantom. The HU values of the DLP- and Polyjet-printed spine vertebrae differed by 54.3 on average. The PTV Dmax dose for the DLP-generated phantom was about 1.488 Gy higher than that for the Polyjet-generated phantom. The organs at risk received a lower dose for the 3D printed spine-shaped phantom image using the DLP technique than for the phantom image using the Polyjet technique. Despite using the same material for printing the spine-shaped phantom, these phantoms generated by different 3D printing techniques, DLP and Polyjet, showed different HU values and these differently appearing HU values according to the printing technique could be an extra consideration for developing the 3D printed spine-shaped phantom depending on the patient's age and the density of the spinal bone. Therefore, the 3D printing technique and materials should be carefully chosen by taking into account the condition of the patient in order to accurately produce 3D printed patient-specific QA

Impact of a competency based curriculum on quality improvement among internal medicine residents.

Science.gov (United States)

Fok, Mark C; Wong, Roger Y

2014-11-28

Teaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care. The literature on QI curricula for internal medicine residents is limited. We sought to evaluate the impact of a competency based curriculum on QI among internal medicine residents. This was a prospective, cohort study over four years (2007-2011) using pre-post curriculum comparison design in an internal medicine residency program in Canada. Overall 175 post-graduate year one internal medicine residents participated. A two-phase, competency based curriculum on QI was developed with didactic workshops and longitudinal, team-based QI projects. The main outcome measures included self-assessment, objective assessment using the Quality Improvement Knowledge Assessment Tool (QIKAT) scores to assess QI knowledge, and performance-based assessment via presentation of longitudinal QI projects. Overall 175 residents participated, with a response rate of 160/175 (91%) post-curriculum and 114/175 (65%) after conducting their longitudinal QI project. Residents' self-reported confidence in making changes to improve health increased and was sustained at twelve months post-curriculum. Self-assessment scores of QI skills improved significantly from pre-curriculum (53.4 to 69.2 percent post-curriculum [p-value 0.002]) and scores were sustained at twelve months after conducting their longitudinal QI projects (53.4 to 72.2 percent [p-value 0.005]). Objective scores using the QIKAT increased post-curriculum from 8.3 to 10.1 out of 15 (p-value for difference value for difference from pre-curriculum based assessment occurred via presentation of all projects at the annual QI Project Podium Presentation Day. The competency based curriculum on QI improved residents' QI knowledge and skills during residency training. Importantly, residents perceived that their QI knowledge improved after the curriculum and this also correlated to improved QIKAT

Progress in approximation theory and applicable complex analysis in memory of Q.I. Rahman

CERN Document Server

Mohapatra, Ram; Qazi, Mohammed; Schmeisser, Gerhard

2017-01-01

Current and historical research methods in approximation theory are presented in this book beginning with the 1800s and following the evolution of approximation theory via the refinement and extension of classical methods and ending with recent techniques and methodologies. Graduate students, postdocs, and researchers in mathematics, specifically those working in the theory of functions, approximation theory, geometric function theory, and optimization will find new insights as well as a guide to advanced topics. The chapters in this book are grouped into four themes; the first, polynomials (Chapters 1 –8), includes inequalities for polynomials and rational functions, orthogonal polynomials, and location of zeros. The second, inequalities and extremal problems are discussed in Chapters 9 –13. The third, approximation of functions, involves the approximants being polynomials, rational functions, and other types of functions and are covered in Chapters 14 –19. The last theme, quadrature, cubature and appl...

A Qualitative Evaluation of Web-Based Cancer Care Quality Improvement Toolkit Use in the Veterans Health Administration.

Science.gov (United States)

Bowman, Candice; Luck, Jeff; Gale, Randall C; Smith, Nina; York, Laura S; Asch, Steven

2015-01-01

Disease severity, complexity, and patient burden highlight cancer care as a target for quality improvement (QI) interventions. The Veterans Health Administration (VHA) implemented a series of disease-specific online cancer care QI toolkits. To describe characteristics of the toolkits, target users, and VHA cancer care facilities that influenced toolkit access and use and assess whether such resources were beneficial for users. Deductive content analysis of detailed notes from 94 telephone interviews with individuals from 48 VHA facilities. We evaluated toolkit access and use across cancer types, participation in learning collaboratives, and affiliation with VHA cancer care facilities. The presence of champions was identified as a strong facilitator of toolkit use, and learning collaboratives were important for spreading information about toolkit availability. Identified barriers included lack of personnel and financial resources and complicated approval processes to support tool use. Online cancer care toolkits are well received across cancer specialties and provider types. Clinicians, administrators, and QI staff may benefit from the availability of toolkits as they become more reliant on rapid access to strategies that support comprehensive delivery of evidence-based care. Toolkits should be considered as a complement to other QI approaches.

What infusion flow should be used for mid-dilution hemodiafiltration?

Science.gov (United States)

Maduell, Francisco; Arias, Marta; Fontseré, Néstor; Vera, Manel; Masso, Elisabeth; Garro, Julia; Barros, Xoana; Martina, Maria N; Elena, Montserrat; Bergadá, Eduardo; Cases, Aleix; Bedini, Jose Luis; Campistol, Josep M

2010-01-01

There is still no consensus on the optimal infusion flow (Qi) in mid-dilution hemodiafiltration. The aim of this study was to compare mid-dilution with varying Qi. Prospective study in 25 patients who underwent seven hemodialysis sessions with a Qi of 0, 50, 100, 150, 200, 250 and 300 ml/min. All sessions were well tolerated except Qi 300 ml/min. No significant differences in urea, creatinine, alpha(1)-microglobulin or alpha(1)-acid glycoprotein reduction ratios were observed. beta(2)-Microglobulin, myoglobin and prolactin reduction ratios were higher with Qi 150, 200, 250 and 300 ml/min in comparison with Qi of 0, 50 and 100 ml/min. There were no differences in the removal of small or larger molecules when Qi was 150 ml/min or higher. Optimal Qi in mid-dilution appears to be in the range of 150-250 ml/min since good clinical outcomes, similar efficiency and no technical complications up to a Qi of 250 ml/min were observed.

Decomposing the trade-environment nexus for Malaysia: what do the technique, scale, composition, and comparative advantage effect indicate?

Science.gov (United States)

Ling, Chong Hui; Ahmed, Khalid; Binti Muhamad, Rusnah; Shahbaz, Muhammad

2015-12-01

This paper investigates the impact of trade openness on CO2 emissions using time series data over the period of 1970QI-2011QIV for Malaysia. We disintegrate the trade effect into scale, technique, composition, and comparative advantage effects to check the environmental consequence of trade at four different transition points. To achieve the purpose, we have employed augmented Dickey-Fuller (ADF) and Phillips-Perron (PP) unit root tests in order to examine the stationary properties of the variables. Later, the long-run association among the variables is examined by applying autoregressive distributed lag (ARDL) bounds testing approach to cointegration. Our results confirm the presence of cointegration. Further, we find that scale effect has positive and technique effect has negative impact on CO2 emissions after threshold income level and form inverted U-shaped relationship-hence validates the environmental Kuznets curve hypothesis. Energy consumption adds in CO2 emissions. Trade openness and composite effect improve environmental quality by lowering CO2 emissions. The comparative advantage effect increases CO2 emissions and impairs environmental quality. The results provide the innovative approach to see the impact of trade openness in four sub-dimensions of trade liberalization. Hence, this study attributes more comprehensive policy tool for trade economists to better design environmentally sustainable trade rules and agreements.

Specific binding assay technique; standardization of reagent

International Nuclear Information System (INIS)

Huggins, K.G.; Roitt, I.M.

1979-01-01

The standardization of a labelled constituent, such as anti-IgE, for use in a specific binding assay method is disclosed. A labelled ligand, such as IgE, is standardized against a ligand reference substance, such as WHO standard IgE, to determine the weight of IgE protein represented by the labelled ligand. Anti-light chain antibodies are contacted with varying concentrations of the labelled ligand. The ligand is then contacted with the labelled constituent which is then quantitated in relation to the amount of ligand protein present. The preparation of 131 I-labelled IgE is described. Also disclosed is an improved specific binding assay test method for determining the potency of an allergen extract in serum from an allergic individual. The improvement involved using a parallel model system of a second complex which consisted of anti-light chain antibodies, labelled ligand and the standardized labelled constituent (anti-IgE). The amount of standardized labelled constituent bound to the ligand in the first complex was determined, as described above, and the weight of ligand inhibited by addition of soluble allergen was then used as a measure of the potency of the allergen extract. (author)

Analysis of classical time-trial performance and technique-specific physiological determinants in elite female cross-country skiers

Directory of Open Access Journals (Sweden)

Øyvind Sandbakk

2016-08-01

Full Text Available The present study investigated the contribution of performance on uphill, flat, and downhill sections to overall performance in an international 10-km classical time-trial in elite female cross-country skiers, as well as the relationships between performance on snow and laboratory-measured physiological variables in the double poling (DP and diagonal (DIA techniques. Ten elite female cross-country skiers were continuously measured by a global positioning system device during an international 10-km cross-country skiing time-trial in the classical technique. One month prior to the race, all skiers performed a 5-min submaximal and 3-min self-paced performance test while roller skiing on a treadmill, both in the DP and DIA techniques. The time spent on uphill (r=0.98 and flat (r=0.91 sections of the race correlated most strongly with the overall 10-km performance (both p<0.05. Approximately 56% of the racing time was spent uphill, and stepwise multiple regression revealed that uphill time explained 95.5% of the variance in overall performance (p<0.001. Distance covered during the 3-min roller-skiing test and body-mass normalized peak oxygen uptake (VO2peak in both techniques showed the strongest correlations with overall time-trial performance (r=0.66-0.78, with DP capacity tending to have greatest impact on the flat and DIA capacity on uphill terrain (all p<0.05. Our present findings reveal that the time spent uphill most strongly determine classical time-trial performance, and that the major portion of the performance differences among elite female cross-country skiers can be explained by variations in technique-specific aerobic power.

Integrating Quality Improvement and Continuing Professional Development at an Academic Medical Center: A Partnership Between Practice Plan, Hospital, and Medical School.

Science.gov (United States)

Gold, Barbara; England, Dawn; Riley, William; Jacobs-Halsey, Ginny; Webb, Corinne; Daniels, Bobbi

2016-01-01

While quality improvement (QI) initiatives can be a highly effective means for improving health care delivery in academic medical centers (AMCs), many health care professionals are not formally trained in basic QI methodology, engaging clinicians in QI activities can be challenging, and there is often a lack of integration and coordination among QI functions (eg, Departments of Quality and Safety, Continuing Professional Development). In our AMC, we undertook a collaborative approach to achieve better vertical and horizontal integration of our QI education efforts. This article provides a case example describing our organizational context, what was done, and with what effect and makes our example and lessons learned available to others. We developed a new educational QI program that was jointly planned and implemented by a group comprising major QI stakeholders. This project was intended to create horizontal organizational linkages between continuing professional development, clinicians, the hospital, and QI department and produce QI activities that aligned with the strategic objectives of senior management. The group developed and implemented a curriculum based on Lean methodology and concepts from the Institute for Health Care Improvement Model for Improvement. Two cohorts (27 teams) completed the training and planned and implemented QI projects. All projects were aligned with organizational quality, safety, and patient experience goals. The majority of projects met their aim statements. This case description provides an example of successful horizontal integration of an AMCs' QI functions to disseminate knowledge and implement meaningful QI aligned with strategic objectives (vertical integration).

Advanced analytical techniques

International Nuclear Information System (INIS)

Mrochek, J.E.; Shumate, S.E.; Genung, R.K.; Bahner, C.T.; Lee, N.E.; Dinsmore, S.R.

1976-01-01

The development of several new analytical techniques for use in clinical diagnosis and biomedical research is reported. These include: high-resolution liquid chromatographic systems for the early detection of pathological molecular constituents in physiologic body fluids; gradient elution chromatography for the analysis of protein-bound carbohydrates in blood serum samples, with emphasis on changes in sera from breast cancer patients; electrophoretic separation techniques coupled with staining of specific proteins in cellular isoenzymes for the monitoring of genetic mutations and abnormal molecular constituents in blood samples; and the development of a centrifugal elution chromatographic technique for the assay of specific proteins and immunoglobulins in human blood serum samples

Community Sourced Knowledge: Solving the Maintenance Problem

Science.gov (United States)

2012-05-01

The end-user doesn’t need further assistance. KPI – Key Performance Indicator KPI -1 = Relayed solution to the end-user. KPI -2 = Trouble ticket is...created for the end-user and escalated for further review. KPI -3 = Trouble ticket is created for the end-user. KPI -4 = End of Call. Start of Process...14i KPI -1 KPI -2 KPI -3 KPI -4 QI-2QI-3 QI-4 QI-5 QI-6 Does the analyst understand the end- user’s rqst. Yes No 7 QI-1 Inform KMT. Legend KMT

Interventions designed using quality improvement methods reduce the incidence of serious airway events and airway cardiac arrests during pediatric anesthesia.

Science.gov (United States)

Spaeth, James P; Kreeger, Renee; Varughese, Anna M; Wittkugel, Eric

2016-02-01

Although serious complications during pediatric anesthesia are less common than they were 20 years ago, serious airway events continue to occur. Based on Quality Improvement (QI) data from our institution, a QI project was designed to reduce the incidence of serious airway events and airway cardiac arrests. A quality improvement team consisting of members of the Department of Anesthesia was formed and QI data from previous years were analyzed. The QI team developed a Smart Aim, Key Driver Diagram, and specific Interventions that focused on the accessibility of emergency drugs, the use of nondepolarizing muscle relaxants for endotracheal intubation in children 2 years and younger, and the presence of anesthesia providers until emergence from anesthesia in high-risk patients. The percentage of cases where muscle relaxants were utilized in children 2 years and younger for endotracheal intubation and where atropine and succinylcholine were readily available increased at both our base and outpatient facilities. Over the 2.5-year study period, the incidence of serious airway events and airway cardiac arrests was reduced by 44% and 59%, respectively compared to the previous 2-year period. We utilized QI methodology to design and implement a project which led to greater standardization of clinical practice within a large pediatric anesthesia group. Based on an understanding of system issues impacting our clinical practice, we designed and tested interventions that led to a significant reduction in the incidence of serious airway events and airway cardiac arrests. © 2015 John Wiley & Sons Ltd.

Are Evidence-based Practices Associated With Effective Prevention of Hospital-acquired Pressure Ulcers in US Academic Medical Centers?

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Padula, William V; Gibbons, Robert D; Valuck, Robert J; Makic, Mary B F; Mishra, Manish K; Pronovost, Peter J; Meltzer, David O

2016-05-01

In 2008, the Centers for Medicare and Medicaid Services (CMS) established nonpayment policies resulting from costliness of hospital-acquired pressure ulcers (HAPUs) to hospitals. This prompted hospitals to adopt quality improvement (QI) interventions that increase use of evidence-based practices (EBPs) for HAPU prevention. To evaluate the longitudinal impact of CMS policy and QI adoption on HAPU rates. We characterized longitudinal adoption of 25 QI interventions that support EBPs through hospital leadership, staff, information technology, and performance and improvement. Quarterly counts of HAPU incidence and inpatient characteristics were collected from 55 University HealthSystem Consortium hospitals between 2007 and 2012. Mixed-effects regression models tested the longitudinal association of CMS policy, HAPU coding, and QI on HAPU rates. The models assumed level-2 random intercepts and random effects for CMS policy and EBP implementation to account for between-hospital variability in HAPU incidence. Controlling for all 25 QI interventions, specific updates to EBPs for HAPU prevention had a significant, though modest reduction on HAPU rates (-1.86 cases/quarter; P=0.002) and the effect of CMS nonpayment policy on HAPU prevention was much greater (-11.32 cases/quarter; P<0.001). HAPU rates were significantly lower after changes in CMS reimbursement. Reductions are associated with hospital-wide implementation of EBPs for HAPU prevention. Given that administrative data were used, it remains unknown whether these improvements were due to changes in coding or improved quality of care.

Computed tomography landmark-based semi-automated mesh morphing and mapping techniques: generation of patient specific models of the human pelvis without segmentation.

Science.gov (United States)

Salo, Zoryana; Beek, Maarten; Wright, David; Whyne, Cari Marisa

2015-04-13

Current methods for the development of pelvic finite element (FE) models generally are based upon specimen specific computed tomography (CT) data. This approach has traditionally required segmentation of CT data sets, which is time consuming and necessitates high levels of user intervention due to the complex pelvic anatomy. The purpose of this research was to develop and assess CT landmark-based semi-automated mesh morphing and mapping techniques to aid the generation and mechanical analysis of specimen-specific FE models of the pelvis without the need for segmentation. A specimen-specific pelvic FE model (source) was created using traditional segmentation methods and morphed onto a CT scan of a different (target) pelvis using a landmark-based method. The morphed model was then refined through mesh mapping by moving the nodes to the bone boundary. A second target model was created using traditional segmentation techniques. CT intensity based material properties were assigned to the morphed/mapped model and to the traditionally segmented target models. Models were analyzed to evaluate their geometric concurrency and strain patterns. Strains generated in a double-leg stance configuration were compared to experimental strain gauge data generated from the same target cadaver pelvis. CT landmark-based morphing and mapping techniques were efficiently applied to create a geometrically multifaceted specimen-specific pelvic FE model, which was similar to the traditionally segmented target model and better replicated the experimental strain results (R(2)=0.873). This study has shown that mesh morphing and mapping represents an efficient validated approach for pelvic FE model generation without the need for segmentation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Construção e validação de um questionário para identificação da Síndrome de Ansiedade de Separação em cães domésticos Development and Validation of a questionnaire to identify Separation Anxiety Syndrome in domestic dogs

Directory of Open Access Journals (Sweden)

Guilherme Marques Soares

2009-06-01

Full Text Available Em cães, a Síndrome de Ansiedade de Separação em Animais (SASA pode ser definida como um conjunto de comportamentos indesejáveis exibidos por esses animais quando afastados da figura de apego. A partir da necessidade de um levantamento epidemiológico sobre esse problema, foi desenvolvido um questionário para identificação da SASA em cães (QI-SASA com base em dados da literatura e validado por meio de dois procedimentos. O primeiro foi a comparação entre pareceres de médicos veterinários brasileiros que atuam na área de etologia clínica a respeito de 40 QI-SASA respondidos por proprietários de cães. O segundo foi a comparação dos resultados da avaliação de 40 QI-SASA, a partir dos critérios estabelecidos neste trabalho, com o resultado de entrevistas para o diagnóstico da SASA. O QI-SASA mostrou-se completo, coerente e confiável com a finalidade de um levantamento epidemiológico do problema.The Separation Anxiety Syndrome in Animals (SASA and being more specific, in dogs, can be defined as a group of undesirable behaviors displayed by dogs when they are away from the attachment subject. The questionnaire was developed due to the need to identify this disorder and conduct an epidemiologic survey on SASA in dogs (QI-SASA. This instrument was developed based on reference data and was validated through two procedures. The first one was the comparison among evaluations of Brazilian ethologists on the appliance of 40 QI-SASA to dogs' owners. The second was the comparison between the previous evaluations, according to the criteria established in this research, with the results of the interviews to diagnose SASA. The QI-SASA seems to be a complete, safe and trustworthy tool to carry out epidemiologic surveys on SASA.

A national study of nurse leadership and supports for quality improvement in rural hospitals.

Science.gov (United States)

Paez, Kathryn; Schur, Claudia; Zhao, Lan; Lucado, Jennifer

2013-01-01

This study assessed the perceptions and actions of rural hospital nurse executives with regard to patient safety and quality improvement (QI). A national sample of rural hospital nurse executives (n = 300) completed a survey measuring 4 domains related to patient safety and QI: (a) patient "Safety Culture," (b) adequacy of QI "Resources," (c) "Barriers" related to QI, and (d) "Nurse Leader Engagement" in activities supporting QI. Perceptions of Safety Culture were strong but 47% of the Resources needed to carry out QI were inadequate, 29% of Barriers were moderate to major, and 25% of Nurse Leader Engagement activities were performed infrequently. Nurse Leader Engagement in quality-related activities was less frequent among nurses in isolated and small rural town hospitals compared with large rural city hospitals. To further QI, rural nurse executives may need to use their communications and actions to raise the visibility of QI.

Interdisciplinary medical, nursing, and administrator education in practice: the Johns Hopkins experience.

Science.gov (United States)

Walrath, Jo M; Muganlinskaya, Nailya; Shepherd, Megan; Awad, Michael; Reuland, Charles; Makary, Martin A; Kravet, Steven

2006-08-01

Reforming graduate medical, nursing and health administrators' education to include the core competencies of interdisciplinary teamwork and quality improvement (QI) techniques is a key strategy to improve quality in hospital settings. Practicing clinicians are best positioned in these settings to understand systems issues and craft potential solutions. The authors describe how, in ten months during 2004 and 2005 the school of medicine, the school of nursing, and an administrative residency program, all at Johns Hopkins University, implemented and evaluated the Achieving Competency Today II Program (ACT II), a structured and interdisciplinary approach to learning QI that was piloted at various sites around the United States. Six teams of learners participated, each consisting of a medical, nursing, and administrative resident. The importance of interdisciplinary participation in planning QI projects, the value of the patient's perspective on systems issues, and the value of a system's perspective in crafting solutions to issues all proved to be valuable lessons. Challenges were encountered throughout the program, such as (1) participants' difficulties in balancing competing academic, personal and clinical responsibilities, (2) difficulties in achieving the intended goals of a broad curriculum, (3) barriers to openly discussing interdisciplinary team process and dynamics, and (4) the need to develop faculty expertise in systems thinking and QI. In spite of these challenges steps have been identified to further enhance and develop interdisciplinary education within this academic setting.

Healthcare quality improvement work: a professional employee perspective.

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Gadolin, Christian; Andersson, Thomas

2017-06-12

Purpose The purpose of this paper is to describe and analyze conditions that influence how employees engage in healthcare quality improvement (QI) work. Design/methodology/approach Qualitative case study based on interviews ( n=27) and observations ( n=10). Findings The main conditions that influence how employees engage in healthcare QI work are professions, work structures and working relationships. These conditions can both prevent and facilitate healthcare QI. Professions and work structures may cement existing institutional logics and thus prevent employees from engaging in healthcare QI work. However, attempts to align QI with professional logics, together with work structures that empower employees, can make these conditions increase employee engagement, which can be accomplished through positive working relationships that foster institutional work, which bridge different competing institutional logics, making it possible to overcome barriers that professions and work structures may constitute. Practical implications Understanding the conditions that influence how employees engage in healthcare QI work will make initiatives more likely to succeed. Originality/value Healthcare QI has mainly been studied from an implementer perspective, and employees have either been neglected or seen as passive resisters. Weak employee perspectives make healthcare QI research incomplete. In our research, healthcare QI work is studied closely at the actor level to understand healthcare QI from an employee perspective.

An analysis of the suitability of public spaces to physical activity practice in Rio de Janeiro, Brazil.

Science.gov (United States)

Vieira, Marcelo Carvalho; Sperandei, Sandro; Reis, Arianne; da Silva, Cláudia Gonçalves Thaumaturgo

2013-09-01

To assess the physical characteristics of public spaces designed for sport/physical activity/leisure in Rio de Janeiro, Brazil, and their relationship to the socioeconomic indicators. Public spaces (n = 38) spread across the city were evaluated between December 2011 and January 2012 using the Physical Activity Resource Assessment (PARA) instrument. Based on PARA results, a Quality Indicator (QI) was prepared and the sample was grouped into "High QI" and "Low QI" using a k-means clustering algorithm. The association between QI and the local Social Development Index (SDI) was tested using a Chi-square test. The average QI was 13.6 ± 4.91 and the median was equal to 13 points. The High QI group, composed of sites with a QI above median, reached 17.9 ± 2.35 points, while the Low QI group reached 9.3 ± 2.16 points. Pearson's Chi-square tests identified a significant association between QI and SDI when the value of SDI 0.7 was used as a criterion for separation (χ(2) = 17.84, p public spaces usually had a lower QI. Policies to encourage physical activity need to focus attention on the built environment also, particularly in socially vulnerable areas. Copyright © 2013 Elsevier Inc. All rights reserved.

A scoping review of online repositories of quality improvement projects, interventions and initiatives in healthcare.

Science.gov (United States)

Bytautas, Jessica P; Gheihman, Galina; Dobrow, Mark J

2017-04-01

Quality improvement (QI) is becoming an important focal point for health systems. There is increasing interest among health system stakeholders to learn from and share experiences on the use of QI methods and approaches in their work. Yet there are few easily accessible, online repositories dedicated to documenting QI activity. We conducted a scoping review of publicly available, web-based QI repositories to (i) identify current approaches to sharing information on QI practices; (ii) categorise these approaches based on hosting, scope and size, content acquisition and eligibility, content format and search, and evaluation and engagement characteristics; and (iii) review evaluations of the design, usefulness and impact of their online QI practice repositories. The search strategy consisted of traditional database and grey literature searches, as well as expert consultation, with the ultimate aim of identifying and describing QI repositories of practices undertaken in a healthcare context. We identified 13 QI repositories and found substantial variation across the five categories. The QI repositories used different terminology (eg, practices vs case studies) and approaches to content acquisition, and varied in terms of primary areas of focus. All provided some means for organising content according to categories or themes and most provided at least rudimentary keyword search functionality. Notably, none of the QI repositories included evaluations of their impact. With growing interest in sharing and spreading best practices and increasing reliance on QI as a key contributor to health system performance, the role of QI repositories is likely to expand. Designing future QI repositories based on knowledge of the range and type of features available is an important starting point for improving their usefulness and impact. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Quality Attribute Techniques Framework

Science.gov (United States)

Chiam, Yin Kia; Zhu, Liming; Staples, Mark

The quality of software is achieved during its development. Development teams use various techniques to investigate, evaluate and control potential quality problems in their systems. These “Quality Attribute Techniques” target specific product qualities such as safety or security. This paper proposes a framework to capture important characteristics of these techniques. The framework is intended to support process tailoring, by facilitating the selection of techniques for inclusion into process models that target specific product qualities. We use risk management as a theory to accommodate techniques for many product qualities and lifecycle phases. Safety techniques have motivated the framework, and safety and performance techniques have been used to evaluate the framework. The evaluation demonstrates the ability of quality risk management to cover the development lifecycle and to accommodate two different product qualities. We identify advantages and limitations of the framework, and discuss future research on the framework.

A multi-state assessment of employer-sponsored quality improvement education for early-career registered nurses.

Science.gov (United States)

Djukic, Maja; Kovner, Christine T; Brewer, Carol S; Fatehi, Farida K; Seltzer, Joanna R

2013-01-01

Increasing participation of registered nurses (RNs) in quality improvement (QI) is a promising strategy to close the health care quality chasm. For RNs to participate effectively in hospital QI, they must have adequate QI knowledge and skills. This descriptive study assessed employer-sponsored QI education and RNs' preparedness across a wide range of QI steps and processes. RNs from 15 U.S. states who were employed in hospitals and were initially licensed to practice in 2007 to 2008 were surveyed. Fewer than one third of respondents reported being very prepared across all measured QI topics. More than half reported receiving zero hours of training in these same topics in the last year. Lack of educational offerings on the topic was the top reason respondents gave for not obtaining QI training. The QI education offered by employers to RNs could be substantially improved. Nurse educators play a critical role in making these improvements. Copyright 2013, SLACK Incorporated.

Radiological interpretation 2020: Toward quantitative image assessment

International Nuclear Information System (INIS)

Boone, John M.

2007-01-01

The interpretation of medical images by radiologists is primarily and fundamentally a subjective activity, but there are a number of clinical applications such as tumor imaging where quantitative imaging (QI) metrics (such as tumor growth rate) would be valuable to the patient’s care. It is predicted that the subjective interpretive environment of the past will, over the next decade, evolve toward the increased use of quantitative metrics for evaluating patient health from images. The increasing sophistication and resolution of modern tomographic scanners promote the development of meaningful quantitative end points, determined from images which are in turn produced using well-controlled imaging protocols. For the QI environment to expand, medical physicists, physicians, other researchers and equipment vendors need to work collaboratively to develop the quantitative protocols for imaging, scanner calibrations, and robust analytical software that will lead to the routine inclusion of quantitative parameters in the diagnosis and therapeutic assessment of human health. Most importantly, quantitative metrics need to be developed which have genuine impact on patient diagnosis and welfare, and only then will QI techniques become integrated into the clinical environment.

Using a behaviour change techniques taxonomy to identify active ingredients within trials of implementation interventions for diabetes care.

Science.gov (United States)

Presseau, Justin; Ivers, Noah M; Newham, James J; Knittle, Keegan; Danko, Kristin J; Grimshaw, Jeremy M

2015-04-23

Methodological guidelines for intervention reporting emphasise describing intervention content in detail. Despite this, systematic reviews of quality improvement (QI) implementation interventions continue to be limited by a lack of clarity and detail regarding the intervention content being evaluated. We aimed to apply the recently developed Behaviour Change Techniques Taxonomy version 1 (BCTTv1) to trials of implementation interventions for managing diabetes to assess the capacity and utility of this taxonomy for characterising active ingredients. Three psychologists independently coded a random sample of 23 trials of healthcare system, provider- and/or patient-focused implementation interventions from a systematic review that included 142 such studies. Intervention content was coded using the BCTTv1, which describes 93 behaviour change techniques (BCTs) grouped within 16 categories. We supplemented the generic coding instructions within the BCTTv1 with decision rules and examples from this literature. Less than a quarter of possible BCTs within the BCTTv1 were identified. For implementation interventions targeting providers, the most commonly identified BCTs included the following: adding objects to the environment, prompts/cues, instruction on how to perform the behaviour, credible source, goal setting (outcome), feedback on outcome of behaviour, and social support (practical). For implementation interventions also targeting patients, the most commonly identified BCTs included the following: prompts/cues, instruction on how to perform the behaviour, information about health consequences, restructuring the social environment, adding objects to the environment, social support (practical), and goal setting (behaviour). The BCTTv1 mapped well onto implementation interventions directly targeting clinicians and patients and could also be used to examine the impact of system-level interventions on clinician and patient behaviour. The BCTTv1 can be used to characterise

Protaper--hybrid technique.

Science.gov (United States)

Simon, Stephane; Lumley, Philip; Tomson, Phillip; Pertot, Wilhelm-Joseph; Machtou, Pierre

2008-03-01

Crown down preparation is the most known and described technique since the introduction of Nickel Titanium (NiTi) rotary instruments in endodontics. This technique gives good results but has limitations, such as not addressing the initial anatomy of oval or dumb-bell shaped canals. The specific design of the Protaper instruments allows use of them with a different technique and, specifically, with a brushing motion in the body of the canal. The recent introduction of hand Protaper files has expanded the range of application of this system, especially in curved canals. The 'hybrid technique', using rotary and hand files, and the advantages of the combination of both instruments, are clearly described in this article. Used with this technique, the Protaper is a very safe system to use, and more controllable, for both inexperienced and experienced practitioners alike, than other systems. To understand the precautions needed with rotary files, and how to use them to preserve the anatomy of the canal and get a tapered shaping, even in severely curved canals.

Applying the Advancing Excellence in America's Nursing Homes Circle of Success to improving and sustaining quality.

Science.gov (United States)

Bakerjian, Debra; Zisberg, Anna

2013-01-01

Looking forward to the Quality Assurance Performance Improvement (QAPI) program to be implemented and required in 2014, and as nursing home staff provide care for residents with increasingly complex health issues, knowledge of how to implement quality improvement (QI) is imperative. The nursing home administrator and director of nursing (DON) provide overall leadership, but it is the primary responsibility of the DON and other registered nurse staff to implement and manage the day to day QI process. This article describes potential roles of nursing leaders and key components of a QI project using a pressure ulcer case study exemplar to illustrate a quality improvement process. The authors suggest specific methods that RN leaders can employ using the Advancing Excellence Campaign Circle of Success as an organizing framework along with evidence-based resources. Nursing home leaders could use this article as a guideline for implementing any clinical quality improvement process. Copyright © 2013 Mosby, Inc. All rights reserved.

Quality Improvement in Otolaryngology Residency: Survey of Program Directors.

Science.gov (United States)

Bowe, Sarah N

2016-02-01

The Clinical Learning Environment Review focuses on the responsibility of the sponsoring institution for quality and patient safety. Very little information is known regarding the status of quality improvement (QI) education during otolaryngology training. The purpose of this survey is to evaluate the extent of resident and faculty participation in QI and identify opportunities for both resident curriculum and faculty development. Cross-sectional survey A 15-item survey was distributed to all 106 otolaryngology program directors. The survey was developed after an informal review of the literature regarding education in QI and patient safety. Questions were directed at the format and content of the QI curriculum, as well as barriers to implementation. There was a 39% response rate. Ninety percent of responding program directors considered education in QI important or very important to a resident's future success. Only 23% of responding programs contained an educational curriculum in QI, and only 33% monitored residents' individual outcome measures. Barriers to implementation of a QI program included inadequate number of faculty with expertise in QI (75%) and competing resident educational demands (90%). Every program director considered morbidity and mortality conferences as an integral component in QI education. Program directors recognize the importance of QI in otolaryngology practice. Unfortunately, this survey identifies a distinct lack of resources in support of these educational goals. The results highlight the need to generate a comprehensive and stepwise approach to QI for faculty development and resident instruction. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Importance of Performance Measurement and MCH Epidemiology Leadership to Quality Improvement Initiatives at the National, State and Local Levels.

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Rankin, Kristin M; Gavin, Loretta; Moran, John W; Kroelinger, Charlan D; Vladutiu, Catherine J; Goodman, David A; Sappenfield, William M

2016-11-01

Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists' contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes.

Wireless, smartphone controlled potentiostat integrated with lab-on-disc platform

DEFF Research Database (Denmark)

Cheng, Chung-Hsiang; Zor, Kinga; Wang, Jen-Hung

A smartphone controlled wireless data transmitting and inductive powering Power Lab-on-disc (PLoD) platform is developed based on 2.4 GHz Bluetooth and 205 kHz Qi techniques, respectively. A potentiostat is integrated on the PLoD platform, and amperometric measurements are performed. The wireless...

Application of the modulated temperature differential scanning calorimetry technique for the determination of the specific heat of copper nanofluids

International Nuclear Information System (INIS)

De Robertis, E.; Cosme, E.H.H.; Neves, R.S.; Kuznetsov, A.Yu.; Campos, A.P.C.; Landi, S.M.; Achete, C.A.

2012-01-01

The purpose of this work is to investigate the applicability of the modulated temperature differential scanning calorimetry technique to measure specific heat of copper nanofluids by using the ASTM E2719 standard procedure, which is generally applied to thermally stable solids and liquids. The one-step method of preparation of copper nanofluid samples is described. The synthesized nanoparticles were separated from the base fluid and examined by X-ray diffraction and transmission electron microscopy in order to evaluate their structure, morphology and chemical nature. The presence of copper nanoparticles in the base fluid alters the characteristics of crystallization and melting processes and reduces the specific heat values of nanofluids in the whole studied temperature range. - Highlights: ► Copper nanofluids prepared by one-step method. ► Methodology of synthesis improved nanofluid stability. ► Specific heat determinations using modulated temperature differential scanning calorimetry. ► Good agreement between theoretical and experimental values.

Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).

Science.gov (United States)

McPheeters, Melissa L; Kripalani, Sunil; Peterson, Neeraja B; Idowu, Rachel T; Jerome, Rebecca N; Potter, Shannon A; Andrews, Jeffrey C

2012-08-01

This review evaluates the effectiveness of quality improvement (QI) strategies in reducing disparities in health and health care. We identified papers published in English between 1983 and 2011 from the MEDLINE® database, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science Social Science Index, and PsycINFO. All abstracts and full-text articles were dually reviewed. Studies were eligible if they reported data on effectiveness of QI interventions on processes or health outcomes in the United States such that the impact on a health disparity could be measured. The review focused on the following clinical conditions: breast cancer, colorectal cancer, diabetes, heart failure, hypertension, coronary artery disease, asthma, major depressive disorder, cystic fibrosis, pneumonia, pregnancy, and end-stage renal disease. It assessed health disparities associated with race or ethnicity, socioeconomic status, insurance status, sexual orientation, health literacy/numeracy, and language barrier. We evaluated the risk of bias of individual studies and the overall strength of the body of evidence based on risk of bias, consistency, directness, and precision. Nineteen papers, representing 14 primary research studies, met criteria for inclusion. All but one of the studies incorporated multiple components into their QI approach. Patient education was part of most interventions (12 of 14), although the specific approach differed substantially across the studies. Ten of the studies incorporated self-management; this would include, for example, teaching individuals with diabetes to check their blood sugar regularly. Most (8 of 14) included some sort of provider education, which may have focused on the clinical issue or on raising awareness about disparities affecting the target population. Studies evaluated the effect of these strategies on disparities in the prevention or treatment of breast or colorectal cancer, cardiovascular disease, depression, or

Can first-year medical students acquire quality improvement knowledge prior to substantial clinical exposure? A mixed-methods evaluation of a pre-clerkship curriculum that uses education as the context for learning.

Science.gov (United States)

Brown, Allison; Nidumolu, Aditya; Stanhope, Alexandra; Koh, Justin; Greenway, Matthew; Grierson, Lawrence

2018-03-19

Quality Improvement (QI) training for health professionals is essential to strengthen health systems. However, QI training during medical school is constrained by students' lack of contextual understanding of the health system and an already saturated medical curriculum. The Program for Improvement in Medical Education (PRIME), an extracurricular offered at the Michael G. DeGroote School of Medicineat McMaster University (Hamilton, Canada), addresses these obstacles by having first-year medical students engage in QI by identifying opportunities for improvement within their own education. A sequential explanatory mixed-methods approach, which combines insights derived from quantitative instruments and qualitative interview methods, was used to examine the impact of PRIME on first-year medical students and the use of QI in the context of education. The study reveals that participation in PRIME increases both knowledge of, and comfort with, fundamental QI concepts, even when applied to clinical scenarios. Participants felt that education provided a meaningful context to learn QI at this stage of their training, and were motivated to participate in future QI projects to drive real-world improvements in the health system. Early exposure to QI principles that uses medical education as the context may be an effective intervention to foster QI competencies at an early stage and ultimately promote engagement in clinical QI. Moreover, PRIME also provides a mechanism to drive improvements in medical education. Future research is warranted to better understand the impact of education as a context for later engagement in clinical QI applications as well as the potential for QI methods to be translated directly into education. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

roposal on the Method of Regulating Ascending Kidney Water and Descending Heart Fire -through pharmacopuncture technique-

Directory of Open Access Journals (Sweden)

Ki Rok, Kwon

2007-12-01

Full Text Available Objectives : The purpose of this study is aimed at diagnosing and suggesting treatment plans for commonly seen clinical manifestation of heat symptom in the upper body and coldness in the lower body, also known as hot above, cold below syndrome. Methods : Various reasons attribute to the presence of hot above, cold below syndrome, but mainly contributed by blockage of normal Qi flow by abnormality of heart-kidney root, spleen-stomach axis, and liver-lung axis. Diagnosing these abnormalities and timely alleviation to the healthy state is presented in the study. Results : 1For heat in the upper body, Huang Lian Jie Du Tang(黃連解毒湯, CF, or JsD pharmacopuctures are injected on GB21, GB20. Qi stagnation in the thoracic area is treated with BUM injection on CV17. For impairment of transportation and transformation in the middle energizer, BUM pharmacopuncture is injected on CV12. Coldness in the lower energizer was relieved by bee venom or Sweet BV(Bee Venom free from enzymes on CV6. Conclusion : Above proposed methods of regulating water-fire were effective in treating hot above, cold below syndrome in clinical manifestations. But once the symptom subsides, treatment focused on eliminating innate cause should be rendered to achieve more successful results.

Persian fencing techniques

Directory of Open Access Journals (Sweden)

Manouchehr Moshtagh Khorasani

2012-07-01

Full Text Available There are numerous manuscripts, poems and stories that describe, specifically and in detail, the different techniques used in Persian swordsmanship. The present article explains the origins and the techniques of Persian swordsmanship. The article also describes the traditional code of conduct for Persian warriors. Additionally, it describes an array of techniques that were deployed in actual combat in Iran’s history. Some of these techniques are represented via the miniatures that are reproduced herein. This is the first article on Persian swordsmanship published in any periodical.

An effective technique for the software requirements analysis of NPP safety-critical systems, based on software inspection, requirements traceability, and formal specification

International Nuclear Information System (INIS)

Koo, Seo Ryong; Seong, Poong Hyun; Yoo, Junbeom; Cha, Sung Deok; Yoo, Yeong Jae

2005-01-01

A thorough requirements analysis is indispensable for developing and implementing safety-critical software systems such as nuclear power plant (NPP) software systems because a single error in the requirements can generate serious software faults. However, it is very difficult to completely analyze system requirements. In this paper, an effective technique for the software requirements analysis is suggested. For requirements verification and validation (V and V) tasks, our technique uses software inspection, requirement traceability, and formal specification with structural decomposition. Software inspection and requirements traceability analysis are widely considered the most effective software V and V methods. Although formal methods are also considered an effective V and V activity, they are difficult to use properly in the nuclear fields as well as in other fields because of their mathematical nature. In this work, we propose an integrated environment (IE) approach for requirements, which is an integrated approach that enables easy inspection by combining requirement traceability and effective use of a formal method. The paper also introduces computer-aided tools for supporting IE approach for requirements. Called the nuclear software inspection support and requirements traceability (NuSISRT), the tool incorporates software inspection, requirement traceability, and formal specification capabilities. We designed the NuSISRT to partially automate software inspection and analysis of requirement traceability. In addition, for the formal specification and analysis, we used the formal requirements specification and analysis tool for nuclear engineering (NuSRS)

Validation of a method for assessing resident physicians' quality improvement proposals.

Science.gov (United States)

Leenstra, James L; Beckman, Thomas J; Reed, Darcy A; Mundell, William C; Thomas, Kris G; Krajicek, Bryan J; Cha, Stephen S; Kolars, Joseph C; McDonald, Furman S

2007-09-01

Residency programs involve trainees in quality improvement (QI) projects to evaluate competency in systems-based practice and practice-based learning and improvement. Valid approaches to assess QI proposals are lacking. We developed an instrument for assessing resident QI proposals--the Quality Improvement Proposal Assessment Tool (QIPAT-7)-and determined its validity and reliability. QIPAT-7 content was initially obtained from a national panel of QI experts. Through an iterative process, the instrument was refined, pilot-tested, and revised. Seven raters used the instrument to assess 45 resident QI proposals. Principal factor analysis was used to explore the dimensionality of instrument scores. Cronbach's alpha and intraclass correlations were calculated to determine internal consistency and interrater reliability, respectively. QIPAT-7 items comprised a single factor (eigenvalue = 3.4) suggesting a single assessment dimension. Interrater reliability for each item (range 0.79 to 0.93) and internal consistency reliability among the items (Cronbach's alpha = 0.87) were high. This method for assessing resident physician QI proposals is supported by content and internal structure validity evidence. QIPAT-7 is a useful tool for assessing resident QI proposals. Future research should determine the reliability of QIPAT-7 scores in other residency and fellowship training programs. Correlations should also be made between assessment scores and criteria for QI proposal success such as implementation of QI proposals, resident scholarly productivity, and improved patient outcomes.

Project JOINTS: what factors affect bundle adoption in a voluntary quality improvement campaign?

Science.gov (United States)

Khodyakov, Dmitry; Ridgely, M Susan; Huang, Christina; DeBartolo, Katherine O; Sorbero, Melony E; Schneider, Eric C

2015-01-01

Diffusion and adoption of effective evidence-based clinical practices can be slow, especially if complex changes are required to implement new practices. To examine how hospital adherence to quality improvement (QI) methods and hospital engagement with a large-scale QI campaign could facilitate the adoption of an enhanced prevention bundle designed to reduce surgical site infection (SSI) rates after orthopaedic surgery (hip and knee arthroplasty). We conducted telephone interviews with hospital QI leaders from 73 of the 109 hospitals (67% response rate) in five states that participated in Project JOINTS (Joining Organizations IN Tackling SSIs), a QI campaign run by Institute for Healthcare Improvement (IHI). Using QI methods grounded in the IHI Model for Improvement, this campaign encouraged hospitals to implement an enhanced SSI prevention bundle. Hospital QI leaders reported on their hospital's adherence to the Project JOINTS QI methods; their level of engagement with Project JOINTS activities; and adoption of the SSI prevention bundle components. Interview data were analysed quantitatively and qualitatively. Both adherence to the QI methods and hospital engagement were positively associated with complete bundle adoption. Hospital engagement, especially the use of project materials and tools, was also positively associated with the initiation of and improved adherence to individual bundle components. Our findings suggest that greater adherence to the QI methods and active hospital engagement in a QI campaign facilitate adoption of evidence-based patient safety bundles in orthopaedic practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Do relationships exist between the scope and intensity of quality improvement activities and hospital operation performance? A 10-year observation in Taiwan.

Science.gov (United States)

Chung, Kuo-Piao; Yu, Tsung-Hsien

2015-08-14

The relationship between the scope and intensity of quality improvement (QI) activities and hospital performance remains unclear. This study investigated the relationship between performance, external environment, and the scope and intensity of QI activities in hospitals. The study used a longitudinal observation. Data regarding the scope and intensity of QI activities were collected using a questionnaire survey among the administrative deputy superintendents / directors of quality management center in 139 hospitals. Hospital performance indicators were abstracted from the 2000-2009 national hospitals profiles. We adopted year 2000 as the baseline, and divided the study period into three 3-year periods. The Generalized Estimating Equations (GEE) model was used for the statistical analysis. Seventy-two hospitals responded to the survey, giving a response rate of 52%. The results showed a significant increase in the scope and intensity of QI activities between 2000 and 2009. The results also showed that the scope and intensity of a hospital's QI activities were associated with the scope and intensity of its competitors' QI activities in the previous period and its own prior performance. The scope of QI activities in the previous period was not significantly related to the selected hospital performance measures. However, the intensity of QI activities in the previous period showed a significant and positive relationship with the number of inpatients and the turnover of beds. The study demonstrates that the intensity of QI activities is associated with the external environment and the hospital's own performance in the previous period. Furthermore, some performance measures are associated with the intensity of the QI activities in the previous period.

Shoulder strengthening exercises adapted to specific shoulder pathologies can be selected using new simulation techniques: a pilot study.

Science.gov (United States)

Charbonnier, Caecilia; Lädermann, Alexandre; Kevelham, Bart; Chagué, Sylvain; Hoffmeyer, Pierre; Holzer, Nicolas

2018-02-01

Shoulder strength training exercises represent a major component of rehabilitation protocols designed for conservative or postsurgical management of shoulder pathologies. Numerous methods are described for exercising each shoulder muscle or muscle group. Limited information is available to assess potential deleterious effects of individual methods with respect to specific shoulder pathologies. Thus, the goal of this pilot study was to use a patient-specific 3D measurement technique coupling medical imaging and optical motion capture for evaluation of a set of shoulder strength training exercises regarding glenohumeral, labral and subacromial compression, as well as elongation of the rotator cuff muscles. One volunteer underwent magnetic resonance imaging (MRI) and motion capture of the shoulder. Motion data from the volunteer were recorded during three passive rehabilitation exercises and twenty-nine strengthening exercises targeting eleven of the most frequently trained shoulder muscles or muscle groups and using four different techniques when available. For each exercise, glenohumeral and labral compression, subacromial space height and rotator cuff muscles elongation were measured on the entire range of motion. Significant differences in glenohumeral, subacromial and labral compressions were observed between sets of exercises targeting individual shoulder muscles. Muscle lengths computed by simulation compared to MRI measurements showed differences of 0-5%. This study represents the first screening of shoulder strengthening exercises to identify potential deleterious effects on the shoulder joint. Motion capture combined with medical imaging allows for reliable assessment of glenohumeral, labral and subacromial compression, as well as muscle-tendon elongation during shoulder strength training exercises.

Identifying quality improvement intervention publications - A comparison of electronic search strategies

Directory of Open Access Journals (Sweden)

Rubenstein Lisa V

2011-08-01

Full Text Available Abstract Background The evidence base for quality improvement (QI interventions is expanding rapidly. The diversity of the initiatives and the inconsistency in labeling these as QI interventions makes it challenging for researchers, policymakers, and QI practitioners to access the literature systematically and to identify relevant publications. Methods We evaluated search strategies developed for MEDLINE (Ovid and PubMed based on free text words, Medical subject headings (MeSH, QI intervention components, continuous quality improvement (CQI methods, and combinations of the strategies. Three sets of pertinent QI intervention publications were used for validation. Two independent expert reviewers screened publications for relevance. We compared the yield, recall rate, and precision of the search strategies for the identification of QI publications and for a subset of empirical studies on effects of QI interventions. Results The search yields ranged from 2,221 to 216,167 publications. Mean recall rates for reference publications ranged from 5% to 53% for strategies with yields of 50,000 publications or fewer. The 'best case' strategy, a simple text word search with high face validity ('quality' AND 'improv*' AND 'intervention*' identified 44%, 24%, and 62% of influential intervention articles selected by Agency for Healthcare Research and Quality (AHRQ experts, a set of exemplar articles provided by members of the Standards for Quality Improvement Reporting Excellence (SQUIRE group, and a sample from the Cochrane Effective Practice and Organization of Care Group (EPOC register of studies, respectively. We applied the search strategy to a PubMed search for articles published in 10 pertinent journals in a three-year period which retrieved 183 publications. Among these, 67% were deemed relevant to QI by at least one of two independent raters. Forty percent were classified as empirical studies reporting on a QI intervention. Conclusions The presented

Training techniques for industry

International Nuclear Information System (INIS)

Jones, D.W.

1978-01-01

The advantages and disadvantages of commonly used training techniques in relation to cost-effective, prevention-oriented Quality Assurance are examined. Important questions are whether training techniques teach cost effectiveness and whether the techniques are, themselves, cost effective. To answer these questions, criteria for evaluating teaching techniques for cost effectiveness were developd, and then commonly used techniques are evaluated in terms of specific training program objectives. Motivation of personnel is also considered important to the success of a training program, and methods are outlined by which recognition of the academic quality of industrial training can be used as a motivational technique

The first ever Cochrane event in Russia and Russian speaking countries - Cochrane Russia Launch - Evidence-based medicine: Achievements and barriers (QiQUM 2015) International Conference, Kazan, December 7-8, 2015.

Science.gov (United States)

Ziganshina, Liliya Eugenevna; Jørgensen, Karsten Juhl

2016-01-01

Kazan hosted Russia's second International Conference QiQUM 2015 on Cochrane evidence for health policy, which was entirely independent of the pharmaceutical or other health industry, bringing together 259 participants from 11 countries and 13 regions of the Russian Federation. The Conference was greeted and endorsed by world leaders in Evidence-based medicine, health and pharmaceutical information, policy and regulation, and the World Health Organization. Participants discussed the professional and social problems arising from biased health information, unethical pharmaceutical promotion, misleading reporting of clinical trials with consequent flaws in health care delivery and the role of Cochrane evidence for informed decisions and better health. The first in history Cochrane workshop, facilitated jointly by experts from Cochrane and the WHO, with 40 participants from Kazakhstan, Kyrgyzstan, Tajikistan and Russia introduced the concept of Cochrane systematic review and the Use of Cochrane evidence in WHO policy setting. Websites document conference materials and provide interface for future collaboration: http://kpfu.ru/biology-medicine/struktura-instituta/kafedry/kfikf/konferenciya/mezhdunarodnaya-konferenciya-39dokazatelnaya.html and http://russia.cochrane.org/news/international-conference.

A Pilot Quality Improvement Collaborative to Improve Safety Net Dental Access for Pregnant Women and Young Children.

Science.gov (United States)

Vander Schaaf, Emily B; Quinonez, Rocio B; Cornett, Amanda C; Randolph, Greg D; Boggess, Kim; Flower, Kori B

2018-02-01

Objectives To determine acceptability and feasibility of a quality improvement (QI) collaborative in safety net dental practices, and evaluate its effects on financial stability, access, efficiency, and care for pregnant women and young children. Methods Five safety net dental practices participated in a 15-month learning collaborative utilizing business assessments, QI training, early childhood oral health training, and prenatal oral health training. Practices collected monthly data on: net revenue, no-show rates, total encounters, and number of encounters for young children and pregnant women. We analyzed quantitative data using paired t-tests before and after the collaborative and collected supplemental qualitative feedback from clinic staff through focus groups and directed email. Results All mean measures improved, including: higher monthly revenue ($28,380-$33,102, p = 0.37), decreased no-show rate (17.7-14.3%, p = 0.11), higher monthly dental health encounters (283-328, p = 0.08), and higher monthly encounters for young children (8.8-10.5, p = 0.65), and pregnant women (2.8-9.7, p = 0.29). Results varied by practice, with some demonstrating largest increases in encounters for young children and others pregnant women. Focus group participants reported that the collaborative improved access for pregnant women and young children, and that QI methods were often new and difficult. Conclusion for practice Participation by safety net dental practices in a QI collaborative is feasible and acceptable. Individual sites saw greater improvements in different outcomes areas, based on their own structures and needs. Future efforts should focus on specific needs of each dental practice and should offer additional QI training.

Engaging multilevel stakeholders in an implementation trial of evidence-based quality improvement in VA women's health primary care.

Science.gov (United States)

Hamilton, Alison B; Brunner, Julian; Cain, Cindy; Chuang, Emmeline; Luger, Tana M; Canelo, Ismelda; Rubenstein, Lisa; Yano, Elizabeth M

2017-09-01

stakeholders need to be engaged in implementation early, with data and discussion that convey the importance and relevance of a new initiative. Stakeholder perspectives on institutional norms (e.g., gender norms) and readiness for population-specific QI are useful drivers of clinical initiatives designed to transform care for clinical subpopulations.

Intraoperative electron beam radiation therapy: technique, dosimetry, and dose specification: report of task force 48 of the radiation therapy committee, American association of physicists in medicine

International Nuclear Information System (INIS)

Palta, Jatinder R.; Biggs, Peter J.; Hazle, John D.; Huq, M. Saiful; Dahl, Robert A.; Ochran, Timothy G.; Soen, Jerry; Dobelbower, Ralph R.; McCullough, Edwin C.

1995-01-01

Intraoperative radiation therapy (IORT) is a treatment modality whereby a large single dose of radiation is delivered to a surgically open, exposed cancer site. Typically, a beam of megavoltage electrons is directed at an exposed tumor or tumor bed through a specially designed applicator system. In the last few years, IORT facilities have proliferated around the world. The IORT technique and the applicator systems used at these facilities vary greatly in sophistication and design philosophy. The IORT beam characteristics vary for different designs of applicator systems. It is necessary to document the existing techniques of IORT, to detail the dosimetry data required for accurate delivery of the prescribed dose, and to have a uniform method of dose specification for cooperative clinical trials. The specific charge to the task group includes the following: (a) identify the multidisciplinary IORT team, (b) outline special considerations that must be addressed by an IORT program, (c) review currently available IORT techniques, (d) describe dosimetric measurements necessary for accurate delivery of prescribed dose, (e) describe dosimetric measurements necessary in documenting doses to the surrounding normal tissues, (f) recommend quality assurance procedures for IORT, (g) review methods of treatment documentation and verification, and (h) recommend methods of dose specification and recording for cooperative clinical trials

Spectrometric techniques 2

CERN Document Server

Vanasse, George A

2013-01-01

Spectrometric Techniques, Volume II provides information pertinent to vacuum ultraviolet techniques to complete the demonstration of the diversity of methods available to the spectroscopist interested in the ultraviolet visible and infrared spectral regions. This book discusses the specific aspects of the technique of Fourier transform spectroscopy.Organized into five chapters, this volume begins with an overview of the large number of systematic effects in the recording of an interferogram. This text then examines the design approach for a Fourier transform spectrometer with focus on optics.

Effectiveness of a quality improvement curriculum for medical students

Directory of Open Access Journals (Sweden)

Kimberly M. Tartaglia

2015-05-01

Full Text Available Introduction: As health systems find ways to improve quality of care, medical training programs are finding opportunities to prepare learners on principles of quality improvement (QI. The impact of QI curricula for medical students as measured by student learning is not well delineated. The aim of this study is to evaluate the effectiveness of a QI curriculum for senior medical students as measured by student knowledge and skills. Methods: This study was an observational study that involved a self-assessment and post-test Quality Improvement Knowledge Application Tool (QIKAT for intervention and control students. A QI curriculum consisting of online modules, live discussions, independent readings and reflective writing, and participation in a mentored QI project was offered to fourth-year medical students completing an honor's elective (intervention group. Senior medical students who received the standard QI curriculum only were recruited as controls. Results: A total of 22 intervention students and 12 control students completed the self-assessment and QIKAT. At baseline, there was no difference between groups in self-reported prior exposure to QI principles. Students in the intervention group reported more comfort with their skills in QI overall and in 9 of the 12 domains (p<0.05. Additionally, intervention students performed better in each of the three case scenarios (p<0.01. Discussion: A brief QI curriculum for senior medical students results in improved comfort and knowledge with QI principles. The strengths of our curriculum include effective use of classroom time and faculty mentorship with reliance on pre-existing online modules and written resources. Additionally, the curriculum is easily expandable to larger groups of students and transferable to other institutions.

Integrating Quality Improvement and Continuing Professional Development: A Model From the Mental Health Care System.

Science.gov (United States)

Sockalingam, Sanjeev; Tehrani, Hedieh; Lin, Elizabeth; Lieff, Susan; Harris, Ilene; Soklaridis, Sophie

2016-04-01

To explore the perspectives of leaders in psychiatry and continuing professional development (CPD) regarding the relationship, opportunities, and challenges in integrating quality improvement (QI) and CPD. In 2013-2014, the authors interviewed 18 participants in Canada: 10 psychiatrists-in-chief, 6 CPD leaders in psychiatry, and 2 individuals with experience integrating these domains in psychiatry who were identified through snowball sampling. Questions were designed to identify participants' perspectives about the definition, relationship, and integration of QI and CPD in psychiatry. Interviews were recorded and transcribed. An iterative, inductive method was used to thematically analyze the transcripts. To ensure the rigor of the analysis, the authors performed member checking and sampling until theoretical saturation was achieved. Participants defined QI as a concept measured at the individual, hospital, and health care system levels and CPD as a concept measured predominantly at the individual and hospital levels. Four themes related to the relationship between QI and CPD were identified: challenges with QI training, adoption of QI into the mental health care system, implementation of QI in CPD, and practice improvement outcomes. Despite participants describing QI and CPD as mutually beneficial, they expressed uncertainty about the appropriateness of aligning these domains within a mental health care context because of the identified challenges. This study identified challenges with aligning QI and CPD in psychiatry and yielded a framework to inform future integration efforts. Further research is needed to determine the generalizability of this framework to other specialties and health care professions.

Epidemiological Distribution and Subtype Analysis of Premenstrual Dysphoric Disorder Syndromes and Symptoms Based on TCM Theories

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Mingqi Qiao

2017-01-01

Full Text Available We performed an epidemiological investigation of subjects with premenstrual dysphoric disorder (PMDD to identify the clinical distribution of the major syndromes and symptoms. The pathogenesis of PMDD mainly involves the dysfunction of liver conveyance and dispersion. Excessive liver conveyance and dispersion are associated with liver-qi invasion syndrome, while insufficient liver conveyance and dispersion are expressed as liver-qi depression syndrome. Additionally, a nonconditional logistic regression was performed to analyze the symptomatic features of liver-qi invasion and liver-qi depression. As a result of this analysis, two subtypes of PMDD are proposed, namely, excessive liver conveyance and dispersion (liver-qi invasion syndrome and insufficient liver conveyance and dispersion (liver-qi depression syndrome. Our findings provide an epidemiological foundation for the clinical diagnosis and treatment of PMDD based on the identification of different types.

The Quintessence of Traditional Chinese Medicine: Syndrome and Its Distribution among Advanced Cancer Patients with Constipation

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Chung-Wah Cheng

2012-01-01

Full Text Available Constipation is a common problem in advanced cancer patients; however, specific clinical guidelines on traditional Chinese medicine (TCM syndrome (Zhang are not yet available. In this cross-sectional study, the TCM syndromes distribution and their common symptoms and signs among 225 constipated advanced cancer patients were determined. Results showed that 127 patients (56.4% and 7 patients (3.1% were in deficient and excessive patterns, respectively, while 91 patients (40.4% were in deficiency-excess complex. The distributions of the five syndromes were: Qi deficiency (93.3%, Qi stagnation (40.0%, blood (Yin deficiency (28.9%, Yang deficiency (22.2%, and excess heat (5.8%. Furthermore, age, functional status, and level of blood haemoglobin were factors related to the type of TCM syndrome. A TCM prescription with the functions on replenishing the Deficiency, redirecting the flow of Qi stagnation and moistening the dryness caused by the blood (Yin deficiency can be made for the treatment of advance cancer patients with constipation. Robust trials are urgently needed for further justifying its efficacy and safety in evidence-based approaches.

Hypertension and hyperlipidemia management in patients treated at community health centers.

Science.gov (United States)

Kirchhoff, Anne C; Drum, Melinda L; Zhang, James X; Schlichting, Jennifer; Levie, Jessica; Harrison, James F; Lippold, Susan A; Schaefer, Cynthia T; Chin, Marshall H

2008-01-01

OBJECTIVE: Community health centers (HCs) provide care for millions of medically underserved Americans with disproportionate burdens of hypertension and hyperlipidemia. For both conditions, treatment guidelines recently became more stringent and quality improvement (QI) efforts have intensified. We assessed hypertension and hyperlipidemia management in HCs during this time of guideline revision and increased QI efforts. DESIGN: Cross-sectional chart review. SETTING AND PARTICIPANTS: Eleven Midwestern HCs for 2000 and 9 for 2002 provided audit data from 2,976 randomly chosen patients with hypertension and/or hyperlipidemia. MEASUREMENT: Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI/VII) and National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III) guidelines were used to assess management of these conditions. RESULTS: Hypertension (2000, N=808; 2002, N=692) and hyperlipidemia (2000, N=774; 2002, N=702) outcomes improved for specific clinical subgroups. Hypertensive patients with 1 or more cardiovascular risk factors demonstrated significant improvement (34% vs. 45% controlled at risk factors (39% vs. 58% controlled at risk groups; however, ongoing QI is necessary.

Developing, implementing, and evaluating a multifaceted quality improvement intervention to promote sleep in an ICU.

Science.gov (United States)

Kamdar, Biren B; Yang, Jessica; King, Lauren M; Neufeld, Karin J; Bienvenu, O Joseph; Rowden, Annette M; Brower, Roy G; Collop, Nancy A; Needham, Dale M

2014-01-01

Critically ill patients commonly experience poor sleep quality in the intensive care unit (ICU) because of various modifiable factors. To address this issue, an ICU-wide, multifaceted quality improvement (QI) project was undertaken to promote sleep in the Johns Hopkins Hospital Medical ICU (MICU). To supplement previously published results of this QI intervention, the present article describes the specific QI framework used to develop and implement this intervention, which consists of 4 steps: (a) summarizing the evidence to create a list of sleep-promoting interventions, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education and regular project evaluation. Measures of performance included daily completion rates of daytime and nighttime sleep improvement checklists and completion rates of individual interventions. Although long-term adherence and sustainability pose ongoing challenges, this model provides a foundation for future ICU sleep promotion initiatives. © 2013 by the American College of Medical Quality.

[Effects of Chinese herbal compound for supplementing qi and activating blood circulation on actin, Cx43 expressions and gap junctional intercellular communication functions of myocardial cells in patients with Coxsackie virus B 3 viral myocarditis].

Science.gov (United States)

Zhang, Ming-xue; He, Wei; Gu, Ping

2010-08-01

To observe the effect of Chinese herbal compound for supplementing qi and activating blood circulation (CHC) on the gap junctional intercellular communication (GJIC) function of myocardial cells in patients with Coxsackie virus B 3 (CVB3) viral myocarditis. Expressions of actin and connexin43 (Cx43) in myocardial cells of patients arranged in three groups (the normal control group, the viral infected group and the CHC treated group) were detected by immunohistochemical method; the fluorescence photobleaching recovery rate of cells was detected by laser scanning confocal microscope. As compared with the viral infected group, the expressions of actin and Cx43 were increased and the GJIC function was improved in the CHC treated group. CHC could antagonize viral injury on skeleton protein, and repair the structure of gap junction channel to improve the GJIC function of myocardial cells after being attacked by CVB3.

Assessing the Organizational Characteristics Influencing Quality Improvement Implementation in Saudi Hospitals.

Science.gov (United States)

Shamsuddin Alaraki, Mohammad

The health care system in Saudi Arabia has serious problems with quality and safety that can be reduced through systematic quality improvement (QI) activities. Despite the use of different QI models to improve health care in Saudi hospitals during the last 2 decades, consistent improvements have not yet been achieved and the results are still far below expectations. This may reflect a problem in introducing and implementing the QI models in the local contexts. The objective of this study is to assess the extent of QI implementation in Saudi hospitals and to identify the organizational characteristics that make Saudi hospitals particularly challenging for QI. Understanding these characteristics can inform efforts to improve them and may lead to more successful implementation. A mixed-methods approach was conducted using 2 data collection tools: questionnaires and interviews. The quantitative phase (questionnaires) aimed to uncover the current level of QI implementation in Saudi hospital as measured by 7 critical dimensions adapted from the literature. The qualitative phase (interviews) aimed to understand the organizational characteristics that impede or underpin QI in Saudi hospitals. The QI implementation was found to be significantly poor across the 7 dimensions with average score ranging between 22.80 ± 0.57 and 2.11 ± 0.69 on a 5-point Likert scale and with P value of less than .05. We also found that the current level of QI implementation helped Saudi hospitals neither to improve "customer satisfaction" nor to achieve measurable improvements in "quality results" scoring significantly low at 2.11 ± 0.69 with P value of .000 and 2.47 ± 0.57 with P value of .000, respectively. Our study confirms the presence of a multitude of organizational barriers that impede QI in Saudi hospitals. These are related to organizational culture, human resources management, processes and systems, and structure. These 4 were found to have the strongest impact on QI in Saudi

Effectiveness of strengthened stimulation during acupuncture for the treatment of Bell palsy: a randomized controlled trial.

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Xu, Sha-bei; Huang, Bo; Zhang, Chen-yan; Du, Peng; Yuan, Qi; Bi, Gui-juan; Zhang, Gui-bin; Xie, Min-jie; Luo, Xiang; Huang, Guang-ying; Wang, Wei

2013-04-02

The traditional Chinese theory of acupuncture emphasizes that the intensity of acupuncture must reach a threshold to generate de qi, which is necessary to achieve the best therapeutic effect. De qi is an internal compound sensation of soreness, tingling, fullness, aching, cool, warmth and heaviness, and a radiating sensation at and around the acupoints. However, the notion that de qi must be achieved for maximum benefit has not been confirmed by modern scientific evidence. We performed a prospective multicentre randomized controlled trial involving patients with Bell palsy. Patients were randomly assigned to the de qi (n = 167) or control (n = 171) group. Both groups received acupuncture: in the de qi group, the needles were manipulated manually until de qi was reached, whereas in the control group, the needles were inserted without any manipulation. All patients received prednisone as a basic treatment. The primary outcome was facial nerve function at month 6. We also assessed disability and quality of life 6 months after randomization. After 6 months, patients in the de qi group had better facial function (adjusted odds ratio [OR] 4.16, 95% confidence interval [CI] 2.23-7.78), better disability assessment (differences of least squares means 9.80, 95% CI 6.29-13.30) and better quality of life (differences of least squares means 29.86, 95% CI 22.33-37.38). Logistic regression analysis showed a positive effect of the de qi score on facial-nerve function (adjusted OR 1.07, 95% CI 1.04-1.09). Among patients with Bell palsy, acupuncture with strong stimulation that elicited de qi had a greater therapeutic effect, and stronger intensity of de qi was associated with the better therapeutic effects. Clinicaltrials.gov no. NCT00685789.

Evaluating the state of quality-improvement science through evidence synthesis: insights from the closing the quality gap series.

Science.gov (United States)

McDonald, Kathryn M; Schultz, Ellen M; Chang, Christine

2013-01-01

The Closing the Quality Gap series from the Agency for Healthcare Research and Quality summarizes evidence for eight high-priority health care topics: outcomes used in disability research, bundled payment programs, public reporting initiatives, health care disparities, palliative care, the patient-centered medical home, prevention of health care-associated infections, and medication adherence. To distill evidence from this series and provide insight into the "state of the science" of quality improvement (QI). We provided common guidance for topic development and qualitatively synthesized evidence from the series topic reports to identify cross-topic themes, challenges, and evidence gaps as related to QI practice and science. Among topics that examined effectiveness of QI interventions, we found improvement in some outcomes but not others. Implementation context and potential harms from QI activities were not widely evaluated or reported, although market factors appeared important for incentive-based QI strategies. Patient-focused and systems-focused strategies were generally more effective than clinician-focused strategies, although the latter approach improved clinician adherence to infection prevention strategies. Audit and feedback appeared better for targeting professionals and organizations, but not patients. Topic reviewers observed heterogeneity in outcomes used for QI evaluations, weaknesses in study design, and incomplete reporting. Synthesizing evidence across topics provided insight into the state of the QI field for practitioners and researchers. To facilitate future evidence synthesis, consensus is needed around a smaller set of outcomes for use in QI evaluations and a framework and lexicon to describe QI interventions more broadly, in alignment with needs of decision makers responsible for improving quality.

Is the implementation of quality improvement methods in hospitals subject to the neighbourhood effect?

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Yu, Tsung-Hsien; Chung, Kuo-Piao

2014-06-01

Quality improvement (QI) methods have been fashionable in hospitals for decades. Previous studies have discussed the relationships between the implementation of QI methods and various external and internal factors, but there has been no examination to date of whether the neighbourhood effect influences such implementation. The aim of this study was to use a multilevel model to investigate whether and how the neighbourhood effect influences the implementation of QI methods in the hospital setting in Taiwan. This is a retrospective questionnaire-based survey. All medical centres, regional hospitals and district teaching hospitals in Taiwan. Directors or persons in charge of implementing QI methods in hospitals. None. The breadth and depth of QI method implementation. Seventy-two of the 139 hospitals contacted returned the questionnaire, yielding a 52% response rate. The breadth and depth of QI method implementation increased over the 10-year study period, particularly between 2004 and 2006. The breadth and depth of the QI methods implemented in the participating hospitals were significantly associated with the average breadth and depth of those implemented by their competitors in the same medical area during the previous period. In addition, time was positively associated with the breadth and depth of QI method implementation. In summary, the findings of this study show that hospitals' QI implementation status is influenced by that of their neighbours. Hence, the neighbourhood effect is an important factor in understanding hospital behaviour. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

[Comparative study of reflectance spectroscopy of women's acupoints around menstruation].

Science.gov (United States)

Jiang, Xing-Hui; Liu, Han-Ping; Guo, Zhou-Yi; Meng, Yao-Yong; Zeng, Chang-Chun; Liu, Song-Hao

2010-12-01

Acupoint was reaction of viscera and its optical parameter was an important characteristic of tissue. In the present work, in order to discuss specificity of acupuncture on the response of qi and blood in human body, we compared the diffuse reflectance of Taichong (LV3), Taibai (SP3), and Chongyang (ST42) before, during and after menstruation. All the acupoints had the same shape of the spectrum and troughs were all at 423.16, 544.06 and 577.47 nm. The values of reflectance during menstruation were greater than before and after menstruation, especially for SP3 and ST42 (P menstruation. Diffuse reflectance may be possibly used in the quantitative analysis of qi and blood.

Orbital Reconstruction: Patient-Specific Orbital Floor Reconstruction Using a Mirroring Technique and a Customized Titanium Mesh.

Science.gov (United States)

Tarsitano, Achille; Badiali, Giovanni; Pizzigallo, Angelo; Marchetti, Claudio

2016-10-01

Enophthalmos is a severe complication of primary reconstruction of orbital floor fractures. The goal of secondary reconstruction procedures is to restore symmetrical globe positions to recover function and aesthetics. The authors propose a new method of orbital floor reconstruction using a mirroring technique and a customized titanium mesh, printed using a direct metal laser-sintering method. This reconstructive protocol involves 4 steps: mirroring of the healthy orbit at the affected site, virtual design of a patient-specific orbital floor mesh, CAM procedures for direct laser-sintering of the customized titanium mesh, and surgical insertion of the device. Using a computed tomography data set, the normal, uninjured side of the craniofacial skeleton was reflected onto the contralateral injured side, and a reconstructive orbital floor mesh was designed virtually on the mirrored orbital bone surface. The solid-to-layer files of the mesh were then manufactured using direct metal laser sintering, which resolves the shaping and bending biases inherent in the indirect method. An intraoperative navigation system ensured accuracy of the entire procedure. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography data in 7 treated patients. The technique described here appears to be a viable method to correct complex orbital floor defects needing delayed reconstruction. This study represents the first step in the development of a wider experimental protocol for orbital floor reconstruction using computer-assisted design-computer-assisted manufacturing technology.

White matter tract-specific quantitative analysis in multiple sclerosis: Comparison of optic radiation reconstruction techniques.

Directory of Open Access Journals (Sweden)

Chenyu Wang

Full Text Available The posterior visual pathway is commonly affected by multiple sclerosis (MS pathology that results in measurable clinical and electrophysiological impairment. Due to its highly structured retinotopic mapping, the visual pathway represents an ideal substrate for investigating patho-mechanisms in MS. Therefore, a reliable and robust imaging segmentation method for in-vivo delineation of the optic radiations (OR is needed. However, diffusion-based tractography approaches, which are typically used for OR segmentation are confounded by the presence of focal white matter lesions. Current solutions require complex acquisition paradigms and demand expert image analysis, limiting application in both clinical trials and clinical practice. In the current study, using data acquired in a clinical setting on a 3T scanner, we optimised and compared two approaches for optic radiation (OR reconstruction: individual probabilistic tractography-based and template-based methods. OR segmentation results were applied to subjects with MS and volumetric and diffusivity parameters were compared between OR segmentation techniques. Despite differences in reconstructed OR volumes, both OR lesion volume and OR diffusivity measurements in MS subjects were highly comparable using optimised probabilistic tractography-based, and template-based, methods. The choice of OR reconstruction technique should be determined primarily by the research question and the nature of the available dataset. Template-based approaches are particularly suited to the semi-automated analysis of large image datasets and have utility even in the absence of dMRI acquisitions. Individual tractography methods, while more complex than template based OR reconstruction, permit measurement of diffusivity changes along fibre bundles that are affected by specific MS lesions or other focal pathologies.

Approaches towards improving the quality of maternal and newborn health services in South Asia: challenges and opportunities for healthcare systems.

Science.gov (United States)

Mian, Naeem Uddin; Alvi, Muhammad Adeel; Malik, Mariam Zahid; Iqbal, Sarosh; Zakar, Rubeena; Zakar, Muhammad Zakria; Awan, Shehzad Hussain; Shahid, Faryal; Chaudhry, Muhammad Ashraf; Fischer, Florian

2018-02-06

South Asia is experiencing a dismal state of maternal and newborn health (MNH) as the region has been falling behind in reducing the levels of maternal and neonatal mortality. Most of the efforts are focused on enhancing coverage of MNH services; however, quality remains a serious concern if the region is to achieve expected outcomes in terms of standardised MNH services within healthcare delivery systems. This research consists of a review of South Asian quality improvement (QI) approaches/interventions, specifically implemented for MNH improvement. A literature review of QI approaches/interventions was conducted using the PRISMA guidelines. Online databases, including PubMed, the Cochrane Library and Google Scholar, were searched. Primary studies published between 1998 and 2013 were considered. Studies were initially screened and selected based upon the selection criteria for data extraction. A thematic synthesis/analysis was performed to organise, group and interpret the key findings according to prominent themes. Thirty studies from six South Asian countries were included in the review. Findings from these selected studies were grouped under eight broad, cross-cutting themes, which emerged from a deductive approach, representing the most commonly employed QI approaches for improving MNH services within different geographical settings. These consist of capacity building of healthcare providers on clinical quality, clinical audits and feedback, financial incentives to beneficiaries, pay-for-performance, supportive supervision, community engagement, collaborative efforts and multidimensional interventions. Employing and documenting QI approaches is essential in order to measure the potential of an intervention, considering its cost-effectiveness, feasibility and acceptability to communities. This research concluded that QI approaches are very diverse and cross-cutting, because they are subject to the varied requirements of regional health systems. This high level

Oral Astragalus (Huang qi) for preventing frequent episodes of acute respiratory tract infection in children.

Science.gov (United States)

Su, Guobin; Chen, Xiankun; Liu, Zhuangzhu; Yang, Lihong; Zhang, La; Stålsby Lundborg, Cecilia; Wen, Zehuai; Guo, Xinfeng; Qin, Xindong; Liang, Jueyao; Liu, Xusheng

2016-12-01

Acute respiratory tract infections (ARTIs) are common in children and can involve both upper and lower airways. Many children experience frequent ARTI episodes or recurrent respiratory tract infections (RRTIs) in early life, which creates challenges for paediatricians, primary care physicians, parents and carers of children.In China, Astragalus (Huang qi), alone or in combination with other herbs, is used by Traditional Chinese Medicine (TCM) practitioners in the form of a water extract, to reduce the risk of ARTIs; it is believed to stimulate the immune system. Better understanding of the therapeutic mechanisms of Astragalus may provide insights into ARTI prevention, and consequently reduced antibiotic use. To assess the effectiveness and safety of oral Astragalus for preventing frequent episodes of acute respiratory tract infections (ARTIs) in children in community settings. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 12, 2015), MEDLINE (Ovid) (1946 to 31 December 2015), Embase (Elsevier) (1974 to 31 December 2015), AMED (Ovid) (1985 to 31 December 2015), Chinese National Knowledge Infrastructure (CNKI) (1979 to 31 December 2015) and Chinese Scientific Journals full text database (CQVIP) (1989 to 31 December 2015), China Biology Medicine disc (CBM 1976 to 31 December 2015) and Wanfang Data Knowledge Service Platform (WanFang) (1998 to 31 December 2015). We included randomised controlled trials (RCTs) comparing oral Astragalus as a sole Chinese herbal preparation with placebo to prevent frequent episodes of ARTIs in children. We used standard Cochrane methodological procedures for this review. We assessed search results to identify relevant studies. We planned to extract data using standardised forms. Disagreements were to be resolved through discussion. Risk of bias was to be assessed using the Cochrane 'Risk of bias' tool. We planned to use mean difference (MD) or standardised mean difference (SMD) for continuous data and risk

78 FR 75345 - Ocean Transportation Intermediary License Applicants

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2013-12-11

.... Romero, President (QI). Application Type: New NVO & OFF License. F.H.L. Logistics, Inc. (NVO & OFF), 1354.... Officers: Arif H. Butt, General Manager (QI), Unni Krishnan Nair, President. Application Type: New NVO...: Stephen F. Crooks, Vice President (QI), Scott Kelly, President. Application Type: Adding NVO Service...

Preliminary probe of quality indicators and quality specification in total testing process in 5753 laboratories in China.

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Fei, Yang; Kang, Fengfeng; Wang, Wei; Zhao, Haijian; He, Falin; Zhong, Kun; Wang, Zhiguo; Chen, Wenxiang

2016-08-01

The aim of the study was to promote the establishment and implementation of quality indicators (QIs) in clinical laboratories, catch up with the state of art, and provide preliminary quality specifications for established QIs. Clinical laboratories from different provinces in China were included in this QIs survey in 2015. All participants were asked to collect data related to QIs and complete QIs questionnaires. Defect percentages and sigma values were calculated for each QI. The 25th percentile, median, and the 75th percentile of defect percentages and TATs were calculated as optimum, desirable and minimum quality specifications. While 25th, median, and 75th of sigma values were calculated as minimum, desirable and optimum quality specifications, respectively. Five thousand seven hundred and fifty-three clinical laboratories from 28 provinces in China participated in this survey. Median defect percentages of pre-examination QIs varied largely from 0.01% (incorrect sample container) to 0.57% (blood culture contamination) with sigma values varied from 4.0σ to 5.1σ. Median defect percentages of examination phase QIs were all really high. The most common problem in examination phase was test uncovered by inter-laboratory comparison (86.67%). Defect percentages of critical values notification and timely critical values notification were all 0.00% (6.0σ). While the median of defect percentages of incorrect laboratory reports was only 0.01% (5.4σ). Improvements are needed in all phases of total testing process (TTP) in laboratories in China, especially in examination phase. More attention should be paid when microbiology specimens are collected and results are reported. Quality specifications can provide directions for laboratories to make effort for.

Current techniques in postmortem imaging with specific attention to paediatric applications

Energy Technology Data Exchange (ETDEWEB)

Sieswerda-Hoogendoorn, Tessa; Rijn, Rick R. van [Academic Medical Centre Amsterdam, Department of Radiology, Amsterdam Zuid-Oost (Netherlands); Netherlands Forensic Institute, Department of Pathology and Toxicology, The Hague (Netherlands)

2010-02-15

In this review we discuss the decline of and current controversies regarding conventional autopsies and the use of postmortem radiology as an adjunct to and a possible alternative for the conventional autopsy. We will address the radiological techniques and applications for postmortem imaging in children. (orig.)

Current techniques in postmortem imaging with specific attention to paediatric applications

International Nuclear Information System (INIS)

Sieswerda-Hoogendoorn, Tessa; Rijn, Rick R. van

2010-01-01

In this review we discuss the decline of and current controversies regarding conventional autopsies and the use of postmortem radiology as an adjunct to and a possible alternative for the conventional autopsy. We will address the radiological techniques and applications for postmortem imaging in children. (orig.)

Parachute technique for partial penectomy

Directory of Open Access Journals (Sweden)

Fernando Korkes

2010-04-01

Full Text Available PURPOSE: Penile carcinoma is a rare but mutilating malignancy. In this context, partial penectomy is the most commonly applied approach for best oncological results. We herein propose a simple modification of the classic technique of partial penectomy, for better cosmetic and functional results. TECHNIQUE: If partial penectomy is indicated, the present technique can bring additional benefits. Different from classical technique, the urethra is spatulated only ventrally. An inverted "V" skin flap with 0.5 cm of extension is sectioned ventrally. The suture is performed with vicryl 4-0 in a "parachute" fashion, beginning from the ventral portion of the urethra and the "V" flap, followed by the "V" flap angles and than by the dorsal portion of the penis. After completion of the suture, a Foley catheter and light dressing are placed for 24 hours. CONCLUSIONS: Several complex reconstructive techniques have been previously proposed, but normally require specific surgical abilities, adequate patient selection and staged procedures. We believe that these reconstructive techniques are very useful in some specific subsets of patients. However, the technique herein proposed is a simple alternative that can be applied to all men after a partial penectomy, and takes the same amount of time as that in the classic technique. In conclusion, the "parachute" technique for penile reconstruction after partial amputation not only improves the appearance of the penis, but also maintains an adequate function.

Quality improvement education incorporated as an integral part of critical care fellows training at the Mayo Clinic.

Science.gov (United States)

Kashani, Kianoush B; Ramar, Kannan; Farmer, J Christopher; Lim, Kaiser G; Moreno-Franco, Pablo; Morgenthaler, Timothy I; Dankbar, Gene C; Hale, Curt W

2014-10-01

The Accreditation Council for Graduate Medical Education emphasizes quality improvement (QI) education in residency/fellowship training programs. The Mayo Clinic Combined Critical Care Fellowship (CCF) program conducted a pilot QI education program to incorporate QI training as a required curriculum for the 2010-2011 academic year. CCF collaborated with the Mayo Quality Academy to customize and teach the existing Mayo Quality Fellows curriculum to the CCF fellows with the help of two quality coaches over five months starting July 2010. All fellows were to achieve Bronze and Silver certification prior to graduation. Silver required passing four written exams and submitting a health care QI project. Five projects were selected on the basis of the Impact-Effort Prioritization matrix, and DMAIC (Define, Measure, Analyze, Improve, and Control) methodology was used to complete the projects. The primary outcome was to assess learners' satisfaction, knowledge, and skill transfer. All 20 fellows were Bronze certified, and 14 (70%) were Silver certified by the time of graduation. All five QI projects were completed and showed positive impacts on patient safety and care. Surveys showed improved learner satisfaction. Graduates felt the QI training improved their QI skills and employment and career advancement. The QI curriculum had appropriate content and teaching pace and did not significantly displace other important clinical core curriculum topics. The pilot was successfully implemented in the CCF program and now is in the fourth academic year as an established and integral part of the fellowship core curriculum.

The Relation between Structure and Quantum Interference in Single Molecule Junctions

DEFF Research Database (Denmark)

Markussen, Troels; Stadler, Robert; Thygesen, Kristian Sommer

2010-01-01

Quantum interference (QI) of electron pathways has recently attracted increased interest as an enabling tool for single-molecule electronic devices. Although various molecular systems have been shown to exhibit QI effects and a number of methods have been proposed for its analysis, simple...... guidelines linking the molecular structure to QI effects in the phase-coherent transport regime have until now been lacking. In the present work we demonstrate that QI in aromatic molecules is intimately related to the topology of the molecule’s π system and establish a simple graphical scheme to predict...

Selectivity/Specificity Improvement Strategies in Surface-Enhanced Raman Spectroscopy Analysis

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Feng Wang

2017-11-01

Full Text Available Surface-enhanced Raman spectroscopy (SERS is a powerful technique for the discrimination, identification, and potential quantification of certain compounds/organisms. However, its real application is challenging due to the multiple interference from the complicated detection matrix. Therefore, selective/specific detection is crucial for the real application of SERS technique. We summarize in this review five selective/specific detection techniques (chemical reaction, antibody, aptamer, molecularly imprinted polymers and microfluidics, which can be applied for the rapid and reliable selective/specific detection when coupled with SERS technique.

Addressing Opioid-Associated Constipation Using Quality Oncology Practice Initiative Scores and Plan-Do-Study-Act Cycles.

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Kaur, Varinder; Haider, Sajjad; Sasapu, Appalanaidu; Mehta, Paulette; Arnaoutakis, Konstantinos; Makhoul, Issam

2017-01-01

Using the Quality Oncology Practice Initiative, an affiliate program of ASCO, we outlined opioid-associated constipation (OAC) as a subject in need of quality improvement (QI) in our fellowship program at the University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System. We initiated a fellow-led QI project to advance the quality of patient care and provide a valuable avenue for QI training of young physicians. Fellows organized meetings with all stakeholders, addressed the scope of the problem, and devised strategies for OAC management. Monthly meetings were organized using Plan-Do-Study-Act principles. Mandatory check boxes were inserted into our electronic medical record templates to remind all physicians to identify patients on opioid medications and assess and address OAC. Final chart audit and patient satisfaction surveys were performed 6 months after project initiation. Assessment of OAC improved from 52% at baseline to 92% ( P < .003). This improvement corresponded with high patient satisfaction scores, with 90% of surveyed patients reporting adequate management of their constipation. In this QI initiative, we showed that participation in ASCO's Quality Oncology Practice Initiative helps identify areas in need of QI, and such fellow-led QI projects can serve as models for QI training of young physicians.

78 FR 78956 - Ocean Transportation Intermediary License Applicants

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2013-12-27

... & OFF), 1515 Kona Drive, Compton, CA 90220, Officers: Won Rok (aka Steve) Choi, CFO (QI), Myeong H. Kim..., El Monte, CA 91731, Officers: Lynn H. Tran, Secretary (QI), Zheng Feng, CFO, Application Type: New.... 25th Street, Suite 107D, Miami, FL 33182, Officers: Sergio I. Lotero, President (QI), Stephen A. Blass...

The technique of express vital determination of radiocesium specific activity in muscular tissue of large agricultural animals by means of the TIM-140 radiometer

International Nuclear Information System (INIS)

1997-01-01

The technique is intended for vital determination of cesium 137 specific activity in muscular tissue of large agricultural animals by means of the TIM-140 radiometer. The specific activity is determined using two measurements. With one measurement the gamma radiation detector is located on a lateral surface of coxofemoral part of the animal, and with the second measurement the absorbing gamma radiation screen is placed between the detector and zone of measurement. The external gamma background and useful signal are registered simultaneously. It allows to carry out measurements with a background till 0.05 mR/h without application of external screens

Study and development of a risk assessment model for intra skull radiosurgery

International Nuclear Information System (INIS)

Teixeira, Flavia Cristina da Silva

2015-01-01

The reported events in radiotherapy that constitute accidents or incidents have increased worldwide in the last 25 years. Most of these events resulted from human failure and have happened in radiotherapy centers that use high technologies. The radiotherapy Quality Management needs a prospective approach through risk analysis. This approach is supported by recent publications as this actually extremely needed due the large number of accidents. Because of the complexity of the process in radiotherapy, the search for quality of care in order to ensure patient safety is one of the most discussed topics worldwide. Although only 14% of radiotherapy centers in Brazil offer treatments with intracranial radiosurgery technique (SRS), studies about the quality of care related to the safety of patients undergoing this technique is of great importance. Any deviations from the prescribed dose using SRS technique is considered more critical than in other methods of radiation treatment, as the delivered doses in SRS are higher, in the range of 10 Gy to 40 Gy, to lesions up to 50 mm in diameter, which are delivered in a single fraction or in five fractions. In view of those information, this work aims to satisfy the new Quality Management paradigm by developing a risk analysis model, and a Quality Index for SRS in Brazil, through the techniques of Process Map and FMEA used in the TG100/AAPM. The study was performed in three high technology reference radiotherapy centers, two located in Rio de Janeiro city and one in Sao Paulo city. A SRS Process Map was identified for each radiotherapy center, and then FMEA technique was applied in every subprocesses identified on the map. >From NPR values obtained by the FMEA a ranking of failure modes was held. Failure modes with NPR ≥ 100 and S ≥ 7 were chosen as priority to implement safety strategies. From the scores assigned to the S parameter in the implementation of FMEA a Severity Index (SI) and a Quality Index (QI) were created from

Study and development of a risk assessment model for intra skull radiosurgery; Estudo e desenvolvimento de um modelo de analise de risco para radiocirurgia intracraniana

Energy Technology Data Exchange (ETDEWEB)

Teixeira, Flavia Cristina da Silva

2015-11-01

The reported events in radiotherapy that constitute accidents or incidents have increased worldwide in the last 25 years. Most of these events resulted from human failure and have happened in radiotherapy centers that use high technologies. The radiotherapy Quality Management needs a prospective approach through risk analysis. This approach is supported by recent publications as this actually extremely needed due the large number of accidents. Because of the complexity of the process in radiotherapy, the search for quality of care in order to ensure patient safety is one of the most discussed topics worldwide. Although only 14% of radiotherapy centers in Brazil offer treatments with intracranial radiosurgery technique (SRS), studies about the quality of care related to the safety of patients undergoing this technique is of great importance. Any deviations from the prescribed dose using SRS technique is considered more critical than in other methods of radiation treatment, as the delivered doses in SRS are higher, in the range of 10 Gy to 40 Gy, to lesions up to 50 mm in diameter, which are delivered in a single fraction or in five fractions. In view of those information, this work aims to satisfy the new Quality Management paradigm by developing a risk analysis model, and a Quality Index for SRS in Brazil, through the techniques of Process Map and FMEA used in the TG100/AAPM. The study was performed in three high technology reference radiotherapy centers, two located in Rio de Janeiro city and one in Sao Paulo city. A SRS Process Map was identified for each radiotherapy center, and then FMEA technique was applied in every subprocesses identified on the map. >From NPR values obtained by the FMEA a ranking of failure modes was held. Failure modes with NPR ≥ 100 and S ≥ 7 were chosen as priority to implement safety strategies. From the scores assigned to the S parameter in the implementation of FMEA a Severity Index (SI) and a Quality Index (QI) were created from

Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project.

Science.gov (United States)

Hoyer, Erik H; Friedman, Michael; Lavezza, Annette; Wagner-Kosmakos, Kathleen; Lewis-Cherry, Robin; Skolnik, Judy L; Byers, Sherrie P; Atanelov, Levan; Colantuoni, Elizabeth; Brotman, Daniel J; Needham, Dale M

2016-05-01

To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P mobility scores between admission and discharge increased from 32% to 45% (P 7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73). Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved mobility, and this may have contributed to a reduction in LOS, particularly for more complex patients with longer expected hospital stay. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

What is needed to implement a web-based audit and feedback intervention with outreach visits to improve care quality: A concept mapping study among cardiac rehabilitation teams.

Science.gov (United States)

van Engen-Verheul, Mariëtte M; Peek, Niels; Haafkens, Joke A; Joukes, Erik; Vromen, Tom; Jaspers, Monique W M; de Keizer, Nicolette F

2017-01-01

Evidence on successful quality improvement (QI) in health care requires quantitative information from randomized clinical trials (RCTs) on the effectiveness of QI interventions, but also qualitative information from professionals to understand factors influencing QI implementation. Using a structured qualitative approach, concept mapping, this study determines factors identified by cardiac rehabilitation (CR) teams on what is needed to successfully implement a web-based audit and feedback (A&F) intervention with outreach visits to improve the quality of CR care. Participants included 49 CR professionals from 18 Dutch CR centres who had worked with the A&F system during a RCT. In three focus group sessions participants formulated statements on factors needed to implement QI successfully. Subsequently, participants rated all statements for importance and feasibility and grouped them thematically. Multi dimensional scaling was used to produce a final concept map. Forty-two unique statements were formulated and grouped into five thematic clusters in the concept map. The cluster with the highest importance was QI team commitment, followed by organisational readiness, presence of an adequate A&F system, access to an external quality assessor, and future use and functionalities of the A&F system. Concept mapping appeared efficient and useful to understand contextual factors influencing QI implementation as perceived by healthcare teams. While presence of a web-based A&F system and external quality assessor were seen as instrumental for gaining insight into performance and formulating QI actions, QI team commitment and organisational readiness were perceived as essential to actually implement and carry out these actions. These two sociotechnical factors should be taken into account when implementing and evaluating the success of QI implementations in future research. Copyright © 2016. Published by Elsevier Ireland Ltd.

Quality improvement cycles that reduced waiting times at Tshwane ...

African Journals Online (AJOL)

improvement. QI in medical practices is a method for continuously finding better ways to provide better care and service.11 The QI cycle is a recognised tool for analysing and improving the efficiency and quality of healthcare services.12 QI is a team effort, requiring knowledge, skills, experience and perspective of each team ...

A Methodology For The Development Of Complex Domain Specific Languages

CERN Document Server

Risoldi, Matteo; Falquet, Gilles

2010-01-01

The term Domain-Specific Modeling Language is used in software development to indicate a modeling (and sometimes programming) language dedicated to a particular problem domain, a particular problem representation technique and/or a particular solution technique. The concept is not new -- special-purpose programming language and all kinds of modeling/specification languages have always existed, but the term DSML has become more popular due to the rise of domain-specific modeling. Domain-specific languages are considered 4GL programming languages. Domain-specific modeling techniques have been adopted for a number of years now. However, the techniques and frameworks used still suffer from problems of complexity of use and fragmentation. Although in recent times some integrated environments are seeing the light, it is not common to see many concrete use cases in which domain-specific modeling has been put to use. The main goal of this thesis is tackling the domain of interactive systems and applying a DSML-based...

Chromosome-specific DNA Repeat Probes

Energy Technology Data Exchange (ETDEWEB)

Baumgartner, Adolf; Weier, Jingly Fung; Weier, Heinz-Ulrich G.

2006-03-16

In research as well as in clinical applications, fluorescence in situ hybridization (FISH) has gained increasing popularity as a highly sensitive technique to study cytogenetic changes. Today, hundreds of commercially available DNA probes serve the basic needs of the biomedical research community. Widespread applications, however, are often limited by the lack of appropriately labeled, specific nucleic acid probes. We describe two approaches for an expeditious preparation of chromosome-specific DNAs and the subsequent probe labeling with reporter molecules of choice. The described techniques allow the preparation of highly specific DNA repeat probes suitable for enumeration of chromosomes in interphase cell nuclei or tissue sections. In addition, there is no need for chromosome enrichment by flow cytometry and sorting or molecular cloning. Our PCR-based method uses either bacterial artificial chromosomes or human genomic DNA as templates with {alpha}-satellite-specific primers. Here we demonstrate the production of fluorochrome-labeled DNA repeat probes specific for human chromosomes 17 and 18 in just a few days without the need for highly specialized equipment and without the limitation to only a few fluorochrome labels.

Fundamentals - state of the art of radiation techniques

International Nuclear Information System (INIS)

Wogman, N.A.

1982-01-01

In minerals exploration and extraction, nuclear techniques have several advantages. The techniques are elementally specific and their exploration range varies from a few millimeters in average rock formations to more than a meter. Because of the heterogeneous disposition of minerals and difficult environments in which measurements are required (in boreholes, on conveyor belts, in bunkers), interrogating techniques are required which exhibit both elemental specificity and range. It is for these fundamental reasons that nuclear techniques are the only possible techniques which satisfy all requirements. A variety of techniques have been developed and used. These are based on energy dispersive x-ray fluorescence (EDXRF), measurement of natural gamma-ray radiation, gamma-ray attenuation and scattering, and on neutron interactions. This paper discusses the fundamentals of these four techniques and their applications. A table is also provided listing some existing selected applications of nuclear techniques in mineral exploration, mining and processing

Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross‐sectional survey

Science.gov (United States)

Phung, Viet‐Hai; Essam, Nadya; Asghar, Zahid; Spaight, Anne

2015-01-01

Abstract Rationale, aims and objectives Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). Methods We used a self‐administered online questionnaire survey sent to front‐line clinicians in all 12 English ambulance services. We conducted a cross‐sectional analysis of quantitative data and qualitative analysis of free‐text responses. Results There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Conclusions Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre‐hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large‐scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments. PMID:26303398

Optimization of digital radiography techniques for specific application

International Nuclear Information System (INIS)

Harara, W.

2010-12-01

A low cost digital radiography system (DRS) for testing weld joints and castings in laboratory was assembled. The DRS is composed from X-ray source, scintillator, first surface mirror with Aluminum coating, charged coupled device (CCD) camera and lens. The DRS was used to test flawed carbon steel welded plates with thicknesses up to 12 mm. The comparison between the digital radiographs of the plates weldments and the radiographs of the same plates weldments using medium speed film type had shown that, the detection capability of the weld flaws are nearly identical for the two radiography techniques, while the sensitivity achieved in digital radiography of the plates weldments was one IQI wire less than the sensitivity achieved by conventional radiography of the same plates weldments according to EN 462-1. Further, the DRS was also successfully used to test (100 x 100 x 100) mm Aluminum casting with artificial flaws of varied dimensions and orientations. The resulted digital radiographs of the casting show that, all the flaws had been detected and their dimensions can be measured accurately, this confirm that, The proposed DRS can be used to detect and measure the flaws in the Aluminum and others light metals castings accurately. (author)

Millimicrosecond pulse techniques

CERN Document Server

Lewis, Ian A D

1959-01-01

Millimicrosecond Pulse Techniques, Second Edition focuses on millimicrosecond pulse techniques and the development of devices of large bandwidth, extending down to comparatively low frequencies (1 Mc/s). Emphasis is on basic circuit elements and pieces of equipment of universal application. Specific applications, mostly in the field of nuclear physics instrumentation, are considered. This book consists of eight chapters and opens with an introduction to some of the terminology employed by circuit engineers as well as theoretical concepts, including the laws of circuit analysis, Fourier analysi

Steps in Modular Specifications for Concurrent Modules

DEFF Research Database (Denmark)

Da Rocha Pinto, Pedro; Dinsdale-Young, Thomas; Gardner, Philippa

2015-01-01

The specification of a concurrent program module is a difficult problem. The specifications must be strong enough to enable reasoning about the intended clients without reference to the underlying module implementation. We survey a range of verification techniques for specifying concurrent module......, in particular highlighting four key concepts: auxiliary state, interference abstraction, resource ownership and atomicity. We show how these concepts combine to provide powerful approaches to specifying concurrent modules.......The specification of a concurrent program module is a difficult problem. The specifications must be strong enough to enable reasoning about the intended clients without reference to the underlying module implementation. We survey a range of verification techniques for specifying concurrent modules...

The science of quality improvement implementation: developing capacity to make a difference.

Science.gov (United States)

Alexander, Jeffrey A; Hearld, Larry R

2011-12-01

Quality improvement (QI) holds promise to improve quality of care; however, organizations often struggle with its implementation. It has been recommended that practitioners, managers, and researchers attempt to increase systematic understanding of the structure, practices, and context of organizations that facilitate or impede the implementation of QI innovations. To critically review the empirical research on QI implementation in health care organizations. A literature review of 107 studies that examined the implementation of QI innovations in health care organizations. Studies were classified into 4 groups based on the types of predictors that were assumed to affect implementation (content of QI innovation, organizational processes, internal context, and external context). Internal context and organizational processes were the most frequently studied categories. External context and organizational process categories exhibited the highest rate of positive effects on QI implementation. The review revealed several important gaps in the QI implementation literature. Studies often lacked clear conceptual frameworks to guide the research, which may hinder efforts to compare relationships across studies. Studies also tended to adopt designs that were narrowly focused on independent effects of predictors and did not include holistic frameworks to capture interactions among the many factors involved in implementation. Other design limitations included the use of cross-sectional designs, single-source data collection, and potential selection bias among study participants.

Characterizing Dissolved Organic Matter and Metabolites in an Actively Serpentinizing Ophiolite Using Global Metabolomics Techniques

Science.gov (United States)

Seyler, L. M.; Rempfert, K. R.; Kraus, E. A.; Spear, J. R.; Templeton, A. S.; Schrenk, M. O.

2017-12-01

Environmental metabolomics is an emerging approach used to study ecosystem properties. Through bioinformatic comparisons to metagenomic data sets, metabolomics can be used to study microbial adaptations and responses to varying environmental conditions. Since the techniques are highly parallel to organic geochemistry approaches, metabolomics can also provide insight into biogeochemical processes. These analyses are a reflection of metabolic potential and intersection with other organisms and environmental components. Here, we used an untargeted metabolomics approach to characterize dissolved organic carbon and aqueous metabolites from groundwater obtained from an actively serpentinizing habitat. Serpentinites are known to support microbial communities that feed off of the products of serpentinization (such as methane and H2 gas), while adapted to harsh environmental conditions such as high pH and low DIC availability. However, the biochemistry of microbial populations that inhabit these environments are understudied and are complicated by overlapping biotic and abiotic processes. The aim of this study was to identify potential sources of carbon in an environment that is depleted of soluble inorganic carbon, and to characterize the flow of metabolites and describe overlapping biogenic and abiogenic processes impacting carbon cycling in serpentinizing rocks. We applied untargeted metabolomics techniques to groundwater taken from a series of wells drilled into the Semail Ophiolite in Oman.. Samples were analyzed via quadrupole time-of-flight liquid chromatography tandem mass spectrometry (QToF-LC/MS/MS). Metabolomes and metagenomic data were imported into Progenesis QI software for statistical analysis and correlation, and metabolic networks constructed using the Genome-Linked Application for Metabolic Maps (GLAMM), a web interface tool. Further multivariate statistical analyses and quality control was performed using EZinfo. Pools of dissolved organic carbon could

SU-G-BRB-01: A Novel 3D Printed Patient-Specific Phantom for Spine SBRT Quality Assurance: Comparison of 3D Printing Techniques

Energy Technology Data Exchange (ETDEWEB)

Lee, S; Kim, M; Lee, M; Suh, T [Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul (Korea, Republic of); Department of Biomedical Engineering, The Catholic University of Korea, Seoul (Korea, Republic of)

2016-06-15

Purpose: The novel 3 dimensional (3D)-printed spine quality assurance (QA) phantoms generated by two different 3D-printing technologies, digital light processing (DLP) and Polyjet, were developed and evaluated for spine stereotactic body radiation treatment (SBRT). Methods: The developed 3D-printed spine QA phantom consisted of an acrylic body and a 3D-printed spine phantom. DLP and Polyjet 3D printers using the high-density acrylic polymer were employed to produce spine-shaped phantoms based on CT images. To verify dosimetric effects, the novel phantom was made it enable to insert films between each slabs of acrylic body phantom. Also, for measuring internal dose of spine, 3D-printed spine phantom was designed as divided laterally exactly in half. Image fusion was performed to evaluate the reproducibility of our phantom, and the Hounsfield unit (HU) was measured based on each CT image. Intensity-modulated radiotherapy plans to deliver a fraction of a 16 Gy dose to a planning target volume (PTV) based on the two 3D-printing techniques were compared for target coverage and normal organ-sparing. Results: Image fusion demonstrated good reproducibility of the fabricated spine QA phantom. The HU values of the DLP- and Polyjet-printed spine vertebrae differed by 54.3 on average. The PTV Dmax dose for the DLP-generated phantom was about 1.488 Gy higher than for the Polyjet-generated phantom. The organs at risk received a lower dose when the DLP technique was used than when the Polyjet technique was used. Conclusion: This study confirmed that a novel 3D-printed phantom mimicking a high-density organ can be created based on CT images, and that a developed 3D-printed spine phantom could be utilized in patient-specific QA for SBRT. Despite using the same main material, DLP and Polyjet yielded different HU values. Therefore, the printing technique and materials must be carefully chosen in order to accurately produce a patient-specific QA phantom.

SU-G-BRB-01: A Novel 3D Printed Patient-Specific Phantom for Spine SBRT Quality Assurance: Comparison of 3D Printing Techniques

International Nuclear Information System (INIS)

Lee, S; Kim, M; Lee, M; Suh, T

2016-01-01

Purpose: The novel 3 dimensional (3D)-printed spine quality assurance (QA) phantoms generated by two different 3D-printing technologies, digital light processing (DLP) and Polyjet, were developed and evaluated for spine stereotactic body radiation treatment (SBRT). Methods: The developed 3D-printed spine QA phantom consisted of an acrylic body and a 3D-printed spine phantom. DLP and Polyjet 3D printers using the high-density acrylic polymer were employed to produce spine-shaped phantoms based on CT images. To verify dosimetric effects, the novel phantom was made it enable to insert films between each slabs of acrylic body phantom. Also, for measuring internal dose of spine, 3D-printed spine phantom was designed as divided laterally exactly in half. Image fusion was performed to evaluate the reproducibility of our phantom, and the Hounsfield unit (HU) was measured based on each CT image. Intensity-modulated radiotherapy plans to deliver a fraction of a 16 Gy dose to a planning target volume (PTV) based on the two 3D-printing techniques were compared for target coverage and normal organ-sparing. Results: Image fusion demonstrated good reproducibility of the fabricated spine QA phantom. The HU values of the DLP- and Polyjet-printed spine vertebrae differed by 54.3 on average. The PTV Dmax dose for the DLP-generated phantom was about 1.488 Gy higher than for the Polyjet-generated phantom. The organs at risk received a lower dose when the DLP technique was used than when the Polyjet technique was used. Conclusion: This study confirmed that a novel 3D-printed phantom mimicking a high-density organ can be created based on CT images, and that a developed 3D-printed spine phantom could be utilized in patient-specific QA for SBRT. Despite using the same main material, DLP and Polyjet yielded different HU values. Therefore, the printing technique and materials must be carefully chosen in order to accurately produce a patient-specific QA phantom.

Data Sharing Between Providers and Quality Initiatives Eliminate Unnecessary Nursing Home Admissions.

Science.gov (United States)

Charles, Ryan J; Singal, Bonita M; Urquhart, Andrew G; Masini, Michael A; Hallstrom, Brian R

2017-05-01

The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) has monitored discharge disposition, after total hip and knee arthroplasties, since inception in 2012 and found the standardized risk of extended care facility (ECF) placement to be highly variable between hospitals. The variation in standardized risks of ECF placement among MARCQI member sites was reported to the collaborative. At the May 2, 2014 quarterly meeting, a quality initiative was started, emphasizing the wide variability between hospitals, the contribution of hospital and surgeon to that variability using median odds ratios, and the need for outlier hospitals to initiate quality improvement (QI) processes. Patients from 29 hospitals that were members of MARCQI before the intervention were included in this analysis. We compared standardized risks before and after the intervention in the entire cohort, and for 3 hospitals that implemented institution-specific QI projects. We report changes in ECF placement, length of stay, emergency room visits, and readmissions over time. This study includes 31,347 patients before and 20,879 patients after the implementation of the quality initiative. The range in standardized risk dropped from 9.4%-46.1% to 9.4%-32.4% and the average dropped from 23.0% to 19.6%. Three outlier hospitals decreased their absolute risk of ECF placement by 12.2%, 8.9%, and 12.4% after QI, without increases in adverse outcomes. Discharge to ECF after primary hip and knee arthroplasties is highly variable and influenced by hospital and surgeon practices. Hospital-level QI measures can decrease ECF admissions. Copyright © 2016 Elsevier Inc. All rights reserved.

Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement.

Science.gov (United States)

Fiori, Kevin; Schechter, Jennifer; Dey, Monica; Braganza, Sandra; Rhatigan, Joseph; Houndenou, Spero; Gbeleou, Christophe; Palerbo, Emmanuel; Tchangani, Elfamozo; Lopez, Andrew; Bensen, Emily; Hirschhorn, Lisa R

2016-03-01

Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39-95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67-100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67-100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo.

Quality of narrative operative reports in pancreatic surgery.

Science.gov (United States)

Wiebe, Meagan E; Sandhu, Lakhbir; Takata, Julie L; Kennedy, Erin D; Baxter, Nancy N; Gagliardi, Anna R; Urbach, David R; Wei, Alice C

2013-10-01

Quality in health care can be evaluated using quality indicators (QIs). Elements contained in the surgical operative report are potential sources for QI data, but little is known about the completeness of the narrative operative report (NR). We evaluated the completeness of the NR for patients undergoing a pancreaticoduodenectomy. We reviewed NRs for patients undergoing a pancreaticoduodenectomy over a 1-year period. We extracted 79 variables related to patient and narrator characteristics, process of care measures, surgical technique and oncology-related outcomes by document analysis. Data were coded and evaluated for completeness. We analyzed 74 NRs. The median number of variables reported was 43.5 (range 13-54). Variables related to surgical technique were most complete. Process of care and oncology-related variables were often omitted. Completeness of the NR was associated with longer operative duration. The NRs were often incomplete and of poor quality. Important elements, including process of care and oncology-related data, were frequently missing. Thus, the NR is an inadequate data source for QI. Development and use of alternative reporting methods, including standardized synoptic operative reports, should be encouraged to improve documentation of care and serve as a measure of quality of surgical care.

One size does not fit all: a qualitative content analysis of the importance of existing quality improvement capacity in the implementation of Releasing Time to Care: the Productive Ward™ in Saskatchewan, Canada.

Science.gov (United States)

Hamilton, Jessica; Verrall, Tanya; Maben, Jill; Griffiths, Peter; Avis, Kyla; Baker, G Ross; Teare, Gary

2014-12-19

Releasing Time to Care: The Productive Ward™ (RTC) is a method for conducting continuous quality improvement (QI). The Saskatchewan Ministry of Health mandated its implementation in Saskatchewan, Canada between 2008 and 2012. Subsequently, a research team was developed to evaluate its impact on the nursing unit environment. We sought to explore the influence of the unit's existing QI capacity on their ability to engage with RTC as a program for continuous QI. We conducted interviews with staff from 8 nursing units and asked them to speak about their experience doing RTC. Using qualitative content analysis, and guided by the Organizing for Quality framework, we describe the existing QI capacity and impact of RTC on the unit environment. The results focus on 2 units chosen to highlight extreme variation in existing QI capacity. Unit B was characterized by a strong existing environment. RTC was implemented in an environment with a motivated manager and collaborative culture. Aided by the structural support provided by the organization, the QI capacity on this unit was strengthened through RTC. Staff recognized the potential of using the RTC processes to support QI work. Staff on unit E did not have the same experience with RTC. Like unit B, they had similar structural supports provided by their organization but they did not have the same existing cultural or political environment to facilitate the implementation of RTC. They did not have internal motivation and felt they were only doing RTC because they had to. Though they had some success with RTC activities, the staff did not have the same understanding of the methods that RTC could provide for continuous QI work. RTC has the potential to be a strong tool for engaging units to do QI. This occurs best when RTC is implemented in a supporting environment. One size does not fit all and administrative bodies must consider the unique context of each environment prior to implementing large-scale QI projects. Use of an

Patterns of Energy Imbalance of the Meridians in Patients with Temporomandibular Dysfunction

Directory of Open Access Journals (Sweden)

Vera L. Rasera Zotelli

2018-02-01

Full Text Available Temporomandibular dysfunction (TMD is a set of changes that affects the muscles of mastication, temporomandibular joint, teeth, and associated periodontal and orofacial structures. According to Traditional Chinese Medicine, the imbalance of energy (Qi circulating in the acupuncture meridians is always the primary etiologic cause of any physical manifestation. The aim of this study was to describe the patterns of Qi imbalance in patients with TMD by means of an objective measurement. The clinical study was conducted at the Piracicaba Dental School (FOP/Unicamp, in Piracicaba-SP, Brazil. We evaluated 40 adult volunteers with TMD. The Qi measurement was carried out by the researcher using the Ryodoraku method using 24 points representing the 12 acupuncture meridians: LU9 (Taiyuan, PC7 (Daling, HT7 (Shemen, SI5 (Yanggu, TE4 (Yangchi, LI5 (Yangxi, SP3 (Taibai, LR3 (Taichong, KI3 (Taixi, BL64 (Jinggu, GB40 (Qiuxu, and ST42 (Chongyang. The average total Qi of 40 volunteers (21.7 μA ± 1.5, was below the normal range (40–60 μA and was classified as deficiency of Qi (empty. The coupled meridians that showed the highest Qi imbalance were the kidney (29.4 μA ± 2.8 and bladder (13.8 μA ± 1. The Qi planes with greatest imbalance were the Shao Yang and Shao Yin. In conclusion, volunteers with TMD presented a pattern of Qi deficiency, and the most prevalent imbalance patterns identified were in the kidney and bladder coupled meridians and in the energetic planes Shao Yin (heart/kidney and Shao Yang (triple energizer/gall bladder.

Developing an Interdisciplinary, Team-Based Quality Improvement Leadership Training Program for Clinicians: The Partners Clinical Process Improvement Leadership Program.

Science.gov (United States)

Rao, Sandhya K; Carballo, Victoria; Cummings, Brian M; Millham, Frederick; Jacobson, Joseph O

Although there has been tremendous progress in quality improvement (QI) education for students and trainees in recent years, much less has been published regarding the training of active clinicians in QI. The Partners Clinical Process Improvement Leadership Program (CPIP) is a 6-day experiential program. Interdisciplinary teams complete a QI project framed by didactic sessions, interactive exercises, case-based problem sessions, and a final presentation. A total of 239 teams composed of 516 individuals have graduated CPIP. On completion, participant satisfaction scores average 4.52 (scale 1-5) and self-reported understanding of QI concepts improved. At 6 months after graduation, 66% of survey respondents reported sustained QI activity. Three opportunities to improve the program have been identified: (1) increasing faculty participation through online and tiered course offerings, (2) integrating the faculty-focused program with the trainee curriculum, and (3) developing a postgraduate curriculum to address the challenges of sustained improvement.

Call to action: Better care, better health, and greater value in college health.

Science.gov (United States)

Ciotoli, Carlo; Smith, Allison J; Keeling, Richard P

2018-03-05

It is time for action by leaders across higher education to strengthen quality improvement (QI) in college health, in pursuit of better care, better health, and increased value - goals closely linked to students' learning and success. The size and importance of the college student population; the connections between wellbeing, and therefore QI, and student success; the need for improved standards and greater accountability; and the positive contributions of QI to employee satisfaction and professionalism all warrant a widespread commitment to building greater capacity and capability for QI in college health. This report aims to inspire, motivate, and challenge college health professionals and their colleagues, campus leaders, and national entities to take both immediate and sustainable steps to bring QI to the forefront of college health practice - and, by doing so, to elevate care, health, and value of college health as a key pathway to advancing student success.

A retrospective evaluation of the Perfecting Patient Care University training program for health care organizations.

Science.gov (United States)

Morganti, Kristy Gonzalez; Lovejoy, Susan; Beckjord, Ellen Burke; Haviland, Amelia M; Haas, Ann C; Farley, Donna O

2014-01-01

This study evaluated how the Perfecting Patient Care (PPC) University, a quality improvement (QI) training program for health care leaders and clinicians, affected the ability of organizations to improve the health care they provide. This training program teaches improvement methods based on Lean concepts and principles of the Toyota Production System and is offered in several formats. A retrospective evaluation was performed that gathered data on training, other process factors, and outcomes after staff completed the PPC training. A majority of respondents reported gaining QI competencies and cultural achievements from the training. Organizations had high average scores for the success measures of "outcomes improved" and "sustainable monitoring" but lower scores for diffusion of QI efforts. Total training dosage was significantly associated with the measures of QI success. This evaluation provides evidence that organizations gained the PPC competencies and cultural achievements and that training dosage is a driver of QI success.

Capacity and readiness for quality improvement among home and community-based service providers.

Science.gov (United States)

Abrahamson, Kathleen; Myers, Jaclyn; Arling, Greg; Davila, Heather; Mueller, Christine; Abery, Brian; Cai, Yun

2016-01-01

The objective of this study was to explore home and community-based service (HCBS) providers' perspectives of organizational readiness for quality improvement (QI). Data were obtained from a survey of participants (N = 56) in a state-sponsored HCBS QI initiative. Quality improvement challenges included lack of time and resources, staff apprehension or resistance, resistance from consumers and families, and project sustainability. Support from leadership was viewed as an important factor in participating organizations' decision to engage in QI. Internal resources available to support QI varied widely between participating organizations, with differences observed between smaller and larger agencies, as well as between provider types and populations served.

Decomposition techniques

Science.gov (United States)

Chao, T.T.; Sanzolone, R.F.

1992-01-01

Sample decomposition is a fundamental and integral step in the procedure of geochemical analysis. It is often the limiting factor to sample throughput, especially with the recent application of the fast and modern multi-element measurement instrumentation. The complexity of geological materials makes it necessary to choose the sample decomposition technique that is compatible with the specific objective of the analysis. When selecting a decomposition technique, consideration should be given to the chemical and mineralogical characteristics of the sample, elements to be determined, precision and accuracy requirements, sample throughput, technical capability of personnel, and time constraints. This paper addresses these concerns and discusses the attributes and limitations of many techniques of sample decomposition along with examples of their application to geochemical analysis. The chemical properties of reagents as to their function as decomposition agents are also reviewed. The section on acid dissolution techniques addresses the various inorganic acids that are used individually or in combination in both open and closed systems. Fluxes used in sample fusion are discussed. The promising microwave-oven technology and the emerging field of automation are also examined. A section on applications highlights the use of decomposition techniques for the determination of Au, platinum group elements (PGEs), Hg, U, hydride-forming elements, rare earth elements (REEs), and multi-elements in geological materials. Partial dissolution techniques used for geochemical exploration which have been treated in detail elsewhere are not discussed here; nor are fire-assaying for noble metals and decomposition techniques for X-ray fluorescence or nuclear methods be discussed. ?? 1992.

Design techniques for mutlivariable flight control systems

Science.gov (United States)

1981-01-01

Techniques which address the multi-input closely coupled nature of advanced flight control applications and digital implementation issues are described and illustrated through flight control examples. The techniques described seek to exploit the advantages of traditional techniques in treating conventional feedback control design specifications and the simplicity of modern approaches for multivariable control system design.

Artificial intelligence techniques in Prolog

CERN Document Server

Shoham, Yoav

1993-01-01

Artificial Intelligence Techniques in Prolog introduces the reader to the use of well-established algorithmic techniques in the field of artificial intelligence (AI), with Prolog as the implementation language. The techniques considered cover general areas such as search, rule-based systems, and truth maintenance, as well as constraint satisfaction and uncertainty management. Specific application domains such as temporal reasoning, machine learning, and natural language are also discussed.Comprised of 10 chapters, this book begins with an overview of Prolog, paying particular attention to Prol

Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project.

Science.gov (United States)

Zgierska, Aleksandra E; Vidaver, Regina M; Smith, Paul; Ales, Mary W; Nisbet, Kate; Boss, Deanne; Tuan, Wen-Jan; Hahn, David L

2018-06-05

Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the implementation of a health system-wide, guideline-driven policy on opioid prescribing in primary care. This manuscript describes the protocol for this QI project. A health system with 28 primary care clinics caring for approximately 294,000 primary care patients developed and implemented a guideline-driven policy on long-term opioid therapy in adults with opioid-treated chronic non-cancer pain (estimated N = 3980). The policy provided multiple recommendations, including the universal use of treatment agreements, urine drug testing, depression and opioid misuse risk screening, and standardized documentation of the chronic pain diagnosis and treatment plan. The project team drew upon existing guidelines, feedback from end-users, experts and health system leadership to develop a robust QI intervention, targeting clinic-level implementation of policy-directed practices. The resulting multi-pronged QI intervention included clinic-wide and individual clinician-level educational interventions. The QI intervention will augment the health system's "routine rollout" method, consisting of a single educational presentation to clinicians in group settings and a separate presentation for staff. A stepped-wedge design will enable 9 primary care clinics to receive the intervention and assessment of within-clinic and between-clinic changes in adherence to the policy items measured by clinic-level electronic health record-based measures and process measures of the experience with the intervention. Developing methods for a health system-tailored QI intervention required a multi-step process to incorporate end-user feedback and account for the needs of

Quality of care achievements of the Prostate Cancer Outcomes Registry-Victoria.

Science.gov (United States)

Sampurno, Fanny; Earnest, Arul; Kumari, Patabendi B; Millar, Jeremy L; Davis, Ian D; Murphy, Declan G; Frydenberg, Mark; Kearns, Paul A; Evans, Sue M

2016-05-02

To analyse the performance of the quality of prostate cancer (CaP) care over a 5-year period with reference to three quality indicators (QIs) reported by the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic):QI-1: Alignment with the modified Prostate Cancer Research International Active Surveillance (PRIAS) protocol guideline;QI-2: Timeliness of CaP care for men with high risk and locally advanced disease;QI-3: Positive surgical margins (PSMs) for organ-confined pathological T2 disease. Between 1 January 2009 and 31 December 2013, 4708 men diagnosed with CaP who met the QI-1, QI-2 or QI-3 inclusion criteria were recruited from Victorian hospitals.Outcome measures and statistical analysis: Trend analysis was conducted to monitor performance according to QI-1, QI-2 and QI-3. We used the autoregressive integrated moving average (ARIMA) model to account for any inherent autocorrelation in the data when analysing the monthly incidence of each indicator. Differences in the annual figures for the indicators across years were also analysed by aggregating data by year and applying the ARIMA model. There was a downward trend over the 5 years in the percentage of men with low risk disease who underwent active treatment (45% to 34%; P = 0.024), an upward trend in the percentage of those with high risk and locally advanced disease who received active treatment within 12 months of diagnosis (88% to 93%; P = 0.181), and a decline in PSM rate in men with pathological T2 disease after radical prostatectomy (21% to 12%; P = 0.036). Limitations of the study include the fact that the improvement in the QIs was detected using PCOR-Vic as a single population, but there may be institutional variations in quality improvement. Over 2009-2013, the performance of the Victorian health system improved according to the three processes of care indicators reported by the PCOR-Vic.

Does lean muddy the quality improvement waters? A qualitative study of how a hospital management team understands lean in the context of quality improvement.

Science.gov (United States)

Savage, Carl; Parke, Louise; von Knorring, Mia; Mazzocato, Pamela

2016-10-19

Health care has experimented with many different quality improvement (QI) approaches with greater variation in name than content. This has been dubbed pseudoinnovation. However, it could also be that the subtleties and differences are not clearly understood. To explore this further, the purpose of this study was to explore how hospital managers perceive lean in the context of QI. We used a qualitative study design with semi-structured interviews to explore twelve top managers' perceptions of the relationship between lean and quality improvement (QI) at a university-affiliated hospital. Managers described that QI and lean shared the same overall purpose: focus on patient needs and improve efficiency and effectiveness. Employee involvement was emphasized in both strategies, as well as the support offered by managers of staff initiatives. QI was perceived as a strategy that could support structural changes at the organizational level whereas lean was seen as applicable at the operational level. Moreover, lean carried a negative connotation, lacked the credibility of QI, and was perceived as a management fad. Aspects of QI and lean were misunderstood. In a context where lean remains an abstract term, and staff associate lean with automotive applications and cost reduction, it may be fruitful for managers to invest time and resources to develop a strategy for continual improvement and utilize vocabulary that resonates with health care staff. This could reduce the risk that improvement efforts are rejected out of hand.

SEM-based characterization techniques

International Nuclear Information System (INIS)

Russell, P.E.

1986-01-01

The scanning electron microscope is now a common instrument in materials characterization laboratories. The basic role of the SEM as a topographic imaging system has steadily been expanding to include a variety of SEM-based analytical techniques. These techniques cover the range of basic semiconductor materials characterization to live-time device characterization of operating LSI or VLSI devices. This paper introduces many of the more commonly used techniques, describes the modifications or additions to a conventional SEM required to utilize the techniques, and gives examples of the use of such techniques. First, the types of signals available from a sample being irradiated by an electron beam are reviewed. Then, where applicable, the type of spectroscopy or microscopy which has evolved to utilize the various signal types are described. This is followed by specific examples of the use of such techniques to solve problems related to semiconductor technology. Techniques emphasized include: x-ray fluorescence spectroscopy, electron beam induced current (EBIC), stroboscopic voltage analysis, cathodoluminescnece and electron beam IC metrology. Current and future trends of some of the these techniques, as related to the semiconductor industry are discussed

Energetics, Biomechanics, and Performance in Masters' Swimmers: A Systematic Review.

Science.gov (United States)

Ferreira, Maria I; Barbosa, Tiago M; Costa, Mário J; Neiva, Henrique P; Marinho, Daniel A

2016-07-01

Ferreira, MI, Barbosa, TM, Costa, MJ, Neiva, HP, and Marinho, DA. Energetics, biomechanics, and performance in masters' swimmers: a systematic review. J Strength Cond Res 30(7): 2069-2081, 2016-This study aimed to summarize evidence on masters' swimmers energetics, biomechanics, and performance gathered in selected studies. An expanded search was conducted on 6 databases, conference proceedings, and department files. Fifteen studies were selected for further analysis. A qualitative evaluation of the studies based on the Quality Index (QI) was performed by 2 independent reviewers. The studies were thereafter classified into 3 domains according to the reported data: performance (10 studies), energetics (4 studies), and biomechanics (6 studies). The selected 15 articles included in this review presented low QI scores (mean score, 10.47 points). The biomechanics domain obtained higher QI (11.5 points), followed by energetics and performance (10.6 and 9.9 points, respectively). Stroke frequency (SF) and stroke length (SL) were both influenced by aging, although SF is more affected than SL. Propelling efficiency (ηp) decreased with age. Swimming performance declined with age. The performance declines with age having male swimmers deliver better performances than female counterparts, although this difference tends to be narrow in long-distance events. One single longitudinal study is found in the literature reporting the changes in performance over time. The remaining studies are cross-sectional designs focusing on the energetics and biomechanics. Overall, biomechanics parameters, such as SF, SL, and ηp, tend to decrease with age. This review shows the lack of a solid body of knowledge (reflected in the amount and quality of the articles published) on the changes in biomechanics, energetics, and performance of master swimmers over time. The training programs for this age-group should aim to preserve the energetics as much as possible and, concurrently, improve the

Hybrid parallel execution model for logic-based specification languages

CERN Document Server

Tsai, Jeffrey J P

2001-01-01

Parallel processing is a very important technique for improving the performance of various software development and maintenance activities. The purpose of this book is to introduce important techniques for parallel executation of high-level specifications of software systems. These techniques are very useful for the construction, analysis, and transformation of reliable large-scale and complex software systems. Contents: Current Approaches; Overview of the New Approach; FRORL Requirements Specification Language and Its Decomposition; Rewriting and Data Dependency, Control Flow Analysis of a Lo

Simultaneous Qualitative and Quantitative Analysis of Multiple Chemical Constituents in YiQiFuMai Injection by Ultra-Fast Liquid Chromatography Coupled with Ion Trap Time-of-Flight Mass Spectrometry

Directory of Open Access Journals (Sweden)

Chunhua Liu

2016-05-01

Full Text Available YiQiFuMai injection (YQFM is a modern lyophilized powder preparation derived from the traditional Chinese medicine Sheng-mai san (SMS used for treating cardiovascular diseases, such as chronic heart failure. However, its chemical composition has not been fully elucidated, particularly for the preparation derived from Ophiopogon japonicus. This study aimed to establish a systematic and reliable method to quickly and simultaneously analyze the chemical constituents in YQFM by ultra-fast liquid chromatography coupled with ion trap time-of-flight mass spectrometry (UFLC-IT-TOF/MS. Sixty-five compounds in YQFM were tentatively identified by comparison with reference substances or literature data. Furthermore, twenty-one compounds, including three ophiopogonins, fifteen ginsenosides and three lignans were quantified by UFLC-IT-TOF/MS. Notably, this is the first determination of steroidal saponins from O. japonicus in YQFM. The relative standard deviations (RSDs of intra- and inter-day precision, reproducibility and stability were <4.9% and all analytes showed good linearity (R2 ≥ 0.9952 and acceptable recovery of 91.8%–104.2% (RSD ≤ 5.4%, indicating that the methods were reliable. These methods were successfully applied to quantitative analysis of ten batches of YQFM. The developed approach can provide useful and comprehensive information for quality control, further mechanistic studies in vivo and clinical application of YQFM.

Identification of variables for site calibration and power curve assessment in complex terrain. Task 8, a literature survey on theory and practice of parameter identification, specification and estimation (ISE) techniques

Energy Technology Data Exchange (ETDEWEB)

Verhoef, J.P.; Leendertse, G.P. [ECN Wind, Petten (Netherlands)

2001-04-01

This document presents the literature survey results on Identification, Specification and Estimation (ISE) techniques for variables within the SiteParIden project. Besides an overview of the different general techniques also an overview is given on EU funded wind energy projects where some of these techniques have been applied more specifically. The main problem in applications like power performance assessment and site calibration is to establish an appropriate model for predicting the considered dependent variable with the aid of measured independent (explanatory) variables. In these applications detailed knowledge on what the relevant variables are and how their precise appearance in the model would be is typically missing. Therefore, the identification (of variables) and the specification (of the model relation) are important steps in the model building phase. For the determination of the parameters in the model a reliable variable estimation technique is required. In EU funded wind energy projects the linear regression technique is the most commonly applied tool for the estimation step. The linear regression technique may fail in finding reliable parameter estimates when the model variables are strongly correlated, either due to the experimental set-up or because of their particular appearance in the model. This situation of multicollinearity sometimes results in unrealistic parameter values, e.g. with the wrong algebraic sign. It is concluded that different approaches, like multi-binning can provide a better way of identifying the relevant variables. However further research in these applications is needed and it is recommended that alternative methods (neural networks, singular value decomposition etc.) should also be tested on their usefulness in a succeeding project. Increased interest in complex terrains, as feasible locations for wind farms, has also emphasised the need for adequate models. A common standard procedure to prescribe the statistical

The Association of Organizational Culture and Quality Improvement Implementation With Neonatal Outcomes in the NICU.

Science.gov (United States)

Mahl, Sukhy; Lee, Shoo K; Baker, G Ross; Cronin, Catherine M G; Stevens, Bonnie; Ye, Xiang Y

2015-01-01

Studies of adult patient populations suggest that organizational culture is associated with quality improvement (QI) implementation, as well as patient outcomes. However, very little research on organizational culture has been performed in neonatal patient populations. This combined cross-sectional survey and retrospective cohort study assessed employee perceptions of organizational culture and QI implementation within 18 Canadian neonatal intensive care units. The associations between these data and neonatal outcomes in extremely preterm infants (born at culture and QI implementation varied according to occupation and age. Higher hierarchical culture was associated with increased survival without major morbidities (odds ratio, 1.04; 95% confidence interval, 1.01-1.06), as were higher QI implementation scores (odds ratio range, 1.20-1.36 by culture type). Our data suggest that organizational culture, particularly hierarchical culture, and level of QI implementation may play a role in neonatal outcomes. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Engaging Australian physicians in evidence-based medicine: a representative national survey.

Science.gov (United States)

Toulkidis, V; Donnelly, N J; Ward, J E

2005-01-01

To assess Australian adult physicians' views about evidence-based medicine (EBM) and quality improvement (QI). Cross-sectional postal survey of two hundred and forty-four randomly selected Australian physicians (78.5% response rate). Physicians' views about the promotion of EBM and QI and their impact on patient care, strategies to support better clinical practice and self-reported understanding of EBM terms. Sixty-eight per cent (95% confidence interval (CI): 62-74%) of physicians had a positive view of the current promotion of EBM in Australia. Significantly fewer (45%; 95% CI: 38-51%) were so positive about QI (P evidence, significantly fewer (21%; 95% CI: 17-27%) agreed they had sufficient time to do so (P Australian physicians have positive views of EBM, QI appears less well regarded. Initiatives to improve quality and safety that incorporate principles and language of EBM will likely be received better by physicians than isolated QI. Further enhancement of EBM requires concomitant attention to physician training, workplace infrastructure and supportive professional development.

Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration.

Science.gov (United States)

Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A

2016-01-01

This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation. © The Author(s) 2014.

A Recombinant Antibody with the Antigen-Specific, Major Histocompatibility Complex-Restricted Specificity of T Cells

Science.gov (United States)

Andersen, Peter S.; Stryhn, Anette; Hansen, Bjarke E.; Fugger, Lars; Engberg, Jan; Buus, Soren

1996-03-01

Specific recognition of peptide/major histocompatibility complex (MHC) molecule complexes by the T-cell receptor is a key reaction in the specific immune response. Antibodies against peptide/MHC complexes would therefore be valuable tools in studying MHC function and T-cell recognition and might lead to novel approaches in immunotherapy. However, it has proven difficult to generate antibodies with the specificity of T cells by conventional hybridoma techniques. Here we report that the phage display technology is a feasible alternative to generate antibodies recognizing specific, predetermined peptide/MHC complexes.

Patterns of Energy Imbalance of the Meridians in Patients with Temporomandibular Dysfunction.

Science.gov (United States)

Rasera Zotelli, Vera L; Grillo, Cássia M; Bressiani Gil, Maria L; Wada, Ronaldo S; Sato, Jorge E; de Sousa, Maria da Luz R

2018-02-01

Temporomandibular dysfunction (TMD) is a set of changes that affects the muscles of mastication, temporomandibular joint, teeth, and associated periodontal and orofacial structures. According to Traditional Chinese Medicine, the imbalance of energy (Qi) circulating in the acupuncture meridians is always the primary etiologic cause of any physical manifestation. The aim of this study was to describe the patterns of Qi imbalance in patients with TMD by means of an objective measurement. The clinical study was conducted at the Piracicaba Dental School (FOP/Unicamp), in Piracicaba-SP, Brazil. We evaluated 40 adult volunteers with TMD. The Qi measurement was carried out by the researcher using the Ryodoraku method using 24 points representing the 12 acupuncture meridians: LU9 (Taiyuan), PC7 (Daling), HT7 (Shemen), SI5 (Yanggu), TE4 (Yangchi), LI5 (Yangxi), SP3 (Taibai), LR3 (Taichong), KI3 (Taixi), BL64 (Jinggu), GB40 (Qiuxu), and ST42 (Chongyang). The average total Qi of 40 volunteers (21.7 μA ± 1.5), was below the normal range (40-60 μA) and was classified as deficiency of Qi (empty). The coupled meridians that showed the highest Qi imbalance were the kidney (29.4 μA ± 2.8) and bladder (13.8 μA ± 1). The Qi planes with greatest imbalance were the Shao Yang and Shao Yin. In conclusion, volunteers with TMD presented a pattern of Qi deficiency, and the most prevalent imbalance patterns identified were in the kidney and bladder coupled meridians and in the energetic planes Shao Yin (heart/kidney) and Shao Yang (triple energizer/gall bladder). Copyright © 2017. Published by Elsevier B.V.

Process Evaluation of a Quality Improvement Project to Decrease Hospital Readmissions From Skilled Nursing Facilities.

Science.gov (United States)

Meehan, Thomas P; Qazi, Daniel J; Van Hoof, Thomas J; Ho, Shih-Yieh; Eckenrode, Sheila; Spenard, Ann; Pandolfi, Michelle; Johnson, Florence; Quetti, Deborah

2015-08-01

To describe and evaluate the impact of quality improvement (QI) support provided to skilled nursing facilities (SNFs) by a Quality Improvement Organization (QIO). Retrospective, mixed-method, process evaluation of a QI project intended to decrease preventable hospital readmissions from SNFs. Five SNFs in Connecticut. SNF Administrators, Directors of Nursing, Assistant Directors of Nursing, Admissions Coordinators, Registered Nurses, Certified Nursing Assistants, Receptionists, QIO Quality Improvement Consultant. QIO staff provided training and technical assistance to SNF administrative and clinical staff to establish or enhance QI infrastructure and implement an established set of QI tools [Interventions to Reduce Acute Care Transfers (INTERACT) tools]. Baseline SNF demographic, staffing, and hospital readmission data; baseline and follow-up SNF QI structure (QI Committee), processes (general and use of INTERACT tools), and outcome (30-day all-cause hospital readmission rates); details of QIO-provided training and technical assistance; QIO-perceived barriers to quality improvement; SNF leadership-perceived barriers, accomplishments, and suggestions for improvement of QIO support. Success occurred in establishing QI Committees and targeting preventable hospital readmissions, as well as implementing INTERACT tools in all SNFs; however, hospital readmission rates decreased in only 2 facilities. QIO staff and SNF leaders noted the ongoing challenge of engaging already busy SNF staff and leadership in QI activities. SNF leaders reported that they appreciated the training and technical assistance that their institutions received, although most noted that additional support was needed to bring about improvement in readmission rates. This process evaluation documented mixed clinical results but successfully identified opportunities to improve recruitment of and provision of technical support to participating SNFs. Recommendations are offered for others who wish to conduct

Soil analysis. Modern instrumental technique

International Nuclear Information System (INIS)

Smith, K.A.

1993-01-01

This book covers traditional methods of analysis and specialist monographs on individual instrumental techniques, which are usually not written with soil or plant analysis specifically in mind. The principles of the techniques are combined with discussions of sample preparation and matrix problems, and critical reviews of applications in soil science and related disciplines. Individual chapters are processed separately for inclusion in the appropriate data bases

EFFECTIVENESS OF INTEGRATED NEUROMUSCULAR INHIBITORY TECHNIQUE (INIT WITH SPECIFIC STRENGTH TRAINING EXERCISES IN SUBJECTS WITH UPPER TRAPEZIUS TRIGGER POINTS

Directory of Open Access Journals (Sweden)

B. Jyothirmai

2015-10-01

Full Text Available Background: Upper trapezius trigger points is a common cause for neck pain, decreased cervical range of motion and functional activities. The purpose of the study was to evaluate the effectiveness of integrated neuromuscular inhibitory technique (INIT along with specific strength training exercises in reducing pain, improving ROM and functional activities in subjects with upper trapezius trigger point. Methods: Thirty subjects were diagnosed with upper trapezius trigger points were included in the study. These patients were randomly allocated to intervention group (n=15, which underwent a 4- weeks training program of INIT along with specific strength training & control group (n=15 that received INIT alone. The outcome measures were taken before and after treatment. Outcomes were measured by visual analogue scale, cervical range of motion and neck disability index. Within the groups VAS, NDI, and cervical lateral flexion and rotation showed significant change in the mean value. The comparison of pre and post VAS in experimental group and control group showed a significant change in the experimental group .Paired sample t- test was used to analyze changes from before and after intervention programmed. Results: There is a statistically significant (p<0.00 improvement in both variables from baseline to 4th week in experimental group and control group but compared to control group, experimental group shows highly significant values in all parameters. Conclusion: INIT along with specific strength training is proved to be effective in reducing pain, decreasing disability and improving range of motion in individuals with upper trapezius trigger points.

Techniques for Wireless Applications

KAUST Repository

Gaaloul, Fakhreddine

2012-05-01

Switching techniques have been first proposed as a spacial diversity techniques. These techniques have been shown to reduce considerably the processing load while letting multi-antenna systems achieve a specific target performance. In this thesis, we take a different look at the switching schemes by implementing them for different other wireless applications. More specifically, this thesis consists of three main parts, where the first part considers a multiuser environment and an adaptive scheduling algorithm based on the switching with post-selection scheme for statistically independent but non-identically distributed channel conditions. The performance of this switched based scheduler is investigated and a multitude of performance metrics are presented. In a second part, we propose and analyze the performance of three switched-based algorithms for interference reduction in the downlink of over-loaded femtocells. For instance, performance metrics are derived in closed-form and these metrics are used to compare these three proposed schemes. Finally in a third part, a switch based opportunistic channel access scheme is proposed for a cognitive radio system and its performance is analyzed in terms of two new proposed metrics namely the average cognitive radio access and the waiting time duration.

78 FR 13342 - Ocean Transportation Intermediary License Applicants

Science.gov (United States)

2013-02-27

.... Officers: Keith Phillips, Vice President (QI), Glenn Henderson, President. Application Type: New NVO & OFF.... Officers: Paul Pellitieri, President (QI), Virginia Pellitieri, Vice President. Application Type: New NVO...

Development of a Multi-Domain Assessment Tool for Quality Improvement Projects.

Science.gov (United States)

Rosenbluth, Glenn; Burman, Natalie J; Ranji, Sumant R; Boscardin, Christy K

2017-08-01

Improving the quality of health care and education has become a mandate at all levels within the medical profession. While several published quality improvement (QI) assessment tools exist, all have limitations in addressing the range of QI projects undertaken by learners in undergraduate medical education, graduate medical education, and continuing medical education. We developed and validated a tool to assess QI projects with learner engagement across the educational continuum. After reviewing existing tools, we interviewed local faculty who taught QI to understand how learners were engaged and what these faculty wanted in an ideal assessment tool. We then developed a list of competencies associated with QI, established items linked to these competencies, revised the items using an iterative process, and collected validity evidence for the tool. The resulting Multi-Domain Assessment of Quality Improvement Projects (MAQIP) rating tool contains 9 items, with criteria that may be completely fulfilled, partially fulfilled, or not fulfilled. Interrater reliability was 0.77. Untrained local faculty were able to use the tool with minimal guidance. The MAQIP is a 9-item, user-friendly tool that can be used to assess QI projects at various stages and to provide formative and summative feedback to learners at all levels.

Progress of Shenqi Fuzheng Injection as Adjuvant Therapy for Malignant Tumors

Directory of Open Access Journals (Sweden)

Jing WANG

2017-09-01

Full Text Available Tumor is a kind of common and frequently-occurring disease that severely impaires human lives and health. As is proposed in Required Readings for Medical Professions, “Accumulation of virus causes insuffcient healthy qi, and then results in invasion of evil qi into the body”. Tumor is caused by interaction of exogenous evil qi and pathogenic products in the body such as phlegm and blood stasis on the basis of healthy qi defciency and disharmony of viscera. Therefore, the condition of healthy qi is not only the key of the occurrence of tumor, but a decisive factor of the development and prognosis of the disease. At present, the main therapeutic approaches for malignant tumors are radiotherapy and chemotherapy. However, during the disease process, the healthy qi gradually decreases due to the consumption of malignant tumors and the injury caused by radiotherapy and chemotherapy. In recent years, taking advantages of traditional Chinese drugs such as Shenqi Fuzheng Injection in combination with radiotherapy or chemotherapy is an important approach for many clinical physicians to improve therapeutic effects and alleviate toxic and side effects induced by radiotherapy and chemotherapy. This study mainly reviewed the progress of mechanisms and application of Shenqi Fuzhen Injection in malignant tumors in recent years.

Evaluation of an on-line methodology for measuring volatile organic compounds (VOC) fluxes by eddy-covariance with a PTR-TOF-Qi-MS

Science.gov (United States)

Loubet, Benjamin; Buysse, Pauline; Lafouge, Florence; Ciuraru, Raluca; Decuq, Céline; Zurfluh, Olivier

2017-04-01

Field scale flux measurements of volatile organic compounds (VOC) are essential for improving our knowledge of VOC emissions from ecosystems. Many VOCs are emitted from and deposited to ecosystems. Especially less known, are crops which represent more than 50% of French terrestrial surfaces. In this study, we evaluate a new on-line methodology for measuring VOC fluxes by Eddy Covariance with a PTR-Qi-TOF-MS. Measurements were performed at the ICOS FR-GRI site over a crop using a 30 m long high flow rate sampling line and an ultrasonic anemometer. A Labview program was specially designed for acquisition and on-line covariance calculation: Whole mass spectra ( 240000 channels) were acquired on-line at 10 Hz and stored in a temporary memory. Every 5 minutes, the spectra were mass-calibrated and normalized by the primary ion peak integral at 10 Hz. The mass spectra peaks were then retrieved from the 5-min averaged spectra by withdrawing the baseline, determining the resolution and using a multiple-peak detection algorithm. In order to optimize the peak detection algorithm for the covariance, we determined the covariances as the integrals of the peaks of the vertical-air-velocity-fluctuation weighed-averaged-spectra. In other terms, we calculate , were w is the vertical component of the air velocity, Sp is the spectra, t is time, lag is the decorrelation lag time and denotes an average. The lag time was determined as the decorrelation time between w and the primary ion (at mass 21.022) which integrates the contribution of all reactions of VOC and water with the primary ion. Our algorithm was evaluated by comparing the exchange velocity of water vapor measured by an open path absorption spectroscopy instrument and the water cluster measured with the PTRQi-TOF-MS. The influence of the algorithm parameters and lag determination is discussed. This study was supported by the ADEME-CORTEA COV3ER project (http://www6.inra.fr/cov3er).

The EDF catalogue of technical specifications (reference HN), standardization center; Catalogue des specifications techniques EDF (reference HN) centre de normalisation

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-12-31

A list of EDF technical specifications, valid at the 01/01/1996 date, is presented. Specifications domains such as electrical installations, equipment and materials, uninsulated and insulated conductors, measurement, control and command, electric power generating or transforming equipment, electrical appliances, telecommunications, electronic and computer systems, are covered

Integrating Morbidity and Mortality Core Competencies and Quality Improvement in Otolaryngology.

Science.gov (United States)

Laury, Adrienne M; Bowe, Sarah N; Lospinoso, Joshua

2017-02-01

To date, an otolaryngology-specific morbidity and mortality (M&M) conference has never been reported or evaluated. To propose a novel otolaryngology-specific M&M format and to assess its success using a validated assessment tool. Preintervention and postintervention cohort study spanning 14 months (September 2014 to November 2015), with 32 faculty, residents, and medical students attending the department of otolaryngology M&M conference, conducted at the the San Antonio Uniformed Services Health Education Consortium. A novel quality assurance conference was implemented in the department of otolaryngology at the San Antonio Uniformed Services Health Education Consortium. This conference incorporates patient safety reports, otolaryngology-specific quality metrics, and individual case presentations. The revised format integrates the Accreditation Council for Graduate Medical Education (ACGME) core competencies and Quality Improvement and Patient Safety (QI/PS) system. This format was evaluated by faculty, residents, and medical students every other month for 14 months to assess changes in attitudes regarding the M&M conference as well as changes in presentation quality. Overall, 13 faculty, 12 residents, and 7 medical students completed 232 evaluations. Summary statistics of both resident and faculty attitudes about the success of the M&M format seem to improve over the 14 months between the prequestionnaires and postquestionnaires. General attitudes for both residents and faculty significantly improved from the pretest to posttest (odds ratio, 0.32 per month; 95% CI, 0.29-0.35). In the pretest period, "established presentation format" was considered the most necessary improvement, whereas in the posttest period this changed to "incorporate more QI." For resident presentations evaluated using the situation, background, assessment, and review/recommendations (SBAR) tool, all evaluations, from all participants, improved over time. The M&M conference is an essential

Comparison of time-resolved autofluorescence in the eye-ground of healthy subjects and patients suffering from age-related macular degeneration

Science.gov (United States)

Schweitzer, Dietrich; Schweitzer, Frank; Hammer, Martin; Schenke, Stefan; Richter, Sandra

2005-08-01

Age-related macular degeneration (AMD) is the most frequent cause for blindness for person older than 65 years in western countries. Besides the subjective pain, it is also an economic problem in the ageing population. As the pathomechanism is unknown, no curative treatment is possible. International research for discovering of early age-related alterations at the fundus is directed on in vivo measurements of autofluorescence. One way is the measurement of fluorescence spectra. Unfortunately, any selective excitation of fluorophores is excluded by the absorption edge of the ocular media at 400 nm. Furthermore, the shape of fluorescence spectra is influenced by the spectral absorption of layers in front of the emitting fluorophore. Weakly emitting fluorophores are covered by intensive emitting substances. The most serious limitation in fluorescence measurements of the living human fundus is the maximal permissible exposure. For that reason, fluorescence spectra of the fundus can not be detected with a high spatial resolution. The detection of dynamic fluorescence provides substance-specific lifetimes Ti, amplitudes Ai, and information about the relative contribution Qi of components in fluorescence images. As these parameters are calculated for each image point, diagrams of Ti vs. Tj, Ai vs. Aj, and Qi vs. Qj can be drawn, in which specific clusters appear for healthy subjects or AMD - patients. The projection of lifetime - clusters onto corresponding axis represents histogram of the considered lifetime. The slope in the correlation between Ai and Aj can also be used as a discriminating mark. Considering image lines as intersection through characteristic anatomical structures (optic disc, macula) profiles of Ti, Ai, or Qi show changes of these parameters (e.g. depigmentation) as function of location, which might be specific for AMD.

Methods for the guideline-based development of quality indicators--a systematic review

Science.gov (United States)

2012-01-01

Background Quality indicators (QIs) are used in many healthcare settings to measure, compare, and improve quality of care. For the efficient development of high-quality QIs, rigorous, approved, and evidence-based development methods are needed. Clinical practice guidelines are a suitable source to derive QIs from, but no gold standard for guideline-based QI development exists. This review aims to identify, describe, and compare methodological approaches to guideline-based QI development. Methods We systematically searched medical literature databases (Medline, EMBASE, and CINAHL) and grey literature. Two researchers selected publications reporting methodological approaches to guideline-based QI development. In order to describe and compare methodological approaches used in these publications, we extracted detailed information on common steps of guideline-based QI development (topic selection, guideline selection, extraction of recommendations, QI selection, practice test, and implementation) to predesigned extraction tables. Results From 8,697 hits in the database search and several grey literature documents, we selected 48 relevant references. The studies were of heterogeneous type and quality. We found no randomized controlled trial or other studies comparing the ability of different methodological approaches to guideline-based development to generate high-quality QIs. The relevant publications featured a wide variety of methodological approaches to guideline-based QI development, especially regarding guideline selection and extraction of recommendations. Only a few studies reported patient involvement. Conclusions Further research is needed to determine which elements of the methodological approaches identified, described, and compared in this review are best suited to constitute a gold standard for guideline-based QI development. For this research, we provide a comprehensive groundwork. PMID:22436067

Establishing a portfolio of quality-improvement projects in pediatric surgery through advanced improvement leadership systems.

Science.gov (United States)

Gerrein, Betsy T; Williams, Christina E; Von Allmen, Daniel

2013-01-01

Formal quality-improvement (QI) projects require that participants are educated in QI methods to provide them with the capability to carry out successful, meaningful work. However, orchestrating a portfolio of projects that addresses the strategic mission of the institution requires an extension of basic QI training to provide the division or business unit with the capacity to successfully develop and manage the portfolio. Advanced Improvement Leadership Systems is a program to help units create a meaningful portfolio. This program, used by the Division of Pediatric General and Thoracic Surgery at Cincinnati Children's Hospital Medical Center, helped establish a portfolio of targeted QI projects designed to achieve outstanding outcomes at competitive costs in multiple clinical areas aligned with the institution's strategic goals (improve disease-based outcomes, patient safety, flow, and patient and family experience). These objectives are addressed in an institutional strategic plan built around 5 core areas: Safety, Productivity, Care Coordination and Outcomes, Patient and Family Experience, and Value. By combining the portfolio of QI projects with improvements in the divisional infrastructure, effective improvement efforts were realized throughout the division. In the 9 months following the program, divisional capability resulted in a 16.5% increase (5.7% to 22.2%) of formally trained staff working on 10 QI teams. Concurrently, a leadership team, designed to coordinate projects, remove barriers, and provide technical support, provided the capacity to pursue this ongoing effort. The Advanced Improvement Leadership Systems program increased the Division's efficiency and effectiveness in pursing the QI mission that is integral at our hospital.

Establishing a Portfolio of Quality-Improvement Projects in Pediatric Surgery through Advanced Improvement Leadership Systems

Science.gov (United States)

Gerrein, Betsy T; Williams, Christina E; von Allmen, Daniel

2013-01-01

Formal quality-improvement (QI) projects require that participants are educated in QI methods to provide them with the capability to carry out successful, meaningful work. However, orchestrating a portfolio of projects that addresses the strategic mission of the institution requires an extension of basic QI training to provide the division or business unit with the capacity to successfully develop and manage the portfolio. Advanced Improvement Leadership Systems is a program to help units create a meaningful portfolio. This program, used by the Division of Pediatric General and Thoracic Surgery at Cincinnati Children’s Hospital Medical Center, helped establish a portfolio of targeted QI projects designed to achieve outstanding outcomes at competitive costs in multiple clinical areas aligned with the institution’s strategic goals (improve disease-based outcomes, patient safety, flow, and patient and family experience). These objectives are addressed in an institutional strategic plan built around 5 core areas: Safety, Productivity, Care Coordination and Outcomes, Patient and Family Experience, and Value. By combining the portfolio of QI projects with improvements in the divisional infrastructure, effective improvement efforts were realized throughout the division. In the 9 months following the program, divisional capability resulted in a 16.5% increase (5.7% to 22.2%) of formally trained staff working on 10 QI teams. Concurrently, a leadership team, designed to coordinate projects, remove barriers, and provide technical support, provided the capacity to pursue this ongoing effort. The Advanced Improvement Leadership Systems program increased the Division’s efficiency and effectiveness in pursing the QI mission that is integral at our hospital. PMID:24361020

Clinical and Educational Outcomes of an Integrated Inpatient Quality Improvement Curriculum for Internal Medicine Residents.

Science.gov (United States)

Ogrinc, Greg; Cohen, Emily S; van Aalst, Robertus; Harwood, Beth; Ercolano, Ellyn; Baum, Karyn D; Pattison, Adam J; Jones, Anne C; Davies, Louise; West, Al

2016-10-01

Integrating teaching and hands-on experience in quality improvement (QI) may increase the learning and the impact of resident QI work. We sought to determine the clinical and educational impact of an integrated QI curriculum. This clustered, randomized trial with early and late intervention groups used mixed methods evaluation. For almost 2 years, internal medicine residents from Dartmouth-Hitchcock Medical Center on the inpatient teams at the White River Junction VA participated in the QI curriculum. QI project effectiveness was assessed using statistical process control. Learning outcomes were assessed with the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) and through self-efficacy, interprofessional care attitudes, and satisfaction of learners. Free text responses by residents and a focus group of nurses who worked with the residents provided information about the acceptability of the intervention. The QI projects improved many clinical processes and outcomes, but not all led to improvements. Educational outcome response rates were 65% (68 of 105) at baseline, 50% (18 of 36) for the early intervention group at midpoint, 67% (24 of 36) for the control group at midpoint, and 53% (42 of 80) for the late intervention group. Composite QIKAT-R scores (range, 0-27) increased from 13.3 at baseline to 15.3 at end point ( P  < .01), as did the self-efficacy composite score ( P  < .05). Satisfaction with the curriculum was rated highly by all participants. Learning and participating in hands-on QI can be integrated into the usual inpatient work of resident physicians.

First use of a compound-specific stable isotope (CSSI) technique to trace sediment transport in upland forest catchments of Chile.

Science.gov (United States)

Bravo-Linares, Claudio; Schuller, Paulina; Castillo, Alejandra; Ovando-Fuentealba, Luis; Muñoz-Arcos, Enrique; Alarcón, Oscar; de Los Santos-Villalobos, Sergio; Cardoso, Renan; Muniz, Marcelo; Meigikos Dos Anjos, Roberto; Bustamante-Ortega, Ramón; Dercon, Gerd

2018-03-15

Land degradation is a problem affecting the sustainability of commercial forest plantations. The identification of critical areas prone to erosion can assist this activity to better target soil conservation efforts. Here we present the first use of the carbon-13 signatures of fatty acids (C14 to C24) in soil samples for spatial and temporal tracing of sediment transport in river bodies of upland commercial forest catchments in Chile. This compound-specific stable isotope (CSSI) technique was tested as a fingerprinting approach to determine the degree of soil erosion in pre-harvested forest catchments with surface areas ranging from 12 to 40ha. For soil apportionment a mixing model based on a Bayesian inference framework was used (CSSIAR v.2.0). Approximately four potential sediment sources were used for the calculations of all of the selected catchments. Unpaved forestry roads were shown to be the main source of sediment deposited at the outlet of the catchments (30-75%). Furthermore, sampling along the stream channel demonstrated that sediments were mainly comprised of sediment coming from the unpaved roads in the upper part of the catchments (74-98%). From this it was possible to identify the location and type of primary land use contributing to the sediment delivered at the outlet of the catchments. The derived information will allow management to focus efforts to control or mitigate soil erosion by improving the runoff features of the forest roads. The use of this CSSI technique has a high potential to help forestry managers and decision makers to evaluate and mitigate sources of soil erosion in upland forest catchments. It is important to highlight that this technique can also be a good complement to other soil erosion assessment and geological fingerprinting techniques, especially when attempting to quantify (sediment loads) and differentiate which type of land use most contributes to sediment accumulation. Copyright © 2017 Elsevier B.V. All rights reserved.

Toward optimizing patient-specific IMRT QA techniques in the accurate detection of dosimetrically acceptable and unacceptable patient plans.

Science.gov (United States)

McKenzie, Elizabeth M; Balter, Peter A; Stingo, Francesco C; Jones, Jimmy; Followill, David S; Kry, Stephen F

2014-12-01

in the performance of any device between gamma criteria of 2%/2 mm, 3%/3 mm, and 5%/3 mm. Finally, optimal cutoffs (e.g., percent of pixels passing gamma) were determined for each device and while clinical practice commonly uses a threshold of 90% of pixels passing for most cases, these results showed variability in the optimal cutoff among devices. IMRT QA devices have differences in their ability to accurately detect dosimetrically acceptable and unacceptable plans. Field-by-field analysis with a MapCheck device and use of the MapCheck with a MapPhan phantom while delivering at planned rotational gantry angles resulted in a significantly poorer ability to accurately sort acceptable and unacceptable plans compared with the other techniques examined. Patient-specific IMRT QA techniques in general should be thoroughly evaluated for their ability to correctly differentiate acceptable and unacceptable plans. Additionally, optimal agreement thresholds should be identified and used as common clinical thresholds typically worked very poorly to identify unacceptable plans.

Essential ultrasound techniques of the pediatric airway

DEFF Research Database (Denmark)

Stafrace, Samuel; Engelhardt, Thomas; Teoh, Wendy H

2016-01-01

Ultrasound of the airways is a technique which has been described in a number of recent articles and reviews highlighting the diagnostic possibilities and simple methodology. However, there is a paucity of information focusing specifically on such methods in children where equipment, technique, a...

78 FR 10173 - Ocean Transportation Intermediary License Applicants

Science.gov (United States)

2013-02-13

... Road, Scituate, MA 02066, Officers: Stephen J. Zambo, Member (QI), Stephen A. Zambo, Member... 60007, Officers: Joshua H. Chau, President (QI), Bessie S. Chau, Secretary, Application Type: New NVO...

Specific developmental pathways underlie host specificity in the parasitic plant Orobanche

Science.gov (United States)

Hiscock, Simon

2010-01-01

Parasitic angiosperms are an ecologically and economically important group of plants. However our understanding of the basis for host specificity in these plants is embryonic. Recently we investigated host specificity in the parasitic angiosperm Orobanche minor, and demonstrated that this host generalist parasite comprises genetically defined races that are physiologically adapted to specific hosts. Populations occurring naturally on red clover (Trifolium pratense) and sea carrot (Daucus carota subsp. gummifer) respectively, showed distinct patterns of host specificity at various developmental stages, and a higher fitness on their natural hosts, suggesting these races are locally adapted. Here we discuss the implications of our findings from a broader perspective. We suggest that differences in signal responsiveness and perception by the parasite, as well as qualitative differences in signal production by the host, may elicit host specificity in this parasitic plant. Together with our earlier demonstration that these O. minor races are genetically distinct based on molecular markers, our recent data provide a snapshot of speciation in action, driven by host specificity. Indeed, host specificity may be an underestimated catalyst for speciation in parasitic plants generally. We propose that identifying host specific races using physiological techniques will complement conventional molecular marker-based approaches to provide a framework for delineating evolutionary relationships among cryptic host-specific parasitic plants. PMID:20081361

Uranium Detection - Technique Validation Report

Energy Technology Data Exchange (ETDEWEB)

Colletti, Lisa Michelle [Los Alamos National Lab. (LANL), Los Alamos, NM (United States). Chemistry Division; Garduno, Katherine [Los Alamos National Lab. (LANL), Los Alamos, NM (United States). Chemistry Division; Lujan, Elmer J. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States). Chemistry Division; Mechler-Hickson, Alexandra Marie [Los Alamos National Lab. (LANL), Los Alamos, NM (United States). Chemistry Division; Univ. of Wisconsin, Madison, WI (United States); May, Iain [Los Alamos National Lab. (LANL), Los Alamos, NM (United States). Chemistry Division; Reilly, Sean Douglas [Los Alamos National Lab. (LANL), Los Alamos, NM (United States). Chemistry Division

2016-04-14

As a LANL activity for DOE/NNSA in support of SHINE Medical Technologies™ ‘Accelerator Technology’ we have been investigating the application of UV-vis spectroscopy for uranium analysis in solution. While the technique has been developed specifically for sulfate solutions, the proposed SHINE target solutions, it can be adapted to a range of different solution matrixes. The FY15 work scope incorporated technical development that would improve accuracy, specificity, linearity & range, precision & ruggedness, and comparative analysis. Significant progress was achieved throughout FY 15 addressing these technical challenges, as is summarized in this report. In addition, comparative analysis of unknown samples using the Davies-Gray titration technique highlighted the importance of controlling temperature during analysis (impacting both technique accuracy and linearity/range). To fully understand the impact of temperature, additional experimentation and data analyses were performed during FY16. The results from this FY15/FY16 work were presented in a detailed presentation, LA-UR-16-21310, and an update of this presentation is included with this short report summarizing the key findings. The technique is based on analysis of the most intense U(VI) absorbance band in the visible region of the uranium spectra in 1 M H₂SO₄, at λ_max = 419.5 nm.

Synthesis and Oxidation of Silver Nano-particles

Science.gov (United States)

2011-01-01

solution (20%wt propyl alcohol, 5%wt hydrochloric acid and 5%wt stannous chloride in water). Scheme 1b and c illustrate the sensitization and silver... Synthesis and Oxidation of Silver Nano-particles Hua Qi*, D. A. Alexson, O.J. Glembocki and S. M. Prokes* Electronics Science and Technology...energy dispersive x-ray (EDX) techniques. The results Quantum Dots and Nanostructures: Synthesis , Characterization, and Modeling VIII, edited by Kurt

78 FR 30921 - Ocean Transportation Intermediary License Applicants

Science.gov (United States)

2013-05-23

.... (NVO & OFF), 2500 Wilcrest Drive, Suite 300, Houston, TX 77042, Officers: Myrian T. Morales, Vice..., FL 33178, Officer: Jose R. Gantus, President (QI), Application Type: QI Change XL Worldwide Corp...

Inter-rater reliability of nursing home quality indicators in the U.S

Directory of Open Access Journals (Sweden)

Roy Jason

2003-11-01

Full Text Available Abstract Background In the US, Quality Indicators (QI's profiling and comparing the performance of hospitals, health plans, nursing homes and physicians are routinely published for consumer review. We report the results of the largest study of inter-rater reliability done on nursing home assessments which generate the data used to derive publicly reported nursing home quality indicators. Methods We sampled nursing homes in 6 states, selecting up to 30 residents per facility who were observed and assessed by research nurses on 100 clinical assessment elements contained in the Minimum Data Set (MDS and compared these with the most recent assessment in the record done by facility nurses. Kappa statistics were generated for all data items and derived for 22 QI's over the entire sample and for each facility. Finally, facilities with many QI's with poor Kappa levels were compared to those with many QI's with excellent Kappa levels on selected characteristics. Results A total of 462 facilities in 6 states were approached and 219 agreed to participate, yielding a response rate of 47.4%. A total of 5758 residents were included in the inter-rater reliability analyses, around 27.5 per facility. Patients resembled the traditional nursing home resident, only 43.9% were continent of urine and only 25.2% were rated as likely to be discharged within the next 30 days. Results of resident level comparative analyses reveal high inter-rater reliability levels (most items >.75. Using the research nurses as the "gold standard", we compared composite quality indicators based on their ratings with those based on facility nurses. All but two QI's have adequate Kappa levels and 4 QI's have average Kappa values in excess of .80. We found that 16% of participating facilities performed poorly (Kappa .75 on 12 or more QI's. No facility characteristics were related to reliability of the data on which Qis are based. Conclusion While a few QI's being used for public reporting

Quality and safety training in primary care: making an impact.

Science.gov (United States)

Byrne, John M; Hall, Susan; Baz, Sam; Kessler, Todd; Roman, Maher; Patuszynski, Mark; Thakkar, Kruti; Kashner, T Michael

2012-12-01

Preparing residents for future practice, knowledge, and skills in quality improvement and safety (QI/S) is a requisite element of graduate medical education. Despite many challenges, residency programs must consider new curricular innovations to meet the requirements. We report the effectiveness of a primary care QI/S curriculum and the role of the chief resident in quality and patient safety in facilitating it. Through the Veterans Administration Graduate Medical Education Enhancement Program, we added a position for a chief resident in quality and patient safety, and 4 full-time equivalent internal medicine residents, to develop the Primary Care Interprofessional Patient-Centered Quality Care Training Curriculum. The curriculum includes a first-or second-year, 1-month block rotation that serves as a foundational experience in QI/S and interprofessional care. The responsibilities of the chief resident in quality and patient safety included organizing and teaching the QI/S curriculum and mentoring resident projects. Evaluation included prerotation and postrotation surveys of self-assessed QI/S knowledge, abilities, skills, beliefs, and commitment (KASBC); an end-of-the-year KASBC; prerotation and postrotation knowledge test; and postrotation and faculty surveys. Comparisons of prerotation and postrotation KASBC indicated significant self-assessed improvements in 4 of 5 KASBC domains: knowledge (P < .001), ability (P < .001), skills (P < .001), and belief (P < .03), which were sustained on the end-of-the-year survey. The knowledge test demonstrated increased QI/S knowledge (P  =  .002). Results of the postrotation survey indicate strong satisfaction with the curriculum, with 76% (25 of 33) and 70% (23 of 33) of the residents rating the quality and safety curricula as always or usually educational. Most faculty members acknowledged that the chief resident in quality and patient safety enhanced both faculty and resident QI/S interest and

The Mechanism Research of Qishen Yiqi Formula by Module-Network Analysis

OpenAIRE

Zheng, Shichao; Zhang, Yanling; Qiao, Yanjiang

2015-01-01

Qishen Yiqi formula (QSYQ) has the effect of tonifying Qi and promoting blood circulation, which is widely used to treat the cardiovascular diseases with Qi deficiency and blood stasis syndrome. However, the mechanism of QSYQ to tonify Qi and promote blood circulation is rarely reported at molecular or systems level. This study aimed to elucidate the mechanism of QSYQ based on the protein interaction network (PIN) analysis. The targets’ information of the active components was obtained from C...

Journal of Genetics | Indian Academy of Sciences

Indian Academy of Sciences (India)

pp 85-91 Research Article. Cloning and study of adult-tissue-specific expression of Sox9 in Cyprinus carpio · Du Qi-Yan Wang Feng-Yu Hua Hui-Ying Chang Zhong-Jie · More Details Abstract Fulltext PDF. The Sox9 gene is one of the important transcription factors in the development of many tissues and organs, particularly ...

78 FR 38336 - Ocean Transportation Intermediary License Applicants

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2013-06-26

..., President (QI), Stephen B. Schwark, Treasurer, Application Type: License Transfer to EFL Container Lines...., Suite K, Mobile, AL 36609, Officers: Thomas (Mac) H. McPhillips IV, Assistant Vice President (QI), Oscar...

An Empirical Study of Critical Soft Factors for Quality Improvement in The Electrical and Electronics Firms in Malaysia

Directory of Open Access Journals (Sweden)

Muhammad Madi Abdullah

2009-03-01

Full Text Available Soft factors are important aspect that sustains the organizations in their efforts towards continuous quality improvement (QI and customer satisfaction. The conventional wisdom states that quality improvement in organizations increases profits and productivity. Therefore, the aim of the paper is to examine the influence of critical soft factors (CSF on quality improvement (QI. For that purpose, this study examine: (i the relationship between the CSF and QI and (ii to what extent the six CSF explain QI. The study used survey data from 255 electrical and electronics (E&E firms in Malaysia. The individual managers representing the each firm made the unit of analysis of the study. The finding reveals that QI was significantly influenced by the following soft factors: management commitment, customer focus, employee involvement, training & education, and reward & recognition. Supplier relationship was not a significant predictor of quality improvement. Finally, this study has empirically shown that quality improvement will increase when the organizations emphasize more on soft factors.Keywords: Critical soft factors, quality improvement, Electrical and Electronics firms

Materials Science and X-ray Techniques

International Nuclear Information System (INIS)

Brock, J.; Sutton, M.

2008-01-01

Many novel synchrotron-based X-ray techniques directly address the core questions of modern materials science but are not yet at the stage of being easy to use because of the lack of dedicated beamlines optimized for specific measurements. In this article, we highlight a few of these X-ray techniques and discuss why, with ongoing upgrades of existing synchrotrons and with new linear-accelerator-based sources under development, now is the time to ensure that these techniques are readily available to the larger materials research community.

Hierarchical and Complex System Entropy Clustering Analysis Based Validation for Traditional Chinese Medicine Syndrome Patterns of Chronic Atrophic Gastritis.

Science.gov (United States)

Zhang, Yin; Liu, Yue; Li, Yannan; Zhao, Xia; Zhuo, Lin; Zhou, Ajian; Zhang, Li; Su, Zeqi; Chen, Cen; Du, Shiyu; Liu, Daming; Ding, Xia

2018-03-22

Chronic atrophic gastritis (CAG) is the precancerous stage of gastric carcinoma. Traditional Chinese Medicine (TCM) has been widely used in treating CAG. This study aimed to reveal core pathogenesis of CAG by validating the TCM syndrome patterns and provide evidence for optimization of treatment strategies. This is a cross-sectional study conducted in 4 hospitals in China. Hierarchical clustering analysis (HCA) and complex system entropy clustering analysis (CSECA) were performed, respectively, to achieve syndrome pattern validation. Based on HCA, 15 common factors were assigned to 6 syndrome patterns: liver depression and spleen deficiency and blood stasis in the stomach collateral, internal harassment of phlegm-heat and blood stasis in the stomach collateral, phlegm-turbidity internal obstruction, spleen yang deficiency, internal harassment of phlegm-heat and spleen deficiency, and spleen qi deficiency. By CSECA, 22 common factors were assigned to 7 syndrome patterns: qi deficiency, qi stagnation, blood stasis, phlegm turbidity, heat, yang deficiency, and yin deficiency. Combination of qi deficiency, qi stagnation, blood stasis, phlegm turbidity, heat, yang deficiency, and yin deficiency may play a crucial role in CAG pathogenesis. In accord with this, treatment strategies by TCM herbal prescriptions should be targeted to regulating qi, activating blood, resolving turbidity, clearing heat, removing toxin, nourishing yin, and warming yang. Further explorations are needed to verify and expand the current conclusions.

Isotope techniques for hydrology

Energy Technology Data Exchange (ETDEWEB)

1964-01-01

In the body of the Panel's report specific conclusions and recommendations are presented in the context of each subject. The general consensus of the Panel is as follows: by the study of this report, the 1961 Panel report, the Proceedings of the March 1963 Tokyo Symposium and other reports of research and technological advances, isotope-technique applications to hydrologic problems have provided some useful avenues for understanding the nature of the hydrologic cycle and in the solution of specific engineering problems. Some techniques are developed thoroughly enough for fairly routine application as tools for use in the solution of practical problems, but further research and development is needed on other concepts to determined whether or not they can be beneficially applied to either research or engineering problems. A concerted effort is required on the part of both hydrologists and isotope specialists working as teams to assure that proper synthesis of scientific advances in the respective fields and translation of these advances into practical technology is achieved.

Isotope techniques for hydrology

International Nuclear Information System (INIS)

1964-01-01

In the body of the Panel's report specific conclusions and recommendations are presented in the context of each subject. The general consensus of the Panel is as follows: by the study of this report, the 1961 Panel report, the Proceedings of the March 1963 Tokyo Symposium and other reports of research and technological advances, isotope-technique applications to hydrologic problems have provided some useful avenues for understanding the nature of the hydrologic cycle and in the solution of specific engineering problems. Some techniques are developed thoroughly enough for fairly routine application as tools for use in the solution of practical problems, but further research and development is needed on other concepts to determined whether or not they can be beneficially applied to either research or engineering problems. A concerted effort is required on the part of both hydrologists and isotope specialists working as teams to assure that proper synthesis of scientific advances in the respective fields and translation of these advances into practical technology is achieved

Quantitative assessments of distributed systems methodologies and techniques

CERN Document Server

Bruneo, Dario

2015-01-01

Distributed systems employed in critical infrastructures must fulfill dependability, timeliness, and performance specifications. Since these systems most often operate in an unpredictable environment, their design and maintenance require quantitative evaluation of deterministic and probabilistic timed models. This need gave birth to an abundant literature devoted to formal modeling languages combined with analytical and simulative solution techniques The aim of the book is to provide an overview of techniques and methodologies dealing with such specific issues in the context of distributed

Developing a Benchmarking Process in Perfusion: A Report of the Perfusion Downunder Collaboration

Science.gov (United States)

Baker, Robert A.; Newland, Richard F.; Fenton, Carmel; McDonald, Michael; Willcox, Timothy W.; Merry, Alan F.

2012-01-01

Abstract: Improving and understanding clinical practice is an appropriate goal for the perfusion community. The Perfusion Downunder Collaboration has established a multi-center perfusion focused database aimed at achieving these goals through the development of quantitative quality indicators for clinical improvement through benchmarking. Data were collected using the Perfusion Downunder Collaboration database from procedures performed in eight Australian and New Zealand cardiac centers between March 2007 and February 2011. At the Perfusion Downunder Meeting in 2010, it was agreed by consensus, to report quality indicators (QI) for glucose level, arterial outlet temperature, and pCO2 management during cardiopulmonary bypass. The values chosen for each QI were: blood glucose ≥4 mmol/L and ≤10 mmol/L; arterial outlet temperature ≤37°C; and arterial blood gas pCO2 ≥ 35 and ≤45 mmHg. The QI data were used to derive benchmarks using the Achievable Benchmark of Care (ABC™) methodology to identify the incidence of QIs at the best performing centers. Five thousand four hundred and sixty-five procedures were evaluated to derive QI and benchmark data. The incidence of the blood glucose QI ranged from 37–96% of procedures, with a benchmark value of 90%. The arterial outlet temperature QI occurred in 16–98% of procedures with the benchmark of 94%; while the arterial pCO2 QI occurred in 21–91%, with the benchmark value of 80%. We have derived QIs and benchmark calculations for the management of several key aspects of cardiopulmonary bypass to provide a platform for improving the quality of perfusion practice. PMID:22730861

Applying ethnography to the study of context in healthcare quality and safety.

Science.gov (United States)

Leslie, Myles; Paradis, Elise; Gropper, Michael A; Reeves, Scott; Kitto, Simon

2014-02-01

Translating and scaling healthcare quality improvement (QI) and patient safety interventions remains a significant challenge. Context has been identified as a major factor in this. QI and patient safety research have begun to focus on context, with ethnography seen as a promising methodology for understanding the professional, organisational and cultural aspects of context. While ethnography is used to investigate the context of a variety of QI and safety interventions, the challenges inherent in effectively importing a qualitative methodology and its social science practitioners into this work have been largely unexamined. We explain ethnography as a research practice grounded in theory and dependent on observations gathered and interpreted in particular ways. We then review the approach of health services literature to evaluating this sort of qualitative research. Although the study of context is an interest shared by both social scientists and healthcare QI and safety researchers, we identify three key points at which those 'exporting' ethnography as a methodology and those 'importing' it to deal with QI and safety challenges may diverge. We describe perspectival divergences on the methodology's mission, form and scale. At the level of mission we demonstrate how ethnography has been adapted to a 'describe and feed back' role in the service of QI. At the level of form, we show how the long-term embedded observation at the heart of ethnography can be adapted only so far to accommodate QI interests if both data quality and ethical standards are to be upheld. Finally, at the level of scale, we demonstrate one ethnographic study design that balances breadth of exposure with depth of experience in its observations and so generates a particular type of scalable findings. The effective export of ethnography into QI and safety research requires discussion and negotiation between social scientific and health services research perspectives, as well as creative approaches

[Effect of medicines for activating blood and reinforcing Qi on angiogenesis in infarcted myocardium edge area of acute myocardial infarction model in rats].

Science.gov (United States)

Zang, Wen-Hua; Yin, Shen-Hua; Tang, De-Cai; Li, Bing-Bing

2014-03-01

To study the effect of medicines for activating blood and reinforcing Qi on the number of new micro-vessels and the protein expressions of VEGF and bFGF in the infarcted myocardium edge area of acute myocardial infarction (AMI) model in rats. The AMI model of rats was established. After the successful model establishment, rats were randomly divided into the sham-operated group, the model group, the Danshen-Huangqi (1 : 2) group, the Danshen-Huangqi (1 : 1) group, the Chuanxiong-Huangqi (1 : 2) group, the Danshen group, the Chuanxiong group, the Chishao group and the Shexiang Baoxin pill group, with five rats in each group. Rats in each medicated group were orally administered with drugs as per 13.5 g x kg(-1) x d(-1) once everyday for three weeks. The immunohistochemical SP method was adopted to detect the expression of vWF in myocardial tissues, and count the number of micro-vessels (MVC). The protein expression of VEGF and bFGF in myocardial tissues were determined by Western blot. The new micro-vessels stained by vWF factor could be found in the infarcted myocardium edge area of the sham-operated group, the model group and all of medicated groups. The sham-operated group show unobvious new micro-vessels in myocardial tissues. A small amount of new micro-vessels could be seen in the infarcted myocardium edge area of the model group. Whereas a larger number of micro-vessels could be seen in the infarcted myocardium edge area of all of medicated groups. The differences between the sham-operated group and the model group had statistical significance (P effect in promoting angiogenesis. Their mechanism for promoting angiogenesis may be related to the improvement of the protein expressions of VEGF and bFGF, so as to increase the contents of VEGF and bFGF and promote the angiogenesis of new vessels.

Morphing methods to parameterize specimen-specific finite element model geometries.

Science.gov (United States)

Sigal, Ian A; Yang, Hongli; Roberts, Michael D; Downs, J Crawford

2010-01-19

Shape plays an important role in determining the biomechanical response of a structure. Specimen-specific finite element (FE) models have been developed to capture the details of the shape of biological structures and predict their biomechanics. Shape, however, can vary considerably across individuals or change due to aging or disease, and analysis of the sensitivity of specimen-specific models to these variations has proven challenging. An alternative to specimen-specific representation has been to develop generic models with simplified geometries whose shape is relatively easy to parameterize, and can therefore be readily used in sensitivity studies. Despite many successful applications, generic models are limited in that they cannot make predictions for individual specimens. We propose that it is possible to harness the detail available in specimen-specific models while leveraging the power of the parameterization techniques common in generic models. In this work we show that this can be accomplished by using morphing techniques to parameterize the geometry of specimen-specific FE models such that the model shape can be varied in a controlled and systematic way suitable for sensitivity analysis. We demonstrate three morphing techniques by using them on a model of the load-bearing tissues of the posterior pole of the eye. We show that using relatively straightforward procedures these morphing techniques can be combined, which allows the study of factor interactions. Finally, we illustrate that the techniques can be used in other systems by applying them to morph a femur. Morphing techniques provide an exciting new possibility for the analysis of the biomechanical role of shape, independently or in interaction with loading and material properties. Copyright 2009 Elsevier Ltd. All rights reserved.

Measurements of quadrupolar interaction by perturbed angular correltion method on intercalated 2H-TaS sub(2)

International Nuclear Information System (INIS)

Saitovitch, H.

1979-01-01

This work is based on our quadrupolar interaction (QI) measurements on intercalated 2H-TaS sub(2) coumponds. As intercalating elements we used the alcalines - Li, Na, K, Cs -as well as the NH sub(3) (ammonia) and C sub(6) H sub(5) N (pyridine) molecules. The (QI) measurements were performed via the differential perturbed angular correlation (DPAC) technique, using Ta sup(181) as the probe isotope, on the hydrated and anhidrous phases of the intercalated systems. Our results happened to be in better agreement with the ionic model, one of the accepted models used to describe the intercalation process, as well as the transfered charges quantities and its distribution in the intercalated systems. And by its side the measured quantities, quadrupole interaction frequencies (QIF) and their distributions δ, contributed to support and to improve the ionic model. A strong charge dynamics between the 2H-TaS sub(2) sandwiches was observed and a relation between the (QIF) changes and amount of transfered charge (e sup(-)/Ta) was established. The attempt to specify the numerical contributions to the (QI) changes arriving from the different components of the 2H-TaS sub(2) intercalated systems put in evidence the probable orbitals involved in the systems bonds. Finally the kinetics of the intercalation process to form the 2H-TaS sub(2) (Li) sub(x) system was followed continuously by the (DPAC) measurements. (author)

The ``hydro-wired``: more than a technique, a global concept; ``L`hydrocable``: plus qu`une technique, un concept global

Energy Technology Data Exchange (ETDEWEB)

Anon.

1998-09-01

The ``hydro-wired`` technique consists in the use of small diameter synthetic pipes for the water supply of hot or cold water to space heating or cooling appliances. This new technique has several advantages regarding the thermal comfort and the realization of installations. However cares must be taken during the application of this technique and the design of installations. This paper describes: the French potential market for this technique (heating and cooling floors, traditional heating, sanitary hot water distribution), the characteristics of this technique with respect to traditional techniques (the sheathing of pipes, the specificities of the `octopus`-type distribution), and the design of installations (the different steps: preliminary thermal analysis, realization, start-up and tests). (J.S.)

Carving Technique – Methodical Perspectives

Directory of Open Access Journals (Sweden)

Adela BADAU

2015-09-01

Full Text Available The alpine skiing has undergone major changes and adjustments due to both technological innovations of materials and update of theoretical and methodological concepts on all levels of specific training. The purpose: the introduction of technological innovation in the field of materials specif ic to carving ski causes a review of methodology, aiming at bringing the execution technique to superior indices in order to obtain positive results. The event took place in Poiana Brasov between December 2014 and March 2015, on an 800m long slope and comp rised a single experimental group made of four males and four females, cadet category, that carried out two lessons per day. The tests targeted the technique level for slalom skiing and giant slalom skiing, having in view four criteria: leg work, basin mov ement, torso position and arms work. As a result of the research and of the statistic - mathematical analysis of the individual values, the giant slalom race registered an average improvement of 3.5 points between the tests, while the slalom race registered 4 points. In conclusion, the use of a specific methodology applied scientifically, which aims to select the most efficient means of action specific to children’s ski, determines technical improvement at an advanced level.

Defining and Assessing Quality Improvement Outcomes: A Framework for Public Health

Science.gov (United States)

Nawaz, Saira; Thomas, Craig; Young, Andrea

2015-01-01

We describe an evidence-based framework to define and assess the impact of quality improvement (QI) in public health. Developed to address programmatic and research-identified needs for articulating the value of public health QI in aggregate, this framework proposes a standardized set of measures to monitor and improve the efficiency and effectiveness of public health programs and operations. We reviewed the scientific literature and analyzed QI initiatives implemented through the Centers for Disease Control and Prevention’s National Public Health Improvement Initiative to inform the selection of 5 efficiency and 8 effectiveness measures. This framework provides a model for identifying the types of improvement outcomes targeted by public health QI efforts and a means to understand QI’s impact on the practice of public health. PMID:25689185

The Perspective of Psychosomatic Medicine on the Effect of Religion on the Mind–Body Relationship in Japan

OpenAIRE

Nakao, Mutsuhiro; Ohara, Chisin

2012-01-01

Shintoism, Buddhism, and Qi, which advocate the unity of mind and body, have contributed to the Japanese philosophy of life. The practice of psychosomatic medicine emphasizes the connection between mind and body and combines the psychotherapies (directed at the mind) and relaxation techniques (directed at the body), to achieve stress management. Participation in religious activities such as preaching, praying, meditating, and practicing Zen can also elicit relaxation responses. Thus, it is ti...

Techniques for Combined Arms for Air Defense

Science.gov (United States)

2016-07-29

4-6 Figure 4-3. Football Field Technique: Jet aiming points...4-7 Figure 4-4. Football Field Technique: Helicopter aiming points............................................. 4-8 Figure 4-5. Firing positions...destroy it.  HOLD FIRE is an emergency fire control order to stop engagement of a specific target. Missiles already in flight must be prevented from

Practical techniques for pediatric computed tomography

International Nuclear Information System (INIS)

Fitz, C.R.; Harwood-Nash, D.C.; Kirks, D.R.; Kaufman, R.A.; Berger, P.E.; Kuhn, J.P.; Siegel, M.J.

1983-01-01

Dr. Donald Kirks has assembled this section on Practical Techniques for Pediatric Computed Tomography. The material is based on a presentation in the Special Interest session at the 25th Annual Meeting of the Society for Pediatric Radiology in New Orleans, Louisiana, USA in 1982. Meticulous attention to detail and technique is required to ensure an optimal CT examination. CT techniques specifically applicable to infants and children have not been disseminated in the radiology literature and in this respect it may rightly be observed that ''the child is not a small adult''. What follows is a ''cookbook'' prepared by seven participants and it is printed in Pediatric Radiology, in outline form, as a statement of individual preferences for pediatric CT techniques. This outline gives concise explanation of techniques and permits prompt dissemination of information. (orig.)

Protocol for chromosome-specific probe construction using PRINS, micromanipulation and DOP-PCR techniques

Directory of Open Access Journals (Sweden)

PAULO Z. PASSAMANI

2017-12-01

Full Text Available ABSTRACT Chromosome-specific probes have been widely used in molecular cytogenetics, being obtained with different methods. In this study, a reproducible protocol for construction of chromosome-specific probes is proposed which associates in situ amplification (PRINS, micromanipulation and degenerate oligonucleotide-primed PCR (DOP-PCR. Human lymphocyte cultures were used to obtain metaphases from male and female individuals. The chromosomes were amplified via PRINS, and subcentromeric fragments of the X chromosome were microdissected using microneedles coupled to a phase contrast microscope. The fragments were amplified by DOP-PCR and labeled with tetramethyl-rhodamine-5-dUTP. The probes were used in fluorescent in situ hybridization (FISH procedure to highlight these specific regions in the metaphases. The results show one fluorescent red spot in male and two in female X chromosomes and interphase nuclei.

Strongly correlated systems experimental techniques

CERN Document Server

Mancini, Ferdinando

2015-01-01

The continuous evolution and development of experimental techniques is at the basis of any fundamental achievement in modern physics. Strongly correlated systems (SCS), more than any other, need to be investigated through the greatest variety of experimental techniques in order to unveil and crosscheck the numerous and puzzling anomalous behaviors characterizing them. The study of SCS fostered the improvement of many old experimental techniques, but also the advent of many new ones just invented in order to analyze the complex behaviors of these systems. Many novel materials, with functional properties emerging from macroscopic quantum behaviors at the frontier of modern research in physics, chemistry and materials science, belong to this class of systems. The volume presents a representative collection of the modern experimental techniques specifically tailored for the analysis of strongly correlated systems. Any technique is presented in great detail by its own inventor or by one of the world-wide recognize...

Novel information theory techniques for phonon spectroscopy

International Nuclear Information System (INIS)

Hague, J P

2007-01-01

The maximum entropy method (MEM) and spectral reverse Monte Carlo (SRMC) techniques are applied to the determination of the phonon density of states (PDOS) from heat-capacity data. The approach presented here takes advantage of the standard integral transform relating the PDOS with the specific heat at constant volume. MEM and SRMC are highly successful numerical approaches for inverting integral transforms. The formalism and algorithms necessary to carry out the inversion of specific heat curves are introduced, and where possible, I have concentrated on algorithms and experimental details for practical usage. Simulated data are used to demonstrate the accuracy of the approach. The main strength of the techniques presented here is that the resulting spectra are always physical: Computed PDOS is always positive and properly applied information theory techniques only show statistically significant detail. The treatment set out here provides a simple, cost-effective and reliable method to determine phonon properties of new materials. In particular, the new technique is expected to be very useful for establishing where interesting phonon modes and properties can be found, before spending time at large scale facilities

Do quality improvement initiatives for diabetes care address social inequities? Secondary analysis of a systematic review.

Science.gov (United States)

Lu, Jacquie Boyang; Danko, Kristin J; Elfassy, Michael D; Welch, Vivian; Grimshaw, Jeremy M; Ivers, Noah M

2018-02-14

Socially disadvantaged populations carry a disproportionate burden of diabetes-related morbidity and mortality. There is an emerging interest in quality improvement (QI) strategies in the care of patients with diabetes, however, the effect of these interventions on disadvantaged groups remains unclear. This is a secondary analysis of a systematic review that seeks to examine the extent of equity considerations in diabetes QI studies, specifically quantifying the proportion of studies that target interventions toward disadvantaged populations and conduct analyses on the impact of interventions on disadvantaged groups. Studies were identified using Medline, HealthStar and the Cochrane Effective Practice and Organisation of Care database. Randomised controlled trials assessing 12 QI strategies targeting health systems, healthcare professionals and/or patients for the management of adult outpatients with diabetes were eligible. The place of residence, race/ethnicity/culture/language, occupational status, gender/sexual identity, religious affiliations, education level, socioeconomic status, social capital, plus age, disability, sexual preferences and relationships (PROGRESS-Plus) framework was used to identify trials that focused on disadvantaged patient populations, to examine the types of equity-relevant factors that are being considered and to explore temporal trends in equity-relevant diabetes QI trials. Of the 278 trials that met the inclusion criteria, 95 trials had equity-relevant considerations. These include 64 targeted trials that focused on a disadvantaged population with the aim to improve the health status of that population and 31 general trials that undertook subgroup analyses to assess the extent to which their interventions may have had differential impacts on disadvantaged subgroups. Trials predominantly focused on race/ethnicity, socioeconomic status and place of residence as potential factors for disadvantage in patients receiving diabetes care. Less

Field Testing of Geophysical Techniques.

Science.gov (United States)

1981-11-01

influence drainage and groundwater movement in the surrounding area. Presumably, the direction of groundwater movement is to the north and out of the...applicable. Specifically, these additional techniques are: e Audio magneto- telluric (AMT) resistivity * Electromagnetics a Ground-probing radar Both

Catalogue of EDF`s technical specifications (HN reference). Centre of standardization; Catalogue des specifications techniques EDF (reference HN). Centre de normalisation

Energy Technology Data Exchange (ETDEWEB)

1998-12-31

This document edited by Electricite de France (EdF), is a catalogue of the French standard documents relative to any type of electrical material and equipment and which contain the technical specifications of these materials and equipments. A brief description of these specifications is given for each type of material or equipment listed. (J.S.)

An integrated technique for developing real-time systems

NARCIS (Netherlands)

Hooman, J.J.M.; Vain, J.

1995-01-01

The integration of conceptual modeling techniques, formal specification, and compositional verification is considered for real time systems within the knowledge engineering context. We define constructive transformations from a conceptual meta model to a real time specification language and give

The Ontario Psychosocial Oncology Framework: a quality improvement tool.

Science.gov (United States)

Li, Madeline; Green, Esther

2013-05-01

To overview the newly developed Psychosocial Health Care for Cancer Patients and Their Families: A Framework to Guide Practice in Ontario and Guideline Recommendations in the context of Canadian psychosocial oncology care and propose strategies for guideline uptake and implementation. Recommendations from the 2008 Institute of Medicine standard Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs were adapted into the Ontario Psychosocial Oncology (PSO) Framework. Existing practice guidelines developed by the Canadian Partnership against Cancer and Cancer Care Ontario and standards developed by the Canadian Association of Psychosocial Oncology are supporting resources for adopting a quality improvement (QI) approach to the implementation of the framework in Ontario. The developed PSO Framework, including 31 specific actionable recommendations, is intended to improve the quality of comprehensive cancer care at both the provider and system levels. Important QI change management processes are described as Educate - raising awareness among medical teams of the significance of psychosocial needs of patients, Evidence - developing a research evidence base for patient care benefits from psychosocial interventions, and Electronics - using technology to collect patient reported outcomes of both physical and emotional symptoms. The Ontario PSO Framework is unique and valuable in providing actionable recommendations that can be implemented through QI processes. Overall, the result will be improved psychosocial health care for the cancer population. Copyright © 2012 John Wiley & Sons, Ltd.

Variations and classification of toxic epitopes related to celiac disease among α-gliadin genes from four Aegilops genomes.

Science.gov (United States)

Li, Jie; Wang, Shunli; Li, Shanshan; Ge, Pei; Li, Xiaohui; Ma, Wujun; Zeller, F J; Hsam, Sai L K; Yan, Yueming

2012-07-01

The α-gliadins are associated with human celiac disease. A total of 23 noninterrupted full open reading frame α-gliadin genes and 19 pseudogenes were cloned and sequenced from C, M, N, and U genomes of four diploid Aegilops species. Sequence comparison of α-gliadin genes from Aegilops and Triticum species demonstrated an existence of extensive allelic variations in Gli-2 loci of the four Aegilops genomes. Specific structural features were found including the compositions and variations of two polyglutamine domains (QI and QII) and four T cell stimulatory toxic epitopes. The mean numbers of glutamine residues in the QI domain in C and N genomes and the QII domain in C, N, and U genomes were much higher than those in Triticum genomes, and the QI domain in C and N genomes and the QII domain in C, M, N, and U genomes displayed greater length variations. Interestingly, the types and numbers of four T cell stimulatory toxic epitopes in α-gliadins from the four Aegilops genomes were significantly less than those from Triticum A, B, D, and their progenitor genomes. Relationships between the structural variations of the two polyglutamine domains and the distributions of four T cell stimulatory toxic epitopes were found, resulting in the α-gliadin genes from the Aegilops and Triticum genomes to be classified into three groups.

Postgraduate Education in Quality Improvement Methods: Initial Results of the Fellows' Applied Quality Training (FAQT) Curriculum.

Science.gov (United States)

Winchester, David E; Burkart, Thomas A; Choi, Calvin Y; McKillop, Matthew S; Beyth, Rebecca J; Dahm, Phillipp

2016-06-01

Training in quality improvement (QI) is a pillar of the next accreditation system of the Accreditation Committee on Graduate Medical Education and a growing expectation of physicians for maintenance of certification. Despite this, many postgraduate medical trainees are not receiving training in QI methods. We created the Fellows Applied Quality Training (FAQT) curriculum for cardiology fellows using both didactic and applied components with the goal of increasing confidence to participate in future QI projects. Fellows completed didactic training from the Institute for Healthcare Improvement's Open School and then designed and completed a project to improve quality of care or patient safety. Self-assessments were completed by the fellows before, during, and after the first year of the curriculum. The primary outcome for our curriculum was the median score reported by the fellows regarding their self-confidence to complete QI activities. Self-assessments were completed by 23 fellows. The majority of fellows (15 of 23, 65.2%) reported no prior formal QI training. Median score on baseline self-assessment was 3.0 (range, 1.85-4), which was significantly increased to 3.27 (range, 2.23-4; P = 0.004) on the final assessment. The distribution of scores reported by the fellows indicates that 30% were slightly confident at conducting QI activities on their own, which was reduced to 5% after completing the FAQT curriculum. An interim assessment was conducted after the fellows completed didactic training only; median scores were not different from the baseline (mean, 3.0; P = 0.51). After completion of the FAQT, cardiology fellows reported higher self-confidence to complete QI activities. The increase in self-confidence seemed to be limited to the applied component of the curriculum, with no significant change after the didactic component.

Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery.

Science.gov (United States)

Cosimi, Lisa A; Dam, Huong V; Nguyen, Thai Q; Ho, Huyen T; Do, Phuong T; Duc, Duat N; Nguyen, Huong T; Gardner, Bridget; Libman, Howard; Pollack, Todd; Hirschhorn, Lisa R

2015-07-17

The global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However, traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care. We trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team (PCT) to provide integrated coaching in clinical HIV skills and quality improvement (QI) to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics, in both QI and clinical skills, was guided by results of performance measurements, gap analyses, and resulting QI plans. After 18 months, the PCT had successfully spread QI activities, and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT activities and clinic performance were sustained after integration of the model into the Vietnam National QI Program. We successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting.

Graphene quantum interference photodetector

Directory of Open Access Journals (Sweden)

Mahbub Alam

2015-03-01

Full Text Available In this work, a graphene quantum interference (QI photodetector was simulated in two regimes of operation. The structure consists of a graphene nanoribbon, Mach–Zehnder interferometer (MZI, which exhibits a strongly resonant transmission of electrons of specific energies. In the first regime of operation (that of a linear photodetector, low intensity light couples two resonant energy levels, resulting in scattering and differential transmission of current with an external quantum efficiency of up to 5.2%. In the second regime of operation, full current switching is caused by the phase decoherence of the current due to a strong photon flux in one or both of the interferometer arms in the same MZI structure. Graphene QI photodetectors have several distinct advantages: they are of very small size, they do not require p- and n-doped regions, and they exhibit a high external quantum efficiency.

Mining software specifications methodologies and applications

CERN Document Server

Lo, David

2011-01-01

An emerging topic in software engineering and data mining, specification mining tackles software maintenance and reliability issues that cost economies billions of dollars each year. The first unified reference on the subject, Mining Software Specifications: Methodologies and Applications describes recent approaches for mining specifications of software systems. Experts in the field illustrate how to apply state-of-the-art data mining and machine learning techniques to address software engineering concerns. In the first set of chapters, the book introduces a number of studies on mining finite

Radio techniques for probing the terrestrial ionosphere.

Science.gov (United States)

Hunsucker, R. D.

The subject of the book is a description of the basic principles of operation, plus the capabilities and limitations of all generic radio techniques employed to investigate the terrestrial ionosphere. The purpose of this book is to present to the reader a balanced treatment of each technique so they can understand how to interpret ionospheric data and decide which techniques are most effective for studying specific phenomena. The first two chapters outline the basic theory underlying the techniques, and each following chapter discusses a separate technique. This monograph is entirely devoted to techniques in aeronomy and space physics. The approach is unique in its presentation of the principles, capabilities and limitations of the most important presently used radio techniques. Typical examples of data are shown for the various techniques, and a brief historical account of the technique development is presented. An extended annotated bibliography of the salient papers in the field is included.

Ins-Robust Primitive Words

OpenAIRE

Srivastava, Amit Kumar; Kapoor, Kalpesh

2017-01-01

Let Q be the set of primitive words over a finite alphabet with at least two symbols. We characterize a class of primitive words, Q_I, referred to as ins-robust primitive words, which remain primitive on insertion of any letter from the alphabet and present some properties that characterizes words in the set Q_I. It is shown that the language Q_I is dense. We prove that the language of primitive words that are not ins-robust is not context-free. We also present a linear time algorithm to reco...

Quality improvement tools and processes.

Science.gov (United States)

Lau, Catherine Y

2015-04-01

The Model for Improvement and the Plan-Do-Study-Act cycle is a popular quality improvement (QI) tool for health care providers to successfully lead QI projects and redesign care processes. This tool has several distinct components that must be addressed in sequence to organize and critically evaluate improvement activities. Unlike other health sciences clinical research, QI projects and research are based on dynamic hypotheses that develop into observable, serial tests of change with continuous collection and feedback of performance data to stakeholders. Copyright © 2015 Elsevier Inc. All rights reserved.

Surface-specific analytical techniques

International Nuclear Information System (INIS)

Riviere, J.C.

1982-01-01

The following methods are discussed: electron excitation (Auger electron spectroscopy; scanning Auger microscopy; electron energy-loss spectroscopy; appearance potential spectroscopy; electron-induced luminescence; electron-stimulated desorption); photon excitation (X-ray photoelectron spectroscopy; X-ray excited Auger electron spectroscopy; synchrotron radiation photoelectron spectroscopy; ultraviolet photoelectron spectroscopy; photoelectron spectromicroscopy; ellipsometry); ion excitation (ion-excited Auger electron spectroscopy; proton-excited Auger electron spectroscopy; ion neutralization spectroscopy; ion beam spectrochemical analysis; glow discharge optical spectroscopy; static secondary ion mass spectrometry; ion scattering spectroscopy; glow discharge mass spectrometry); resolution and sensitivity. (U.K.)

Methylation-Specific PCR Unraveled

Directory of Open Access Journals (Sweden)

Sarah Derks

2004-01-01

Full Text Available Methylation‐specific PCR (MSP is a simple, quick and cost‐effective method to analyze the DNA methylation status of virtually any group of CpG sites within a CpG island. The technique comprises two parts: (1 sodium bisulfite conversion of unmethylated cytosine's to uracil under conditions whereby methylated cytosines remains unchanged and (2 detection of the bisulfite induced sequence differences by PCR using specific primer sets for both unmethylated and methylated DNA. This review discusses the critical parameters of MSP and presents an overview of the available MSP variants and the (clinical applications.

Nuclear techniques in medicine

International Nuclear Information System (INIS)

Basson, J.K.

1984-01-01

The use of nuclear techniques in medicine has, also in South Africa, increased enormously, especially as regards diagnosis and reseach. In 1983 in vivo tests with radioisotopes were carried out and also in vitro tests, mainly by radioimmunoassay. Therapy with open and sealed radioactive sources was concentrated mainly on cancer treatments. In 1983 NUCOR supported 83 research projects in the life sciences. Imaging of organs or tissues in the body with nuclear techniques has developed into the most important application of nuclear medicine, with the development of even more specific labelled compounds as the main objective. Radioimmunoassay is at an exciting watershed, now that labelled monoclonal antibodies with high specificity for early diagnosis (also in cancer) and even localised radiotherapy have become available. The establishment of the 200 MeV open-sector cyclotron by the National Accelerator Centre also for medical purposes will, in addition to the large-scale production of the protonrich isotopes, also make a substantial contribution to radiotherapy with nuclear particles such as neutrons, protons and helium-3

Microalgae harvesting techniques: A review.

Science.gov (United States)

Singh, Gulab; Patidar, S K

2018-07-01

Microalgae with wide range of commercial applications have attracted a lot of attention of the researchers in the last few decades. However, microalgae utilization is not economically sustainable due to high cost of harvesting. A wide range of solid - liquid separation techniques are available for microalgae harvesting. The techniques include coagulation and flocculation, flotation, centrifugation and filtration or a combination of various techniques. Despite the importance of harvesting to the economics and energy balance, there is no universal harvesting technique for microalgae. Therefore, this review focuses on assessing technical, economical and application potential of various harvesting techniques so as to allow selection of an appropriate technology for cost effectively harvesting of microalgae from their culture medium. Various harvesting and concentrating techniques of microalgae were reviewed to suggest order of suitability of the techniques for four main microalgae applications i.e biofuel, human and animal food, high valued products, and water quality restoration. For deciding the order of suitability, a comparative analysis of various harvesting techniques based on the six common criterions (i.e biomass quality, cost, biomass quantity, processing time, species specific and toxicity) has been done. Based on the order of various techniques vis-a-vis various criteria and preferred order of criteria for various applications, order of suitability of harvesting techniques for various applications has been decided. Among various harvesting techniques, coagulation and flocculation, centrifugation and filtration were found to be most suitable for considered applications. These techniques may be used alone or in combination for increasing the harvesting efficiency. Copyright © 2018 Elsevier Ltd. All rights reserved.

Specific energy released in power reactors

International Nuclear Information System (INIS)

Zaritskaya, T.S.; Kiselev, G.V.; Rudik, A.P.; Tsenter, Eh.M.

1986-01-01

Technique of determination are described and analysis of specific energy for different methods of critically maintance of RBMK and WWER-440 reactors are conducted. Characteristics of the optimal mode of critically maintanance are determined

Radon reduction techniques for suspended timber floors and pressure field extension assessment of hardcore specifications

International Nuclear Information System (INIS)

Gregory, T.J.; Stephen, R.K.

1994-01-01

This paper comprises two case studies. The first describes a series of mitigation measures carried out in a small primary school fitted with a suspended timber floor. Radon levels had been successfully reduced but the floor subsequently collapsed due to an outbreak of dry-rot. The floor was replaced with a ground-bearing concrete slab fitted with a typical example of one of 200 or so sump-and-fan systems fitted by Cornwall County Council (CCC). Following consultation with the Building Research Establishment (BRE) a network of small bore pipes was fitted below the floor during construction to record variations in radon levels and pressures. The second case study describes the floor replacement at a second, similar school but with a permeable layer of material under the concrete slab and more pressure measurement points. The pressure measurements and their subsequent analysis are described and the performance of the two installations compared. Using BRE and CCC expertise, this technique is now being applied to a number of other replacement floors in order to assess pressure field extension in a variety of hardcore and blinding materials. It is hoped that by careful selection of hardcore and blinding specifications the increased pressure field extension obtained could result in a new-build properties requiring fewer underfloor suction points and/or a reduction in fan power consumption with a greater degree of confidence of success than at present. The selection and design of suction systems to date has been on a very pragmatic basis. (author)

Chemical constituents of Cyperus rotundus L. and their inhibitory ...

African Journals Online (AJOL)

Background: Xiang Fu (Cyperus rotundus L) enters the liver, spleen and triple warmer meridians, and has qi stagnation-removing, qi circulation-promoting, menstruation-regulating and pain-relieving effects. Besides, it can improve ovarian function, and has hypolipidemic, hypoglycemic and neuroprotective actions.

Utility of Modified Ultrafast Papanicolaou Stain in Cytological Diagnosis.

Science.gov (United States)

Sinkar, Prachi; Arakeri, Surekha Ulhas

2017-03-01

Need for minimal turnaround time for assessing Fine Needle Aspiration Cytology (FNAC) has encouraged innovations in staining techniques that require lesser staining time with unequivocal cell morphology. The standard protocol for conventional Papanicolaou (PAP) stain requires about 40 minutes. To overcome this, Ultrafast Papanicolaou (UFP) stain was introduced which reduces staining time to 90 seconds and also enhances the quality. However, reagents required for this were not easily available hence, Modified Ultrafast Papanicolaou (MUFP) stain was introduced subsequently. To assess the efficacy of MUFP staining by comparing the quality of MUFP stain with conventional PAP stain. FNAC procedure was performed by using 10 ml disposable syringe and 22-23 G needle. Total 131 FNAC cases were studied which were lymph node (30), thyroid (38), breast (22), skin and soft tissue (24), salivary gland (11) and visceral organs (6). Two smears were prepared and stained by MUFP and conventional PAP stain. Scores were given on four parameters: background of smears, overall staining pattern, cell morphology and nuclear staining. Quality Index (QI) was calculated from ratio of total score achieved to maximum score possible. Statistical analysis using chi square test was applied to each of the four parameters before obtaining the QI in both stains. Students t-test was applied to evaluate the efficacy of MUFP in comparison with conventional PAP stain. The QI of MUFP for thyroid, breast, lymph node, skin and soft tissue, salivary gland and visceral organs was 0.89, 0.85, 0.89, 0.83, 0.92, and 0.78 respectively. Compared to conventional PAP stain QI of MUFP smears was better in all except visceral organ cases and was statistically significant. MUFP showed clear red blood cell background, transparent cytoplasm and crisp nuclear features. MUFP is fast, reliable and can be done with locally available reagents with unequivocal morphology which is the need of the hour for a cytopathology set-up.

Design of in situ dispersible and calcium cross-linked alginate pellets as intestinal-specific drug carrier by melt pelletization technique.

Science.gov (United States)

Nurulaini, Harjoh; Wong, Tin Wui

2011-06-01

Conventional alginate pellets underwent rapid drug dissolution and loss of multiparticulate characteristics such as aggregation in acidic medium, thereby promoting oral dose dumping. This study aimed to design sustained-release dispersible alginate pellets through rapid in situ matrix dispersion and cross-linking by calcium salts during dissolution. Pellets made of alginate and calcium salts were prepared using a solvent-free melt pelletization technique that prevented reaction between processing materials during agglomeration and allowed such a reaction to occur only in dissolution phase. Drug release was remarkably retarded in acidic medium when pellets were formulated with water-soluble calcium acetate instead of acid-soluble calcium carbonate. Different from calcium salt-free and calcium carbonate-loaded matrices that aggregated or underwent gradual erosion, rapid in situ solvation of calcium acetate in pellets during dissolution resulted in burst of gas bubbles, fast pellet breakup, and dispersion. The dispersed fragments, though exhibiting a larger specific surface area for drug dissolution than intact matrix, were rapidly cross-linked by Ca(2+) from calcium acetate and had drug release retarded till a change in medium pH from 1.2 to 6.8. Being dispersible and pH-dependent in drug dissolution, these pellets are useful as multiparticulate intestinal-specific drug carrier without exhibiting dose dumping tendency of a "single-unit-like" system via pellet aggregation. Copyright © 2011 Wiley-Liss, Inc.

Principles, Techniques, and Applications of Tissue Microfluidics

Science.gov (United States)

Wade, Lawrence A.; Kartalov, Emil P.; Shibata, Darryl; Taylor, Clive

2011-01-01

The principle of tissue microfluidics and its resultant techniques has been applied to cell analysis. Building microfluidics to suit a particular tissue sample would allow the rapid, reliable, inexpensive, highly parallelized, selective extraction of chosen regions of tissue for purposes of further biochemical analysis. Furthermore, the applicability of the techniques ranges beyond the described pathology application. For example, they would also allow the posing and successful answering of new sets of questions in many areas of fundamental research. The proposed integration of microfluidic techniques and tissue slice samples is called "tissue microfluidics" because it molds the microfluidic architectures in accordance with each particular structure of each specific tissue sample. Thus, microfluidics can be built around the tissues, following the tissue structure, or alternatively, the microfluidics can be adapted to the specific geometry of particular tissues. By contrast, the traditional approach is that microfluidic devices are structured in accordance with engineering considerations, while the biological components in applied devices are forced to comply with these engineering presets.

Survey of immunoassay techniques for biological analysis

International Nuclear Information System (INIS)

Burtis, C.A.

1986-10-01

Immunoassay is a very specific, sensitive, and widely applicable analytical technique. Recent advances in genetic engineering have led to the development of monoclonal antibodies which further improves the specificity of immunoassays. Originally, radioisotopes were used to label the antigens and antibodies used in immunoassays. However, in the last decade, numerous types of immunoassays have been developed which utilize enzymes and fluorescent dyes as labels. Given the technical, safety, health, and disposal problems associated with using radioisotopes, immunoassays that utilize the enzyme and fluorescent labels are rapidly replacing those using radioisotope labels. These newer techniques are as sensitive, are easily automated, have stable reagents, and do not have a disposal problem. 6 refs., 1 fig., 2 tabs

Beyond coverage: improving the quality of antenatal care delivery through integrated mentorship and quality improvement at health centers in rural Rwanda.

Science.gov (United States)

Manzi, Anatole; Nyirazinyoye, Laetitia; Ntaganira, Joseph; Magge, Hema; Bigirimana, Evariste; Mukanzabikeshimana, Leoncie; Hirschhorn, Lisa R; Hedt-Gauthier, Bethany

2018-02-23

Inadequate antenatal care (ANC) can lead to missed diagnosis of danger signs or delayed referral to emergency obstetrical care, contributing to maternal mortality. In developing countries, ANC quality is often limited by skill and knowledge gaps of the health workforce. In 2011, the Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) program was implemented to strengthen providers' ANC performance at 21 rural health centers in Rwanda. We evaluated the effect of MESH-QI on the completeness of danger sign assessments. Completeness of danger sign assessments was measured by expert nurse mentors using standardized observation checklists. Checklists completed from October 2010 to May 2011 (n = 330) were used as baseline measurement and checklists completed between February and November 2012 (12-15 months after the start of MESH-QI implementation) were used for follow-up. We used a mixed-effects linear regression model to assess the effect of the MESH-QI intervention on the danger sign assessment score, controlling for potential confounders and the clustering of effect at the health center level. Complete assessment of all danger signs improved from 2.1% at baseline to 84.2% after MESH-QI (p ANC screening items. After controlling for potential confounders, the improvement in danger sign assessment score was significant. However, the effect of the MESH-QI was different by intervention district and type of observed ANC visit. In Southern Kayonza District, the increase in the danger sign assessment score was 6.28 (95% CI: 5.59, 6.98) for non-first ANC visits and 5.39 (95% CI: 4.62, 6.15) for first ANC visits. In Kirehe District, the increase in danger sign assessment score was 4.20 (95% CI: 3.59, 4.80) for non-first ANC visits and 3.30 (95% CI: 2.80, 3.81) for first ANC visits. Assessment of critical danger signs improved under MESH-QI, even when controlling for nurse-mentees' education level and previous training in focused ANC. MESH-QI

Factors influencing the long-term sustainment of quality improvements made in addiction treatment facilities: a qualitative study.

Science.gov (United States)

Stumbo, Scott P; Ford, James H; Green, Carla A

2017-11-01

A greater understanding of the factors that influence long-term sustainment of quality improvement (QI) initiatives is needed to promote organizational ability to sustain QI practices over time, help improve future interventions, and increase the value of QI investments. We approached 83 of 201 executive sponsors or change leaders at addiction treatment organizations that participated in the 2007-2009 NIATx200 QI intervention. We completed semi-structured interviews with 33 individuals between November 2015 and April 2016. NIATx200 goals were to decrease wait time, increase admissions and improve retention in treatment. Interviews sought to understand factors that either facilitated or impeded long-term sustainment of organizational QI practices made during the intervention. We used thematic analysis to organize the data and group patterns of responses. We assessed available quantitative outcome data and intervention engagement data to corroborate qualitative results. We used narrative analysis to group four important themes related to long-term sustainment of QI practices: (1) finding alignment between business- and client-centered practices; (2) staff engagement early in QI process added legitimacy which facilitated sustainment; (3) commitment to integrating data into monitoring practices and the identification of a data champion; and (4) adequate organizational human resources devoted to sustainment. We found four corollary factors among agencies which did not sustain practices: (1) lack of evidence of impact on business practices led to discontinuation; (2) disengaged staff and lack of organizational capacity during implementation period led to lack of sustainment; (3) no data integration into overall business practices and no identified data champion; and (4) high staff turnover. In addition, we found that many agencies' current use of NIATx methods and tools suggested a legacy effect that might improve quality elsewhere, even absent overall sustainment of

Evaluating the effectiveness of a tailored multifaceted performance feedback intervention to improve the quality of care: protocol for a cluster randomized trial in intensive care

Directory of Open Access Journals (Sweden)

Westert Gert P

2011-10-01

Full Text Available Abstract Background Feedback is potentially effective in improving the quality of care. However, merely sending reports is no guarantee that performance data are used as input for systematic quality improvement (QI. Therefore, we developed a multifaceted intervention tailored to prospectively analyzed barriers to using indicators: the Information Feedback on Quality Indicators (InFoQI program. This program aims to promote the use of performance indicator data as input for local systematic QI. We will conduct a study to assess the impact of the InFoQI program on patient outcome and organizational process measures of care, and to gain insight into barriers and success factors that affected the program's impact. The study will be executed in the context of intensive care. This paper presents the study's protocol. Methods/design We will conduct a cluster randomized controlled trial with intensive care units (ICUs in the Netherlands. We will include ICUs that submit indicator data to the Dutch National Intensive Care Evaluation (NICE quality registry and that agree to allocate at least one intensivist and one ICU nurse for implementation of the intervention. Eligible ICUs (clusters will be randomized to receive basic NICE registry feedback (control arm or to participate in the InFoQI program (intervention arm. The InFoQI program consists of comprehensive feedback, establishing a local, multidisciplinary QI team, and educational outreach visits. The primary outcome measures will be length of ICU stay and the proportion of shifts with a bed occupancy rate above 80%. We will also conduct a process evaluation involving ICUs in the intervention arm to investigate their actual exposure to and experiences with the InFoQI program. Discussion The results of this study will inform those involved in providing ICU care on the feasibility of a tailored multifaceted performance feedback intervention and its ability to accelerate systematic and local quality

Simultaneous estimation of QTL parameters for mapping multiple traits

Indian Academy of Sciences (India)

LIANG TONG

2018-03-13

XM ji ) denotes the conditional probability of the QTL genotype. X. ∗ ji (QiQi, Qiqi or ... random error of the ith trait value of the jth subject, with mean zero and ..... to adjust the conditional probabilities in table 1 when conducting ...

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A novel field transplantation technique reveals intra-specific metal-induced oxidative responses in strains of Ectocarpus siliculosus with different pollution histories

International Nuclear Information System (INIS)

Sáez, Claudio A.; González, Alberto; Contreras, Rodrigo A.; Moody, A. John; Moenne, Alejandra; Brown, Murray T.

2015-01-01

A novel field transplantation technique, in which seaweed material is incorporated into dialysis tubing, was used to investigate intra-specific responses to metals in the model brown alga Ectocarpus siliculosus. Metal accumulation in the two strains was similar, with higher concentrations in material deployed to the metal-contaminated site (Ventanas, Chile) than the pristine site (Quintay, Chile). However, the oxidative responses differed. At Ventanas, strain Es147 (from low-polluted site) underwent oxidative damage whereas Es524 (from highly polluted site) was not affected. Concentrations of reduced ascorbate (ASC) and reduced glutathione (GSH) were significantly higher in Es524. Activities of the antioxidant enzymes superoxide dismutase (SOD), ascorbate peroxidase (APX), catalase (CAT), and glutathione reductase (GR) all increased in Es524, whereas only SOD increased in Es147. For the first time, employing a field transplantation technique, we provide unambiguous evidence of inter-population variation of metal-tolerance in brown algae and establish that antioxidant defences are, in part, responsible. - Highlights: • Metal tolerance in Ectocarpus siliculosus populations was studied through in situ experiments. • Metal tolerance in E. siliculosus populations is partly based in antioxidant defences. • In situ experiments using a dialysis tubing device was successful for metal diagnosis. - Field transplantation experimentation provides evidence that differential antioxidant defences, in part, mediate inter-population tolerance to metal pollution in the model brown alga Ectocarpus siliculosus

Thermal property testing technique on micro specimen

International Nuclear Information System (INIS)

Baba, Tetsuya; Kishimoto, Isao; Taketoshi, Naoyuki

2000-01-01

This study aims at establishment of further development on some testing techniques on the nuclear advanced basic research accumulated by the National Research Laboratory of Metrology for ten years. For this purpose, a technology to test heat diffusion ratio and specific heat capacity of less than 3 mm in diameter and 1 mm in thickness of micro specimen and technology to test heat diffusion ratio at micro area of less than 1 mm in area along cross section of less than 10 mm in diameter of column specimen were developed to contribute to common basic technology supporting the nuclear power field. As a result, as an element technology to test heat diffusion ratio and specific heat capacity of the micro specimen, a specimen holding technique stably to hold a micro specimen with 3 mm in diameter could be developed. And, for testing the specific heat capacity by using the laser flush differential calorimetry, a technique to hold two specimen of 5 mm in diameter at their proximities was also developed. In addition, by promoting development of thermal property data base capable of storing thermal property data obtained in this study and with excellent workability in this 1998 fiscal year a data in/out-put program with graphical user interface could be prepared. (G.K.)

Prescribed Renoprotective Chinese Herbal Medicines Were Associated with a Lower Risk of All-Cause and Disease-Specific Mortality among Patients with Chronic Kidney Disease: A Population-Based Follow-Up Study in Taiwan

Directory of Open Access Journals (Sweden)

Chuan-Fa Hsieh

2017-01-01

Full Text Available Chinese herbal medicines (CHMs containing aristolochic acid (AA are associated with chronic kidney disease (CKD, but some prescribed CHMs have been shown to possess renoprotective effects. We conducted a nationwide retrospective cohort study to delineate the role of prescribed CHMs on the CKD progression. Renoprotective CHM (RPCHM was defined if a CHM contained dong chong xia cao (Cordyceps sinensis (Berk. Sacc., da huang (Rheum palmatum L, huang qi (Astragalus membranaceus, dan shen (Salvia miltiorrhiza Bge., and dong quai (Angelica sinensis (Oliv. Diels or belonged to specific mixture herbal formulations (Yishen capsule, Saireito, or Wen Pi Tang. Subjects who had ever used AA-containing CHMs, had cancer or HIV prior to CKD diagnosis, or died within the first month of CKD diagnosis were excluded. A total of 11,625 patients were eligible subjects. The adjusted hazard ratio (aHR for all-cause mortality was 0.6 (p < 0.001 and 0.6 (p = 0.013 among subjects receiving RPCHMs containing Angelica sinensis and those receiving other RPCHMs, respectively. For CKD-related mortality, the aHR among subjects receiving RPCHMs containing Angelica sinensis was 0.6 (p = 0.025. The use of specific RPCHMs, especially those that contained Angelica sinensis, was associated with a lower risk of mortality among CKD patients.

Biomechanical aspects of new techniques in alpine skiing and ski-jumping.

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Müller, Erich; Schwameder, Hermann

2003-09-01

There have been considerable changes in equipment design and movement patterns in the past few years both in alpine skiing and ski-jumping. These developments have been matched by methods of analysing movements in field conditions. They have yielded new insights into the skills of these specific winter sports. Analytical techniques have included electromyography, kinetic and kinematic methods and computer simulations. Our aim here is to review biomechanical research in alpine skiing and ski-jumping. We present in detail the techniques currently used in alpine skiing (carving technique) and ski-jumping (V-technique), primarily using data from the authors' own research. Finally, we present a summary of the most important results in biomechanical research both in alpine skiing and ski-jumping. This includes an analysis of specific conditions in alpine skiing (type of turn, terrain, snow, speed, etc.) and the effects of equipment, materials and individual-specific abilities on performance, safety and joint loading in ski-jumping.

Competition in collaborative clothing: a qualitative case study of influences on collaborative quality improvement in the ICU.

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Dainty, Katie N; Scales, Damon C; Sinuff, Tasnim; Zwarenstein, Merrick

2013-04-01

Multiorganisational quality improvement (QI) collaborative networks are promoted for improving quality within healthcare. Recently, several large-scale QI initiatives have been conducted in the intensive care unit (ICU) environment with successful quantitative results. However, the mechanisms through which such networks lead to QI success remain uncertain. We aim to understand ICU staff perspectives on collaborative QI based on involvement in a multiorganisational improvement network and hypothesise about theoretical constructs that might explain the effect of collaboration in such networks. Qualitative study using a modified grounded theory approach. Key informant interviews were conducted with staff from 12 community hospital ICUs that participated in a cluster randomized control trial (RCT) of a QI intervention using a collaborative approach between 2006 and 2008. Data analysis followed the standard procedure for grounded theory using constant comparative methodology. The collaborative network was perceived to promote increased intrateam cooperation over interorganisational cooperation, but friendly competition with other ICUs appeared to be a prominent driver of behaviour change. Bedsides, clinicians reported that belonging to a collaborative network provided recognition for the high-quality patient care that they already provided. However, the existing communication structure was perceived to be ineffective for staff engagement since it was based on a hierarchical approach to knowledge transfer and project awareness. QI collaborative networks may promote behaviour change by improving intrateam communication, fostering competition with other institutions, and increasing recognition for providing high-quality care. Other commonly held assumptions about their potential impact, for instance, increasing interorganisational legitimisation, communication and collaboration, may be less important.

Developing a caries risk registry to support caries risk assessment and management for children: A quality improvement initiative.

Science.gov (United States)

Ruff, Jesley C; Herndon, Jill Boylston; Horton, Roger A; Lynch, Julie; Mathwig, Dawn C; Leonard, Audra; Aravamudhan, Krishna

2017-10-27

Health registries are commonly used in medicine to support public health activities and are increasingly used in quality improvement (QI) initiatives. Illustrations of dental registries and their QI applications are lacking. Within dentistry, caries risk assessment implementation and documentation are vital to optimal patient care. The purpose of this article is to describe the processes used to develop a caries risk assessment registry as a QI initiative to support clinical caries risk assessment, caries prevention, and disease management for children. Developmental steps reflected Agency for Healthcare Research and Quality recommendations for planning QI registries and included engaging "champions," defining the project, identifying registry features, defining performance dashboard indicators, and pilot testing with participant feedback. We followed Standards for Quality Improvement Reporting Excellence guidelines. Registry eligibility is patients aged 0-17 years. QI tools include prompts to register eligible patients; decision support tools grounded in evidence-based guidelines; and performance dashboard reports delivered at the provider and aggregated levels at regular intervals. The registry was successfully piloted in two practices with documented caries risk assessment increasing from 57 percent to 92 percent and positive feedback regarding the potential to improve dental practice patient centeredness, patient engagement and education, and quality of care. The caries risk assessment registry demonstrates how dental registries may be used in QI efforts to promote joint patient and provider engagement, foster shared decision making, and systematically collect patient information to generate timely and actionable data to improve care quality and patient outcomes at the individual and population levels. © 2017 American Association of Public Health Dentistry.

Improving Tanzanian childbirth service quality.

Science.gov (United States)

Jaribu, Jennie; Penfold, Suzanne; Green, Cathy; Manzi, Fatuma; Schellenberg, Joanna

2018-04-16

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

Is immunotherapy-induced birch-pollen-specific IgG4 a marker for decreased allergen-specific sensitivity?

DEFF Research Database (Denmark)

Bodtger, U; Ejrnaes, A M; Hummelshoj, L

2005-01-01

The role of IgG4 during allergen-specific immunotherapy (SIT) is still controversial. The available studies present paramount differences in in vitro techniques, allergens, and clinical outcome parameters. By implementing a sensitive method, and pivotal clinical outcome parameters, we wanted to a...

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Interventional neuroradiology techniques in interventional radiology

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Murphy, Kieran; Robertson, Fergus; Watkinson, Anthony

2013-01-01

This book provides accessible technique-specific information on interventional radiology procedures, in a format suitable for reference in the IR treatment room or as a carry-around guide. Offers step-by-step points, key point summaries and illustrations.

Research and quality improvement experience and knowledge: a nursing survey.

Science.gov (United States)

Fox, Jolene; Bagley, Lisa; Day, Suzanne; Holleran, Renee; Handrahan, Diana

2011-07-01

To assess nursing staff's background and research and quality improvement (QI) experience. In this corporation, participation in research and QI is encouraged, but little is known about nurses' experiences. A web-based survey was distributed. Nursing staffs from an academic/teaching medical centre and other intra-corporation non-academic facilities were compared. Respondents included: 148 (52.9%) medical centre and 132 (47.1%) non-medical centre subjects. Medical centre respondents had a higher proportion previously engaged in research, currently engaged in research and previously engaged in QI. Productivity (grant, published and presented) was low for both groups but statistically lower for the non-medical centre group. Medical centre employees used research resources more often than the non-medical centre. Time was the most frequently mentioned barrier to participation in research and QI initiatives. A moderate proportion of respondents had research and QI experience, yet productivity and use of resources was low. Nurses at non-academically focused facilities were in most need of assistance. Familiarizing nurses with resources and providing protected time may increase productivity. Developing an infrastructure to support nursing research is a worthy goal. Information about interest and experience of nurses can aid management in determining how to focus financial resources. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change.

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McAlearney, Ann Scheck; Terris, Darcey; Hardacre, Jeanne; Spurgeon, Peter; Brown, Claire; Baumgart, Andre; Nyström, Monica E

2014-01-01

We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

Methods and Techniques for the Design and Implementation of Domain-Specific Languages

NARCIS (Netherlands)

Hemel, Z.

2012-01-01

Domain-Specific Languages (DSLs) are programming language aimed at a particular problem domain, e.g. banking, database querying or website page lay-outs. Through the use of high-level concepts, a DSL raises the level of abstraction and expressive power of the programmer, and reduces the size of

Do family physicians need more payment for working better? Financial incentives in primary care.

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Kolozsvári, László Róbert; Orozco-Beltran, Domingo; Rurik, Imre

2014-05-01

Financial incentives are widely used in health services to improve the quality of care or to reach some specific targets. Pay for performance systems were also introduced in the primary health care systems of many European countries. Our study aims to describe and compare recent existing primary care indicators and related financing in European countries. Literature search was performed and questionnaires were sent to primary care experts of different countries within the European General Practice Research Network. Ten countries have published primary care quality indicators (QI) associated with financial incentives. The number of QI varies from 1 to 134 and can modify the finances of physicians with up to 25% of their total income. The implementations of these schemes should be critically evaluated with continuous monitoring at national or regional level; comparison is required between targets and their achievements, health gains and use of resources as well. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Quality Improvement Initiatives in Inflammatory Bowel Disease.

Science.gov (United States)

Berry, Sameer K; Siegel, Corey A; Melmed, Gil Y

2017-08-01

This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD). IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs-all consistent with "the triple aim" put forth by the Institute for Healthcare Improvement (IHI). Current QI initiatives include the development of quality measure sets to standardize processes and outcomes, learning health systems to foster collaborative improvement, and patient-centered medical homes specific to patients with IBD in shared risk models of care. Some of these programs have demonstrated early success in improving patient outcomes, reducing costs, improving patient satisfaction, and facilitating patient engagement. However, further studies are needed to evaluate and compare the effects of these programs over time on clinical outcomes in order to demonstrate long-term value and sustainability.

Design, Manufacturing, and In Vitro Testing of a Patient-Specific Shape-Memory Expander for Nose Reconstruction With Forehead Flap Technique.

Science.gov (United States)

Borghi, Alessandro; Rodgers, Will; Schievano, Silvia; Ponniah, Allan; O'Hara, Justine; Jeelani, Owase; Dunaway, David

2016-01-01

Forehead skin is widely acknowledged as a good donor site for total nasal reconstruction, thanks to its matching color, texture, and abundant vascularity. The forehead flap technique uses an axial pattern flap forehead skin to replace missing nasal tissue. To increase the amount of available tissue and reduce the size of the tissue defect after flap mobilization, tissue expanders may be used. Although this is a relatively established technique, limitations include reduced moldability of the forehead skin (which is thicker than the nasal skin), and the need for multiple sessions of expansion to achieve a sufficient yield to close the forehead.Shape-memory metals, such as nitinol, can be programmed to "remember" complex shapes. In this work, the methodology for producing a prototype of nitinol tissue expander able to mold the skin in a predetermined patient-specific skin shape is described. A realistic nose mold was manufactured using metal rapid prototyping; nitinol sheet and mesh were molded into nose-shape constructs, having hyperelastic as well as shape-memory capability. Computed tomography scanning was performed to assess the ability of the structure to regain its shape after phase transformation upon cooling within 2% of initial dimensions. The prototypes were implanted in a pig forehead to test its ability to impose a nose shape to the forehead skin.The shape-memory properties of nitinol offer the possibility of producing bespoke tissue expanders able to deliver complex, precisely designed skin envelopes. The hyperelastic properties of nitinol allow constant preprogrammed expansion forces to be generated throughout the expansion process.

Anatomic partial nephrectomy: technique evolution.

Science.gov (United States)

Azhar, Raed A; Metcalfe, Charles; Gill, Inderbir S

2015-03-01

Partial nephrectomy provides equivalent long-term oncologic and superior functional outcomes as radical nephrectomy for T1a renal masses. Herein, we review the various vascular clamping techniques employed during minimally invasive partial nephrectomy, describe the evolution of our partial nephrectomy technique and provide an update on contemporary thinking about the impact of ischemia on renal function. Recently, partial nephrectomy surgical technique has shifted away from main artery clamping and towards minimizing/eliminating global renal ischemia during partial nephrectomy. Supported by high-fidelity three-dimensional imaging, novel anatomic-based partial nephrectomy techniques have recently been developed, wherein partial nephrectomy can now be performed with segmental, minimal or zero global ischemia to the renal remnant. Sequential innovations have included early unclamping, segmental clamping, super-selective clamping and now culminating in anatomic zero-ischemia surgery. By eliminating 'under-the-gun' time pressure of ischemia for the surgeon, these techniques allow an unhurried, tightly contoured tumour excision with point-specific sutured haemostasis. Recent data indicate that zero-ischemia partial nephrectomy may provide better functional outcomes by minimizing/eliminating global ischemia and preserving greater vascularized kidney volume. Contemporary partial nephrectomy includes a spectrum of surgical techniques ranging from conventional-clamped to novel zero-ischemia approaches. Technique selection should be tailored to each individual case on the basis of tumour characteristics, surgical feasibility, surgeon experience, patient demographics and baseline renal function.

Patient-reported quality indicators for osteoarthritis: a patient and public generated self-report measure for primary care.

Science.gov (United States)

Blackburn, Steven; Higginbottom, Adele; Taylor, Robert; Bird, Jo; Østerås, Nina; Hagen, Kåre Birger; Edwards, John J; Jordan, Kelvin P; Jinks, Clare; Dziedzic, Krysia

2016-01-01

People with osteoarthritis desire high quality care, support and information. However, the quality of care for people with OA in general practice is not routinely collected. Quality Indicators can be used to benefit patients by measuring whether minimum standards of quality care are being met from a patient perspective. The aim of this study was to describe how a Research User Group (RUG) worked alongside researchers to co-produce a set of self-reported quality indicators for people with osteoarthritis when visiting their general practitioner or practice nurse (primary care). These were required in the MOSAICS study, which developed and evaluated a new model of supported self-management of OA to implement the NICE quality standards for OA. This article describes the public involvement in the MOSAICS study. This was 1) the co-development by RUG members and researchers of an Osteoarthritis Quality Indicators United Kingdom (OA QI (UK)) questionnaire for use in primary care, and 2) the comparison of the OA QI (UK) with a similar questionnaire developed in Norway. This study shows how important and effective a research user group can be in working with researchers in developing quality care indicators for osteoarthritis for use in a research study and, potentially, routine use in primary care. The questionnaire is intended to benefit patients by enabling the assessment of the quality of primary care for osteoarthritis from a patient's perspective. The OA QI (UK) has been used to examine differences in the quality of osteoarthritis care in four European countries. Background People with osteoarthritis (OA) desire high quality care, support and information about OA. However, the quality of care for people with OA in general practice is not routinely collected. Quality Indicators (QI) can be used to benefit patients by measuring whether minimum standards of quality care (e.g. NICE quality standards) are being met from a patient perspective. A Research User Group (RUG

Graduating the age-specific fertility pattern using Support Vector Machines

Directory of Open Access Journals (Sweden)

Anastasia Kostaki

2009-06-01

Full Text Available A topic of interest in demographic literature is the graduation of the age-specific fertility pattern. A standard graduation technique extensively used by demographers is to fit parametric models that accurately reproduce it. Non-parametric statistical methodology might be alternatively used for this graduation purpose. Support Vector Machines (SVM is a non-parametric methodology that could be utilized for fertility graduation purposes. This paper evaluates the SVM techniques as tools for graduating fertility rates In that we apply these techniques to empirical age specific fertility rates from a variety of populations, time period, and cohorts. Additionally, for comparison reasons we also fit known parametric models to the same empirical data sets.

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Investigation of the sequential validity of quality improvement team ...

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Background: Self-assessment is widely used in the health care improvement collaboratives quality improvement (QI) teams' to assess their own performance. There is mixed evidence on the validity of this approach. This study investigated sequential validity of self-assessments in a QI HIV collaborative in Tanzania.

Journal of Genetics | Indian Academy of Sciences

Indian Academy of Sciences (India)

Home; Journals; Journal of Genetics. SHUWU QI. Articles written in Journal of Genetics. Volume 96 Issue 4 September 2017 pp 695-700 RESEARCH NOTE. Clinical and genetic characterization of six cases with complete androgen insensitivity syndrome in China · JING HE SHUWU QI HUIJUN ZHANG JINGJING GUO ...

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Science.gov (United States)

2013-04-18

.... Logistics, Inc. dba BE Logistics dba Belogistics dba Core Logistics (NVO), 12911 Simms Avenue, Hawthorn, CA... (QI), Kevin L. Miller, Secretary, Application Type: QI Change Triple Eagle Logistics Inc. dba Triple Eagle Logistic Canada Inc. (NVO & OFF), 17890 Castleton Street, Suite 367, City of Industry, CA 91748...

75 FR 66099 - Ocean Transportation Intermediary License Applicants

Science.gov (United States)

2010-10-27

... Logistics, Inc. (NVO), 17890 Castleton Street, Suite 398, City of Industry, CA 91748, Officers: Jennifer X... (Qualifying Individual), Application Type: QI Change. Concert Group Logistics, Inc. (NVO & OFF), 1430 Branding... Individual), Daniel Para, CEO, Application Type: QI Change. De Well Logistics LLC dba De Well Logistics, dba...

75 FR 60124 - Ocean Transportation Intermediary License Applicants

Science.gov (United States)

2010-09-29

... Individual), Sharlene Chesnes, EVP/COB/EVP/Secretary, Application Type: QI Change IAL Container Line (USA..., Vice President (Qualifying Individual), Arjun Menon, Director, Application Type: QI Change LTA Import & Export, Inc. (NVO & OFF), 14331 SW 120th Street, 203, Miami, FL 33186, Officers: Eric E. Diaz, Director...

77 FR 76483 - Ocean Transportation Intermediary License Applicants The Commission gives notice that the...

Science.gov (United States)

2012-12-28

... Transport Co., PAC International Logistics Company, & Book Express Network. Stealth Logistics LLC (NVO & OFF.... Application Type: QI Change. Efrinsa Global Logistics Inc. (NVO & OFF), 8441 NW 68th Street, Miami, FL 33166... (QI), Sheila E. Lawrence, President. Application Type: New OFF License. MMC Logistics, LLC (OFF), 2853...

78 FR 28845 - Ocean Transportation Intermediary License Applicants

Science.gov (United States)

2013-05-16

..., President, Application Type: QI Change Contract Logistics, LLC (NVO), 4911 North Portland Avenue, Suite 200..., Application Type: Add Trade Name Smart Lines Worldwide Feiliks Global Logistics Corporation (NVO), 176-20 S..., Director, Application Type: QI Change Intermodal Tank Transport (USA), Inc. (NVO), 2537 S. Gessner, Suite...

Quality Index Method (QIM) scheme developed for farmed Atlantic salmon ( Salmo salar )

DEFF Research Database (Denmark)

Sveinsdóttir, K.; Hyldig, Grethe; Martinsdóttir, E.

2003-01-01

The aim of the study was to develop 'Quality Index Method (QIM) scheme for raw, farmed Atlantic salmon (Salmo salar) and to evaluate the scheme. in a shelf life study. QIM is based on the evaluation of key parameters in the deterioration of seafood's. Demerit points are assigned to selected...... parameters according to their importance and a Quality Index (QI) is established by cumulating the resulting scores. The maximum storage time in ice was determined with Quantitative Descriptive Analysis (QDA) of the salmon after cooking and found to be 20-21 days. This was used as a reference to enable...... prediction of the remaining storage time of raw salmon in ice with QIM. The calculated QI evolved linearly with storage time in ice (QI=0.82x (days in ice)+0.18, R-2=0.97). Individual salmon varied in QI within each storage day. However, the multivariate analysis (PLS1) demonstrated that storage time could...

Physician Perceptions of Performance Feedback in a Quality Improvement Activity.

Science.gov (United States)

Eden, Aimee R; Hansen, Elizabeth; Hagen, Michael D; Peterson, Lars E

2017-10-01

Physician performance and peer comparison feedback can affect physician care quality and patient outcomes. This study aimed to understand family physician perspectives of the value of performance feedback in quality improvement (QI) activities. This study analyzed American Board of Family Medicine open-ended survey data collected between 2004 and 2014 from physicians who completed a QI module that provided pre- and post-QI project individual performance data and peer comparisons. Physicians made 3480 comments in response to a question about this performance feedback, which were generally positive in nature (86%). Main themes that emerged were importance of accurate feedback data, enhanced detail in the content of feedback, and ability to customize peer comparison groups to compare performance to peers with similar patient populations or practice characteristics. Meaningful and tailored performance feedback may be an important tool for physicians to improve their care quality and should be considered an integral part of QI project design.

The Role of Higher Education in National Quality Infrastructure Policy-Making

Directory of Open Access Journals (Sweden)

Jelena Ruso

2017-05-01

Full Text Available The aim of the paper is to raise awareness of the importance of the policy makers’ knowledge and expertise about quality infrastructure (QI for the successful policy-making. This article, which addresses the role of higher education in Serbian quality infrastructure policy-making, is an analysis of QI related contents of higher education institution curriculum. The target institutions are public faculties from whose official websites the data were collected. Depending on the keywords, the analysis was performed in order to classify the faculties into three categories. After reviewing the 307 subject titles and descriptions of undergraduate courses, the results show that the concepts of QI are widely recognized as an important and popular topic. The analysis of the QI adoption and diffusion indicates that although some of the faculties might be ‘leaders’ in a particular dimension, they still do not necessarily fall into the ‘leader’ category. JEL Classification:I21, I23, H54, L15

Tai Chi and Qi Gong

Science.gov (United States)

... of Grants and Contracts General Award Mechanisms Small Business Research Grant Program (SBIR) Funding for: Natural Product Research ... tai chi and qigong in older adults. Western Journal of Nursing Research. 2009;31(2):245–279. Saeed SA, Antonacci ...

Patient perspectives: Kundalini yoga meditation techniques for psycho-oncology and as potential therapies for cancer.

Science.gov (United States)

Shannahoff-Khalsa, David S

2005-03-01

The ancient system of Kundalini Yoga (KY) includes a vast array of meditation techniques. Some were discovered to be specific for treating psychiatric disorders and others are supposedly beneficial for treating cancers. To date, 2 clinical trials have been conducted for treating obsessive-compulsive disorder (OCD). The first was an open uncontrolled trial and the second a single-blinded randomized controlled trial (RCT) comparing a KY protocol against the Relaxation Response and Mindfulness Meditation (RRMM) techniques combined. Both trials showed efficacy on all psychological scales using the KY protocol; however, the RCT showed no efficacy on any scale with the RRMM control group. The KY protocol employed an OCD-specific meditation technique combined with other techniques that are individually specific for anxiety, low energy, fear, anger, meeting mental challenges, and turning negative thoughts into positive thoughts. In addition to OCD symptoms, other symptoms, including anxiety and depression, were also significantly reduced. Elements of the KY protocol other than the OCD-specific technique also may have applications for psycho-oncology patients and are described here. Two depression-specific KY techniques are described that also help combat mental fatigue and low energy. A 7-part protocol is described that would be used in KY practice to affect the full spectrum of emotions and distress that complicate a cancer diagnosis. In addition, there are KY techniques that practitioners have used in treating cancer. These techniques have not yet been subjected to formal clinical trials but are described here as potential adjunctive therapies. A case history demonstrating rapid onset of acute relief of intense fear in a terminal breast cancer patient using a KY technique specific for fear is presented. A second case history is reported for a surviving male diagnosed in 1988 with terminal prostate cancer who has used KY therapy long term as part of a self

Methods for Estimation of Radiation Risk in Epidemiological Studies Accounting for Classical and Berkson Errors in Doses

KAUST Repository

Kukush, Alexander

2011-01-16

With a binary response Y, the dose-response model under consideration is logistic in flavor with pr(Y=1 | D) = R (1+R)(-1), R = λ(0) + EAR D, where λ(0) is the baseline incidence rate and EAR is the excess absolute risk per gray. The calculated thyroid dose of a person i is expressed as Dimes=fiQi(mes)/Mi(mes). Here, Qi(mes) is the measured content of radioiodine in the thyroid gland of person i at time t(mes), Mi(mes) is the estimate of the thyroid mass, and f(i) is the normalizing multiplier. The Q(i) and M(i) are measured with multiplicative errors Vi(Q) and ViM, so that Qi(mes)=Qi(tr)Vi(Q) (this is classical measurement error model) and Mi(tr)=Mi(mes)Vi(M) (this is Berkson measurement error model). Here, Qi(tr) is the true content of radioactivity in the thyroid gland, and Mi(tr) is the true value of the thyroid mass. The error in f(i) is much smaller than the errors in ( Qi(mes), Mi(mes)) and ignored in the analysis. By means of Parametric Full Maximum Likelihood and Regression Calibration (under the assumption that the data set of true doses has lognormal distribution), Nonparametric Full Maximum Likelihood, Nonparametric Regression Calibration, and by properly tuned SIMEX method we study the influence of measurement errors in thyroid dose on the estimates of λ(0) and EAR. The simulation study is presented based on a real sample from the epidemiological studies. The doses were reconstructed in the framework of the Ukrainian-American project on the investigation of Post-Chernobyl thyroid cancers in Ukraine, and the underlying subpolulation was artificially enlarged in order to increase the statistical power. The true risk parameters were given by the values to earlier epidemiological studies, and then the binary response was simulated according to the dose-response model.

Effectiveness of teaching quality improvement to clinicians: a systematic review.

Science.gov (United States)

Boonyasai, Romsai T; Windish, Donna M; Chakraborti, Chayan; Feldman, Leonard S; Rubin, Haya R; Bass, Eric B

2007-09-05

Accreditation requirements mandate teaching quality improvement (QI) concepts to medical trainees, yet little is known about the effectiveness of teaching QI. To perform a systematic review of the effectiveness of published QI curricula for clinicians and to determine whether teaching methods influence the effectiveness of such curricula. The electronic literature databases of MEDLINE, EMBASE, CINAHL, and ERIC were searched for English-language articles published between January 1, 1980, and April 30, 2007. Experts in the field of QI were queried about relevant studies. Two independent reviewers selected studies for inclusion if the curriculum taught QI principles to clinicians and the evaluation used a comparative study design. Information about the features of each curriculum, its use of 9 principles of adult learning, and the type of educational and clinical outcomes were extracted. The relationship between the outcomes and the number of educational principles used was assessed. Of 39 studies that met eligibility criteria, 31 described team-based projects; 37 combined didactic instruction with experiential learning. The median number of adult learning principles used was 7 (range, 2-8). Evaluations included 22 controlled trials (8 randomized and 14 nonrandomized) and 17 pre/post or time series studies. Fourteen studies described educational outcomes (attitudes, knowledge, or skills or behaviors) and 28 studies described clinical process or patient outcomes. Nine of the 10 studies that evaluated knowledge reported only positive effects but only 2 of these described a validated assessment tool. The 6 assessments of attitudes found mixed results. Four of the 6 studies on skill or behavior outcomes reported only positive effects. Eight of the 28 studies of clinical outcomes reported only beneficial effects. Controlled studies were more likely than other studies to report mixed or null effects. Only 4 studies evaluated both educational and clinical outcomes

Methods for estimation of radiation risk in epidemiological studies accounting for classical and Berkson errors in doses.

Science.gov (United States)

Kukush, Alexander; Shklyar, Sergiy; Masiuk, Sergii; Likhtarov, Illya; Kovgan, Lina; Carroll, Raymond J; Bouville, Andre

2011-02-16

With a binary response Y, the dose-response model under consideration is logistic in flavor with pr(Y=1 | D) = R (1+R)(-1), R = λ(0) + EAR D, where λ(0) is the baseline incidence rate and EAR is the excess absolute risk per gray. The calculated thyroid dose of a person i is expressed as Dimes=fiQi(mes)/Mi(mes). Here, Qi(mes) is the measured content of radioiodine in the thyroid gland of person i at time t(mes), Mi(mes) is the estimate of the thyroid mass, and f(i) is the normalizing multiplier. The Q(i) and M(i) are measured with multiplicative errors Vi(Q) and ViM, so that Qi(mes)=Qi(tr)Vi(Q) (this is classical measurement error model) and Mi(tr)=Mi(mes)Vi(M) (this is Berkson measurement error model). Here, Qi(tr) is the true content of radioactivity in the thyroid gland, and Mi(tr) is the true value of the thyroid mass. The error in f(i) is much smaller than the errors in ( Qi(mes), Mi(mes)) and ignored in the analysis. By means of Parametric Full Maximum Likelihood and Regression Calibration (under the assumption that the data set of true doses has lognormal distribution), Nonparametric Full Maximum Likelihood, Nonparametric Regression Calibration, and by properly tuned SIMEX method we study the influence of measurement errors in thyroid dose on the estimates of λ(0) and EAR. The simulation study is presented based on a real sample from the epidemiological studies. The doses were reconstructed in the framework of the Ukrainian-American project on the investigation of Post-Chernobyl thyroid cancers in Ukraine, and the underlying subpolulation was artificially enlarged in order to increase the statistical power. The true risk parameters were given by the values to earlier epidemiological studies, and then the binary response was simulated according to the dose-response model.

Advanced imaging techniques in pediatric body MRI

Energy Technology Data Exchange (ETDEWEB)

Courtier, Jesse [UCSF Benioff Children' s Hospital, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Rao, Anil G. [Medical University of South Carolina, Department of Radiology, Charleston, SC (United States); Anupindi, Sudha A. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

2017-05-15

While there are many challenges specific to pediatric abdomino-pelvic MRI, many recent advances are addressing these challenges. It is therefore essential for radiologists to be familiar with the latest advances in MR imaging. Laudable efforts have also recently been implemented in many centers to improve the overall experience of pediatric patients, including the use of dedicated radiology child life specialists, MRI video goggles, and improved MR suite environments. These efforts have allowed a larger number of children to be scanned while awake, with fewer studies being done under sedation or anesthesia; this has resulted in additional challenges from patient motion and difficulties with breath-holding and tolerating longer scan times. In this review, we highlight common challenges faced in imaging the pediatric abdomen and pelvis and discuss the application of the newest techniques to address these challenges. Additionally, we highlight the newest advances in quantified imaging techniques, specifically in MR liver iron quantification. The techniques described in this review are all commercially available and can be readily implemented. (orig.)

E-learning systems intelligent techniques for personalization

CERN Document Server

Klašnja-Milićević, Aleksandra; Ivanović, Mirjana; Budimac, Zoran; Jain, Lakhmi C

2017-01-01

This monograph provides a comprehensive research review of intelligent techniques for personalisation of e-learning systems. Special emphasis is given to intelligent tutoring systems as a particular class of e-learning systems, which support and improve the learning and teaching of domain-specific knowledge. A new approach to perform effective personalization based on Semantic web technologies achieved in a tutoring system is presented. This approach incorporates a recommender system based on collaborative tagging techniques that adapts to the interests and level of students' knowledge. These innovations are important contributions of this monograph. Theoretical models and techniques are illustrated on a real personalised tutoring system for teaching Java programming language. The monograph is directed to, students and researchers interested in the e-learning and personalization techniques. .

Immunological diagnosis of human hydatid cyst using Western immunoblotting technique

Directory of Open Access Journals (Sweden)

Mahboubeh Hadipour

2016-01-01

Full Text Available Background: Echinococcosis is a parasitic disease with worldwide distribution which is caused by the tapeworms Echinococcus granulosus. Diagnosis of the disease relies on imaging techniques, but the techniques are not able to differentiate the cyst from benign or malignant tumors; hence, appropriate serologic methods are required for the differential diagnosis of the infection. Materials and Methods: In this investigation, different sheep hydatid cyst antigens probed with thirty sera of patients with hydatid cyst and also thirty human normal sera using Western immunoblotting technique. Considering results of surgery as gold standard, sensitivity and specificity of Western blotting was estimated. Results: Sera of 29, 26, and 16 patients with hydatid cyst reacted with specific bands of hydatid cyst fluid (HCF, protoscolex crude antigen, and cyst wall crude antigen, respectively. However, none of the normal human sera reacted with those specific bands. Conclusion: A 20 kDa band of sheep HCF is an appropriate antigen for serodiagnosis of hydatid cyst infection.

Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre

DEFF Research Database (Denmark)

Hollesen, Rikke von Benzon; Johansen, Rie Laurine Rosenthal; Rørbye, Christina

2018-01-01

with a peer when using an oxytocin infusion and the use of a checklist before vacuum extractions. CONCLUSION: This QI project illustrates how aspects of patient safety, such as the prevention of asphyxia, can be improved using QI methods to more reliably implement best practice, even in high...

An Evaluation of the Technical Adequacy of a Revised Measure of Quality Indicators of Transition

Science.gov (United States)

Morningstar, Mary E.; Lee, Hyunjoo; Lattin, Dana L.; Murray, Angela K.

2016-01-01

This study confirmed the reliability and validity of the Quality Indicators of Exemplary Transition Programs Needs Assessment-2 (QI-2). Quality transition program indicators were identified through a systematic synthesis of transition research, policies, and program evaluation measures. To verify reliability and validity of the QI-2, we…

Evaluation of Inhaler Techniques Among Asthma Patients Seen in ...

African Journals Online (AJOL)

Background: An Adequate and an effective dose of inhalation drugs can be administered only if the correct inhaler‑specific technique is followed by asthma patients. There is paucity of data on this subject among Nigerians and Africans. Aims: This observational study was to assess the inhaler techniques among asthma ...

Slicing AADL specifications for model checking

NARCIS (Netherlands)

Odenbrett, M.R.; Nguyen, V.Y.; Noll, T.

2010-01-01

To combat the state-space explosion problem in model checking larger systems, abstraction techniques can be employed. Here, methods that operate on the system specification before constructing its state space are preferable to those that try to minimize the resulting transition system as they

Using an online quiz-based reinforcement system to teach healthcare quality and patient safety and care transitions at the University of California.

Science.gov (United States)

Shaikh, Ulfat; Afsar-Manesh, Nasim; Amin, Alpesh N; Clay, Brian; Ranji, Sumant R

2017-10-01

Implementing quality improvement (QI) education during clinical training is challenging due to time constraints and inadequate faculty development in these areas. Quiz-based reinforcement systems show promise in fostering active engagement, collaboration, healthy competition and real-time formative feedback, although further research on their effectiveness is required. An online quiz-based reinforcement system to increase resident and faculty knowledge in QI, patient safety and care transitions. Experts in QI and educational assessment at the 5 University of California medical campuses developed a course comprised of 3 quizzes on Introduction to QI, Patient Safety and Care Transitions. Each quiz contained 20 questions and utilized an online educational quiz-based reinforcement system that leveraged spaced learning. Approximately 500 learners completed the course (completion rate 66-86%). Knowledge acquisition scores for all quizzes increased after completion: Introduction to QI (35-73%), Patient Safety (58-95%), and Care Transitions (66-90%). Learners reported that the quiz-based system was an effective teaching modality and preferred this type of education to classroom-based lectures. Suggestions for improvement included reducing frequency of presentation of questions and utilizing more questions that test learners on application of knowledge instead of knowledge acquisition. A multi-campus online quiz-based reinforcement system to train residents in QI, patient safety and care transitions was feasible, acceptable, and increased knowledge. The course may be best utilized to supplement classroom-based and experiential curricula, along with increased attention to optimizing frequency of presentation of questions and enhancing application skills. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Achieving and sustaining automated health data linkages for learning systems: barriers and solutions.

Science.gov (United States)

Van Eaton, Erik G; Devlin, Allison B; Devine, Emily Beth; Flum, David R; Tarczy-Hornoch, Peter

2014-01-01

Delivering more appropriate, safer, and highly effective health care is the goal of a learning health care system. The Agency for Healthcare Research and Quality (AHRQ) funded enhanced registry projects: (1) to create and analyze valid data for comparative effectiveness research (CER); and (2) to enhance the ability to monitor and advance clinical quality improvement (QI). This case report describes barriers and solutions from one state-wide enhanced registry project. The Comparative Effectiveness Research and Translation Network (CERTAIN) deployed the commercially available Amalga Unified Intelligence System™ (Amalga) as a central data repository to enhance an existing QI registry (the Automation Project). An eight-step implementation process included hospital recruitment, technical electronic health record (EHR) review, hospital-specific interface planning, data ingestion, and validation. Data ownership and security protocols were established, along with formal methods to separate data management for QI purposes and research purposes. Sustainability would come from lowered chart review costs and the hospital's desire to invest in the infrastructure after trying it. CERTAIN approached 19 hospitals in Washington State operating within 12 unaffiliated health care systems for the Automation Project. Five of the 19 completed all implementation steps. Four hospitals did not participate due to lack of perceived institutional value. Ten hospitals did not participate because their information technology (IT) departments were oversubscribed (e.g., too busy with Meaningful Use upgrades). One organization representing 22 additional hospitals expressed interest, but was unable to overcome data governance barriers in time. Questions about data use for QI versus research were resolved in a widely adopted project framework. Hospitals restricted data delivery to a subset of patients, introducing substantial technical challenges. Overcoming challenges of idiosyncratic EHR

Analysis of the phonon surface specific heat using Green function techniques

International Nuclear Information System (INIS)

Silva Carrico, A. da; Albuquerque, E.L. de

1981-01-01

Green functions are derived for the displacement associated with acoustic vibrations in isotropic elastic media and used to evaluate the surface specific heat in the harmonic approximation. Only the low-temperature limit case is considered since, provided K sub(B) T/h is very small, the dispersion relation for the three acoustic branches can be replaced by its long-wavelenght form. The contributions of surface elastic waves of the Rayleigh and Love types are pointed out and their features discussed. The nature of the result and their relations to previous work in this field is also presented and discussed. (Author) [pt

Analysis of the phonon surface specific heat using Green function techniques

International Nuclear Information System (INIS)

Carrico, A.S.; Albuquerque, E.L.

1980-01-01

Green functions are derived for the displacement associated with acoustic vibrations in isotropic elastic media and used to evaluate the surface specific heat in the harmonic approximation. We consider only the low-temperature limit case since, provided K B 1/h is very samll, we can replace the dispersion relation for the three acoustic branches by its long-wavelenghts form. The contributions of surface elastic waves ot the Rayleigh and Love types are pointed out and their features discussed. The nature of the result and their relations to previous work in this field is also presented and discussed. (author) [pt

A new estimation technique of sovereign default risk

Directory of Open Access Journals (Sweden)

Mehmet Ali Soytaş

2016-12-01

Full Text Available Using the fixed-point theorem, sovereign default models are solved by numerical value function iteration and calibration methods, which due to their computational constraints, greatly limits the models' quantitative performance and foregoes its country-specific quantitative projection ability. By applying the Hotz-Miller estimation technique (Hotz and Miller, 1993- often used in applied microeconometrics literature- to dynamic general equilibrium models of sovereign default, one can estimate the ex-ante default probability of economies, given the structural parameter values obtained from country-specific business-cycle statistics and relevant literature. Thus, with this technique we offer an alternative solution method to dynamic general equilibrium models of sovereign default to improve upon their quantitative inference ability.

Alveolar Ridge Split Technique Using Piezosurgery with Specially Designed Tips

Directory of Open Access Journals (Sweden)

Alessandro Moro

2017-01-01

Full Text Available The treatment of patients with atrophic ridge who need prosthetic rehabilitation is a common problem in oral and maxillofacial surgery. Among the various techniques introduced for the expansion of alveolar ridges with a horizontal bone deficit is the alveolar ridge split technique. The aim of this article is to give a description of some new tips that have been specifically designed for the treatment of atrophic ridges with transversal bone deficit. A two-step piezosurgical split technique is also described, based on specific osteotomies of the vestibular cortex and the use of a mandibular ramus graft as interpositional graft. A total of 15 patients were treated with the proposed new tips by our department. All the expanded areas were successful in providing an adequate width and height to insert implants according to the prosthetic plan and the proposed tips allowed obtaining the most from the alveolar ridge split technique and piezosurgery. These tips have made alveolar ridge split technique simple, safe, and effective for the treatment of horizontal and vertical bone defects. Furthermore the proposed piezosurgical split technique allows obtaining horizontal and vertical bone augmentation.

Alveolar Ridge Split Technique Using Piezosurgery with Specially Designed Tips.

Science.gov (United States)

Moro, Alessandro; Gasparini, Giulio; Foresta, Enrico; Saponaro, Gianmarco; Falchi, Marco; Cardarelli, Lorenzo; De Angelis, Paolo; Forcione, Mario; Garagiola, Umberto; D'Amato, Giuseppe; Pelo, Sandro

2017-01-01

The treatment of patients with atrophic ridge who need prosthetic rehabilitation is a common problem in oral and maxillofacial surgery. Among the various techniques introduced for the expansion of alveolar ridges with a horizontal bone deficit is the alveolar ridge split technique. The aim of this article is to give a description of some new tips that have been specifically designed for the treatment of atrophic ridges with transversal bone deficit. A two-step piezosurgical split technique is also described, based on specific osteotomies of the vestibular cortex and the use of a mandibular ramus graft as interpositional graft. A total of 15 patients were treated with the proposed new tips by our department. All the expanded areas were successful in providing an adequate width and height to insert implants according to the prosthetic plan and the proposed tips allowed obtaining the most from the alveolar ridge split technique and piezosurgery. These tips have made alveolar ridge split technique simple, safe, and effective for the treatment of horizontal and vertical bone defects. Furthermore the proposed piezosurgical split technique allows obtaining horizontal and vertical bone augmentation.

Machine learning \\& artificial intelligence in the quantum domain

OpenAIRE

Dunjko, Vedran; Briegel, Hans J.

2017-01-01

Quantum information technologies, and intelligent learning systems, are both emergent technologies that will likely have a transforming impact on our society. The respective underlying fields of research -- quantum information (QI) versus machine learning (ML) and artificial intelligence (AI) -- have their own specific challenges, which have hitherto been investigated largely independently. However, in a growing body of recent work, researchers have been probing the question to what extent th...

Vocabulário e memória de trabalho predizem desempenho em leitura de crianças

OpenAIRE

Piccolo, Luciane da Rosa; Salles, Jerusa Fumagalli

2013-01-01

Resumo: Este trabalho investiga a relação entre leitura (palavras e texto), memória de trabalho, quociente de inteligência (QI) e vocabulário em crianças (2ª-5ª séries) de escolas públicas. Analisou-se também qual dessas habilidades melhor contribui para explicar o desempenho em leitura. Realizaram-se análises com e sem crianças com QI abaixo da média. Primeiro, avaliaram-se 57 crianças (9-11 anos) em QI, vocabulário, leitura de palavras isoladas, compreensão de leitura textual e quatro taref...

Factors influencing the long-term sustainment of quality improvements made in addiction treatment facilities: a qualitative study

Directory of Open Access Journals (Sweden)

Scott P. Stumbo

2017-11-01

Full Text Available Abstract Background A greater understanding of the factors that influence long-term sustainment of quality improvement (QI initiatives is needed to promote organizational ability to sustain QI practices over time, help improve future interventions, and increase the value of QI investments. Methods We approached 83 of 201 executive sponsors or change leaders at addiction treatment organizations that participated in the 2007–2009 NIATx200 QI intervention. We completed semi-structured interviews with 33 individuals between November 2015 and April 2016. NIATx200 goals were to decrease wait time, increase admissions and improve retention in treatment. Interviews sought to understand factors that either facilitated or impeded long-term sustainment of organizational QI practices made during the intervention. We used thematic analysis to organize the data and group patterns of responses. We assessed available quantitative outcome data and intervention engagement data to corroborate qualitative results. Results We used narrative analysis to group four important themes related to long-term sustainment of QI practices: (1 finding alignment between business- and client-centered practices; (2 staff engagement early in QI process added legitimacy which facilitated sustainment; (3 commitment to integrating data into monitoring practices and the identification of a data champion; and (4 adequate organizational human resources devoted to sustainment. We found four corollary factors among agencies which did not sustain practices: (1 lack of evidence of impact on business practices led to discontinuation; (2 disengaged staff and lack of organizational capacity during implementation period led to lack of sustainment; (3 no data integration into overall business practices and no identified data champion; and (4 high staff turnover. In addition, we found that many agencies’ current use of NIATx methods and tools suggested a legacy effect that might improve

Improved importance sampling technique for efficient simulation of digital communication systems

Science.gov (United States)

Lu, Dingqing; Yao, Kung

1988-01-01

A new, improved importance sampling (IIS) approach to simulation is considered. Some basic concepts of IS are introduced, and detailed evolutions of simulation estimation variances for Monte Carlo (MC) and IS simulations are given. The general results obtained from these evolutions are applied to the specific previously known conventional importance sampling (CIS) technique and the new IIS technique. The derivation for a linear system with no signal random memory is considered in some detail. For the CIS technique, the optimum input scaling parameter is found, while for the IIS technique, the optimum translation parameter is found. The results are generalized to a linear system with memory and signals. Specific numerical and simulation results are given which show the advantages of CIS over MC and IIS over CIS for simulations of digital communications systems.

Machine learning techniques to examine large patient databases.

Science.gov (United States)

Meyfroidt, Geert; Güiza, Fabian; Ramon, Jan; Bruynooghe, Maurice

2009-03-01

Computerization in healthcare in general, and in the operating room (OR) and intensive care unit (ICU) in particular, is on the rise. This leads to large patient databases, with specific properties. Machine learning techniques are able to examine and to extract knowledge from large databases in an automatic way. Although the number of potential applications for these techniques in medicine is large, few medical doctors are familiar with their methodology, advantages and pitfalls. A general overview of machine learning techniques, with a more detailed discussion of some of these algorithms, is presented in this review.

Methods for Estimation of Radiation Risk in Epidemiological Studies Accounting for Classical and Berkson Errors in Doses

KAUST Repository

Kukush, Alexander; Shklyar, Sergiy; Masiuk, Sergii; Likhtarov, Illya; Kovgan, Lina; Carroll, Raymond J; Bouville, Andre

2011-01-01

thyroid dose of a person i is expressed as Dimes=fiQi(mes)/Mi(mes). Here, Qi(mes) is the measured content of radioiodine in the thyroid gland of person i at time t(mes), Mi(mes) is the estimate of the thyroid mass, and f(i) is the normalizing multiplier

Training Psychiatry Residents in Quality Improvement: An Integrated, Year-Long Curriculum

Science.gov (United States)

Arbuckle, Melissa R.; Weinberg, Michael; Cabaniss, Deborah L.; Kistler; Susan C.; Isaacs, Abby J.; Sederer, Lloyd I.; Essock, Susan M.

2013-01-01

Objective: The authors describe a curriculum for psychiatry residents in Quality Improvement (QI) methodology. Methods: All PGY3 residents (N=12) participated in a QI curriculum that included a year-long group project. Knowledge and attitudes were assessed before and after the curriculum, using a modified Quality Improvement Knowledge Assessment…

75 FR 21329 - Medicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying...

Science.gov (United States)

2010-04-23

... includes payment for premiums for Medicare Part B. Section 4732 of the Balanced Budget Act of 1997 (BBA... formula for determining State allotments. However, since certain States projected a deficit in their... minimize the impact on States with FY QI allotments that might be greater than their QI expenditures for...

A Longitudinal, Experiential Quality Improvement Curriculum Meeting ACGME Competencies for Geriatrics Fellows: Lessons Learned

Science.gov (United States)

Callahan, Kathryn E.; Rogers, Matthew T.; Lovato, James F.; Fernandez, Helen M.

2013-01-01

Quality improvement (QI) initiatives are critical in the care of older adults who are more vulnerable to substandard care. QI education meets aspects of core Accreditation Council of Graduate Medical Education competencies and prepares learners for the rising focus on performance measurement in health care. The authors developed, implemented, and…

Diagnosis of deep endometriosis: clinical examination, ultrasonography, magnetic resonance imaging, and other techniques.

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Bazot, Marc; Daraï, Emile

2017-12-01

The aim of the present review was to evaluate the contribution of clinical examination and imaging techniques, mainly transvaginal sonography and magnetic resonance imaging (MRI) to diagnose deep infiltrating (DE) locations using prisma statement recommendations. Clinical examination has a relative low sensitivity and specificity to diagnose DE. Independently of DE locations, for all transvaginal sonography techniques a pooled sensitivity and specificity of 79% and 94% are observed approaching criteria for a triage test. Whatever the protocol and MRI devices, the pooled sensitivity and specificity for pelvic endometriosis diagnosis were 94% and 77%, respectively. For rectosigmoid endometriosis, pooled sensitivity and specificity of MRI were 92% and 96%, respectively fulfilling criteria of replacement test. In conclusion, advances in imaging techniques offer high sensitivity and specificity to diagnose DE with at least triage value and for rectosigmoid endometriosis replacement value imposing a revision of the concept of laparoscopy as the gold standard. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Specificity of Structural Assessment of Knowledge

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Trumpower, David L.; Sharara, Harold; Goldsmith, Timothy E.

2010-01-01

This study examines the specificity of information provided by structural assessment of knowledge (SAK). SAK is a technique which uses the Pathfinder scaling algorithm to transform ratings of concept relatedness into network representations (PFnets) of individuals' knowledge. Inferences about individuals' overall domain knowledge based on the…

Newly introduced sample preparation techniques: towards miniaturization.

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Costa, Rosaria

2014-01-01

Sampling and sample preparation are of crucial importance in an analytical procedure, representing quite often a source of errors. The technique chosen for the isolation of analytes greatly affects the success of a chemical determination. On the other hand, growing concerns about environmental and human safety, along with the introduction of international regulations for quality control, have moved the interest of scientists towards specific needs. Newly introduced sample preparation techniques are challenged to meet new criteria: (i) miniaturization, (ii) higher sensitivity and selectivity, and (iii) automation. In this survey, the most recent techniques introduced in the field of sample preparation will be described and discussed, along with many examples of applications.

Improving the Quality of Care for Patients Diagnosed With Glioma During the Perioperative Period

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Riblet, Natalie B.V.; Schlosser, Evelyn M.; Homa, Karen; Snide, Jennifer A.; Jarvis, Lesley A.; Simmons, Nathan E.; Sargent, David H.; Mason, Linda P.; Cooney, Tobi J.; Kennedy, Nancy L.; Fadul, Camilo E.

2014-01-01

Purpose: Although there is agreement on the oncologic management of patients with glioma, few guidelines exist to standardize other aspects of care, including supportive care. Methods: A quality improvement (QI) project was chartered to improve the care provided to patients with glioma. A multidisciplinary team was convened and identified 10 best-practice measures. Using a plan-do-study-act framework, the team brainstormed and implemented various improvement interventions between June 2011 and October 2012. Statistical process control charts were used to evaluate progress. A dashboard of quality measures was generated to allow for ongoing measurement and reporting. Results: The retrospective assessment phase consisted of 43 patients with diagnosis of glioma. A manual medical record review for these patients showed that compliance with 10 best-practice measures ranged from 23% to 100%. Several factors contributed to less-than-ideal process performance, including poor communication among disciplines and lack of familiarity with the larger system of care. After implementing improvement interventions, performance was measured in 96 consecutive patients with glioma. The proportion of patients who met criteria for 10 practice measures significantly improved (pre-QI work, 63%; post-QI work, 85%; P = .003). The largest improvement was observed in the measure assessing for preoperative notification of the neuro-oncology program (pre-QI work, 39%; post-QI work, 97%; P sustaining process improvements. PMID:25294392

Innovative model of delivering quality improvement education for trainees – a pilot project

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Kannan Ramar

2015-09-01

Full Text Available Background: After incorporating quality improvement (QI education as a required curriculum for our trainees in 2010, a need arose to readdress our didactic sessions as they were too long, difficult to schedule, and resulting in a drop in attendance. A ‘flipped classroom’ (FC model to deliver QI education was touted to be an effective delivery method as it allows the trainees to view didactic materials on videos, on their own time, and uses the classroom to clarify concepts and employ learned tools on case-based scenarios including workshops. Methods: The Mayo Quality Academy prepared 29 videos that incorporated the previously delivered 17 weekly didactic sessions, for a total duration of 135 min. The half-day session clarified questions related to the videos, followed by case examples and a hands-on workshop on how to perform and utilize a few commonly used QI tools and methods. Results: Seven trainees participated. There was a significant improvement in knowledge as measured by pre- and post-FC model test results [improvement by 40.34% (SD 16.34, p<0.001]. The survey results were overall positive about the FC model with all trainees strongly agreeing that we should continue with this model to deliver QI education. Conclusions: The pilot project of using the FC model to deliver QI education was successful in a small sample of trainees.

A novel approach to leveraging electronic health record data to enhance pediatric surgical quality improvement bundle process compliance.

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Fisher, Jason C; Godfried, David H; Lighter-Fisher, Jennifer; Pratko, Joseph; Sheldon, Mary Ellen; Diago, Thelma; Kuenzler, Keith A; Tomita, Sandra S; Ginsburg, Howard B

2016-06-01

Quality improvement (QI) bundles have been widely adopted to reduce surgical site infections (SSI). Improvement science suggests when organizations achieve high-reliability to QI processes, outcomes dramatically improve. However, measuring QI process compliance is poorly supported by electronic health record (EHR) systems. We developed a custom EHR tool to facilitate capture of process data for SSI prevention with the aim of increasing bundle compliance and reducing adverse events. Ten SSI prevention bundle processes were linked to EHR data elements that were then aggregated into a snapshot display superimposed on weekly case-log reports. The data aggregation and user interface facilitated efficient review of all SSI bundle elements, providing an exact bundle compliance rate without random sampling or chart review. Nine months after implementation of our custom EHR tool, we observed centerline shifts in median SSI bundle compliance (46% to 72%). Additionally, as predicted by high reliability principles, we began to see a trend toward improvement in SSI rates (1.68 to 0.87 per 100 operations), but a discrete centerline shift was not detected. Simple informatics solutions can facilitate extraction of QI process data from the EHR without relying on adjunctive systems. Analyses of these data may drive reductions in adverse events. Pediatric surgical departments should consider leveraging the EHR to enhance bundle compliance as they implement QI strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

Survey on risk perception of radiation following an incident involving a stuck 60Co source in Henan Province, China

International Nuclear Information System (INIS)

Lei, C.; Sun, Q.; Cheng, X.; Zhang, Q.; Fu, Y.; Chu, C.; Zhao, Y.; Qin, W.; Su, X.

2012-01-01

In July 2009, an incident involving a stuck Co-60 source led hundreds of thousands of people to escape Qi County, Henan Province, China, although no medical or environmental consequences were related to the incident. To investigate knowledge about radiation, public risk-perception of radiation, and evaluation of the official response, a survey was conducted in Qi and Hui County (control). Face-to-face questionnaire interviews were conducted among three groups with different educational backgrounds. In total, 1340 valid questionnaires were collected from people interviewed. Knowledge about radiation was low in all groups in both counties, although knowledge in Qi County was higher than that in Hui County (control). More than 40 % respondents supported construction of nuclear power plants (NPPs) in China, while only a few supported constructing NPPs in their vicinity. The main reasons for the mass escape following the incident were assumed to be lack of knowledge about radiation, misinformation, the government's failure to disclose information in time and imitation of group behaviour. Over 60 % in Group I and II trusted the local government. About 64 % disapproved the response of the Qi County government. After the incident, the population in Qi County still knows little about radiation. Although people trust the government, they are dissatisfied with the response of the local government regarding the incident. (authors)

Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States.

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Padula, William V; Makic, Mary Beth F; Mishra, Manish K; Campbell, Jonathan D; Nair, Kavita V; Wald, Heidi L; Valuck, Robert J

2015-06-01

Prevention of pressure ulcers, one of the hospital-acquired conditions (HACs) targeted by the 2008 nonpayment policy of the Centers for Medicare & Medicaid Services (CMS), is a critical issue. This study was conducted to determine the comparative effectiveness of quality improvement (QI) interventions associated with reduced hospital-acquired pressure ulcer (HAPU) rates. In an quasi-experimental design, interrupted time series analyses were conducted to determine the correlation between HAPU incidence rates and adoption of QI interventions. Among University HealthSystem Consortium hospitals, 55 academic medical centers were surveyed from September 2007 through February 2012 for adoption patterns of QI interventions for pressure ulcer prevention, and hospital-level data for 5,208 pressure ulcer cases were analyzed. Between- and within-hospital reduction significance was tested with t-tests post-CMS policy intervention. Fifty-three (96%) of the 55 hospitals used QI interventions for pressure ulcer prevention. The effect size analysis identified five effective interventions that each reduced pressure ulcer rates by greater than 1 case per 1,000 patient discharges per quarter: leadership initiatives, visual tools, pressure ulcer staging, skin care, and patient nutrition. The greatest reductions in rates occurred earlier in the adoption process (pprevention protocol for pressure ulcers. Hospitals can not only use these findings from this study as part of a QI bundle for preventing HAPUs.

The Role of Theory-Specific Techniques and Therapeutic Alliance in Promoting Positive Outcomes: Integrative Psychotherapy for World Trade Center Responders.

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Haugen, Peter Tejas; Werth, Aditi Sinha; Foster, Alyce Lauren; Owen, Jesse

2016-12-01

World Trade Center responders demonstrate high symptom burden, underscoring the importance of refining treatment approaches for this cohort. One method is examining the impact of therapy techniques on outcomes, and the interactions between technique and alliance on outcomes. This study a) examined the interaction of early treatment techniques on integrative psychotherapy outcomes and b) explored whether associations differed at varying levels of alliance. Twenty-nine adult responders diagnosed with partial or full posttraumatic stress disorder received outpatient psychotherapy and completed weekly measures of alliance, technique, and symptom distress. Analyses indicated significant interactions between 1) alliance and psychodynamic interventions on outcomes and 2) alliance and cognitive behavioral (CB) interventions on outcomes. Clients with high alliance had better outcomes when their therapist used fewer CB techniques. No meaningful differences were found between technique and outcomes for clients with lower alliance. These findings reiterate the critical roles technique and responsiveness to the alliance play in engendering successful outcomes.

Computer Assisted Audit Techniques

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Eugenia Iancu

2007-01-01

Full Text Available From the modern point of view, audit takes intoaccount especially the information systems representingmainly the examination performed by a professional asregards the manner for developing an activity by means ofcomparing it to the quality criteria specific to this activity.Having as reference point this very general definition ofauditing, it must be emphasized that the best known segmentof auditing is the financial audit that had a parallel evolutionto the accountancy one.The present day phase of developing the financial audithas as main trait the internationalization of the accountantprofessional. World wide there are multinational companiesthat offer services in the financial auditing, taxing andconsultancy domain. The auditors, natural persons and auditcompanies, take part at the works of the national andinternational authorities for setting out norms in theaccountancy and auditing domain.The computer assisted audit techniques can be classified inseveral manners according to the approaches used by theauditor. The most well-known techniques are comprised inthe following categories: testing data techniques, integratedtest, parallel simulation, revising the program logics,programs developed upon request, generalized auditsoftware, utility programs and expert systems.

Near-infrared light-triggered theranostics for tumor-specific enhanced multimodal imaging and photothermal therapy

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Wu B

2017-06-01

Full Text Available Bo Wu,1,* Bing Wan,2,* Shu-Ting Lu,1 Kai Deng,3 Xiao-Qi Li,1 Bao-Lin Wu,1 Yu-Shuang Li,1 Ru-Fang Liao,1 Shi-Wen Huang,3 Hai-Bo Xu1,2 1Department of Radiology, Zhongnan Hospital of Wuhan University, 2Department of Radiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 3Department of Chemistry, Key Laboratory of Biomedical Polymers, Ministry of Education, Wuhan University, Wuhan, People’s Republic of China *These authors contributed equally to this work Abstract: The major challenge in current clinic contrast agents (CAs and chemotherapy is the poor tumor selectivity and response. Based on the self-quench property of IR820 at high concentrations, and different contrast effect ability of Gd-DOTA between inner and outer of liposome, we developed “bomb-like” light-triggered CAs (LTCAs for enhanced CT/MRI/FI multimodal imaging, which can improve the signal-to-noise ratio of tumor tissue specifically. IR820, Iohexol and Gd-chelates were firstly encapsulated into the thermal-sensitive nanocarrier with a high concentration. This will result in protection and fluorescence quenching. Then, the release of CAs was triggered by near-infrared (NIR light laser irradiation, which will lead to fluorescence and MRI activation and enable imaging of inflammation. In vitro and in vivo experiments demonstrated that LTCAs with 808 nm laser irradiation have shorter T1 relaxation time in MRI and stronger intensity in FI compared to those without irradiation. Additionally, due to the high photothermal conversion efficiency of IR820, the injection of LTCAs was demonstrated to completely inhibit C6 tumor growth in nude mice up to 17 days after NIR laser irradiation. The results indicate that the LTCAs can serve as a promising platform for NIR-activated multimodal imaging and photothermal therapy. Keywords: light triggered, near-infrared light, tumor-specific, multimodal imaging, photothermal therapy, contrast agents

Methods and techniques for decontamination design and construction of facilities

International Nuclear Information System (INIS)

Augustin, X.; Cohen, S.

1986-01-01

TECHNICATOME and STMI have jointly solved a wide range of problems specific to decontamination from the very design studies up to operation. TECHNICATOME has brought its expertise in the design and construction of nuclear facilities concerned in particular with decontamination and radwaste management. STMI is an experienced operator with expertise in designing tools and developing advanced techniques in the same fields. The expertise of both companies in this field cumulated for many years has resulted in developing techniques and tools adapted to most of the decontamination problems including specific cases [fr

Evaluation of Women with Myofascial Abdominal Syndrome Based on Traditional Chinese Medicine

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Andréia Mitidieri

2015-12-01

Full Text Available Objectives: This study used semiology based on traditional Chinese medicine (TCM to investigate vital energy (Qi behavior in women with abdominal myofascial pain syndrome (AMPS. Methods: Fifty women diagnosed with chronic pelvic pain (CPP secondary to AMPS were evaluated by using a questionnaire based on the theories of “yin-yang,” “zang-fu”, and “five elements”. We assessed the following aspects of the illness: symptomatology; specific location of myofascial trigger points (MTrPs; onset, cause, duration and frequency of symptoms; and patient and family history. The patients tongues, lips, skin colors, and tones of speech were examined. Patients were questioned on various aspects related to breathing, sweating, sleep quality, emotions, and preferences related to color, food, flavors, and weather or seasons. Thirst, gastrointestinal dysfunction, excreta (feces and urine, menstrual cycle, the five senses, and characteristic pain symptoms related to headache, musculoskeletal pain, abdomen, and chest were also investigated. Results: Patients were between 22 and 56 years old, and most were married (78%, possessed a elementary school (66%, and had one or two children (76%. The mean body mass index and body fat were 26.86 kg/ cm2 (range: 17.7 — 39.0 and 32.4% (range: 10.7 — 45.7, respectively. A large majority of women (96% exhibited alterations in the kidney meridian, and 98% had an altered gallbladder meridian. We observed major changes in the kidney and the gallbladder Qi meridians in 76% and 62% of patients, respectively. Five of the twelve meridians analyzed exhibited Qi patterns similar to pelvic innervation Qi and meridians, indicating that the paths of some of these meridians were directly related to innervation of the pelvic floor and abdominal region. Conclusion: The women in this study showed changes in the behavior of the energy meridians, and the paths of some of the meridians were directly related to innervation of the

Relative importance of pasture size and grazing continuity for the long-term conservation of Europena dung beetles

Czech Academy of Sciences Publication Activity Database

Buse, J.; Šlachta, M.; Sládeček, František Xaver Jiří; Pung, M.; Wagner, T.; Entling, M. H.

2015-01-01

Roč. 187, JUL 01 (2015), s. 112-119 ISSN 0006-3207 Grant - others:GA MZe(CZ) QI111C034 Program:QI Institutional support: RVO:60077344 Keywords : habitat area * habitat continuity * geotrupidae Subject RIV: EH - Ecology, Behaviour Impact factor: 3.985, year: 2015 http://www.sciencedirect.com/science/article/pii/S0006320715001561

The technique of flashback in selected Northern Sotho literary texts

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M.J. Mojalefa

2005-07-01

Full Text Available This article aims at investigating and explaining the application of the technique of flashback in selected Northern Sotho literary texts. Five kinds of flashback are distinguished, namely external retrospection, internal retrospection, mixed retrospection, flashback to complicate events and flashback of similar events. These kinds of flashback have certain and specific functions, such as reminding readers of past events, foregrounding themes of the text, and so on. This technique is evident in a text when ordinary, everyday events turn out to be the key to surprising secrets that are revealed later. Though flashback seems to be similar to foreshadowing (prolepsis in that both techniques contain features of repetition and the narration of a specific experience, the techniques, however, differ in that flashback focuses on the elements of secrecy, suspense and surprise, and foreshadowing does not. This article also reveals that a relationship between flashback and the structure of detective stories can be indicated.

COMPARISON OF RECURSIVE ESTIMATION TECHNIQUES FOR POSITION TRACKING RADIOACTIVE SOURCES

International Nuclear Information System (INIS)