42 CFR 412.304 - Implementation of the capital prospective payment system.

Science.gov (United States)

2010-10-01

... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs General Provisions § 412.304 Implementation of the capital prospective payment system. (a) General rule. As described in §§ 412.312 through 412.370...

Prospective evaluation of the need for internal monitoring

International Nuclear Information System (INIS)

Barton, T.P.; Bowers, R.R.; Volza, P.

1992-01-01

This paper reports that under the revision of 10 CFR 20, workers must be monitored for internal dose only if a prospective evaluation shows that they are likely to exceed 10 percent of an ALI in a year. Past positive whole body counts were reviewed at the Perry Nuclear Power Plant, and the largest uptake was found to be 1.3 percent of an ALI. Past RWPs which had the potential for significant airborne exposure were identified and reviewed. The highest possible uptake was calculated to be 2.5 percent of an ALI, not taking credit for respiratory protection. Committed dose from alpha and pure beta emitters which would not be identified by gamma-sensitive bioassay was found to be negligible. Based on this prospective evaluation, monitoring personnel for internal dose is not required at this facility

Evaluation of undrilled prospects. Sensitivity to economic and geological factors

International Nuclear Information System (INIS)

Hermanrud, C.; Abrahamsen, K.; Vollset, J.; Nordahl, S.; Jourdan, C.

1996-01-01

Economic prospect evaluation at an early stage involves personnel with different skills, such as geoscientists, reservoir engineers, construction engineers and economists. Data are transferred between these groups of people who often have only a vague understanding of the accuracy of the data they receive. This lack of communication naturally limits the correctness of the results. To improve this communication, the complete process of prospect evaluation (including both geological and economical aspects) has been followed here in order to show the different data sets that are transferred and to comment upon their accuracy. Although this paper is based entirely on Statoil's methodology, it is nevertheless believed to be of general relevance. In Statoil's methodology, prospect volumes calculated by geoscientists are given as likelihood distributions. Post-drilling examination of such volume distributions show that historically they have been too optimistic. However, historical prospect risking has correctly identified the most important risk factors and has been able to separate low-risk from high-risk prospects in a satisfactory manner. The number of appraisal wells that are needed before the development of a field can be decided upon is often crucial to the economic evaluations. This number, however, is usually underestimated during the early stages of exploration, probably because data limitations mask reservoir heterogeneities. Reservoir performance is of utmost importance to early economic calculations as it influences both the drilling costs and the production of hydrocarbons vs. time. Of course, reservoir productivity is highly uncertain when judged prior to drilling the first well. Historical data show that reserve estimates of producing fields tend to be upgraded as reservoir depletion proceeds, although several fields have had their reserve estimates downgraded shortly after production start-up. The operational and investment costs are not generally

An approach to assessing risk in coalbed methane prospect evaluation

International Nuclear Information System (INIS)

Vanorsdale, C.R.

1991-01-01

The economic evaluation of drilling prospects requires assessing the degree of risk involved and its impact on reserve estimates. In developed areas, risk can be determined in a fairly straightforward manner. In remote wildcat areas, risk can almost never be adequately identified or quantified. Between these extremes lie complex reservoirs -- reservoirs to heterogeneous that each well drilled could exhibit production characteristics unlike those of its neighbors. This paper illustrates the use of a risk assessment methodology in a case study of Fruitland coal prospects in the San Juan Basin of New Mexico. This approach could be applied to coalbed methane prospects or any unconventional or highly heterogeneous reservoir with appropriate modification. The utility of this approach is made apparent in a graphical analysis that relates reserves, rate of return and payout time for managerial or financial presentation. This graphical technique and the underlying risk assessment were used to aid a conservative management team in evaluating participation in a multi-well coalbed project

Patientsmate©: the implementation and evaluation of an online prospective audit system.

LENUS (Irish Health Repository)

McHugh, Seamus Mark

2010-11-18

Introduction  Inaccuracy in Hospital Inpatient Enquiry (HIPE)\\/Casemix-based data has been reported as high as 26%. This results in financial waste and makes effective audit impossible. We aimed to develop a novel web-based outcome audit system. Methods  A web-based online audit system, Patientsmate©, was developed using an integrated database system written in the programme language PHP. Data were inputted by the surgical team responsible for the patients care. A prospective comparison study of the new Patientsmate© and the standard HIPE systems, was performed over a 1-month period and involving two general surgical teams in April 2010. In addition, a Likert-scale based questionnaire was designed and hosted within the Patientsmate© system. A focus group of those clinicians directly involved in data accessing and input were then invited to complete the questionnaire in order to assess usability of the system. Results  During the study period there were a total of 108 patients and 88 procedures. Our study confirms the accuracy of clinician derived data, with the Patientsmate© system more accurately recording number of patients (83% vs. 80.6%), number of procedures (85.2% vs. 68.1%) and hospital day case rate (52% vs. 47.1%). Inputting data using Patientsmate© for a single patient took 6-7 minutes. Of those using the system, 75% reported feeling comfortable after using it once only and 100% were satisfied with the layout of the online interface. Conclusion  The Patientsmate© system allows for increased accuracy in outcome-based data as compared with the HIPE system, facilitating audit, financial savings and the appropriate allocation of services.

Patientsmate©: the implementation and evaluation of an online prospective audit system.

Science.gov (United States)

McHugh, Seamus Mark; Loh, Kah Poh; Corrigan, Mark Anthony; Sheikh, Athar; Lehane, Elaine; Hill, Arnold David Konrad

2012-04-01

Inaccuracy in Hospital Inpatient Enquiry (HIPE)/Casemix-based data has been reported as high as 26%. This results in financial waste and makes effective audit impossible. We aimed to develop a novel web-based outcome audit system. A web-based online audit system, Patientsmate©, was developed using an integrated database system written in the programme language PHP. Data were inputted by the surgical team responsible for the patients care. A prospective comparison study of the new Patientsmate© and the standard HIPE systems, was performed over a 1-month period and involving two general surgical teams in April 2010. In addition, a Likert-scale based questionnaire was designed and hosted within the Patientsmate© system. A focus group of those clinicians directly involved in data accessing and input were then invited to complete the questionnaire in order to assess usability of the system. During the study period there were a total of 108 patients and 88 procedures. Our study confirms the accuracy of clinician derived data, with the Patientsmate© system more accurately recording number of patients (83% vs. 80.6%), number of procedures (85.2% vs. 68.1%) and hospital day case rate (52% vs. 47.1%). Inputting data using Patientsmate© for a single patient took 6-7 minutes. Of those using the system, 75% reported feeling comfortable after using it once only and 100% were satisfied with the layout of the online interface. The Patientsmate© system allows for increased accuracy in outcome-based data as compared with the HIPE system, facilitating audit, financial savings and the appropriate allocation of services. © 2010 Blackwell Publishing Ltd.

Antimicrobial stewardship: a review of prospective audit and feedback systems and an objective evaluation of outcomes.

Science.gov (United States)

Chung, Gladys W; Wu, Jia En; Yeo, Chay Leng; Chan, Douglas; Hsu, Li Yang

2013-02-15

Antimicrobial stewardship is an emerging field currently defined by a series of strategies and interventions aimed toward improving appropriate prescription of antibiotics in humans in all healthcare settings. The ultimate goal is the preservation of current and future antibiotics against the threat of antimicrobial resistance, although improving patient safety and reducing healthcare costs are important concurrent aims. Prospective audit and feedback interventions are probably the most widely practiced of all antimicrobial stewardship strategies. Although labor-intensive, they are more easily accepted by physicians compared with formulary restriction and preauthorization strategies and have a higher potential for educational opportunities. Objective evaluation of antimicrobial stewardship is critical for determining the success of such programs. Nonetheless, there is controversy over which outcomes to measure and there is a pressing need for novel study designs that can objectively assess antimicrobial stewardship interventions despite the limitations inherent in the structure of most such programs.

[Prospective evaluation on ventilator-associated events: a cohort study from eight intensive care units].

Science.gov (United States)

Chen, W S; Liu, J; Liu, H; Song, Y Y; Chen, H Y; Wang, R; Zhang, Y P; Jiang, W; Li, H F; Li, S Q; Zhang, S M; Liu, B; Zhang, X; Zhang, W H

2016-08-10

The aim of this study was to prospectively investigate the incidence of ventilator associated events (VAEs) in intensive care units (ICUs) among adult patients, and to evaluate the correlation between VAEs and ventilator associated pneumonia (VAP). A prospective 3-month cohort study (January 2015 to March 2015) was carried out. VAEs were divided into three groups: with ventilator-associated condition (VAC), with infection related ventilator-associated complication (IVAC) and with possible VAP (PVAP). Sensitivity and specificity of VAEs were evaluated and compared to the traditional VAP. Kappa test was applied to judge the consistency of VAC and VAP. During Jan. 2015 and Mar. 2015, 1 014 patients were admitted to 8 ICUs, with 7 977 patients per day. In total, 197 patients used the mechanical ventilation installation, with, a total number of 3 152 ventilator-days. Finally, 1 214 ventilation days in the VAC group and 1 938 ventilation days in the non-VAC group) that were available for final analysis. 46 VAC cases were identified including 22 classified as IVAC (14.59 and 6.98 per 1 000 ventilation days, respectively). Length of ICU stay and duration on mechanical ventilation for VAC patients were both significantly longer than those for non-VAC patients (PVAC criteria for the detection of VAP were 36.92% and 83.33%, respectively. The VAEs surveillance paradigms could be applied to monitor patients on the use of mechanical ventilation installation. However, sensitivity and specificity of VAC were under pool for the diagnosis of VAP. However, automatically surveillance programs was relied on the improvement of auto-information systems.

A multicenter prospective study of surgical audit systems.

Science.gov (United States)

Haga, Yoshio; Ikejiri, Koji; Wada, Yasuo; Takahashi, Tadateru; Ikenaga, Masakazu; Akiyama, Noriyoshi; Koike, Shoichiro; Koseki, Masato; Saitoh, Toshihiro

2011-01-01

This study was undertaken to evaluate a modified form of Estimation of Physiologic Ability and Surgical Stress (E-PASS) for surgical audit comparing with other existing models. Although several scoring systems have been devised for surgical audit, no nation-wide survey has been performed yet. We modified our previous E-PASS surgical audit system by computing the weights of 41 procedures, using data from 4925 patients who underwent elective digestive surgery, designated it as mE-PASS. Subsequently, a prospective cohort study was conducted in 43 national hospitals in Japan from April 1, 2005, to April 8, 2007. Variables for the E-PASS and American Society of Anesthesiologists (ASA) status-based model were collected for 5272 surgically treated patients. Of the 5272 patients, we also collected data for the Portsmouth modification of Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in 3128 patients. The area under the receiver operative characteristic curve (AUC) was used to evaluate discrimination performance to detect in-hospital mortality. The ratio of observed to estimated in-hospital mortality rates (OE ratio) was defined as a measure of quality. The numbers of variables required were 10 for E-PASS, 7 for mE-PASS, 20 for P-POSSUM, and 4 for the ASA status-based model. The AUC (95% confidence interval) values were 0.86 (0.79-0.93) for E-PASS, 0.86 (0.79-0.92) for mE-PASS, 0.81 (0.75-0.88) for P-POSSUM, and 0.73 (0.63-0.83) for the ASA status-based model. The OE ratios for mE-PASS among large-volume hospitals significantly correlated with those for E-PASS (R = 0.93, N = 9, P = 0.00026), P-POSSUM (R = 0.96, N = 6, P = 0.0021), and ASA status-based model (R = 0.83, N = 9, P = 0.0051). Because of its features of easy use, accuracy, and generalizability, mE-PASS is a candidate for a nation-wide survey.

Prospective evaluation of the International Neuroblastoma Staging System (INSS) and the International Neuroblastoma Response Criteria (INRC) in a multicentre setting.

Science.gov (United States)

Castel, V; García-Miguel, P; Cañete, A; Melero, C; Navajas, A; Ruíz-Jiménez, J I; Navarro, S; Badal, M D

1999-04-01

The aim of this study was to classify prospectively a series of neuroblastoma tumours according to the International Neuroblastoma Staging System (INSS) and the International Neuroblastoma Response Criteria (INRC) and to evaluate the difficulties and pitfalls involved in a multicentre setting. Each hospital provided their data for central review. The surgical procedures and their complications were reported. Kaplan-Meier estimates of survival and event-free survival were calculated according to stage and response to therapy. From June 1992 to December 1996, 194 patients were included in the study, with a mean age of 2 years. Initial studies were performed according to INSS recommendations without major problems. INSS stage was correctly applied to all patients except for 9 (95%). Post-operative complications were observed in 15 patients (8.3%). Response to therapy (INRC) was studied in 63 stage 4 patients, 11 of whom were not classified correctly (17%). Differences in survival according to stage (INSS) and group of response to therapy (INRC) were statistically significant (P INSS was easy to use and separated different prognostic groups. Surgical complications and mortality did not increase in this series because of using the INSS. The feasibility of INRC was evaluated in a small series of stage 4 patients and the designation of response was problematic in a relatively high proportion of cases. The prognostic value of the different responses was highly significant, but less informative than had been hoped for.

42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

Science.gov (United States)

2010-10-01

... prospective payment system. 419.20 Section 419.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL... Outpatient Prospective Payment System § 419.20 Hospitals subject to the hospital outpatient prospective...

Prospective validation of a surgical complications grading system in a cohort of 2114 patients.

Science.gov (United States)

Mazeh, Haggi; Cohen, Oded; Mizrahi, Ido; Hamburger, Tamar; Stojadinovic, Alexander; Abu-Wasel, Bassam; Alaiyan, Bilal; Freund, Herbert R; Eid, Ahmed; Nissan, Aviram

2014-05-01

We recently reported a grading system for surgical complications. This system proved to have a high sensitivity for recording minor but meaningful complications prolonging hospital stay in patients after colorectal surgery. We aimed to prospectively validate the complication grading system in a general surgery department over 1 year. All surgical procedures and related complications were prospectively recorded between January 1st and December 31st, 2009. Surgical complications were graded on a severity scale of 1-5. The system classifies short-term outcome by grade emphasizing intensity of therapy required for treatment of the defined complication. During the study period, 2114 patients underwent surgery. Elective and oncological surgeries were performed in 1606 (76%) and 465 (22%) patients, respectively. There were 422 surgical complications in 304 (14%) patients (Grade 1/2: 203 [67%]; Grade 3/4: 90 [29%]; Grade 5: 11 [4%]). Median length of stay correlated significantly with complication severity: 2.3 d for no complication, 6.2 and 11.8 d for Grades 1/2 and 3/4, respectively (P 2 (OR 2.07, P Grade (OR 1.85, P = 0.001), oncological (OR 2.82, P 120 min (OR 2.08, P grading surgical complications permits standardized reporting of surgical morbidity according to the severity of impact. Prospective validation of this system supports its use in a general surgery setting as a tool for surgical outcome assessment and quality assurance. Copyright © 2014 Elsevier Inc. All rights reserved.

Advancements, prospects, and impacts of automated driving systems

Directory of Open Access Journals (Sweden)

Ching-Yao Chan

2017-09-01

Full Text Available Over the last decade, significant progress has been made in automated driving systems (ADS. Given the current momentum and progress, ADS can be expected to continue to advance and a variety of ADS products will become commercially available within a decade. It is envisioned that automated driving technology will lead to a paradigm shift in transportation systems in terms of user experience, mode choices, and business models. In this paper, we start with a review of the state-of-the-art in the field of ADS and their deployment paths. It is followed by a discussion of the future prospects of ADS and their effects on various aspects of the transportation field. We then identify two specific use cases of ADS where the impacts can be significant – personal mobility services and vehicle automation for aging society. A survey of impact assessment studies and the associated methodologies for evaluating ADS is given, which is followed by concluding remarks at the end of the paper.

End-Stage Renal Disease Prospective Payment System

Data.gov (United States)

U.S. Department of Health & Human Services — This final rule implements a case-mix adjusted bundled prospective payment system (PPS) for Medicare outpatient end-stage renal disease (ESRD) dialysis facilities...

Management of 2nd-degree facial burns using the Versajet(®) hydrosurgery system and xenograft: a prospective evaluation of 20 cases.

Science.gov (United States)

Duteille, Franck; Perrot, Pierre

2012-08-01

There is no single therapeutic scheme for the management of intermediary 2nd-degree facial burns, which can cause problems because of their uncertain course. It is preferable to obtain optimal healing of the face in order to avoid functional or cosmetic sequelae. Some practitioners recommend early excision (first week) of these burns, whereas others prefer to wait and perform surgery later (after 2 weeks). The practice in our burns unit is early surgery (from the first week) associated with hydrosurgical excision and application of a biosynthetic dressing (xenograft). A prospective follow-up of 20 cases was carried out to evaluate the efficacy of our protocol. The prospective evaluation was performed with follow-up at 2 weeks and 3, 6 and 12 months. The patients included had intermediary 2nd-degree burns on at least 15% of the face and no life-threatening prognosis. The mean age in our series was 40.5 years (16-72), the mean percentage of burn surface area was 27.75% and the mean percentage of facial burn was 60.75%. Early excision was performed (day 5-10) using the Versajet(®) system, which allows tangential water-dissection. Porcine xenograft (E-Z Derm(®)) was applied immediately afterwards. Patients whose healing process was not complete at 2 weeks were then scheduled to receive a thin autograft. Patients were followed up 2 weeks, 3, 6 and 12 months after discharge. Excision was performed at a mean 7.6 days, and mean initial healing time was 13.4 days. In three cases, a full-thickness skin graft was used, whereas healing occurred in the other patients without further grafts. Two patients had functional sequelae (ectropion) corrected later by repair surgery. The course of healing for the other patients proceeded normally. There is no consensus about the management of intermediate depth 2nd-degree facial burns. We chose to perform early surgery using the Versajet(®) system, which allows fine, precise excision, leaving nearly all of the healthy tissue in place

A high-speed transmission method for large-scale marine seismic prospecting systems

International Nuclear Information System (INIS)

KeZhu, Song; Ping, Cao; JunFeng, Yang; FuMing, Ruan

2012-01-01

A marine seismic prospecting system is a kind of data acquisition and transmission system with large-scale coverage and synchronous multi-node acquisition. In this kind of system, data transmission is a fundamental and difficult technique. In this paper, a high-speed data-transmission method is proposed, its implications and limitations are discussed, and conclusions are drawn. The method we propose has obvious advantages over traditional techniques with respect to long-distance operation, high speed, and real-time transmission. A marine seismic system with four streamers, each 6000 m long and capable of supporting up to 1920 channels, was designed and built based on this method. The effective transmission baud rate of this system was found to reach up to 240 Mbps, while the minimum sampling interval time was as short as 0.25 ms. This system was found to achieve a good synchronization: 83 ns. Laboratory and in situ experiments showed that this marine-prospecting system could work correctly and robustly, which verifies the feasibility and validity of the method proposed in this paper. In addition to the marine seismic applications, this method can also be used in land seismic applications and certain other transmission applications such as environmental or engineering monitoring systems. (paper)

A high-speed transmission method for large-scale marine seismic prospecting systems

Science.gov (United States)

KeZhu, Song; Ping, Cao; JunFeng, Yang; FuMing, Ruan

2012-12-01

A marine seismic prospecting system is a kind of data acquisition and transmission system with large-scale coverage and synchronous multi-node acquisition. In this kind of system, data transmission is a fundamental and difficult technique. In this paper, a high-speed data-transmission method is proposed, its implications and limitations are discussed, and conclusions are drawn. The method we propose has obvious advantages over traditional techniques with respect to long-distance operation, high speed, and real-time transmission. A marine seismic system with four streamers, each 6000 m long and capable of supporting up to 1920 channels, was designed and built based on this method. The effective transmission baud rate of this system was found to reach up to 240 Mbps, while the minimum sampling interval time was as short as 0.25 ms. This system was found to achieve a good synchronization: 83 ns. Laboratory and in situ experiments showed that this marine-prospecting system could work correctly and robustly, which verifies the feasibility and validity of the method proposed in this paper. In addition to the marine seismic applications, this method can also be used in land seismic applications and certain other transmission applications such as environmental or engineering monitoring systems.

78 FR 26879 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

Science.gov (United States)

2013-05-08

... Prospective Payment System for Federal Fiscal Year 2014; Proposed Rule #0;#0;Federal Register / Vol. 78, No... Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2014 AGENCY... IRF prospective payment system's (PPS) case-mix groups and a description of the methodology and data...

Between-individual comparisons in performance evaluation: a perspective from prospect theory.

Science.gov (United States)

Wong, Kin Fai Ellick; Kwong, Jessica Y Y

2005-03-01

This article examines how between-individual comparisons influence performance evaluations in rating tasks. The authors demonstrated a systematic change in the perceived difference across ratees as a result of changing the way performance information is expressed. Study 1 found that perceived performance difference between 2 individuals was greater when their objective performance levels were presented with small numbers (e.g., absence rates of 2% vs. 5%) than when they were presented with large numbers (e.g., attendance rates of 98% vs. 95%). Extending this finding to situations involving trade-offs between multiple performance attributes across ratees, Study 2 showed that the relative preference for 1 ratee over another actually reversed when the presentation format of the performance information changed. The authors draw upon prospect theory to offer a theoretical framework describing the between-individual comparison aspect of performance evaluation.

What Prospects for the World Trading System?

Directory of Open Access Journals (Sweden)

Agnes Ghibuțiu

2014-07-01

Full Text Available New developments and dramatic changes are under way in the world trading system. This paper aims to take stock of the latest and most relevant developments and highlight the prospects for global trade governance. The focus is on three major issues, i.e. : (1 the outcome of the Ninth WTO Ministerial Conference in December 2013 in Bali (Indonesia and especially its significance for enhancing the multilateral trading system; (2 the accelerated pace and scale of negotiations on regional trade agreements (RTAs and their wider impact; and (3 the positive results of continued unilateral trade liberalization efforts, in contrast with the pervasiveness of crisis-related protectionist measures. The paper concludes that, despite improved prospects for multilateral trade liberalization following the last WTO Ministerial Conference, the world trading system is becoming more fragmented and less coherent, and also more uncertain, being increasingly driven by RTAs and a variable geometry approach to WTO trade agreements.

Evaluation of a fast PLC module in prospect of the LHC beam interlock system

CERN Document Server

Zaera-Sanz, Manuel

2005-01-01

The LHC Beam Interlock system requires a controller performing a simple matrix function to collect the different beam dump requests. To satisfy the expected safety level of the Interlock, the system should be robust and reliable. The PLC is a promising candidate to fulfil both aspects but too slow to meet the expected response time which is of the order of mseconds. Siemens has introduced a “so called” fast module (FM352-5 Boolean Processor) that provides independent and extremely fast control of a process within a larger control system using an onboard processor, a Field Programmable Gate Array (FPGA), to execute code in parallel which results in extremely fast scan times. It is interesting to investigate its features and to evaluate it as a possible candidate for the beam interlock system. This note publishes the results of this study. As well, this note could be useful for other applications requiring fast processing using a PLC.

A prospective, multicenter, post marketing surveillance study to evaluate the safety and effectiveness of the Superia-Sirolimus Eluting Coronary Stent System (SSECSS) implanted during routine clinical practice in India.

Science.gov (United States)

Chandra, Praveen; Kumar, Tarun

2014-01-01

A prospective, multicenter, post marketing surveillance study to evaluate the safety and effectiveness of the Superia-Sirolimus Eluting Coronary Stent System (SSECSS) implanted during routine clinical practice in India. 1. To study the MACE and in stent and In-segment Loss at Six Months (in a pre selected group of 50 patients). 1. Clinical and procedural success. This is a prospective, open label, single-arm, multicenter (16 sites), post marketing observational study enrolling patients implanted with Superia-Sirolimus Eluting Coronary Stent (SSECS) in routine clinical practice in India. A total of 200 Patients of coronary Artery Disease (CAD) implanted with Superia-Sirolimus Eluting Coronary Stent (SSECS) were enrolled. Clinical assessments were done at 30 days, 180 days and at 1, 2 years either telephonically or office visit. A cohort of 50 pre-selected patients were followed up for angiographic evaluation at 180 days. MACE at 12 month of follow up was 1.71%.Late lumen loss, in segment was 0.14 and in stent was 0.10 mm at 6 month of follow-up. TLR was required only in 2 patients. Superia stent is as safe as other biodegradable polymer stent in the market and time has come for biodegradable polymer stent with thin struts. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

A modular, prospective, semi-automated drug safety monitoring system for use in a distributed data environment.

Science.gov (United States)

Gagne, Joshua J; Wang, Shirley V; Rassen, Jeremy A; Schneeweiss, Sebastian

2014-06-01

The aim of this study was to develop and test a semi-automated process for conducting routine active safety monitoring for new drugs in a network of electronic healthcare databases. We built a modular program that semi-automatically performs cohort identification, confounding adjustment, diagnostic checks, aggregation and effect estimation across multiple databases, and application of a sequential alerting algorithm. During beta-testing, we applied the system to five databases to evaluate nine examples emulating prospective monitoring with retrospective data (five pairs for which we expected signals, two negative controls, and two examples for which it was uncertain whether a signal would be expected): cerivastatin versus atorvastatin and rhabdomyolysis; paroxetine versus tricyclic antidepressants and gastrointestinal bleed; lisinopril versus angiotensin receptor blockers and angioedema; ciprofloxacin versus macrolide antibiotics and Achilles tendon rupture; rofecoxib versus non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs) and myocardial infarction; telithromycin versus azithromycin and hepatotoxicity; rosuvastatin versus atorvastatin and diabetes and rhabdomyolysis; and celecoxib versus ns-NSAIDs and myocardial infarction. We describe the program, the necessary inputs, and the assumed data environment. In beta-testing, the system generated four alerts, all among positive control examples (i.e., lisinopril and angioedema; rofecoxib and myocardial infarction; ciprofloxacin and tendon rupture; and cerivastatin and rhabdomyolysis). Sequential effect estimates for each example were consistent in direction and magnitude with existing literature. Beta-testing across nine drug-outcome examples demonstrated the feasibility of the proposed semi-automated prospective monitoring approach. In retrospective assessments, the system identified an increased risk of myocardial infarction with rofecoxib and an increased risk of rhabdomyolysis with cerivastatin years

A Multicenter, Prospective Trial to Assess the Safety and Performance of the Spinal Modulation Dorsal Root Ganglion Neurostimulator System in the Treatment of Chronic Pain

NARCIS (Netherlands)

A.L. Liem (Liong); M. Russo (Marc); F.J.P.M. Huygen (Frank); J.P. Van Buyten (Jean-Pierre); I. Smets (Ilse); P. Verrills (Paul); M. Cousins (Michael); C. Brooker (Charles); R. Levy (Richard); T. Deer (Timothy); J. Kramer (Jeffery)

2013-01-01

textabstractObjectives: This multicenter prospective trial was conducted to evaluate the clinical performance of a new neurostimulation system designed to treat chronic pain through the electrical neuromodulation of the dorsal root ganglia (DRG) neurophysiologically associated with painful regions

Can surveillance systems identify and avert adverse drug events? A prospective evaluation of a commercial application.

Science.gov (United States)

Jha, Ashish K; Laguette, Julia; Seger, Andrew; Bates, David W

2008-01-01

Computerized monitors can effectively detect and potentially prevent adverse drug events (ADEs). Most monitors have been developed in large academic hospitals and are not readily usable in other settings. We assessed the ability of a commercial program to identify and prevent ADEs in a community hospital. and Measurement We prospectively evaluated the commercial application in a community-based hospital. We examined the frequency and types of alerts produced, how often they were associated with ADEs and potential ADEs, and the potential financial impact of monitoring for ADEs. Among 2,407 patients screened, the application generated 516 high priority alerts. We were able to review 266 alerts at the time they were generated and among these, 30 (11.3%) were considered substantially important to warrant contacting the physician caring for the patient. These 30 alerts were associated with 4 ADEs and 11 potential ADEs. In all 15 cases, the responsible physician was unaware of the event, leading to a change in clinical care in 14 cases. Overall, 23% of high priority alerts were associated with an ADE (95% confidence interval [CI] 12% to 34%) and another 15% were associated with a potential ADE (95% CI 6% to 24%). Active surveillance used approximately 1.5 hours of pharmacist time daily. A commercially available, computer-based ADE detection tool was effective at identifying ADEs. When used as part of an active surveillance program, it can have an impact on preventing or ameliorating ADEs.

Identification and diagnostic evaluation of possible dementia in general practice. A prospective study

DEFF Research Database (Denmark)

Waldorff, Frans Boch; Rishøj, Susanne; Waldemar, Gunhild

2005-01-01

, and 4 (3%) were treated for depression or referred for another condition. A total of 6 patients were lost to follow-up. In the remaining 102 undiagnosed patients the main reasons for not performing a diagnostic evaluation of dementia were patient/relative hesitation (34%), the GP thought that it would......OBJECTIVE: To investigate the rate of diagnostic evaluation of dementia for patients in whom a suspicion of dementia was raised, and to investigate reasons why a diagnostic evaluation was not always being performed. DESIGN: A prospective study among elderly patients aged 65+, and a follow-up study...... of dementia, laboratory-screening tests prescribed by the GPs and referral status after 6 months, and follow-up questionnaire. RESULTS: Of 793 patients a total of 138 patients were identified with possible dementia. Among the identified patients 26 (20%) were referred for further evaluation within 6 months...

Hospital Outpatient Prospective Payment System (OPPS) Lim...

Data.gov (United States)

U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Limited Data Set This file contains select claim level data and is derived from 2010 hospital outpatient PPS...

A Prospective Controlled Trial of an Electronic Hand Hygiene Reminder System.

Science.gov (United States)

Ellison, Richard T; Barysauskas, Constance M; Rundensteiner, Elke A; Wang, Di; Barton, Bruce

2015-12-01

Background.  The use of electronic hand hygiene reminder systems has been proposed as an approach to improve hand hygiene compliance among healthcare workers, although information on efficacy is limited. We prospectively assessed whether hand hygiene activities among healthcare workers could be increased using an electronic hand hygiene monitoring and reminder system. Methods.  A prospective controlled clinical trial was conducted in 2 medical intensive care units (ICUs) at an academic medical center with comparable patient populations, healthcare staff, and physical layout. Hand hygiene activity was monitored concurrently in both ICUs, and the reminder system was installed in the test ICU. The reminder system was tested during 3 administered phases including: room entry/exit chimes, display of real-time hand hygiene activity, and a combination of the 2. Results.  In the test ICU, the mean number of hand hygiene events increased from 1538 per day at baseline to 1911 per day (24% increase) with the use of a combination of room entry/exit chimes, real-time displays of hand hygiene activity, and manager reports (P performance returned to baseline (1473 hand hygiene events per day) during the follow-up phase. There was no significant change in hand hygiene activity in the control ICU during the course of the trial. Conclusions.  In an ICU setting, an electronic hand hygiene reminder system that provided real-time feedback on overall unit-wide hand hygiene performance significantly increased hand hygiene activity.

First clinical evaluation of a new single-use flexible ureteroscope (LithoVue™): a European prospective multicentric feasibility study

NARCIS (Netherlands)

Doizi, Steeve; Kamphuis, Guido; Giusti, Guido; Andreassen, Kim Hovgaard; Knoll, Thomas; Osther, Palle Jörn; Scoffone, Cesare; Pérez-Fentes, Daniel; Proietti, Silvia; Wiseman, Oliver; de la Rosette, Jean; Traxer, Olivier

2017-01-01

We evaluated a new digital single-use flexible ureteroscope, LithoVue™ with respect to deflection, image quality and maneuverability. A prospective cohort study was conducted in eight tertiary reference centers in Europe in December 2015 and January 2016. All consecutive patients included underwent

42 CFR 412.20 - Hospital services subject to the prospective payment systems.

Science.gov (United States)

2010-10-01

... payment systems. 412.20 Section 412.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Hospital Services Subject to and Excluded From the Prospective Payment Systems for Inpatient...

Qualitative study of sexual functioning in couples with erectile dysfunction: prospective evaluation of the thermography diagnostic system.

Science.gov (United States)

Ng, Wan Kee; Ng, Yin Kwee; Tan, Yung Khan

2009-01-01

To evaluate the prospective use of the thermography diagnostic system in assessing sexual function in patients with erectile dysfunction (ED). Thermographs were taken on 14 subjects in a clinical trial conducted at Tan Tock Seng Hospital. After a thorough clinical interview with a standardized questionnaire, patients were scanned for baseline temperature profile before being given an oral dose of sildenafil 100 mg. Subjects were scanned again in the same setting an hour later. If so desired, subjects were given visual stimulation and were allowed minimum direct stimulation, excluding the penis, to elicit erection. Temperature profiles were analyzed using the thermography analysis software in the VarioCAM camera. Three representative cases are presented to illustrate the potential for using the Infrared thermography (IR) diagnostic system in differentiating psychogenic ED. IR was able to capture a significant difference in blood flow to the corpus cavernosum. Subjects with psychogenic ED have higher surface temperatures (34.3 degrees C +/- 0.71 in the flaccid state and 35.3 degrees C +/- 0.2 during erection) compared to subjects with organic ED (33.64 degrees C +/- 0.4 in flaccid and 33.55 degrees C +/- 0.91 during erection). The difference in surface temperature between flaccid and erected states in subjects with organic ED was not significant. The proposed diagnostic test based on IR has tremendous clinical potential in differentiating psychogenic ED from organic ED. IR could potentially be a portable, noninvasive and convenient adjunct in the diagnosis and management of ED.

42 CFR 419.21 - Hospital outpatient services subject to the outpatient prospective payment system.

Science.gov (United States)

2010-10-01

... outpatient prospective payment system. 419.21 Section 419.21 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM... Excluded From the Hospital Outpatient Prospective Payment System § 419.21 Hospital outpatient services...

76 FR 41178 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for...

Science.gov (United States)

2011-07-13

... Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment...; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates'' which appeared in the...

Effect of prospective reimbursement on nursing home costs.

OpenAIRE

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-01-01

OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and ...

Medicare's prospective payment system for hospitals: new evidence on transitions among health care settings

OpenAIRE

Qian, Xufeng; Russell, Louise B.; Valiyeva, Elmira; Miller, Jane E.

2007-01-01

Previous studies of Medicare’s prospective payment system for hospitals (PPS), introduced in 1983, evaluated only its first few years, using data collected during the hospital stay to control for patients’ health. We examine transitions among health care settings over a full decade following implementation of PPS, using survival models and a national longitudinal survey with independent information on health. We find that the rate of discharge from hospitals to nursing homes continued to rise...

Prospective Evaluation of Self-Reported Aggression in Transgender Persons.

Science.gov (United States)

Defreyne, Justine; T'Sjoen, Guy; Bouman, Walter Pierre; Brewin, Nicola; Arcelus, Jon

2018-05-01

from friends in transgender women. Hormone-prescribing physicians can be reassured that the long-term administration of testosterone in transgender men does not increase aggressive behavior. This is the 1st prospective study to assess the effect of gender-affirming hormonal care on aggression. Limitations included the use of different laboratories, the use of a patient-reported outcome measure, and the lack of aggression subtypes. Testosterone therapy was not associated with an increase in levels of aggression in transgender men or a decrease in aggressive behavior in transgender women on antiandrogen and estrogen therapy, but other psychological and/or social factors, such as anxiety levels, appear to contribute to self-reported aggression in transgender people. Defreyne J, T'Sjoen G, Bouman WP, et al. Prospective Evaluation of Self-Reported Aggression in Transgender Persons. J Sex Med 2018;15:768-776. Copyright © 2018 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Impact of two interventions on timeliness and data quality of an electronic disease surveillance system in a resource limited setting (Peru: a prospective evaluation

Directory of Open Access Journals (Sweden)

Quispe Jose A

2009-03-01

Full Text Available Abstract Background A timely detection of outbreaks through surveillance is needed in order to prevent future pandemics. However, current surveillance systems may not be prepared to accomplish this goal, especially in resource limited settings. As data quality and timeliness are attributes that improve outbreak detection capacity, we assessed the effect of two interventions on such attributes in Alerta, an electronic disease surveillance system in the Peruvian Navy. Methods 40 Alerta reporting units (18 clinics and 22 ships were included in a 12-week prospective evaluation project. After a short refresher course on the notification process, units were randomly assigned to either a phone, visit or control group. Phone group sites were called three hours before the biweekly reporting deadline if they had not sent their report. Visit group sites received supervision visits on weeks 4 & 8, but no phone calls. The control group sites were not contacted by phone or visited. Timeliness and data quality were assessed by calculating the percentage of reports sent on time and percentage of errors per total number of reports, respectively. Results Timeliness improved in the phone group from 64.6% to 84% in clinics (+19.4 [95% CI, +10.3 to +28.6]; p Conclusion Regular phone reminders significantly improved timeliness of reports in clinics and ships, whereas supervision visits led to improved data quality only among clinics. Further investigations are needed to establish the cost-effectiveness and optimal use of each of these strategies.

Intraoperative discomfort associated with the use of a rotary or reciprocating system: a prospective randomized clinical

Directory of Open Access Journals (Sweden)

Aline Cristine Gomes

2017-05-01

Full Text Available Objectives The aim of this randomized, controlled, prospective clinical study was to evaluate patients' intraoperative discomfort during root canal preparations in which either multi-file rotary (Mtwo or single-file reciprocating (Reciproc systems were used. Materials and Methods Fifty-five adult patients, aged between 25 and 69 years old, with irreversible pulpitis or pulp necrosis participated in this study. Either the mesiobuccal or the distobuccal canals for maxillary molars and either the mesiobuccal or the mesiolingual canals for mandibular molars were randomly chosen to be instrumented with Mtwo multi-file rotary or Reciproc single-file reciprocating systems. Immediately after each canal instrumentation under anesthesia, patient discomfort was assessed using a 1 - 10 visual analog scale (VAS, ranging from ‘least possible discomfort’ (1 to ‘greatest possible discomfort’ (10. The Wilcoxon signed-rank test was used to determine significant differences at p< 0.05. Results Little intraoperative discomfort was found in all cases. No statistically significant differences in intraoperative discomfort between the 2 systems were found (p = 0.660. Conclusions Root canal preparation with multi-file rotary or single-file reciprocating systems had similar and minimal effects on patients' intraoperative discomfort.

A Prospective Controlled Trial of an Electronic Hand Hygiene Reminder System

Science.gov (United States)

Ellison, Richard T.; Barysauskas, Constance M.; Rundensteiner, Elke A.; Wang, Di; Barton, Bruce

2015-01-01

Background. The use of electronic hand hygiene reminder systems has been proposed as an approach to improve hand hygiene compliance among healthcare workers, although information on efficacy is limited. We prospectively assessed whether hand hygiene activities among healthcare workers could be increased using an electronic hand hygiene monitoring and reminder system. Methods. A prospective controlled clinical trial was conducted in 2 medical intensive care units (ICUs) at an academic medical center with comparable patient populations, healthcare staff, and physical layout. Hand hygiene activity was monitored concurrently in both ICUs, and the reminder system was installed in the test ICU. The reminder system was tested during 3 administered phases including: room entry/exit chimes, display of real-time hand hygiene activity, and a combination of the 2. Results. In the test ICU, the mean number of hand hygiene events increased from 1538 per day at baseline to 1911 per day (24% increase) with the use of a combination of room entry/exit chimes, real-time displays of hand hygiene activity, and manager reports (P hand hygiene to room entry/exit events also increased from 26.1% to 36.6% (40% increase, P hand hygiene events per day) during the follow-up phase. There was no significant change in hand hygiene activity in the control ICU during the course of the trial. Conclusions. In an ICU setting, an electronic hand hygiene reminder system that provided real-time feedback on overall unit-wide hand hygiene performance significantly increased hand hygiene activity. PMID:26430698

Multimodal system designed to reduce errors in recording and administration of drugs in anaesthesia: prospective randomised clinical evaluation.

Science.gov (United States)

Merry, Alan F; Webster, Craig S; Hannam, Jacqueline; Mitchell, Simon J; Henderson, Robert; Reid, Papaarangi; Edwards, Kylie-Ellen; Jardim, Anisoara; Pak, Nick; Cooper, Jeremy; Hopley, Lara; Frampton, Chris; Short, Timothy G

2011-09-22

To clinically evaluate a new patented multimodal system (SAFERSleep) designed to reduce errors in the recording and administration of drugs in anaesthesia. Prospective randomised open label clinical trial. Five designated operating theatres in a major tertiary referral hospital. Eighty nine consenting anaesthetists managing 1075 cases in which there were 10,764 drug administrations. Use of the new system (which includes customised drug trays and purpose designed drug trolley drawers to promote a well organised anaesthetic workspace and aseptic technique; pre-filled syringes for commonly used anaesthetic drugs; large legible colour coded drug labels; a barcode reader linked to a computer, speakers, and touch screen to provide automatic auditory and visual verification of selected drugs immediately before each administration; automatic compilation of an anaesthetic record; an on-screen and audible warning if an antibiotic has not been administered within 15 minutes of the start of anaesthesia; and certain procedural rules-notably, scanning the label before each drug administration) versus conventional practice in drug administration with a manually compiled anaesthetic record. Primary: composite of errors in the recording and administration of intravenous drugs detected by direct observation and by detailed reconciliation of the contents of used drug vials against recorded administrations; and lapses in responding to an intermittent visual stimulus (vigilance latency task). Secondary: outcomes in patients; analyses of anaesthetists' tasks and assessments of workload; evaluation of the legibility of anaesthetic records; evaluation of compliance with the procedural rules of the new system; and questionnaire based ratings of the respective systems by participants. The overall mean rate of drug errors per 100 administrations was 9.1 (95% confidence interval 6.9 to 11.4) with the new system (one in 11 administrations) and 11.6 (9.3 to 13.9) with conventional methods (one

Prospective evaluation of a clinical guideline recommending hospital length of stay in upper gastrointestinal tract hemorrhage.

Science.gov (United States)

Hay, J A; Maldonado, L; Weingarten, S R; Ellrodt, A G

Upper gastrointestinal tract hemorrhage (UGIH) is a common and potentially life-threatening disorder. Resource utilization can vary without adverse effect on patient outcome. Clinical practice guidelines are a potential solution to reduce variation in practice while improving patient outcomes. To validate prospectively the safety, acceptability, and impact of a clinical practice guideline defining the medically appropriate length of stay (LOS) for patients hospitalized with UGIH. Prospective, controlled time-series study with an alternate-month design. Outcome surveyors and patients were blinded to study group allocation. GUIDELINE: A retrospectively validated scoring system using 4 independent variables: hemodynamics, time from bleeding, comorbidity, and esophagogastroduodenoscopy (EGD) findings to predict risk of adverse events. The quantitative risk for the low-risk subset was 0.6% (95% confidence interval [CI], 0.0%-2.0%) for subsequent complications and 0% (95% CI, 0.0%-0.9%) for life-threatening complications from this retrospective evaluation. A 1000-bed, not-for-profit, university-affiliated teaching hospital. Consecutive adult patients hospitalized for acute UGIH. Concurrent feedback of guideline recommendation (same-day hospital discharge) to physicians caring for patients at low risk for complication. No risk information was provided during control months. Seventy percent (209/299) of UGIH patients achieved low-risk status according to the guideline and were therefore potentially suitable for early discharge from the hospital. Providing real-time quantitative risk information (intervention group only) was associated with an increase in guideline compliance from 30% to 70% (Preduction of 1.7 days per patient; P<.001). No differences in complications, patient health status, or patient satisfaction were found when measured 1 month after discharge. An independent variable predicting decreased hospital LOS for low-risk UGIH patients was early EGD

Ventilation System Strategy for a Prospective Korean Radioactive Waste Repository

International Nuclear Information System (INIS)

Kim, Jin; Kwon, Sang Ki

2005-01-01

In the stage of conceptual design for the construction and operation of the geologic repository for radioactive wastes, it is important to consider a repository ventilation system which serves the repository working environment, hygiene and safety of the public at large, and will allow safe maintenance like moisture content elimination in repository for the duration of the repositories life, construction/operation/closure, also allowing safe waste transportation and emplacement. This paper describes the possible ventilation system design criteria and requirements for the prospective Korean radioactive waste repositories with emphasis on the underground rock cavity disposal method in the both cases of low and medium-level and high-level wastes. It was found that the most important concept is separate ventilation systems for the construction (development) and waste emplacement (storage) activities. In addition, ventilation network system modeling, natural ventilation, ventilation monitoring systems and real time ventilation simulation, and fire simulation and emergency system in the repository are briefly discussed.

42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.

Science.gov (United States)

2010-10-01

... facility prospective payment system. 412.432 Section 412.432 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Services of Inpatient...

75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2010-10-01

...; RIN 0938-AP33 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY 2011 Rates; Provider... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective...

Evaluation of the utility of temporal subtraction images in successive whole-body bone scans: a prospective clinical study

International Nuclear Information System (INIS)

Shiraishi, J.; Appelbaum, D.; Pu, Y.; Engelmann, R.; Li Qiang; Doi, K.

2007-01-01

We have begun a prospective clinical study for evaluating the clinical utility of temporal subtraction images in successive whole-body bone scans. The computerized temporal subtraction technique has been developed in order to highlight interval changes of abnormal lesions due to skeletal metastases, primary bone tumors, osteomyelitis, and fractures. In our initial preliminary results of the prospective study which was started on November 22, 2006 in our hospital, radiologists reported some interval changes which were not recognized in the initial standard readings, but were obvious when temporal subtraction images were viewed. The usefulness of the temporal subtraction images will be investigated in terms of its clinical utility by the prospective clinical study. (orig.)

76 FR 9502 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

Science.gov (United States)

2011-02-18

... [CMS-1510-F2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... set forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: The... the Medicare prospective payment system for HHAs. This correcting amendment corrects a technical error...

42 CFR 412.6 - Cost reporting periods subject to the prospective payment systems.

Science.gov (United States)

2010-10-01

... payment systems. 412.6 Section 412.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES... prospective payment system for inpatient operating costs, the reasonable costs of services furnished before...

42 CFR 413.217 - Items and services included in the ESRD prospective payment system.

Science.gov (United States)

2010-10-01

... payment system. 413.217 Section 413.217 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT....217 Items and services included in the ESRD prospective payment system. The following items and services are included in the ESRD prospective payment system effective January 1, 2011: (a) Renal dialysis...

The evaluation of a formalized queue management system for coronary angiography waiting lists.

Science.gov (United States)

Alter, D A; Newman, Alice M; Cohen, Eric A; Sykora, Kathy; Tu, Jack V

2005-11-01

Lengthy waiting lists for coronary angiography have been described in many health care systems worldwide. The extent to which formal queue management systems may improve the prioritization and survival of patients in the angiography queue is unknown. To prospectively evaluate the performance of a formal queue management system for patients awaiting coronary angiography in Ontario. The coronary angiography urgency scale, a formal queue management system developed in 1993 using a modified Delphi panel, allocates recommended maximum waiting times (RMWTs) in accordance with clinical necessity. By using a provincial clinical registry, 35,617 consecutive patients referred into the coronary angiography queue between April 1, 2001, and March 31, 2002, were prospectively tracked. Cox proportional hazards models were used to examined mortality risk across urgency after adjusting for additional clinical and comorbid factors. Good agreement was determined in urgency ratings between scores from the coronary angiography urgency scale and implicit physician judgement, which was obtained independently at the time of the index referral (weighted kappa = 0.49). The overall mortality in the queue was 0.3% (0.47%, 0.26% and 0.13% for urgent, semiurgent and elective patients, respectively). Urgency, as specified by the coronary angiography urgency scale, was the strongest predictor of death in the queue (Pqueue management system may decrease mortality in the coronary angiography queue. The authors recommend its implementation in health care systems where patients experience excessive waiting time delays for coronary angiography.

75 FR 34614 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

Science.gov (United States)

2010-06-17

... Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and Rate Year 2010 Rates... Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long-Term Care...

77 FR 4908 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2012-02-01

... Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal... the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates...

77 FR 65495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2012-10-29

... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates...

78 FR 15882 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2013-03-13

... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals...

A prospective evaluation of plastibell® circumcision in older children

Directory of Open Access Journals (Sweden)

Jose Murillo Bastos Netto

2013-07-01

Full Text Available Introduction and Objective Circumcision is one of the oldest surgical procedures and one of the most frequently performed worldwide. It can be done by many different techniques. This prospective series presents the results of Plastibell® circumcision in children older than 2 years of age, evaluating surgical duration, immediate and late complications, time for plastic device separation and factors associated with it. Materials and Methods We prospectively analyzed 119 children submitted to Plastic Device Circumcision with Plastibell® by only one surgeon from December 2009 to June 2011. In all cases the surgery was done under general anesthesia associated with dorsal penile nerve block. Before surgery length of the penis and latero-lateral diameter of the glans were measured. Surgical duration, time of Plastibell® separation and use of analgesic medication in the post-operative period were evaluated. Patients were followed on days 15, 45, 90 and 120 after surgery. Results Age at surgery varied from 2 to 12.5 (5.9 ± 2.9 years old. Mean surgical time was 3.7 ± 2.0 minutes (1.9 to 9 minutes. Time for plastic device separation ranged from 6 to 26 days (mean: 16 ± 4.2 days, being 14.8 days for children younger than 5 years of age and 17.4 days for those older than 5 years of age (p < 0.0001. The diameter of the Plastibell® does not interfered in separations time (p = 0,484. Late complications occurred in 32 (26.8% subjects, being the great majority of low clinical significance, especially prepucial adherences, edema of the mucosa and discrete hypertrophy of the scar, all resolving with clinical treatment. One patient still using diaper had meatus stenosis and in one case the Plastibell® device stayed between the glans and the prepuce and needed to be removed manually. conclusions Circumcision using a plastic device is a safe, quick and an easy technique with low complications, that when occur are of low clinical importance and of easy

Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study.

Science.gov (United States)

Sena Esteves, Sara; Gonçalves Ferreira, Miguel; Carvalho Almeida, João; Abrunhosa, José; Almeida E Sousa, Cecília

Evaluation of surgery outcome measured by patient satisfaction or quality of life is very important, especially in plastic surgery. There is increasing interest in self-reporting outcomes evaluation in plastic surgery. The aim of our study was to determine patient satisfaction in regard to nose appearance and function with the use of a validated questionnaire, before and after rhinoplasty surgery. A prospective study was realized at a tertiary centre. All rhinoplasty surgeries performed in adults between February 2013 and August 2014 were included. Many patients underwent additional nasal surgery such as septoplasty or turbinoplasty. The surgical procedures and patients' characteristics were also recorded. Among 113 patients, 107 completed the questionnaires and the follow-up period. Analysis of pre-operative and post-operative Rhinoplasty Evaluation Outcome showed a significant improvement after 3 and 6 months in functional and aesthetic questions (pprocedures, primary or revision surgery and open versus closed approach. We found that patients with lower literacy degree were more satisfied with the procedure. Rhinoplasty surgery significantly improved patient quality of life regarding nose function and appearance. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Science.gov (United States)

2010-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... § 413.210 Conditions for payment under the end-stage renal disease (ESRD) prospective payment system... prospective payment system described in § 413.215 through § 413.235 of this part. (a) Qualifications for...

Prospective evaluation of frequency of signs of systemic sclerosis in 76 patients with morphea.

Science.gov (United States)

Lipsker, Dan; Bessis, Didier; Cosnes, Anne; Kluger, Nicolas; Lutz, Virginie; Sauleau, Erik; Francès, Camille

2015-01-01

Some authors consider that morphoea and systemic sclerosis (SSc) could be part of the same disease spectrum. The aim of this study was to analyse the prevalence of signs indicative of SSc in a cohort of patients with morphoea. This is a prospective multi-centre study performed in four French academic dermatology departments: 76 patients with morphoea and 101 age- and sex-matched controls, who underwent complete clinical examination, were enrolled. A systemic search for signs indicative of SSc (e.g. Raynaud's phenomenon, reflux) was performed with the help of a standardised questionnaire. There were 58 women and 18 men (ration=3/1) with a median age of 59 years. Mean age at diagnosis was 54 years (extremes, 13-87). 49 subjects had plaque morphoea, 9 had generalised morphoea and 18 had linear morphoea. Mean duration of morphoea was 7.9 years. Signs possibly indicative of SSc were noted in four patients of the control group and in 8 patients with morphoea. This difference was not statistically significant (p=0.129). Further investigations ruled out SSc in all patients. Signs indicative of SSc are statistically not more frequently present in patients with morphoea than in controls and this study does not support the view that those 2 entities are part of a common disease spectrum.

Ablation of atrial fibrillation with the Epicor system: a prospective observational trial to evaluate safety and efficacy and predictors of success

Directory of Open Access Journals (Sweden)

Diez Claudius

2010-05-01

Full Text Available Abstract Background High intensity focused ultrasound (HIFU energy has evolved as a new surgical tool to treat atrial fibrillation (AF. We evaluated safety and efficacy of AF ablation with HIFU and analyzed predictors of success in a prospective clinical study. Methods From January 2007 to June 2008, 110 patients with AF and concomitant open heart surgery were enrolled into the study. Main underlying heart diseases were aortic valve disease (50%, ischemic heart disease (48%, and mitral valve disease (18%. AF was paroxysmal in 29%, persistent in 31%, and long standing persistent in 40% of patients, lasting for 1 to 240 months (mean 24 months. Mean left atrial diameter was 50 ± 7 mm. Each patient underwent left atrial ablation with the Epicor system prior to open heart surgery. After surgery, the patients were treated with amiodarone and coumadin for 6 months. Follow-up studies including resting ECG, 24 h Holter ECG, and echocardiography were obtained at 6 and 12 months. Results All patients had successful application of the system on the beating heart prior to initiation of extracorporeal circulation. On average, 11 ± 1 ultrasound transducer elements were used to create the box lesion. The hand-held probe for additional linear lesions was employed in 83 cases. No device-related deaths occurred. Postoperative pacemaker insertion was necessary in 4 patients. At 6 months, 62% of patients presented with sinus rhythm. No significant changes were noted at 12 months. Type of AF and a left atrial diameter > 50 mm were predictors for failure of AF ablation. Conclusion AF ablation with the Epicor system as a concomitant procedure during open heart surgery is safe and acceptably effective. Our overall conversion rate was lower than in previously published reports, which may be related to the lower proportion of isolated mitral valve disease in our study population. Left atrial size may be useful to determine patients who are most likely to benefit from

77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2012-10-17

... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates..., 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for...

42 CFR 412.125 - Effect of change of ownership on payments under the prospective payment systems.

Science.gov (United States)

2010-10-01

... prospective payment systems. 412.125 Section 412.125 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.125 Effect of change of...

76 FR 59265 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing...

Science.gov (United States)

2011-09-26

... [CMS-1351-CN] RIN 0938-AQ29 Medicare Program; Prospective Payment System and Consolidated Billing for... rule entitled ``Medicare Program; Prospective Payment System and Consolidated Billing for Skilled... Payment System (PPS) final rule (76 FR 48486, 48540) inadvertently included several technical errors in...

A prospective evaluation of Dignity Therapy in advanced cancer patients admitted to palliative care

DEFF Research Database (Denmark)

Houmann, Lise Jul; Chochinov, Harvey M; Kristjanson, Linda J

2014-01-01

questionnaires were completed when patients received the generativity document (T1) and 2 weeks later (T2). Changes from baseline (T0) were measured in sense of dignity, Structured Interview for Symptoms and Concerns items, Patient Dignity Inventory, Hospital Anxiety and Depression Scale and European...... and will to live. Quality of life decreased (mean = -9 (95% confidence interval: -14.54; -2.49)) and depression increased (mean = 0.31 (0.06; 0.57)) on one of several depression measures. At T2 (n = 31), sense of dignity (mean = -0.52 (-1.01; -0.02)) and sense of being a burden to others (mean = -0.26 (-0.49; -0......Background:Dignity Therapy is a brief, psychosocial intervention for patients with incurable disease.Aim:To investigate participation in and evaluation of Dignity Therapy and longitudinal changes in patient-rated outcomes.Design:A prospective (pre/post) evaluation design was employed. Evaluation...

75 FR 76293 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

Science.gov (United States)

2010-12-08

... [CMS-1510-CN] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification... effective as if they had been included in the Medicare Program; Home Health Prospective Payment System Rate...

Prospective evaluation of EUS-guided fine needle biopsy in pancreatic mass lesions

DEFF Research Database (Denmark)

Larsen, M H; Fristrup, C W; Detlefsen, S

2018-01-01

Background and study aim : Due to the scarcity of specific data on endoscopic ultrasound (EUS)-guided fine-needle biopsies (SharkCore) FNB in the evaluation of pancreatic lesions, we performed a prospective study of the diagnostic performance of EUS SharkCore FNB in patients with pancreatic lesions...

3D laparoscopic surgery: a prospective clinical trial.

Science.gov (United States)

Agrusa, Antonino; Di Buono, Giuseppe; Buscemi, Salvatore; Cucinella, Gaspare; Romano, Giorgio; Gulotta, Gaspare

2018-04-03

Since it's introduction, laparoscopic surgery represented a real revolution in clinical practice. The use of a new generation three-dimensional (3D) HD laparoscopic system can be considered a favorable "hybrid" made by combining two different elements: feasibility and diffusion of laparoscopy and improved quality of vision. In this study we report our clinical experience with use of three-dimensional (3D) HD vision system for laparoscopic surgery. Between 2013 and 2017 a prospective cohort study was conducted at the University Hospital of Palermo. We considered 163 patients underwent to laparoscopic three-dimensional (3D) HD surgery for various indications. This 3D-group was compared to a retrospective-prospective control group of patients who underwent the same surgical procedures. Considerating specific surgical procedures there is no significant difference in term of age and gender. The analysis of all the groups of diseases shows that the laparoscopic procedures performed with 3D technology have a shorter mean operative time than comparable 2D procedures when we consider surgery that require complex tasks. The use of 3D laparoscopic technology is an extraordinary innovation in clinical practice, but the instrumentation is still not widespread. Precisely for this reason the studies in literature are few and mainly limited to the evaluation of the surgical skills to the simulator. This study aims to evaluate the actual benefits of the 3D laparoscopic system integrating it in clinical practice. The three-dimensional view allows advanced performance in particular conditions, such as small and deep spaces and promotes performing complex surgical laparoscopic procedures.

75 FR 81138 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

Science.gov (United States)

2010-12-27

... [CMS-1510-CN2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... ``Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in... Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home...

76 FR 68525 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012

Science.gov (United States)

2011-11-04

... Prospective Payment System Rate Update for Calendar Year 2012; Final Rule #0;#0;Federal Register / Vol. 76, No... 0938-AQ30 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012... sets forth updates to the home health prospective payment system (HH PPS) rates, including: the...

42 CFR 412.404 - Conditions for payment under the prospective payment system for inpatient hospital services of...

Science.gov (United States)

2010-10-01

... payment system for inpatient hospital services of psychiatric facilities. 412.404 Section 412.404 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital... must meet the conditions of this section to receive payment under the prospective payment system...

Technological pedagogical content knowledge of prospective mathematics teachers regarding evaluation and assessment

Directory of Open Access Journals (Sweden)

Ercan Atasoy

2016-04-01

Full Text Available The ‘technology integrated assessment process’ is an innovative method to capture and determine students’ understanding of mathematics. This assessment process is claimed to provide a singular dynamism for teaching and learning activities and it is also claimed to be of the most important elements of instruction in the educational system. In this sense, this study aims to investigate technological pedagogical content knowledge (TPACK of prospective mathematics teachers regarding the ‘evaluation’ and ‘assessment’ process. To achieve this aim, the method of qualitative research was conducted with 20 teachers. Video records and lesson plans were collected and a Mathematics Teacher TPACK Development Model was utilized to reveal themes and key features of the data. The findings revealed that, although the majority of teachers stated that they would like to use technology-integrated tools in the assessment and evaluation processes, they strongly preferred to use traditional assessment and evaluation techniques, such as pen and paper activities, multiple-choice questions in virtual environments, etc. Hence, the evidence suggests that teachers would be unable to use appropriately the technological assessment process in order to reveal students’ understanding of mathematics. As seen from the teachers’ lectures, they perceived that technology would be suitable for evaluation and assessment but in a limited way.

The Evaluation of the Opinions of Prospective Teachers about the Objectives of Human Rights Education

Science.gov (United States)

Özbek, Ramazan

2017-01-01

The aim of this study is to evaluate opinions of prospective teachers attending Social Sciences Teaching Department Primary Education Section on the objectives of Human Rights Education in the scope of Citizenship and Democracy Education Curriculum. This study is vital for learning of democratic life. 25 prospective teachers studying in the 8th…

Regression Discontinuity in Prospective Evaluations: The Case of the FFVP Evaluation

Science.gov (United States)

Klerman, Jacob Alex; Olsho, Lauren E. W.; Bartlett, Susan

2015-01-01

While regression discontinuity has usually been applied retrospectively to secondary data, it is even more attractive when applied prospectively. In a prospective design, data collection can be focused on cases near the discontinuity, thereby improving internal validity and substantially increasing precision. Furthermore, such prospective…

Ahmed glaucoma valve in post-penetrating-keratoplasty glaucoma: A critically evaluated prospective clinical study

Science.gov (United States)

Panda, Anita; Prakash, Vadivelu Jaya; Dada, Tanuj; Gupta, Anoop Kishore; Khokhar, Sudarshan; Vanathi, Murugesan

2011-01-01

Aim: The aim was to evaluate the outcome of Ahmed glaucoma valve (AGV) in post-penetrating-keratoplasty glaucoma (PKPG). Materials and Methods: In this prospective study, 20 eyes of 20 adult patients with post-PKPG with intraocular pressure (IOP) >21 mmHg, on two or more antiglaucoma medications, underwent AG (model FP7) implantation and were followed up for a minimum of 6 months. Absolute success was defined as 5 glaucoma managed by AGV implantation revealed a satisfactory outcome up to 6 months of follow-up. PMID:21586837

A Study on Perception of Librarian's Job Prospects

Directory of Open Access Journals (Sweden)

Younghee Noh

2017-03-01

Full Text Available The purpose of this study is to investigate awareness of librarian’s job prospects, and to do this a survey was conducted with 502 college students in 14 Departments of Library and Information Science around Korea and 753 librarians in libraries and related agencies. The study results are as follows. First, satisfaction with educational curriculum was higher in students than librarians. Second, both students and librarians regarded workplace based practical training as employment requirements and also evaluated certifications and academic performance as important requirements. Third, both groups asked that information on employment rates be available in a timely manner, and perceived that the librarian’s job prospects were not bright. Therefore, in order to improve employment of librarians, it will be necessary to establish a job information system, reorganize the current educational curriculum into a practice-oriented curriculum, and introduce the national curriculum statements (NCS-based curriculum.

42 CFR 413.220 - Methodology for calculating the per-treatment base rate under the ESRD prospective payment system...

Science.gov (United States)

2010-10-01

... rate under the ESRD prospective payment system effective January 1, 2011. 413.220 Section 413.220...-treatment base rate under the ESRD prospective payment system effective January 1, 2011. (a) Data sources. The methodology for determining the per treatment base rate under the ESRD prospective payment system...

A prospective evaluation of hippocampal radiation dose volume effects and memory deficits following cranial irradiation.

Science.gov (United States)

Ma, Ting Martin; Grimm, Jimm; McIntyre, Riley; Anderson-Keightly, Heather; Kleinberg, Lawrence R; Hales, Russell K; Moore, Joseph; Vannorsdall, Tracy; Redmond, Kristin J

2017-11-01

To prospectively evaluate hippocampal radiation dose volume effects and memory decline following cranial irradiation. Effects of hippocampal radiation over a wide range of doses were investigated by combining data from three prospective studies. In one, adults with small cell lung cancer received hippocampal-avoidance prophylactic cranial irradiation. In the other two, adults with glioblastoma multiforme received neural progenitor cell sparing radiation or no sparing with extra dose delivered to subventricular zone. Memory was measured by the Hopkins Verbal Learning Test-Revised Delayed Recall (HVLT-R DR) at 6 months after radiation. Dose-volume histograms were generated and dose-response data were fitted to a nonlinear model. Of 60 patients enrolled, 30 were analyzable based on HVLT-R DR testing completion status, baseline HVLT-R DR and intracranial metastasis/recurrence or prior hippocampal resection status. We observed a dose-response of radiation to the hippocampus with regard to decline in HVLT-R DR. D50% of the bilateral hippocampi of 22.1 Gy is associated with 20% risk of decline. This prospective study demonstrates an association between hippocampal dose volume effects and memory decline measured by HVLT-R DR over a wide dose range. These data support a potential benefit of hippocampal sparing and encourage continued trial enrollment. Copyright © 2017 Elsevier B.V. All rights reserved.

Prospective evaluation of the utility of routine postoperative cystogram after traumatic bladder injury.

Science.gov (United States)

Inaba, Kenji; Okoye, Obi T; Browder, Timothy; Best, Charles; Branco, Bernardino C; Teixeira, Pedro G; Barmparas, Galinos; Reddy, Sravanthi; Demetriades, Demetrios

2013-12-01

The value of routinely testing bladder repair integrity with a cystogram before urinary catheter removal is unclear. The purpose of this study was to prospectively evaluate the utility of routine postoperative cystogram after traumatic bladder injury. All patients sustaining a bladder injury requiring operative repair at two Level I trauma centers were prospectively enrolled during a 62-month study period ending on January 2011. Injury demographics, imaging data, and outcomes were extracted. All patients were evaluated with either a plain or a computed tomography cystogram. A total of 127 patients were enrolled (mean [SD] age, 30.4 [13.5] years; blunt trauma, 63.8%, mean [SD] Injury Severity Score [ISS], 17.7 [10.6]). A total of 75 patients (59.1%) had an intraperitoneal (IP) bladder injury, 44 (34.6%) had an extraperitoneal (EP) bladder injury, and 8 had a (6.3%) combined IP/EP bladder injury. All patients with IP and IP/EP injuries (n = 83) underwent operative repair and a postoperative cystogram at 8.6 (1.8) days (range, 5-13 days). Sixty-nine IP injuries (83.1%) were simple (dome or body disruption/penetrating injury), while 14 (16.9%) were complex (trigone/requiring ureter implantation). There were no deaths during the follow-up period. With the exception of one patient (1.2%) with a complex injury requiring ureteric implantation, there were no leaks demonstrated on postoperative cystogram, and the urinary catheters were successfully removed. In this prospective evaluation of the role of bladder evaluation after operative repair, routine use of follow-up cystograms for simple injuries did not impact clinical management. For complex repairs to the trigone or those requiring ureter implantation, a follow-up cystogram should be obtained before catheter removal. Diagnostic study, level II.

Effect of prospective reimbursement on nursing home costs.

Science.gov (United States)

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-04-01

This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.

75 FR 70013 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

Science.gov (United States)

2010-11-16

... 0938-AP89 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal... the July 22, 2010 Federal Register entitled, ``Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2011.'' DATES: Effective Date. This correction is effective for IRF...

76 FR 59256 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

Science.gov (United States)

2011-09-26

...; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size... [CMS-1349-CN] RIN 0938-AQ28 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size and Square Footage of Inpatient Rehabilitation Units...

76 FR 32085 - Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Rate...

Science.gov (United States)

2011-06-03

..., ``Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY... [CMS-1346-CN] RIN 0938-AQ23 Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY 2012); Correction AGENCY: Centers for Medicare...

Evaluation of the Alexon-Trend ProSpecT Campylobacter Microplate Assay

Science.gov (United States)

Tolcin, Rita; LaSalvia, Margaret M.; Kirkley, Barbara A.; Vetter, Emily A.; Cockerill, Franklin R.; Procop, Gary W.

2000-01-01

We evaluated stool specimens known to contain or be free of Campylobacter by traditional culture, using the ProSpecT Campylobacter microplate assay (Alexon-Trend, Ramsey, Minn.). This rapid enzyme immunoassay for the detection of Campylobacter-specific antigens demonstrated 96% sensitivity and 99% specificity and is an acceptable alternative method of Campylobacter detection. PMID:11015419

Prospective Patient-Related Outcome Evaluation of Secondary Cleft Rhinoplasty Using a Validated Questionnaire.

Science.gov (United States)

Sawyer, Adam R; Robinson, Stephen; Cadier, Michael

2017-07-01

To evaluate patient satisfaction and quality of life following secondary cleft rhinoplasty. Prospective consecutive patient, single unit, single surgeon study. Spires Cleft Centre, Salisbury, Wilshire, United Kingdom, and private practice. 56 (27 secondary cleft rhinoplasty) patients completed evaluation forms preoperatively and 3 to 6 months postoperatively. Subjective assessment was performed using a validated Rhinoplasty Outcomes Evaluation (ROE) questionnaire. This instrument comprises six questions that capture three quality-of-life domains: physical, mental/emotional, and social. Rhinoplasty outcomes evaluation scores were calculated (range = 0 to 100) to indication satisfaction with rhinoplasty outcomes. Average age was 28 years (range = 18 to 59 years). There was a significant subjective improvement in the total ROE evaluation scores from 28 ± 10 to 80 ± 11 (P aesthetic appearance improved from 0.3 ± 0.2 to 3.2 ± 0.3 (P < .01) in secondary cleft rhinoplasty. No significant change was seen in breathing capacity in secondary cleft rhinoplasty (from 2.7 ± 0.3 to 3.2 ± 0.2; P = .29). All patients said they would undergo the procedure again. Our results demonstrate high patient satisfaction after cleft rhinoplasty with particular regard to cosmetic appearance. These results are similar to those for noncleft rhinoplasty. We would recommend the use of this simple and quick validated outcome tool with all rhinoplasty patients.

Possibilities of systems approach in oil and gas prospecting in the Perm Urals

Energy Technology Data Exchange (ETDEWEB)

Viksman, S.I.; Kalabin, S.N.; Makalovskiy, V.V.

1985-01-01

An examination is made of the possibility of systems approach in prospecting and exploration for oil and gas; the advantages of this approach in purposeful selection of priority directions of prospecting and exploration are given.

Prospective evaluation of radiation-induced skin toxicity in a race/ethnically diverse breast cancer population

International Nuclear Information System (INIS)

Wright, Jean L.; Takita, Cristiane; Reis, Isildinha M.; Zhao, Wei; Lee, Eunkyung; Nelson, Omar L.; Hu, Jennifer J.

2016-01-01

We evaluated predictors of radiation-induced skin toxicity in a prospective study of a tri-racial/ethnic breast cancer population. We evaluated patient demographics, tumor characteristics, and treatment variables in the first 392 patients in a prospective study assessing radiation-induced skin toxicity. Logistic regression analyses were conducted to evaluate potential predictors of skin toxicity. The study consists of 59 non-Hispanic whites (NHW; 15%), 241 Hispanic Whites (HW; 62%), 79 black or African Americans (AA; 20%), and 13 others (3%). Overall, 48% developed grade 0–1 skin toxicity, 49.8% grade 2, and 2.2% grade 3 by the National Cancer Institute's Common Toxicity Criteria for Adverse Events (CTCAE) scale. Twenty-one percent developed moist desquamation. In multivariate analysis, higher body mass index (BMI; OR = 2.09; 95%CI = 1.15, 3.82), higher disease stage (OR = 1.82; 95%CI = 1.06, 3.11), ER-positive/PR-negative status (OR = 2.74; 95%CI = 1.26, 5.98), and conventionally fractionated regimens (OR = 3.25; 95%CI = 1.76, 6.01) were significantly associated with higher skin toxicity grade after adjustment for age, race, ethnicity, ER status, and breast volume. BMI specifically predicted for moist desquamation, but not degree of erythema. In this racially and ethnically diverse cohort of breast cancer patients receiving radiation to the intact breast, risk factors including BMI, disease stage, and conventionally fractionated radiation predicted for higher skin toxicity grade, whereas age, race, ethnicity, and breast volume did not. BMI specifically predicted for moist desquamation, suggesting that preventive measures to address this particular outcome should be investigated

Development and prospects of guidance system for operators in nuclear power station

International Nuclear Information System (INIS)

Aeba, Youichi

1988-01-01

In nuclear power plants, the information on plant process and the status of machinery and equipment is collected in a central control room, and operators watch the information and carry out the necessary operation according to circumstances, in this way, the stable safe operation is carried out. Recently, process parameters and the status of machinery and equipment are displayed, being classified by the objectives of monitoring, and when operators evaluate the condition of a plant, the burden of collecting required information is reduced, and the identification of the cause of abnormality and the forecast of the range of spread and the development of abnormality are eased. However, the burden of operators in the case of coping with the abnormal event in a plant is still heavy. In this report, the prospect of the operation-supporting system to which knowledge engineering is applied and the status of its development are described. The concept, system constitution, knowledge expression and inference control mechanism of the operation-supporting system, the test of the system and the results, and the perspective of the system hereafter are reported. (Kako, I.)

New Fluorescent Reporter Systems for Evaluation of the Expression of E- and N-Cadherins.

Science.gov (United States)

Burmistrova, O A; Nikulin, S V; Zakharova, G S; Fomicheva, K A; Alekseev, B Ya; Shkurnikov, M Yu

2018-05-24

During metastatic growth, cells of solid tumors undergo phenotypical changes related to epithelial-mesenchymal transition. Epithelial-mesenchymal transition is regarded as a potential target for prospective antitumor drugs. Fluorescent reporter systems for evaluation of the expression of markers of epithelial and mesenchymal status (E- and N-cadherins) were created. The described approaches can be used for creation of analogous reporter systems.

Pre-Service Teachers' Retrospective and Prospective Evaluations: Program, Self, and Teaching Profession

Science.gov (United States)

Ulusoy, Mustafa

2015-01-01

This study aimed to investigate teacher candidates' retrospective and prospective evaluations about the classroom teacher education program, self, and the teaching profession. Observations, interviews, focus group interviews, and surveys were used to collect data from the 240 subjects. Teacher candidates believed that the teaching profession is…

Prospective phase II study of image-guided local boost using a real-time tumor-tracking radiotherapy (RTRT) system for locally advanced bladder cancer

International Nuclear Information System (INIS)

Nishioka, Kentaro; Shimizu, Shinichi; Shinohara, Nobuo

2014-01-01

The real-time tumor-tracking radiotherapy system with fiducial markers has the advantage that it can be used to verify the localization of the markers during radiation delivery in real-time. We conducted a prospective Phase II study of image-guided local-boost radiotherapy for locally advanced bladder cancer using a real-time tumor-tracking radiotherapy system for positioning, and here we report the results regarding the safety and efficacy of the technique. Twenty patients with a T2-T4N0M0 urothelial carcinoma of the bladder who were clinically inoperable or refused surgery were enrolled. Transurethral tumor resection and 40 Gy irradiation to the whole bladder was followed by the transurethral endoscopic implantation of gold markers in the bladder wall around the primary tumor. A boost of 25 Gy in 10 fractions was made to the primary tumor while maintaining the displacement from the planned position at less than ±2 mm during radiation delivery using a real-time tumor-tracking radiotherapy system. The toxicity, local control and survival were evaluated. Among the 20 patients, 14 were treated with concurrent chemoradiotherapy. The median follow-up period was 55.5 months. Urethral and bowel late toxicity (Grade 3) were each observed in one patient. The local-control rate, overall survival and cause-specific survival with the native bladder after 5 years were 64, 61 and 65%. Image-guided local-boost radiotherapy using a real-time tumor-tracking radiotherapy system can be safely accomplished, and the clinical outcome is encouraging. A larger prospective multi-institutional study is warranted for more precise evaluations of the technological efficacy and patients' quality of life. (author)

Evaluation of aesthetics of implant-supported single-tooth replacements using different bone augmentation procedures : A prospective randomized clinical study

NARCIS (Netherlands)

Meijndert, Leo; Meijer, Henny J. A.; Stellingsma, Kees; Stegenga, Boudewijn; Raghoebar, Gerry M.

2007-01-01

Objectives: The aim of this study was to evaluate the aesthetics of implant-supported single-tooth replacements using different augmentation procedures in a prospective study with the use of an objective rating index and with a subjective patient questionnaire, and to compare the results with each

Conceptual Paradigms and Empirical Investigations for Evaluating INTELSAT's Past Performance and Future Prospects.

Science.gov (United States)

Snow, Marcellus S.

This paper summarizes the results of a recent study of the past performance and future prospects of the International Telecommunications Satellite (INTELSAT) Organization. First, an overview of INTELSAT's history is provided and major policy issues are detailed. Five alternative paradigms are then presented through which to evaluate INTELSAT's…

76 FR 13292 - Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2011...

Science.gov (United States)

2011-03-11

... Prospective Payment System and CY 2011 Payment Rates; Changes to the Ambulatory Surgical Center Payment System..., 2010, entitled ``Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates; Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Payments to Hospitals for...

Development of expert evaluation system for advanced nuclear power stations

International Nuclear Information System (INIS)

Yang Mengjia; Ren Junsheng; Zhou Zhiwei; Zhang Qi; Zhu Shutang

2005-01-01

The wheels of the nuclear power industry in China are going to roll on the fast rails soon: It is important to establish an expert evaluation system for optimally selecting new types of NPPs in the future based on scientific evaluation. Under such a background, an expert evaluation system is developed to evaluate Various types of NPPs for the following two decades by taking into account the advices of selected top specialists in Chinese nuclear power industry, and by adopting different evaluation methods. The evaluation system is designed to use the database-MS-SQL Server or Oracle for manipulating experts' knowledge and objective data for scaling NPPs by user-selected evaluation methods for evaluating NPPs. The system includes two subsystems: one is called the Data Management Module and the other called the Evaluation Arithmetic Module. The Data Management Module is used to manage expert knowledge in forms of item marks of the NPPs given by experts of nuclear engineering. The Evaluation Arithmetic Module is used to analyze and deal with the evaluation based on the data in the Database by certain designed evaluation method, and to provide the evaluation results. Based on the users' selection, the evaluation of the NPPs is processed, and the results can be dynamically listed in table or displayed in graphics. So it can be used as a consulting tool to help users make optimal selection of prospective NPPs. The system is developed in architecture of the mixture framework C/S(Client/Server) and B/S(Browse/Server), thus is safe, advanced, extensible and user- friendly. The present system is computer network based, so it can be used not only in personal PC and local network, but also in the Web Server which can be browsed by remote users. To develop such an evaluation system is an initiative R and D project in Chinese nuclear R and D activities. Although the evaluation system is far from perfect, however, the preliminary evaluation results produced by the evaluation

A prospective cohort study to evaluate peridomestic infection as a determinant of dengue transmission: Protocol

Directory of Open Access Journals (Sweden)

Martínez-Vega Ruth

2012-04-01

Full Text Available Abstract Background Vector control programs, which have focused mainly on the patient house and peridomestic areas around dengue cases, have not produced the expected impact on transmission. This project will evaluate the assumption that the endemic/epidemic transmission of dengue begins around peridomestic vicinities of the primary cases. Its objective is to assess the relationship between symptomatic dengue case exposure and peridomestic infection incidence. Methods/Design A prospective cohort study will be conducted (in Tepalcingo and Axochiapan, in the state of Morelos, Mexico, using the state surveillance system for the detection of incident cases. Paired blood specimens will be collected from both the individuals who live with the incident cases and a sample of subjects residing within a 25-meter radius of such cases (exposed cohort, in order to measure dengue-specific antibodies. Other subjects will be selected from areas which have not presented any incident cases within 200 meters, during the two months preceding the sampling (non-exposed cohort. Symptomatic/asymptomatic incident infection will be considered as the dependent variable, exposure to confirmed dengue cases, as the principal variable, and the socio-demographic, environmental and socio-cultural conditions of the subjects, as additional explanatory variables. Discussion Results indicating a high infection rate among the exposed subjects would justify the application of peridomestic control measures and call for an evaluation of alternate causes for insufficient program impact. On the other hand, a low incidence of peridomestic-infected subjects would support the hypothesis that infection occurs outside the domicile, and would thus explain why the vector control measures applied in the past have exerted such a limited impact on cases incidence rates. The results of the present study may therefore serve to reassess site selection for interventions of this type.

A prospective evaluation of whole-exome sequencing as a first-tier molecular test in infants with suspected monogenic disorders.

Science.gov (United States)

Stark, Zornitza; Tan, Tiong Y; Chong, Belinda; Brett, Gemma R; Yap, Patrick; Walsh, Maie; Yeung, Alison; Peters, Heidi; Mordaunt, Dylan; Cowie, Shannon; Amor, David J; Savarirayan, Ravi; McGillivray, George; Downie, Lilian; Ekert, Paul G; Theda, Christiane; James, Paul A; Yaplito-Lee, Joy; Ryan, Monique M; Leventer, Richard J; Creed, Emma; Macciocca, Ivan; Bell, Katrina M; Oshlack, Alicia; Sadedin, Simon; Georgeson, Peter; Anderson, Charlotte; Thorne, Natalie; Melbourne Genomics Health Alliance; Gaff, Clara; White, Susan M

2016-11-01

To prospectively evaluate the diagnostic and clinical utility of singleton whole-exome sequencing (WES) as a first-tier test in infants with suspected monogenic disease. Singleton WES was performed as a first-tier sequencing test in infants recruited from a single pediatric tertiary center. This occurred in parallel with standard investigations, including single- or multigene panel sequencing when clinically indicated. The diagnosis rate, clinical utility, and impact on management of singleton WES were evaluated. Of 80 enrolled infants, 46 received a molecular genetic diagnosis through singleton WES (57.5%) compared with 11 (13.75%) who underwent standard investigations in the same patient group. Clinical management changed following exome diagnosis in 15 of 46 diagnosed participants (32.6%). Twelve relatives received a genetic diagnosis following cascade testing, and 28 couples were identified as being at high risk of recurrence in future pregnancies. This prospective study provides strong evidence for increased diagnostic and clinical utility of singleton WES as a first-tier sequencing test for infants with a suspected monogenic disorder. Singleton WES outperformed standard care in terms of diagnosis rate and the benefits of a diagnosis, namely, impact on management of the child and clarification of reproductive risks for the extended family in a timely manner.Genet Med 18 11, 1090-1096.

NNWSI project information management system concepts evaluation report. Final report

International Nuclear Information System (INIS)

1986-08-01

This report is intended as a first step in developing detailed information management system specifications for the Nevada Nuclear Waste Storage Investigations (NNWSI) Project. The current state of information management at the NNWSI Project level is investigated and an information management system (IMS) is proposed. The IMS as it relates to aspects of Project and records management is discussed. Information management concepts and prospective IMS system components are investigated. Concepts and system components include: indexing, searching, retrieval, data base management system technology, computers, storage media, computer-assisted retrieval (CAR) of microfilm, electronic imaging-based systems, optical character recognition, and communications. Performance criteria and desirable system attributes applicable to the IMS are discussed. Six conceptual system approaches capable of satisfying the performance criteria are defined. System approaches include: fully centralized microfilm system based on CAR retrieval (Approach 1), partially distributed microfilm system based on CAR retrieval (Approach 2), fully distributed microfilm system based on CAR retrieval (Approach 3), fully centralized optical disk system based on electronic image and full-text retrieval (Approach 4), partially distributed optical system based on electron image and full-text retrieval (Approach 5), and fully distributed optical disk system based on electronic image and full-text retrieval (Approach 6). Technical and cost considerations associated with the six conceptual approaches are evaluated. Technical evaluation results indicate Approach 4 is the best conceptual approach, and cost evaluation results show no significant differences among approaches. On the basis of the evaluation, Approach 4 is recommended

Prospective Genotyping of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Isolates by Use of a Novel, Highly Discriminatory Binary Typing System

Science.gov (United States)

Zhou, Fei; Sintchenko, Vitali; Gilbert, Gwendolyn L.

2012-01-01

In settings of high methicillin-resistant Staphylococcus aureus (MRSA) prevalence, detection of nosocomial transmission events can be difficult without strain typing. Prospective typing of all MRSA isolates could potentially identify transmission in a timely fashion, making infection control responses to outbreaks more effective. We describe the development and evaluation of a novel 19-target binary typing system for MRSA using the multiplex-PCR/reverse line blot hybridization platform. Pulse-field gel electrophoresis (PFGE), spa typing, and phage-derived open reading frame (PDORF) typing were performed for comparison. The system was utilized to identify transmission events in three general surgical wards over a 12-month period. Initial MRSA isolates from 273 patients were differentiated into 55 unique binary types. One or more potential contacts colonized with the same MRSA strain were identified in 69 of 87 cases (79%) in which definite or possible nosocomial MRSA acquisition had occurred. The discriminatory power of the typing system was similar to that of PFGE (Simpson's index of diversity [D] = 0.994, versus 0.987) and higher than that of spa typing (D = 0.926). Strain typing reduced the total number of potential MRSA-colonized source contacts from 859 to 212 and revealed temporal clustering of transmission events. Prospective MRSA typing using this novel binary typing method can rapidly identify nosocomial transmission events, even in high-prevalence settings, which allows timely infection control interventions. The system is rapid, inexpensive, discriminatory, and suitable for routine, high-throughput use in the hospital microbiology laboratory. PMID:22895043

Prospective Payment System (PPS)-Exempt Cancer Hospital Quality Reporting (PCHQR)

Data.gov (United States)

U.S. Department of Health & Human Services — Prospective Payment System (PPS)-Exempt Cancer Hospital Quality Reporting (PCHQR) Program currently uses one clinical effectiveness measure—External Beam...

78 FR 38679 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2013-06-27

... Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... regarding MS-DRG classifications and new technology add-on payments. Eva Fung (410) 786-7539, for...

75 FR 45699 - Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2010...

Science.gov (United States)

2010-08-03

... Prospective Payment System and CY 2010 Payment Rates; Changes to the Ambulatory Surgical Center Payment System...-1414-CN2] RIN 0938-AP41 Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2010 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2010...

Surgical approach to TIR3 cytology class A prospective evaluation.

Science.gov (United States)

D'Alessandro, Nicola; Fasano, Giovanni Michele; Gilio, Francesco; Iside, Giovanni; Izzo, Maria Lucia; Loffredo, Andrea; Pinto, Margherita; Tramontano, Salvatore; Tramutola, Giuseppe; Citro, Giuseppe

2014-01-01

Fine-needle aspiration (FNA) has proven to be a safe and reliable method of investigation of thyroid lesions. Referencing to European classification, the associated risk of malignancy for TIR3, category reserved for aspirates that contain architectural and/or nuclear atypia, is variable in such studies. Aims of study were evaluating safety of surgical approach, assessing perioperative parameters surgically related, and estimating neoplastic rate for TIR3 group. A prospective evaluation of all TIR3 submitted to thyroidectomy was conducted by assessing histopatohologic results between January 2005 and December 2012, considering two categories, positive (neoplastic) and negative (not neoplastic) group. Intraoperative and complication rate was analyzed on TIR3 population. A total of 1514 total thyroidectomy was performed from 2005 to 2012: a total of 148 cases was considered on TIR3 group. Positive cases amounted to 64 (43.2%), 29 of which were carcinoma (19.6% of total population) and 35 of which were adenoma, while negative cases amounted to 84 (56.8%). Sensitivity and specificity of TIR3 as neoplastic screening was 43.2% and 82.1%. A total of 32 linfectomies was performed (21.6% of group). Positive group presented a significant lower mean age than negative group (42.1 vs 56.2 years) TIR3 group represents a various category, with probably different malignancy risk. Our results and neoplasms rate confirmed that surgical option should be gold standard, in order to define atypical pattern and reduce delayed diagnoses. Choice of a second FNA or a imaging monitoring should be adopted for specific condition. Fine-needle aspiration, Thyroidectomy, TIR3, Thyroid cancer.

Evaluation of the Prevention and Reactivation Care Program (PReCaP) for the hospitalized elderly: A prospective nonrandomized controlled trial

NARCIS (Netherlands)

K.J.E. Asmus-Szepesi (Kirsten); L.E. Flinterman (Linda); M.A. Koopmanschap (Marc); A.P. Nieboer (Anna); T.J.E.M. Bakker (Ton); J.P. Mackenbach (Johan); E.W. Steyerberg (Ewout)

2015-01-01

textabstractBackground: The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly. Methods: The prospective nonrandomized controlled

Prospective comparison of PI-RADS version 2 and qualitative in-house categorization system in detection of prostate cancer.

Science.gov (United States)

Gaur, Sonia; Harmon, Stephanie; Mehralivand, Sherif; Bednarova, Sandra; Calio, Brian P; Sugano, Dordaneh; Sidana, Abhinav; Merino, Maria J; Pinto, Peter A; Wood, Bradford J; Shih, Joanna H; Choyke, Peter L; Turkbey, Baris

2018-03-31

Prostate Imaging-Reporting and Data System v. 2 (PI-RADSv2) provides standardized nomenclature for interpretation of prostate multiparametric MRI (mpMRI). Inclusion of additional features for categorization may provide benefit to stratification of disease. To prospectively compare PI-RADSv2 to a qualitative in-house system for detecting prostate cancer on mpMRI. Prospective. In all, 338 patients who underwent mpMRI May 2015-May 2016, with subsequent MRI/transrectal ultrasound fusion-guided biopsy. 3T mpMRI (T 2 W, diffusion-weighted [DW], apparent diffusion coefficient [ADC] map, b-2000 DWI acquisition, and dynamic contrast-enhanced [DCE] MRI). One genitourinary radiologist prospectively read mpMRIs using both in-house and PI-RADSv2 5-category systems. In lesion-based analysis, overall and clinically significant (CS) tumor detection rates (TDR) were calculated for all PI-RADSv2 and in-house categories. The ability of each scoring system to detect cancer was assessed by area under receiver operator characteristic curve (AUC). Within each PI-RADSv2 category, lesions were further stratified by their in-house categories to determine if TDRs can be increased by combining features of both systems. In 338 patients (median prostate-specific antigen [PSA] 6.5 [0.6-113.6] ng/mL; age 64 [44-84] years), 733 lesions were identified (47% tumor-positive). Predictive abilities of both systems were comparable for all (AUC 76-78%) and CS cancers (AUCs 79%). The in-house system had higher overall and CS TDRs than PI-RADSv2 for categories 3 and 4 (P house 65%, PI-RADSv2 22.1%). For lesions categorized as PI-RADSv2 = 4, characterization of suspicious/indeterminate extraprostatic extension (EPE) and equivocal findings across all mpMRI sequences contributed to significantly different TDRs for both systems (TDR range 19-75%, P < 0.05). PI-RADSv2 behaves similarly to an existing validated system that relies on the number of sequences on which a lesion is seen. This prospective

42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

Science.gov (United States)

2010-10-01

... payment system for inpatient rehabilitation facilities. 412.604 Section 412.604 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for payment under the prospective payment system for inpatient...

76 FR 18930 - Medicare Programs: Changes to the End-Stage Renal Disease Prospective Payment System Transition...

Science.gov (United States)

2011-04-06

... Payment System Transition Budget-Neutrality Adjustment AGENCY: Centers for Medicare & Medicaid Services... in the CY 2011 ESRD Prospective Payment System (PPS) final rule for renal dialysis services provided...-Stage Renal Disease Prospective Payment System'', hereinafter, referred to as the CY 2011 ESRD PPS final...

78 FR 21131 - Prospective Grant of An Exclusive Evaluation Option License: Pre-clinical Evaluation of Anti...

Science.gov (United States)

2013-04-09

... technology family, to SPEED BioSystems, LLC. The patent rights in these inventions have been assigned to the... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Prospective Grant of An... Immunotoxins for the Treatment of Human Cancers AGENCY: National Institutes of Health, HHS. ACTION: Notice...

A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures.

Science.gov (United States)

Pieracci, Fredric M; Lin, Yihan; Rodil, Maria; Synder, Madelyne; Herbert, Benoit; Tran, Dong Kha; Stoval, Robert T; Johnson, Jeffrey L; Biffl, Walter L; Barnett, Carlton C; Cothren-Burlew, Clay; Fox, Charles; Jurkovich, Gregory J; Moore, Ernest E

2016-02-01

Previous studies of surgical stabilization of rib fractures (SSRF) have been limited by small sample sizes, retrospective methodology, and inclusion of only patients with flail chest. We performed a prospective, controlled evaluation of SSRF as compared with optimal medical management for severe rib fracture patterns among critically ill trauma patients. We hypothesized that SSRF improves acute outcomes. We conducted a 2-year clinical evaluation of patients with any of the following rib fracture patterns: flail chest, three or more fractures with bicortical displacement, 30% or greater hemithorax volume loss, and either severe pain or respiratory failure despite optimal medical management. In the year 2013, all patients were managed nonoperatively. In the year 2014, all patients were managed operatively. Outcomes included respiratory failure, tracheostomy, pneumonia, ventilator days, tracheostomy, length of stay, daily maximum incentive spirometer volume, narcotic requirements, and mortality. Univariate and multivariable analyses were performed. Seventy patients were included, 35 in each group. For the operative group, time from injury to surgery was 2.4 day, operative time was 1.5 hours, and the ratio of ribs fixed to ribs fractured was 0.6. The operative group had a significantly higher RibScore (4 vs. 3, respectively, p fracture patterns. Therapeutic study, level II.

Prospective microbiologic evaluation of the forceps elevator in closed-channel duodenoscopes after reprocessing.

Science.gov (United States)

Paula, Helga; Tribl, Barbara; Presterl, Elisabeth; Diab-El Schahawi, Magda

2017-02-01

Endoscopes are well-known sources of bacterial transmission in health care facilities offering endoscopy services. The association between multidrug-resistant bacterial infections in patients who had undergone an endoscopic retrograde cholangiopancreatography procedure with reprocessed duodenoscopes has been much discussed. Bacterial contamination of duodenoscopes has been attributed to difficulties with reprocessing these devices, specifically the distal end of the scope, which features a movable forceps elevator. In light of a recent Food and Drug Administration warning letter to Olympus regarding their closed-channel duodenoscope model TJF-Q180V, the aim of our study was to prospectively evaluate the efficacy and safety of our current reprocessing procedures with regard to the TJF-Q180V duodenoscope models used in our hospital. From August 2015-March 2016, we prospectively collected microbiologic surveillance samples from 6 TJF-Q180V model duodenoscopes in routine use at the Division of Gastroenterology and Hepatology using the ESwab collection system (COPAN Diagnostics Inc, Murrieta, CA). A total of 237 microbiologic samples from the forceps elevator were obtained during the survey period. None of the samples yielded microorganism growth. These findings suggest that when following a diligent and validated reprocessing standard in accordance with manufacturer's recommendations, closed-channel endoscope models can still be used. Nevertheless, validated adaptions of current closed-channel duodenoscope models are needed to allow for simple and safe reprocessing. Furthermore, comprehensive postmarket surveillance needs to be established. Copyright © 2017. Published by Elsevier Inc.

Neurocognitive systems related to real-world prospective memory.

Directory of Open Access Journals (Sweden)

Grégoria Kalpouzos

Full Text Available BACKGROUND: Prospective memory (PM denotes the ability to remember to perform actions in the future. It has been argued that standard laboratory paradigms fail to capture core aspects of PM. METHODOLOGY/PRINCIPAL FINDINGS: We combined functional MRI, virtual reality, eye-tracking and verbal reports to explore the dynamic allocation of neurocognitive processes during a naturalistic PM task where individuals performed errands in a realistic model of their residential town. Based on eye movement data and verbal reports, we modeled PM as an iterative loop of five sustained and transient phases: intention maintenance before target detection (TD, TD, intention maintenance after TD, action, and switching, the latter representing the activation of a new intention in mind. The fMRI analyses revealed continuous engagement of a top-down fronto-parietal network throughout the entire task, likely subserving goal maintenance in mind. In addition, a shift was observed from a perceptual (occipital system while searching for places to go, to a mnemonic (temporo-parietal, fronto-hippocampal system for remembering what actions to perform after TD. Updating of the top-down fronto-parietal network occurred at both TD and switching, the latter likely also being characterized by frontopolar activity. CONCLUSION/SIGNIFICANCE: Taken together, these findings show how brain systems complementary interact during real-world PM, and support a more complete model of PM that can be applied to naturalistic PM tasks and that we named PROspective MEmory DYnamic (PROMEDY model because of its dynamics on both multi-phase iteration and the interactions of distinct neurocognitive networks.

Definition of a prospective payment system to reimburse emergency departments.

Science.gov (United States)

Levaggi, Rosella; Montefiori, Marcello

2013-10-11

Payers are increasingly turning to Prospective Payment Systems (PPSs) because they incentivize efficiency, but their application to emergency departments (EDs) is difficult because of the high level of uncertainty and variability in the cost of treating each patient.To the best of our knowledge, our work represents the first attempt at defining a PPS for this part of hospital activity. Data were specifically collected for this study and relate to 1011 patients who were triaged at an ED of a major Italian hospital, during 1 week in December 2010.The cost for each patient was analytically estimated by adding up several components: 1) physician and other staff costs that were imputed on the basis of the time each physician claimed to have spent treating the patient; 2) the cost for each test/treatment each patient actually underwent; 3) overhead costs, shared among patients using the time elapsed between first examination and discharge from the ED. The distribution of costs by triage code shows that, although the average cost increases across the four triage groups, the variance within each code is quite high. The maximum cost for a yellow code is €1074.7, compared with €680 for red, the most serious code. Using cluster analysis, the red code cluster is enveloped by yellow, and their costs are therefore indistinguishable, while green codes span all cost groups. This suggests that triage code alone is not a good proxy for the patient cost, and that other cost drivers need to be included. Crude triage codes cannot be used to define PPSs because they are not sufficiently correlated with costs and are characterized by large variances. However, if combined with other information, such as the number of laboratory and non-laboratory tests/examinations, it is possible to define cost groups that are sufficiently homogeneous to be reimbursed prospectively. This should discourage strategic behavior and allow the ED to break even or create profits, which can be reinvested to

Evaluation of a blood conservation strategy in the intensive care unit: a prospective, randomised study.

LENUS (Irish Health Repository)

Mahdy, Saad

2009-06-01

Anemia is a common problem in the ICU population. Most patients are anemic at admission, their hemoglobin concentrations declining further thereafter. The aim of the present study was to evaluate the effect of a combination strategy, involving closed arterial blood gas sampling and the use of pediatric vials for phlebotomy (Group A), on the sampling-induced blood loss and the rate of decline in hemoglobin in adult ICU patients. Combination (Group A) was compared to the current standard technique of arterial line sampling and adult vial phlebotomy (Group B) in a prospective, randomised, ethically-approved trial for the first 72 hours of their ICU stay. Peri-operative, oncology, coagulopathic and uremic patients were excluded. All other ICU patients with arterial cannulae and predicted to stay beyond 3 days, were enrolled.

Estimate and prospective studies on Peruvian environmental legal system after Río + 20

Directory of Open Access Journals (Sweden)

Pierre Foy Valencia

2013-12-01

Full Text Available This article is intended to explain core ideas resulting from processes of which Peruvian environmental legal system is derived; it is morean overview rather than a system characterization, as well as a perspective or sampling foresight representing Río +20 process meaning. In that sense, it examines the modern environmental regulations rising context and provides a brief retrospective of Peruvian environmental legal system development and prospective studies within the frame of green economy paradigms and the environmental governance, presenting only three prospective references aschallenges and trends on: Climate and Energy Law, a new legal Framework for a Green Economy and Sustainable Enterprise, and finally, stressing emphatically on mega-cities, Conurbation and Land use Planning issues given little attention usually law renders to this matters.

A system design of gamma-ray spectrometric data processing for gold prospecting

International Nuclear Information System (INIS)

Yin Xueqin; Cheng Xuchu; Fang Lianxi; Huang Zuofeng.

1992-01-01

Based on different correlation between gamma-ray spectrometric data and gold grade in different types of gold deposits, it is necessary and possible to establish a mathematical model of gamma-ray spectrometric data processing for predicting specific gold deposits. A system design of gamma-ray spectrometric data processing for prospecting gold deposits has been worked out according to the mathematical method and procedure of data processing. The prediction effectiveness of commonly used multiple linear regression analysis is always not ideal but regression accuracy will be evidently increased after pre-processing of the calculated weight, deviation and favorability on gamma-ray spectrometric data. This system can establish more than ten models at the same time which enable users to have more choice. Tree structure and Chinese menu prompting are adopted in this system which can be utilized separately, sub-systems at different levels can be also individually operated. It can be transplanted to data processing of other similar geological deposit models (including non-gamma ray spectrometric data). The system is rapid, accurate, simple, convenient and flexible in use, more practical and easily popularized

Heat extraction and power production forecast of a prospective Enhanced Geothermal System site in Songliao Basin, China

International Nuclear Information System (INIS)

Huang, Xiaoxue; Zhu, Jialing; Niu, Chengke; Li, Jun; Hu, Xia; Jin, Xianpeng

2014-01-01

As a promising advanced technology, Enhanced Geothermal System (EGS) utilizing deep geothermal energy has gained increasing attention. Production performance of a prospective EGS site in Songliao Basin was evaluated through mathematical modeling. Firstly, numerical simulation of heat extraction process in the fractured reservoir was carried out. To take account of the flow process in wellbores, reservoir-wellbore coupled simulation was undertaken through indirect coupling of TOUGH2 with the wellbore simulator HOLA, in which dynamic treatment of the wellbottom pressure was enabled. Power production performance was then investigated through thermodynamic modeling of an electricity generation system using the output from the reservoir-wellbore coupled simulation. The results suggest that the desirable thermal efficiency and gross power output could be obtained initially, whereas the decrease in production arising from thermal depletion of the reservoir is significant at later stages of operation. Meanwhile, the power consumption of the injection pump takes up an increasing amount of the generated power. It can be inferred from the comparison between simulations with and without coupling that a downhole pump could improve the hydraulic performance notably with little sacrifice of the thermal performance. - Highlights: • An Enhanced Geothermal System based on field data in Songliao Basin is modelled. • We apply reservoir-wellbore and thermodynamic modeling for production evaluation. • Commercial objective is attained at the early stages, and decreases heavily afterward. • Mass flow rate decreases due to wellbottom pressure variation as enthalpy decreases. • Hydraulic performance is improved under the constant wellbottom pressure

Under a crimson sun prospects for life in a red dwarf system

CERN Document Server

Stevenson, David S

2013-01-01

Gliese 581 is a red dwarf star some 20.3 light years from Earth. Red dwarfs are among the most numerous stars in the galaxy, and they sport diverse planetary systems. At magnitude 10, Gliese 581 is visible to amateur observers but does not stand out. So what makes this star so important? It is that professional observers have confirmed that it has at least four planets orbiting it, and in 2009, Planet d was described in the letters of The Astrophysical Journal as “the first confirmed exoplanet that could support Earth-like life.”   Under a Crimson Sun looks at the nature of red dwarf systems such as Gliese as potential homes for life.   Realistically, what are prospects for life on these distant worlds? Could life evolve and survive there? How do these planetary surfaces and geology evolve? How would life on a red dwarf planet differ from life on Earth? And what are the implications for finding further habitable worlds in our galaxy?   Stevenson provides readers with insight into the habitability of pl...

The impact of prospective pricing on the information system in the health care industry.

Science.gov (United States)

Matta, K F

1988-02-01

The move from a retrospective payment system (value added) to a prospective payment system (diagnostic related) has not only influenced the health care business but also changed their information systems' requirements. The change in requirements can be attributed both to an increase in data processing tasks and also to an increase in the need for information to more effectively manage the organization. A survey was administered to capture the response of health care institutions, in the area of information systems, to the prospective payment system. The survey results indicate that the majority of health care institutions have responded by increasing their information resources, both in terms of hardware and software, and have moved to integrate the medical and financial data. In addition, the role of the information system has changed from a cost accounting system to one intended to provide a competitive edge in a highly competitive marketing environment.

Combating information overload: a six-month pilot evaluation of a knowledge management system in general practice.

Science.gov (United States)

O'Brien, C; Cambouropoulos, P

2000-01-01

A six-month prospective study was conducted on the usefulness and usability of a representative electronic knowledge management tool, the WAX Active Library, for 19 general practitioners (GPs) evaluated using questionnaires and audit trail data. The number of pages accessed was highest in the final two months, when over half of the access trails were completed within 40 seconds. Most GPs rated the system as easy to learn, fast to use, and preferable to paper for providing information during consultations. Such tools could provide a medium for the activities of knowledge officers, help demand management, and promote sharing of information within primary care groups and across NHSnet or the Internet. PMID:10962792

Prospective safety performance evaluation on construction sites.

Science.gov (United States)

Wu, Xianguo; Liu, Qian; Zhang, Limao; Skibniewski, Miroslaw J; Wang, Yanhong

2015-05-01

This paper presents a systematic Structural Equation Modeling (SEM) based approach for Prospective Safety Performance Evaluation (PSPE) on construction sites, with causal relationships and interactions between enablers and the goals of PSPE taken into account. According to a sample of 450 valid questionnaire surveys from 30 Chinese construction enterprises, a SEM model with 26 items included for PSPE in the context of Chinese construction industry is established and then verified through the goodness-of-fit test. Three typical types of construction enterprises, namely the state-owned enterprise, private enterprise and Sino-foreign joint venture, are selected as samples to measure the level of safety performance given the enterprise scale, ownership and business strategy are different. Results provide a full understanding of safety performance practice in the construction industry, and indicate that the level of overall safety performance situation on working sites is rated at least a level of III (Fair) or above. This phenomenon can be explained that the construction industry has gradually matured with the norms, and construction enterprises should improve the level of safety performance as not to be eliminated from the government-led construction industry. The differences existing in the safety performance practice regarding different construction enterprise categories are compared and analyzed according to evaluation results. This research provides insights into cause-effect relationships among safety performance factors and goals, which, in turn, can facilitate the improvement of high safety performance in the construction industry. Copyright © 2015 Elsevier Ltd. All rights reserved.

42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals.

Science.gov (United States)

2010-10-01

... payment system for long-term care hospitals. 412.505 Section 412.505 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...

Critical Appraisal of the System of Education and Prospects of ...

African Journals Online (AJOL)

The main purpose of this article is to review the South African system of education and assess the country's prospects of meeting current and future manpower and developmental needs. This inquiry is based primarily on an assessment of the current status quo in education in South Africa in order to gain a better ...

System and prospects of China's intercity rail transit technology

Science.gov (United States)

Gong, Ming

2018-06-01

City clusters and metropolitan areas in China are flourishing in the midst of the deepening urbanization in the country, thereby resulting in the emergence of intercity rail transit. Intercity railways connect mainline and urban railways for an integrated regional transportation system that underpins and leads the development of city clusters and metropolitan areas. This study explores the development mode and service characteristics of intercity rail transit, as well as proposes overviews on this system and prospects of its future technology in China.

Evaluation of PET and laparoscopy in STagIng advanced gastric cancer: a multicenter prospective study (PLASTIC-study).

Science.gov (United States)

Brenkman, H J F; Gertsen, E C; Vegt, E; van Hillegersberg, R; van Berge Henegouwen, M I; Gisbertz, S S; Luyer, M D P; Nieuwenhuijzen, G A P; van Lanschot, J J B; Lagarde, S M; de Steur, W O; Hartgrink, H H; Stoot, J H M B; Hulsewe, K W E; Spillenaar Bilgen, E J; van Det, M J; Kouwenhoven, E A; van der Peet, D L; Daams, F; van Sandick, J W; van Grieken, N C T; Heisterkamp, J; van Etten, B; Haveman, J W; Pierie, J P; Jonker, F; Thijssen, A Y; Belt, E J T; van Duijvendijk, P; Wassenaar, E; van Laarhoven, H W M; Wessels, F J; Haj Mohammad, N; van Stel, H F; Frederix, G W J; Siersema, P D; Ruurda, J P

2018-04-20

Initial staging of gastric cancer consists of computed tomography (CT) and gastroscopy. In locally advanced (cT3-4) gastric cancer, fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT or PET) and staging laparoscopy (SL) may have a role in staging, but evidence is scarce. The aim of this study is to evaluate the impact and cost-effectiveness of PET and SL in addition to initial staging in patients with locally advanced gastric cancer. This prospective observational cohort study will include all patients with a surgically resectable, advanced gastric adenocarcinoma (cT3-4b, N0-3, M0), that are scheduled for treatment with curative intent after initial staging with gastroscopy and CT. The modalities to be investigated in this study is the addition of PET and SL. The primary outcome of this study is the proportion of patients in whom the PET or SL lead to a change in treatment strategy. Secondary outcome parameters are: diagnostic performance, morbidity and mortality, quality of life, and cost-effectiveness of these additional diagnostic modalities. The study recently started in August 2017 with a duration of 36 months. At least 239 patients need to be included in this study to demonstrate that the diagnostic modalities are break-even. Based on the annual number of gastrectomies in the participating centers, it is estimated that approximately 543 patients are included in this study. In this study, it is hypothesized that performing PET and SL for locally advanced gastric adenocarcinomas results in a change of treatment strategy in 27% of patients and an annual cost-reduction in the Netherlands of €916.438 in this patient group by reducing futile treatment. The results of this study may be applicable to all countries with comparable treatment algorithms and health care systems. NCT03208621 . This trial was registered prospectively on June 30, 2017.

Cognitive dysfunction improves in systemic lupus erythematosus: Results of a 10 years prospective study.

Directory of Open Access Journals (Sweden)

Fulvia Ceccarelli

Full Text Available Cognitive impairment (CI has been described in 3-80% of Systemic lupus erythematosus (SLE patients but only short-term studies evaluated its over-time changes, suggesting that CI is usually a stable finding. We aimed at evaluating the changes of SLE-related CI in a 10-years prospective single center cohort study.We evaluated 43 patients (M/F 5/38; mean age = 45.7±10.1 years; mean disease duration = 230.8±74.3 months at baseline (T0 and after 10 years (T1. A test battery designed to detect fronto-subcortical dysfunction across five domains (memory, attention, abstract reasoning, executive and visuospatial function was administered. A global cognitive dysfunction score (GCD was obtained and associated with clinical and laboratory features.Prevalence of CI was 20.9% at T0 and 13.9% at T1 (P = NS. This impairment was prevalently mild at T0 (55.5% and mild or moderate at T1 (36.3% for both degrees. After 10 years, CI improved in 50% of patients, while 10% worsened. Impaired memory (P = 0.02, executive functions (P = 0.02 and abstract reasoning (P = 0.03 were associated with dyslipidemia at T0. Worsening of visuospatial functions was significantly associated with dyslipidemia and Lupus Anticoagulant (P = 0.04 for both parameters. Finally, GCD significantly correlated with chronic damage measured by SLICC/damage index at T0 (r = 0.3; P = 0.04 and T1 (r = 0.3; P = 0.03.For the first time, we assessed CI changes over 10-years in SLE. CI improved in the majority of the patients. Furthermore, we observed an improvement of the overall cognitive functions. These results could suggest that an appropriate management of the disease during the follow-up could be able to control SLE-related CI.

Evaluation of an exposed-radiation dose on a dual-source cardiac computed tomography examination with a prospective electrocardiogram-gated fast dual spiral scan

International Nuclear Information System (INIS)

Matsubara, Kosuke; Koshida, Kichiro; Koshida, Haruka; Sakuta, Keita; Hayashi, Hiroyuki; Takata, Tadanori; Horii, Junsei; Kawai, Keiichi; Yamamoto, Tomoyuki

2012-01-01

We evaluated exposed-radiation doses on dual-source cardiac computed tomography (CT) examinations with prospective electrocardiogram (ECG)-gated fast dual spiral scans. After placing dosimeters at locations corresponding to each of the thoracic organs, prospective ECG-gated fast dual spirals and retrospective ECG-gated dual spiral scans were performed to measure the absorbed dose of each organ. In the prospective ECG-gated fast dual spiral scans, the average absorbed doses were 5.03 mGy for the breast, 9.96 mGy for the heart, 6.60 mGy for the lung, 6.48 mGy for the bone marrow, 9.73 mGy for the thymus, and 4.58 mGy for the skin. These values were about 5% of the absorbed doses for the retrospective ECG-gated dual spiral scan. However, the absorbed dose differed greatly at each scan, especially in the external organs such as the breast. For effective and safe use of the prospective ECG-gated fast dual spiral scan, it is necessary to understand these characteristics sufficiently. (author)

A prospective evaluation of occult disorders in obstructed defecation using the 'iceberg diagram'.

Science.gov (United States)

Pescatori, M; Spyrou, M; Pulvirenti d'Urso, A

2007-06-01

Surgical treatment of constipation and obstructed defecation (OD) carries frequent recurrences, as OD is an 'iceberg syndrome' characterized by 'underwater rocks' or occult diseases which may affect the outcome of surgery. The aim of this study was to evaluate occult disorders, in order to alert the clinician of these and minimize failures. One hundred consecutive constipated patients with OD symptoms, 81 women, median age 52 years, underwent perineal examination, proctoscopy, anorectal manometry and anal/vaginal ultrasound (US). Anorectal physiology and imaging tests were also carried out when indicated, as well as psychological and urogynaecological consultations. Symptoms were graded using a modified 1-20 constipation score. Both evident (e.g. rectocele) and occult (e.g. anismus) diseases were prospectively evaluated using a novel 'iceberg diagram'. The type of treatment, whether conservative or surgical, was also recorded. Fifty-four (54%) patients had both mucosal prolapse and rectocele. All patients had at least two occult OD-related diseases, 66 patients had at least three of them: anxiety-depression, anismus and rectal hyposensation were the most frequent (66%, 44% and 33%, respectively). The median constipation score was 11 (range 2-20), the median number of 'occult disorders' was 5 (range 2-8). Conservative treatment was carried out in most cases. Surgery was carried out in 14 (14%) patients. The novel 'iceberg diagram' allowed the adequate evaluation of OD-related occult diseases and better selection of patients for treatment. Most were managed conservatively, and only a minority were treated by surgery.

A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears.

Science.gov (United States)

Keener, Jay D; Galatz, Leesa M; Teefey, Sharlene A; Middleton, William D; Steger-May, Karen; Stobbs-Cucchi, Georgia; Patton, Rebecca; Yamaguchi, Ken

2015-01-21

The purpose of this prospective study was to report the long-term risks of rotator cuff tear enlargement and symptom progression associated with degenerative asymptomatic tears. Subjects with an asymptomatic rotator cuff tear in one shoulder and pain due to rotator cuff disease in the contralateral shoulder enrolled as part of a prospective longitudinal study. Two hundred and twenty-four subjects (118 initial full-thickness tears, fifty-six initial partial-thickness tears, and fifty controls) were followed for a median of 5.1 years. Validated functional shoulder scores were calculated (visual analog pain scale, American Shoulder and Elbow Surgeons [ASES], and simple shoulder test [SST] scores). Subjects were followed annually with shoulder ultrasonography and clinical evaluations. Tear enlargement was seen in 49% of the shoulders, and the median time to enlargement was 2.8 years. The occurrence of tear-enlargement events was influenced by the severity of the final tear type, with enlargement of 61% of the full-thickness tears, 44% of the partial-thickness tears, and 14% of the controls (p tear enlargement. One hundred subjects (46%) developed new pain. The final tear type was associated with a greater risk of pain development, with the new pain developing in 28% of the controls, 46% of the shoulders with a partial-thickness tear, and 50% of those with a full-thickness tear (p tear enlargement was associated with the onset of new pain (p muscle were associated with tear enlargement, with supraspinatus muscle degeneration increasing in 4% of the shoulders with a stable tear compared with 30% of the shoulders with tear enlargement (p tear showed increased infraspinatus muscle degeneration compared with 28% of those in which the tear had enlarged (p = 0.07). This study demonstrates the progressive nature of degenerative rotator cuff disease. The risk of tear enlargement and progression of muscle degeneration is greater for shoulders with a full-thickness tear, and tear

Diffuse malignant mesothelioma. Prospective evaluation of 69 patients

International Nuclear Information System (INIS)

Chahinian, A.P.; Pajak, T.F.; Holland, J.F.; Norton, L.; Ambinder, R.M.; Mandel, E.M.

1982-01-01

From 1974 to 1980, 69 patients with ith diffuse malignant mesothelioma were prospectively evaluated. The initial site of involvement was the pleura in 57 patients and the peritoneum in 12. Previous asbestos exposure was found in 53 patients (77%), with a shorter period of latency for peritoneal (mean, 28 years) than for ith pleural mesothelioma (mean, 35 years) than for pleural mesothelioma (mean, 35 years). Other associated exposure or diseases included talc, mica, familial Mediterranean fever, and diffuse lymphocytic lymphoma (one patient each). Thrombocytosis was common, as were thromboembolic episodes. Survival was significantly better for patients with an epithelial subtype, with pleural versus peritoneal mesothelioma, and for those under 65 years of age. Surgery was never curative, but its extent was correlated with survival and earlier diagnosis. Results of chemotherapy with doxorubicin and 5-azacytidine yielded a somewhat better survival rate than a combined program with doxorubicin and radiotherapy. Survival after chemotherapy was correlated with performance status, response to chemotherapy, and extent of previous surgery

Hypoparathyroidism after total thyroidectomy: prospective evaluation and relation with early hypocalcemia.

Science.gov (United States)

D'Alessandro, Nicola; Tramutola, Giuseppe; Fasano, Giovanni Michele; Gilio, Francesco; Iside, Giovanni; Izzo, Maria Lucia; Loffredo, Andrea; Pici, Mariano; Pinto, Margherita; Tramontano, Salvatore; Citro, Giuseppe

2016-01-01

Definitive hypoparathyrodism (hypo-PTH) represents one of the most dangerous complication after total thyroidectomy. Partial or total lesion or accidental removal of parathyroid glands is an unpredictable adverse event, although real incidence is not well defined, such as management of this deficit. We started a prospective evaluation of patients treated with total thyroidectomy in our centre, to identify incidence of hypo-PTH, symptomatic or not, in relation to incidence of early postoperative hypocalcemia in our experience. We prospectively evaluated 177 patients treated for benign and malign pathology, measuring calcium before surgery and calcium and PTH at least three months after surgery. Postoperative hypocalcemia was observed in 37.3% of cases. Eight patients (4.5% of cohort) presented low level of PTH, at mean follow-up of 9.1 months. Positive predictive value for postoperative hypocalcemia was 12.1%, while negative predictive was 95.4%; confirming high sensitivity (100%) and low specificity (65.4%) for detecting hypo-PTH. All patients with late hypo-PTH presented hypocalcemia on early analysis, while no case with normal postoperative calcemia accounted with hypo-PTH: this may indicate calcemia as valid prognostic factor of good gland production, when is in the range. Moreover, isolated analysis is too limited to determine real predictability. Technical standardization represents the best method for prevention of hypo-PTH. Early hypocalcemia is a prognostic factor, even with a low specificity, of deficit of PTH-production. This observation must be related to other known prognostic factors. Postoperative normal calcemia should be a positive prognostic factor of an acceptable PTHfunction, supported by large cohorts. Hypocalcemia, Parathormone, Thyroidectomy.

Coronary computed tomography angiography using prospective electrocardiography-gated axial scans with 64-detector computed tomography. Evaluation of stair-step artifacts and padding time

International Nuclear Information System (INIS)

Kimura, Fumiko; Umezawa, Tatsuo; Asano, Tomonari; Chihara, Ruri; Nishi, Naoko; Nishimura, Shigeyoshi; Sakai, Fumikazu

2010-01-01

We compared stair-step artifacts and radiation dose between prospective electrocardiography (ECG)-gated coronary computed tomography angiography (prospective CCTA) and retrospective CCTA using 64-detector CT and determined the optimal padding time (PT) for prospective CCTA. We retrospectively evaluated 183 patients [mean heart rate (HR) <65 beats/min, maximum HR instability <5 beats/min] who had undergone CCTA. We scored stair-step artifacts from 1 (severe) to 5 (none) and evaluated the effective dose in 53 patients with retrospective CCTA and 130 with prospective CCTA (PT 200 ms, n=32; PT 50 ms, n=98). Mean artifact scores were 4.3 in both retrospective and prospective CCTAs. However, statistically more arteries scored <3 (nonassessable) on prospective CCTA (P<0.001). Mean scores for prospective CCTA with 200- and 50-ms PT were 4.1 and 4.3, respectively (no significant difference). The radiation dose of prospective CCTA was reduced by 59.1% to 80.7%. Prospective CCTA reduces the radiation dose and allows diagnostic imaging in most cases but shows more nonevaluable artifacts than retrospective CCTA. Use of 50-ms instead of 200-ms PT appears to maintain image quality in patients with a mean HR <65 beats/min and HR instability of <5 beats/min. (author)

Key Performance Indicators Evaluation and Performance Measurement in Dry Port-Seaport System: A Multi Criteria Approach

Directory of Open Access Journals (Sweden)

Fatimazahra BENTALEB

2015-12-01

Full Text Available Dry port-seaport services are key elements of a multimodal transport. They represent the needed infrastructure for its development. In this case, evaluating and improving their performance is necessary to achieve international competitiveness. The purpose of this paper is to develop a new model of performance measurement for the dry port-seaport system. To this aim, we have consolidated available researches and existing studies in order to identify and develop our proposed model framework. In this paper, a multi-criteria hierarchical model framework using MACBETH for dry port-seaport system has been developed. This framework can be used by managers at different levels of the system. The proposed model has been developed by exploring measurement gaps in multimodal transport field and by discovering prospective options from this area. The results and the methodology are practical. We obtain the global performance level of our involved system using our methodology, which can help managers in taken decisions and increase global performance of this system.

A prospective randomized clinical trial to evaluate methods of postoperative care of hypospadias.

Science.gov (United States)

McLorie, G; Joyner, B; Herz, D; McCallum, J; Bagli, D; Merguerian, P; Khoury, A

2001-05-01

Hypospadias repair is a common operation performed by pediatric urologists. Perhaps the greatest variable and source of controversy of postoperative care is the surgical dressing. We hypothesized that using no dressing would achieve surgically comparable results to those traditionally achieved by a postoperative dressing and it would also simplify postoperative parent delivered home care. Accordingly we designed a prospective randomized clinical trial to compare surgical outcome and postoperative care after hypospadias repair in boys with no dressing and those who received 1 of the 2 most common types of dressing. In a 12-month period 120 boys with an average age of 2.2 years underwent primary 1-stage hypospadias repair at a single center with 4 participating surgeons. Repair was performed in 60 boys with proximal and 60 with distal hypospadias on an outpatient basis. Ethics and Internal Review Board approval, and informed consent were obtained. Boys were then prospectively randomized to receive no dressing, an adhesive biomembrane dressing or a compressive wrap dressing. Comprehensive instructions on postoperative care were distributed to all families and a questionnaire was distributed to the parents at the initial followup. Surgical outcome was evaluated and questionnaire responses were analyzed. Fisher's exact test was done to test the significance of differences in surgical outcomes and questionnaire responses. A total of 117 boys completed the prospective randomized trial. Surgical staff withdrew 3 cases from randomized selection to place a dressing for postoperative hemostasis. We obtained 101 questionnaires for response analysis. The type or absence of the dressing did not correlate with the need for repeat procedures, urethrocutaneous fistula, or meatal stenosis or regression. Analysis revealed less narcotic use in the no dressing group and fewer telephone calls to the urology nurse, or on-call resident and/or fellow. These findings were statistically

Single dose systemic acetaminophen to improve patient reported quality of recovery after ambulatory segmental mastectomy: A prospective, randomized, double-blinded, placebo controlled, clinical trial.

Science.gov (United States)

De Oliveira, Gildasio S; Rodes, Meghan E; Bialek, Jane; Kendall, Mark C; McCarthy, Robert J

2017-11-15

Few systemic drug interventions are efficacious to improve patient reported quality of recovery after ambulatory surgery. We aimed to evaluate whether a single dose systemic acetaminophen improve quality of recovery in female patients undergoing ambulatory breast surgery. We hypothesized that patients receiving a single dose systemic acetaminophen at the end of the surgical procedure would have a better global quality of postsurgical recovery compared to the ones receiving saline. The study was a prospective randomized double blinded, placebo controlled, clinical trial. Healthy female subjects were randomized to receive 1 g single dose systemic acetaminophen at the end of the surgery or the same volume of saline. The primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24 hours after surgery. Other data collected included opioid consumption and pain scores. Data were analyzed using group t tests and the Wilcoxon exact test. The association between opioid consumption and quality of recovery was evaluated using Spearman rho. P quality of recovery, P = .007. A single dose of systemic acetaminophen improves patient reported quality of recovery after ambulatory breast surgery. The use of systemic acetaminophen is an efficacious strategy to improve patient perceived quality of postsurgical recovery and analgesic outcomes after hospital discharge for ambulatory breast surgery. © 2017 Wiley Periodicals, Inc.

Thirty Years of Prospect Theory in Economics: A Review and Assessment

OpenAIRE

Nicholas C. Barberis

2013-01-01

In 1979, Daniel Kahneman and Amos Tversky, published a paper in Econometrica titled "Prospect Theory: An Analysis of Decision under Risk." The paper presented a new model of risk attitudes called "prospect theory," which elegantly captured the experimental evidence on risk taking, including the documented violations of expected utility. More than 30 years later, prospect theory is still widely viewed as the best available description of how people evaluate risk in experimental settings. Howev...

Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes.

Science.gov (United States)

Oh, Lawrence J; Nguyen, Chu Luan; Wong, Eugene; Wang, Samuel S Y; Francis, Ian C

2017-01-01

To evaluate surgical outcomes (SOs) and visual outcomes (VOs) in cataract surgery comparing the Centurion ® phacoemulsification system (CPS) with the Infiniti ® phacoemulsification system (IPS). Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced ® tip ( n =207) or the IPS using the 30-degree Kelman ® tip ( n =205). Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS) grade, cumulated dissipated energy (CDE), preoperative corrected distance visual acuity (CDVA), and CDVA at one month were recorded. CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS ( n =70) compared with IPS ( n =44) ( P =0.010). Surgical complications were not statistically different between the two subcohorts ( P =0.083), but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs) at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5) in the CPS and -0.15 logMAR (6/4.5) in the IPS subcohort respectively ( P =0.033). CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei.

Communication-based positioning systems: past, present and prospects

International Nuclear Information System (INIS)

Ma Guanyi; Wan Qingtao; Gan Tong

2012-01-01

This paper reviews positioning systems in the context of communication systems. First, the basic positioning technique is described for location based service (LBS) in mobile communication systems. Then the high integrity global positioning system (iGPS) is introduced in terms of aspects of what it is and how the low Earth orbit (LEO) Iridium telecommunication satellites enhance the global positioning system (GPS). Emphasis is on the Chinese Area Positioning System (CAPS) which is mainly based on commercial geostationary (GEO) communication satellites, including decommissioned GEO and inclined geosynchronous communication satellites. Characterized by its low cost, high flexibility, wide-area coverage and ample frequency resources, a distinctive feature of CAPS is that its navigation messages are generated on the ground, then uploaded to and forwarded by the communication satellites. Fundamental principles and key technologies applied in the construction of CAPS are presented in detail from the CAPS validation phase to its experimental system setup. A prospective view of CAPS has concluded it to be a seamless, high accuracy, large capacity navigation and communication system which can be achieved by expanding it world wide and enhancing it with LEO satellites and mobile base stations. Hence, this system is a potential candidate for the next generation of radio navigation after GPS. (invited reviews)

Digital versus analogue pleural drainage phase 1: prospective evaluation of interobserver reliability in the assessment of pulmonary air leaks.

Science.gov (United States)

McGuire, Anna L; Petrcich, William; Maziak, Donna E; Shamji, Farid M; Sundaresan, Sudhir R; Seely, Andrew J E; Gilbert, Sebastien

2015-10-01

The ability to accurately characterize a pulmonary air leak is an essential skill in chest medicine and surgery. The objective was to evaluate interobserver variability in air leak assessments using analogue and digital pleural drainage systems. Air leak severity in lung resection patients with a pulmonary air leak was prospectively evaluated by at least one thoracic surgeon, one surgical resident and one to two nurses using a standardized questionnaire. The first assessment was performed with pleural drains connected to an analogue system. Subsequently, patients were re-assessed after changing from the analogue to a digital drainage system. The thoracic surgeon's evaluation was considered the reference standard for comparison. Agreement between observers was quantified using the kappa (κ) statistic. A total of 128 air leak evaluations were completed in 30 patients (thoracic surgeon = 30; nurses = 56; resident = 30; physiotherapists = 12). The mean time between analogue and digital assessment was 2.16 (±1.66) h. The level of observer agreement regarding air leak severity significantly increased from very slight to substantial when using the digital drainage system [analogue κ = 0.03; confidence interval (CI): 0.04-0.11; P = 0.40) (digital κ = 0.61; CI: 0.49-0.73; P pleural drainage technology improves the agreement level between members of the health-care team when assessing the severity of a pulmonary air leak after lung resection. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Design and Evaluation of a DIY Construction System for Educational Robot Kits

Science.gov (United States)

Vandevelde, Cesar; Wyffels, Francis; Ciocci, Maria-Cristina; Vanderborght, Bram; Saldien, Jelle

2016-01-01

Building a robot from scratch in an educational context can be a challenging prospect. While a multitude of projects exist that simplify the electronics and software aspects of a robot, the same cannot be said for construction systems for robotics. In this paper, we present our efforts to create a low-cost do-it-yourself construction system for…

78 FR 41013 - Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014...

Science.gov (United States)

2013-07-09

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 431 [CMS-1450-CN] RIN 0938-AR52 Medicare and Medicaid Programs; Home Health Prospective Payment System Rate... period titled ``Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY...

Coronary Artery Stent Evaluation Using a Vascular Model at 64-Detector Row CT: Comparison between Prospective and Retrospective ECG-Gated Axial Scans

International Nuclear Information System (INIS)

Suzuki, Shigeru; Furui, Shigeru; Kaminaga, Tatsuro; Miyazawa, Akiyoshi; Ueno, Yasunari; Konno, Kumiko; Kuwahara, Sadatoshi; Mehta, Dhruv

2009-01-01

We wanted to evaluate the performance of prospective electrocardiogram (ECG)-gated axial scans for assessing coronary stents as compared with retrospective ECG-gated helical scans. As for a vascular model of the coronary artery, a tube of approximately 2.5-mm inner diameter was adopted and as for stents, three (Bx-Velocity, Express2, and Micro Driver) different kinds of stents were inserted into the tube. Both patent and stenotic models of coronary artery were made by instillating different attenuation (396 vs. 79 Hounsfield unit [HU]) of contrast medium within the tube in tube model. The models were scanned with two types of scan methods with a simulated ECG of 60 beats per minute and using display field of views (FOVs) of 9 and 18 cm. We evaluated the in-stent stenosis visually, and we measured the attenuation values and the diameter of the patent stent lumen. The visualization of the stent lumen of the vascular models was improved with using the prospective ECG-gated axial scans and a 9-cm FOV. The inner diameters of the vascular models were underestimated with mean measurement errors of -1.10 to -1.36 mm. The measurement errors were smaller with using the prospective ECG-gated axial scans (Bx-Velocity and Express2, p < 0.0001; Micro Driver, p = 0.0004) and a 9-cm FOV (all stents: p < 0.0001), as compared with the other conditions, respectively. The luminal attenuation value was overestimated in each condition. For the luminal attenuation measurement, the use of prospective ECG-gated axial scans provided less measurement error compared with the retrospective ECG-gated helical scans (all stents: p < 0.0001), and the use of a 9-cm FOV tended to decrease the measurement error. The visualization of coronary stents is improved by the use of prospective ECG-gated axial scans and using a small FOV with reduced blooming artifacts and increased spatial resolution

THE BANKING SYSTEM OF THE RUSSIAN FEDERATION: STATUS AND PROSPECTS

Directory of Open Access Journals (Sweden)

L. N. Sotnikova

2015-01-01

Full Text Available The features and current trends in the development of the banking system of the Russian Federation are highlighted in the article. The authors propose an original method of evaluation of activities of credit organizations with the use of statistical data and rating agencies. The concept of the banking system is summarized in this article. Also its structure is analyzed by the number of credit institutions and the quality of their operations. The authors identifie differences between the concepts of banking service, banking operation and banking product and propose classification according to different characteristics of banking institutions and operations that they carry out. Then the authors go to estimating the volume of banking services in Russia and their patterns in total. Separately the main passive (deposits and loans and active operations (lending to legal entities and individuals are characterized. The authors identifie the major developments in the banking system of the Russian Federation in 2014 due to political and economic sanctions by the U.S. and Eurozone countries. The article provides a vision of the authors on the further development of the banking activity in Russia and proposes specific measures to adapt the banking system of the Russian Federation in a constantly changing political and economic conditions (financial sanctions, a change of key Central Bank rates, devaluation, etc.. According to the authors' opinion the expected prospects of development of the banking system of the Russian Federation to 2015 are: the growth in savings accounts in banks; sanctions will be of a personal nature and will not affect the largest credit institutions; the active growth of the corporate loan portfolio will continue; the growth of retail lending portfolio will continue to slow; mortgage lending will increase in the total loan portfolio of the banking sector of Russia.

42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

Science.gov (United States)

2010-10-01

... rehabilitation facility receives payment under this subpart for inpatient operating costs and capital-related... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR... and for costs of an approved education program and other costs paid outside the prospective payment...

Prognosis, prospecting and development of gas fields in the far north of Siberia - as a single methodological approach to an optimal development of the territorial resources; Prevision, prospection et developpement des champs de gaz naturel du grand nord Siberien - approche methodologique unique pour un developpement optimal des ressources du territoire

Energy Technology Data Exchange (ETDEWEB)

Remizov, V.V.; Dmitrievsky, A.N.; Ermilov, O.M.; Neelov, Y.V.; Chugunov, L.S.; Gurari, F.G.; Goldin, S.V.; Karagodin, Y.N. [OJSC Gaprom, Russian Academy of Sciences (Russian Federation)

2000-07-01

This presentation realizes a systems approach to the study of the oil and gas complex of the Far North of Siberia as a single sophisticated system starting from prognosis and prospecting of fields to their development at different stages of operation. This paper shows for the first time the whole complex of studies, including the methodology of systems studies of the structure, evolution and genesis of oil and gas reservoirs, the model of geologic structure and the evaluation of oil and gas resources, the technique of prospecting and surveys of oil and gas fields, techniques and methods of an effective system of prospecting and development, particularly at the stage of achieving maximum and the onset of production decrease. (authors)

Atrial Fibrillation Screening in Nonmetropolitan Areas Using a Telehealth Surveillance System With an Embedded Cloud-Computing Algorithm: Prospective Pilot Study

Science.gov (United States)

Chen, Ying-Hsien; Hung, Chi-Sheng; Huang, Ching-Chang; Hung, Yu-Chien

2017-01-01

Background Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. Objective The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. Methods We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Results Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician’s ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%. Conclusions AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. PMID:28951384

Prospects for high thermoelectric figures of merit in 2D systems

Energy Technology Data Exchange (ETDEWEB)

Dresselhaus, M S; Sun, X; Cronin, S B; Koga, T; Dresselhaus, G; Wang, K L

1997-07-01

Enhanced ZT has been predicted theoretically and observed experimentally in 2D quantum wells, with good agreement between theory and experiment. Advantages of low dimensional systems for thermoelectric applications are described and prospects for further enhancement of ZT are discussed.

Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass.

Science.gov (United States)

Remadi, Jean Paul; Rakotoarivelo, Zava; Marticho, Paul; Benamar, Amar

2006-01-01

To assess the potential benefits of a new concept of cardiopulmonary bypass (CPB), the mini-extracorporeal circulation (MECC) Jostra System, we conducted a prospective randomized study among patients who underwent coronary artery bypass grafting (CABG) with a MECC Jostra System or with a standard CPB. In a prospective randomized study, 400 patients underwent elective CABG using a standard CPB (200 patients) or a Jostra MECC System (200 patients). The patients were randomly assigned to have preoperative data similar for both groups. The operative mortality rate (system is a new concept of CPB that seems to be reliable and safe. To perform CABG, the MECC provides an excellent surgical exposure like a standard CPB and a better biologic profile like CABG without CPB.

Development and Evaluation of Disaster Information Management System Using Digital Pens and Tabletop User Interfaces

Science.gov (United States)

Fukada, Hidemi; Kobayashi, Kazue; Satou, Kenji; Kawana, Hideyuki; Masuda, Tomohiro

Most traditional disaster information systems are necessary to post expert staff with high computer literacy to operate the system quickly and correctly in the tense situation when a disaster occurs. However, in the current disaster response system of local governments, it is not easy for local governments to post such expert staff because they are struggling with staff cuts due to administrative and fiscal reform. In this research, we propose a disaster information management system that can be easily operated, even under the disorderly conditions of a disaster, by municipal personnel in charge of disaster management. This system achieves usability enabling easy input of damage information, even by local government staff with no expertise, by using a digital pen and tabletop user interface. Evaluation was conducted by prospective users using a prototype, and the evaluation results are satisfactory with regard to the function and operationality of the proposed system.

Clinical observed performance evaluation: a prospective study in final year students of surgery.

LENUS (Irish Health Repository)

Markey, G C

2010-06-24

We report a prospective study of clinical observed performance evaluation (COPE) for 197 medical students in the pre-qualification year of clinical education. Psychometric quality was the main endpoint. Students were assessed in groups of 5 in 40-min patient encounters, with each student the focus of evaluation for 8 min. Each student had a series of assessments in a 25-week teaching programme. Over time, several clinicians from a pool of 16 surgical consultants and registrars evaluated each student by direct observation. A structured rating form was used for assessment data. Variance component analysis (VCA), internal consistency and inter-rater agreement were used to estimate reliability. The predictive and convergent validity of COPE in relation to summative OSCE, long case, and overall final examination was estimated. Median number of COPE assessments per student was 7. Generalisability of a mean score over 7 COPE assessments was 0.66, equal to that of an 8 x 7.5 min station final OSCE. Internal consistency was 0.88-0.97 and inter-rater agreement 0.82. Significant correlations were observed with OSCE performance (R = 0.55 disattenuated) and long case (R = 0.47 disattenuated). Convergent validity was 0.81 by VCA. Overall final examination performance was linearly related to mean COPE score with standard error 3.7%. COPE permitted efficient serial assessment of a large cohort of final year students in a real world setting. Its psychometric quality compared well with conventional assessments and with other direct observation instruments as reported in the literature. Effect on learning, and translation to clinical care, are directions for future research.

A prospective neurocognitive evaluation of children treated with additional chemotherapy and craniospinal irradiation following isolated central nervous system relapse in acute lymphoblastic leukemia

International Nuclear Information System (INIS)

Kumar, Parvesh; Mulhern, Raymond K.; Regine, William F.; Rivera, Gaston K.; Kun, Larry E.

1995-01-01

Purpose: A prospective assessment of neurocognitive performance was conducted in children with acute lymphoblastic leukemia (ALL) following isolated central nervous system (CNS) relapse to evaluate the impact of additional systemic/intrathecal (IT) chemotherapy and craniospinal irradiation (CSI) upon long-term intellectual function. Methods and Materials: Twenty-one children with ALL manifesting an isolated CNS relapse between 1984 through 1989 underwent serial evaluations of intellectual function. Neurocognitive function was measured by the full-scale intelligence quotient (FSIQ) as determined by the age-appropriate Wechsler Intelligence Scale and by achievement in reading, math, and spelling as assessed by the Wide Range Achievement Test (WRAT). Intelligence testing was initiated following isolated CNS relapse after clearance of cerebrospinal fluid (CSF) cytology but prior to CSI and continued at annual intervals for a minimum of 4 years postmeningeal failure. Protocol treatment for isolated CNS relapse consisted of reinduction and maintenance systemic therapy, intrathecal (IT) triple-agent chemotherapy, and early CSI (cranium to 24 Gy and spine to 15 Gy at 1.5 Gy/fraction) as outlined on the institutional 'Total XI' trial. Results: All 21 children attained secondary CNS remission and underwent the planned additional systemic/IT chemotherapy and CSI. Fourteen of the 21 children remain in secondary continuous remission, while the remaining 7 experienced a second relapse and were removed from further neurocognitive assessment. For the eight female and six male long-term survivors, mean ages at original diagnosis and at CSI were 5.7 years (range = 0.6-16.2) and 7.0 years (range = 1.8-17.0), respectively. At a median follow-up interval of 4.6 years (ranges 1.7-6.8) post-CNS relapse, comparison of group mean initial to final FSIQs revealed no statistically significant difference between the two measures (94.5 vs. 95.9, respectively, n = 11, p = 0.52). None of the

Prospects for regional safeguards systems - State-level Approach

International Nuclear Information System (INIS)

Peixoto, O.J.M.

2013-01-01

The increased co-operation with Regional Safeguard's System (RSAC) is a relevant tool for strengthening effectiveness and improving the efficiency of the international safeguard. The new safeguards system that emerges from the application of the Additional Protocol (INFCIRC/540) and the full use of State-level Concept is a challenge and an opportunity for effectively incorporate RSAC into the international safeguards scheme. The challenge is to determine how the co-operation and coordination will be implemented on this new safeguards scheme. This paper presents some discussions and prospects on the issues to be faced by RSAC and IAEA during the implementation of State-level Approach (SLA) using all information available. It is also discussed how different levels of co-operation could be achieved when SLA is applied by IAEA safeguards. The paper is followed by the slides of the presentation. (authors)

Two-Dimensional Cutting (TDC Vitrectome: In Vitro Flow Assessment and Prospective Clinical Study Evaluating Core Vitrectomy Efficiency versus Standard Vitrectome

Directory of Open Access Journals (Sweden)

Mitrofanis Pavlidis

2016-01-01

Full Text Available Purpose. To evaluate comparative aspiration flow performance and also vitrectomy operating time efficiency using a double-cutting open port vitreous cutting system incorporated in a two-dimensional cutting (TDC, DORC International vitrectome design versus standard vitreous cutter. Methods. In vitro investigations compared aspiration flow rates in artificial vitreous humor at varying cutter speeds and vacuum levels using a TDC vitrectome and a standard vitrectome across different aspiration pump systems. A prospective single-centre clinical study evaluated duration of core vitrectomy in 80 patients with macular pucker undergoing 25-gauge or 27-gauge vitrectomy using either a TDC vitrectome at 16,000 cuts per minute (cpm or standard single-cut vitrectome, combined with a Valve Timing intelligence (VTi pump system (EVA, DORC International. Results. Aspiration flow rates remained constant independent of TDC vitrectome cut rate, while flow rates decreased linearly at higher cutter speeds using a classic single-blade vitrectome. Mean duration of core vitrectomy surgeries using a TDC vitreous cutter system was significantly (p<0.001 shorter than the mean duration of core vitrectomy procedures using a single-cut vitrectome of the same diameter (reduction range, 34%–50%. Conclusion. Vitrectomy surgery performed using a TDC vitrectome was faster than core vitrectomy utilizing a standard single-action vitrectome at similar cut speeds.

Prospective relations between family conflict and adolescent maladjustment: security in the family system as a mediating process.

Science.gov (United States)

Cummings, E Mark; Koss, Kalsea J; Davies, Patrick T

2015-04-01

Conflict in specific family systems (e.g., interparental, parent-child) has been implicated in the development of a host of adjustment problems in adolescence, but little is known about the impact of family conflict involving multiple family systems. Furthermore, questions remain about the effects of family conflict on symptoms of specific disorders and adjustment problems and the processes mediating these effects. The present study prospectively examines the impact of family conflict and emotional security about the family system on adolescent symptoms of specific disorders and adjustment problems, including the development of symptoms of anxiety, depression, conduct problems, and peer problems. Security in the family system was examined as a mediator of these relations. Participants included 295 mother-father-adolescent families (149 girls) participating across three annual time points (grades 7-9). Including auto-regressive controls for initial levels of emotional insecurity and multiple adjustment problems (T1), higher-order emotional insecurity about the family system (T2) mediated relations between T1 family conflict and T3 peer problems, anxiety, and depressive symptoms. Further analyses supported specific patterns of emotional security/insecurity (i.e., security, disengagement, preoccupation) as mediators between family conflict and specific domains of adolescent adjustment. Family conflict was thus found to prospectively predict the development of symptoms of multiple specific adjustment problems, including symptoms of depression, anxiety, conduct problems, and peer problems, by elevating in in adolescent's emotional insecurity about the family system. The clinical implications of these findings are considered.

Evaluating Management Information Systems, A Protocol for Automated Peer Review Systems

Science.gov (United States)

Black, Gordon C.

1980-01-01

This paper discusses key issues in evaluating an automated Peer Review System. Included are the conceptual base, design, steps in planning structural components, operation parameters, criteria, costs and a detailed outline or protocol for use in the evaluation. At the heart of the Peer Review System is the criteria utilized for measuring quality. Criteria evaluation should embrace, as a minimum, appropriateness, validity and reliability, and completemess or comprehensiveness of content. Such an evaluation is not complete without determining the impact (clinical outcome) of the service system or the patient and the population served.

Evaluation of a Clinical Decision Support System for Dyslipidemia Treatment (HTE-DLPR by QoE questionnaire

Directory of Open Access Journals (Sweden)

Alberto Zamora

2017-01-01

Full Text Available Introduction: Clinical decision support systems (CDSS are computer systems designed to assist clinicians with patient-related decision making, such as diagnosis and treatment. CDSS have shown to improve both patient outcomes and cost of care.Methods: A multi-center observational prospective study was conducted. Ten physicians agreed to participate. Seventy-seven patients with high or very high cardiovascular risk were included. After using CDSS for dyslipidemia (HTE-DLPR for a 3 months period, participants were asked to evaluate their experience with HTE-DLPR using a quality of experience questionnaire (QoE tool for mHealth applications.Results: Total score on the QoE was 3.89 out of 5. The highest scores were received for precision, ease of use and content quality. The lowest scores were given to security, appearance and performance. Physicians were in strong agreement with the 1st HTEDLPR recommendation in 86.1% and the system’s use was described as comfortablein 85% of cases. Users positively evaluated the development of a new version of HTEDLPR in the future receiving a total score of 4.25 out of 5.Conclusions: A CDSS for dyslipidemia (HTE-DLP has been positively evaluated by physicians using QoE questionnaire.

Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes

Directory of Open Access Journals (Sweden)

Lawrence J. Oh

2017-11-01

Full Text Available AIM: To evaluate surgical outcomes (SOs and visual outcomes (VOs in cataract surgery comparing the Centurion® phacoemulsification system (CPS with the Infiniti® phacoemulsification system (IPS. METHODS: Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced® tip (n=207 or the IPS using the 30-degree Kelman® tip (n=205. Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS grade, cumulated dissipated energy (CDE, preoperative corrected distance visual acuity (CDVA, and CDVA at one month were recorded. RESULTS: CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS (n=70 compared with IPS (n=44 (P=0.010. Surgical complications were not statistically different between the two subcohorts (P=0.083, but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5 in the CPS and -0.15 logMAR (6/4.5 in the IPS subcohort respectively (P=0.033. CONCLUSION: CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei.

Prospective comparison of 3D FIESTA versus fat-suppressed 3D SPGR MRI in evaluating knee cartilage lesions

International Nuclear Information System (INIS)

Li, X.; Yu, C.; Wu, H.; Daniel, K.; Hu, D.; Xia, L.; Pan, C.; Xu, A.; Hu, J.; Wang, L.; Peng, W.; Li, F.

2009-01-01

Aim: To prospectively compare the accuracy of three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) sequences with that of fat-suppressed three-dimensional spoiled gradient-recalled (3D SPGR) in the diagnosis of knee articular cartilage lesions, using arthroscopy as the reference standard. Materials and methods: Fifty-eight knees in 54 patients (age range 21-82 years; mean 36 years) were prospectively evaluated by using sagittal 3D FIESTA and sagittal fat-suppressed 3D SPGR sequences. Articular cartilage lesions were graded on MRI and during arthroscopy with a modified Noyes scoring system. Sensitivity, specificity, and accuracy were assessed. Interobserver agreement was determined with κ statistics. Results: The performance of 3D FIESTA sequences (sensitivity, specificity, and accuracy were 80, 94, and 92%, respectively, for reader 1 and 76, 94, and 90%, respectively, for reader 2) was similar to that of fat-suppressed 3D SPGR sequences (sensitivity, specificity, and accuracy were 82, 92, and 90%, respectively, for reader 1 and 82, 90, and 88%, respectively, for reader 2) in the detection of knee articular cartilage lesions. The interobserver agreement varied from fair to good to excellent (kappa values from 0.43-0.83). Conclusion: 3D FIESTA has good diagnostic performance, comparable with fat-suppressed 3D SPGR in evaluating knee cartilage lesions, and it can be incorporated into routine knee MRI protocols due to the short acquisition time.

Prospective comparison of 3D FIESTA versus fat-suppressed 3D SPGR MRI in evaluating knee cartilage lesions

Energy Technology Data Exchange (ETDEWEB)

Li, X.; Yu, C. [Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 (China); Wu, H. [Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 (China)], E-mail: lilyboston2002@163.com; Daniel, K. [Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA 02115 (United States); Hu, D.; Xia, L.; Pan, C.; Xu, A.; Hu, J.; Wang, L.; Peng, W. [Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 (China); Li, F. [Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 (China)

2009-10-15

Aim: To prospectively compare the accuracy of three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) sequences with that of fat-suppressed three-dimensional spoiled gradient-recalled (3D SPGR) in the diagnosis of knee articular cartilage lesions, using arthroscopy as the reference standard. Materials and methods: Fifty-eight knees in 54 patients (age range 21-82 years; mean 36 years) were prospectively evaluated by using sagittal 3D FIESTA and sagittal fat-suppressed 3D SPGR sequences. Articular cartilage lesions were graded on MRI and during arthroscopy with a modified Noyes scoring system. Sensitivity, specificity, and accuracy were assessed. Interobserver agreement was determined with {kappa} statistics. Results: The performance of 3D FIESTA sequences (sensitivity, specificity, and accuracy were 80, 94, and 92%, respectively, for reader 1 and 76, 94, and 90%, respectively, for reader 2) was similar to that of fat-suppressed 3D SPGR sequences (sensitivity, specificity, and accuracy were 82, 92, and 90%, respectively, for reader 1 and 82, 90, and 88%, respectively, for reader 2) in the detection of knee articular cartilage lesions. The interobserver agreement varied from fair to good to excellent (kappa values from 0.43-0.83). Conclusion: 3D FIESTA has good diagnostic performance, comparable with fat-suppressed 3D SPGR in evaluating knee cartilage lesions, and it can be incorporated into routine knee MRI protocols due to the short acquisition time.

A prospective PET study of patients with glioblastoma multiforme

DEFF Research Database (Denmark)

Andersen, Preben B.; Blinkenberg, M; Lassen, U

2006-01-01

OBJECTIVE: To study the post-surgical metabolic and structural cerebral changes in patients with glioblastoma multiforme (GBM). MATERIALS AND METHODS: We examined ten patients prospectively with newly diagnosed GBM. All patients were primarily treated with surgery, followed by chemotherapy...... compared with structural imaging in the prospective evaluation of GBM. We found a difference in metabolic increase and tumor growth between the two treatment regimens, although this finding has limited relevance due to the design of the study....

Evaluation of the implementation of a quality system in a basic research laboratory: viability and impacts.

Science.gov (United States)

Fraga, Hilda Carolina de Jesus Rios; Fukutani, Kiyoshi Ferreira; Celes, Fabiana Santana; Barral, Aldina Maria Prado; Oliveira, Camila Indiani de

2012-01-01

To evaluate the process of implementing a quality management system in a basic research laboratory of a public institution, particularly considering the feasibility and impacts of this improvement. This was a prospective and qualitative study. We employed the norm "NIT DICLA 035--Princípios das Boas Práticas de Laboratório (BPL)" and auxiliary documents of Organisation for Economic Co-operation and Development to complement the planning and implementation of a Quality System, in a basic research laboratory. In parallel, we used the PDCA tool to define the goals of each phase of the implementation process. This study enabled the laboratory to comply with the NIT DICLA 035 norm and to implement this norm during execution of a research study. Accordingly, documents were prepared and routines were established such as the registration of non-conformities, traceability of research data and equipment calibration. The implementation of a quality system, the setting of a laboratory focused on basic research is feasible once certain structural changes are made. Importantly, impacts were noticed during the process, which could be related to several improvements in the laboratory routine.

IDEA: A Unifying Theory for Evaluation Systems

DEFF Research Database (Denmark)

Bella, Giampaolo; Giustolisi, Rosario

2017-01-01

Secure systems for voting, exams, auctions and conference paper management are theorised to address the same problem, that of secure evaluations. In support of such a unifying theory comes a model for Secure Evaluation Systems (SES), which offers innovative common grounds to understand all four...

A prospective evaluation of the safety and efficacy of the TAXUS Element paclitaxel-eluting coronary stent system for the treatment of de novo coronary artery lesions: Design and statistical methods of the PERSEUS clinical program

Directory of Open Access Journals (Sweden)

Wehrenberg Scott

2010-01-01

Full Text Available Abstract Background Paclitaxel-eluting stents decrease angiographic and clinical restenosis following percutaneous coronary intervention compared to bare metal stents. TAXUS Element is a third-generation paclitaxel-eluting stent which incorporates a novel, thinner-strut, platinum-enriched metal alloy platform. The stent is intended to have enhanced radiopacity and improved deliverability compared to other paclitaxel-eluting stents. The safety and efficacy of the TAXUS Element stent are being evaluated in the pivotal PERSEUS clinical trials. Methods/Design The PERSEUS trials include two parallel studies of the TAXUS Element stent in single, de novo coronary atherosclerotic lesions. The PERSEUS Workhorse study is a prospective, randomized (3:1, single-blind, non-inferiority trial in subjects with lesion length ≤28 mm and vessel diameter ≥2.75 mm to ≤4.0 mm which compares TAXUS Element to the TAXUS Express2 paclitaxel-eluting stent system. The Workhorse study employs a novel Bayesian statistical approach that uses prior information to limit the number of study subjects exposed to the investigational device and thus provide a safer and more efficient analysis of the TAXUS Element stent. PERSEUS Small Vessel is a prospective, single-arm, superiority trial in subjects with lesion length ≤20 mm and vessel diameter ≥2.25 mm to Discussion The TAXUS PERSEUS clinical trial program uses a novel statistical approach to evaluate whether design and metal alloy iterations in the TAXUS Element stent platform provide comparable safety and improved procedural performance compared to the previous generation Express stent. PERSEUS trial enrollment is complete and primary endpoint data are expected in 2010. PERSEUS Workhorse and Small Vessel are registered at http://www.clinicaltrials.gov, identification numbers NCT00484315 and NCT00489541.

Nanoagroparticles emerging trends and future prospect in modern agriculture system.

Science.gov (United States)

Baker, Syed; Volova, Tatiana; Prudnikova, Svetlana V; Satish, S; Prasad M N, Nagendra

2017-07-01

Increment of technical knowledge has remarkably uplifted logical thinking among scientific communities to shape the theoretical concepts into near product-oriented research. The concept of nanotechnology has overwhelmed almost all forms of lives and has traded its applications in myriad fields. Despite rapid expansion of nanotechnology, sustainable competitions still do exist in the field of agriculture. In current scenario, agriculture is a manifestation demand to provide adequate nutrition for relentless growing global population. It is estimated that nearly one-third of the global crop production is destroyed annually. The loss owes to various stresses such as pest infestation, microbial pathogens, weeds, natural calamities, lack of soil fertility and much more. In order to overcome these limitations, various technological strategies are implemented but a majority of these have their own repercussions. Hence there is a scrawling progress on the evaluation of nanoparticles into agriculture sector which can reform the modern agricultural system. Applications of these nanomaterials can add tremendous value in the current scenario of a global food scarcity. Nanotechnology can address the adverse effects posed by the abundant use of chemical agrochemicals which are reported to cause biomagnification in an ecosystem. Based on these facts and consideration, present review envisages on nanoparticles as nanoherbicides, nanopesticides, onsite detection agro-pathogens and nanoparticles in post harvest management. The review also elucidates on the importance of nanoparticles in soil fertility, irrigation management and its influence on improving crop yield. With scanty reports available on nanotechnology in agriculture system, present review attributes toward developing nanoagroparticles as the future prospect which can give new facelift for existing agriculture system. Copyright © 2017 Elsevier B.V. All rights reserved.

Atrial Fibrillation Screening in Nonmetropolitan Areas Using a Telehealth Surveillance System With an Embedded Cloud-Computing Algorithm: Prospective Pilot Study.

Science.gov (United States)

Chen, Ying-Hsien; Hung, Chi-Sheng; Huang, Ching-Chang; Hung, Yu-Chien; Hwang, Juey-Jen; Ho, Yi-Lwun

2017-09-26

Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician's ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%. AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. ©Ying-Hsien Chen, Chi-Sheng Hung, Ching-Chang Huang, Yu-Chien Hung, Juey-Jen Hwang, Yi-Lwun Ho. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 26.09.2017.

MR imaging of silicone breast implants: evaluation of prospective and retrospective interpretations and interobserver agreement.

Science.gov (United States)

Quinn, S F; Neubauer, N M; Sheley, R C; Demlow, T A; Szumowski, J

1996-01-01

MR imaging was used to evaluate the integrity of silicone breast implants in 54 women with 108 implants. MR images were interpreted by relatively inexperienced readers who tried to reproduce the experiences reported in the literature. The study examines the interobserver agreement using different diagnostic signs and the influence of experience on interpretation errors. Prospective and retrospective interpretations were compared with surgical findings at the time of explanation. Diagnostic indicators, including the linguine sign, the inverted tear drop sign, the C sign, water droplets mixed with silicone, and extracapsular globules of silicone, were evaluated for diagnostic efficacy and interobserver agreement. The prospective sensitivity and specificity were 87% and 78%, respectively. With the retrospective interpretations, the sensitivity and specificity increased to 93% and 92%, respectively. Most of the prospective false-positive interpretations were due to misinterpreting radial folds as signs of implant rupture. Six implants interpreted retrospectively as false positives had gross amounts of silicone around the implants at surgery but there were no obvious rents in the implant shells. There was fair to excellent interobserver agreement with the individual diagnostic signs except for extracapsular globules of silicone. All of the signs had specificities of greater than 90%. The sensitivities of the individual signs were less than the overall retrospective sensitivity. With experience, the sensitivity improved from 87% to 93% and the specificity improved from 78% to 92%. This study helps substantiate the use of diagnostic signs used by other authors to detect silicone loss from breast implants by MR imaging; however, questions remain as to the clinical role of MR imaging in evaluating implants for silicone loss.

Hybrid surgery-radiosurgery therapy for metastatic epidural spinal cord compression: A prospective evaluation using patient-reported outcomes.

Science.gov (United States)

Barzilai, Ori; Amato, Mary-Kate; McLaughlin, Lily; Reiner, Anne S; Ogilvie, Shahiba Q; Lis, Eric; Yamada, Yoshiya; Bilsky, Mark H; Laufer, Ilya

2018-05-01

Patient-reported outcomes (PRO) represent an important measure of cancer therapy effect. For patients with metastatic epidural spinal cord compression (MESCC), hybrid therapy using separation surgery and stereotactic radiosurgery preserves neurologic function and provides tumor control. There is currently a paucity of data reporting PRO after such combined modality therapy for MESCC. Delineation of hybrid surgery-radiosurgery therapy effect on PRO validates the hybrid approach as an effective therapy resulting in meaningful symptom relief. Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory-Spine Tumor (MDASI-SP), PROs validated in the cancer population, were prospectively collected. Patients with MESCC who underwent separation surgery followed by stereotactic radiosurgery were included. Separation surgery included a posterolateral approach without extensive cytoreductive tumor excision. A median postoperative radiosurgery dose of 2700 cGy was delivered. The change in PRO 3 months after the hybrid therapy represented the primary study outcome. Preoperative and postoperative evaluations were analyzed using the Wilcoxon signed-rank test for matched pairs. One hundred eleven patients were included. Hybrid therapy resulted in a significant reduction in the BPI items "worst" and "right now" pain ( P < .0001), and in all BPI constructs (severity, interference with daily activities, and pain experience, P < .001). The MDASI-SP demonstrated reduction in spine-specific pain severity and interference with general activity ( P < .001), along with decreased symptom interference ( P < .001). Validated PRO instruments showed that in patients with MESCC, hybrid therapy with separation surgery and radiosurgery results in a significant decrease in pain severity and symptom interference. These prospective data confirm the benefit of hybrid therapy for treatment of MESCC and should facilitate referral of patients with MESCC for surgical evaluation.

Evaluating Online Dictionaries From Faculty Prospective: A Case Study Performed On English Faculty Members At King Saud University--Wadi Aldawaser Branch

Science.gov (United States)

Abouserie, Hossam Eldin Mohamed Refaat

2010-01-01

The purpose of this study was to evaluate online dictionaries from faculty prospective. The study tried to obtain in depth information about various forms of dictionaries the faculty used; degree of awareness and accessing online dictionaries; types of online dictionaries accessed; basic features of information provided; major benefits gained…

Evaluation of the Prevention and Reactivation Care Program (PReCaP) for the hospitalized elderly: A prospective nonrandomized controlled trial

OpenAIRE

Asmus-Szepesi, Kirsten; Flinterman, Linda; Koopmanschap, Marc; Nieboer, Anna; Bakker, Ton; Mackenbach, Johan; Steyerberg, Ewout

2015-01-01

textabstractBackground: The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly. Methods: The prospective nonrandomized controlled trial reported here was performed in three hospitals in the Netherlands. One hospital implemented the Prevention and Reactivation Care Program (PReCaP), while two other hospitals providing usual car...

Variation in Payment Rates under Medicare's Inpatient Prospective Payment System.

Science.gov (United States)

Krinsky, Sam; Ryan, Andrew M; Mijanovich, Tod; Blustein, Jan

2017-04-01

To measure variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identify the main payment adjustments that drive variation. Medicare cost reports for all Medicare-certified hospitals, 1987-2013, and Dartmouth Atlas geographic files. We measure the Medicare payment rate as a hospital's total acute inpatient Medicare Part A payment, divided by the standard IPPS payment for its geographic area. We assess variation using several measures, both within local markets and nationally. We perform a factor decomposition to identify the share of variation attributable to specific adjustments. We also describe the characteristics of hospitals receiving different payment rates and evaluate changes in the magnitude of the main adjustments over time. Data downloaded from the Centers for Medicare and Medicaid Services, the National Bureau of Economic Research, and the Dartmouth Atlas. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations. The magnitude of variation has increased over time. Adjustments are a large and growing share of Medicare hospital payments, and they create significant variation in payment rates. © Health Research and Educational Trust.

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study.

Science.gov (United States)

Dobbie, Fiona; Hiscock, Rosemary; Leonardi-Bee, Jo; Murray, Susan; Shahab, Lion; Aveyard, Paul; Coleman, Tim; McEwen, Andy; McRobbie, Hayden; Purves, Richard; Bauld, Linda

2015-11-01

NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned. The main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives. The ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use. The setting for the study was SSSs in England. For the secondary analysis, routine data from 49 services were obtained. For the prospective study and its added elements, nine services were involved. The target population was clients of these services. There were 202,804 cases included in secondary analysis and 3075 in the prospective study. A combination of behavioural support and stop smoking medication delivered by SSS practitioners. Abstinence from smoking at 4 and 52 weeks after setting a quit date, validated by a carbon monoxide (CO) breath test. Just over 4 in 10 smokers (41%) recruited to the prospective study were biochemically validated as abstinent from smoking at 4 weeks (which was broadly comparable with findings from the secondary analysis of routine service data, where self-reported 4-week quit rates were 48%, falling to 34% when biochemical validation had occurred). At the 1-year follow-up, 8% of prospective study clients were CO validated as abstinent from smoking. Clients who received specialist one-to-one behavioural support were twice as likely to have

Prospects and strategy for large scale utility applications of photovoltaic power systems

International Nuclear Information System (INIS)

Vigotti, R.; Lysen, E.; Cole, A.

1996-01-01

The status and prospects of photovoltaic (PV) power systems are reviewed. The market diffusion strategy for the application of PV systems by utilities is described, and the mission, objectives and thoughts of the collaboration programme launched among 18 industrialized countries under the framework of the International Energy Agency are highly with particular reference to technology transfer to developing countries. Future sales of PV systems are expected to grow in the short and medium term mainly in the sector of isolated systems. (R.P.)

Recommendations for Pathologic Evaluation of Reduction Mammoplasty Specimens: A Prospective Study With Systematic Tissue Sampling.

Science.gov (United States)

Ambaye, Abiy B; Goodwin, Andrew J; MacLennan, Susan E; Naud, Shelly; Weaver, Donald L

2017-11-01

- Breast reduction mammaplasty (RMP) for symptomatic macromastia or correction of asymmetry is performed in more than 100 000 patients per year in the United States. The reported incidence of significant pathologic findings (SPF), that is, carcinoma and atypical hyperplasia, ranges from 0.06% to 12.8%. No standard pathology assessment for RMP exists. - To propose standard sampling for microscopic evaluation in RMP specimens, to evaluate the incidence of occult carcinoma and atypical hyperplasia, and to identify clinical risk factors for SPF in patients undergoing RMP. - All RMP specimens from 2006 to 2013 at a single institution were prospectively examined. After baseline gross and microscopic evaluations, each specimen was subjected to systematic additional sampling. The incidence of SPF was tabulated, and variables such as age, specimen weight, previous history of SPF, and results of preoperative mammogram were examined. Clinical follow-up review was also subsequently undertaken. - A total of 595 patients were evaluated. Significant pathologic findings were present in 9.8% (58 of 595) of patients. No cancer was identified in patients younger than 40 years; the rates of carcinoma were 2.4% (14 of 595) in all patients, 3.6% (14 of 392) in patients aged 40 years or older, and 4.3% (10 of 233) in patients aged 50 years or older. No carcinoma or atypical hyperplasia was identified on preoperative mammogram. Increased sampling was associated with a significantly greater frequency of SPF only in patients aged 40 years or older. - In patients younger than 35 years, gross-only evaluation is sufficient. However, increased sampling may be necessary in patients older than 40 years.

Laboratory Computerization: The Case for a Prospective Analysis

OpenAIRE

Hurdle, John F.; Schwamm, Harry A.

1982-01-01

The argument is made that computerization of a laboratory should be preceeded by a thorough prospective analysis of laboratory operations. Points to be pondered include complementation of retrospective data, system cost justification, system performance justification, post-installation personnel adjustments, improved system utilization, improved manual performance, and insight into “how much” system to buy. A brief, general outline is offered describing how to approach such a study.

Nuclear data evaluation method and evaluation system

International Nuclear Information System (INIS)

Liu Tingjin

1995-01-01

The evaluation methods and Nuclear Data Evaluation System have been developed in China. A new version of the system has been established on Micro-VAX2 computer, which is supported by IAEA under the technology assistance program. The flow chart of Chinese Nuclear Data Evaluation System is shown out. For last ten years, the main efforts have been put on the double differential cross section, covariance data and evaluated data library validation. The developed evaluation method and Chinese Nuclear Data Evaluation System have been widely used at CNDC and in Chinese Nuclear Data Network for CENDL. (1 tab., 15 figs.)

Document Level Assessment of Document Retrieval Systems in a Pairwise System Evaluation

Science.gov (United States)

Rajagopal, Prabha; Ravana, Sri Devi

2017-01-01

Introduction: The use of averaged topic-level scores can result in the loss of valuable data and can cause misinterpretation of the effectiveness of system performance. This study aims to use the scores of each document to evaluate document retrieval systems in a pairwise system evaluation. Method: The chosen evaluation metrics are document-level…

A wireless sensor network-based portable vehicle detector evaluation system.

Science.gov (United States)

Yoo, Seong-eun

2013-01-17

In an upcoming smart transportation environment, performance evaluations of existing Vehicle Detection Systems are crucial to maintain their accuracy. The existing evaluation method for Vehicle Detection Systems is based on a wired Vehicle Detection System reference and a video recorder, which must be operated and analyzed by capable traffic experts. However, this conventional evaluation system has many disadvantages. It is inconvenient to deploy, the evaluation takes a long time, and it lacks scalability and objectivity. To improve the evaluation procedure, this paper proposes a Portable Vehicle Detector Evaluation System based on wireless sensor networks. We describe both the architecture and design of a Vehicle Detector Evaluation System and the implementation results, focusing on the wireless sensor networks and methods for traffic information measurement. With the help of wireless sensor networks and automated analysis, our Vehicle Detector Evaluation System can evaluate a Vehicle Detection System conveniently and objectively. The extensive evaluations of our Vehicle Detector Evaluation System show that it can measure the traffic information such as volume counts and speed with over 98% accuracy.

Prospective Freshman English Teachers’ Knowledge of the English Sound System

OpenAIRE

TEZEL, Kadir Vefa

2016-01-01

Foreign language teachers use the spoken form of the target language when they teach. One of their professional responsibilities while teaching is to form a good model of pronunciation for their students. In Turkey, English is the primary foreign language taught in all educational institutions. Prospective English teachers in the English Teacher Education departments in Faculties of Education are the products of that system, and they come to their universities having been taught English for y...

Trimodal endoscopic imaging for the detection and differentiation of colorectal adenomas: a prospective single-centre clinical evaluation.

Science.gov (United States)

Rotondano, Gianluca; Bianco, Maria Antonia; Sansone, Stefano; Prisco, Antonio; Meucci, Costantino; Garofano, Maria Lucia; Cipolletta, Livio

2012-03-01

The purpose of this study is to evaluate an endoscopic trimodal imaging (ETMI) system (high resolution, autofluorescence, and NBI) in the detection and differentiation of colorectal adenomas. A prospective randomised trial of tandem colonoscopies was carried out using the Olympus XCF-FH260AZI system. Each colonic segment was examined twice for lesions, once with HRE and once with AFI, in random order per patient. All detected lesions were assessed with NBI for pit pattern and with AFI for colour. All lesions were removed and sent for histology. Any lesion identified on the second examination was considered as missed by the first examination. Outcome measures are adenoma miss rates of AFI and HRE, and diagnostic accuracy of NBI and AFI for differentiating neoplastic from non-neoplastic lesions. Ninety-four patients underwent colonoscopy with ETMI (47 in each group). Among 47 patients examined with AFI first, 31 adenomas in 15 patients were detected initially [detection rate 0.66 (0.52-0.75)]. Subsequent HRE inspection identified six additional adenomas. Among 47 patients examined with HRE first, 29 adenomas in 14 patients were detected initially [detection rate 0.62 (0.53-0.79)]. Successive AFI yielded seven additional adenomas. Adenoma miss rates of AFI and HRE were 14% and 16.2%, respectively (p = 0.29). Accuracy of AFI alone for differentiation was lower than NBI (63% vs. 80%, p HRE. AFI alone had a disappointing accuracy for adenoma differentiation, which could be improved by combination of AFI and NBI.

Usability Evaluation of a Web-Based Learning System

Science.gov (United States)

Nguyen, Thao

2012-01-01

The paper proposes a contingent, learner-centred usability evaluation method and a prototype tool of such systems. This is a new usability evaluation method for web-based learning systems using a set of empirically-supported usability factors and can be done effectively with limited resources. During the evaluation process, the method allows for…

77 FR 59941 - Prospective Grant of Exclusive License: Terahertz Scanning Systems for Cancer Pathology

Science.gov (United States)

2012-10-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Prospective Grant of Exclusive License: Terahertz Scanning Systems for Cancer Pathology AGENCY: National Institutes of Health... field of use limited to terahertz scanning systems for cancer pathology. Upon the expiration or...

BIO PROSPECTING IN NIGERIA: EVALUATING THE ADEQUACY ...

African Journals Online (AJOL)

in strategic planning and policy formulation on bio prospecting, amongst ... into the challenging field of exploring biological diversity for commercially ...... sions of these regulations, such body corporate, or any person who was purporting to act.

Prospective, unmasked evaluation of the iStent® inject system for open-angle glaucoma: synergy trial.

Science.gov (United States)

Voskanyan, Lilit; García-Feijoó, Julián; Belda, Jose I; Fea, Antonio; Jünemann, Anselm; Baudouin, Christophe

2014-02-01

Micro-invasive glaucoma surgical implantation of trabecular micro-bypass stents, previously shown to be safe and effective for open-angle glaucoma (OAG) subjects during cataract surgery, was considered for evaluation as a sole procedure. The aim of this study was to evaluate the safety and intraocular pressure (IOP)-lowering efficacy after ab interno implantation of two Glaukos Trabecular Micro-Bypass iStent inject second generation devices in subjects with OAG. This study was performed at sites in France, Germany, Italy, Republic of Armenia, and Spain. In this pan-European, multi-center prospective, post-market, unmasked study, 99 patients with OAG on at least two topical ocular hypotensive medications who required additional IOP lowering to control glaucoma disease underwent implantation of two GTS400 stents in a stand-alone procedure. Patients were qualified if they presented with preoperative mean IOP between 22 and 38 mmHg after medication washout. Postoperatively, subjects were assessed at Day 1, Months 1, 3, 6, 7, 9, and 12. IOP, medication use and safety were assessed at each visit. Sixty-six percent of subjects achieved IOP ≤18 mmHg at 12 months without medication, and 81% of subjects achieved Month 12 IOP ≤ 18 mmHg with either a single medication or no medication. Mean baseline washout IOP values decreased by 10.2 mmHg or 39.7% from 26.3 (SD 3.5) mmHg to 15.7 (SD 3.7) mmHg at Month 12. Mean IOP at 12 months was 14.7 (SD 3.1) mmHg in subjects not using ocular hypotensive medications. Reduction from preoperative medication burden was achieved in 86.9% of patients, including 15.2% with reduction of one medication and 71.7% with reduction of two or more medications. Postoperative complications occurred at a low rate and resolved without persistent effects. In this series, implantation of two trabecular micro-bypass second generation stents in subjects with OAG resulted in IOP and medication reduction and favorable safety outcomes.

Actual performance and characteristic of a grid connected photovoltaic power system in the tropics: A short term evaluation

International Nuclear Information System (INIS)

Khatib, Tamer; Sopian, Kamaruzzaman; Kazem, Hussein A.

2013-01-01

Highlights: • We analyzed an actual performance of grid connected PV system. • We derived accurate models for the system based on the actual performance. • We assist the electricity productively of the proposed system. - Abstract: This paper presents a field operation experience for a grid connected PV system under tropical climate. The system is consisted of a 5 kWp photovoltaic (PV) array and a 6 kW DC/AC inverter. The operation performance data are recorded in order to develop accurate mathematical models for the system as well as to evaluate the productivity of the system. The experiment results show that, the average PV performance (the ratio of the theoretical performance to the actual performance) is 73.12% while the average inverter performance (the ratio of the theoretical inverter efficiency to the actual inverter efficiency) is 98.56%. Moreover, it is found that the daily yield factor of the PV system is 2.51 kW h/kWp day while, the capacity factor is 10.47%. However, it is concluded that the productivity of the system is below the prospected rate and thus, an inspection of the system must be done in order to diagnose the problem of the system’s low productivity. This paper presents worthwhile information for those who are interested in PV system installation in Malaysia and nearby country

In-hospital resuscitation evaluated by in situ simulation: a prospective simulation study

DEFF Research Database (Denmark)

Mondrup, Frederik; Brabrand, Mikkel; Folkestad, Lars

2011-01-01

, and to examine differences in the resuscitation performance between the first responders and the cardiac arrest team. METHOD: S: A prospective observational study of 16 unannounced simulated cardiopulmonary arrest scenarios was conducted. The participants of the study involved all health care personel on duty...

FLT-PET for early response evaluation of colorectal cancer patients with liver metastases: a prospective study.

Science.gov (United States)

Mogensen, Marie Benzon; Loft, Annika; Aznar, Marianne; Axelsen, Thomas; Vainer, Ben; Osterlind, Kell; Kjaer, Andreas

2017-12-01

Fluoro-L-thymidine (FLT) is a positron emission tomography/computed tomography (PET/CT) tracer which reflects proliferative activity in a cancer lesion. The main objective of this prospective explorative study was to evaluate whether FLT-PET can be used for the early evaluation of treatment response in colorectal cancer patients (CRC) with liver metastases. Patients with metastatic CRC having at least one measurable (>1 cm) liver metastasis receiving first-line chemotherapy were included. A FLT-PET/CT scan was performed at baseline and after the first treatment. The maximum and mean standardised uptake values (SUV max , SUV mean ) were measured. After three cycles of chemotherapy, treatment response was assessed by CT scan based on RECIST 1.1. Thirty-nine consecutive patients were included of which 27 were evaluable. Dropout was mainly due to disease complications. Nineteen patients (70%) had a partial response, seven (26%) had stable disease and one (4%) had progressive disease. A total of 23 patients (85%) had a decrease in FLT uptake following the first treatment. The patient with progressive disease had the highest increase in FLT uptake in SUV max . There was no correlation between the response according to RECIST and the early changes in FLT uptake measured as SUV max (p = 0.24). No correlation was found between early changes in FLT uptake after the first cycle of treatment and the response evaluated from subsequent CT scans. It seems unlikely that FLT-PET can be used on its own for the early response evaluation of metastatic CRC.

Overview of the Publications From the Anthroposophic Medicine Outcomes Study (AMOS): A Whole System Evaluation Study.

Science.gov (United States)

Hamre, Harald Johan; Kiene, Helmut; Ziegler, Renatus; Tröger, Wilfried; Meinecke, Christoph; Schnürer, Christof; Vögler, Hendrik; Glockmann, Anja; Kienle, Gunver Sophia

2014-01-01

Anthroposophic medicine is a physician-provided complementary therapy system that was founded by Rudolf Steiner and Ita Wegman. Anthroposophic therapy includes special medicinal products, artistic therapies, eurythmy movement exercises, and special physical therapies. The Anthroposophic Medicine Outcomes Study (AMOS) was a prospective observational multicenter study of 1631 outpatients starting anthroposophic therapy for anxiety disorders, asthma, attention deficit hyperactivity disorder, depression, low back pain, migraine, and other chronic indications under routine conditions in Germany. AMOS INCORPORATED TWO FEATURES PROPOSED FOR THE EVALUATION OF INTEGRATIVE THERAPY SYSTEMS: (1) a sequential approach, starting with the whole therapy system (use, safety, outcomes, perceived benefit), addressing comparative effectiveness and proceeding to the major system components (physician counseling, anthroposophic medicinal products, art therapy, eurythmy therapy, rhythmical massage therapy) and (2) a mix of different research methods to build an information synthesis, including pre-post analyses, prospective comparative analyses, economic analyses, and safety analyses of individual patient data. AMOS fostered two methodological innovations for the analysis of single-arm therapy studies (combined bias suppression, systematic outcome comparison with corresponding cohorts in other studies) and the first depression cost analysis worldwide comparing primary care patients treated for depression vs depressed patients treated for another disorder vs nondepressed patients. A total of 21 peer-reviewed publications from AMOS have resulted. This article provides an overview of the main research questions, methods, and findings from these publications: anthroposophic treatment was safe and was associated with clinically relevant improvements in symptoms and quality of life without cost increase; improvements were found in all age, diagnosis, and therapy modality groups and were

Multi-purpose canister system evaluation: A systems engineering approach

International Nuclear Information System (INIS)

1994-09-01

This report summarizes Department of Energy (DOE) efforts to investigate various container systems for handling, transporting, storing, and disposing of spent nuclear fuel (SNF) assemblies in the Civilian Radioactive Waste Management System (CRWMS). The primary goal of DOE's investigations was to select a container technology that could handle the vast majority of commercial SNF at a reasonable cost, while ensuring the safety of the public and protecting the environment. Several alternative cask and canister concepts were evaluated for SNF assembly packaging to determine the most suitable concept. Of these alternatives, the multi-purpose canister (MPC) system was determined to be the most suitable. Based on the results of these evaluations, the decision was made to proceed with design and certification of the MPC system. A decision to fabricate and deploy MPCs will be made after further studies and preparation of an environmental impact statement

Evaluation of total alloplastic temporo-mandibular joint replacement with two different types of prostheses: A three-year prospective study.

Science.gov (United States)

Gonzalez-Perez, L-M; Gonzalez-Perez-Somarriba, B; Centeno, G; Vallellano, C; Montes-Carmona, J-F

2016-11-01

Temporo-Mandibular Joint (TMJ) replacement has been used clinically for years. The objective of this study was to evaluate outcomes achieved in patients with two different categories of TMJ prostheses. All patients who had a TMJ replacement (TMJR) implanted during the study period from 2006 through 2012 were included in this 3-year prospective study. All procedures were performed using the Biomet Microfixation TMJ Replacement System, and all involved replacing both the skull base component (glenoid fossa) and the mandibular condyle. Fifty-seven patients (38 females and 19 males), involving 75 TMJs with severe disease requiring reconstruction (39 unilateral, 18 bilateral) were operated on consecutively, and 68 stock prostheses and 7 custom-made prostheses were implanted. The mean age at surgery was 52.6±11.5 years in the stock group and 51.8±11.7 years in the custom-made group. In the stock group, after three years of TMJR, results showed a reduction in pain intensity from 6.4±1.4 to 1.6±1.2 (p<0.001), and an improvement in jaw opening from 2.7±0.9 cm to 4.2±0.7 cm (p<0.001). In the custom-made group, after three years of TMJR, results showed a reduction in pain intensity from 6.0±1.6 to 2.2±0.4 (p<0.001), and an improvement in jaw opening from 1.5±0.5 cm to 4.3±0.6 cm (p<0.001). No statistically significant differences between two groups were detected. The results of this three-year prospective study support the surgical placement of TMJ prostheses (stock prosthetic, and custom-made systems), and show that the approach is efficacious and safe, reduces pain, and improves maximum mouth opening movement, with few complications. As such, TMJR represents a viable technique and a stable long-term solution for cranio-mandibular reconstruction in patients with irreversible end-stage TMJ disease. Comparing stock and custom-made groups, no statistically significant differences were detected with respect to pain intensity reduction and maximum mouth opening

MR cholangiography using a fast spin-echo technique: prospective evaluation in 20 patients

International Nuclear Information System (INIS)

Rondeau, Y.; Meduri, B.; Spelle, L.; Gouhiri, M.; Aubert, A.; Scherrer, A.; Soyer, Ph.; Rymer, R.

1998-01-01

To evaluate a MR cholangiographic technique using a non breath-hold fast spin-echo technique in patients with suspected bile duct obstruction. Twenty patients with suspected bile duct obstruction were prospectively investigated with MR cholangiography using a T2-weighted non breath-hold fast spin-echo technique (TR 8000-9000 msec, effective TE 120-266 msec, ETL = 16-32, acquisition time = 1-3 min) with a body coil. Results of MR cholangiography were compared to those obtained with endoscopic retrograde cholangiography (n = 20 patients) and endoscopic sonography (n 12 patients) that were considered as reference. MR cholangiography provided high-quality images in 19 out of 20 cases (95 %). MR cholangiography had 100 % sensitivity, 100 % specificity and 73 % accuracy in the diagnosis of bile duct obstruction. MR cholangiography failed to depict small stones (< 3 mm) of the main bile duct in 4 cases in which no bile duct dilation was found. MR cholangiography using a non breath-hold fast spin-echo technique depicts bile duct dilatation with a degree of accuracy comparable to that achieved with endoscopic examination. In the absence of bile duct dilatation, small stones of the main bile duct may be undetected with MR cholangiography. (author)

Promoting evaluation capacity building in a complex adaptive system.

Science.gov (United States)

Lawrenz, Frances; Kollmann, Elizabeth Kunz; King, Jean A; Bequette, Marjorie; Pattison, Scott; Nelson, Amy Grack; Cohn, Sarah; Cardiel, Christopher L B; Iacovelli, Stephanie; Eliou, Gayra Ostgaard; Goss, Juli; Causey, Lauren; Sinkey, Anne; Beyer, Marta; Francisco, Melanie

2018-04-10

This study provides results from an NSF funded, four year, case study about evaluation capacity building in a complex adaptive system, the Nanoscale Informal Science Education Network (NISE Net). The results of the Complex Adaptive Systems as a Model for Network Evaluations (CASNET) project indicate that complex adaptive system concepts help to explain evaluation capacity building in a network. The NISE Network was found to be a complex learning system that was supportive of evaluation capacity building through feedback loops that provided for information sharing and interaction. Participants in the system had different levels of and sources of evaluation knowledge. To be successful at building capacity, the system needed to have a balance between both centralized and decentralized control, coherence, redundancy, and diversity. Embeddedness of individuals within the system also provided support and moved the capacity of the system forward. Finally, success depended on attention being paid to the control of resources. Implications of these findings are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

DADOS-Prospective: an open source application for Web-based prospective data collection

Directory of Open Access Journals (Sweden)

Nguyen Lam

2006-11-01

Full Text Available Abstract Background Randomized, prospective trials involving multi-institutional collaboration have become a central part of clinical and translational research. However, data management and coordination of multi-center studies is a complex process that involves developing systems for data collection and quality control, tracking data queries and resolutions, as well as developing communication procedures. We describe DADOS-Prospective, an open-source Web-based application for collecting and managing prospective data on human subjects for clinical and translational trials. DADOS-Prospective not only permits users to create new clinical research forms (CRF and supports electronic signatures, but also offers the advantage of containing, in a single environment, raw research data in downloadable spreadsheet format, source documentation and regulatory files stored in PDF format, and audit trails. Results Feedback from formal and field usability tests was used to guide the design and development of DADOS-Prospective. To date, DADOS-Prospective has been implemented in five prospective clinical studies at our institution. Four of these studies are still in the CRF creation phase and one study has been entirely launched. Conclusion DADOS-Prospective has significant advantages over existing Web-based data collecting programs. At our institution, it has been demonstrated to be an efficient tool for prospective clinical studies.

Prospects for stability in a nuclear subcontinent

International Nuclear Information System (INIS)

Rajagopal, S; Chari, Sridhar K.

2003-01-01

This book explore the prospects for stability in a nuclear sub-continent. The nonproliferation regimes and nuclear threat reduction, nonproliferation regimes and south asia - is there a meeting point?; maintaining a threshold of strategic autonomy at least cost: continuity in the evolution of India's nuclear policies; role of nuclear doctrines and the state of the armed forces in South Asia; nuclear weapons, deterrence and stability in the international system: South Asian dynamics; assessing China's Asian role and security policies; Kargil war to current threat of war: prospects for stability; discussion; international terrorism and its impact on South Asian stability; a view from Bangladesh etc. are some of the topics covered

Technical Evaluation Report 30: Vendor-Assisted Evaluation of a Learning Management System

Directory of Open Access Journals (Sweden)

Adrienne De Schutter

2004-04-01

Full Text Available A product evaluation was conducted of Desire2Learn, an online learning management system gaining popularity in educational institutions. Since an online trial version of the software was not available for evaluation, an inspection meeting with the vendor was arranged. This provided the evaluation team with an opportunity to examine the precautions necessary for ensuring the objectivity of a product evaluation based on vendor-supplied information. The report outlines the team’s use of evaluator-driven enquiry and a triangulated approach to information checking. The Desire2Learn product is assessed as a flexible and useful addition to the range of learning management system options.

Comparison of scoring systems for nonvariceal upper gastrointestinal bleeding: a multicenter prospective cohort study.

Science.gov (United States)

Yang, Hae Min; Jeon, Seong Woo; Jung, Jin Tae; Lee, Dong Wook; Ha, Chang Yoon; Park, Kyung Sik; Lee, Si Hyung; Yang, Chang Heon; Park, Jun Hyung; Park, Youn Sun

2016-01-01

The Glasgow-Blatchford score (GBS) and Rockall score (RS) are widely used to assess risk in patients with upper gastrointestinal bleeding (UGIB). We compared both scoring systems and evaluated their clinical usefulness. Between February 2011 and December 2013, 1584 patients with nonvariceal UGIB were included in the study. A prospective study was conducted to compare the performance of the GBS, pre-RS, and full RS. We compared the performance of these scores using receiver operating characteristic curves. For prediction of the need for hospital-based intervention, the GBS was similar to the full RS (area under the receiver operating characteristic curves [AUROC] 0.705 vs 0.727; P = 0.282) and superior to the pre-RS (AUROC 0.705 vs 0.601; P < 0.0001). In predicting death, the full RS was superior to the GBS (AUROC 0.758 vs 0.644; P = 0.0006) and similar to the pre-RS (AUROC 0.758 vs 0.754; P = 0.869). In predicting rebleeding, the full RS was superior to both GBS (AUROC 0.642 vs 0.585; P = 0.031) and pre-RS (AUROC 0.642 vs 0.593; P = 0.0003). Of 1584 patients, 13 (0.8%) scored 0 on the GBS. Therapeutic intervention was not performed in any of these patients. The GBS is more useful than the pre-RS for predicting the need for hospital-based intervention. A cutoff value of 0 for low-risk patients who might be suitable for outpatient management is useful. The full RS is helpful in predicting death. None of the systems accurately predict rebleeding with a low AUROC. ( cris.nih.go.kr/KCT0000514). © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

"System evaluates system": method for evaluating the efficiency of IS

Directory of Open Access Journals (Sweden)

Dita Blazkova

2016-10-01

Full Text Available In paper I deal with the possible solution of evaluating the efficiency of information systems in companies. The large number of existing methods used to address the efficiency of information systems is dependent on the subjective responses of the user that may distort output evaluation. Therefore, I propose a method that eliminates the subjective opinion of a user as the primary data source. Applications, which I suggests as part of the method, collects relevant data. In this paper I describe the application in detail. This is a follow-on program on any system that runs parallel with it. The program automatically collects data for evaluation. Data include mainly time data, positions the mouse cursor, printScreens, i-grams of previous, etc. I propose a method of evaluation of the data, which identifies the degree of the friendliness of the information system to the user. Thus, the output of the method is the conclusion whether users, who work with the information system, can handle effectively work with it.

A prospective comparative assessment of the accuracy of the FibroScan in evaluating liver steatosis

Science.gov (United States)

Park, Eui Ju; Jang, Jae Young; Jeong, Soung Won; Lee, Sae Hwan; Kim, Sang Gyune; Cha, Sang-Woo; Kim, Young Seok; Cho, Young Deok; Kim, Hong Soo; Kim, Boo Sung; Jin, So Young; Park, Suyeon

2017-01-01

Background/aims Recent studies have demonstrated the utility of the FibroScan® device in diagnosing liver steatosis, but its usefulness has not been thoroughly appraised. We investigated the usefulness of the controlled attenuation parameter (CAP) in detecting and quantifying liver steatosis. Methods A prospective analysis was applied to 79 chronic liver disease patients who underwent a liver biopsy, a FibroScan investigation, ultrasonography, and hepatic steatosis index (HSI). The presence and degree of steatosis as measured by the FibroScan device, ultrasonography and HSI were compared with the results for the liver biopsy tissue. Results There was substantial concordance between the liver biopsy results and the CAP as evaluated by the kappa (κ) index test for detecting liver steatosis (κCAP = 0.77, Phepatic steatosis was 247 dB/m, which produced sensitivity and specificity values of 91.9% and 85.7%, respectively, as well as a positive predictive value of 85.0% and a negative predictive value of 92.3%. Conclusion The CAP produces results that are highly concordant with those of a liver biopsy in detecting steatosis. Therefore, the CAP is a noninvasive and reliable tool for evaluating liver steatosis, even in the early stages. PMID:28813448

Midterm prospective evaluation of TVT-Secur reveals high failure rate.

Science.gov (United States)

Cornu, Jean-Nicolas; Sèbe, Philippe; Peyrat, Laurence; Ciofu, Calin; Cussenot, Olivier; Haab, Francois

2010-07-01

TVT-Secur has been described as a new minimally invasive sling for women's stress urinary incontinence (SUI) management, showing promising results in short-term studies. Our goal was to evaluate the outcome of this procedure after a midterm follow-up. A prospective evaluation involved 45 consecutive patients presenting SUI associated with urethral hypermobility. Fourteen patients preoperatively reported overactive bladder (OAB) symptoms, but none had objective detrusor overactivity. Eight patients had low maximal urethral closure pressure (MUCP). Four patients had pelvic organ prolapse (POP). Patients with POP were treated under general anesthesia by Prolift and TVT-Secur procedure. The 41 other patients received TVT-Secur under local anesthesia on an outpatient basis. All interventions were made by the same surgeon. Postoperative assessment included pad count, bladder diary, clinical examination with stress test, evaluation of satisfaction with the Patient Global Impression of Improvement (PGI-I) scale, and evaluation of side effects. Patients were classified as cured if they used no pads, had no leakage, and had a PGI-I score 50% and PGI-I score TVT or transobturator tape during follow-up. Age, MUCP, or OAB were not associated with failure. Side effects were limited to five cases of de novo OAB and three cases of urinary tract infection. This work is limited by the absence of a comparison group. Our experience shows that despite its good short-term efficacy, TVT-Secur is associated with a high recurrence rate of SUI. Therefore, TVT-Secur does not seem appropriate for SUI first-line management in women. Copyright 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Prospective audit to evaluate the potential of the coronial system to increase solid organ donation.

Science.gov (United States)

Twamley, Huw; Haigh, Andrew; Williment, Claire; Hudson, Cara; Whitney, Julie; Neuberger, James

2016-07-08

Anecdotal evidence suggests that organ donation from deceased donors referred to the Coroner/Procurator Fiscal (PF) could be increased if all followed best practice. The aim of this prospective audit was to establish how referrals affected organ donation and to develop evidence-based guidelines to ensure that organ donation can be facilitated safely without interfering in the Coroner/PF's investigative process. Prospective audit. All acute National Health Service Hospitals in the UK where deceased organ donation was considered. 1437 deceased patients who met the eligibility criteria for organ donation and were referred to Coroner/PF. Number of cases where permission for transplantation was given, number of organs where permission was refused and number of organs which might have been transplanted if all had followed best practice. Full permission for organ retrieval was given in 87% cases and partial permission in 9%. However, if full permission had been given where no autopsy was performed or restrictions seemed unjustified, up to 77 organs (22 lungs, 22 kidneys, 9 pancreases, 9 livers, 8 hearts and 7 small bowels) could have been available for transplant. Coroners/PFs and their officers show strong support for transplantation but improvement in practice could result in a small but significant increase in life-saving and life-enhancing transplants. 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/

Evaluation Use in Evaluation Systems

DEFF Research Database (Denmark)

Højlund, Steven

2014-01-01

This article investigates the European Union’s evaluation system and its conduciveness to evaluation use. Taking the European Commission’s LIFE programme as its case, the article makes an empirical contribution to an emerging focus in the literature on the importance of organization...... and institutions when analyzing evaluation use. By focusing on the European Union’s evaluation system the article finds that evaluation use mainly takes place in the European Commission and less so in the European Parliament and the European Council. The main explanatory factors enabling evaluation use relate...... to the system’s formalization of evaluation implementation and use; these factors ensure evaluation quality, timeliness and capacity in the Commission. At the same time, however, the system’s formalization also impedes evaluation use, reducing the direct influence of evaluations on policy-making and effectively...

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces.

Science.gov (United States)

Assil, Kerry K; Harris, Lindsay; Cecka, Jeannie

2015-01-01

To compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems. Assil Eye Institute, Beverly Hills, CA, USA. Prospective, randomized, clinician-masked, contralaterally controlled single-center evaluation. Patients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery. Similar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (Ptransverse system vs torsional (Ptransverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system. The transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient.

Decomposition of Factors and Criteria for Evaluating the Process of Intellectualization of Enterprise Management Systems

Directory of Open Access Journals (Sweden)

Kuzmin Oleh Ye.

2017-03-01

Full Text Available The article presents the author’s vision of solving the scientific problem of determining factors of influence and forming criteria for evaluating the process of intellectualization of enterprise management systems. It is found that diagnostic evaluation of the process of intellectualization of enterprise management systems depends on the influence of factors of the internal environment of the management systems, personal motivation factors, and the external environment. There carried out decomposition of the process of intellectualization of management systems into separate constituents and group criteria for diagnosing and their detailed indicators are selected. The basic group criteria for evaluating the process of intellectualization of management systems include: knowledge potential of carriers of intelligence; human capital; intellectual competence level of the management personnel; motivation of carriers of intelligence; state of the management development; scientific and research potential; development of information and communication technologies; intellectual and economic activity; formation of intellectual capital; institutional development of the management system, formation of knowledge and innovation prospects; complexity of the intellectualization process.

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

Data.gov (United States)

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

Where are we now? The strengthened safeguards system: Origins, aims, features, issues and prospects

International Nuclear Information System (INIS)

Schriefer, D.

1998-01-01

The present status of the strengthened safeguards system includes the origins, aims, features, issues and future prospects. The areas of emphasis concerning the strengthened safeguards system are: access to information (environmental sampling and improved information analysis), access to sites, rational use of resources (cost analysis of present safeguards, increased cooperation with state systems, cost savings in traditional safeguards activities)

Prospective evaluation of MRI, 11C-acetate PET/CT and contrast-enhanced CT for staging of bladder cancer

International Nuclear Information System (INIS)

Vargas, H.A.; Akin, O.; Schöder, H.; Olgac, S.; Dalbagni, G.; Hricak, H.; Bochner, B.H.

2012-01-01

Purpose: To prospectively evaluate the diagnostic performance of magnetic resonance imaging (MRI), 11 C-acetate positron emission tomography/computed tomography (PET/CT) and contrast-enhanced CT for bladder cancer staging, using whole-mount pathologic review of radical cystectomy and pelvic lymph node specimens as the reference standard. Materials and methods: The institutional review board approved this prospective study, which was compliant with the Health Insurance Portability and Accountability Act. Written informed consent was obtained from 16 patients with histologically confirmed bladder cancer who underwent MRI, 11 C-acetate PET/CT and contrast-enhanced CT before radical cystectomy and pelvic lymph node dissection. Before imaging 4/16 patients had received intravesical Bacillus Calmette-Guérin treatment, 6 had received systemic chemotherapy, 3 had received both and 3 had received neither. Measures of diagnostic performance including accuracy, sensitivity and specificity were estimated separately for each imaging modality. Results: MRI correctly staged 56% of patients (9/16), overstaged 38% (6/16) and understaged 6% (1/16). CT correctly staged 50% of patients (8/16), overstaged 44% (7/16) and understaged 6% (1/16). In 9 patients, 11 C-acetate PET/CT showed uptake within the bladder wall; the uptake was true-positive in 7 patients and false-positive in 2 patients. Of the remaining 7 patients, 5 had true-negative and 2 had false-negative PET/CT results for cancer in the bladder wall. For all modalities, staging accuracy was reduced in patients with a history of prior intravesical and/or systemic chemotherapy. Conclusion: In staging bladder cancer, MRI, 11 C-acetate PET/CT and CT displayed similar levels of accuracy. For all modalities, a history of intravesical and/or systemic chemotherapy affected staging accuracy.

A Photovoltaic System Payback Calculator

Energy Technology Data Exchange (ETDEWEB)

Riley, Daniel M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Fleming, Jeffrey E. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Gallegos, Gerald R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2016-06-01

The Roof Asset Management Program (RAMP) is a DOE NNSA initiative to manage roof repairs and replacement at NNSA facilities. In some cases, installation of a photovoltaic system on new roofs may be possible and desired for financial reasons and to meet federal renewable energy goals. One method to quantify the financial benefits of PV systems is the payback period, or the length of time required for a PV system to generate energy value equivalent to the system's cost. Sandia Laboratories created a simple spreadsheet-based solar energy valuation tool for use by RAMP personnel to quickly evaluate the estimated payback period of prospective or installed photovoltaic systems.

Exploring with PAM: Prospecting ANTS Missions for Solar System Surveys

Science.gov (United States)

Clark, P. E.; Rilee, M. L.; Curtis, S. A.

2003-01-01

ANTS (Autonomous Nano-Technology Swarm), a large (1000 member) swarm of nano to picoclass (10 to 1 kg) totally autonomous spacecraft, are being developed as a NASA advanced mission concept. ANTS, based on a hierarchical insect social order, use an evolvable, self-similar, hierarchical neural system in which individual spacecraft represent the highest level nodes. ANTS uses swarm intelligence attained through collective, cooperative interactions of the nodes at all levels of the system. At the highest levels this can take the form of cooperative, collective behavior among the individual spacecraft in a very large constellation. The ANTS neural architecture is designed for totally autonomous operation of complex systems including spacecraft constellations. The ANTS (Autonomous Nano Technology Swarm) concept has a number of possible applications. A version of ANTS designed for surveying and determining the resource potential of the asteroid belt, called PAM (Prospecting ANTS Mission), is examined here.

[Medical hemostasis. II. Systemic hemostatics, a critical evaluation].

Science.gov (United States)

van den Bogaard, A E

1989-02-01

The control of spontaneous and traumatic haemorrhage is a matter of constant concern to veterinary practitioners. In some instances, the control of bleeding may be relatively simple using some topical therapeutic procedure, but when haemostatic defects are present, treatment with topical agents alone might not be sufficient, and more radical and life-saving procedures are indicated: replacement therapy with blood or blood products. As this is not easy to perform in most veterinary clinical situations, any therapeutic agent, which facilitates control of haemorrhage is a welcome addition to the therapeutic armament. Besides vitamin K, blood products and agents for topical use, there are only a few agents having a well-defined action on the mechanism of haemostasis. On the other hand several drugs are propagated in the Netherlands as systemic haemostatics in the treatment of bleeding disorders and prevention of haemorrhage during operation. None of these is of proven clinical value in veterinary practice. The only agent, which possibly showed some clinical effect: ethamsylate, has recently been withdrawn from the Dutch market by the manufacturers. Double-blind prospective trials with quantitation of loss of blood showed that antifibrinolytic agents such as tranexamic acid are clinically effective in certain conditions in humans. Because of their mode of action, it might reasonably be expected that these drugs might have positive results in veterinary medicine. Therefore, clinical trials with antifibrinolytic agents are urgently indicated to evaluate the effectiveness and side-effects of these drugs in animals showing severe bleeding or in the prevention of peroperative haemorrhage.

Prospective evaluation for the sugar cane factory transformation in biorefinery

International Nuclear Information System (INIS)

Rodríguez Plaza, Rocío; Armas Martínez, Ana Celia de; Rodríguez Carvajal, Lily Elena; García Orozco, Yamila; Torres, Alfredo

2015-01-01

The present work has as goal to evaluate prospectively alternative of transformation in the '5 de Septiembre' sugar industry, located in Cienfuegos, for a superfine alcohol biorefinery. Two alternatives were taking into account; the first one was the installation of a distillery for a capacity of 500 hl/d of superfine alcohol, using the molasses and 10% of the filters juice coming from the sugar mill, as complement of the stage of fermentation, and also a plant of biodiesel production starting from microalgae biomass and of mud separated in the sugar mill and another installation of a distillery for a similar capacity of 500 Hl/d of superfine ethanol using molasses, the filters juices and microalgae hydrolysate. For the second alternative, it intends a distillery where saving of 67 % for the molasses, and 22.73 % for the water, these results are experimentally obtained. The most feasible alternative obtain 5 years of payback period, 21 % of an IRR and U$D 37104 419.21 of NPV. (author)

Evaluation of a flat-panel detector system

International Nuclear Information System (INIS)

Sato, Masami; Eguchi, Yoichi; Yamada, Kinichi; Kaga, Yuji; Endo, Yutaka; Yamazaki, Tatsuya

2001-01-01

We evaluated the imaging performance of a flat-panel detector digital radiography system (CXDI-11 X-ray Digital Camera, Canon Inc.) and a computed radiography system (FCR9000C-HQ, Fuji Film). The characteristics of the two detectors and of the overall systems were compared. This included evaluation and comparison of the fundamental physical characteristics, including x-ray response curve, modulation transfer function (MTF), Wiener spectra, noise-equivalent quanta, and x-ray tube voltage-dependent detector response. Overall system performance was evaluated using receiver operating characteristic (ROC) analysis. The results of the study showed that the dynamic range of the CXDI-11 measured relative to the input x-ray flux was 10 3 , similar to that of the FCR9000C-HQ. Both systems showed similar final MTFs, although the pre-sampling MTF of the CXDI-11 was better than that of the FCR9000C-HQ. Noise analysis, based on noise-equivalent quanta and Wiener spectra, showed that for normal exposure conditions the CXDI-11 had superior performance. With both systems, x-ray response (system output/incident x-ray exposure) increased with increasing x-ray tube voltage. ROC analysis indicated that the CXDI-11 was superior in overall performance. (author)

Works carried out by DGEMP about energy prospects for 2030-2050

International Nuclear Information System (INIS)

2005-01-01

The 2004 year has been rich in publications and analyses about energy prospects. The French general direction of energy and raw materials (DGEMP) from the Ministry of Economy, Finances and Industry, has organized a round table on June 30, 2004 in order to present and compare different energy scenarios at the 2030 and 2050 prospects. The aim is to evaluate the available modeling system and to prepare the reflexions to implement. This paper presents: the limitations of a long-term energy prospect and the main hypotheses made, and the main results of the prospective studies carried out by DGEMP at the 2030 and 2050 prospects. The conclusions of this study is that there exists forbidden actions (postponing the implementation of energy saving actions, consuming fossil-fuels for thermal and power generation purposes and keeping petroleum preponderance in transportation), necessary actions (increase of energy efficiency in all sectors, saving peak-use power, changing transportation habits, developing nuclear and renewable energies), and some technology rupture needs (low emission technologies, power storage and hydrogen uses, CO 2 captation and sequestration). (J.S.)

Prospective evaluation of the Alere i Influenza A&B nucleic acid amplification versus Xpert Flu/RSV.

Science.gov (United States)

Nguyen Van, J C; Caméléna, F; Dahoun, M; Pilmis, B; Mizrahi, A; Lourtet, J; Behillil, S; Enouf, V; Le Monnier, A

2016-05-01

The rapid and accurate detection of influenza virus in respiratory specimens is required for optimal management of patients with acute respiratory infections. Because of the variability of the symptoms and the numerous other causes of influenza-like illness, the diagnosis of influenza cannot be made on the basis of clinical criteria alone. Thus, rapid influenza diagnostic tests have been developed such as the Alere i Influenza A&B isothermal nucleic acid assay. We prospectively evaluated the performance of the Alere i Influenza A&B assay in comparison with our routine Xpert Flu/RSV assay. Positive samples were subtyped according to the protocol from the National Influenza Center (Paris, France). A total of 96 respiratory nasal swab samples were analyzed: with both methods, 38 were positive and 56 were negative. Samples were prospectively collected from January 20 to April 8, 2015, from patient (86 adult and 10 pediatric patients) presenting with an influenza-like illness through the French influenza season. In comparison with the Xpert Flu/RSV assay, the overall sensitivity and specificity of the Alere i Influenza A&B assay were 95% and 100%, respectively. Our results indicate that the Alere i Influenza A&B assay has a good overall analytical performance and a high degree of concordance with the PCR-based Xpert Flu/RSV assay. The Alere i Influenza A&B isothermal nucleic acid amplification test is a powerful tool for influenza detection due to its high sensitivity and specificity as well as its ability to generate results within 15min. Copyright © 2016 Elsevier Inc. All rights reserved.

A Prospective Clinical Trial Combining Radiation Therapy With Systemic Immunotherapy in Metastatic Melanoma

Energy Technology Data Exchange (ETDEWEB)

Hiniker, Susan M., E-mail: shiniker@stanford.edu [Department of Radiation Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California (United States); Reddy, Sunil A. [Division of Oncology, Department of Medicine, Stanford University Medical Center and Cancer Institute, Stanford, California (United States); Maecker, Holden T.; Subrahmanyam, Priyanka B.; Rosenberg-Hasson, Yael [Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University Medical Center, Stanford, California (United States); Swetter, Susan M. [Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California (United States); Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (United States); Saha, Saurabh [Atlas Venture, Cambridge, Massachusetts (United States); Shura, Lei; Knox, Susan J. [Department of Radiation Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California (United States)

2016-11-01

Purpose: Local radiation therapy (RT) combined with systemic anti-cytotoxic T-lymphocyte–associated protein-4 immunotherapy may enhance induction of systemic antimelanoma immune responses. The primary objective of the present trial was to assess the safety and efficacy of combining ipilimumab with RT in patients with stage IV melanoma. The secondary objectives included laboratory assessment of induction of antimelanoma immune responses. Methods and Materials: In our prospective clinical trial, 22 patients with stage IV melanoma were treated with palliative RT and ipilimumab for 4 cycles. RT to 1 to 2 disease sites was initiated within 5 days after starting ipilimumab. Patients had ≥1 nonirradiated metastasis measuring ≥1.5 cm available for response assessment. Tumor imaging studies were obtained at baseline, 2 to 4 weeks after cycle 4 of ipilimumab, and every 3 months until progression. Laboratory immune response parameters were measured before and during treatment. Results: Combination therapy was well-tolerated without unexpected toxicities. Eleven patients (50.0%) experienced clinical benefit from therapy, including complete and partial responses and stable disease at median follow-up of 55 weeks. Three patients (27.3%) achieved an ongoing systemic complete response at a median follow-up of 55 weeks (range 32-65), and 3 (27.3%) had an initial partial response for a median of 40 weeks. Analysis of immune response data suggested a relationship between elevated CD8-activated T-cells and response. Conclusion: This is the second prospective clinical trial of treatment of metastatic melanoma using the combination of RT and systemic immunotherapy and the first using this sequence of therapy. The results from the present trial demonstrate that a subset of patients may benefit from combination therapy, arguing for continued clinical investigation of the use of RT combined with immunotherapy, including programmed cell death 1 inhibitors, which might have the

A Prospective Clinical Trial Combining Radiation Therapy With Systemic Immunotherapy in Metastatic Melanoma

International Nuclear Information System (INIS)

Hiniker, Susan M.; Reddy, Sunil A.; Maecker, Holden T.; Subrahmanyam, Priyanka B.; Rosenberg-Hasson, Yael; Swetter, Susan M.; Saha, Saurabh; Shura, Lei; Knox, Susan J.

2016-01-01

Purpose: Local radiation therapy (RT) combined with systemic anti-cytotoxic T-lymphocyte–associated protein-4 immunotherapy may enhance induction of systemic antimelanoma immune responses. The primary objective of the present trial was to assess the safety and efficacy of combining ipilimumab with RT in patients with stage IV melanoma. The secondary objectives included laboratory assessment of induction of antimelanoma immune responses. Methods and Materials: In our prospective clinical trial, 22 patients with stage IV melanoma were treated with palliative RT and ipilimumab for 4 cycles. RT to 1 to 2 disease sites was initiated within 5 days after starting ipilimumab. Patients had ≥1 nonirradiated metastasis measuring ≥1.5 cm available for response assessment. Tumor imaging studies were obtained at baseline, 2 to 4 weeks after cycle 4 of ipilimumab, and every 3 months until progression. Laboratory immune response parameters were measured before and during treatment. Results: Combination therapy was well-tolerated without unexpected toxicities. Eleven patients (50.0%) experienced clinical benefit from therapy, including complete and partial responses and stable disease at median follow-up of 55 weeks. Three patients (27.3%) achieved an ongoing systemic complete response at a median follow-up of 55 weeks (range 32-65), and 3 (27.3%) had an initial partial response for a median of 40 weeks. Analysis of immune response data suggested a relationship between elevated CD8-activated T-cells and response. Conclusion: This is the second prospective clinical trial of treatment of metastatic melanoma using the combination of RT and systemic immunotherapy and the first using this sequence of therapy. The results from the present trial demonstrate that a subset of patients may benefit from combination therapy, arguing for continued clinical investigation of the use of RT combined with immunotherapy, including programmed cell death 1 inhibitors, which might have the

Intraoperative Cochlear Implant Device Testing Utilizing an Automated Remote System: A Prospective Pilot Study.

Science.gov (United States)

Lohmann, Amanda R; Carlson, Matthew L; Sladen, Douglas P

2018-03-01

Intraoperative cochlear implant device testing provides valuable information regarding device integrity, electrode position, and may assist with determining initial stimulation settings. Manual intraoperative device testing during cochlear implantation requires the time and expertise of a trained audiologist. The purpose of the current study is to investigate the feasibility of using automated remote intraoperative cochlear implant reverse telemetry testing as an alternative to standard testing. Prospective pilot study evaluating intraoperative remote automated impedance and Automatic Neural Response Telemetry (AutoNRT) testing in 34 consecutive cochlear implant surgeries using the Intraoperative Remote Assistant (Cochlear Nucleus CR120). In all cases, remote intraoperative device testing was performed by trained operating room staff. A comparison was made to the "gold standard" of manual testing by an experienced cochlear implant audiologist. Electrode position and absence of tip fold-over was confirmed using plain film x-ray. Automated remote reverse telemetry testing was successfully completed in all patients. Intraoperative x-ray demonstrated normal electrode position without tip fold-over. Average impedance values were significantly higher using standard testing versus CR120 remote testing (standard mean 10.7 kΩ, SD 1.2 vs. CR120 mean 7.5 kΩ, SD 0.7, p automated testing with regard to the presence of open or short circuits along the array. There were, however, two cases in which standard testing identified an open circuit, when CR120 testing showed the circuit to be closed. Neural responses were successfully obtained in all patients using both systems. There was no difference in basal electrode responses (standard mean 195.0 μV, SD 14.10 vs. CR120 194.5 μV, SD 14.23; p = 0.7814); however, more favorable (lower μV amplitude) results were obtained with the remote automated system in the apical 10 electrodes (standard 185.4 μV, SD 11.69 vs. CR

China's health care system reform: Progress and prospects.

Science.gov (United States)

Li, Ling; Fu, Hongqiao

2017-07-01

This paper discusses the progress and prospects of China's complex health care reform beginning in 2009. The Chinese government's undertaking of systemic reform has achieved laudable achievements, including the expansion of social health insurance, the reform of public hospitals, and the strengthening of primary care. An innovative policy tool in China, policy experimentation under hierarchy, played an important role in facilitating these achievements. However, China still faces gaps and challenges in creating a single payer system, restructuring the public hospitals, and establishing an integrated delivery system. Recently, China issued the 13th 5-year plan for medical reform, setting forth the goals, policy priorities, and strategies for health reform in the following 5 years. Moreover, the Chinese government announced the "Healthy China 2030" blueprint in October 2016, which has the goals of providing universal health security for all citizens by 2030. By examining these policy priorities against the existing gaps and challenges, we conclude that China's health care reform is heading in the right direction. To effectively implement these policies, we recommend that China should take advantage of policy experimentation to mobilize bottom-up initiatives and encourage innovations. Copyright © 2017 John Wiley & Sons, Ltd.

Formulating autism systemically: Part 2 - A 12-year prospective case study.

Science.gov (United States)

Brewerton, Nicky; Robson, Katrina; Crittenden, Patricia M

2017-07-01

This prospective case study illustrates the ideas on the developmental origins of some cases of autism that were described in Part 1 of this article. We explored and found support for several systemic hypotheses regarding the experience of 'Graeme' and his mother. Graeme's story is told prospectively from the age of 3 until 15. Three independent sources of information are reported: hypotheses from the literature and case review in Part 1 of this article, the school's experience, and observations from the assessments of attachment when Graeme was turning 6. These three streams of information are integrated here. The review of the literature and clinical cases gives us a wide-angle lens, empirically supporting our focus on danger in relationships. The school's experience describes working with a child with undiagnosed autism. The assessments of attachment both provide information about family members' psychological strategies for protection from danger and also include the mother's childhood history of family threat. Their synthesis permits us to construct a developmental history, from Graeme's mother's childhood history of being triangulated into her parents' hidden marital discord to it's repetition for Graeme in her own marriage. New observations included mum's postural/gestural communication to Graeme and her possible ambivalence about males. Strikingly, Graeme was a case study (Attachment & Family Therapy, ch. 6) before he was diagnosed with autism. That presentation focused on Graeme's feeling of rejection by his father. In the same book, an interpersonal formulation of autism was offered (ch. 3), but it was not connected to Graeme, showing that when one lacks crucial information, the clinical formulation is distorted. The crucial information in this case was the mother's psychological history. Our case suggests that filling the blind spot in the research on autism with information about family functioning over at least two generations might change the

National Options for a Sustainable Nuclear Energy System: MCDM Evaluation Using an Improved Integrated Weighting Approach

Directory of Open Access Journals (Sweden)

Ruxing Gao

2017-12-01

Full Text Available While the prospects look bright for nuclear energy development in China, no consensus about an optimum transitional path towards sustainability of the nuclear fuel cycle has been achieved. Herein, we present a preliminary study of decision making for China’s future nuclear energy systems, combined with a dynamic analysis model. In terms of sustainability assessment based on environmental, economic, and social considerations, we compared and ranked the four candidate options of nuclear fuel cycles combined with an integrated evaluation analysis using the Multi-Criteria Decision Making (MCDM method. An improved integrated weighting method was first applied in the nuclear fuel cycle evaluation study. This method synthesizes diverse subjective/objective weighting methods to evaluate conflicting criteria among the competing decision makers at different levels of expertise and experience. The results suggest that the fuel cycle option of direct recycling of spent fuel through fast reactors is the most competitive candidate, while the fuel cycle option of direct disposal of all spent fuel without recycling is the least attractive for China, from a sustainability perspective. In summary, this study provided a well-informed decision-making tool to support the development of national nuclear energy strategies.

A real options evaluation model for the diffusion prospects of new renewable power generation technologies

International Nuclear Information System (INIS)

Kumbaroglu, Guerkan; Madlener, Reinhard; Demirel, Mustafa

2008-01-01

This study presents a policy planning model that integrates learning curve information on renewable power generation technologies into a dynamic programming formulation featuring real options analysis. The model recursively evaluates a set of investment alternatives on a year-by-year basis, thereby taking into account that the flexibility to delay an irreversible investment expenditure can profoundly affect the diffusion prospects of renewable power generation technologies. Price uncertainty is introduced through stochastic processes for the average wholesale price of electricity and for input fuel prices. Demand for electricity is assumed to be increasingly price-sensitive, as the electricity market deregulation proceeds, reflecting new options of consumers to react to electricity price changes (such as time-of-use pricing, unbundled electricity services, and choice of supplier). The empirical analysis is based on data for the Turkish electricity supply industry. Apart from general implications for policy-making, it provides some interesting insights about the impact of uncertainty and technical change on the diffusion of various emerging renewable energy technologies

Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study

NARCIS (Netherlands)

Kolk, M. van der; Boogaard, M.H.W.A. van den; Becking-Verhaar, F.; Custers, H.; Hoeven, H. van der; Pickkers, P.; Laarhoven, K. van

2017-01-01

INTRODUCTION: Medical and nursing protocols in perioperative care for pancreaticoduodenectomy are mainly mono-disciplinary, limiting their integration and transparency in a continuous health care system. The aims of this study were to evaluate adherence to a multidisciplinary clinical pathway for

Development of a School Leadership Evaluation System

Science.gov (United States)

Orlando, Nik

2014-01-01

This action research study examined the effectiveness of the process implemented by Partnerships to Uplift Communities (PUC) Schools Charter Management Organization to develop their school leader evaluation system in collaboration with current PUC school leaders. The development of the leadership evaluation system included the collective voices of…

Evaluation of a Cyber Security System for Hospital Network.

Science.gov (United States)

Faysel, Mohammad A

2015-01-01

Most of the cyber security systems use simulated data in evaluating their detection capabilities. The proposed cyber security system utilizes real hospital network connections. It uses a probabilistic data mining algorithm to detect anomalous events and takes appropriate response in real-time. On an evaluation using real-world hospital network data consisting of incoming network connections collected for a 24-hour period, the proposed system detected 15 unusual connections which were undetected by a commercial intrusion prevention system for the same network connections. Evaluation of the proposed system shows a potential to secure protected patient health information on a hospital network.

Evaluation of image quality and radiation dose at prospective ECG-triggered axial 256-slice multi-detector CT in infants with congenital heart disease

Energy Technology Data Exchange (ETDEWEB)

Huang, Mei-ping; Liang, Chang-hong; Zhao, Zhen-jun; Liu, Hui; Li, Jing-lei; Zhang, Jin-e; Cui, Yan-hai; Yang, Lin; Liu, Qi-shun [Guangdong Academy of Medical Sciences, Guangdong General Hospital, Department of Radiology, Guangzhou (China); Ivanc, Thomas B.; Vembar, Mani [Philips Healthcare, CT Clinical Science, Highland Heights, OH (United States)

2011-07-15

There are a limited number of reports on the technical and clinical feasibility of prospective electrocardiogram (ECG)-gated multi-detector computed tomography (MDCT) in infants with congenital heart disease (CHD). To evaluate image quality and radiation dose at weight-based low-dose prospectively gated 256-slice MDCT angiography in infants with CHD. From November 2009 to February 2010, 64 consecutive infants with CHD referred for pre-operative or post-operative CT were included. All were scanned on a 256-slice MDCT system utilizing a low-dose protocol (80 kVp and 60-120 mAs depending on weight: 60 mAs for {<=}3 kg, 80 mAs for 3.1-6 kg, 100 mAs for 6.1-10 kg, 120 mAs for 10.1-15 kg). No serious adverse events were recorded. A total of 174 cardiac deformities, confirmed by surgery or heart catheterization, were studied. The sensitivity of MDCT for cardiac deformities was 97.1%; specificity, 99.4%; accuracy, 95.9%. The mean heart rate during scan was 136.7 {+-} 14.9/min (range, 91-160) with a corresponding heart rate variability of 2.8 {+-} 2.2/min (range, 0-8). Mean scan length was 115.3 {+-} 11.7 mm (range, 93.6-143.3). Mean volume CT dose index, mean dose-length product and effective dose were 2.1 {+-} 0.4 mGy (range, 1.5-2.8), 24.7 {+-} 5.9 mGy.cm (range, 14.7-35.8) and 1.6 {+-} 0.3 mSv (range, 1.1-2.5), respectively. Diagnostic-quality images were achieved in all cases. Satisfactory diagnostic quality for visualization of all/proximal/distal coronary artery segments was achieved in 88.4/98.8/80.0% of the scans. Low-dose prospectively gated axial 256-slice CT angiography is a valuable tool in the routine clinical evaluation of infants with CHD, providing a comprehensive three-dimensional evaluation of the cardiac anatomy, including the coronary arteries. (orig.)

A prospective longitudinal study to estimate the prevalence of ...

African Journals Online (AJOL)

A prospective longitudinal study to estimate the prevalence of obesity in Egyptian children with nocturnal enuresis and the association between body mass index and ... Egyptian Journal of Medical Human Genetics ... Response to the treatment was evaluated statistically and correlated with body mass index percentile.

Theory–practice dichotomy: Prospective teachers' evaluations about teaching English to young learners

Directory of Open Access Journals (Sweden)

Süleyman Nihat ŞAD

2010-10-01

Full Text Available This study aims at examining the prospective teachers. evaluations about the implementation of the primary ELT curriculum. Also it is aimed to inquire the possible problems and difficulties in teaching English to children. The study is based on qualitative case study design. Qualitative data were collected using participant journaling method from 31 preservice teachers who kept reflective journals throughout their observations of five mentor teachers. The data were analyzed using qualitative content analysis method by coding and creating categories/themes. Results showed that actual practices do not adequately meet the curricular and theoretical requirements in terms of objectives, content, learning-teaching experiences and evaluation. This theory-practice dichotomy about teaching English to children mainly includes the problems such as non-communicative objectives, failure to appeal students emotionally, overdominance of coursebooks and grammar content over communicative content, use of restricted methodology, ineffective use of technology and materials, insecure (coercive, aggressive, and discriminative classroom atmosphere, lack of or inproper use of game activities, lack of group or pair work, failure to consider individual differences, lack or inappropriate integration of language skills, improper process evaluation, inadequate feedback, and traditional evaluation practices.

Role of echocardiography in the evaluation of syncope: a prospective study

Science.gov (United States)

Sarasin, F P; Junod, A-F; Carballo, D; Slama, S; Unger, P-F; Louis-Simonet, M

2002-01-01

Objective: To study the role of echocardiography in the stepwise evaluation of syncope. Design: A prospective observational study with an 18 month follow up. Setting: University teaching hospital providing primary and tertiary care. Subjects: 650 consecutive patients with syncope and clinical suspicion of an obstructive valvar lesion, or with syncope not explained by history, physical examination, or a 12 lead ECG, who underwent bidimensional Doppler transthoracic echocardiography. Main outcome measures: The causes of syncope were assigned using published diagnostic criteria. Echocardiography was considered diagnostic when confirming a suspected diagnosis, or when revealing occult cardiac disease explaining the syncope. Results: A systolic murmur was identified in 61 of the 650 patients (9%). Severe aortic stenosis was suspected in 20 of these and was confirmed by echocardiography in eight. Follow up excluded further cases of aortic stenosis. In patients with unexplained syncope (n = 155), routine echocardiography showed no abnormalities that established the cause of the syncope. Echocardiography was normal or non-relevant in all patients with a negative cardiac history and a normal ECG (n = 67). In patients with a positive cardiac history or an abnormal ECG (n = 88), echocardiography showed systolic dysfunction (left ventricular ejection fraction ≤ 40%) in 24 (27%) and minor non-relevant findings in the remaining 64. Arrhythmias were diagnosed in 12 of the 24 patients with systolic dysfunction (50%), and in 12 of the 64 remaining patients (19%) (p < 0.01). Conclusions: Echocardiography was most useful for assessing the severity of the underlying cardiac disease and for risk stratification in patients with unexplained syncope but with a positive cardiac history or an abnormal ECG. PMID:12231593

A prospective, randomized, controlled study of a suspension positioning system used with elderly bedridden patients with neurogenic fecal incontinence.

Science.gov (United States)

Su, Mei-Yin; Lin, Shi-Quan; zhou, Ye-Wen; Zhou, Ye-Wen; Liu, Si-Ya; Lin, Ai; Lin, Xi-Rong

2015-01-01

Elderly patients with acute neurological impairment are prone to severe disability, fecal incontinence (FI), and resultant complications. A suspension positioning system (SPS), based on the orthopedic suspension traction system commonly used for conservative treatment of pediatric femoral fracture and uncomplicated adult pelvic fracture, was developed to facilitate FI management in patients immobilized secondary to an acute neurological condition. To evaluate the effectiveness and safety of the system, a prospective, randomized, controlled study was conducted between October 2009 and July 2012. Two hundred (200) elderly, bedridden, hospitalized patients with acute, nonchronic neurological impairment were randomly assigned to receive routine FI nursing care (ie, individualized dietary modification, psychological support, health education, and social support for caregivers and family members [control group]) or routine incontinence care plus the SPS (experimental group) during the day. Rates of perianal fecal contamination, skin breakdown, incontinence associated dermatitis, pressure ulcer development, and lower urinary tract infection (LUTI) were significantly lower in the SPS than in the control group (P <0.05). Length of hospitalization and costs of care were also lower in the SPS group (P <0.05). Patient quality-of-life (QoL) and FI QoL scores were similar at baseline but significantly higher (better) at the 6-month follow-up interview in the SPS than in the control group (P <0.05). In this study, the rate of FI-associated morbidities was lower and 6-month patient QoL scores were higher in the SPS than in the control group. No adverse events were observed, and all patients completed the study. Further clinical studies are needed to examine the long-term effects of SPS use among neurologically impaired FI patients.

The Relationship between Positive Well-Being and Academic Assessment: Results from a Prospective Study on Dental Students

Directory of Open Access Journals (Sweden)

Cristina Teodora Preoteasa

2016-01-01

Full Text Available Background. Presumably, the academic stress that builds throughout the academic year has a negative effect on dental students’ psychological well-being and may have a relationship with academic performance. This research aimed to analyse the variation of positive well-being in second-year dental students, across the academic semester, in relation to consecutive examinations as part of academic assessment system (1 and to observe the relationship between academic performance during semester evaluation period and dental students’ positive well-being (2. Methods. A prospective study was conducted on second-year dental students, data on positive well-being being collected with WHO-Five Well-Being Index (WHO-5, at the beginning of the semester and after three consecutive mandatory examinations. Results. One hundred and forty-six dental students were included (77% response rate. Repeated ANOVA showed a significant progressive decline of positive well-being over the semester, which was clinically significant for an important part of them. Students who performed better in the semester evaluation period registered higher well-being levels at the beginning of the semester but a more pronounced decline of it until the semester evaluation period. Conclusion. Based on this research, a relationship between positive well-being, academic assessments, and academic performance is suggested, when evaluating them in a prospective frame.

A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions.

Science.gov (United States)

Boyer, Anthony F; Schoenberg, Noah; Babcock, Hilary; McMullen, Kathleen M; Micek, Scott T; Kollef, Marin H

2015-01-01

The Centers for Disease Control and Prevention has shifted policy away from using ventilator-associated pneumonia (VAP) and toward using ventilator-associated conditions (VACs) as a marker of ICU quality. To date, limited prospective data regarding the incidence of VAC among medical and surgical ICU patients, the ability of VAC criteria to capture patients with VAP, and the potential clinical preventability of VACs are available. This study was a prospective 12-month cohort study (January 2013 to December 2013). We prospectively surveyed 1,209 patients ventilated for ≥ 2 calendar days. Sixty-seven VACs were identified (5.5%), of which 34 (50.7%) were classified as an infection-related VAC (IVAC) with corresponding rates of 7.0 and 3.6 per 1,000 ventilator days, respectively. The mortality rate of patients having a VAC was significantly greater than that of patients without a VAC (65.7% vs 14.4%, P VACs included IVACs (50.7%), ARDS (16.4%), pulmonary edema (14.9%), and atelectasis (9.0%). Among IVACs, 44.1% were probable VAP and 17.6% were possible VAP. Twenty-five VACs (37.3%) were adjudicated to represent potentially preventable events. Eighty-six episodes of VAP occurred in 84 patients (10.0 of 1,000 ventilator days) during the study period. The sensitivity of the VAC criteria for the detection of VAP was 25.9% (95% CI, 16.7%-34.5%). Although relatively uncommon, VACs are associated with greater mortality and morbidity when they occur. Most VACs represent nonpreventable events, and the VAC criteria capture a minority of VAP episodes.

A prospective study evaluating the performance of first trimester combined screening for trisomy 21 using repeated sampling of the maternal serum markers PAPP-A and free β-hCG

DEFF Research Database (Denmark)

Ekelund, Charlotte Kvist; Wright, Dave; Ball, Susan

2012-01-01

OBJECTIVE: To prospectively evaluate the performance of first-trimester combined screening for trisomy 21 using the biochemical markers pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (free β-hCG) obtained before and at the time of the nuchal translucency...

A Standardized Evaluation System for Decadal Climate Prediction

Science.gov (United States)

Kadow, C.; Cubasch, U.

2012-12-01

The evaluation of decadal prediction systems is a scientific challenge as well as a technical challenge in the climate research. The major project MiKlip (www.fona-miklip.de) for medium-term climate prediction funded by the Federal Ministry of Education and Research in Germany (BMBF) has the aim to create a model system that can provide reliable decadal forecasts on climate and weather. The model system to be developed will be novel in several aspects, with great challenges for the methodology development. This concerns especially the determination of the initial conditions, the inclusion into the model of processes relevant to decadal predictions, the increase of the spatial resolution through regionalisation, the improvement or adjustment of statistical post-processing, and finally the synthesis and validation of the entire model system. Therefore, a standardized evaluation system will be part of the MiKlip system to validate it - developed by the project 'Integrated data and evaluation system for decadal scale prediction' (INTEGRATION). The presentation gives an overview of the different linkages of such a project, shows the different development stages and gives an outlook for users and possible end users in climate service. The technical interface combines all projects inside of MiKlip and invites them to participate in a common evaluation system. The system design and the validation strategy from a standalone tool in the beginning to a user friendly web based system using GRID technologies to an integrated part of the operational MiKlip system for industry and society will give the opportunity to enhance the MiKlip strategy. First results of different possibilities of such a system will be shown to present the scientific background through Taylor diagrams, ensemble skill scores and e.g. climatological means to show the usability and possibilities of MiKlip and the INTEGRATION project.

Prototype of evaluation guidance system in Integrated Nuclear Data Evaluation System

International Nuclear Information System (INIS)

Fukahori, T.; Nakagawa, T.

1992-01-01

Integrated Nuclear Data Evaluation System (INDES) is being developed to keep experiences of nuclear data evaluation for JENDL-3 and to support new evaluations. One of the INDES functions is to set up input data of theoretical calculation codes automatically. In order to use INDES effectively, a prototype of nuclear data evaluation guidance system (E.T.; Evaluation Tutor) was made to help users in selecting a set of suitable theoretical calculation codes by applying knowledge engineering technology. E.T. consists of an inference engine, frames, a rule-base, two example-bases and calculating modules of certainty factors. The inference engine and the calculating modules are written in FORTRAN77. (author)

Comparative analysis of three drug-drug interaction screening systems against probable clinically relevant drug-drug interactions: a prospective cohort study.

Science.gov (United States)

Muhič, Neža; Mrhar, Ales; Brvar, Miran

2017-07-01

Drug-drug interaction (DDI) screening systems report potential DDIs. This study aimed to find the prevalence of probable DDI-related adverse drug reactions (ADRs) and compare the clinical usefulness of different DDI screening systems to prevent or warn against these ADRs. A prospective cohort study was conducted in patients urgently admitted to medical departments. Potential DDIs were checked using Complete Drug Interaction®, Lexicomp® Online™, and Drug Interaction Checker®. The study team identified the patients with probable clinically relevant DDI-related ADRs on admission, the causality of which was assessed using the Drug Interaction Probability Scale (DIPS). Sensitivity, specificity, and positive and negative predictive values of screening systems to prevent or warn against probable DDI-related ADRs were evaluated. Overall, 50 probable clinically relevant DDI-related ADRs were found in 37 out of 795 included patients taking at least two drugs, most common of them were bleeding, hyperkalemia, digitalis toxicity, and hypotension. Complete Drug Interaction showed the best sensitivity (0.76) for actual DDI-related ADRs, followed by Lexicomp Online (0.50), and Drug Interaction Checker (0.40). Complete Drug Interaction and Drug Interaction Checker had positive predictive values of 0.07; Lexicomp Online had 0.04. We found no difference in specificity and negative predictive values among these systems. DDI screening systems differ significantly in their ability to detect probable clinically relevant DDI-related ADRs in terms of sensitivity and positive predictive value.

Organisational justice and mental health: a systematic review of prospective studies.

Science.gov (United States)

Ndjaboué, Ruth; Brisson, Chantal; Vézina, Michel

2012-10-01

The models most commonly used, to study the effects of psychosocial work factors on workers' health, are the demand-control-support (DCS) model and Effort-Reward Imbalance (ERI) model. An emerging body of research has identified Organisational Justice as another model that can help to explain deleterious health effects. This review aimed: (1) to identify prospective studies of the associations between organisational justice and mental health in industrialised countries from 1990 to 2010; (2) to evaluate the extent to which organisational justice has an effect on mental health independently of the DCS and ERI models; and (3) to discuss theoretical and empirical overlap and differences with previous models. The studies had to present associations between organisational justice and a mental health outcome, be prospective, and be entirely available in English or in French. Duplicated papers were excluded. Eleven prospective studies were selected for this review. They provide evidence that procedural justice and relational justice are associated with mental health. These associations remained significant even after controlling for the DCS and ERI models. There is a lack of prospective studies on distributive and informational justice. In conclusion, procedural and relational justice can be considered a different and complementary model to the DCS and ERI models. Future studies should evaluate the effect of change in exposure to organisational justice on employees' mental health over time.

Hydrokinetic Energy Conversion Systems: Prospects and ...

African Journals Online (AJOL)

Being also a variant of the small hydropower scheme, which are usually site specific, much of the studies done on the technology are suited to specific sites and the peculiar hydrology of those localities. This paper, thus, explores this new emerging technology and its prospects, potentials, challenges and frameworks for its ...

Technical issues and a prospect of ICAI. Chiteki CAI no gijutsu kadai to kongo no doko

Energy Technology Data Exchange (ETDEWEB)

Otsuki, S. (Kyushu Institute of Technology, Kitakyushu (Japan))

1992-12-10

This paper explains technical issues and a prospect for intelligent computer assisted instruction (ICAI) which combines the intelligent tutoring system (ITS) with an open-ended (discovery) type education system. The paper summarizes the ITS characterized by modelling students based on error-origin diagnostic technologies; various functions that have been realized for the first time therefrom; different methods for error diagnosis and error-origin diagnosis; and criteria to evaluate these methods (evaluating generality, coverage, and tractability). The paper indicates that no complete diagnostic methods have been obtained according to these criteria, that, therefore, an issue of incompleteness in the student model still remains, and that unsolved issues in the ITS include some that exceed the framework of the ITS. Also mentioned in the paper are that the discovery type education system has a possibility of realizing an education with new quality, and that a new attempt is being performed to merge the ITS with the discovery type education system. 17 refs., 2 figs.

Electronic prescribing: criteria for evaluating handheld prescribing systems and an evaluation of a new, handheld, wireless wide area network (WWAN) prescribing system.

Science.gov (United States)

Goldblum, O M

2001-02-01

The objectives of this study were: 1) to establish criteria for evaluating handheld computerized prescribing systems; and 2) to evaluate out-of-box performance and features of a new, Palm Operating System (OS)-based, handheld, wireless wide area network (WWAN) prescribing system. The system consisted of a Palm Vx handheld organizer, a Novatel Minstrel V wireless modem, OmniSky wireless internet access and ePhysician ePad 1.1, the Palm OS electronic prescribing software program. A dermatologist familiar with healthcare information technology conducted an evaluation of the performance and features of a new, handheld, WWAN electronic prescribing system in an office practice during a three-month period in 2000. System performance, defined as transmission success rate, was determined from data collected during the three-month trial. Evaluation criteria consisted of an analysis of features found in electronic prescribing systems. All prescriptions written for all patients seen during a three-month period (August - November, 2000) were eligible for inclusion. Prescriptions written for patients who intended to fill them at pharmacies without known facsimile receiving capabilities were excluded from the study. The performance of the system was evaluated using data collected during the study. Criteria for evaluating features of electronic prescribing systems were developed and used to analyze the system employed in this study. During this three-month trial, 200 electronic prescriptions were generated for 132 patients included in the study. Of these prescriptions, 92.5 percent were successfully transmitted to pharmacies. Transmission failures resulted from incorrect facsimile numbers and non-functioning facsimile machines. Criteria established for evaluation of electronic prescribing systems included System (Hardware & Software), Costs, System Features, Printing & Transmission, Formulary & Insurance, Customization, Drug Safety and Security. This study is the first effort to

System reliability evaluation of a touch panel manufacturing system with defect rate and reworking

International Nuclear Information System (INIS)

Lin, Yi-Kuei; Huang, Cheng-Fu; Chang, Ping-Chen

2013-01-01

In recent years, portable consumer electronic products, such as cell phone, GPS, digital camera, tablet PC, and notebook are using touch panel as interface. With the demand of touch panel increases, performance assessment is essential for touch panel production. This paper develops a method to evaluate system reliability of a touch panel manufacturing system (TPMS) with defect rate of each workstation and takes reworking actions into account. The system reliability which evaluates the possibility of demand satisfaction can provide to managers with an understanding of the system capability and can indicate possible improvements. First, we construct a capacitated manufacturing network (CMN) for a TPMS. Second, a decomposition technique is developed to determine the input flow of each workstation based on the CMN. Finally, we generate the minimal capacity vectors that should be provided to satisfy the demand. The system reliability is subsequently evaluated in terms of the minimal capacity vectors. A further decision making issue is discussed to decide a reliable production strategy. -- Graphical abstract: The proposed procedure to evaluate system reliability of the touch panel manufacturing system (TPMS). Highlights: • The system reliability of a touch panel manufacturing system (TPMS) is evaluated. • The reworking actions are taken into account in the TPMS. • A capacitated manufacturing network is constructed for the TPMS. • A procedure is proposed to evaluate system reliability of TPMS

Evaluation of a prototype infrasound system

International Nuclear Information System (INIS)

Whitaker, R.; Sandoval, T.; Breding, D.; Kromer, D.

1997-01-01

Under Department of Energy sponsorship, Sandia National Laboratories and Los Alamos National Laboratory cooperated to develop a prototype infrasonic array, with associated documentation, that could be used as part of the International Monitoring System. The United States Government or foreign countries could procure commercially available systems based on this prototype to fulfill their Comprehensive Test Ban Treaty (CTBT) obligations. The prototype is a four-element array in a triangular layout as recommended in CD/NTB/WP.224 with an element at each corner and one in the center. The prototype test configuration utilize an array spacing of 1 km. The prototype infrasound system has the following objectives: (1) Provide a prototype that reliably acquires and transmits near real-time infrasonic data to facilitate the rapid location and identification of atmospheric events. (2) Provide documentation that could be used by the United States and foreign countries to procure infrasound systems commercially to fulfill their CTBT responsibilities. Infrasonic monitoring is an effective, low cost technology for detecting atmospheric explosions. The low frequency components of explosion signals propagate to long ranges (few thousand kilometers) where they can be detected with an array of sensors. Los Alamos National Laboratory's expertise in infrasound systems and phenomenology when combined with Sandia's expertise in providing verification quality system for treaty monitoring make an excellent team to provide the prototype infrasound sensor system. By September 1997, the prototype infrasound system will have been procured, integrated, evaluated and documented. Final documentation will include a system requirements document, an evaluation report and a hardware design document. The hardware design document will describe the various hardware components used in the infrasound prototype and their interrelationships

Prospective evaluation of MRI, {sup 11}C-acetate PET/CT and contrast-enhanced CT for staging of bladder cancer

Energy Technology Data Exchange (ETDEWEB)

Vargas, H.A., E-mail: vargasah@mskcc.org [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Akin, O.; Schöder, H. [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Olgac, S. [Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Dalbagni, G. [Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Hricak, H. [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Bochner, B.H. [Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

2012-12-15

Purpose: To prospectively evaluate the diagnostic performance of magnetic resonance imaging (MRI), {sup 11}C-acetate positron emission tomography/computed tomography (PET/CT) and contrast-enhanced CT for bladder cancer staging, using whole-mount pathologic review of radical cystectomy and pelvic lymph node specimens as the reference standard. Materials and methods: The institutional review board approved this prospective study, which was compliant with the Health Insurance Portability and Accountability Act. Written informed consent was obtained from 16 patients with histologically confirmed bladder cancer who underwent MRI, {sup 11}C-acetate PET/CT and contrast-enhanced CT before radical cystectomy and pelvic lymph node dissection. Before imaging 4/16 patients had received intravesical Bacillus Calmette-Guérin treatment, 6 had received systemic chemotherapy, 3 had received both and 3 had received neither. Measures of diagnostic performance including accuracy, sensitivity and specificity were estimated separately for each imaging modality. Results: MRI correctly staged 56% of patients (9/16), overstaged 38% (6/16) and understaged 6% (1/16). CT correctly staged 50% of patients (8/16), overstaged 44% (7/16) and understaged 6% (1/16). In 9 patients, {sup 11}C-acetate PET/CT showed uptake within the bladder wall; the uptake was true-positive in 7 patients and false-positive in 2 patients. Of the remaining 7 patients, 5 had true-negative and 2 had false-negative PET/CT results for cancer in the bladder wall. For all modalities, staging accuracy was reduced in patients with a history of prior intravesical and/or systemic chemotherapy. Conclusion: In staging bladder cancer, MRI, {sup 11}C-acetate PET/CT and CT displayed similar levels of accuracy. For all modalities, a history of intravesical and/or systemic chemotherapy affected staging accuracy.

Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds.

Science.gov (United States)

Rawlins, Matthew D M; Raby, Edward; Sanfilippo, Frank M; Douglass, Rae; Chambers, Jonathan; McLellan, Duncan; Dyer, John R

2018-05-04

To evaluate the impact of the adaptation of an existing electronic referral application for use in antimicrobial stewardship prospective audit and feedback rounds (antimicrobial rounds). Retrospective, single-centre observational study between March 2015 and February 2016. A new quaternary referral centre. Adults referred for antimicrobial rounds outside of the intensive care and haematology units. Adaptation of an electronic referral application used by medical and allied health staff. A questionnaire-style referral form was designed to capture patient clinical details using a combination of free text and dropdown menus. Clinical pharmacists were educated and granted access to the system. The proportion of completed electronic referrals of total round reviews by month for the 12 months after implementation. The time from request to completion of reviews. The impact on adherence to advice provided on rounds. The impact on the institutional usage of broad-spectrum antibiotics: glycopeptides, carbapenems, third and fourth generation cephalosporins, fluoroquinolones and piperacillin/tazobactam. Over the study period, the proportion of electronic referrals of completed antimicrobial round reviews increased from 59% to 88% (P < 0.001); 75.7% of accepted electronic referrals were seen within 48 h of request. The proportion of advice ignored fell from 18% to 8.5% (P < 0.001). Piperacillin/tazobactam, fluoroquinolone and glycopeptide usage decreased. The adaptation of an electronic referral application for antimicrobial rounds was associated with increased adherence to advice and reduction in use in target antibiotics. Our model is now used at other institutions.

Learning towards system innovation: Evaluating a systemic instrument

NARCIS (Netherlands)

Mierlo, B. van; Leeuwis, C.; Smits, R.; Klein Woolthuis, R.J.A.

2010-01-01

In this paper we develop an analytical framework for studying learning processes in the context of efforts to bring about system innovation by building new networks of actors who are willing to work on a change towards sustainable development. We then use it to evaluate two specific intervention

Reliability evaluation of a natural circulation system

International Nuclear Information System (INIS)

Jafari, Jalil; D'Auria, Francesco; Kazeminejad, Hossein; Davilu, Hadi

2003-01-01

This paper discusses a reliability study performed with reference to a passive thermohydraulic natural circulation (NC) system, named TTL-1. A methodology based on probabilistic techniques has been applied with the main purpose to optimize the system design. The obtained results have been adopted to estimate the thermal-hydraulic reliability (TH-R) of the same system. A total of 29 relevant parameters (including nominal values and plausible ranges of variations) affecting the design and the NC performance of the TTL-1 loop are identified and a probability of occurrence is assigned for each value based on expert judgment. Following procedures established for the uncertainty evaluation of thermal-hydraulic system codes results, 137 system configurations have been selected and each configuration has been analyzed via the Relap5 best-estimate code. The reference system configuration and the failure criteria derived from the 'mission' of the passive system are adopted for the evaluation of the system TH-R. Four different definitions of a less-than-unity 'reliability-values' (where unity represents the maximum achievable reliability) are proposed for the performance of the selected passive system. This is normally considered fully reliable, i.e. reliability-value equal one, in typical Probabilistic Safety Assessment (PSA) applications in nuclear reactor safety. The two 'point' TH-R values for the considered NC system were found equal to 0.70 and 0.85, i.e. values comparable with the reliability of a pump installed in an 'equivalent' forced circulation (active) system having the same 'mission'. The design optimization study was completed by a regression analysis addressing the output of the 137 calculations: heat losses, undetected leakage, loop length, riser diameter, and equivalent diameter of the test section have been found as the most important parameters bringing to the optimal system design and affecting the TH-R. As added values for this work, the comparison has

A prospective evaluation of missed injuries in trauma patients, before and after formalising the trauma tertiary survey.

Science.gov (United States)

Keijzers, Gerben B; Campbell, Don; Hooper, Jeffrey; Bost, Nerolie; Crilly, Julia; Steele, Michael Craig; Del Mar, Chris; Geeraedts, Leo M G

2014-01-01

This study prospectively evaluated in-hospital and postdischarge missed injury rates in admitted trauma patients, before and after the formalisation of a trauma tertiary survey (TTS) procedure. Prospective before-and-after cohort study. TTS were formalised in a single regional level II trauma hospital in November 2009. All multitrauma patients admitted between March-October 2009 (preformalisation of TTS) and December 2009-September 2010 (post-) were assessed for missed injury, classified into three types: Type I, in-hospital, (injury missed at initial assessment, detected within 24 h); Type II, in-hospital (detected in hospital after 24 h, missed at initial assessment and by TTS); Type III, postdischarge (detected after hospital discharge). Secondary outcome measures included TTS performance rates and functional outcomes at 1 and 6 months. A total of 487 trauma patients were included (pre-: n = 235; post-: n = 252). In-hospital missed injury rate (Types I and II combined) was similar for both groups (3.8 vs. 4.8 %, P = 0.61), as were postdischarge missed injury rates (Type III) at 1 month (13.7 vs. 11.5 %, P = 0.43), and 6 months (3.8 vs. 3.3 %, P = 0.84) after discharge. TTS performance was substantially higher in the post-group (27 vs. 42 %, P cumulative missed injury rates >15 %. Some of these injuries were clinically relevant. Although TTS performance was significantly improved by formalising the process (from 27 to 42 %), this did not decrease missed injury rates.

Usability evaluation of complex systems. A literature review

International Nuclear Information System (INIS)

Norros, L.; Savioja, P.

2004-04-01

In this literature study the task of usability evaluation is approached through recent publications and known practises. The scope of the reviewed literature and the overall problematic of evaluating complex systems are first defined. Then existing evaluation methods and tools and a set of design guidelines and standards is introduced. In there view the distinction between the evaluation of the design process and evaluation of the outcome of the design process is made. Also the existing criteria for usability is provided. These criteria can be used as measures in the evaluation procedures described in the previous chapter. Then, the problem of validity in the evaluation and validation procedures of complex cognitive systems is shortly discusses. The final chapter covers the conclusions of the literature review. There is a need for deepening the relationship between usage and design. Usage must be the driver also in the design of process technology, plant's safety, and instrumentation and control as well as that of the design of man-machine interface. The collaborative activity is called activity-oriented design. In order to enable activity-oriented design we need to create design methods that drive the design activity into this direction. Criteria for evaluating what is good design are not available in present standards. Criteria for good tools and practices must consider human in a favourable role in the various tasks of operating an industrial plant as opposed to the view of human as a source of error. This is the way to create an optimal system, which takes advantage of the unique capabilities of both the human operators and the automation systems. (orig.)

Covariance evaluation system

International Nuclear Information System (INIS)

Kawano, Toshihiko; Shibata, Keiichi.

1997-09-01

A covariance evaluation system for the evaluated nuclear data library was established. The parameter estimation method and the least squares method with a spline function are used to generate the covariance data. Uncertainties of nuclear reaction model parameters are estimated from experimental data uncertainties, then the covariance of the evaluated cross sections is calculated by means of error propagation. Computer programs ELIESE-3, EGNASH4, ECIS, and CASTHY are used. Covariances of 238 U reaction cross sections were calculated with this system. (author)

Evaluation of the influenza sentinel surveillance system in Madagascar, 2009-2014.

Science.gov (United States)

Rakotoarisoa, Alain; Randrianasolo, Laurence; Tempia, Stefano; Guillebaud, Julia; Razanajatovo, Norosoa; Randriamampionona, Lea; Piola, Patrice; Halm, Ariane; Heraud, Jean-Michel

2017-05-01

Evaluation of influenza surveillance systems is poor, especially in Africa. In 2007, the Institut Pasteur de Madagascar and the Malagasy Ministry of Public Health implemented a countrywide system for the prospective syndromic and virological surveillance of influenza-like illnesses. In assessing this system's performance, we identified gaps and ways to promote the best use of resources. We investigated acceptability, data quality, flexibility, representativeness, simplicity, stability, timeliness and usefulness and developed qualitative and/or quantitative indicators for each of these attributes. Until 2007, the influenza surveillance system in Madagascar was only operational in Antananarivo and the observations made could not be extrapolated to the entire country. By 2014, the system covered 34 sentinel sites across the country. At 12 sites, nasopharyngeal and/or oropharyngeal samples were collected and tested for influenza virus. Between 2009 and 2014, 177 718 fever cases were detected, 25 809 (14.5%) of these fever cases were classified as cases of influenza-like illness. Of the 9192 samples from patients with influenza-like illness that were tested for influenza viruses, 3573 (38.9%) tested positive. Data quality for all evaluated indicators was categorized as above 90% and the system also appeared to be strong in terms of its acceptability, simplicity and stability. However, sample collection needed improvement. The influenza surveillance system in Madagascar performed well and provided reliable and timely data for public health interventions. Given its flexibility and overall moderate cost, this system may become a useful platform for syndromic and laboratory-based surveillance in other low-resource settings.

System and prospect assesment of the small innovative reactor IRIS-50

International Nuclear Information System (INIS)

Lumbanraja, Sahala M.; Wibowo

2002-01-01

System and prospect of the small innovative reactor IRIS-50 in Indonesia have been studied. IRIS-50 (International Reactor Innovative and Secure) is an advanced light water cooled modular reactor being developed by an international consortium led by Westinghouse. This reactor is specifically developed to match market demands, or to developing country. This reactor is based on simplified operation and maintenance, enhanced and safety, easy to inspect, short construction time, small investment cost, competitive generating cost, and easily suited to the infrastructures. IRIS main characteristic is integral reactor concept, being all the major reactor coolant system components located inside the pressure vessel

42 CFR 412.428 - Publication of Updates to the inpatient psychiatric facility prospective payment system.

Science.gov (United States)

2010-10-01

... maintain the appropriate outlier percentage. (e) Describe the ICD-9-CM coding changes and DRG classification changes discussed in the annual update to the hospital inpatient prospective payment system...

Prospect of HTGRs for hydrogen production in Indonesia

International Nuclear Information System (INIS)

Rusli, A.; Dasuki, A.S.; Rahman, M.; Nuriman; Sudarto

1997-01-01

Hydrogen energy system is interesting to many people of the world that because of hydrogen promised to save our planet earth from destroying of burning of fossil fuels. The selected development of hydrogen production from water such as electrolysis and thermochemical cycles are evaluated. These processes are allowed to split the water at lower temperature, still in the range of HTGRs' working temperature. An overview of related studies in recent years enables the development of research to be followed, studied and evaluated are mentioned. The prospect of hydrogen market in Indonesia and economic consideration based on previous studied are also analyzed and evaluated. (author). 11 refs, 5 figs, 13 tabs

Teaching Evaluation of Higher Education Institutions: Retrospect and Prospect

Science.gov (United States)

Siping, Gao

2009-01-01

China started up pilot projects for the evaluation of teaching work at regular higher education institutions (HEIs) in 1994, and, beginning in 2003, the Ministry of Education (MOE) formally set up a system of cyclical teaching evaluation. Among the 592 undergraduate colleges and universities that were listed in the plan for the first round of…

Modeling a support system for the evaluator

International Nuclear Information System (INIS)

Lozano Lima, B.; Ilizastegui Perez, F; Barnet Izquierdo, B.

1998-01-01

This work gives evaluators a tool they can employ to give more soundness to their review of operational limits and conditions. The system will establish the most adequate method to carry out the evaluation, as well as to evaluate the basis for technical operational specifications. It also includes the attainment of alternative questions to be supplied to the operating entity to support it in decision-making activities

PROSPECTIVE EVALUATION FOR THE SUGAR CANE FACTORY TRANSFORMATION IN BIOREFINERY

Directory of Open Access Journals (Sweden)

Rocío Rodríguez Plaza

2015-10-01

Full Text Available The present work has as goal to evaluate prospectively alternative of transformation in the "5 de Septiembre" sugar industry, located in Cienfuegos, for a superfine alcohol biorefinery. Two alternatives were taking into account; the first one was the installation of a distillery for a capacity of 500 hl/d of superfine alcohol, using the molasses and 10% of the filters juice coming from the sugar mill, as complement of the stage of fermentation, and also a plant of biodiesel production starting from microalgae biomass and of mud separated in the sugar mill and another installation of a distillery for a similar capacity of 500 Hl/d of superfine ethanol using molasses, the filters juices and microalgae hydrolysate. For the second alternative, it intends a distillery where saving of 67 % for the molasses, and 22.73 % for the water, these results are experimentally obtained. The most feasible alternative obtain 5 years of payback period, 21 % of an IRR and U$D 37104 419.21 of NPV.

Planning for a smooth transition: evaluation of a succession planning program for prospective nurse unit managers.

Science.gov (United States)

Manning, Vicki; Jones, Alan; Jones, Pamela; Fernandez, Ritin S

2015-01-01

The current and projected nurse workforce shortage has created significant pressure on health care organizations to examine their approach to managing talent. This includes the need for strategic development of new formal leaders. This article reports on a succession planning program for prospective nursing unit managers. Eight prospective management candidates participated in a Future Nursing Unit Managers program. The effectiveness of the program was measured through a comparison of pre- and postprogram surveys relating to participants' perception of personal managerial and leadership skills. Significant differences in scores from baseline to 6-month follow-up surveys were observed in the participants' confidence in undertaking the nursing unit manager role and in their management skills. Investment in structured programs to prepare nurses for leadership roles is strongly recommended as a management workforce strategy.

Using Fuzzy Probability Weights in Cumulative Prospect Theory

Directory of Open Access Journals (Sweden)

Užga-Rebrovs Oļegs

2016-12-01

Full Text Available During the past years, a rapid growth has been seen in the descriptive approaches to decision choice. As opposed to normative expected utility theory, these approaches are based on the subjective perception of probabilities by the individuals, which takes place in real situations of risky choice. The modelling of this kind of perceptions is made on the basis of probability weighting functions. In cumulative prospect theory, which is the focus of this paper, decision prospect outcome weights are calculated using the obtained probability weights. If the value functions are constructed in the sets of positive and negative outcomes, then, based on the outcome value evaluations and outcome decision weights, generalised evaluations of prospect value are calculated, which are the basis for choosing an optimal prospect.

Nursing workload as a risk factor for healthcare associated infections in ICU: a prospective study.

Directory of Open Access Journals (Sweden)

Renata M Daud-Gallotti

Full Text Available INTRODUCTION: Nurse understaffing is frequently hypothesized as a potential risk factor for healthcare-associated infections (HAI. This study aimed to evaluate the role of nursing workload in the occurrence of HAI, using Nursing Activities Score (NAS. METHODS: This prospective cohort study enrolled all patients admitted to 3 Medical ICUs and one step-down unit during 3 months (2009. Patients were followed-up until HAI, discharge or death. Information was obtained from direct daily observation of medical and nursing rounds, chart review and monitoring of laboratory system. Nursing workload was determined using NAS. Non-compliance to the nurses' patient care plans (NPC was identified. Demographic data, clinical severity, invasive procedures, hospital interventions, and the occurrence of other adverse events were also recorded. Patients who developed HAI were compared with those who did not. RESULTS: 195 patients were included and 43 (22% developed HAI: 16 pneumonia, 12 urinary-tract, 8 bloodstream, 2 surgical site, 2 other respiratory infections and 3 other. Average NAS and average proportion of non compliance with NPC were significantly higher in HAI patients. They were also more likely to suffer other adverse events. Only excessive nursing workload (OR: 11.41; p: 0.019 and severity of patient's clinical condition (OR: 1.13; p: 0.015 remained as risk factors to HAI. CONCLUSIONS: Excessive nursing workload was the main risk factor for HAI, when evaluated together with other invasive devices except mechanical ventilation. To our knowledge, this study is the first to evaluate prospectively the nursing workload as a potential risk factor for HAI, using NAS.

Usefulness of temporal bone prototype for drilling training: A prospective study.

Science.gov (United States)

Aussedat, C; Venail, F; Nguyen, Y; Lescanne, E; Marx, M; Bakhos, D

2017-12-01

Dissection of cadaveric temporal bones (TBs) is considered the gold standard for surgical training in otology. For many reasons, access to the anatomical laboratory and cadaveric TBs is difficult for some facilities. The aim of this prospective and comparative study was to evaluate the usefulness of a physical TB prototype for drilling training in residency. Prospective study. Tertiary referral centre. Thirty-four residents were included. Seventeen residents (mean age 26.7±1.6) drilled on only cadaveric TBs ("traditional" group), in the traditional training method, while seventeen residents (mean age 26.5±1.7) drilled first on a prototype and then on a cadaveric TB ("prototype" group). Drilling performance was assessed using a validated scale. Residents completed a mastoid image before and after each drilling to enable evaluation of mental representations of the mastoidectomy. No differences were observed between the groups with respect to age, drilling experience and level of residency. Regarding drilling performance, we found a significant difference across the groups, with a better score in the prototype group (P=.0007). For mental representation, the score was statistically improved (P=.0003) after drilling in both groups, suggesting that TB drilling improves the mental representation of the mastoidectomy whether prototype or cadaveric TB is used. The TB prototype improves the drilling performance and mental representation of the mastoidectomy in the young resident population. A drilling simulation with virtual or physical systems seems to be a beneficial tool to improve TB drilling. © 2017 John Wiley & Sons Ltd.

A Process For Performance Evaluation Of Real-Time Systems

Directory of Open Access Journals (Sweden)

Andrew J. Kornecki

2003-12-01

Full Text Available Real-time developers and engineers must not only meet the system functional requirements, but also the stringent timing requirements. One of the critical decisions leading to meeting these timing requirements is the selection of an operating system under which the software will be developed and run. Although there is ample documentation on real-time systems performance and evaluation, little can be found that combines such information into an efficient process for use by developers. As the software industry moves towards clearly defined processes, creation of appropriate guidelines describing a process for performance evaluation of real-time system would greatly benefit real-time developers. This technology transition research focuses on developing such a process. PROPERT (PROcess for Performance Evaluation of Real Time systems - the process described in this paper - is based upon established techniques for evaluating real-time systems. It organizes already existing real-time performance criteria and assessment techniques in a manner consistent with a well-formed process, based on the Personal Software Process concepts.

Impact of a CAD system in a screen-film mammography screening program: A prospective study

International Nuclear Information System (INIS)

Sanchez Gómez, S.; Torres Tabanera, M.; Vega Bolivar, A.; Sainz Miranda, M.; Baroja Mazo, A.; Ruiz Diaz, M.; Martinez Miravete, P.; Lag Asturiano, E.; Muñoz Cacho, P.; Delgado Macias, T.

2011-01-01

Objective: The purpose of our study was to perform a prospective assessment of the impact of a CAD system in a screen-film mammography screening program during a period of 3 years. Materials and methods: Our study was carried out on a population of 21,855 asymptomatic women (45–65 years). Mammograms were processed in a CAD system and independently interpreted by one of six radiologists. We analyzed the following parameters: sensitivity of radiologist's interpretation (without and with CAD), detection increase, recall rate and positive predictive value of biopsy, CAD's marks, radiologist's false negatives and comparative analysis of carcinomas detected and non-detected by CAD. Results: Detection rate was 4.3‰. CAD supposed an increase of 0.1‰ in detection rate and 1% in the total number of cases (p < 0.005). The impact on recall rate was not significant (0.4%) and PPV of percutaneous biopsy was unchanged by CAD (20.23%). CAD's marks were 2.7 per case and 0.7 per view. Radiologist's false negatives were 13 lesions which were initially considered as CAD's false positives. Conclusions: CAD supposed a significant increase in detection, without modifications in recall rates and PPV of biopsy. However, better results could have been achieved if radiologists had considered actionable those cases marked by CAD but initially misinterpreted.

Ahmed glaucoma valve in post-penetrating-keratoplasty glaucoma: A critically evaluated prospective clinical study

Directory of Open Access Journals (Sweden)

Anita Panda

2011-01-01

Full Text Available Aim: The aim was to evaluate the outcome of Ahmed glaucoma valve (AGV in post-penetrating-keratoplasty glaucoma (PKPG. Materials and Methods: In this prospective study, 20 eyes of 20 adult patients with post-PKPG with intraocular pressure (IOP >21 mmHg, on two or more antiglaucoma medications, underwent AG (model FP7 implantation and were followed up for a minimum of 6 months. Absolute success was defined as 5 < IOP < 21 mmHg and qualified success as 5 < IOP < 21 mmHg with medications or minor procedures. Results: The mean IOP decreased from 42.95 ± 10.24 to 17.69 ± 3.64 mmHg (P < 0.001 and the use of medications dropped from 2.92 to 0.39 (P < 0.001 after AGV implantation. The absolute success was achieved in 11 eyes and qualified success in 9. There was no significant change in best corrected visual acuity, graft clarity, or graft thickness. Six device-related complications occurred after AGV implantations which were successfully managed with medical or minor surgical therapy. Conclusions: Postkeratoplasty refractory glaucoma managed by AGV implantation revealed a satisfactory outcome up to 6 months of follow-up.

The Oil Security Metrics Model: A Tool for Evaluating the Prospective Oil Security Benefits of DOE's Energy Efficiency and Renewable Energy R&D Programs

Energy Technology Data Exchange (ETDEWEB)

Greene, David L [ORNL; Leiby, Paul Newsome [ORNL

2006-05-01

Energy technology R&D is a cornerstone of U.S. energy policy. Understanding the potential for energy technology R&D to solve the nation's energy problems is critical to formulating a successful R&D program. In light of this, the U.S. Congress requested the National Research Council (NRC) to undertake both retrospective and prospective assessments of the Department of Energy's (DOE's) Energy Efficiency and Fossil Energy Research programs (NRC, 2001; NRC, 2005). ("The Congress continued to express its interest in R&D benefits assessment by providing funds for the NRC to build on the retrospective methodology to develop a methodology for assessing prospective benefits." NRC, 2005, p. ES-2) In 2004, the NRC Committee on Prospective Benefits of DOE's Energy Efficiency and Fossil Energy R&D Programs published a report recommending a new framework and principles for prospective benefits assessment. The Committee explicitly deferred the issue of estimating security benefits to future work. Recognizing the need for a rigorous framework for assessing the energy security benefits of its R&D programs, the DOE's Office of Energy Efficiency and Renewable Energy (EERE) developed a framework and approach for defining energy security metrics for R&D programs to use in gauging the energy security benefits of their programs (Lee, 2005). This report describes methods for estimating the prospective oil security benefits of EERE's R&D programs that are consistent with the methodologies of the NRC (2005) Committee and that build on Lee's (2005) framework. Its objective is to define and implement a method that makes use of the NRC's typology of prospective benefits and methodological framework, satisfies the NRC's criteria for prospective benefits evaluation, and permits measurement of that portion of the prospective energy security benefits of EERE's R&D portfolio related to oil. While the Oil Security Metrics (OSM) methodology described

ISOS: A job evaluation system to implement comparable worth

Directory of Open Access Journals (Sweden)

Albert Corominas

2008-01-01

Full Text Available A fair pay structure is an essential element of the personnel policy of a firm. If the pay structure is perceived as arbitrary by the members of the staff, it becomes a cause of disturbance of the labor relations. Particularly, a pay structure is unfair if it discriminates against women. Job evaluation is a traditional tool used by companies to assist in the process of determining pay structures that can be also useful to detect and combat wage discrimination, since allow determining whether two jobs are of comparable worth or not. Although there are many kinds of systems, authors agree when defining point factor methods as the most appropriate and fair job evaluation systems. However, even being well defined from a technical point of view, most existing systems give discriminatory results regarding to gender. ISOS, a new job evaluation system which is described in this paper, has been designed, with the aim to define a neutral system with regard to gender, based on present jobs characteristics, existing job evaluation systems and job description questionnaires, international experts’ knowledge and a wide body of literature on gender discrimination and its relation with job evaluation. Using ISOS can contribute to detect, combat and eliminate part of the existing wage discrimination in general and, in particular, against women. ISOS includes all aspects of the work so no characteristics are omitted. The system can be applied in any company and to evaluate any job, and offers flexibility to be adapted to the specific characteristics of an organization. ISOS can also be used to detect and combat wage discrimination. Furthermore, characteristics of present jobs, such as cross-training or flexible working time, are also included so the system can be considered innovative in a very traditional field of industrial engineering.

A review of wireless power transfer for electric vehicles: Prospects to enhance sustainable mobility

International Nuclear Information System (INIS)

Bi, Zicheng; Kan, Tianze; Mi, Chunting Chris; Zhang, Yiming; Zhao, Zhengming; Keoleian, Gregory A.

2016-01-01

Highlights: • Reviewed technology advances and sustainability performance of WPT for EVs. • Identified the technical bottlenecks for improving system performance. • Highlighted system performance of case studies and real-world demonstrations. • Evaluated energy, environmental, economic, and societal impacts of WPT deployment. • Defined WPT challenges and opportunities for enhancing future sustainable mobility. - Abstract: Wireless power transfer (WPT), which transmits power by an electromagnetic field across an intervening space, provides the prospect of new opportunities for electric vehicles (EVs) to enhance sustainable mobility. This review article evaluates WPT technology for EV applications from both technical and sustainability perspectives. The objectives of this review include: (1) to present the state-of-the-art technical progress and research bottlenecks in WPT development and applications in the transportation sector; (2) to characterize the demonstrations of the real-world deployment of WPT EV systems; and (3) to evaluate the sustainable performance and identify challenges and opportunities for improvement. From the technical perspective, progress on coil design, compensation topologies, and power electronics converters and control methods are reviewed with a focus on system performance. From the sustainability perspective, performance is defined in terms of energy, environmental, and economic metrics, and policy drivers and issues of health and safety are also examined.

A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance

Directory of Open Access Journals (Sweden)

Kumudha Ramasubbu

2010-09-01

Full Text Available Kumudha Ramasubbu1, Anita Deswal1, Cheryl Herdejurgen2, David Aguilar1, Adaani E Frost21Section of Cardiology, Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA; 2Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USABackground: Pulmonary hypertension (PH, a disease which carries substantial morbidity and mortality, has been reported to occur in 25%–45% of dialysis patients. No prospective evaluation of the prevalence or clinical significance of PH in chronic dialysis patients in the United States (US has been undertaken.Methods: Echocardiograms were performed prospectively in chronic hemodialysis patients prior to dialysis at a single dialysis center. PH was defined as a tricuspid regurgitant jet ≥2.5 m/s and “more severe PH” as ≥3.0 m/s. Clinical outcomes recovered were all-cause hospitalizations and death at 12 months.Results: In a cohort of 90 patients, 42 patients (47% met the definition of PH. Of those, 18 patients (20% met the definition of more severe PH. At 12 months, mortality was significantly higher in patients with PH (26% compared with patients without PH (6%. All-cause hospitalizations were similar in patients with PH and without PH. Echocardiographic findings suggesting impaired left ventricular function and elevated pulmonary capillary wedge pressure were significantly associated with PH.Conclusion: This prospective cross-sectional study of a single dialysis unit suggests that PH may be present in nearly half of US dialysis patients and when present is associated with increased mortality. Echocardiographic findings demonstrate an association between elevated filling pressures, elevated pulmonary artery pressures, and higher mortality, suggesting that the PH may be secondary to diastolic dysfunction and compounded by volume overload.Keywords: renal failure, pulmonary hypertension, diastolic dysfunction

Towards a Clinical Trial Protocol to Evaluate Health Information Systems: Evaluation of a Computerized System for Monitoring Tuberculosis from a Patient Perspective in Brazil.

Science.gov (United States)

Crepaldi, Nathalia Yukie; de Lima, Inacia Bezerra; Vicentine, Fernanda Bergamini; Rodrigues, Lídia Maria Lourençon; Sanches, Tiago Lara Michelin; Ruffino-Netto, Antonio; Alves, Domingos; Rijo, Rui Pedro Charters Lopes

2018-05-08

Assessment of health information systems consider different aspects of the system itself. They focus or on the professional who will use the software or on its usability or on the software engineering metrics or on financial and managerial issues. The existent approaches are very resources consuming, disconnected, and not standardized. As the software becomes more critical in the health organizations and in patients, becoming used as a medical device or a medicine, there is an urgency to identify tools and methods that can be applied in the development process. The present work is one of the steps of a broader study to identify standardized protocols to evaluate the health information systems as medicines and medical devices are evaluated by clinical trials. The goal of the present work was to evaluate the effect of the introduction of an information system for monitoring tuberculosis treatment (SISTB) in a Brazilian municipality from the patients' perspective. The Patient Satisfaction Questionnaire and the Hospital Consumer Assessment of Healthcare Providers and Systems were answered by the patients before and after the SISTB introduction, for comparison. Patients from an outpatient clinic, formed the control group, that is, at this site was not implanted the SISTB. Descriptive statistics and mixed effects model were used for data analysis. Eighty-eight interviews were conducted in the study. The questionnaire's results presented better averages after the system introduction but were not considered statistically significant. Therefore, it was not possible to associate system implantation with improved patient satisfaction. The HIS evaluation need be complete, the technical and managerial evaluation, the safety, the impact on the professionals and direct and/or indirect impact on patients are important. Developing the right tools and methods that can evaluate the software in its entirety, from the beginning of the development cycle with a normalized scale, are

Accuracy and Predictability of PANC-3 Scoring System over APACHE II in Acute Pancreatitis: A Prospective Study.

Science.gov (United States)

Rathnakar, Surag Kajoor; Vishnu, Vikram Hubbanageri; Muniyappa, Shridhar; Prasath, Arun

2017-02-01

Acute Pancreatitis (AP) is one of the common conditions encountered in the emergency room. The course of the disease ranges from mild form to severe acute form. Most of these episodes are mild and spontaneously subsiding within 3 to 5 days. In contrast, Severe Acute Pancreatitis (SAP) occurring in around 15-20% of all cases, mortality can range between 10 to 85% across various centres and countries. In such a situation we need an indicator which can predict the outcome of an attack, as severe or mild, as early as possible and such an indicator should be sensitive and specific enough to trust upon. PANC-3 scoring is such a scoring system in predicting the outcome of an attack of AP. To assess the accuracy and predictability of PANC-3 scoring system over APACHE II in predicting severity in an attack of AP. This prospective study was conducted on 82 patients admitted with the diagnosis of pancreatitis. Investigations to evaluate PANC-3 and APACHE II were done on all the patients and the PANC-3 and APACHE II score was calculated. PANC-3 score has a sensitivity of 82.6% and specificity of 77.9%, the test had a Positive Predictive Value (PPV) of 0.59 and Negative Predictive Value (NPV) of 0.92. Sensitivity of APACHE II in predicting SAP was 91.3% and specificity was 96.6% with PPV of 0.91, NPV was 0.96. Our study shows that PANC-3 can be used to predict the severity of pancreatitis as efficiently as APACHE II. The interpretation of PANC-3 does not need expertise and can be applied at the time of admission which is an advantage when compared to classical scoring systems.

Evaluating Management Information Systems, A Protocol for Automated Peer Review Systems

OpenAIRE

Black, Gordon C.

1980-01-01

This paper discusses key issues in evaluating an automated Peer Review System. Included are the conceptual base, design, steps in planning structural components, operation parameters, criteria, costs and a detailed outline or protocol for use in the evaluation.

Fast magnetic resonance imaging of the knee using a parallel acquisition technique (mSENSE): a prospective performance evaluation

International Nuclear Information System (INIS)

Kreitner, K.F.; Romaneehsen, Bernd; Oberholzer, Katja; Dueber, Christoph; Krummenauer, Frank; Mueller, L.P.

2006-01-01

The performance of a magnetic resonance (MR) imaging strategy that uses multiple receiver coil elements and integrated parallel imaging techniques (iPAT) in traumatic and degenerative disorders of the knee and to compare this technique with a standard MR imaging protocol was evaluated. Ninety patients with suspected internal derangements of the knee joint prospectively underwent MR imaging at 1.5 T. For signal detection, a 6-channel array coil was used. All patients were investigated with a standard imaging protocol consisting of different turbo spin-echo sequences proton density (PD), T 2 -weighted turbo spin echo (TSE) with and without fat suppression in three imaging planes. All sequences were repeated with an integrated parallel acquisition technique (iPAT) using the modified sensitivity encoding (mSENSE) algorithm with an acceleration factor of 2. Two radiologists independently evaluated and scored all images with regard to overall image quality, artefacts and pathologic findings. Agreement of the parallel ratings between readers and imaging techniques, respectively, was evaluated by means of pairwise kappa coefficients that were stratified for the area of evaluation. Agreement between the parallel readers for both the iPAT imaging and the conventional technique, respectively, as well as between imaging techniques was found encouraging with inter-observer kappa values ranging between 0.78 and 0.98 for both imaging techniques, and the inter-method kappa values ranging between 0.88 and 1.00 for both clinical readers. All pathological findings (e.g. occult fractures, meniscal and cruciate ligament tears, torn and interpositioned Hoffa's cleft, cartilage damage) were detected by both techniques with comparable performance. The use of iPAT lead to a 48% reduction of acquisition time compared with standard technique. Parallel imaging using mSENSE proved to be an efficient and economic tool for fast musculoskeletal MR imaging of the knee joint with comparable

42 CFR 412.525 - Adjustments to the Federal prospective payment.

Science.gov (United States)

2010-10-01

... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.525 Adjustments to the Federal prospective payment. (a... its estimated costs for a patient exceed the adjusted LTC-MS-DRG payment plus a fixed-loss amount. For...

Prospective study of clinician-entered research data in the Emergency Department using an Internet-based system after the HIPAA Privacy Rule

Directory of Open Access Journals (Sweden)

Webb William B

2004-10-01

Full Text Available Abstract Background Design and test the reliability of a web-based system for multicenter, real-time collection of data in the emergency department (ED, under waiver of authorization, in compliance with HIPAA. Methods This was a phase I, two-hospital study of patients undergoing evaluation for possible pulmonary embolism. Data were collected by on-duty clinicians on an HTML data collection form (prospective e-form, populated using either a personal digital assistant (PDA or personal computer (PC. Data forms were uploaded to a central, offsite server using secure socket protocol transfer. Each form was assigned a unique identifier, and all PHI data were encrypted, but were password-accessible by authorized research personnel to complete a follow-up e-form. Results From April 15, 2003-April 15 2004, 1022 prospective e-forms and 605 follow-up e-forms were uploaded. Complexities of PDA use compelled clinicians to use PCs in the ED for data entry for most forms. No data were lost and server log query revealed no unauthorized entry. Prospectively obtained PHI data, encrypted upon server upload, were successfully decrypted using password-protected access to allow follow-up without difficulty in 605 cases. Non-PHI data from prospective and follow-up forms were available to the study investigators via standard file transfer protocol. Conclusions Data can be accurately collected from on-duty clinicians in the ED using real-time, PC-Internet data entry in compliance with the Privacy Rule. Deidentification-reidentification of PHI was successfully accomplished by a password-protected encryption-deencryption mechanism to permit follow-up by approved research personnel.

A Prospective, Single Arm, Multi-site, Clinical Evaluation of a Nonradioactive Surgical Guidance Technology for the Location of Nonpalpable Breast Lesions during Excision.

Science.gov (United States)

Cox, Charles E; Russell, Scott; Prowler, Vanessa; Carter, Ebonie; Beard, Abby; Mehindru, Ankur; Blumencranz, Peter; Allen, Kathleen; Portillo, Michael; Whitworth, Pat; Funk, Kristi; Barone, Julie; Norton, Denise; Schroeder, Jerome; Police, Alice; Lin, Erin; Combs, Freddie; Schnabel, Freya; Toth, Hildegard; Lee, Jiyon; Anglin, Beth; Nguyen, Minh; Canavan, Lynn; Laidley, Alison; Warden, Mary Jane; Prati, Ronald; King, Jeff; Shivers, Steven C

2016-10-01

This study was a multicenter evaluation of the SAVI SCOUT(®) breast localization and surgical guidance system using micro-impulse radar technology for the removal of nonpalpable breast lesions. The study was designed to validate the results of a recent 50-patient pilot study in a larger multi-institution trial. The primary endpoints were the rates of successful reflector placement, localization, and removal. This multicenter, prospective trial enrolled patients scheduled to have excisional biopsy or breast-conserving surgery of a nonpalpable breast lesion. From March to November 2015, 154 patients were consented and evaluated by 20 radiologists and 16 surgeons at 11 participating centers. Patients had SCOUT(®) reflectors placed up to 7 days before surgery, and placement was confirmed by mammography or ultrasonography. Implanted reflectors were detected by the SCOUT(®) handpiece and console. Presence of the reflector in the excised surgical specimen was confirmed radiographically, and specimens were sent for routine pathology. SCOUT(®) reflectors were successfully placed in 153 of 154 patients. In one case, the reflector was placed at a distance from the target that required a wire to be placed. All 154 lesions and reflectors were successfully removed during surgery. For 101 patients with a preoperative diagnosis of cancer, 86 (85.1 %) had clear margins, and 17 (16.8 %) patients required margin reexcision. SCOUT(®) provides a reliable and effective alternative method for the localization and surgical excision of nonpalpable breast lesions using no wires or radioactive materials, with excellent patient, radiologist, and surgeon acceptance.

Prospects and strategy for large scale utility applications of photovoltaic power systems

International Nuclear Information System (INIS)

Cole, A.; Vigotti, R.; Lysen, E.

1995-01-01

The paper reviews the status and prospects of photovoltaic power systems and the R and D trends (silicon performances, thin films, balance of systems components), and describes the market diffusion strategy for the application of PV systems: at the short and medium term level, isolated systems for rural electricity supply in IEA member countries and decentralized energy supply (remote users and village power) in developing countries; at the medium and long term level, decentralized building integration in urban and rural areas, power stations for peak power and local grid support. The objectives of the IEA collaboration programme launched among 18 industrialized countries are summarized, with particular reference to technology transfer to developing countries. 4 figs

Physical security system effectiveness evaluation: a status report

International Nuclear Information System (INIS)

Todd, J.L.; Nickell, W.C.

1975-01-01

A method to permit objective comparisons of physical security systems is under development and is expected to be useful in the optimization of system design and in cost benefit analysis. The procedure involves identifying the possible or potential characteristics of a postulated adversary, the counter-measures to deny or diminish adversary success and the response capabilities of the defender. These, in conjunction with system definition information, are evaluated by the use of analytical models which provide a menas of ranking systems against threats. The status of this effort and an overview of the methodology with a brief description of various models being considered for use in effective evaluation are discussed. (U.S.)

Oncology E-Learning for Undergraduate. A Prospective Randomized Controlled Trial.

Science.gov (United States)

da Costa Vieira, René Aloisio; Lopes, Ana Helena; Sarri, Almir José; Benedetti, Zuleica Caulada; de Oliveira, Cleyton Zanardo

2017-06-01

The e-learning education is a promising method, but there are few prospective randomized publications in oncology. The purpose of this study was to assess the level of retention of information in oncology from undergraduate students of physiotherapy. A prospective, controlled, randomized, crossover study, 72 undergraduate students of physiotherapy, from the second to fourth years, were randomized to perform a course of physiotherapy in oncology (PHO) using traditional classroom or e-learning. Students were offered the same content of the subject. The teacher in the traditional classroom model and the e-learning students used the Articulate® software. The course tackled the main issues related to PHO, and it was divided into six modules, 18 lessons, evaluated by 126 questions. A diagnosis evaluation was performed previous to the course and after every module. The sample consisted of 67 students, allocated in groups A (n = 35) and B (n = 32), and the distribution was homogeneous between the groups. Evaluating the correct answers, we observed a limited score in the pre-test (average grade 44.6 %), which has significant (p e-learning, a fact that encourages the use of e-learning in oncology. REBECU1111-1142-1963.

Retrospective and prospective evaluation of the Carbapenem inactivation method for the detection of carbapenemase-producing Enterobacteriaceae

Science.gov (United States)

Gauthier, Lauraine; Dortet, Laurent; Naas, Thierry

2017-01-01

Background There is an urgent need for accurate and rapid diagnostic tests to identify carbapenemase producing enterobacteria (CPE). Here, we have evaluated the Carbapenem Inactivation Method (CIM) test to detect CPEs from cultured colonies. Methods A total of 256 enterobacterial isolates were used to evaluate the performance of the CIM in comparison to Carba NP test and molecular detection used a reference method. Ninety three well-characterized isolates (including 29 non-CPE and 63 CPEs of worldwide origin) with decreased susceptibility to at least one carbapenem were used to (i) evaluate the efficacy of CIM test and (ii) to compare it to the Carba NP test. We also tested different carbapenems to determine the best substrate for this test. Finally, the CIM test was then evaluated prospectively against 164 isolates referred to the French National Reference Center (NRC) for Antimicrobial Resistance from may 2016 to july 2016. Results Based on the results of this retrospective study, sensitivity and specificity of the CIM and the Carba NP test were 92.1% and 100%, respectively. We demonstrated that the meropenem was the best substrate to perform the CIM test since sensitivity and specificity were 81.1% and 100% using ertapenem disk, and 100% and 65,6% using imipenem disk, and respectively. Taking in account the results of retrospective and prospective studies, CIM and Carba NP tests have similar sensitivity, specificity, positive predictive value and negative predictive values being 96.3%, 98.9%, 99.0% and 98.4% for the CIM test versus 96.9%, 100%, 100% and 100% for the Carba NP test. Conclusions Our results confirm that the CIM test may be a useful tool for the reliable confirmation of carbapenemase-activity in enterobacterial isolates, especially in clinical microbiological laboratories with limited resources, no trained personnel, and no specialized equipment. PMID:28158310

Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS®) reverse shoulder arthroplasty: a prospective comparative non-randomised study.

Science.gov (United States)

Kadum, Bakir; Mukka, Sebastian; Englund, Erling; Sayed-Noor, Arkan; Sjödén, Göran

2014-05-01

The aims of this study were to assess the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome. This was a prospective comparative non-randomised study. A total of 37 consecutive patients (40 shoulders) underwent TESS RSA between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66), we evaluated range of motion (ROM), pain and functional outcome with QuickDASH and quality of life with EQ-5D score. Radiologically, component positioning, signs of loosening, SN and arm length difference were documented. We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. No humeral loosening was evident, but there were four glenoid loosenings. In 12 shoulders that developed SN, seven already had scapular bone impression (SBI) evident on initial post-operative radiographs. Glenoid overhang seemed to decrease the risk of SN. Arm lengthening was associated with better EQ-5D but did not influence ROM or functional outcome. Reverse shoulder arthroplasty markedly improved shoulder function. SN is of concern in RSA, but proper positioning of the glenoid component may prevent its development.

Peripheral nerve field stimulation (PNFS) in chronic low back pain: a prospective multicenter study.

Science.gov (United States)

Kloimstein, Herwig; Likar, Rudolf; Kern, Michael; Neuhold, Josef; Cada, Miroslav; Loinig, Nadja; Ilias, Wilfried; Freundl, Brigitta; Binder, Heinrich; Wolf, Andreas; Dorn, Christian; Mozes-Balla, Eva Maria; Stein, Rolf; Lappe, Ivo; Sator-Katzenschlager, Sabine

2014-02-01

The goal of this study was to evaluate the long-term efficacy and safety of peripheral nerve field stimulation (PNFS) for chronic low back pain (cLBP). In this prospective, multicenter observational study, 118 patients were admitted to 11 centers throughout Austria and Switzerland. After a screening visit, all patients underwent a trial stimulation period of at least seven days before implantation of the permanent system. Leads were placed in the subcutaneous tissues of the lower back directly in the region of greatest pain. One hundred five patients were implanted with a permanent stimulating system. Patients' evaluation of pain and functional levels were completed before implantation and one, three, and six months after implantation. Adverse events, medication usage, and coverage of the painful area and predictive value of transcutaneous electrical nerve stimulation (TENS) were monitored. All pain and quality-of-life measures showed statistically significant improvement during the treatment period. These included the average pain visual analog scale, the Oswestry Disability Questionnaire, the Becks Depression Inventory, and the Short Form-12 item Health survey. Additionally, medication usage with opioids, nonsteroidal anti-inflammatory drugs, and anti-convulsants showed a highly significant reduction. Complications requiring surgical intervention were reported in 9.6% of the patients. The degree of coverage of painful areas seems to be an important criterion for efficacy of PNFS, whereas TENS is presumably no predictor. This prospective, multicenter study confirms that PNFS is an effective therapy for the management of cLBP. Significant improvements in many aspects of the pain condition were measured, and complications were minimal. © 2013 International Neuromodulation Society.

Comparison of Tension-Band Wiring With the Cable Pin System in Patella Fractures: A Randomized Prospective Study.

Science.gov (United States)

Tian, Qing-xian; Hai, Yong; Du, Xin-ru; Xu, Zi-yu; Lu, Tie; Shan, Lei; Liu, Yang; Zhou, Jun-lin

2015-12-01

To compare the outcome of tension-band wiring (TBW) with the cable pin system (CPS) for transverse fractures of the patella. Randomized prospective study. Academic Level I trauma center. From February 2008 to December 2011, 73 consecutive patients with transverse fractures of the patella were prospectively enrolled in this study. The patients were randomly divided into 2 groups: one group was treated using the CPS, and the other group was treated using the modified TBW. The clinical outcome assessment included analyses of the radiographic images, the modified Hospital for Special Surgery scoring system, and complications. The follow-up time ranged from 12 to 29 months. All fractures healed, with a union rate of 100%. The fracture healing time was significantly shorter in the CPS group (8.51 ± 2.59 weeks, n = 34) compared with the TBW group (11.79 ± 3.04 weeks, n = 39). Postoperative complications in the CPS and TBW groups were observed in 1 and 9 patients, respectively, a difference that was statistically significant. The mean Hospital for Special Surgery score for the CPS group (90.53 ± 5.19 points) was significantly higher than that for the TBW group (81.36 ± 12.71 points). The CPS is a viable option for transverse fractures of the patella and is associated with a shorter healing time, fewer complications, and better function than TBW. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

No causal relationship between Yersinia enterocolitica infection and autoimmune thyroid disease: evidence from a prospective study

NARCIS (Netherlands)

Effraimidis, G.; Tijssen, J. G. P.; Strieder, T. G. A.; Wiersinga, W. M.

2011-01-01

P>The objective of this study was to evaluate prospectively the relationship between Yersinia enterocolitica (YE) infection and the development of overt autoimmune hypo- or hyperthyroidism (study A) and the de novo occurrence of thyroid antibodies (study B). This was a prospective cohort study of

Disposal systems evaluations and tool development : Engineered Barrier System (EBS) evaluation.

Energy Technology Data Exchange (ETDEWEB)

Rutqvist, Jonny (LBNL); Liu, Hui-Hai (LBNL); Steefel, Carl I. (LBNL); Serrano de Caro, M. A. (LLNL); Caporuscio, Florie Andre (LANL); Birkholzer, Jens T. (LBNL); Blink, James A. (LLNL); Sutton, Mark A. (LLNL); Xu, Hongwu (LANL); Buscheck, Thomas A. (LLNL); Levy, Schon S. (LANL); Tsang, Chin-Fu (LBNL); Sonnenthal, Eric (LBNL); Halsey, William G. (LLNL); Jove-Colon, Carlos F.; Wolery, Thomas J. (LLNL)

2011-01-01

Key components of the nuclear fuel cycle are short-term storage and long-term disposal of nuclear waste. The latter encompasses the immobilization of used nuclear fuel (UNF) and radioactive waste streams generated by various phases of the nuclear fuel cycle, and the safe and permanent disposition of these waste forms in geological repository environments. The engineered barrier system (EBS) plays a very important role in the long-term isolation of nuclear waste in geological repository environments. EBS concepts and their interactions with the natural barrier are inherently important to the long-term performance assessment of the safety case where nuclear waste disposition needs to be evaluated for time periods of up to one million years. Making the safety case needed in the decision-making process for the recommendation and the eventual embracement of a disposal system concept requires a multi-faceted integration of knowledge and evidence-gathering to demonstrate the required confidence level in a deep geological disposal site and to evaluate long-term repository performance. The focus of this report is the following: (1) Evaluation of EBS in long-term disposal systems in deep geologic environments with emphasis on the multi-barrier concept; (2) Evaluation of key parameters in the characterization of EBS performance; (3) Identification of key knowledge gaps and uncertainties; and (4) Evaluation of tools and modeling approaches for EBS processes and performance. The above topics will be evaluated through the analysis of the following: (1) Overview of EBS concepts for various NW disposal systems; (2) Natural and man-made analogs, room chemistry, hydrochemistry of deep subsurface environments, and EBS material stability in near-field environments; (3) Reactive Transport and Coupled Thermal-Hydrological-Mechanical-Chemical (THMC) processes in EBS; and (4) Thermal analysis toolkit, metallic barrier degradation mode survey, and development of a Disposal Systems

Disposal systems evaluations and tool development: Engineered Barrier System (EBS) evaluation

International Nuclear Information System (INIS)

Rutqvist, Jonny; Liu, Hui-Hai; Steefel, Carl I.; Serrano de Caro, M.A.; Caporuscio, Florie Andre; Birkholzer, Jens T.; Blink, James A.; Sutton, Mark A.; Xu, Hongwu; Buscheck, Thomas A.; Levy, Schon S.; Tsang, Chin-Fu; Sonnenthal, Eric; Halsey, William G.; Jove-Colon, Carlos F.; Wolery, Thomas J.

2011-01-01

Key components of the nuclear fuel cycle are short-term storage and long-term disposal of nuclear waste. The latter encompasses the immobilization of used nuclear fuel (UNF) and radioactive waste streams generated by various phases of the nuclear fuel cycle, and the safe and permanent disposition of these waste forms in geological repository environments. The engineered barrier system (EBS) plays a very important role in the long-term isolation of nuclear waste in geological repository environments. EBS concepts and their interactions with the natural barrier are inherently important to the long-term performance assessment of the safety case where nuclear waste disposition needs to be evaluated for time periods of up to one million years. Making the safety case needed in the decision-making process for the recommendation and the eventual embracement of a disposal system concept requires a multi-faceted integration of knowledge and evidence-gathering to demonstrate the required confidence level in a deep geological disposal site and to evaluate long-term repository performance. The focus of this report is the following: (1) Evaluation of EBS in long-term disposal systems in deep geologic environments with emphasis on the multi-barrier concept; (2) Evaluation of key parameters in the characterization of EBS performance; (3) Identification of key knowledge gaps and uncertainties; and (4) Evaluation of tools and modeling approaches for EBS processes and performance. The above topics will be evaluated through the analysis of the following: (1) Overview of EBS concepts for various NW disposal systems; (2) Natural and man-made analogs, room chemistry, hydrochemistry of deep subsurface environments, and EBS material stability in near-field environments; (3) Reactive Transport and Coupled Thermal-Hydrological-Mechanical-Chemical (THMC) processes in EBS; and (4) Thermal analysis toolkit, metallic barrier degradation mode survey, and development of a Disposal Systems

Development of FBR cycle data base system

International Nuclear Information System (INIS)

Kubota, Sadae; Ohtaki, Akira; Hirao, Kazuhiro

2002-06-01

In the 'Feasibility Study on Commercialized Fast Reactor Cycle System (F/S)'. scenario evaluations, cost-benefit evaluations and system characteristic evaluations to show significance of the Fast Breeder Reactor (FBR) cycle system introduction concretely are performed in parallel with a design study for FBR plants, reprocessing systems and fabrication systems. In these evaluations, informations such as economic prospects, prospects for supply and demand of resources and a progress of engineering development are used in addition to design information. This report explains a FBR Cycle Database in order to carry out management and search of various design information and the relating information. The prototype system of the database was completed in the 2000 fiscal year, and the problem of the user number restriction of the prototype system has been improved by Web-ization in the 2001 fiscal year. About 7,000 data are stored in this data base (as of the end of March, 2002). The expansion of user etc., and the continuation of input work of various evaluation information will be carried out, in the phase 2 of F/S. (author)

The Opinions of Prospective Teachers about Peer Assessment

Directory of Open Access Journals (Sweden)

Erdal Bay

2011-12-01

Full Text Available Introduction: Peer assessment has been popular in teacher education for decades. In this study, the opinions of prospective teachers about peer-assessment after an implemented course were collected. The correlation between peer-assessment scores and those of self-assessment and teacher assessments were also investigated. Method: A survey was administered to 56 prospective teachers taking the “Measurement and Evaluation” course in the department of English language teaching. Peer assessment, as well as self-evaluation and teacher-based assessment were applied in the study. To collect the data, open-ended questionnaires and interview forms were employed. Finding: The results indicated that that prospective teacher thought that they acquired professional skills through peer assessment. They also perceived that peer assessment enhanced the quality of learning, provided constructive feedback in learning process, and enabled them to obtain some democratic values. It was also regarded as a tiring and time-consuming activity. Lastly, as parallel to the literature, prospective teachers criticized peer assessment that they were not capable of evaluating themselves effectively because of several reasons such as peer-effect, emotional improper acts and unreliability among peers against each other‟s. Besides, significant a positive correlation was found among peer, self and teacher assessment scores. Conclusion: In conclusion, secrecy, usage of the rubrics, better comprehension of the criteria, training of prospective teachers in evaluation, and spending less time can be the factors that affect the peer assessment. Teachers are suggested that they should adopt contemporary measurement and evaluation techniques reflected within constructivist implementations in learning environments

Evaluating the Predictive Impact of an Emergent Literacy Model on Dyslexia in Italian Children: A Four-Year Prospective Cohort Study.

Science.gov (United States)

Bigozzi, Lucia; Tarchi, Christian; Pezzica, Sara; Pinto, Giuliana

2016-01-01

The strong differences in manifestation, prevalence, and incidence in dyslexia across languages invite studies in specific writing systems. In particular, the question of the role played by emergent literacy in opaque and transparent writing systems remains a fraught one. This research project tested, through a 4-year prospective cohort study, an emergent literacy model for the analysis of the characteristics of future dyslexic children and normally reading peers in Italian, a transparent writing system. A cohort of 450 children was followed from the last year of kindergarten to the third grade in their reading acquisition process. Dyslexic children were individuated (Grade 3), and their performances in kindergarten in textual competence, phonological awareness, and conceptual knowledge of the writing system were compared with a matched group of normally reading peers. Results showed the predictive relevance of the conceptual knowledge of the writing system. The study's implications are discussed. © Hammill Institute on Disabilities 2014.

Reliability analysis of scram system of a critical nuclear power plant

International Nuclear Information System (INIS)

Vieira Neto, A.S.; Souza Borges, W. de

1986-01-01

The object of this paper is to show the relevancy of reliability analysis of nuclear systems as a mean of evaluating their prospect performance in design phase. For this purpose a typical scram system design for light water cooled critical facilities is analized to verify the effects of alternative maintenance procedure and design redundancies in realibility characteristics. (Author) [pt

Prospective guidance in a free-swimming cell.

Science.gov (United States)

Delafield-Butt, Jonathan T; Pepping, Gert-Jan; McCaig, Colin D; Lee, David N

2012-07-01

A systems theory of movement control in animals is presented in this article and applied to explaining the controlled behaviour of the single-celled Paramecium caudatum in an electric field. The theory-General Tau Theory-is founded on three basic principles: (i) all purposive movement entails prospectively controlling the closure of action-gaps (e.g. a distance gap when reaching, or an angle gap when steering); (ii) the sole informational variable required for controlling gaps is the relative rate of change of the gap (the time derivative of the gap size divided by the size), which can be directly sensed; and (iii) a coordinated movement is achieved by keeping the relative rates of change of gaps in a constant ratio. The theory is supported by studies of controlled movement in mammals, birds and insects. We now show for the first time that it is also supported by single-celled paramecia steering to the cathode in a bi-polar electric field. General Tau Theory is deployed to explain this guided steering by the cell. This article presents the first computational model of prospective perceptual control in a non-neural, single-celled system.

Power Distribution System Planning Evaluation by a Fuzzy Multi-Criteria Group Decision Support System

Directory of Open Access Journals (Sweden)

Tiefeng Zhang

2010-10-01

Full Text Available The evaluation of solutions is an important phase in power distribution system planning (PDSP which allows issues such as quality of supply, cost, social service and environmental implications to be considered and usually involves the judgments of a group of experts. The planning problem is thus suitable for the multi-criteria group decision-making (MCGDM method. The evaluation process and evaluation criteria often involve uncertainties incorporated in quantitative analysis with crisp values and qualitative judgments with linguistic terms; therefore, fuzzy sets techniques are applied in this study. This paper proposes a fuzzy multi-criteria group decision-making (FMCGDM method for PDSP evaluation and applies a fuzzy multi-criteria group decision support system (FMCGDSS to support the evaluation task. We introduce a PDSP evaluation model, which has evaluation criteria within three levels, based on the characteristics of a power distribution system. A case-based example is performed on a test distribution network and demonstrates how all the problems in a PDSP evaluation are addressed using FMCGDSS. The results are acceptable to expert evaluators.

Prospective, randomized evaluation of a personal digital assistant-based research tool in the emergency department

Directory of Open Access Journals (Sweden)

Dinizio Anthony

2008-01-01

Full Text Available Abstract Background Personal digital assistants (PDA offer putative advantages over paper for collecting research data. However, there are no data prospectively comparing PDA and paper in the emergency department. The aim of this study was to prospectively compare the performance of PDA and paper enrollment instruments with respect to time required and errors generated. Methods We randomized consecutive patients enrolled in an ongoing prospective study to having their data recorded either on a PDA or a paper data collection instrument. For each method, we recorded the total time required for enrollment, and the time required for manual transcription (paper onto a computer database. We compared data error rates by examining missing data, nonsensical data, and errors made during the transcription of paper forms. Statistical comparisons were performed by Kruskal-Wallis and Poisson regression analyses for time and errors, respectively. Results We enrolled 68 patients (37 PDA, 31 paper. Two of 31 paper forms were not available for analysis. Total data gathering times, inclusive of transcription, were significantly less for PDA (6:13 min per patient compared to paper (9:12 min per patient; p Conclusion Using a PDA-based data collection instrument for clinical research reduces the time required for data gathering and significantly improves data integrity.

Antiaging therapy: a prospective hypothesis

Directory of Open Access Journals (Sweden)

Shahidi Bonjar MR

2015-01-01

Full Text Available Mohammad Rashid Shahidi Bonjar,1 Leyla Shahidi Bonjar2 1School of Dentistry, Kerman University of Medical Sciences, Kerman Iran; 2Department of Pharmacology, College of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran Abstract: This hypothesis proposes a new prospective approach to slow the aging process in older humans. The hypothesis could lead to developing new treatments for age-related illnesses and help humans to live longer. This hypothesis has no previous documentation in scientific media and has no protocol. Scientists have presented evidence that systemic aging is influenced by peculiar molecules in the blood. Researchers at Albert Einstein College of Medicine, New York, and Harvard University in Cambridge discovered elevated titer of aging-related molecules (ARMs in blood, which trigger cascade of aging process in mice; they also indicated that the process can be reduced or even reversed. By inhibiting the production of ARMs, they could reduce age-related cognitive and physical declines. The present hypothesis offers a new approach to translate these findings into medical treatment: extracorporeal adjustment of ARMs would lead to slower rates of aging. A prospective “antiaging blood filtration column” (AABFC is a nanotechnological device that would fulfill the central role in this approach. An AABFC would set a near-youth homeostatic titer of ARMs in the blood. In this regard, the AABFC immobilizes ARMs from the blood while blood passes through the column. The AABFC harbors antibodies against ARMs. ARM antibodies would be conjugated irreversibly to ARMs on contact surfaces of the reaction platforms inside the AABFC till near-youth homeostasis is attained. The treatment is performed with the aid of a blood-circulating pump. Similar to a renal dialysis machine, blood would circulate from the body to the AABFC and from there back to the body in a closed circuit until ARMs were sufficiently depleted from the blood. The

A longitudinal evaluation of performance of automated BCR-ABL1 quantitation using cartridge-based detection system.

Science.gov (United States)

Enjeti, Anoop; Granter, Neil; Ashraf, Asma; Fletcher, Linda; Branford, Susan; Rowlings, Philip; Dooley, Susan

2015-10-01

An automated cartridge-based detection system (GeneXpert; Cepheid) is being widely adopted in low throughput laboratories for monitoring BCR-ABL1 transcript in chronic myelogenous leukaemia. This Australian study evaluated the longitudinal performance specific characteristics of the automated system.The automated cartridge-based system was compared prospectively with the manual qRT-PCR-based reference method at SA Pathology, Adelaide, over a period of 2.5 years. A conversion factor determination was followed by four re-validations. Peripheral blood samples (n = 129) with international scale (IS) values within detectable range were selected for assessment. The mean bias, proportion of results within specified fold difference (2-, 3- and 5-fold), the concordance rate of major molecular remission (MMR) and concordance across a range of IS values on paired samples were evaluated.The initial conversion factor for the automated system was determined as 0.43. Except for the second re-validation, where a negative bias of 1.9-fold was detected, all other biases fell within desirable limits. A cartridge-specific conversion factor and efficiency value was introduced and the conversion factor was confirmed to be stable in subsequent re-validation cycles. Concordance with the reference method/laboratory at >0.1-≤10 IS was 78.2% and at ≤0.001 was 80%, compared to 86.8% in the >0.01-≤0.1 IS range. The overall and MMR concordance were 85.7% and 94% respectively, for samples that fell within ± 5-fold of the reference laboratory value over the entire period of study.Conversion factor and performance specific characteristics for the automated system were longitudinally stable in the clinically relevant range, following introduction by the manufacturer of lot specific efficiency values.

Nutritional risk in major abdominal surgery: NURIMAS Liver (DRKS00010923 – protocol of a prospective observational trial to evaluate the prognostic value of different nutritional scores in hepatic surgery

Directory of Open Access Journals (Sweden)

Pascal Probst

Full Text Available Background: Malnutrition is commonly known as a risk factor in surgical procedures. The nutritional status seems particularly relevant to the clinical outcome of patients undergoing hepatic resection. Thus, identifying affected individuals and taking preventive therapeutic actions before surgery is an important task. However, there are only very few studies, that investigate which existing nutritional assessment score (NAS is suited best to predict the postoperative outcome in liver surgery. Objective: Nutritional Risk in Major Abdominal Surgery (NURIMAS Liver is a prospective observational trial that analyses the predictive value of 12 different NAS for postoperative morbidity and mortality after liver resection. Methods: After admission to the surgical department of the University Hospital in Heidelberg or the municipal hospital of Karlsruhe, all patients scheduled for elective liver resection will be screened for eligibility. Participants will fill in a questionnaire and undergo a physical examination in order to evaluate nutritional status according to Nutritional Risk Index, Nutritional Risk Screening Score, Subjective Global Assessment, Malnutrition Universal Screening Tool, Mini Nutritional Assessment, Short Nutritional Assessment Questionnaire, Imperial Nutritional Screening System, Imperial Nutritional Screening System II, Nutritional Risk Classification and the ESPEN malnutrition criteria. Postoperative morbidity and mortality will be tracked prospectively throughout the postoperative course. The association of malnutrition according to each score and occurrence of at least one major complication will be analysed using both chi-squared tests and a multivariable logistic regression analysis. Already established risk factors in liver surgery will be added as covariates. Discussion: NURIMAS Liver is a bicentric, prospective observational trial. The aim of this study is to investigate the predictive value of clinical nutritional assessment

Prospects for a bio-based succinate industry.

Science.gov (United States)

McKinlay, James B; Vieille, C; Zeikus, J Gregory

2007-09-01

Bio-based succinate is receiving increasing attention as a potential intermediary feedstock for replacing a large petrochemical-based bulk chemical market. The prospective economical and environmental benefits of a bio-based succinate industry have motivated research and development of succinate-producing organisms. Bio-based succinate is still faced with the challenge of becoming cost competitive against petrochemical-based alternatives. High succinate concentrations must be produced at high rates, with little or no by-products to most efficiently use substrates and to simplify purification procedures. Herein are described the current prospects for a bio-based succinate industry, with emphasis on specific bacteria that show the greatest promise for industrial succinate production. The succinate-producing characteristics and the metabolic pathway used by each bacterial species are described, and the advantages and disadvantages of each bacterial system are discussed.

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

Science.gov (United States)

Mbuthia, Jackson Mwenda; Rewe, Thomas Odiwuor; Kahi, Alexander Kigunzu

2015-02-01

This study evaluated pig production practices by smallholder farmers in two distinct production systems geared towards addressing their constraints and prospects for improvement. The production systems evaluated were semi-intensive and extensive and differed in remoteness, market access, resource availability and pig production intensity. Data were collected using structured questionnaires where a total of 102 pig farmers were interviewed. Qualitative and quantitative research methods were employed to define the socioeconomic characteristics of the production systems, understanding the different roles that pigs play, marketing systems and constraints to production. In both systems, regular cash income and insurance against emergencies were ranked as the main reasons for rearing pigs. Marketing of pigs was mainly driven by the type of production operation. Finances, feeds and housing were identified as the major constraints to production. The study provides important parameters and identifies constraints important for consideration in design of sustainable production improvement strategies. Feeding challenges can be improved through understanding the composition and proper utilization of local feed resources. Provision of adequate housing would improve the stocking rates and control mating.

The prospective impact of food pricing on improving dietary consumption: A systematic review and meta-analysis

OpenAIRE

Afshin, Ashkan; Peñalvo, José L.; Del Gobbo, Liana; Silva, Jose; Michaelson, Melody; O'Flaherty, Martin; Capewell, Simon; Spiegelman, Donna; Danaei, Goodarz; Mozaffarian, Dariush

2017-01-01

Background: While food pricing is a promising strategy to improve diet, the prospective impact of food pricing on diet has not been systematically quantified. Objective: To quantify the prospective effect of changes in food prices on dietary consumption. Design: We systematically searched online databases for interventional or prospective observational studies of price change and diet; we also searched for studies evaluating adiposity as a secondary outcome. Studies were excluded if price dat...

A scheme for evaluating a local queue warning system.

NARCIS (Netherlands)

Botma, H. & Oei, H.-L.

2018-01-01

This article outlines a method of evaluating a 'local queue warning system', in principle intended only to warn drivers of unexpected congestion at known discontinuities of the road geomctry (bottleneck) and give them advisory speed indications. A prerequisite for installing this system is therefore

Evaluation of hybrid power system alternatives: a case study

International Nuclear Information System (INIS)

Rosenthal, Andrew L.

1999-01-01

Pursuant to executive and statutory policies, the National Park Service (NPS) has been evaluating the use of photovoltaic (PV) hybrid power systems, for many of its remote, off-grid areas. This paper reports the results of a detailed technical and economic evaluation for one such area: the Needles District of Canyonlands National Park. The study evaluates the presented power systems and five alternative power generation configurations, four of which utilise PV. Projections are provided for the generator run-time and fuel use associated with each configuration as well as all initial and future costs. Included in the study are specific recommendations for energy efficiency improvements at the site. Results show that the generation systems presently in use, two full-time diesel generators, has the lowest conventional 20-year life cycle costs (LCC) of the six systems evaluated. However, when emissions costs are included (per NPS guidelines), several of the PV hybrid alternatives attain a lower LCC than the diesel-only systems. General discussion of the effects of initial versus future costs of PV hybrids as they compare with engine generator system is presented. (Author)

Prospects and challenges for the FPSO

International Nuclear Information System (INIS)

Henery, D.; Inglis, R.B.

1995-01-01

The reasons for the recent growth of interest in the use of the Floating Production Storage and Off-loading (FPSO) system in oil field developments are examined. An evaluation of oil field characteristics that influence concept selection is made which shows that the FPSO is a very flexible solution in a wide range of situations. Costs and cost drivers are discussed and some measures of cost effectiveness are proposed to serve as benchmarks for the future. Some technology development challenges are identified. The findings give a high level view of the techno-economic prospects for the FPSO in field developments over the next decade

A taxonomy of prospection: introducing an organizational framework for future-oriented cognition.

Science.gov (United States)

Szpunar, Karl K; Spreng, R Nathan; Schacter, Daniel L

2014-12-30

Prospection--the ability to represent what might happen in the future--is a broad concept that has been used to characterize a wide variety of future-oriented cognitions, including affective forecasting, prospective memory, temporal discounting, episodic simulation, and autobiographical planning. In this article, we propose a taxonomy of prospection to initiate the important and necessary process of teasing apart the various forms of future thinking that constitute the landscape of prospective cognition. The organizational framework that we propose delineates episodic and semantic forms of four modes of future thinking: simulation, prediction, intention, and planning. We show how this framework can be used to draw attention to the ways in which various modes of future thinking interact with one another, generate new questions about prospective cognition, and illuminate our understanding of disorders of future thinking. We conclude by considering basic cognitive processes that give rise to prospective cognitions, cognitive operations and emotional/motivational states relevant to future-oriented cognition, and the possible role of procedural or motor systems in future-oriented behavior.

Ease of adoption of clinical natural language processing software: An evaluation of five systems.

Science.gov (United States)

Zheng, Kai; Vydiswaran, V G Vinod; Liu, Yang; Wang, Yue; Stubbs, Amber; Uzuner, Özlem; Gururaj, Anupama E; Bayer, Samuel; Aberdeen, John; Rumshisky, Anna; Pakhomov, Serguei; Liu, Hongfang; Xu, Hua

2015-12-01

considerable struggles. The results of the Track 3 evaluation show that the adoptability of the five participating clinical NLP systems has a great margin for improvement. Remedy strategies suggested by the evaluators included (1) more detailed and operation system specific use instructions; (2) provision of more pertinent onscreen feedback for easier diagnosis of problems; (3) including screen walk-throughs in use instructions so users know what to expect and what might have gone wrong; (4) avoiding jargon and acronyms in materials intended for end users; and (5) packaging prerequisites required within software distributions so that prospective adopters of the software do not have to obtain each of the third-party components on their own. Copyright © 2015 Elsevier Inc. All rights reserved.

Multifunctional systems in vehicles:a usability evaluation

OpenAIRE

Rydström, Annie; Bengtsson, Peter; Grane, Camilla; Broström, Robert; Agardh, Johannes; Nilsson, Jennie

2005-01-01

Car Human-Machine Interaction (HMI) is becoming increasingly complex as the extension of functionality necessitates new interface concepts. Various multifunctional systems operated by haptic rotary switches, touch screen, and voice control have been developed. A usability study of multifunctional systems available on the market was carried out to evaluate and compare different manual interaction principles. The systems used in the study were the BMW iDrive and the Audi MMI, both operated by a...

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

Science.gov (United States)

2010-10-01

... inpatient operating costs and capital-related costs for each discharge only following submission of a..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL... education program, blood clotting factors, anesthesia services furnished by hospital-employed nonphysician...

A future of living machines?: International trends and prospects in biomimetic and biohybrid systems

Science.gov (United States)

Prescott, Tony J.; Lepora, Nathan; Vershure, Paul F. M. J.

2014-03-01

Research in the fields of biomimetic and biohybrid systems is developing at an accelerating rate. Biomimetics can be understood as the development of new technologies using principles abstracted from the study of biological systems, however, biomimetics can also be viewed from an alternate perspective as an important methodology for improving our understanding of the world we live in and of ourselves as biological organisms. A biohybrid entity comprises at least one artificial (engineered) component combined with a biological one. With technologies such as microscale mobile computing, prosthetics and implants, humankind is moving towards a more biohybrid future in which biomimetics helps us to engineer biocompatible technologies. This paper reviews recent progress in the development of biomimetic and biohybrid systems focusing particularly on technologies that emulate living organisms—living machines. Based on our recent bibliographic analysis [1] we examine how biomimetics is already creating life-like robots and identify some key unresolved challenges that constitute bottlenecks for the field. Drawing on our recent research in biomimetic mammalian robots, including humanoids, we review the future prospects for such machines and consider some of their likely impacts on society, including the existential risk of creating artifacts with significant autonomy that could come to match or exceed humankind in intelligence. We conclude that living machines are more likely to be a benefit than a threat but that we should also ensure that progress in biomimetics and biohybrid systems is made with broad societal consent.

Prospects of a Unified Management System

DEFF Research Database (Denmark)

Jørgensen, Tine Herreborg; Simonsen, Gorm

2002-01-01

In this article, the trend among management systems towards a common structure and the inclusion of additional areas of corporate concern (quality, environment, occupational health and safety and social responsibility) is outlined. The article suggests that a large part of the work associated...... with implementing and maintaining standardised management systems can be rationalised by developing a ?unified system?. The unified system is proposed to consist of a common basic standard of general managerial methodology expandable with supplements, which are related to the specific areas of concern...

Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: a prospective study

NARCIS (Netherlands)

Surawicz, C. M.; Elmer, G. W.; Speelman, P.; McFarland, L. V.; Chinn, J.; van Belle, G.

1989-01-01

Saccharomyces boulardii, a nonpathogenic yeast, has been widely used in Europe to prevent antibiotic-associated diarrhea (AAD). We performed a prospective double-blind controlled study to investigate AAD in hospitalized patients and to evaluate the effect of S. boulardii, a living yeast, given in

Making Sense of Alternative Assessment in a Qualitative Evaluation System

Science.gov (United States)

Rojas Serrano, Javier

2017-01-01

In a Colombian private English institution, a qualitative evaluation system has been incorporated. This type of evaluation poses challenges to students who have never been evaluated through a system that eliminates exams or quizzes and, as a consequence, these students have to start making sense of it. This study explores the way students face the…

Evaluation of a blood conservation strategy in the intensive care unit: a prospective, randomised study.

LENUS (Irish Health Repository)

Mahdy, Saad

2012-02-01

OBJECTIVE AND METHODS: Anemia is a common problem in the ICU population. Most patients are anemic at admission, their hemoglobin concentrations declining further thereafter. The aim of the present study was to evaluate the effect of a combination strategy, involving closed arterial blood gas sampling and the use of pediatric vials for phlebotomy (Group A), on the sampling-induced blood loss and the rate of decline in hemoglobin in adult ICU patients. Combination (Group A) was compared to the current standard technique of arterial line sampling and adult vial phlebotomy (Group B) in a prospective, randomised, ethically-approved trial for the first 72 hours of their ICU stay. Peri-operative, oncology, coagulopathic and uremic patients were excluded. All other ICU patients with arterial cannulae and predicted to stay beyond 3 days, were enrolled. RESULTS: 39 patients entered the study, 20 in Group A, and 19 in Group B. Data collection was complete for all. There was a statistically significant difference in sampling-induced blood loss between the groups over the first 72 hours of treatment (mean +\\/- standard deviation: 15.16 +\\/- 5.3 ml Group A vs 45.11 +\\/- 14 ml Group B, p<0.001). There was a smaller decline in mean hemoglobin level, which was not statistically significant (0.79 +\\/- 0.6 g\\/dL vs 1.30 +\\/- 1.13, p = 0.09). CONCLUSIONS: Overall, this strategy reduced measurable blood losses from phlebotomy. In larger trials it might also preserve hemoglobin levels.

Prospective Evaluation of Severe Skin Toxicity and Pain During Postmastectomy Radiation Therapy

NARCIS (Netherlands)

Pignol, Jean-Philippe; Thi Trinh Thuc Vu, [Unknown; Mitera, Gunita; Bosnic, Sandy; Verkooijen, Helena M.; Truong, Pauline

2015-01-01

Purpose: To prospectively capture acute toxicities and pain associated with postmastectomy radiation therapy (PMRT), to analyze patient and treatment risk factors for severe side effects. Methods and Materials: Women referred for PMRT were prospectively enrolled and assessed weekly during and after

Physical security system effectiveness evaluation, a status report

International Nuclear Information System (INIS)

Todd, J.L. Jr.; Nickell, W.C.

1975-07-01

A method to permit objective comparisons of physical security is under development and is expected to be useful in the optimization of system design and in cost benefit analysis. The procedure involves identifying the possible or potential characteristics of a postulated adversary, the countermeasures to deny or diminish adversary success, and the response capabilities of the defender. These, in conjunction with system definition information, are evaluated by the use of analytical models which provide a means of ranking systems against threats. This paper describes the status of this effort and includes an overview of the methodology with a brief description of various models being considered for use in effectiveness evaluation. (U.S.)

A Prospective, Randomized, Double-blind Clinical Trial of One Nano ...

African Journals Online (AJOL)

2015-12-16

Dec 16, 2015 ... prospective randomized clinical trial that evaluated the clinical performance of one high‑viscosity bulk‑fill composite resin in Class II cavities of posterior teeth. .... amount of glass ionomer needed was used to cover the calcium ...

Evaluation of EIT system performance.

Science.gov (United States)

Yasin, Mamatjan; Böhm, Stephan; Gaggero, Pascal O; Adler, Andy

2011-07-01

An electrical impedance tomography (EIT) system images internal conductivity from surface electrical stimulation and measurement. Such systems necessarily comprise multiple design choices from cables and hardware design to calibration and image reconstruction. In order to compare EIT systems and study the consequences of changes in system performance, this paper describes a systematic approach to evaluate the performance of the EIT systems. The system to be tested is connected to a saline phantom in which calibrated contrasting test objects are systematically positioned using a position controller. A set of evaluation parameters are proposed which characterize (i) data and image noise, (ii) data accuracy, (iii) detectability of single contrasts and distinguishability of multiple contrasts, and (iv) accuracy of reconstructed image (amplitude, resolution, position and ringing). Using this approach, we evaluate three different EIT systems and illustrate the use of these tools to evaluate and compare performance. In order to facilitate the use of this approach, all details of the phantom, test objects and position controller design are made publicly available including the source code of the evaluation and reporting software.

Astronautics summary and prospects

CERN Document Server

Kiselev, Anatoly Ivanovich; Menshikov, Valery Alexandrovich

2003-01-01

The monograph by A.I.Kiselev, A.A. Medvedev and Y.A.Menshikov, Astronautics: Summary and Prospects, aroused enthusiasm both among experts and the public at large. This is due to the felicitous choice of presentation that combines a simple description of complex space matters with scientificsubstantiation of the sub­ jectmatter described. The wealth of color photos makes the book still more attractive, and it was nominated for an award at the 14th International Moscow Book Fair, being singled out as the "best publication of the book fair". The book's popularity led to a second edition, substantially revised and enlarged. Since the first edition did not sufficiently cover the issues of space impact on ecology and the prospective development of space systems, the authors revised the entire volume, including in it the chapter "Space activity and ecology" and the section "Multi-function space systems". Using the federal monitoring system, now in the phase of system engi­ neering, as an example, the authors consi...

Ultrasonic root-end preparation in apical surgery : a prospective randomized study

NARCIS (Netherlands)

de Lange, Jan; Putters, Thomas; Baas, Erik M.; van Ingen, Johan M.

2007-01-01

Objective. The purpose of this study was to evaluate the potential benefit of an ultrasonic device in apical surgery on the outcome of treatment. Study design. A randomized prospective design was used in a standardized treatment protocol. Patients were allocated to treatment with an ultrasonic

Evaluation of coronal shift as an indicator of neuroaxial abnormalities in adolescent idiopathic scoliosis: a prospective study.

Science.gov (United States)

Karami, Mohsen; Sagheb, Soodeh; Mazda, Keyvan

2014-01-01

In previous studies, many indicator factors have been proposed to select patients who need an MRI screening of the spinal canal. In current study, the clinical and radiologic factors including coronal parameters of the curve were evaluated to find out which indicator is more important. A prospective study included 143 consecutive patients with the diagnosis of adolescent idiopathic scoliosis who were treated between 2010 and 2013 at our spinal clinics. Only patients with normal or subtle neurologic findings were included. All patients were evaluated by a total spine MRI protocol for examination of neuroaxial abnormalities. Known indicators and also coronal shift were analysed in all patients with or without abnormal MRI. The incidence of neuroaxial abnormalities was 11.9% (17 of 143); only 5 patients (3.5%) were operated to treat their neuroaxial problem. The significant indicators of the abnormalities in our patients were: younger age at onset, asymmetric superficial abdominal reflex and, coronal shift more than 15 mm (P = 0.03). Some previously known indicators like atypical curves, male gender, double curves and absence of thoracic lordosis were not different between two groups of the patients. A total spine MRI is recommended at presentation in patients with younger age, abnormal neurologic findings and severe coronal shift.

The evaluator as technical assistant: A model for systemic reform support

Science.gov (United States)

Century, Jeanne Rose

This study explored evaluation of systemic reform. Specifically, it focused on the evaluation of a systemic effort to improve K-8 science, mathematics and technology education. The evaluation was of particular interest because it used both technical assistance and evaluation strategies. Through studying the combination of these roles, this investigation set out to increase understanding of potentially new evaluator roles, distinguish important characteristics of the evaluator/project participant relationship, and identify how these roles and characteristics contribute to effective evaluation of systemic science education reform. This qualitative study used interview, document analysis, and participant observation as methods of data collection. Interviews were conducted with project leaders, project participants, and evaluators and focused on the evaluation strategies and process, the use of the evaluation, and technical assistance. Documents analyzed included transcripts of evaluation team meetings and reports, memoranda and other print materials generated by the project leaders and the evaluators. Data analysis consisted of analytic and interpretive procedures consistent with the qualitative data collected and entailed a combined process of coding transcripts of interviews and meetings, field notes, and other documents; analyzing and organizing findings; writing of reflective and analytic memos; and designing and diagramming conceptual relationships. The data analysis resulted in the development of the Multi-Function Model for Systemic Reform Support. This model organizes systemic reform support into three functions: evaluation, technical assistance, and a third, named here as "systemic perspective." These functions work together to support the project's educational goals as well as a larger goal--building capacity in project participants. This model can now serve as an informed starting point or "blueprint" for strategically supporting systemic reform.

A Fuzzy Rule-Based Expert System for Evaluating Intellectual Capital

Directory of Open Access Journals (Sweden)

Mohammad Hossein Fazel Zarandi

2012-01-01

Full Text Available A fuzzy rule-based expert system is developed for evaluating intellectual capital. A fuzzy linguistic approach assists managers to understand and evaluate the level of each intellectual capital item. The proposed fuzzy rule-based expert system applies fuzzy linguistic variables to express the level of qualitative evaluation and criteria of experts. Feasibility of the proposed model is demonstrated by the result of intellectual capital performance evaluation for a sample company.

Retinal micropseudocysts in diabetic retinopathy: prospective functional and anatomic evaluation.

Science.gov (United States)

Forte, Raimondo; Cennamo, Gilda; Finelli, Maria Luisa; Bonavolontà, Paola; Greco, Giovanni Maria; de Crecchio, Giuseppe

2012-01-01

To evaluate the prevalence, progression and functional predictive value of retinal micropseudocysts (MPCs) in diabetic patients. Prospective controlled observational study. From among all the type 2 diabetic patients evaluated during a period of 5 months between September 2009 and January 2010, we enrolled all patients with retinal MPCs at spectral-domain scanning laser ophthalmoscope/optical coherence tomography (SD-SLO/OCT) not previously treated for diabetic retinopathy. Forty diabetic patients without MPCs served as the control group. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), macular sensitivity and stability of fixation at SD-SLO/OCT microperimetry were measured monthly for 12 months. 22/156 patients with type 2 diabetes (14.1%, 32 eyes) met the inclusion criteria. The 95% confidence interval for the prevalence estimate of MPCs was 12.3-16.6%. Mean BCVA, CRT and central retinal sensitivity at baseline were 77.53 ± 2.2 Early Treatment Diabetic Retinopathy Study letters, 242.31 ± 31.0 µm and 15.95 ± 0.61 dB, respectively. Fixation was stable in all cases. Compared to the control group, eyes with MPCs had similar BCVA but greater CRT (p = 0.01) and reduced macular sensitivity (p = 0.001) at baseline and at each follow-up visit. Over time, CRT remained stable in eyes with MPCs, whereas macular sensitivity progressively decreased. MPCs in diabetic retinopathy are associated, temporally or causally, with a progressive reduction of macular sensitivity despite a stable BCVA, CRT and fixation. Copyright © 2011 S. Karger AG, Basel.

Gravity versus manual external rotation stress view in evaluating ankle stability: a prospective study.

Science.gov (United States)

LeBa, Thu-Ba; Gugala, Zbigniew; Morris, Randal P; Panchbhavi, Vinod K

2015-06-01

The purpose of this prospective study was to determine whether gravity versus manual external rotation stress testing effectively detects widening of the medial clear space in isolated ankle fractures when compared with the uninjured contralateral side. Manual external rotation stress and gravity stress tests were performed on injured and uninjured ankles of ankle fracture patients in a clinic setting. Medial clear space measurements were recorded and differences between gravity and manual stress views were determined. Twenty consecutive patients with ankle injury were enrolled in the study. When compared with the uninjured side, gravity stress views showed a statistically significant (P = .017) increase in medial clear space widening (1.85 ± 1.07 mm) compared with manual stress view widening (1.35 ± 1.04 mm). This study suggests that gravity stress views are as effective as manual external rotation stress views in detecting medial clear space widening in isolated fibular fractures. Diagnostic, Level II: Prospective, comparative trial. © 2014 The Author(s).

Prospective Safety Analysis and the Complex Aviation System

Science.gov (United States)

Smith, Brian E.

2013-01-01

Fatal accident rates in commercial passenger aviation are at historic lows yet have plateaued and are not showing evidence of further safety advances. Modern aircraft accidents reflect both historic causal factors and new unexpected "Black Swan" events. The ever-increasing complexity of the aviation system, along with its associated technology and organizational relationships, provides fertile ground for fresh problems. It is important to take a proactive approach to aviation safety by working to identify novel causation mechanisms for future aviation accidents before they happen. Progress has been made in using of historic data to identify the telltale signals preceding aviation accidents and incidents, using the large repositories of discrete and continuous data on aircraft and air traffic control performance and information reported by front-line personnel. Nevertheless, the aviation community is increasingly embracing predictive approaches to aviation safety. The "prospective workshop" early assessment tool described in this paper represents an approach toward this prospective mindset-one that attempts to identify the future vectors of aviation and asks the question: "What haven't we considered in our current safety assessments?" New causation mechanisms threatening aviation safety will arise in the future because new (or revised) systems and procedures will have to be used under future contextual conditions that have not been properly anticipated. Many simulation models exist for demonstrating the safety cases of new operational concepts and technologies. However the results from such models can only be as valid as the accuracy and completeness of assumptions made about the future context in which the new operational concepts and/or technologies will be immersed. Of course that future has not happened yet. What is needed is a reasonably high-confidence description of the future operational context, capturing critical contextual characteristics that modulate

A clinical decision support system algorithm for intravenous to oral antibiotic switch therapy: validity, clinical relevance and usefulness in a three-step evaluation study.

Science.gov (United States)

Akhloufi, H; Hulscher, M; van der Hoeven, C P; Prins, J M; van der Sijs, H; Melles, D C; Verbon, A

2018-04-26

To evaluate a clinical decision support system (CDSS) based on consensus-based intravenous to oral switch criteria, which identifies intravenous to oral switch candidates. A three-step evaluation study of a stand-alone CDSS with electronic health record interoperability was performed at the Erasmus University Medical Centre in the Netherlands. During the first step, we performed a technical validation. During the second step, we determined the sensitivity, specificity, negative predictive value and positive predictive value in a retrospective cohort of all hospitalized adult patients starting at least one therapeutic antibacterial drug between 1 and 16 May 2013. ICU, paediatric and psychiatric wards were excluded. During the last step the clinical relevance and usefulness was prospectively assessed by reports to infectious disease specialists. An alert was considered clinically relevant if antibiotics could be discontinued or switched to oral therapy at the time of the alert. During the first step, one technical error was found. The second step yielded a positive predictive value of 76.6% and a negative predictive value of 99.1%. The third step showed that alerts were clinically relevant in 53.5% of patients. For 43.4% it had already been decided to discontinue or switch the intravenous antibiotics by the treating physician. In 10.1%, the alert resulted in advice to change antibiotic policy and was considered useful. This prospective cohort study shows that the alerts were clinically relevant in >50% (n = 449) and useful in 10% (n = 85). The CDSS needs to be evaluated in hospitals with varying activity of infectious disease consultancy services as this probably influences usefulness.

Preliminary study of Songa-Wayaua geothermal prospect area using volcanostratigraphy and remote sensing analysis

Science.gov (United States)

Asokawaty, Ribka; Nugroho, Indra; Satriana, Joshua; Hafidz, Muhamad; Suryantini

2017-12-01

Songa-Wayaua geothermal prospect area is located on Bacan Island, Northern Molluca Province. Geothermal systems in this area associated with three Quartenary volcanoes, such as Mt. Pele-pele, Mt. Lansa, and Mt. Bibinoi. Based on literature study, five surface manifestations such as hot springs and alteration occurred within this area. The active manifestations indicate that Songa-Wayaua area has potential geothermal resource. This study objective is to evaluate Songa-Wayaua geothermal system on preliminary study stage by using volcanostratigraphy and remote sensing analysis to delineate the boundary of geothermal system area. The result of this study showed that Songa-Wayaua prospect area has four heat sources potential (e.g. Pele-pele Hummock, Lansa Hummock, Songa Hummock, and Bibinoi Hummock), controlled by geological structure presented by Pele-pele Normal Fault, and had three places as the recharge and discharge area which are very fulfilling as a geothermal system.

Multicenter Prospective Clinical Series Evaluating Radiofrequency Ablation in the Treatment of Painful Spine Metastases

International Nuclear Information System (INIS)

Bagla, Sandeep; Sayed, Dawood; Smirniotopoulos, John; Brower, Jayson; Neal Rutledge, J.; Dick, Bradley; Carlisle, James; Lekht, Ilya; Georgy, Bassem

2016-01-01

BackgroundRadiofrequency ablation (RFA) of vertebral body metastases (VBM) has been reported as safe and effective in retrospective studies. This single-arm prospective multicenter clinical study evaluates RFA in the treatment of painful VBM.MethodsFifty patients with VBM were prospectively enrolled during a 13-month period at eight US centers under an IRB-approved study. Percutaneous RFA was performed under imaging guidance with cement augmentation at the discretion of the operator. Pain, disability and quality of life were evaluated at baseline, prior to discharge, days 3, 7, 30 and 90 using the Numerical Pain Rating Scale, Oswestry Disability Index (ODI), the Functional Assessment of Cancer Therapy-General 7 (FACT-G7) and Functional Assessment of Cancer Therapy Quality-of-Life Measurement in Patients with Bone Pain (FACT-BP). Adverse events were monitored throughout this time interval.ResultsTwenty-six male and 24 female patients (mean age 61.0) underwent 69 treatments (30 thoracic and 39 lumbar). Cement augmentation was performed in 96 % of reported levels. Significant improvement in mean scores for pain, disability and cancer-specific health-related quality of life from baseline to all time intervals was seen. NRPS improved from 5.9 to 2.1 (p < 0.0001). ODI improved from 52.9 to 37.0 (p < 0.08). FACT-G7 improved form 10.9 to 16.2 (p = 0.0001). FACT-BP improved from 22.6 to 38.9 (p < 0.001). No complications related to the procedure were reported.ConclusionRFA with cement augmentation safely and effectively reduces pain and disability rapidly, while increasing quality of life in patients suffering from vertebral body metastases.

Multicenter Prospective Clinical Series Evaluating Radiofrequency Ablation in the Treatment of Painful Spine Metastases.

Science.gov (United States)

Bagla, Sandeep; Sayed, Dawood; Smirniotopoulos, John; Brower, Jayson; Neal Rutledge, J; Dick, Bradley; Carlisle, James; Lekht, Ilya; Georgy, Bassem

2016-09-01

Radiofrequency ablation (RFA) of vertebral body metastases (VBM) has been reported as safe and effective in retrospective studies. This single-arm prospective multicenter clinical study evaluates RFA in the treatment of painful VBM. Fifty patients with VBM were prospectively enrolled during a 13-month period at eight US centers under an IRB-approved study. Percutaneous RFA was performed under imaging guidance with cement augmentation at the discretion of the operator. Pain, disability and quality of life were evaluated at baseline, prior to discharge, days 3, 7, 30 and 90 using the Numerical Pain Rating Scale, Oswestry Disability Index (ODI), the Functional Assessment of Cancer Therapy-General 7 (FACT-G7) and Functional Assessment of Cancer Therapy Quality-of-Life Measurement in Patients with Bone Pain (FACT-BP). Adverse events were monitored throughout this time interval. Twenty-six male and 24 female patients (mean age 61.0) underwent 69 treatments (30 thoracic and 39 lumbar). Cement augmentation was performed in 96 % of reported levels. Significant improvement in mean scores for pain, disability and cancer-specific health-related quality of life from baseline to all time intervals was seen. NRPS improved from 5.9 to 2.1 (p < 0.0001). ODI improved from 52.9 to 37.0 (p < 0.08). FACT-G7 improved form 10.9 to 16.2 (p = 0.0001). FACT-BP improved from 22.6 to 38.9 (p < 0.001). No complications related to the procedure were reported. RFA with cement augmentation safely and effectively reduces pain and disability rapidly, while increasing quality of life in patients suffering from vertebral body metastases.

Multicenter Prospective Clinical Series Evaluating Radiofrequency Ablation in the Treatment of Painful Spine Metastases

Energy Technology Data Exchange (ETDEWEB)

Bagla, Sandeep, E-mail: sandeep.bagla@gmail.com [Vascular Institute of Virginia, LLC (United States); Sayed, Dawood [University of Kansas Medical Center (United States); Smirniotopoulos, John [New York Presbyterian Hospital/Weill Cornell Medical Center (United States); Brower, Jayson [Providence Sacred Heart Medical Center and Children’s Hospital (United States); Neal Rutledge, J. [Seton Medical Center (United States); Dick, Bradley [Suburban Hospital (United States); Carlisle, James [St. Mark’s Hospital (United States); Lekht, Ilya [University of Southern California (United States); Georgy, Bassem [San Diego Imaging (United States)

2016-09-15

BackgroundRadiofrequency ablation (RFA) of vertebral body metastases (VBM) has been reported as safe and effective in retrospective studies. This single-arm prospective multicenter clinical study evaluates RFA in the treatment of painful VBM.MethodsFifty patients with VBM were prospectively enrolled during a 13-month period at eight US centers under an IRB-approved study. Percutaneous RFA was performed under imaging guidance with cement augmentation at the discretion of the operator. Pain, disability and quality of life were evaluated at baseline, prior to discharge, days 3, 7, 30 and 90 using the Numerical Pain Rating Scale, Oswestry Disability Index (ODI), the Functional Assessment of Cancer Therapy-General 7 (FACT-G7) and Functional Assessment of Cancer Therapy Quality-of-Life Measurement in Patients with Bone Pain (FACT-BP). Adverse events were monitored throughout this time interval.ResultsTwenty-six male and 24 female patients (mean age 61.0) underwent 69 treatments (30 thoracic and 39 lumbar). Cement augmentation was performed in 96 % of reported levels. Significant improvement in mean scores for pain, disability and cancer-specific health-related quality of life from baseline to all time intervals was seen. NRPS improved from 5.9 to 2.1 (p < 0.0001). ODI improved from 52.9 to 37.0 (p < 0.08). FACT-G7 improved form 10.9 to 16.2 (p = 0.0001). FACT-BP improved from 22.6 to 38.9 (p < 0.001). No complications related to the procedure were reported.ConclusionRFA with cement augmentation safely and effectively reduces pain and disability rapidly, while increasing quality of life in patients suffering from vertebral body metastases.

Evaluation of hydroacid complex in the forward osmosis–membrane distillation (FO–MD) system for desalination

KAUST Repository

Wang, Peng; Cui, Yue; Ge, Qingchun; Fern Tew, Tjin; Chung, Neal Tai-Shung

2015-01-01

The incorporation of membrane distillation (MD) into forward osmosis (FO) provides process sustainability to regenerate the draw solution and to produce clean water simultaneously. However, the reverse salt flux is the major hurdle in the FO-MD system because it not only reduces the effective osmotic driving force across the membrane but also increases the replenishment cost and scaling issue. For the first time, a hydroacid complex with abundant hydrophilic groups and ionic species is evaluated as the draw solutes in the hybrid FO-MD system consisting of multi-bore PVDF MD membranes for seawater/brackish desalination. In order to evaluate the practicality of the hydroacid complex in the FO-MD system, FO and MD experiments were conducted at elevated temperatures and concentrations. The hydroacid complex has displayed desired properties such as high solubility, low viscosity, excellent thermal stability and minimal reverse salt flux suitable for FO and MD operations. FO-MD desalination process was demonstrated with a highest seawater desalination flux of 6/32 LMH (FO/MD). This study may open up the prospective of employing the hydroacid complex as the draw solute in FO-MD hybrid systems for seawater /brackish desalination. © 2015 Elsevier B.V.

Evaluation of hydroacid complex in the forward osmosis–membrane distillation (FO–MD) system for desalination

KAUST Repository

Wang, Peng

2015-11-01

The incorporation of membrane distillation (MD) into forward osmosis (FO) provides process sustainability to regenerate the draw solution and to produce clean water simultaneously. However, the reverse salt flux is the major hurdle in the FO-MD system because it not only reduces the effective osmotic driving force across the membrane but also increases the replenishment cost and scaling issue. For the first time, a hydroacid complex with abundant hydrophilic groups and ionic species is evaluated as the draw solutes in the hybrid FO-MD system consisting of multi-bore PVDF MD membranes for seawater/brackish desalination. In order to evaluate the practicality of the hydroacid complex in the FO-MD system, FO and MD experiments were conducted at elevated temperatures and concentrations. The hydroacid complex has displayed desired properties such as high solubility, low viscosity, excellent thermal stability and minimal reverse salt flux suitable for FO and MD operations. FO-MD desalination process was demonstrated with a highest seawater desalination flux of 6/32 LMH (FO/MD). This study may open up the prospective of employing the hydroacid complex as the draw solute in FO-MD hybrid systems for seawater /brackish desalination. © 2015 Elsevier B.V.

Iranian New Junior High School Book (Prospect 1 Weighted against Material Evaluation Checklist from Teachers' Perspective

Directory of Open Access Journals (Sweden)

Touran Ahour

2013-11-01

Full Text Available The aim of this study was to evaluate the new version of Iranian EFL junior high school textbook (Prospect1 from the teachers’ perspectives. The participants included90experienced English teachers (42 females and 48 males randomly selected from different junior high schools in different districts of Gilan province, Iran. The evaluation of the textbook was conducted quantitatively through a 5-point Likert scale with seven criteria including subject and content, activities, skills, physical layout, practical consideration, language and general criteria. However, it was accompanied by some open-ended questions that solicited teachers' views about each criterion and the book in general. The descriptive statistics including standard deviation, mean, percentage and frequency were used in the data analysis.The findings revealed that teachers have positive perceptions toward this book.They had a positive view about the prospect1 because of its content and topic relevancy to learners' needs, including real life situations, enjoying challenging subject, having communicative pair and group works and attending to four skills equally. However, they intensified some problems in their open ended questions such as insufficiency of teaching time that is 1.5 hour during a week, not focusing on explicit presentation of some words and grammatical points and not paying attention to some sub-skill strategies. These findings can be helpful for curriculum designers and textbook writers to design some valuable textbooks for other levels and to consider correspondence between time of teaching and volume of the book.

Intraoperative evaluation of renal blood flow during laparoscopic partial nephrectomy with a novel Doppler system.

Science.gov (United States)

Mues, Adam C; Okhunov, Zhamshid; Badani, Ketan; Gupta, Mantu; Landman, Jaime

2010-12-01

Hemostasis remains a major challenge associated with laparoscopic renal surgery. We evaluated a cost-effective novel Doppler probe (DP) for assessment of vascular control during laparoscopic partial nephrectomy (LPN). We prospectively collected data during LPN procedures. We documented tumor location and size as well as subjective quality of the hilar dissection. The DP was compared with our standard intraoperative ultrasound system (SUS) for the ability to detect blood flow during hilar dissection and to determine parenchymal ischemia around the tumor after clamping of the renal vessels. Twenty patients underwent LPN by a single surgeon. The mean tumor size was 3.0 cm (range: 1.2-6.3 cm). The times to assess the kidney using the SUS and DP were 68.6 seconds (range: 20-155) and 44.5 seconds (range: 15-180), respectively. Evaluation prior to renal hilar clamping demonstrated the presence of blood flow in all 20 patients (100%) using the SUS and in 17 of 20 (85%) using the DP. Similarly, cessation of blood flow with clamping was documented in 100% of cases with SUS and 85% with DP. Persistent flow was detected by both SUS and DP in two patients requiring further dissection and reclamping. Then, both systems detected the absence of flow before tumor resection. With blood flow interruption confirmation, no patient had significant bleeding at the time of renal parenchymal transection. Intraoperative Doppler ultrasound technologies minimize the risk of significant bleeding during LPN. The DP is a small, simple, effective probe that can be used to assess blood flow interruption to the kidney during laparoscopic renal surgery.

A miniature concentrating photovoltaic and thermal system

International Nuclear Information System (INIS)

Kribus, Abraham; Kaftori, Daniel; Mittelman, Gur; Hirshfeld, Amir; Flitsanov, Yuri; Dayan, Abraham

2006-01-01

A novel miniature concentrating PV (MCPV) system is presented and analyzed. The system is producing both electrical and thermal energy, which is supplied to a nearby consumer. In contrast to PV/thermal (PV/T) flat collectors, the heat from an MCPV collector is not limited to low-temperature applications. The work reported here refers to the evaluation and preliminary design of the MCPV approach. The heat transport system, the electric and thermal performance, the manufacturing cost, and the resulting cost of energy in case of domestic water heating have been analyzed. The results show that the new approach has promising prospects

A prospective evaluation of pancreatic exocrine function in patients with acute pancreatitis: correlation with extent of necrosis and pancreatic endocrine insufficiency.

Science.gov (United States)

Boreham, B; Ammori, B J

2003-01-01

The aim of this prospective study was to assess pancreatic exocrine function in patients recovering from a first attack of acute pancreatitis, and to evaluate its relationship to severity of attack, extent of pancreatic necrosis and severity of pancreatic endocrine insufficiency. Between December 2000 and November 2001, 23 patients were prospectively evaluated. Pancreatic exocrine function was measured by the faecal elastase-1 test and insufficiency was classified as moderately impaired or severely impaired. Pancreatic necrosis was determined by contrast-enhanced CT scan, and its extent was categorised according to Balthazar's classification. The severity of pancreatic endocrine insufficiency was categorised according to insulin dependence. Attacks were classified as mild (n = 16) or severe (n = 7) according to the Atlanta criteria. Pancreatic exocrine insufficiency was significantly more frequent in patients recovering from severe attacks than mild (n = 6, 86% vs. n = 2, 13%; p = 0.002), and in those who developed pancreatic necrosis or pseudocyst than those who did not (6 of 7 patients vs. 2 of 16 patients, and 5 of 5 patients vs. 3 of 18 patients respectively; p = 0.002). The development of exocrine insufficiency correlated strongly with the extent of pancreatic necrosis (r = -0.754, p pancreatic endocrine insufficiency (n = 4, r = -0.453, p = 0.03). Pancreatic exocrine insufficiency is a common occurrence in patients recovering from severe acute pancreatitis, and its severity correlates with the extent of pancreatic necrosis and the severity of concomitant pancreatic endocrine insufficiency. Copyright 2003 S. Karger AG, Basel and IAP

A prospective randomized evaluation of the prophylactic use of low-dose dopamine in cancer patients receiving interleukin-2.

Science.gov (United States)

Cormier, J N; Hurst, R; Vasselli, J; Lee, D; Kim, C J; McKee, M; Venzon, D; White, D; Marincola, F M; Rosenberg, S A

1997-07-01

The administration of high-dose interleukin-2 (IL-2) causes tumor regression in 17-25% of patients with metastatic melanoma or renal cell carcinoma. Renal dysfunction is a common dose-limiting toxicity of IL-2 administration, limiting 26% of treatment cycles. We have conducted a prospective randomized trial to evaluate whether the prophylactic administration of low-dose dopamine (2 mg/kg/min) can minimize renal toxicity and thus affect the amount of IL-2 administered. Forty-two patients were randomly assigned to receive systemic high-dose IL-2 with standard supportive measures (group A = 21 patients) or with the addition of prophylactic dopamine (group B = 21 patients) at 2 mg/kg/min. For patients in group B, dopamine was instituted 1 h before the initiation of IL-2 administration and was discontinued 6-12 h after the maximum number of doses of IL-2 were given. There was no difference in the amount of IL-2 administered for each course of therapy for groups A and B. Despite differences in urine flow (milliliters per kilogram per day), fluid balance (liters per day), and overall weight gain, prophylactic low-dose dopamine did not significantly alter maximum plasma urea or creatinine levels in group B when compared with the control group (group A). The overall toxicity profile considering all grade 3 and 4 toxicities for patients in groups A and B was comparable. Thus, there is no evidence to support the routine use of prophylactic low-dose dopamine in patients receiving high-dose IL-2.

A Wind Farm Electrical Systems Evaluation with EeFarm-II

NARCIS (Netherlands)

Pierik, J.; Axelsson, U.; Eriksson, E.; Salomonsson, D.; Bauer, P.; Czech, B.

2010-01-01

EeFarm-II is used to evaluate 13 different electrical systems for a 200 MW wind farm with a 100 km connection to shore. The evaluation is based on component manufacturer data of 2009. AC systems are compared to systems with DC connections inside the wind farm and DC connection to shore. Two options

The application of the Ten Group classification system (TGCS in caesarean delivery case mix adjustment. A multicenter prospective study.

Directory of Open Access Journals (Sweden)

Gianpaolo Maso

Full Text Available BACKGROUND: Caesarean delivery (CD rates are commonly used as an indicator of quality in obstetric care and risk adjustment evaluation is recommended to assess inter-institutional variations. The aim of this study was to evaluate whether the Ten Group classification system (TGCS can be used in case-mix adjustment. METHODS: Standardized data on 15,255 deliveries from 11 different regional centers were prospectively collected. Crude Risk Ratios of CDs were calculated for each center. Two multiple logistic regression models were herein considered by using: Model 1- maternal (age, Body Mass Index, obstetric variables (gestational age, fetal presentation, single or multiple, previous scar, parity, neonatal birth weight and presence of risk factors; Model 2- TGCS either with or without maternal characteristics and presence of risk factors. Receiver Operating Characteristic (ROC curves of the multivariate logistic regression analyses were used to assess the diagnostic accuracy of each model. The null hypothesis that Areas under ROC Curve (AUC were not different from each other was verified with a Chi Square test and post hoc pairwise comparisons by using a Bonferroni correction. RESULTS: Crude evaluation of CD rates showed all centers had significantly higher Risk Ratios than the referent. Both multiple logistic regression models reduced these variations. However the two methods ranked institutions differently: model 1 and model 2 (adjusted for TGCS identified respectively nine and eight centers with significantly higher CD rates than the referent with slightly different AUCs (0.8758 and 0.8929 respectively. In the adjusted model for TGCS and maternal characteristics/presence of risk factors, three centers had CD rates similar to the referent with the best AUC (0.9024. CONCLUSIONS: The TGCS might be considered as a reliable variable to adjust CD rates. The addition of maternal characteristics and risk factors to TGCS substantially increase the

Influence of Age on Clinical Performance of Mandibular Two-Implant Overdentures : A 10-Year Prospective Comparative Study

NARCIS (Netherlands)

Hoeksema, Arie R.; Visser, Anita; Raghoebar, Gerry M.; Vissink, Arjan; Meijer, Henny J. A.

Purpose: The aim of this prospective comparative study was to assess whether age has influence on peri-implant health in patients treated with mandibular two-implant overdentures during a 10-year evaluation period. Materials and Methods: A prospective study was carried out with two groups of

Quality of optometry referrals to neovascular age-related macular degeneration clinic: a prospective study

OpenAIRE

Muen, Wisam J; Hewick, Simon A

2011-01-01

Objectives To evaluate the quality of referrals to a neovascular age-related macular degeneration clinic from optometrists using the standard Rapid Access Referral Form (RARF) from the Royal College of Ophthalmologists. Design A prospective study. Prospective data were gathered from all optometry referrals using the RARF, between the periods of December 2006 to August 2009. These were assessed for accuracy of history, clinical signs and final diagnosis as compared to a macula expert. Setting ...

A Study on Pharmacokinetics of Bosentan with Systems Modeling, Part 2: Prospectively Predicting Systemic and Liver Exposure in Healthy Subjects.

Science.gov (United States)

Li, Rui; Kimoto, Emi; Niosi, Mark; Tess, David A; Lin, Jian; Tremaine, Larry M; Di, Li

2018-04-01

Predicting human pharmacokinetics of novel compounds is a critical step in drug discovery and clinical study design but continues to be a challenging task for hepatic transporter substrates, particularly in predicting their liver exposures. In this study, using bosentan as an example, we prospectively predicted systemic exposure and the (pseudo) steady-state unbound liver-to-unbound plasma ratio ( K p uu ) in healthy subjects using 1) a mechanistic approach solely based on in vitro hepatocyte assays and 2) an approach based on hepatic process rates from monkey in vivo data but Michaelis-Menten constants from in vitro data. Both methods reasonably match the observed human systemic time course data, but the second method leads to better prediction accuracy. In addition, the second method can predict a human K p uu value that is close to the value deduced using clinical data. We also generated rat and monkey liver K p uu values in terminal studies. However, these directly measured animal values are different from the deduced human value. Copyright © 2018 by The American Society for Pharmacology and Experimental Therapeutics.

Prospective Evaluation of Intra-Articular Dextrose Prolotherapy for Treatment of Osteoarthritis in Dogs.

Science.gov (United States)

Sherwood, J Matthew; Roush, James K; Armbrust, Laura J; Renberg, Walter C

The objective of this study was to evaluate intra-articular dextrose prolotherapy for osteoarthritis of the elbow or stifle in dogs in a randomized, double-blind, placebo-controlled, prospective pilot study. Seventeen dogs were evaluated with 10 meeting inclusion criteria for this study. Evaluations included orthopedic exam, visual lameness scoring, Canine Brief Pain Inventory (CBPI), goniometry, kinetic gait analysis, and radiography. Initial lameness score, age, body weight, duration of lameness, and CBPI scores did not differ between groups. Change in CBPI pain severity score in the prolotherapy group from wk 6-12 was significantly less improved than in the placebo group, with no other significant differences in pain severity or pain interference scores between groups. Range of motion and radiographic scores did not differ between groups at any time. Mean kinetic forces improved in prolotherapy dogs but were not significantly different between treatment groups at any time. Although easily performed and well-tolerated, there were no statistically significant benefits of dextrose prolotherapy for treatment of osteoarthritis of the elbow and stifle in dogs. Post hoc power analysis of these sample means and standard deviations found that 29-106 animals per group would be necessary to demonstrate significant differences in kinetic forces, providing useful guidance for future studies.

Prospective evaluation of laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation.

Science.gov (United States)

Rawlings, Clarence A; Mahaffey, Mary B; Bement, Shannon; Canalis, Chanda

2002-12-01

To determine long-term outcome associated with laparoscopic-assisted gastropexy in prevention of gastric dilatation-volvulus (GDV) in susceptible dogs and to evaluate use of laparoscopy to correct GDV. Prospective study. 25 client-owned large-breed dogs. 23 dogs susceptible to GDV were referred as candidates for elective gastropexy. These dogs had a history of treatment for gastric dilatation, clinical signs of gastric dilatation, or family members with gastric dilatation. Laparoscopic-assisted gastropexy was performed. One year after surgery, abdominal ultrasonography was performed to evaluate the attachment of the stomach to the abdominal wall. Two dogs with GDV were also treated with laparoscopic-assisted derotation of the stomach and gastropexy. None of the dogs developed GDV during the year after gastropexy, and all 20 dogs examined ultrasonographically had an intact attachment. Another dog was euthanatized at 11.5 months for unrelated problems. Two dogs with GDV successfully underwent laparoscopic-assisted gastropexy after the stomach was repositioned. Laparoscopic-assisted gastropexy resulted in a persisting attachment between the stomach and abdominal wall, an absence of GDV development, and few complications. Dogs with a high probability for development of GDV should be considered candidates for minimally invasive gastropexy. Carefully selected dogs with GDV can be treated laparoscopically.

A method of rapidly evaluating image quality of NED optical system

Science.gov (United States)

Sun, Qi; Qiu, Chuankai; Yang, Huan

2014-11-01

In recent years, with the development of technology of micro-display, advanced optics and the software and hardware, near-to-eye display ( NED) optical system will have a wide range of potential applications in the fields of amusement and virtual reality. However, research on the evaluating image quality of this kind optical system is comparatively lagging behind. Although now there are some methods and equipment for evaluation, they can't be applied in commercial production because of their complex operation and inaccuracy. In this paper, an academic method is proposed and a Rapid Evaluation System (RES) is designed to evaluate the image of optical system rapidly and exactly. Firstly, a set of parameters that eyes are sensitive to and also express the quality of system should be extracted and quantized to be criterion, so the evaluation standards can be established. Then, some parameters can be detected by RES consisted of micro-display, CCD camera and computer and so on. By process of scaling, the measuring results of the RES are exact and creditable, relationship between object measurement, subjective evaluation and the RES will be established. After that, image quality of optical system can be evaluated just by detecting parameters of that. The RES is simple and the results of evaluation are exact and keeping with human vision. So the method can be used not only for optimizing design of optical system, but also for evaluation in commercial production.

Prospective, randomized, blinded evaluation of donor semen quality provided by seven commercial sperm banks.

Science.gov (United States)

Carrell, Douglas T; Cartmill, Deborah; Jones, Kirtly P; Hatasaka, Harry H; Peterson, C Matthew

2002-07-01

To evaluate variability in donor semen quality between seven commercial donor sperm banks, within sperm banks, and between intracervical insemination and intrauterine insemination. Prospective, randomized, blind evaluation of commercially available donor semen samples. An academic andrology laboratory. Seventy-five cryopreserved donor semen samples were evaluated. Samples were coded, then blindly evaluated for semen quality. Standard semen quality parameters, including concentration, motility parameters, World Health Organization criteria morphology, and strict criteria morphology. Significant differences were observed between donor semen banks for most semen quality parameters analyzed in intracervical insemination samples. In general, the greatest variability observed between banks was in percentage progressive sperm motility (range, 8.8 +/- 5.8 to 42.4 +/- 5.5) and normal sperm morphology (strict criteria; range, 10.1 +/- 3.3 to 26.6 +/- 4.7). Coefficients of variation within sperm banks were generally high. These data demonstrate the variability of donor semen quality provided by commercial sperm banks, both between banks and within a given bank. No relationship was observed between the size or type of sperm bank and the degree of variability. The data demonstrate the lack of uniformity in the criteria used to screen potential semen donors and emphasize the need for more stringent screening criteria and strict quality control in processing samples.

Evaluating the impact of agricultural extension programmes in sub-Saharan Africa: Challenges and prospects

Directory of Open Access Journals (Sweden)

Hailemichael Taye

2013-09-01

Full Text Available Background: In sub-Saharan Africa (SSA, impact evaluation has been used to assess whether agricultural extension interventions have brought the intended result or to establish causal linkages between interventions and outcomes. However, there is some scepticism about the validity and reliability of the results of the impact evaluation reports due to some contradictory and exaggerated results. Objectives: This article analyses some impact evaluation studies conducted in SSA as to why contradictions and exaggerations are manifested in some reports and what would be the future prospects of impact evaluation of agricultural extension programmes in the region. Methods: Impact evaluation reports and results of agricultural extension programmes from 10 SSA countries were reviewed and analysed based on impact evaluation principles and theories. Results: The results show that most of the evaluations reported positive impacts. There are also conflicting reports on extension performance. The fact that the overwhelming majority of impact evaluation reports claim positive extension impacts is not in line with the reports on agricultural productivity growth in the region. There are various reasons for over estimated impacts and contradictory results, which include use of poor impact evaluation methodologies, lack of reliable data and insufficient capacity to conduct rigorous impact evaluations. Conclusion: Due to these challenges and the shift in agricultural research and extension approaches, it is recommended that rather than investing effort in trying to prove impact, greater attention should be given to improving impact as well as using other innovative monitoring and evaluation (M&E and learning tools that consider the dynamic nature of agricultural development.

Parenting styles and body mass index: a systematic review of prospective studies among children.