A qualitative study of the relationship between clinician attributes, organization, and patient characteristics on implementation of a disease management program

The purpose of this study was to examine the challenges of integrating an asthma disease management (DM) program into a primary care setting from the perspective of primary care practitioners. A second goal was to examine whether barriers differed between urban-based and nonurban-based practices. Using a qualitative design, data were gathered using focus groups in primary care pediatric practices. A purposeful sample included an equal number of urban and nonurban practices. Participants represented all levels in the practice setting. Important themes that emerged from the data were coded and categorized. A total of 151 individuals, including physicians, advanced practice clinicians, registered nurses, other medical staff, and nonmedical staff participated in 16 focus groups that included 8 urban and 8 nonurban practices. Content analyses identified 4 primary factors influencing the implementation of a DM program in a primary care setting. They were related to providers, the organization, patients, and characteristics of the DM program. This study illustrates the complexity of the primary care environment and the challenge of changing practice in these settings. The results of this study identified areas in a primary care setting that influence the adoption of a DM program. These findings can assist in identifying effective strategies to change clinical behavior in primary care practices. © 2008 Mary Ann Liebert, Inc.

Stability Analysis and Implementation of a Decentralized Formation Control Strategy for Unmanned Vehicles

This paper presents a new methodology for solving the multi-vehicle formation control problem. It employs a unique extension-decomposition-aggregation scheme to transform the overall complex formation control problem into a group of subproblems, which work via boundary interactions or disturbances. Thus, it is proved that the overall formation system is exponentially stable in the sense of Lyapunov, if all the individual augmented subsystems (IASs) are stable. Linear matrix inequality-based H8 control methodology is employed to design the decentralized formation controllers to reject the impact of the formation changes being treated as boundary disturbances and guarantee the stability of all the IASs, consequently maintaining the stability of the overall formation system. Simulation studies are performed to verify the stability, performance, and effectiveness of the proposed strategy.

Are We Ready for SDN? Implementation Challenges for Software-Defined Networks

Cloud services are exploding, and organizations are converging their data centers in order to take advantage of the predictability, continuity, and quality of service delivered by virtualization technologies. In parallel, energy-efficient and high-security networking is of increasing importance. Network operators, and service and product providers require a new network solution to efficiently tackle the increasing demands of this changing network landscape. Software-defined networking has emerged as an efficient network technology capable of supporting the dynamic nature of future network functions and intelligent applications while lowering operating costs through simplified hardware, software, and management. In this article, the question of how to achieve a successful carrier grade network with software-defined networking is raised. Specific focus is placed on the challenges of network performance, scalability, security, and interoperability with the proposal of potential solution directions.

Implementation and Evaluation of Measurement-Based Admission Control Schemes Within a Converged Networks QoS Management Framework

Policy-based network management (PBNM) paradigms provide an effective tool for end-to-end resource
management in converged next generation networks by enabling unified, adaptive and scalable solutions
that integrate and co-ordinate diverse resource management mechanisms associated with heterogeneous
access technologies. In our project, a PBNM framework for end-to-end QoS management in converged
networks is being developed. The framework consists of distributed functional entities managed within a
policy-based infrastructure to provide QoS and resource management in converged networks. Within any
QoS control framework, an effective admission control scheme is essential for maintaining the QoS of
flows present in the network. Measurement based admission control (MBAC) and parameter basedadmission control (PBAC) are two commonly used approaches. This paper presents the implementationand analysis of various measurement-based admission control schemes developed within a Java-based
prototype of our policy-based framework. The evaluation is made with real traffic flows on a Linux-based experimental testbed where the current prototype is deployed. Our results show that unlike with classic MBAC or PBAC only schemes, a hybrid approach that combines both methods can simultaneously result in improved admission control and network utilization efficiency

Design and Implementation of a Measurement-Based Policy-Driven Resource Management Framework For Converged Networks

This paper presents the design and implementation of a measurement-based QoS and resource management framework, CNQF (Converged Networks’ QoS Management Framework). CNQF is designed to provide unified, scalable QoS control and resource management through the use of a policy-based network
management paradigm. It achieves this via distributed functional entities that are deployed to co-ordinate the resources of the transport network through centralized policy-driven decisions supported by measurement-based control architecture. We present the CNQF architecture, implementation of the
prototype and validation of various inbuilt QoS control mechanisms using real traffic flows on a Linux-based experimental test bed.

Secure Implementation in Production Economies

This paper shows that, in production economies, the generalized serial social choice functions defined by Shenker (1992) are securely implementable (in the sense of Saijo et al., 2007) and that they include the well-known fixed path social choice functions.

Implementation of phantom-less IMRT delivery verification using Varian DynaLog files and R/V output

This study aims to evaluate the use of Varian radiotherapy dynamic treatment log (DynaLog) files to verify IMRT plan delivery as part of a routine quality assurance procedure. Delivery accuracy in terms of machine performance was quantified by multileaf collimator (MLC) position errors and fluence delivery accuracy for patients receiving intensity modulated radiation therapy (IMRT) treatment. The relationship between machine performance and plan complexity, quantified by the modulation complexity score (MCS) was also investigated. Actual MLC positions and delivered fraction of monitor units (MU), recorded every 50 ms during IMRT delivery, were extracted from the DynaLog files. The planned MLC positions and fractional MU were taken from the record and verify system MLC control file. Planned and delivered beam data were compared to determine leaf position errors with and without the overshoot effect. Analysis was also performed on planned and actual fluence maps reconstructed from the MLC control file and delivered treatment log files respectively. This analysis was performed for all treatment fractions for 5 prostate, 5 prostate and pelvic node (PPN) and 5 head and neck (H&N) IMRT plans, totalling 82 IMRT fields in ∼5500 DynaLog files. The root mean square (RMS) leaf position errors without the overshoot effect were 0.09, 0.26, 0.19 mm for the prostate, PPN and H&N plans respectively, which increased to 0.30, 0.39 and 0.30 mm when the overshoot effect was considered. Average errors were not affected by the overshoot effect and were 0.05, 0.13 and 0.17 mm for prostate, PPN and H&N plans respectively. The percentage of pixels passing fluence map gamma analysis at 3%/3 mm was 99.94 ± 0.25%, which reduced to 91.62 ± 11.39% at 1%/1 mm criterion. Leaf position errors, but not gamma passing rate, were directly related to plan complexity as determined by the MCS. Site specific confidence intervals for average leaf position errors were set at -0.03-0.12 mm for prostate and -0.02-0.28 mm for more complex PPN and H&N plans. For all treatment sites confidence intervals for RMS errors with the overshoot was set at 0-0.50 mm and for the percentage of pixels passing a gamma analysis at 1%/1 mm a confidence interval of 68.83% was set also for all treatment sites. This work demonstrates the successful implementation of treatment log files to validate IMRT deliveries and how dynamic log files can diagnose delivery errors not possible with phantom based QC. Machine performance was found to be directly related to plan complexity but this is not the dominant determinant of delivery accuracy.

Rigorous Specification and Low-Latency Implementation of Technical Market Indicators

Technical market indicators are tools used by technical an- alysts to understand trends in trading markets. Technical (market) indicators are often calculated in real-time, as trading progresses. This paper presents a mathematically- founded framework for calculating technical indicators. Our framework consists of a domain specific language for the un- ambiguous specification of technical indicators, and a run- time system based on Click, for computing the indicators. We argue that our solution enhances the ease of program- ming due to aligning our domain-specific language to the mathematical description of technical indicators, and that it enables executing programs in kernel space for decreased latency, without exposing the system to users’ programming errors.