High Technical Performance Research Articles

Electronic clinical quality measure reporting challenges: findings from the Medicare EHR Incentive Program's Controlling High Blood Pressure Measure.

To identify physician and practice characteristics associated with high clinical and technical performance on the electronic clinical quality measure (eCQM) that calculates the proportion of patients with hypertension who have controlled blood pressure. The study included 268 602 physicians participating in the Medicare Electronic Health Record Incentive Program between 2011 and 2014. Independent variables included delivery reform participation and physician, practice level, and area characteristics. Successful technical performance was a reported eCQM with non-zero values in both the numerator and denominator. Successful clinical performance was a reported eCQM value of ≥70% hypertension control. Physicians with longer experience using certified health information technology, participants in delivery reform programs, and specialists that traditionally manage hypertension were 5%-15% more likely to achieve 70% control. Physicians in smaller and rural practices and a subset of physicians unlikely to primarily manage hypertension were more likely to submit measures with a zero value in either the numerator or denominator. More physicians are using eCQMs to track and report their quality improvement efforts. This research presents the first examination of national eCQM data to identify physician and practice-level characteristics associated with performance. With careful selection of measures relevant to the clinician's specialty, complete data entry, and support for continuous quality improvement, health care professionals can excel technically and clinically. As care delivery transitions from fee-for-service to quality- and value-based models, high performers may realize financial gains and better patient outcomes. These analyses suggest patterns that may inform steps to improve performance.

Immediate and short-term performance of a novel sirolimus-coated balloon during complex percutaneous coronary interventions. The FAtebenefratelli SIrolimus COated-balloon (FASICO) registry.

Drug-coated balloons (DCB) currently represent an alternative to drug-eluting stents (DES) for the treatment of in-stent restenosis and they are also variably used for small coronary vessel and bifurcation lesion management. All DCB variably elute paclitaxel as an anti-proliferative drug. The first sirolimus coated balloon (SCB) received the CE mark in 2016, but its clinical performance has not been shown yet. FASICO in an all-comer registry of the first consecutive patients with at least one lesion treated with SCB between March and July 2016 at the first European centre that used this device. All patients were prospectively enrolled in a dedicated database. Primary endpoint was procedural success; co-primary endpoint was the rate of major adverse cardiac events at short-term follow-up. The 32 patients (34 lesions) enrolled had at least 6-month clinical follow up available. Forty-five percent had diabetes and indication to PCI was ISR in 47% of the cases. Lesions were always pre-dilated and device deployment was successful in all the cases. Procedural success was achieved in 100% of patients. We observed 3 cases of TLR at follow-up. SCB shows high immediate technical performance and adequate short-term efficacy and safety. The ongoing EASTBOURNE registry will shed light on mid-and long-term performance of this device in an adequately powered population.

Analysis of technical efficiency and eco-efficiency in container terminals

This paper shows the results of performance assessments of 15 container terminals in Brazil, considering both eco-efficiency and technical efficiency measures. It was necessary to determine indicators and measures in order to apply a multi-criteria decision-making technique known as grey relational analysis, to aggregate values that have different scales and units of measurement and to rank the container terminals according to their performance levels. It was possible to determine that higher performance levels in eco-efficiency do not, necessarily, mean that higher technical performance is taking place. Variations in the weights assigned to technical efficiency and eco-efficiency measures might influence the performance ranking of the terminals.

Analysis of technical efficiency and eco-efficiency in container terminals

This paper shows the results of performance assessments of 15 container terminals in Brazil, considering both eco-efficiency and technical efficiency measures. It was necessary to determine indicators and measures in order to apply a multi-criteria decision-making technique known as grey relational analysis, to aggregate values that have different scales and units of measurement and to rank the container terminals according to their performance levels. It was possible to determine that higher performance levels in eco-efficiency do not, necessarily, mean that higher technical performance is taking place. Variations in the weights assigned to technical efficiency and eco-efficiency measures might influence the performance ranking of the terminals.

Method and application of characterisation of life cycle impact data of construction materials using geographic information systems

This research presents a methodology to characterize life cycle impact data (LCIA) of alternative construction materials outside of the European context. This methodology was based on the characterization of data and life cycle assessment (LCA) using geographic information systems (GIS), which has been proposed as an effective alternative for this purpose. The data were characterized at three levels: global, represented by different production efficiency of materials; regional, represented by the type of electricity mix used in the production and the national transport at the country level; and local, represented by external factors, such as seismic and wind risk zones at the city level. A comparative LCA was used as case study to test the methodology. The functional unit for the LCA was defined as an 18 m2 core shelter unit consisting of structural elements only. The bill of materials for five designs were calculated, each using a distinctive construction material: bamboo, brick, concrete hollow block, ferro-cement panels, and soil-stabilised bricks. The contributions’ variability and uncertainty analysis were used to validate the consistency of the results. The effect of the external constraints (earthquakes and wind) were analysed, and the environmental impact over the whole life cycle was assessed. Five house designs were calculated in twenty locations based on three levels of production efficiency and three transport distance ranges for each country. The results of the bamboo, concrete hollow block and ferro-cement houses overlapped and changed depending on the construction materials’ transport distance. Therefore, the level of impact of an average bamboo house can also be achieved by a high-performance block or ferro-cement house. The results showed that in most cases, the buildings with high technical performance can be achieved with low environmental impacts. The use of GIS enables the development of characterized LCIA data for construction materials and buildings with a high degree of consistency. Moreover, the proposed approach was able to accurately represent the range of production practices used outside Europe. Finally, the use of the proposed methodology allows for the assessment of building in the early stages of design when uncertainty is at its highest, thereby identifying the improvement potential of each design and recognising the structural needs in specific locations.

Numerical modelling of porous cement-based materials by superabsorbent polymers

The development of new cementitious materials raises new challenges with regard to structural design. One of the potential applications of superabsorbent polymers (SAP) is to deliver well-defined porosity to cement systems. This is particularly interesting for the development of porous cement-based materials with high technical performance. In this paper, a numerical approach to model the basic mechanical properties of the porous cement with SAP is developed. The modelling approach is based on computational micromechanics and uses a representative volume element that emulates the microstructure of the cement-based material to determine the overall material response and the local behaviour. Using this approach several sensitivity analyses are undertaken examining various parameters. The modelling approach is compared with experimental results showing reasonable correlation. The proposed approach provides faster and cheaper tool to design porous materials due to a reduction in the required experimental effort.

Radiothérapie guidée par l’image pour les petits animaux : une nouvelle ère pour les études précliniques

Preclinical external beam radiotherapy irradiations used to be delivered with a static broad beam. To promote the transfer from animal to man, the preclinical treatment techniques dedicated to the animal have been optimized to be similar to those delivered to patients in clinical practice. In this context, preclinical irradiators have been developed. Due to the small sizes of the animals, and the irradiation beams, the scaling to the small animal dimensions involves specific problems. Reducing the size and energy of the irradiation beams require very high technical performance, especially for the mechanical stability of the irradiator and the spatial resolution of the imaging system. In addition, the determination of the reference absorbed dose rate must be conducted with a specific methodology and suitable detectors. To date, three systems are used for preclinical studies in France. The aim of this article is to present these new irradiators dedicated to small animals from a physicist point of view, including the commissioning and the quality control.

Global or local construction materials for post-disaster reconstruction? Sustainability assessment of twenty post-disaster shelter designs

The number and intensity of natural disasters is growing every year, with 394 major events affecting over 268 million people worldwide in the past decade. The objective of this study was to identify whether it is more appropriate to use local or global materials in post-disaster reconstruction projects. Twenty transitional shelters were identified over 11 different locations worldwide, and their environmental, economic, and mechanical/technical performances were compared. The environmental and economic assessments were based on life cycle cost and life cycle assessment. In the mechanical/technical assessments, the relationships between hazard zones and their performances were assessed for earthquakes, wind loads and floods. Sustainability was assessed using a benchmark system that incorporates the results from these three categories. The results show that shelters with high technical performance can be achieved with low price/low environmental impact per functional unit regardless of the type of material used. Local materials withhold higher potential for low environmental impacts and costs and global materials have higher potential to produce better technical performances. Although local constructive systems can provide the best compromise between environmental impacts and cost, their structural design requires more effort.

OPTIMIZATION ALGORITHM COIL DESIGN KILNS COLLECTIVELY HYDRODYNAMICS TWO-PHASE FLOW AND STRENGTH

In order to achieve high technical and economic performance of the kilns is paramount task of optimizing the design of the tubular coil. Optimization can be carried out by the technical-economic indicators operating kilns in general. In this case, for the optimization criteria can be taken such as: minimum unit costs of materials, subject to the specified performance and reliability indices; providing continuous and stable nominal plant capacity; the maximum yield of the desired products with minimum fuel consumption and energy resources. In this paper, E. Feigin, considered one of the tasks of optimizing the design of the coils, which is to calculate the optimal temperature trajectory along the length of the coil at a given technological parameters of governance. A large number of accidents at the tube furnace due to the depressurization of the tubular coil and the release of process fluid in the volume of the furnace. In this connection special importance is the optimization of conditions to reduce the probability of failure of the coil. Another aspect lies in the optimization of the optimal coil design process in order to reduce metal consumption while providing the required strength and rigidity conditions. The article discusses the most common form in the task of realizing the sequence and content of the various stages of optimization procedures coils using their mathematical counterparts, obtained by computer simulation using ANSYS software system and FlowVision. Determine the direction of the coil and its optimization criteria. We consider algorithms for optimization of the coil according to the velocity of product yield from the oven and provide the desired strength.

Effect of Calcination Temperature on the Pozzolanic Activity of Brazilian Sugar Cane Bagasse Ash (SCBA)

This study evaluated the feasibility of using sugar cane bagasse ash (SCBA), a by-product of the sugar cane ethanol industry, obtained under controlled calcination as a partial replacement for Portland cement in mortars. Materials with pozzolanic characteristics may be used to partially replace cement in mortars or concrete and are known to provide durability to the products. Initially, TG/DTA curves of the sugar cane bagasse were conducted to define suitable calcination temperatures (500oC, 600oC and 700oC), and tests were conducted to characterize the physical-chemical parameters of the SCBA and the pozzolanic activity according to NP EN 196-5. The results showed the technical feasibility of using the SCBA as a pozzolanic material in construction, which would provide an alternative to proper disposal for this waste while providing products with high technical performance.

Complementarities and competition: Unpacking the drivers of entrants' technology choices in the solar photovoltaic industry

Entrants in new industries pursue distinct technologies in hopes of winning the technology competition and achieving sustainable competitive advantage. We draw on the complementary assets framework to predict entrants' technology choices in an emerging industry. Evidence from the global solar photovoltaic industry supports our arguments that entrants are more likely to choose technologies with higher technical performance and for which key complementary assets are available in the ecosystem. However, diversifying entrants are more likely to trade off superior performance for complementary asset availability whereas start‐up entrants are more likely to trade off complementary asset availability for superior performance. This difference is largely due to diversifying entrants with pre‐entry capabilities related to the industry. The study offers a novel illustration of how complementarities and competition shape entry strategies. Copyright © 2013 John Wiley & Sons, Ltd.

Innovative Technology for Multifunctionalization of Cotton Fabric through Cellulase Biotreatment, Reactive Dyeing and Easy Care Finishing

INNOVATIVE technology for preparation of multifunctionalized ….. cotton fabrics with high technical performance was established. The innovation entailed the following consecutive sequence: cotton fabrics were subjected to cellulase biotreatment followed by reactive dyeing then easy care finishing treatment. pH was adjusted at 7 before commencing dyeing and finishing. No washing or drying was involved in the sequence. The so obtained fabrics displayed high technical performance as monitored by color strength, wrinkle recovery angle, retained strength in addition to softness and smoothness. Anchoring the enzyme to the cotton fabric ought to be taken as one of the reasons accounting for such high performance. It is believed that the enzyme protein molecules are fixed and immobilized within the molecules structure of cotton via their attachment to the cellulose hydroxyls by the finish molecules. The latter acts as bridges connecting the protein molecules of the enzyme with the cellulose macromolecules of the cotton fabric.

Simulation on Control Strategies of Hybrid Energy Storage

Hybrid energy storage system, applied in micro-grid, can bring a higher technical performance. A hybrid energy storage system, including batteries and super-capacitors, is presented in this paper. For maintaining the micro-grid stability, the control strategy of the hybrid energy storage system is divided into two layers:central control systemandlocal control system. The central control system is used to calculate the total output power which the micro-grid wants, and the local control system is used to divide the total output power signal into a frequent fluctuant part and a smooth part, and control the super-capacitors inverters and the batteries inverters to output with these two power signals respectively. With the example system in PSCAD/EMTDC, it proves the effectiveness and feasibility of the control strategy.

Conservation, invention, distribution

Purpose – The purpose of this paper is to focus on the professional activity development of prop makers. These professionals are responsible for creating a huge variety of objects for the stage, ranging from furniture and soft furnishings to weapons, statues, jewelry and animated models. A feature of the work is to create objects that are new almost every time. In Western Switzerland, there is neither initial training nor continuing education for the profession of prop maker. Therefore the aim of this study is to better understand the professional practices and informal learning of prop makers at the Grand Théâtre de Genève. Design/methodology/approach – Given their interest in the details of how work is learned and carried out, the authors used ethnographic methods to study the prop makers' working practices. These methods place an emphasis on the detailed observation of practices through intensive, long-term involvement. The fieldwork began in November 2005 and ended in May 2007. This period was organized into three phases articulating direct observation and participant observation. The data were processed according to the methodology of grounded theory. Theoretical sensitivity came from a number of sources; however, French-speaking ergonomics, and particularly the course-of-action theoretical framework, have largely determined our conception of activity and workplace learning. Findings – The results allowed the authors to identify the core of a substantive theory of prop makers' activity and self-construction. Three components formed the core of this theory: conservation, invention, and distribution (CID). These three components are essential to understanding how prop makers are able to achieve, maintain and develop professional expertise both individually and collectively in the near total absence of initial and ongoing training and in a context of constant demand for high technical performance. Research limitations/implications – Despite the limitations of this study and the need for caution, the study seems to have two main implications. First, it leads to the reaxamination of the concept of informal learning and to assume the self-constructive dimension of activity. Second, it encourages studies to question the triple developmental process: technical, individual, and collective. Further studies are needed to better understand the triple process of individuation (technical, individual and collective) that operates in work situations and to test the heuristic power of this notion to account for learning and development in the workplace. Originality/value – The originality of this work is to address the issue of professional development in relation to the work of Simondon Gilbert on technical invention and his theory of individuation.

A New Fast Silicon Photomultiplier Photometer11Based on observations made with the 152 cm Cassini telescope at the Loiano station of the Bologna Observatory and with the 50 cm telescope of the Università di Roma “La Sapienza” at Vallinfreda (Rome).

ABSTRACTThe realization of low-cost instruments with high technical performance is a goal that deserves some efforts in an epoch of fast technological developments; indeed, such instruments can be easily reproduced and therefore allow new research programs to be opened in several observatories. We realized a fast optical photometer based on the SiPM technology, using commercially available modules. Using low-cost components, we have developed a custom electronic chain to extract the signal produced by a commercial MPPC module produced by Hamamatsu Photonics, in order to obtain submillisecond sampling of the light curve of astronomical sources (typically, pulsars). In the early 2011 February, we observed the Crab pulsar with the Cassini telescope with our prototype photometer, deriving its period and power spectrum and the shape of its light curve, in very good agreement with the results obtained in the past with other instruments.

Wertheim-Meigs operation for cervical cancer and complementary therapy: critical analysis of 5 years

Review and critical analysis of the Wertheim-Meigs Operations performed at our institution in the context of cervical cancer and to assess the proportion who underwent treatment with adjuvant radiotherapy (with or without chemotherapy) and the main indications. Retrospective review of Wertheim-Meigs operations, conducted in the context of carcinoma of the cervix, between 01.01.2005 and 31.12.2010, through consultation with clinical processes. It was later performed a descriptive statistical analysis of the cases. During this period 119 Wertheim-Meigs Operations were performed. Four were excluded: two, for primary indication for adjuvant therapy due to histological subtype; two for the inability to exclude invasive disease preoperatively and the invasion was not confirmed after surgery. A total of 115 cases were reviewed and analyzed, and of these 50 (43.5%) underwent complementary therapy, the main indication being the presence of lymphovascular invasion in 21 cases (42% of cases submitted to complementary therapy ). The mean age of patients undergoing radical surgery is 49 years, with stage IB1 most often determining its performance. Complementary therapy was performed in 43.5% of cases, the main indication being lymphovascular invasion (42%) followed by lymph node invasion (16%). Internal audit to the Service is satisfactory, with 16.5% surgical complication rate and high technical performance.

Strategies for Tax Teaching: A Teams Based Approach

This paper examines an experiment in team based learning (TBL) undertaken with undergraduate business and law students studying taxation law. The paper found that TBL produced many benefits for university students and teachers, as well as employers. TBL aided educational outcomes, as seen by the high levels technical performance and participation. TBL encouraged group development. For university teachers, TBL worked to transform the joy of teaching.

Influence of composition on mechanical behaviour of porcelain tile. Part I: Microstructural characterization and developed phases after firing

The porcelain tile is a ceramic product with high technical and aesthetic performance, whose composition is formulated from a mixture of clay or kaolin, quartz and feldspar. This paper is the first part of a study focusing on determining the influence of the porcelain tile composition on mechanical behaviour of sintered bodies. Seven compositions were prepared according to a simplex-centroid mixture design for a triaxial mixture, comprised of kaolinite, quartz and albite. The mixtures were processed reproducing industrial conditions: wet mixing followed by spray-drying, forming by pressing and fast firing with maximum temperatures ranged from 1210 to 1260 °C. The presence of kaolinite increases the dry apparent density in a significant way up to 30 wt%. Because of the fast firing, the microstructure is directly influenced by particle packing after forming. The internal porosity presented little change as a function of starting composition in the tested intervals. The surface porosity of the polished product increased with higher amounts of quartz. The results obtained in this first part of the study showed how the starting and end composition could generate the microstructure and suggest its influence on the mechanical properties of the porcelain tile, which will be later analysed in the second part of this paper.

Techno-economic assessment of pulverized coal boilers and IGCC power plants with CO2 capture

The current studies on power plant technologies suggest that Integrated Gasification Combined Cycle (IGCC) systems are an effective and economic CO2 capture technology pathway. In addition, the system in conventional configuration has the advantage of being more “CO2 capture ready” than other technologies. Pulverized coal boilers (PC) have, however, proven high technical performance attributes and are economically often most practical technologies. To highlight the pros and cons of both technologies in connection with an integrated CO2 capture, a comparative analysis of ultrasupercritical PC and IGCC is carried out in this paper. The technical design, the mass and energy balance and the system optimizations are implemented by using the ECLIPSE chemical plant simulation software package. Built upon these technologies, the CO2 capture facilities are incorporated within the system. The most appropriate CO2 capture systems for the PC system selected for this work are the oxy-fuel system and the postcombustion scheme using Monoethanolamine solvent scrubber column (MEA). The IGCC systems are designed in two configurations: Water gas shift reactor and Selexol-based separation. Both options generate CO2-rich and hydrogen rich-gas streams. Following the comparative analysis of the technical performance attributes of the above cycles, the economic assessment is carried out using the economic toolbox of ECLIPSE is seamlessly connected to the results of the mass and energy balance as well as the utility usages. The total cost assessment is implemented according to the step-count exponential costing method using the dominant factors and/or a combination of parameters. Subsequently, based on a set of assumptions, the net present value estimation is implemented to calculate the breakeven electricity selling prices and the CO2 avoidance cost.

Development and adoption of TVS-2M for advanced fuel cycles

Many technical problems must be solved in order to adopt advanced fuel cycles at nuclear power plants with VVER-1000 reactors. The TVS-2 structure was initially developed in the process of solving these problems; it gave high technical performance and cost-effectiveness and provided a base for subsequent upgrading. The TVS-2M structure with a larger fuel load was developed on the basis of tested and new technological solutions to maximize fuel utilization in VVER-1000 reactors.