Method of Producing Improved Bearing Components by Elimination or Control of Fiber Orientation, Including Magnetic Analysis

Producing improved bearing components by elimination or control of fiber orientatio

Reforming marketing for sustainability: towards a framework for evolved marketing

This paper seeks to provide guidance to the question ‘how can we evolve marketing so that it becomes a force for sustainability?’. Much useful advice has been produced on the how existing norms of marketing can be applied to the topic of sustainability – for example, taking the marketing ‘Ps’ and integrating a sustainability approach into each. Many people on the ground trying to implement ‘Sustainable Marketing’ find that there is much high-level enthusiasm for this kind of change, at a management and strategic level, but this enthusiasm is quelled or blocked when the realities of day-to-day marketing activities are faced. Why is this? We conclude that many of the barriers marketers and organisations face in this respect is due to 1) A misalignment between the perceived role of marketing and sustainability 2) Lack of an agreed definition and structure for evolution that companies can follow and stakeholders can use to hold them accountable. This report therefore starts by looking at the very foundations of modern marketing and where best practice is pointing – both of which have the potential to provide a very suitable base for Sustainable Marketing, but equally they could motivate the opposite. By combining these insights with insights on what is required in order for social, economic and environmental sustainability to be met, we suggest that marketing needs to adopt an approach of ‘guide-an-co-create’ rather than a ‘make-and-sell’ or ‘sense-and-respond’ to its customers and society and put forward a set of 6 foundations that could form the basis of a ‘framework for evolved marketing’. These are: 1) Pursue a relentless focus on understanding and satisfying real primary needs 2) Acknowledge the critical leadership role marketing plays 3) Recognise and build upon relationships 4) Adopt a long-term sustainability mindset 5) Take a rigorous approach to measuring the sustainability of all marketing decisions 6) Put marketing at the heart of all organisational strategic decisions This report is intended to provide the starting point for discussion about if there is support for a framework that might be used in the way a voluntary code might, and if so, are the 6 suggested here the right ones? The hard work then comes when companies work with the framework to innovate their own examples of best practice in each. Through this practice sector level key performance indicators and benchmarks are likely to evolve. By using a question based maturity –matrix style approach (as has been used successfully in other sustainability settings) it will therefore become clear over time, which companies are leading in this area and can make valid claims and those who are not. The framework presented is intended to support organisations in setting their strategic direction so that it is aligned with sustainability though its marketing - which in advanced companies should be driving their strategic direction. It is equally intended to support the journey of those who are doing marketing on a day-to-day basis – both those who formally consider them to be marketers as well as the many, many people who are doing marketing but don’t define themselves in that way. We believe that by providing a common language and common direction for the evolution of marketing, it could become a key driving force for a sustainable future

Pharmakologische Untersuchungen zum Einfluss von Angiotensin II auf die Insulinsekretion an der Insulinomazelllinie INS-1

Es gibt viele, übereinstimmende Hinweise für die Existenz eines lokalen RAS im endogenen Pankreas. Über die Wirkung des vasokonstriktorisch wirkenden Angiotensin II (ANG II) auf die Insulinsekretion besteht hingegen eine gewisse Uneinigkeit. In dieser Dissertation konnten sowohl durch Bindungsstudien, als auch durch Western Blot-Untersuchungen ANG II-Bindungsstellen und im speziellen der AT1-Rezeptor an der Insulinomazelllinie INS-1 nachgewiesen werden. Über diesen Rezeptor kommt es durch ANG II zu einer dosisabhängigen Steigerung der Insulinsekretion, da eine gleichzeitige Inkubation mit dem spezifischen AT1-Rezeptorantagonisten Losartan die Insulinsekretion wieder normalisiert. Diese Steigerung der Insulinsekretion scheint durch typische Gq-Kopplung des AT1-Rezeptors mit einer Entleerung von intrazellulären Calciumspeichern zu erfolgen, da es in Experimenten zur Aufnahme von 45Calcium zu keiner Steigerung der Calciumaufnahme durch ANG II kam

Involving patients in patient safety programmes: A scoping review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care

This is the final version of the article. Available from Taylor & Francis via the DOI in this record.BACKGROUND: Patient involvement has only recently received attention as a potentially useful approach to patient safety in primary care. OBJECTIVE: To summarize work conducted on a scoping review of interventions focussing on patient involvement for patient safety; to develop consensus-based recommendations in this area. METHODS: Scoping review of the literature 2006-2011 about methods and effects of involving patients in patient safety in primary care identified evidence for previous experiences of patient involvement in patient safety. This information was fed back to an expert panel for the development of recommendations for healthcare professionals and policy makers. RESULTS: The scoping review identified only weak evidence in support of the effectiveness of patient involvement. Identified barriers included a number of patient factors but also the healthcare workers' attitudes, abilities and lack of training. The expert panel recommended the integration of patient safety in the educational curricula for healthcare professionals, and expected a commitment from professionals to act as first movers by inviting and encouraging the patients to take an active role. The panel proposed a checklist to be used by primary care clinicians at the point of care for promoting patient involvement. CONCLUSION: There is only weak evidence on the effectiveness of patient involvement in patient safety. The recommendations of the panel can inform future policy and practice on patient involvement in safety in primary care.The research leading to these results has received funding from the European Community's Seventh Framework Programme FP7/2008–2012 under grant agreement no. 223424

Tearing down walls: opening the border between hospital and ambulatory care for quality improvement in Germany

The hospital benchmarking system in Germany was originally introduced to detect unintended consequences of reimbursement based on diagnosis-related groups. The new nationwide SQG programme aims to provide information on quality and outcomes of health care provided in hospital, ambulatory specialist and primary care settings, including the healthcare delivery across different sectors. In 2010 the topics for indicator development were cataract surgery, cervical conization, colectoral cancer and percutaneous coronary interventions or coronary angiography. A systematic stepwise modified RAND/UCLA procedure is applied to develop quality indicators in each of these domains. A general framework for data collection is implemented. Benchmarking results are fed back to providers on a regular basis

General practitioners' views and experiences in caring for patients after sepsis:a qualitative interview study

Contains fulltext : 232438.pdf (Publisher’s version ) (Open Access)BACKGROUND: Patients surviving critical illnesses, such as sepsis, often suffer from long-term complications. After discharge from hospital, most patients are treated in primary care. Little is known how general practitioners (GPs) perform critical illness aftercare and how it can be improved. Within a randomised controlled trial, an outreach training programme has been developed and applied. OBJECTIVES: The aim of this study is to describe GPs' views and experiences of caring for postsepsis patients and of participating a specific outreach training. DESIGN: Semistructured qualitative interviews. SETTING: 14 primary care practices in the metropolitan area of Berlin, Germany. PARTICIPANTS: 14 GPs who had participated in a structured sepsis aftercare programme in primary care. RESULTS: Themes identified in sepsis aftercare were: continuity of care and good relationship with patients, GP's experiences during their patient's critical illness and impact of persisting symptoms. An outreach education as part of the intervention was considered by the GPs to be acceptable, helpful to improve knowledge of the management of postintensive care complications and useful for sepsis aftercare in daily practice. CONCLUSIONS: GPs provide continuity of care to patients surviving sepsis. Better communication at the intensive care unit-GP interface and training in management of long-term complications of sepsis may be helpful to improve sepsis aftercare. TRIAL REGISTRATION NUMBER: ISRCTN61744782

Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study

<p>Abstract</p> <p>Background</p> <p>Quality improvement collaboratives (QICs) bring together groups of healthcare professionals to work in a structured manner to improve the quality of healthcare delivery within particular domains. We explored which characteristics of the composition, participation, functioning, and organization of these collaboratives related to changes in the healthcare for patients with anxiety disorders, dual diagnosis, or schizophrenia.</p> <p>Methods</p> <p>We studied three QICs involving 29 quality improvement (QI) teams representing a number of mental healthcare organizations in the Netherlands. The aims of the three QICs were the implementation of multidisciplinary practice guidelines in the domains of anxiety disorders, dual diagnosis, and schizophrenia, respectively. We used eight performance indicators to assess the impact of the QI teams on self-reported patient outcomes and process of care outcomes for 1,346 patients. The QI team members completed a questionnaire on the characteristics of the composition, participation in a national program, functioning, and organizational context for their teams. It was expected that an association would be found between these team characteristics and the quality of care for patients with anxiety disorders, dual diagnosis, and schizophrenia.</p> <p>Results</p> <p>No consistent patterns of association emerged. Theory-based factors did not perform better than practice-based factors. However, QI teams that received support from their management and both active and inspirational team leadership showed better results. Rather surprisingly, a lower average level of education among the team members was associated with better results, although less consistently than the management and leadership characteristics. Team views with regard to the QI goals of the team and attitudes towards multidisciplinary practice guidelines did not correlate with team success.</p> <p>Conclusions</p> <p>No general conclusions about the impact of the characteristics of QI teams on the quality of healthcare can be drawn, but support of the management and active, inspirational team leadership appear to be important. Not only patient outcomes but also the performance indicators of monitoring and screening/assessment showed improvement in many but not all of the QI teams with such characteristics. More studies are needed to identify factors associated with the impact of multidisciplinary practice guidelines in mental healthcare.</p

Hybrid Volitional Control of a Robotic Transtibial Prosthesis using a Phase Variable Impedance Controller

For robotic transtibial prosthesis control, the global kinematics of the tibia can be used to monitor the progression of the gait cycle and command smooth and continuous actuation. In this work, these global tibia kinematics are used to define a phase variable impedance controller (PVIC), which is then implemented as the nonvolitional base controller within a hybrid volitional control framework (PVI-HVC). The gait progression estimation and biomechanic performance of one able-bodied individual walking on a robotic ankle prosthesis via a bypass adapter are compared for three control schemes: a passive benchmark controller, PVIC, and PVI-HVC. The different actuation of each controller had a direct effect on the global tibia kinematics, but the average deviation between the estimated and ground truth gait percentage were 1.6%, 1.8%, and 2.1%, respectively, for each controller. Both PVIC and PVI-HVC produced good agreement with able-bodied kinematic and kinetic references. As designed, PVI-HVC results were similar to those of PVIC when the user used low volitional intent, but yielded higher peak plantarflexion, peak torque, and peak power when the user commanded high volitional input in late stance. This additional torque and power also allowed the user to volitionally and continuously achieve activities beyond level walking, such as ascending ramps, avoiding obstacles, standing on tip-toes, and tapping the foot. In this way, PVI-HVC offers the kinetic and kinematic performance of the PVIC during level ground walking, along with the freedom to volitionally pursue alternative activities.Comment: 7 pages, 7 figures, submitted to ICRA 202

Does patient satisfaction of general practice change over a decade?

Background The Patient Participation Program (PPP) was a patient satisfaction survey endorsed by the Royal Australian College of General Practitioners and designed to assist general practitioners in continuous quality improvement (CQI). The survey was been undertaken by 3500 practices and over a million patients between 1994 and 2003. This study aimed to use pooled patient questionnaire data to investigate changes in satisfaction with primary care over time. Methods The results of 10 years of the PPP surveys were analyzed with respect to 10 variables including the year of completion, patient age, gender, practice size, attendance at other doctors, and whether the practice had previously undertaken the survey. Comparisons were made using Logistic Generalized Estimating Equations (LGEE). Results There was a very high level of satisfaction with general practice in Australia (99% of respondents). An independent indicator of satisfaction was created by pooling the results of 12 questions. This new indicator had a greater variance than the single overall satisfaction question. Participants were shown to have higher levels of satisfaction if they were male, older, did not attend other practitioners or the practice was small in size. A minimal improvement in satisfaction was detected in this pooled indicator for the second or third survey undertaken by a practice. There was however no statistically significant change in pooled satisfaction with the year of survey. Conclusion The very high level of satisfaction made it difficult to demonstrate change. It is likely that this and the presentation of results made it difficult for GPs to use the survey to improve their practices. A more useful survey would be more sensitive to detect negative patient opinions and provide integrated feedback to GPs. At present, there are concerns about the usefulness of the PPP in continuous quality improvement in general practice.James Allan, Peter Schattner, Nigel Stocks and Emmae Ramsa