THEORETICAL VALIDATION OF TEST RESULTS FOR THE PRESSURE DROP VALUES OF CIRCULAR PINS WITH A MAXIMUM LENGTH TO DIAMETER RATIO OF 3.0 USING EXISTING EQUATIONS AND TEST DATA FOR HEAT EXCHANGER APPLICATION

Paper presented at the 8th International Conference on Heat Transfer, Fluid Mechanics and Thermodynamics, Mauritius, 11-13 July, 2011.Pins are a very common type of extended surface used in the field of heat transfer; their main use being in the electronics field. In this report, the use of pins as an extended surface is considered for a Heat Exchanger application in the aerospace field. The Heat Exchanger uses forced convective heat transfer mechanism for the dissipation of heat and the implicated fluid is air. For this application the pin layout and design is completely unique in that the pin’s maximum length to diameter ratio is 3.0 and the layout of the pins produces an X T value of 7, which has not been explored in any previous work. The Length: Diameter ratio of these new pins is very small when compared to the Length: Diameter ratios of tubes currently used in heat exchangers to enhance heat transfer. Moreover, the distance between the pins in this arrangement is much greater than those for the tubes. Testing has been performed on this pin design and the theoretical validation of those test results is one of the main aspects discussed in this report. Due to the innovative nature of the pin designs, there is insufficient existing test data or established equations that can be used. Assumptions are made in order to be able to apply the current equations for pressure drop calculations with valid justifications. The theoretical results for the total pressure drop show an average deviation of 6% from the test results for mass flow rates between 0.14 kg/s and 0.36 kg/s. The maximum pressure drop was found to be caused by the pins and it was in the range of 89%-91%of the total. In this article, the limitations of existing equations are discussed and the gap in the theoretical knowledge regarding novel pin designs is highlighted.mp201

Measuring patient-centered care for specific populations: A necessity for improvement

The measurement of patient-centered care (PCC) is a fundamental component of assessing and improving health care quality. There are a variety of PCC measures available which have been tailored to different health care conditions and settings. These distinct measures are valuable given the diversity of health conditions and contexts encountered in the health care system. However, the type of patient has received significantly less attention when measuring PCC despite the multitude of unique patient populations that exist. Specific patient populations raise several core challenges for PCC measurement to which researchers and practitioners need to attend: identifying what principles to measure, who is the most appropriate assessor, and how best to measure PCC. Examples of specific patient populations include geriatric patients, refugees, migrants and dyadic patients. Dyadic patients, such as the mother-infant dyad, are two individual, independent, yet inextricably linked patients who require simultaneous care. In this commentary, we use the mother-infant dyad as one example of a specific population to illustrate the challenges and argument for why additional specific patient populations warrant dedicated measures of PCC. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Theoretical validation of test results for the pressure drop values of circular pins with maximum length to diameter ratio of 3.0 using existing equations and test data for heat exchanger application

Paper presented at the 8th International Conference on Heat Transfer, Fluid Mechanics and Thermodynamics, Mauritius, 11-13 July, 2011.Pins are a very common type of extended surface used in the field of heat transfer; their main use being in the electronics field. In this report, the use of pins as an extended surface is considered for a Heat Exchanger application in the aerospace field. The Heat Exchanger uses forced convective heat transfer mechanism for the dissipation of heat and the implicated fluid is air. For this application the pin layout and design is completely unique in that the pin’s maximum length to diameter ratio is 3.0 and the layout of the pins produces an X T value of 7, which has not been explored in any previous work. The Length: Diameter ratio of these new pins is very small when compared to the Length: Diameter ratios of tubes currently used in heat exchangers to enhance heat transfer. Moreover, the distance between the pins in this arrangement is much greater than those for the tubes. Testing has been performed on this pin design and the theoretical validation of those test results is one of the main aspects discussed in this report. Due to the innovative nature of the pin designs, there is insufficient existing test data or established equations that can be used. Assumptions are made in order to be able to apply the current equations for pressure drop calculations with valid justifications. The theoretical results for the total pressure drop show an average deviation of 6% from the test results for mass flow rates between 0.14 kg/s and 0.36 kg/s. The maximum pressure drop was found to be caused by the pins and it was in the range of 89%-91%of the total. In this article, the limitations of existing equations are discussed and the gap in the theoretical knowledge regarding novel pin designs is highlighted.mp201

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Abstract Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.http://deepblue.lib.umich.edu/bitstream/2027.42/78272/1/1748-5908-4-50.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/2/1748-5908-4-50-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/3/1748-5908-4-50-S3.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/4/1748-5908-4-50-S4.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/5/1748-5908-4-50.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/6/1748-5908-4-50-S2.PDFPeer Reviewe

Ethnic and socioeconomic variation in incidence of congenital heart defects

Introduction: Ethnic differences in the birth prevalence of congenital heart defects (CHDs) have been reported; however, studies of the contemporary UK population are lacking. We investigated ethnic variations in incidence of serious CHDs requiring cardiac intervention before 1 year of age. Methods: All infants who had a cardiac intervention in England and Wales between 1 January 2005 and 31 December 2010 were identified in the national congenital heart disease surgical audit and matched with paediatric intensive care admission records to create linked individual child records. Agreement in reporting of ethnic group by each audit was evaluated. For infants born 1 January 2006 to 31 December 2009, we calculated incidence rate ratios (IRRs) for CHDs by ethnicity and investigated age at intervention, antenatal diagnosis and area deprivation. Results: We identified 5350 infants (2940 (55.0%) boys). Overall CHD incidence was significantly higher in Asian and Black ethnic groups compared with the White reference population (incidence rate ratios (IRR) (95% CIs): Asian 1.5 (1.4 to 1.7); Black 1.4 (1.3 to 1.6)); incidence of specific CHDs varied by ethnicity. No significant differences in age at intervention or antenatal diagnosis rates were identified but affected children from non-White ethnic groups were more likely to be living in deprived areas than White children. Conclusions: Significant ethnic variations exist in the incidence of CHDs, including for specific defects with high infant mortality. It is essential that healthcare provision mitigates ethnic disparity, including through timely identification of CHDs at screening, supporting parental choice and effective interventions. Future research should explore the factors underlying ethnic variation and impact on longer-term outcomes

Survival of infants born with esophageal atresia among 24 international birth defects surveillance programs

Background: Esophageal atresia (EA) affects around 2.3–2.6 per 10,000 births world-wide. Infants born with this condition require surgical correction soon after birth. Most survival studies of infants with EA are locally or regionally based. We aimed to describe survival across multiple world regions. Methods: We included infants diagnosed with EA between 1980 and 2015 from 24 birth defects surveillance programs that are members of the International Clearinghouse for Birth Defects Surveillance and Research. We calculated survival as the proportion of liveborn infants alive at 1 month, 1- and 5-years, among all infants with EA, those with isolated EA, those with EA and additional anomalies or EA and a chromosomal anomaly or genetic syndrome. We also investigated trends in survival over the decades, 1980s–2010s. Results: We included 6,466 liveborn infants with EA. Survival was 89.4% (95% CI 88.1–90.5) at 1-month, 84.5% (95% CI 83.0–85.9) at 1-year and 82.7% (95% CI 81.2–84.2) at 5-years. One-month survival for infants with isolated EA (97.1%) was higher than for infants with additional anomalies (89.7%) or infants with chromosomal or genetic syndrome diagnoses (57.3%) with little change at 1- and 5-years. Survival at 1 month improved from the 1980s to the 2010s, by 6.5% for infants with isolated EA and by 21.5% for infants with EA and additional anomalies. Conclusions: Almost all infants with isolated EA survived to 5 years. Mortality was higher for infants with EA and an additional anomaly, including chromosomal or genetic syndromes. Survival improved from the 1980s, particularly for those with additional anomalies

CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes

<p>Abstract</p> <p>Background</p> <p>Quality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occurs within the context of relationships and interactions among individuals. Thus, QI programs will not result in optimal changes in staff behavior unless the context for social learning is present. Accordingly, we developed CONNECT, an intervention to foster systematic use of management practices, which we propose will enhance effectiveness of a nursing home Falls QI program by strengthening the staff-to-staff interactions necessary for clinical problem-solving about complex problems such as falls. The study aims are to compare the impact of the CONNECT intervention, plus a falls reduction QI intervention (CONNECT + FALLS), to the falls reduction QI intervention alone (FALLS), on fall-related process measures, fall rates, and staff interaction measures.</p> <p>Methods/design</p> <p>Sixteen nursing homes will be randomized to one of two study arms, CONNECT + FALLS or FALLS alone. Subjects (staff and residents) are clustered within nursing homes because the intervention addresses social processes and thus must be delivered within the social context, rather than to individuals. Nursing homes randomized to CONNECT + FALLS will receive three months of CONNECT first, followed by three months of FALLS. Nursing homes randomized to FALLS alone receive three months of FALLs QI and are offered CONNECT after data collection is completed. Complexity science measures, which reflect staff perceptions of communication, safety climate, and care quality, will be collected from staff at baseline, three months after, and six months after baseline to evaluate immediate and sustained impacts. FALLS measures including quality indicators (process measures) and fall rates will be collected for the six months prior to baseline and the six months after the end of the intervention. Analysis will use a three-level mixed model.</p> <p>Discussion</p> <p>By focusing on improving local interactions, CONNECT is expected to maximize staff's ability to implement content learned in a falls QI program and integrate it into knowledge and action. Our previous pilot work shows that CONNECT is feasible, acceptable and appropriate.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00636675">NCT00636675</a></p

Aplicación de modelos de mejoramiento de procesos utilizando estudios de tiempos en el área de licitaciones de la empresa Mapfre Seguros

Trabajo de InvestigaciónEl trabajo va orientado a la elaboración de un plan de mejoramiento en un área específica de la empresa Mapfre Seguros. Este objetivo se logró después de hacer un análisis de la situación actual del área a través de varias herramientas de calidad, diagnóstico del proceso del área mediante un estudio de tiempos, y finalmente se realiza el diseño del plan de mejoramiento que permite perfeccionar el proceso del área investigadaINTRODUCCIÓN 1. GENERALIDADES 2. RECOPILACIÓN Y ANÁLISIS DE LA INFORMACIÓN 3. DIAGNÓSTICO DEL ÁREA DE LICITACIONES 4. PROPUESTA DE MEJORAMIENTO 5. CONCLUSIONES 6. RECOMENDACIONES BIBLIOGRAFÍA ANEXOSPregradoIngeniero Industria