DEVELOPMENT AND IMPLEMENTATION OF A REMOTE AUDIT TOOL FOR HIGH DOSE RATE (HDR) 192IR BRACHYTHERAPY USING OPTICALLY STIMULATED LUMINESCENCE DOSIMETRY

This work aimed to create a mailable and OSLD-based phantom with accuracy suitable for RPC audits of HDR brachytherapy sources at institutions participating in NCI-funded cooperative clinical trials. An 8 × 8 × 10 cm3 prototype with two slots capable of holding nanoDot Al2O3:C OSL dosimeters (Landauer, Glenwood, IL) was designed and built. The phantom has a single channel capable of accepting all 192Ir HDR brachytherapy sources in current clinical use in the United States. Irradiations were performed with an 192Ir HDR source to determine correction factors for linearity with dose, dose rate, and the combined effect of irradiation energy and phantom construction. The uncertainties introduced by source positioning in the phantom and timer resolution limitations were also investigated. It was found that the linearity correction factor was where dose is in cGy, which differed from that determined by the RPC for the same batch of dosimeters under 60Co irradiation. There was no significant dose rate effect. Separate energy+block correction factors were determined for both models of 192Ir sources currently in clinical use and these vendor-specific correction factors differed by almost 2.6%. For Nucletron sources, this correction factor was 1.026±0.004 (99% Confidence Interval) and for Varian sources it was 1.000±0.007 (99% CI). Reasonable deviations in source positioning within the phantom and the limited resolution of the source timer had insignificant effects on the ability to measure dose. Overall measurement uncertainty of the system was estimated to be ±2.5% for both Nucletron and Varian source audits (95% CI). This uncertainty was sufficient to establish a ±5% acceptance criterion for source strength audits under a formal RPC audit program. Trial audits of eight participating institutions resulted in an average RPC-to-institution dose ratio of 1.000 with a standard deviation of 0.011.

A review of the Malaria Chemoprophylaxis Compliance Program at ExxonMobil Corporation

ExxonMobil, a Fortune 500 oil and gas corporation, has a global workforce with employees assigned to projects in areas at risk for infectious diseases, particularly malaria. As such, the corporation has put in place a program to protect the health of workers and ensure their safety in malaria endemic zones. This program is called the Malaria Control Program (MCP). One component of this program is the more specific Malaria Chemoprophylaxis Compliance Program (MCCP), in which employees enroll following consent to random drug testing for compliance with the company's chemoprophylaxis requirements. Each year, data is gathered on the number of employees working in these locations and are selected randomly and tested for chemoprophylaxis compliance. The selection strives to test each eligible worker once per year. Test results that come back positive for the chemoprophylaxis drug are considered "detects" and tests that are negative for the drug and therefore show the worker is non-compliant at risk for severe malaria infection are considered "non-detect". ^ The current practice report used aggregate data to calculate statistics on test results to reflect compliance among both employees and contractors in various malaria-endemic areas. This aggregate, non-individualized data has been compiled and reflects the effectiveness and reach of ExxonMobil's Malaria Chemoprophylaxis Compliance Program. In order to assess compliance, information on the number of non-detect test results was compared to the number of tests completed per year. The data shows that over time, non-detect results have declined in both employee and contractor populations, and vary somewhat by location due to size and scope of the MCCP implemented in-country. Although the data indicate a positive trend for the corporation, some recommendations have been made for future implementation of the program.^

The Colic Clinic---a comprehensive program evaluation

Child abuse correlated with excessive infant crying affects millions of families each year, with consequences of the abuse lasting a lifetime. The University Of Texas School Of Medicine's Colic Clinic is currently in the early stages of testing Dr. Harvey Karp's combinatorial soothing technique for infants called "The Happiest Baby on the Block". In order to gauge the program's potential effectiveness, the Colic Clinic Protocol was examined in order to assess the applicability of the intervention to known causal factors of child abuse associated with excessive infant crying. ^ This evaluation also carried out an anticipated cost-benefit breakout analysis for the implementation of the intervention for 100 children and compared the cost of the program implementation to the cost associated with a single instance of child abuse. The analysis revealed that while accounting for materials, advertising, salaried personnel and other overhead expenses, the cost to implement the intervention was less than half the cost of the medical treatment associated with a single victim of whiplash-shaken infant syndrome. ^ Although the program is still in its early evaluative phase, the future implications of this work are extensive. If this intervention is revealed to be relevant and cost effective, it will precipitate sweeping changes in medical education and training, public health detection and prevention programs, and law enforcement.^

Sacred vocation program follow up evaluation at the Baylor healthcare system

Background: The Sacred Vocation Program (SVP) (Amick B, Karff S., 2003) helps workers find meaning, spirituality, and see their job as a sacred vocation. The SVP is based on Participatory Action Research (PAR) (Minkler & Wallerstein, 1997; Parker & Wall, 1998). This study aims to evaluate the SVP implemented at the Baylor Healthcare System, Dallas-Fort Worth. ^ Methods: The study design is a qualitative design. We used data from study participants who have participated in focus groups. During these focus groups specific questions and probes regarding the effectiveness of the SVP have been asked. We analyzed the focus groups and derived themes. ^ Results: Results of this study demonstrate SVP helps graduates feel valued and important. The SVP has improved meaningful work for employees and improved a sense of belonging for participants. The program has also increased participant spirituality. The coping techniques developed during a SVP class helps participants deal with stressful situations. The SVP faces challenges of implementation fidelity, poor communication, program viability in tough economic times and implementation of phase II. Another sustainability challenge for SVP is the perception of the program being a religious one versus a spiritual program. ^ Conclusion: Several aspects of the SVP work. The phase I of SVP is successful in improving meaningful work and a sense of belonging for participants. The coping techniques help participants deal with difficult work situations. The SVP can increase effectiveness through improvements in implementation fidelity, communication and leadership commitment. ^

An evaluation of the centers for Medicare & Medicaid Services' Hospital Acquired Conditions and Present on Admission Indicator Reporting program

Objective: This dissertation evaluated three aspects of the Centers for Medicare and Medicaid Services' Hospital Acquired Conditions and Present on Admission Indicator Reporting program (HACPOA program) to produce three journal articles for publication. ^ Methods: All payer admission records from state inpatient databases from Arizona, New Jersey and Washington states were analyzed for the year 2008. However some analyses required a sample of adult only Medicare patients in the first two studies. California's inpatient data (2004 – 2010) was also analyzed in the third study to examine the reporting and non-payment program elements' impact on the incidence of hospital acquired conditions. ^ Results: Majority diagnoses reported in inpatient prospective payment systems hospitals were present on admission. However, some diagnoses are still coded as "not present on admission" and "insufficient documentation to determine whether or not conditions are present on admission or not". This is important because it reveals that hospital complications still occur in hospitals. Hospital fall and trauma injuries were the most common hospital acquired conditions observed in this study. Predictors of hospital fall injuries include age, gender, number of diagnoses, number of procedures, number of chronic conditions while predictors of hospital trauma injuries include number of e-codes, number of diagnoses and the presence of chronic conditions on a patient's admission records. Finally, the implementation of the present on admission reporting requirement increased reports of certain hospital acquired conditions while the non-payment policy element in the Hospital Acquired Conditions program reduced the incidence of hospital fall and trauma injuries in particular. ^ Conclusion: The implementation of the Hospital Acquired Conditions and Present on Admission Indicator Reporting program has made the state inpatient database a more useful source of data capable of now identifying hospital complications. The reporting and nonpayment program elements in the HACPOA program have also impacted the incidence of hospital acquired conditions. ^

Development and evaluation of a video-based modeling strategy for the dissemination phase of a school health tobacco -use prevention program

Even the best school health education programs will be unsuccessful if they are not disseminated effectively in a manner that encourages classroom adoption and implementation. This study involved two components: (1) the development of a videotape intervention to be used in the dissemination phase of a 4-year, NCI-funded diffusion study and (2) the evaluation of that videotape intervention strategy in comparison with a print (information transfer) strategy. Conceptualization has been guided by Social Learning Theory, Diffusion Theory, and communication theory. Additionally, the PRECEDE Framework has been used. Seventh and 8th grade classroom teachers from Spring Branch Independent School District in west Houston participated in the evaluation of the videotape and print interventions using a 57-item preadoption survey instrument developed by the UT Center for Health Promotion Research and Development. Two-way ANOVA was used to study individual score differences for five outcome variables: Total Scale Score (comprised of 57 predisposing, enabling, and reinforcing items), Adoption Characteristics Subscale, Attitude Toward Innovation Subscale, Receptivity Toward Innovation, and Reinforcement Subscale. The aim of the study is to compare the effect upon score differences of video and print interventions alone and in combination. Seventy-three 7th and 8th grade classroom teachers completed the study providing baseline and post-intervention measures on factors related to the adoption and implementation of tobacco-use prevention programs. Two-way ANOVA, in relation to the study questions, found significant scoring differences for those exposed to the videotape intervention alone for both the Attitude Toward Innovation Subscale and the Receptivity to Adopt Subscale. No significant results were found to suggest that print alone influences favorable scoring differences between baseline and post-intervention testing. One interaction effect was found suggesting video and print combined are more effective for influencing favorable scoring differences for the Reinforcement for the Adoption Subscale.^ This research is unique in that it represents a newly emerging field in health promotion communications research with implications for Social Learning Theory, Diffusion Theory, and communication science that are applicable to the development of improved school health interventions. ^

Abstract multiple specialization and its application to program parallelization.

Program specialization optimizes programs for known valúes of the input. It is often the case that the set of possible input valúes is unknown, or this set is infinite. However, a form of specialization can still be performed in such cases by means of abstract interpretation, specialization then being with respect to abstract valúes (substitutions), rather than concrete ones. We study the múltiple specialization of logic programs based on abstract interpretation. This involves in principie, and based on information from global analysis, generating several versions of a program predicate for different uses of such predicate, optimizing these versions, and, finally, producing a new, "multiply specialized" program. While múltiple specialization has received theoretical attention, little previous evidence exists on its practicality. In this paper we report on the incorporation of múltiple specialization in a parallelizing compiler and quantify its effects. A novel approach to the design and implementation of the specialization system is proposed. The resulting implementation techniques result in identical specializations to those of the best previously proposed techniques but require little or no modification of some existing abstract interpreters. Our results show that, using the proposed techniques, the resulting "abstract múltiple specialization" is indeed a relevant technique in practice. In particular, in the parallelizing compiler application, a good number of run-time tests are eliminated and invariants extracted automatically from loops, resulting generally in lower overheads and in several cases in increased speedups.

Implementation of multiple specialization in logic programs

We study the múltiple specialization of logic programs based on abstract interpretation. This involves in general generating several versions of a program predícate for different uses of such predícate, making use of information obtained from global analysis performed by an abstract interpreter, and finally producing a new, "multiply specialized" program. While the topic of múltiple specialization of logic programs has received considerable theoretical attention, it has never been actually incorporated in a compiler and its effects quantified. We perform such a study in the context of a parallelizing compiler and show that it is indeed a relevant technique in practice. Also, we propose an implementation technique which has the same power as the strongest of the previously proposed techniques but requires little or no modification of an existing abstract interpreter.

A technique for recursive invariance detection and selective program specialization

This paper presents a technique for achieving a class of optimizations related to the reduction of checks within cycles. The technique uses both Program Transformation and Abstract Interpretation. After a ñrst pass of an abstract interpreter which detects simple invariants, program transformation is used to build a hypothetical situation that simpliñes some predicates that should be executed within the cycle. This transformation implements the heuristic hypothesis that once conditional tests hold they may continué doing so recursively. Specialized versions of predicates are generated to detect and exploit those cases in which the invariance may hold. Abstract interpretation is then used again to verify the truth of such hypotheses and conñrm the proposed simpliñcation. This allows optimizations that go beyond those possible with only one pass of the abstract interpreter over the original program, as is normally the case. It also allows selective program specialization using a standard abstract interpreter not speciñcally designed for this purpose, thus simplifying the design of this already complex module of the compiler. In the paper, a class of programs amenable to such optimization is presented, along with some examples and an evaluation of the proposed techniques in some application áreas such as floundering detection and reducing run-time tests in automatic logic program parallelization. The analysis of the examples presented has been performed automatically by an implementation of the technique using existing abstract interpretation and program transformation tools.

A generic preprocessor for program validation and debugging

We present a generic preprocessor for combined static/dynamic validation and debugging of constraint logic programs. Passing programs through the preprocessor prior to execution allows detecting many bugs automatically. This is achieved by performing a repertoire of tests which range from simple syntactic checks to much more advanced checks based on static analysis of the program. Together with the program, the user may provide a series of assertions which trigger further automatic checking of the program. Such assertions are written using the assertion language presented in Chapter 2, which allows expressing a wide variety of properties. These properties extend beyond the predefined set which may be understandable by the available static analyzers and include properties defined by means of user programs. In addition to user-provided assertions, in each particular CLP system assertions may be available for predefined system predicates. Checking of both user-provided assertions and assertions for system predicates is attempted first at compile-time by comparing them with the results of static analysis. This may allow statically proving that the assertions hold (Le., they are validated) or that they are violated (and thus bugs detected). User-provided assertions (or parts of assertions) which cannot be statically proved ñor disproved are optionally translated into run-time tests. The implementation of the preprocessor is generic in that it can be easily customized to different CLP systems and dialects and in that it is designed to allow the integration of additional analyses in a simple way. We also report on two tools which are instances of the generic preprocessor: CiaoPP (for the Ciao Prolog system) and CHIPRE (for the CHIP CLP(FL>) system). The currently existing analyses include types, modes, non-failure, determinacy, and computational cost, and can treat modules separately, performing incremental analysis.

Using global analysis, partial specifications, and an extensible assertion language for program validation and debugging

We discuss a framework for the application of abstract interpretation as an aid during program development, rather than in the more traditional application of program optimization. Program validation and detection of errors is first performed statically by comparing (partial) specifications written in terms of assertions against information obtained from (global) static analysis of the program. The results of this process are expressed in the user assertion language. Assertions (or parts of assertions) which cannot be checked statically are translated into run-time tests. The framework allows the use of assertions to be optional. It also allows using very general properties in assertions, beyond the predefined set understandable by the static analyzer and including properties defined by user programs. We also report briefly on an implementation of the framework. The resulting tool generates and checks assertions for Prolog, CLP(R), and CHIP/CLP(fd) programs, and integrates compile-time and run-time checking in a uniform way. The tool allows using properties such as types, modes, non-failure, determinacy, and computational cost, and can treat modules separately, performing incremental analysis.

Parallelism and implementation of logic and constraint logic programming

CIAO is an advanced programming environment supporting Logic and Constraint programming. It offers a simple concurrent kernel on top of which declarative and non-declarative extensions are added via librarles. Librarles are available for supporting the ISOProlog standard, several constraint domains, functional and higher order programming, concurrent and distributed programming, internet programming, and others. The source language allows declaring properties of predicates via assertions, including types and modes. Such properties are checked at compile-time or at run-time. The compiler and system architecture are designed to natively support modular global analysis, with the two objectives of proving properties in assertions and performing program optimizations, including transparently exploiting parallelism in programs. The purpose of this paper is to report on recent progress made in the context of the CIAO system, with special emphasis on the capabilities of the compiler, the techniques used for supporting such capabilities, and the results in the áreas of program analysis and transformation already obtained with the system.

A program transformation for continuation call-based tabled execution

The advantages of tabled evaluation regarding program termination and reduction of complexity are well known —as are the significant implementation, portability, and maintenance efforts that some proposals (especially those based on suspensión) require. This implementation effort is reduced by program transformation-based continuation cali techniques, at some eñrciency cost. However, the traditional formulation of this proposal by Ramesh and Cheng limits the interleaving of tabled and non-tabled predicates and thus cannot be used as-is for arbitrary programs. In this paper we present a complete translation for the continuation cali technique which, using the runtime support needed for the traditional proposal, solves these problems and makes it possible to execute arbitrary tabled programs. We present performance results which show that CCall offers a useful tradeoff that can be competitive with state-of-the-art implementations.

Some improvements over the continuation call tabling implementation technique

Tabled evaluation has been proved an effective method to improve several aspeets of goal-oriented query evaluation, including termination and complexity. Several "native" implementations of tabled evaluation have been developed which offer good performance, but many of them need significant changes to the underlying Prolog implementation. More portable approaches, generally using program transformation, have been proposed but they often result in lower efficieney. We explore some techniques aimed at combining the best of these worlds, i.e., developing a portable and extensible implementation, with minimal modifications at the abstract machine level, and with reasonably good performance. Our preliminary results indícate promising results.

An overview of the ciao multiparadigm language and program development environment and its design philosophy

We describe some of the novel aspects and motivations behind the design and implementation of the Ciao multiparadigm programming system. An important aspect of Ciao is that it provides the programmer with a large number of useful features from different programming paradigms and styles, and that the use of each of these features can be turned on and off at will for each program module. Thus, a given module may be using e.g. higher order functions and constraints, while another module may be using objects, predicates, and concurrency. Furthermore, the language is designed to be extensible in a simple and modular way. Another important aspect of Ciao is its programming environment, which provides a powerful preprocessor (with an associated assertion language) capable of statically finding non-trivial bugs, verifying that programs comply with specifications, and performing many types of program optimizations. Such optimizations produce code that is highly competitive with other dynamic languages or, when the highest levéis of optimization are used, even that of static languages, all while retaining the interactive development environment of a dynamic language. The environment also includes a powerful auto-documenter. The paper provides an informal overview of the language and program development environment. It aims at illustrating the design philosophy rather than at being exhaustive, which would be impossible in the format of a paper, pointing instead to the existing literature on the system.