scholarly journals Successful Implementation of Low-Cost Tele-Critical Care Solution by the U.S. Navy: Initial Experience and Recommendations

2017 ◽  
Vol 182 (5) ◽  
pp. e1702-e1707 ◽  
Author(s):  
Konrad Davis ◽  
Alexandra Perry-Moseanko ◽  
Matthew D. Tadlock ◽  
Nichole Henry ◽  
Jeremy Pamplin
Keyword(s):  
Critical Care ◽  
Low Cost ◽  
Successful Implementation ◽  
Initial Experience ◽  
The U.S

Retrospective on the 1970’s “Low Cost Shore Protection” program

Shore & Beach ◽  
2019 ◽  
pp. 3-12
Author(s):  
Joan Pope
Keyword(s):  
Coastal Erosion ◽  
Low Cost ◽  
Management Strategies ◽  
Public Information ◽  
Coastal Engineering ◽  
Shoreline Erosion ◽  
Shore Protection ◽  
Demonstration Program ◽  
Alternative Approaches ◽  
The U.S

In the 1970s, the U.S. Congress authorized and funded a five-year demonstration program on low-cost methods for shore protection called the “U.S. Army Engineers Shoreline Erosion Control Demonstration (Section 54) Program.” The Section 54 also known as the “Low-Cost Shore Protection” demonstration program is revisited. Demonstration and monitoring sites including the materials, devices, vegetative plantings, approaches tested, and program findings are discussed. Simply put, a major finding of the Section 54 program was that the concept of “low-cost shore protection” was a bit naïve. However, the program did lead to a wealth of public information documents and practical coastal engineering lessons that are still resonating as home owners, communities, and engineers consider alternative approaches for managing coastal erosion. The program structure and findings are applicable 40 years later as consideration is given toward the use of Natural and Nature-based Features (NNBF) for addressing coastal erosion. Evolution in thought relative to coastal erosion and shoreline enhancement activities since the 1970s has built upon many of the lessons and concepts of the Section 54 program and other real-world coastal erosion management success-failure experiences. This growth has led to a modern appreciation that those features that emulate NNBF are promising and responsible alternative coastal erosion management strategies if proper engineering standard elements of design are included in the project.

scholarly journals Barriers to training in laparoscopic surgery in low- and middle-income countries: A systematic review

2021 ◽  
pp. 004947552199818
Author(s):  
Ellen Wilkinson ◽  
Noel Aruparayil ◽  
J Gnanaraj ◽  
Julia Brown ◽  
David Jayne
Keyword(s):  
Laparoscopic Surgery ◽  
Low Cost ◽  
Surgical Care ◽  
Successful Implementation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Technological Advances ◽  
Local Access ◽  
And Training ◽  
Low And Middle Income

Laparoscopic surgery has the potential to improve care in resource-deprived low- and-middle-income countries (LMICs). This study aims to analyse the barriers to training in laparoscopic surgery in LMICs. Medline, Embase, Global Health and Web of Science were searched using ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Two researchers screened results with mutual agreement. Included papers were in English, focused on abdominal laparoscopy and training in LMICs. PRISMA guidelines were followed; 2992 records were screened, and 86 full-text articles reviewed to give 26 key papers. Thematic grouping identified seven key barriers: funding; availability and maintenance of equipment; local access to experienced laparoscopic trainers; stakeholder dynamics; lack of knowledge on effective training curricula; surgical departmental structure and practical opportunities for trainees. In low-resource settings, technological advances may offer low-cost solutions in the successful implementation of laparoscopic training and improve access to surgical care.

scholarly journals A Cotton Module Feeder Plastic Contamination Inspection System

2020 ◽  
Vol 2 (2) ◽  
pp. 280-293
Author(s):  
Mathew G. Pelletier ◽  
Greg A. Holt ◽  
John D. Wanjura
Keyword(s):  
Mechanical Design ◽  
Low Cost ◽  
Processing System ◽  
Technical Note ◽  
Inspection System ◽  
Learning Program ◽  
Cotton Lint ◽  
Cotton Industry ◽  
Bill Of Materials ◽  
The U.S

The removal of plastic contamination in cotton lint is an issue of top priority to the U.S. cotton industry. One of the main sources of plastic contamination showing up in marketable cotton bales, at the U.S. Department of Agriculture’s classing office, is plastic from the module wrap used to wrap cotton modules produced by the new John Deere round module harvesters. Despite diligent efforts by cotton ginning personnel to remove all plastic encountered during unwrapping of the seed cotton modules, plastic still finds a way into the cotton gin’s processing system. To help mitigate plastic contamination at the gin; an inspection system was developed that utilized low-cost color cameras to see plastic on the module feeder’s dispersing cylinders, that are normally hidden from view by the incoming feed of cotton modules. This technical note presents the design of an automated intelligent machine-vision guided cotton module-feeder inspection system. The system includes a machine-learning program that automatically detects plastic contamination in order to alert the cotton gin personnel as to the presence of plastic contamination on the module feeder’s dispersing cylinders. The system was tested throughout the entire 2019 cotton ginning season at two commercial cotton gins and at one gin in the 2018 ginning season. This note describes the over-all system and mechanical design and provides an over-view and coverage of key relevant issues. Included as an attachment to this technical note are all the mechanical engineering design files as well as the bill-of-materials part source list. A discussion of the observational impact the system had on reduction of plastic contamination is also addressed.

scholarly journals Learning from Past Policy: Assessing United States Foreign Policy over Indonesia in Resolving the 1999 East Timor Crisis

2021 ◽  
Vol 23 (1) ◽  
pp. 1
Author(s):  
Sigit S. Nugroho
Keyword(s):  
United States ◽  
Foreign Policy ◽  
Low Cost ◽  
The United States ◽  
East Timor ◽  
United States Foreign Policy ◽  
Case Study Analysis ◽  
High Degree ◽  
The U.S

Assessing the output of past foreign policy is instrumental for any country to learn policy-relevant insights, to appreciate its experience, and to improve its future conduct. To glean such insights, this article borrows Baldwin’s framework in assessing the success and failure in foreign policy. Using a case study analysis, it assesses the United States’ (U.S.) influence attempt towards Indonesia to resolve the 1999 East Timor humanitarian crisis. President Clinton’s decision to undergo an influence attempt primarily aimed to change Indonesia’s policy while gaining support from U.S. allies in the process. The article finds that Clinton’s decision was a highly successful attempt. This finding is based on several factors: (1) the attempt effectively attained the intended primary and secondary goals at a considerably high degree; (2) it was conducted at a considerably low cost for the U.S.; (3) it inflicted a high cost towards Indonesia; (4) the increase in Clinton’s stake strengthened the U.S. resolve to pursue the influence attempt; and (5) Clinton had successfully overcome the difficult undertaking as Indonesia possessed higher stake over East Timor. These findings provide some lessons for both U.S. and Indonesian foreign policymakers to chart future relations for the two nations.

scholarly journals Flying in the Face of Adversity: A Drosophila-based Virtual CURE Provides Semester-long Authentic Research Opportunity to the Flipped Classroom.

2021 ◽  
Author(s):  
Edward A Waddell ◽  
Dara Ruiz-Whalen ◽  
Alana M O'Reilly ◽  
Nathan T. Fried
Keyword(s):  
Flipped Classroom ◽  
Undergraduate Research ◽  
Low Cost ◽  
Successful Implementation ◽  
Self Assessment ◽  
Research Experiences ◽  
Complex Design ◽  
Research Opportunity ◽  
The Face ◽  
Upper Level

A call for the integration of research experiences into all biology curricula has been a major goal for educational reform efforts nationally. Course-Based Undergraduate Research Experiences (CUREs) have been the predominant method of accomplishing this, but their associated costs and complex design can limit their wide adoption. In 2020, the COVID-19 pandemic forced programs to identify unique ways to still provide authentic research experiences while students were virtual. We report here a full guide for the successful implementation of a semester-long virtual CURE that uses Drosophila behavioral assays to explore the connection between pain and addiction with the use of a "lab-in-a-box" sent home to students. Individual components were piloted across three semesters and launched as a 100-level introductory course with 19 students. We found that this course increased science identity and successfully improved key research competencies as per the Undergraduate Research Student Self-Assessment (URSSA) survey. This course is ideal for flipped classrooms ranging from introductory biology to upper-level neuroscience courses and can be integrated directly into the lecture period without the need for building a new course. Given the low cost, recent comfort with virtual learning environments, and the current proliferation of flipped biology classrooms following the 2020 pandemic, this curriculum could serve as an ideal project-based active-learning tool for equitably increasing access to authentic research experiences.

scholarly journals STRATEGY IMPLEMENTATION OF NATIONAL HEALTH INSURANCE USING BALANCED SCORECARD METHOD: A CASE STUDY IN AN – NISA HOSPITAL IN TANGERANG

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Luh Putu Sinthya Ulandari
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Balanced Scorecard ◽  
Business Models ◽  
Clinical Pathways ◽  
Low Cost ◽  
Successful Implementation ◽  
Target Market ◽  
Depth Interview

One of the private hospital successful implementation the National Health Insurance with cost efficiency without neglecting the quality of service is An-Nisa Hospital. This study aimed to finding out the strategy of An-Nisa Hospital in the implementation of the National Health Insurance with Balanced Scorecard. The research was conducted in May 2018 using qualitative approach. Data was collected through in-depth interview to 7 informants from hospital and 2 informants from BPJS Kesehatan. The subjects were selected purposively and the data was analyzed using thematic analysis. The results show that there are several strategies that have been developed and implemented, including: adding types of services, increasing the capacity of inpatients and polyclinics, increasing doctor practice slots, completing medical equipment, applying the principle of low cost and increasing working capital, choosing JKN patients as target market, develop 5 values propotition, complaint management, develop standard operating procedures, develop drug formulary and clinical pathways, carry out operational and audit controls, build business models, form casemix teams and claim management, develop training, giving reward and good salaries, build a competitive work environments, and pay attention to employee career paths. Through this strategy, An-Nisa Hospital is able to implement the JKN Program well and still record a surplus without sacrificing service quality

The Electric Arc Spray Manufacture of Rapid Production Tooling: A Case Study

1998 ◽  
Author(s):  
A.P. Newbery ◽  
P.S. Grant ◽  
R.M. Jordan ◽  
A.D. Roche ◽  
T.C. Carr
Keyword(s):  
Injection Moulding ◽  
Low Cost ◽  
Spray Forming ◽  
Electric Arc ◽  
Internal Stresses ◽  
Forming Process ◽  
Polymer Injection ◽  
Spray Process ◽  
Arc Spray ◽  
The U.S

Abstract The manufacture of tooling using the electric arc spray process to spray steel directly onto a master pattern offers substantial reductions in the lead times required to make complex tooling for polymer injection moulding and other applications. The process of spray forming is fast, efficient, and low cost, and has been shown to be dimensionally accurate with proper control over the residual stresses that develop during spraying. Poor dimensional control because of high internal stresses in thick arc sprayed steel coatings is well known, but these problems can be avoided by the use of correct spraying conditions. This paper describes the STD SPRAYFORM process for the manufacture of tooling for the polymer injection moulding of a component for a leading company in the U.S. The steps in the spray forming process, both before and after spraying, are described. The spray forming route competed directly with a traditional method for toolmaking and considerably reduced the lead time from order to completion. The tooling produced by spray forming has been operating commercially in production in the U.S. and has to date produced in the region of half a million parts without appreciable wear. The incorporation of contoured cooling channels during spraying has enabled plastic injection moulding cycle times to be decreased by 15%.

scholarly journals Successful Implementation of a Pediatric Early Warning Score in a Resource-Limited Pediatric Oncology Hospital in Guatemala

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 60s-60s
Author(s):  
Asya Agulnik ◽  
Dora Judith Soberanis Vasquez ◽  
Jose Emigdio García Ortiz ◽  
Lupe Nataly Mora Robles ◽  
Ricardo Mack ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pediatric Oncology ◽  
Early Warning ◽  
Conflicts Of Interest ◽  
Low Cost ◽  
Early Warning Score ◽  
Level Of Care ◽  
Successful Implementation ◽  
Oncology Patients ◽  
Resource Limited

Abstract 25 Background: Hospitalized pediatric oncology patients are at high risk for clinical decline and mortality, particularly in resource-limited settings. Pediatric Early Warning Scores (PEWS) are commonly used to aid with early identification of clinical deterioration; however, these scores have never been studied in oncology patients in low-resource settings. We describe the successful implementation of a modified PEWS at Unidad Nacional de Oncología Pediátrica (UNOP), a national pediatric oncology hospital in Guatemala. Methods: The PEWS used at Boston Children's Hospital (BCH) was modified through key informant meetings at UNOP, adjusting for practice variations between the two hospitals. After an initial pilot of the tool, the PEWS was implemented in all non-ICU inpatient areas at UNOP (60 beds with about 2,000 admissions/year). During implementation, systems were created to monitor errors in calculating PEWS, patient transfers to a higher level of care, and high PEWS scores for ongoing quality improvement. Results: Hospital-wide implementation occurred over 6 months, when 113 nurses were trained in the PEWS tool and algorithm. Compliance with PEWS performance and documentation was 100% by the end of the implementation period, with 300 to 400 PEWS measured daily and less than 10% errors. Monitoring of PEWS results reports an average of 5 high PEWS per week with 30% transferring to a higher level of care. Among patients requiring ICU transfer, 86% had an abnormal PEWS prior to transfer, which is similar to results at BCH (90%). Staff surveys showed a high degree of satisfaction with PEWS (4.6/5) and minimal difficulty using the score (2.3/5) (n=67). Conclusions: We describe the successful implementation of a PEWS in a pediatric oncology hospital in Guatemala. This work demonstrates that PEWS is a feasible, well-accepted, and low-cost quality improvement measure in this resource-limited setting. We now plan to evaluate the effects of this implementation on patient care and outcomes. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

scholarly journals Evolution of the United States Military Extracorporeal Membrane Oxygenation Transport Team

2020 ◽  
Vol 185 (11-12) ◽  
pp. e2055-e2060
Author(s):  
Matthew D Read ◽  
Jason J Nam ◽  
Mauer Biscotti ◽  
Lydia C Piper ◽  
Sarah B Thomas ◽  
...  
Keyword(s):  
Critical Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Demographic Data ◽  
The United States ◽  
Published Data ◽  
Medical Treatment Facility ◽  
Membrane Oxygenation ◽  
Transport Distance ◽  
Primary Indication ◽  
The U.S

Abstract Introduction The use of extracorporeal membrane oxygenation (ECMO) for the care of critically ill adult patients has increased over the past decade. It has been utilized in more austere locations, to include combat wounded. The U.S. military established the Acute Lung Rescue Team in 2005 to transport and care for patients unable to be managed by standard medical evacuation resources. In 2012, the U.S. military expanded upon this capacity, establishing an ECMO program at Brooke Army Medical Center. To maintain currency, the program treats both military and civilian patients. Materials and methods We conducted a single-center retrospective review of all patients transported by the sole U.S. military ECMO program from September 2012 to December 2019. We analyzed basic demographic data, ECMO indication, transport distance range, survival to decannulation and discharge, and programmatic growth. Results The U.S. military ECMO team conducted 110 ECMO transports. Of these, 88 patients (80%) were transported to our facility and 81 (73.6%) were cannulated for ECMO by our team prior to transport. The primary indication for ECMO was respiratory failure (76%). The range of transport distance was 6.5 to 8,451 miles (median air transport distance = 1,328 miles, median ground transport distance = 16 miles). In patients who were cannulated remotely, survival to decannulation was 76% and survival to discharge was 73.3%. Conclusions Utilization of the U.S. military ECMO team has increased exponentially since January 2017. With an increased tempo of transport operations and distance of critical care transport, survival to decannulation and discharge rates exceed national benchmarks as described in ELSO published data. The ability to cannulate patients in remote locations and provide critical care transport to a military medical treatment facility has allowed the U.S. military to maintain readiness of a critical medical asset.

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