Clinical Performance Challenges in an Era of Accountability, and Performance-based Budgets: Part 1

2003 ◽  
Author(s):  
Theresa Cullen ◽  
Eric Bothwell ◽  
Linza Bethea ◽  
Stephen Mader ◽  
Ralph Ettinger
Keyword(s):  
Clinical Performance ◽  
And Performance ◽  
Performance Challenges

scholarly journals CERN Tape Archive — from development to production deployment

2019 ◽  
Vol 214 ◽  
pp. 04015
Author(s):  
Michael C. Davis ◽  
Vladímir Bahyl ◽  
Germán Cancio ◽  
Eric Cano ◽  
Julien Leduc ◽  
...  
Keyword(s):  
Storage System ◽  
File Transfer ◽  
Disk Storage ◽  
And Performance ◽  
And Migration ◽  
Performance Challenges ◽  
Archive Solution

The first production version of the CERN Tape Archive (CTA) software is planned to be released during 2019. CTA is designed to replace CASTOR as the CERN tape archive solution, to face the scalability and performance challenges arriving with LHC Run–3. In this paper, we describe the main commonalities and differences between CTA and CASTOR. We outline the functional enhancements and integration steps required to add the CTA tape back-end to an EOS disk storage system. We present and discuss the different deployment and migration scenarios for replacing the five CASTOR instances at CERN, including a description of how the File Transfer Service (FTS) will interface with EOS and CTA.

scholarly journals Quality improvement through public reporting: The surgeon scorecard – are we there yet?

2018 ◽  
Vol 7 (4) ◽  
pp. 27
Author(s):  
Afshin A. Anoushiravani ◽  
Zain Sayeed ◽  
Muhammad T. Padela ◽  
James E. Feng ◽  
Paul Barach ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Healthcare Providers ◽  
Healthcare Organizations ◽  
Surgical Performance ◽  
Elective Surgical Procedures ◽  
National Debate ◽  
Patient Advocates ◽  
And Performance ◽  
Knee And Hip Arthroplasty ◽  
The Impact

As national healthcare reform continues to place greater emphasis on providing high value care, measures designed to track clinical performance remain relatively overlooked. To that extent, several organizations have attempted to create objective grading systems to evaluate orthopaedic surgeon quality and performance. While attempting to address these issues, ProPublica’s Surgeon Scorecard has provoked national debate among patient advocates and healthcare providers. The methodology behind the Scorecard was developed at the Harvard School of Public Health with an aim to provide a more robust means of comparing surgical performance and outcomes for patients and healthcare organizations. Currently, the Scorecard assesses eight elective surgical procedures, including total knee and hip arthroplasty, through the use of the Medicare Claims Dataset. The impact of the Scorecard on orthopaedic practice has yet to be established. In this discussion, we analyze the Scorecard from the perspective of various stakeholders to identify its benefits and shortcomings, as well as offer direction for further improvement.

People and Performance: Challenges for the Future Public Service- the Report from the Wye River Conference

2000 ◽  
Vol 60 (1) ◽  
pp. 54-60 ◽  
Author(s):  
Patricia Wallace Ingraham ◽  
Sally Coleman Selden ◽  
Donald P. Moynihan
Keyword(s):  
Public Service ◽  
The Future ◽  
And Performance ◽  
Performance Challenges

scholarly journals ATL

2014 ◽  
Vol 24 (3) ◽  
pp. 576-585 ◽  
Author(s):  
Jose Jeronimo ◽  
Pooja Bansil ◽  
Jeanette Lim ◽  
Roger Peck ◽  
Proma Paul ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Screening Method ◽  
Intraepithelial Neoplasia ◽  
Severe Dysplasia ◽  
Papanicolaou Test ◽  
Dna Test ◽  
Hpv Dna ◽  
Resource Limited ◽  
Grade 3 ◽  
And Performance

ObjectiveThis study evaluates the feasibility and performance of careHPV, a novel human papillomavirus (HPV) DNA test, when used for screening women for cervical cancer in low-resource settings.Methods and MaterialsClinician-collected (cervical) and self-collected (vaginal) careHPV specimens, visual inspection with acetic acid (VIA), and Papanicolaou test were evaluated among 16,951 eligible women in India, Nicaragua, and Uganda. Women with positive screening results received colposcopy and histologic follow-up as indicated. The positivity of each screening method was calculated overall, by site, and age. In addition, the clinical performance of each screening test was determined for detection of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2+) and CIN grade 3.ResultsModerate or severe dysplasia or cancer (taken together as CIN2+) was diagnosed in 286 women. The positivity rate ranged between 2.4% to 19.6% for vaginal careHPV, 2.9% to 20.2% for cervical careHPV, 5.5% to 34.4% for VIA, and 2.8% to 51.8% for Papanicolaou test. Cervical careHPV was the most sensitive for CIN2+ (81.5%; 95% confidence interval [CI], 76.5–85.8) and CIN grade 3 (85.3%; 95% CI, 78.6–90.6) at all sites, followed by vaginal careHPV (69.6% and 71.3%, respectively). The sensitivity of VIA ranged from 21.9% to 73.6% and Papanicolaou test from 40.7% to 73.7%. The pooled specificities of cervical careHPV, vaginal careHPV, VIA, and Papanicolaou test were 91.6%, 90.6%, 84.2%, and 87.7%, respectively.ConclusionscareHPV performed well in large multicountry demonstration studies conducted in resource-limited settings that have not previously been conducted this type of testing; its sensitivity using cervical samples or vaginal self-collected samples was better than VIA or Papanicolaou test. The feasibility of using careHPV in self-collected vaginal samples opens the possibility of increasing coverage and early detection in resource-constrained areas.

scholarly journals Feasibility of Low-Throughput Next Generation Sequencing for Germline DNA Screening

2014 ◽  
Vol 60 (12) ◽  
pp. 1549-1557 ◽  
Author(s):  
Nur Sabrina Sapari ◽  
Eiram Elahi ◽  
Mengchu Wu ◽  
Marie Loh ◽  
Hong Kiat Ng ◽  
...  
Keyword(s):  
Next Generation Sequencing ◽  
Clinical Performance ◽  
Asian Population ◽  
Clinical Diagnostics ◽  
Personal Genome ◽  
Next Generation ◽  
Array Annotation ◽  
Cost Efficient ◽  
And Performance ◽  
Generation Sequencing

Abstract BACKGROUND Next generation sequencing (NGS) promises many benefits for clinical diagnostics. However, current barriers to its adoption include suboptimal amenability for low clinical throughputs and uncertainty over data accuracy and analytical procedures. We assessed the feasibility and performance of low-throughput NGS for detecting germline mutations for Lynch syndrome (LS). METHODS Sequencing depth, time, and cost of 6 formats on the MiSeq and Personal Genome Machine platforms at 1–12 samples/run were calculated. Analytical performance was assessed from 3 runs of 3 DNA samples annotated for 7500 nucleotides by BeadChip arrays. The clinical performance of low-throughput NGS and 9 analytical processes were assessed through blinded analysis of DNA samples from 12 LS cases confirmed by Sanger sequencing, and 3 control cases. RESULTS The feasibility analysis revealed different formats were optimal at different throughputs. Detection was reproducible for 2619/2635 (99.39%) replicate variants, and sensitivity and specificity to array annotation were 99.42% and 99.99% respectively. Eleven of 16 inconsistently detected variants could be specifically identified by having allele frequencies ≤0.15, strand biases >−35, or genotype quality scores ≤80. Positive selection for variants in the Human Genome Mutation Database (colorectal cancer, nonpolyposis) and variants with ≤5% frequency in the Asian population gave the best clinical performance (92% sensitivity, 67% specificity). CONCLUSIONS Low-throughput NGS can be a cost-efficient and reliable approach for screening germline variants; however, its clinical utility is subject to the quality of annotation of clinically relevant variants.

Manufacturing and Performance Assessments of Several Applications of Electrotextiles and Large-Area Flexible Circuits

2002 ◽  
Vol 736 ◽  
Author(s):  
David P. Cadogan ◽  
Lauren S. Shook
Keyword(s):  
Signal Transmission ◽  
Electrostatic Charge ◽  
Membrane Structures ◽  
Large Area ◽  
Solar Sails ◽  
Commercial Market ◽  
Low Mass ◽  
Conductive Fibers ◽  
And Performance ◽  
Performance Challenges

ABSTRACTNumerous applications of electrotextiles and flexible circuits have been identified that can advance systems performance for many commercial, military, and aerospace devices. Several novel uses of electrotextiles have been developed for lab testing, while others have been utilized in products on the commercial market, as well as items that have flown in space. ILC Dover, Inc. has utilized conductive fibers in various inflatable and tensile structures for signal transmission and electrostatic charge protection. Conductive and pressure sensitive textiles have been incorporated in the advanced development space suit (I-Suit) as switch controls for lights and rovers, and as signal transmission cables. Conductive fibers have been used in several stitched applications for electrostatic charge dissipation. These applications include large pharmaceutical containment enclosures where fine potent powders are being captured for transfer between manufacturing facilities, as well as impact attenuation airbags used in landing spacecraft on the surface of Mars. In both cases, conductive threads are uniquely located in seams and panel locations to gather and direct charge through surface fibers and panel interconnects. Conductive fibers have also been utilized in a conformal Sensate Liner garment for the identification of wound locations and medical sensor signal transmission for soldier health monitoring while on the battlefield. The performance challenges of these structures require a careful, systematic application of electrotextiles because of the flexing, straining, and exposure of the materials to harsh environments. ILC has also been developing “gossamer” spacecraft components utilizing unique materials and multi-functional structures to achieve extremely low mass and low launch volumes. Examples of large deployable structures featuring very thin, large flexible circuits for use in space include synthetic aperture radar (SAR) antennas, communications antenna reflectarrays, and active variable reflectance solar sails. Design and materials challenges of electrotextile and large-area flexible circuit membrane structures as demonstrated in engineered applications will be discussed in this paper.

scholarly journals Self-efficacy and Clinical Performance of Nurses Initiated and Management of Antiretroviral Therapy: Narrative Review

2019 ◽  
Vol 12 (1) ◽  
pp. 86-93
Author(s):  
Nozuko Glenrose Mangi ◽  
Daniel Ter Goon ◽  
Elizabeth Matsidiso Yako
Keyword(s):  
South African ◽  
Self Efficacy ◽  
Clinical Performance ◽  
Future Studies ◽  
Negative Effect ◽  
African Context ◽  
Professional Nurses ◽  
And Performance ◽  
Mentoring Support

Introduction: Self-efficacy plays a major role in the behaviour of a human being by how he/she approaches a goal, task or a challenge so that a desired level of performance is produced. The objective of this paper is to review and analyse literature on self-efficacy and clinical performance among professional nurses regarding quality of care in implementation of NIMART programme. Methodology: A literature review was conducted using online resources. Search engines included EBSCO, Google Scholar, Medline, PubMed, Psych info and BIOMED Central articles and journals published between 2007 and 2017. Relevant papers on self-efficacy and clinical performance regarding the implementation of NIMART programme in South Africa were analysed. Results: 278 papers were identified and 22 eligible papers were selected for analysis. Reviewed literature exhibited that self-efficacy is very crucial in the clinical performance of nurses in the implementation of NIMART. Self-efficacy helps to predict motivation and performance of individuals. Lack of mentoring, support and exposure to clinical practice had negative effect on nurse’s self-efficacy. Conclusion: Given the paucity of information on self-efficacy and clinical performance of NIMART in the South African context, future studies are warranted to gain more understanding of self-efficacy in the clinical performance of professional nurses.

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