The Benchmarking Effort for Networking Children's Hospitals (BENCHmark)

BACKGROUND: In 1992, 12 large children's hospitals established the Benchmarking Effort for Networking Children's Hospitals (BENCHmark). The goal was for the BENCHmark effort to supplement the hospitals' continuous quality improvement (CQI) programs and to speed adoption of best practices from peer institutions. For three years, the hospitals have been comparing data on cost, quality, and speed indicators. Also, "best practice" groups have met to share information on how processes can be improved. RESULTS: The BENCHmark hospitals have experienced significant process improvement in areas such as emergency department waiting time and admitting process time. EXAMPLE: The BENCHmark hospitals selected admitting as one of the first best practice groups to meet. Interdisciplinary staff from all BENCHmark hospitals met three times over the course of a year to define their indicator and share information on best practices. St Louis Children's Hospital, as a result, instituted a pre-arrival team and cross-trained staff, with the result being a reduction of admitting processing time from 58 minutes to 19 minutes. Same-day surgery patients now bypass the admitting department and go directly to the surgical floor. Patient and surgeon satisfaction has increased greatly. CONCLUSIONS: Hospitals that are planning to benchmark are encouraged to reach consensus on project goals and to focus on indicators that provide a clear business advantage. Physician involvement is key to improving performance and physicians will only be engaged if the hospitals against whom they are benchmarked are considered peers. Being willing to share initial data openly seems to be a key factor in determining successful integration of the BENCHmark process into hospital CQI efforts. The BENCHmark project has been so successful that a second group of 12 comparable pediatric institutions, known as the Network II, has been established.     

Pain threshold values during periodontal probing: assessment of maxillary incisor and molar sites

Probing pain threshold (PPT) assessments were conducted in the facial and oral sulci of maxillary central incisors and first molars of 10 periodontally healthy adults. All subjects were systemically healthy, free of pain, and reported no current medication usage. A computer-linked electronic probe, modified to deliver steadily increasing forces up to 200 grams, was used to collect the data. The system contained a subject operated "off-switch" which, upon activation, signaled the computer to record the subject's PPT. Assessments of each subject's PPTs were conducted on 3 separate occasions at 7-day intervals. Results indicated that the facial sulci of the incisors were the most pain sensitive. They displayed a mean PPT of 50.9 +/- 26.6 grams. The oral sulci of the incisors exhibited a mean PPT of 76.5 +/- 45.2 grams. Facial and oral sulci of the molars evidenced mean PPT values of 102.6 +/- 52.1 grams and 113.5 +/- 51.3 grams, respectively. These data suggest that sulci associated with incisor teeth are nearly twice as pain sensitive as sulci associated with molar teeth. In addition, facial sulci are significantly more pain sensitive than oral sulci. Data did not indicate a visit effect nor a side-of-mouth effect on PPT values.     

Usability engineering for augmented reality: employing user-based studies to inform design

A major challenge, and thus opportunity, in the field of human-computer interaction and specifically usability engineering is designing effective user interfaces for emerging technologies that have no established design guidelines or interaction metaphors or introduce completely new ways for users to perceive and interact with technology and the world around them. Clearly, augmented reality is one such emerging technology. We propose a usability engineering approach that employs user-based studies to inform design, by iteratively inserting a series of user-based studies into a traditional usability engineering lifecycle to better inform initial user interface designs. We present an exemplar user-based study conducted to gain insight into how users perceive text in outdoor augmented reality settings and to derive implications for design in outdoor augmented reality. We also describe lessons learned from our experiences conducting user-based studies as part of the design process.     

Community intervention with the elderly: a social network approach

A technique is described for using the advantages of a social systems approach when working with elderly persons in psychiatric distress. The technique is based on the assumption that the solution to a variety of human predicaments lies within the collective instrumental and affective resources of the client's social network. The vehicle for accomplishing this objective is the "Network Session" during which a mental health professional meets with the elderly person and members of his/her social network to help resolve the difficulty. A case report demonstrating use of the technique is included.     

Effect of post-slaughter processing and freezing on the functionality of hot-boned meat from young bull

The effects of variation in the times of mincing post mortem (2, 4, or 6 h), pre-rigor salting (1.5% wt wt ) and freezing rate [fast (10 min, liquid nitrogen); medium (4-6 h at -40 °C and 0.8 m s(-1) air velocity); or slow (36-38 h at -10 °C and 0.1 m s(-1) air velocity followed by 12 h at -20 °C and 0.1 m s(-1) air velocity)] on the functionality of young bull meat were examined using hot-boned forequarters. At 52 h post packaging, the meat was thawed (72 h at 4 °C), its pH measured, and it was used to make finely comminuted batters. Cook yield and stress and strain of the cooked batters were measured. Time of mincing had no effect on meat pH, cook yield or stress and strain. There was a significant interaction (P < 0.05) between pre-rigor salting and freezing rate for pH. Freezing rate did not affect the pH of pre-rigor salted meat whereas the pH of unsalted pre-rigor meat was highest at the fastest freezing rate. Meat salted pre-rigor had a significantly (P < 0.05) higher pH than the post-rigor chilled control. Pre-rigor salting decreased the stress values of cooked batter whereas the slowest freezing rate increased stress. Stress and strain values for cooked batters from thawed meat were not significantly different from the values for batters made from the unfrozen control. Cook yields of batters made from pre-rigor frozen meat were higher than that of the postrigor control but not significantly so. The results indicate that suppliers can use pre-rigor salted and frozen meat when manufacturing comminuted products without major detrimental effects on the cook yield and texture of the finished product.     

Microwave technique for reflector antenna profile measurement

A method for microwave measurement of the reflector antenna surface profile is described. The technique uses a focused monostatic secondary reflector located on axis at approximately two focal lenths from the reflector under test. Measurement of the two-ways phase change provides profile error information over a set of annular sections. Practical results are provided to illustrate the spatial resolution and sensitivity of the technique.     

Voigt–Reuss topology optimization for structures with linear elastic material behaviours

The desired results of variable topology material layout computations are stable and discrete material distributions that optimize the performance of structural systems. To achieve such material layout designs a continuous topology design framework based on hybrid combinations of classical Reuss (compliant) and Voigt (stiff) mixing rules is investigated. To avoid checkerboarding instabilities, the continuous topology optimization formulation is coupled with a novel spatial filtering procedure. The issue of obtaining globally optimal discrete layout designs with the proposed formulation is investigated using a continuation method which gradually transitions from the stiff Voigt formulation to the compliant Reuss formulation. The very good performance of the proposed methods is demonstrated on four structural topology design optimization problems from the literature. © 1997 John Wiley & sons, Ltd.     

The role of insulin and glucagon in the regulation of basal glucose production in the postabsorptive dog

The aim of the present experiments was to determine the role of insulin and glucagon in the regulation of basal glucose production in dogs fasted overnight. A deficiency of either or both pancreatic hormones was achieved by infusin somatostatin (1 mug/kg per min), a potent inhibitor of both insulin and glucagon secretion, alone or in combination with intraportal replacement infusions of either pancreatic hormone. Infusion of somatostatin alone caused the arterial levels of insulin and glucagon to drop rapidly by 72+/-6 and 81+/-8%, respectively. Intraportal infusion of insulin and glucagon at rates of 400 muU/kg per min and 1 ng/kg per min, respectively, resulted in the maintenance of the basal levels of each hormone. Glucose production was measured using tracer (primed constant infusion of [3-3H]glucose) and arteriovenous difference techniques. Isolated glucagon deficiency resulted in a 35+/-5% (P less than 0.05) rapid and sustained decrease in glucose production which was abolished upon restoration of the plasma glucagon level. Isolated insulin deficiency resulted in a 52+/-16% (P less than 0.01) increase in the rate of glucose production which was abolished when the insulin level was restored. Somatostatin had no effect on glucose production when the changes in the pancreatic hormone levels which it normally induces were prevented by simultaneous intraportal infusion of both insulin and glucagon. In conclusion, in the anesthetized dog fasted overnight; (a) basal glucagon is responsible for at least one-third of basal glucose production, (b) basal insulin prevents the increased glucose production which would result from the unrestrained action of glucagon, and (c) somatostatin has no acute effects on glucose turnover other than those it induces through perturbation of pancreatic hormone secretion. This study indicates that the opposing actions of the two pancreatic hormones are important in the regulation of basal glucose production in the postabsorptive state.     

Anatomic correction of transposition of the great vessels

We present a new approach for anatomic correction of transposition of the great arteries. The two coronary arteries, with a piece of the aortic wall attached, are transposed to the posterior artery. The two aortic openings are closed with a patch. The aorta and pulmonary artery are transected, contraposed, ant then anastomosed. The interventricular septal defect is closed with a patch, through a right ventriculotomy approach, because the right ventricle is no longer part of the systemic circulation. Two patients, aged 3 months and 40 days weighing 4,200 and 3,700 grams, respectively, were operated upon with deep hypothermia and total circulatory arrest. There was good recovery from the operation, with normal cardiocirculatory conditions. Renal failure developed in the first patient, and she died on the third postoperative day. During this time the cardiocirculatory conditions were good. The second patient made an uneventful recovery. Hemodynamic studies 20 days after the operation showed complete correction of the malformation. Five and one-half months after the operation, he weighs 7,500 grams, and his development is very good. We believe that this operation will be reproducible by most cardiovascular septal defect and pulmonary hypertension.