Retaining System for a Dynamometer

Tato diplomová práce je zaměřena na optimalizaci sloupku zádržného systému užívaného na válcových dynamometrech. Dále pak na úpravu objímky sloužící k zavěšení háku řetězu držícího vůz. V úvodní části je vysvětlen důvod užití zádržných systémů, dále vznik problému, díky kterému je nutné současný sloupek optimalizovat, a nakonec rozdělení zádržných systémů. Druhá část obsahuje výpočty týkající se stávajícího řešení sloupku a výstupem je graf popisující rozsah užití tohoto řešení. Třetí část je zaměřena na experiment, jeho přípravu a samotné měření na zkušebním válcovém dynamometru. Čtvrtá část obsahuje návrh nového řešení sloupku a objímky na základě analytických výpočtů upravených dle poznatků z experimentu a obdobně vytvořeného MKP modelu.This master thesis is focused on optimalization of a retaining system column used on chassis dynamometers. Further on adjustment of a clip, which is used for hanging up of a chain, which retains a car. In the first part a reason of using retaining system is explained, after that an issue is described and whole part is finished by sorting of retaining systems. The second part contains calculations regards to the original column and output is a graph describing range of use of the original column. The third part is focused on preparation of an experiment, calibration of tenzometric senzors and measurement itself on a trial chassis dynamometer. The fourth part contains design of the new column and clip on base of analytical calculations adjusted according the experiment and likewise created FEM model.347 - Katedra částí a mechanismů strojůvýborn

Alignment of patient and primary care practice member perspectives of chronic illness care: a cross-sectional analysis

Polly H. Noel and Luci K. Leykum are with the South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA -- Polly H. Noel, Ray F. Palmer, Raquel L. Romero, Luci K. Leykum, Holly J. Lanham, and Krista W. Bowers are with the Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA -- Michael L. Parchman is with the MacColl Center for Healthcare Innovation, Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave 1600, Seattle, WA 98101, USA -- Holly J. Leykum is with the The McCombs School of Business, The University of Texas at Austin, 2110 Speedway, Stop B6000, Austin, TX 78712, USA -- John E. Zeber is with the Central Texas Veterans Health Care System, 1901 S. 1st St, Temple, TX 76504, USA and Scott and White Healthcare Center for Applied Health Research, 2401 S. 31st St, Temple, TX 76508, USABackground: Little is known as to whether primary care teams’ perceptions of how well they have implemented the Chronic Care Model (CCM) corresponds with their patients’ own experience of chronic illness care. We examined the extent to which practice members’ perceptions of how well they organized to deliver care consistent with the CCM were associated with their patients’ perceptions of the chronic illness care they have received. Methods: Analysis of baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM in small, community-based primary care practices. All practice “members” (i.e., physician providers, non-physician providers, and staff) completed the Assessment of Chronic Illness Care (ACIC) survey and adult patients with 1 or more chronic illnesses completed the Patient Assessment of Chronic Illness Care (PACIC) questionnaire. Results: Two sets of hierarchical linear regression models accounting for nesting of practice members (N = 283) and patients (N = 1,769) within 39 practices assessed the association between practice member perspectives of CCM implementation (ACIC scores) and patients’ perspectives of CCM (PACIC). ACIC summary score was not significantly associated with PACIC summary score or most of PACIC subscale scores, but four of the ACIC subscales were consistently associated with PACIC summary score and the majority of PACIC subscale scores after controlling for patient characteristics. The magnitude of the coefficients, however, indicates that the level of association is weak. Conclusions: The ACIC and PACIC scales appear to provide complementary and relatively unique assessments of how well clinical services are aligned with the CCM. Our findings underscore the importance of assessing both patient and practice member perspectives when evaluating quality of chronic illness care.Information, Risk, and Operations Management (IROM)[email protected]

Implementation research design: integrating participatory action research into randomized controlled trials

Luci K. Leykum and Jacqueline A. Pugh are with VERDICT, a VA HSRD REAP at the South Texas Veterans Health Care System, San Antonio, Texas, USA and the Department of Medicine, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA -- Joel Harmon is with the School of Business, Fairleigh Dickinson University, Madison, New Jersey, USA -- Holly J. Lanham and Reuben R. McDaniel Jr. are with the Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, Austin, Texas, USABackground: A gap continues to exist between what is known to be effective and what is actually delivered in the usual course of medical care. The goal of implementation research is to reduce this gap. However, a tension exists between the need to obtain generalizeable knowledge through implementation trials, and the inherent differences between healthcare organizations that make standard interventional approaches less likely to succeed. The purpose of this paper is to explore the integration of participatory action research and randomized controlled trial (RCT) study designs to suggest a new approach for studying interventions in healthcare settings. Discussion: We summarize key elements of participatory action research, with particular attention to its collaborative, reflective approach. Elements of participatory action research and RCT study designs are discussed and contrasted, with a complex adaptive systems approach used to frame their integration. Summary: The integration of participatory action research and RCT design results in a new approach that reflects not only the complex nature of healthcare organizations, but also the need to obtain generalizeable knowledge regarding the implementation process.Information, Risk, and Operations Management (IROM)[email protected]

Features of successful academic hospitalist programs: Insights from the SCHOLAR (SuCcessful HOspitaLists in academics and research) project

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/1/jhm2603.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/2/jhm2603-sup-0004-suppinfo4.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/3/jhm2603-sup-0001-suppinfo1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/4/jhm2603-sup-0010-suppinfo10.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/5/jhm2603-sup-0006-suppinfo6.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/6/jhm2603-sup-0005-suppinfo5.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/7/jhm2603-sup-0009-suppinfo9.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/8/jhm2603-sup-0012-suppinfo12.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/9/jhm2603-sup-0003-suppinfo3.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/10/jhm2603-sup-0002-suppinfo2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/11/jhm2603_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/12/jhm2603-sup-0008-suppinfo8.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/13/jhm2603-sup-0011-suppinfo11.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/14/jhm2603-sup-0007-suppinfo7.pd

Survey of overnight academic hospitalist supervision of trainees

In 2003, Accreditation Council for Graduate Medical Education (ACGME) announced the first in a series of guidelines related to the residency training. The most recent recommendations include explicit recommendations regarding the provision of on‐site clinical supervision for trainees of internal medicine. To meet these standards, many internal medicine residency programs turned to hospitalist programs to fill that need. However, much is unknown about the current relationships between hospitalist and residency programs, specifically with regard to supervisory roles and supervision policies. We aimed to describe how academic hospitalists currently supervise housestaff during the on‐call, or overnight, period and hospitalist program leader their perceptions of how these new policies would impact trainee‐hospitalist interactions. Journal of Hospital Medicine 2012; © 2012 Society of Hospital MedicinePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93713/1/1961_ftp.pd

Tried and true: A survey of successfully promoted academic hospitalists

BACKGROUND: Academic hospital medicine is a new and rapidly growing field. Hospitalist faculty members often fill roles not typically held by other academic faculty, maintain heavy clinical workloads, and participate in nontraditional activities. Because of these differences, there is concern about how academic hospitalists may fare in the promotions process. OBJECTIVE: To determine factors critical to the promotion of successfully promoted hospitalists who have achieved the rank of either associate professor or professor. DESIGN: A cross‐sectional survey. PARTICIPANTS: Thirty‐three hospitalist faculty members at 22 academic medical centers promoted to associate professor rank or higher between 1995 and 2008. MEASUREMENTS: Respondents were asked to describe their institution, its promotions process, and the activities contributing to their promotion. We identified trends across respondents. RESULTS: Twenty‐six hospitalists responded, representing 20 institutions (79% response rate). Most achieved promotion in a nontenure track (70%); an equal number identified themselves as clinician‐administrators and clinician educators (40%). While hospitalists were engaged in a wide range of activities in the traditional domains of service, education, and research, respondents considered peer‐reviewed publication to be the most important activity in achieving promotion. Qualitative responses demonstrated little evidence that being a hospitalist was viewed as a hindrance to promotion. CONCLUSIONS: Successful promotion in academic hospital medicine depends on accomplishment in traditional academic domains, raising potential concerns for academic hospitalists with less traditional roles. This study may provide guidance for early‐career academic hospitalists and program leaders. Journal of Hospital Medicine 2011. © 2011 Society of Hospital MedicinePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86910/1/894_ftp.pd

Reciprocal learning and chronic care model implementation in primary care: results from a new scale of learning in primary care

<p>Abstract</p> <p>Background</p> <p>Efforts to improve the care of patients with chronic disease in primary care settings have been mixed. Application of a complex adaptive systems framework suggests that this may be because implementation efforts often focus on education or decision support of individual providers, and not on the dynamic system as a whole. We believe that learning among clinic group members is a particularly important attribute of a primary care clinic that has not yet been well-studied in the health care literature, but may be related to the ability of primary care practices to improve the care they deliver.</p> <p>To better understand learning in primary care settings by developing a scale of learning in primary care clinics based on the literature related to learning across disciplines, and to examine the association between scale responses and chronic care model implementation as measured by the Assessment of Chronic Illness Care (ACIC) scale.</p> <p>Methods</p> <p>Development of a scale of learning in primary care setting and administration of the learning and ACIC scales to primary care clinic members as part of the baseline assessment in the ABC Intervention Study. All clinic clinicians and staff in forty small primary care clinics in South Texas participated in the survey.</p> <p>Results</p> <p>We developed a twenty-two item learning scale, and identified a five-item subscale measuring the construct of reciprocal learning (Cronbach alpha 0.79). Reciprocal learning was significantly associated with ACIC total and sub-scale scores, even after adjustment for clustering effects.</p> <p>Conclusions</p> <p>Reciprocal learning appears to be an important attribute of learning in primary care clinics, and its presence relates to the degree of chronic care model implementation. Interventions to improve reciprocal learning among clinic members may lead to improved care of patients with chronic disease and may be relevant to improving overall clinic performance.</p

The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure

Luci K. Leykum, Jacqueline Pugh, Valerie Lawrence, and Polly H. Noel are with the South Texas Veterans Health Care System and Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio TX, 78229, USA -- Michael Parchman is with the South Texas Veterans Health Care System and Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio TX, 78229, USA -- Reuben R. McDaniel Jr. is with the McComb's School of Business, University of Texas at Austin, Austin TX, USABackground: Despite applications of models of care and organizational or system-level interventions to improve patient outcomes for chronic disease, consistent improvements have not been achieved. This may reflect a mismatch between the interventions and the nature of the settings in which they are attempted. The application of complex adaptive systems (CAS) framework to understand clinical systems and inform efforts to improve them may lead to more successful interventions. We performed a systematic review of interventions to improve outcomes of patients with congestive heart failure (CHF) to examine whether interventions consistent with CAS are more likely to be effective. We then examine differences between interventions that are most effective for improving outcomes for patients with CHF versus previously published data for type 2 diabetes to explore the potential impact of the nature of the disease on the types of interventions that are more likely to be effective. Methods: We conducted a systematic review of the literature between 1998 and 2008 of organizational interventions to improve care of patients with CHF. Two independent reviewers independently assessed studies that met inclusion criteria to determine whether each reported intervention reflected one or more CAS characteristics. The effectiveness of interventions was rated as either 0 (no effect), 0.5 (mixed effect), or 1.0 (effective) based on the type, number, and significance of reported outcomes. Fisher's exact test was used to examine the association between CAS characteristics and intervention effectiveness. Specific CAS characteristics associated with intervention effectiveness for CHF were contrasted with previously published data for type 2 diabetes. Results and discussion: Forty-four studies describing 46 interventions met eligibility criteria. All interventions utilized at least one CAS characteristic, and 85% were either 'mixed effect' or 'effective' in terms of outcomes. The number of CAS characteristics present in each intervention was associated with effectiveness (p < 0.001), supporting the idea that interventions consistent with CAS are more likely to be effective. The individual CAS characteristics associated with CHF intervention effectiveness were learning, self-organization, and co-evolution, a finding different from our previously published analysis of interventions for diabetes. We suggest this difference may be related to the degree of uncertainty involved in caring for patients with diabetes versus CHF. Conclusion: These results suggest that for interventions to be effective, they must be consistent with the CAS nature of clinical systems. The difference in specific CAS characteristics associated with intervention effectiveness for CHF and diabetes suggests that interventions must also take into account attributes of the disease.McCombs School of [email protected]