This paper presents the design and development of a friction-based coupling device for a fiber-optic monitoring system capable of measuring pressure, strain, and temperature that can be deployed on existing subsea structures. A summary is provided of the design concept, prototype development, prototype performance testing, and subsequent design refinements of the device. The results of laboratory testing of the first prototype performed at the National Aeronautics and Space Administration (NASA) Johnson Space Center (JSC) are also included. Limitations of the initial concept were identified during testing and future design improvements were proposed and later implemented. These new features enhance the coupling of the sensor device and improve the monitoring system measurement capabilities.A major challenge of a post-installed instrumentation monitoring system is to ensure adequate coupling between the instruments and the structure of interest for reliable measurements. Friction-based devices have the potential to overcome coupling limitations caused by marine growth and soil contamination on flowlines, risers, and other subsea structures. The work described in this paper investigates the design and test of a friction-based coupling device (herein referred to as a friction clamp) which is suitable for pipelines and structures that are suspended in the water column as well as for those that are resting on the seabed. The monitoring elements consist of fiberoptic sensors that are bonded to a stainless steel clamshell assembly with a high-friction surface coating. The friction clamp incorporates a single hinge design to facilitate installation of the clamp and dual rows of opposing fasteners to distribute the clamping force along the structure. The friction clamp can be modified to be installed by commercial divers in shallow depths or by remotely operated vehicles in deep-water applications. NASA-JSC was involved in the selection and testing of the friction coating, and in the design and testing of the prototype clamp device. Four-inch diameter and eight-inch diameter sub-scale friction clamp prototypes were built and tested to evaluate the strain measuring capabilities of the design under different loading scenarios. The testing revealed some limitations of the initial design concept, and subsequent refinements were explored to improve the measurement performance of the system.
The International Space Station (ISS) total organic carbon analyzer (TOCA) is designed to autonomously assess recovered water quality by providing an indication of total organic carbon (TOC). The current TOCA has been on the ISS since November 2008. Functional checkout and operations revealed complex operating considerations. Specifically, failure of the hydrogen (H 2 ) catalyst resulted in development of an innovative oxidation analysis method. This method reduces activation time and limits the H 2 produced during analysis, while retaining the ability to indicate TOC concentrations within 25% accuracy. Subsequent testing and comparison to archived samples returned from the station and tested on the ground yield high confidence in this method, and in the quality of the recovered water.
BACKGROUND: Quality improvement (QI) education is a requirement at all stages of medical education training. Pediatric training programs are required to assess their trainees on quality improvement reflection and knowledge as part of the Pediatric Milestones. However, there is currently no validated tool for use in pediatrics to assess reflection on quality improvement opportunities. The Mayo Evaluation of Reflection on Improvement Tool (MERIT) has been previously published with validity evidence for use in internal medicine programs, but it has not been studied for use in pediatric training programs.OBJECTIVE: To validate the MERIT assessment tool for use in pediatric residency programs to aid in quality improvement milestone evaluation. DESIGN/METHODS: All University of Texas Southwestern (UTSW) pediatric residents completed annual improvement reflections between 2015-2017. De-identified reflections were assessed by five independent reviewers. Reviewers were oriented to the MERIT tool and compared 10 initial evaluations to ensure consistency. Completed MERIT evaluation scores were compared. Inter-rater reliability for each item on the tool was compared with intra-class correlation coefficients (ICC) and corresponding 95% confidence intervals (CI) using a mean-rating, absolute-agreement, 2-way mixed effects model. Internal consistency for each section and the overall tool was evaluated with Cronbach's alpha and inter-item correlations. All calculations were done with SPSS statistical package version 25.RESULTS: 150 resident reflections were evaluated yielding 749 evaluation forms for study. Item mean scores were highest for the Problem of Merit section (3.19) and lowest for the Reflection on System Characteristics of Quality Improvement (1.94). Interrater reliability was good for all 18 items on the MERIT tool (ICC range: 0.78 -0.90). Inter-rater reliability was good to excellent for 13 of the 18 items on the tool when 95% CI was used. Internal consistency was excellent (Cronbach's alpha 0.93 overall and 0.94 -0.95 for each section). The Cronbach's alpha did not improve if any single item was removed. Inter-item correlations were high for all three sections, but highest for the Problem of Merit section (0.67 -0.92).CONCLUSION(S): Validity evidence supports the use of the MERIT in pediatric residency programs to assess resident reflections on quality improvement. The pediatric validity evidence is consistent with the previously published validation study in an Internal Medicine residency program.
OBJECTIVES: Progress notes communicate providers’ assessments of patients’ diagnoses, progress, and treatment plans; however, providers perceive that note quality has degraded since the introduction of electronic health records. In this study, we aimed to (1) develop a tool to evaluate progress note assessments and plans with high interrater reliability and (2) assess whether a bundled intervention was associated with improved intern note quality without delaying note file time. METHODS: An 8-member stakeholder team developed a 19-item progress note assessment and plan evaluation (PNAPE) tool and bundled intervention consisting of a new note template and intern training curriculum. Interrater reliability was evaluated by calculating the intraclass correlation coefficient. Blinded assessors then used PNAPE to evaluate assessment and plan quality in pre- and postintervention notes (fall 2017 and 2018). RESULTS: PNAPE revealed high internal interrater reliability between assessors (intraclass correlation coefficient = 0.86; 95% confidence interval: 0.66–0.95). Total median PNAPE score increased from 13 (interquartile range [IQR]: 12–15) to 15 (IQR: 14–17; P = .008), and median file time decreased from 4:30 pm (IQR: 2:33 pm–6:20 pm) to 1:13 pm (IQR: 12:05 pm–3:59 pm; P < .001) in pre- and postintervention notes. In the postintervention period, a higher proportion of assessments and plans indicated the primary problem requiring ongoing hospitalization and progress of this problem (P = .0016 and P < .001, respectively). CONCLUSIONS: The PNAPE tool revealed high reliability between assessors, and the bundled intervention may be associated with improved intern note assessment and plan quality without delaying file time. Future studies are needed to evaluate whether these improvements can be sustained throughout residency and reproduced in future intern cohorts and other inpatient settings.
Introduction: Physicians enter residency with varied knowledge regarding the purpose of progress notes and proficiency writing them. The objective of this study was to test whether resident knowledge, beliefs, and confidence writing inpatient progress notes improved after a 2.5-hour workshop intervention. Methods: An educational workshop and note assessment tool was constructed by resident and faculty stakeholders based on a review of literature and institutional best practices. The Progress Note Assessment and Plan Evaluation (PNAPE) tool was designed to assess adherence to best practices in the assessment and plan section of progress notes. Thirty-four residents from a midsized pediatric residency program attended the workshop, which consisted of didactics and small-group work evaluating sample notes using the PNAPE tool. Participants completed a four-question online pre-and postworkshop survey to evaluate their knowledge of progress note components and attitudes regarding note importance. Pre-post analysis was performed with Chi-square testing for true/false questions, and Mann-Whitney testing for Likert scale questions and summative scores. Results: A majority of pediatric residents completed the preintervention (n = 26, 76% response rate) and postintervention (n = 23, 68% response rate) surveys. Accurate response rate improved in 15 of 20 of the true/false items, with a statistically significant improvement in five items. Resident perceptions of note importance and confidence in note writing also increased. Discussion: A workshop intervention may effectively educate pediatric residents about progress note best practices. Further studies should assess the impact of the intervention on sustained knowledge and beliefs about progress notes and subsequent note quality.
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