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Ubiquitous light emitting devices and low-cost commercial digital cameras facilitate optical wireless communication system such as visual MIMO where handheld cameras communicate with electronic displays. While intensity-based optical communications are more prevalent in camera-display messaging, we present a novel method that uses modulated light phase for messaging and time-of-flight (ToF) cameras for receivers. With intensity-based methods, light signals can be degraded by reflections and ambient illumination. By comparison, communication using ToF cameras is more robust against challenging lighting conditions. Additionally, the concept of phase messaging can be combined with intensity messaging for a significant data rate advantage. In this work, we design and construct a phase messaging array (PMA), which is the first of its kind, to communicate to a ToF depth camera by manipulating the phase of the depth camera's infrared light signal. The array enables message variation spatially using a plane of infrared light emitting diodes and temporally by varying the induced phase shift. In this manner, the phase messaging array acts as the transmitter by electronically controlling the light signal phase. The ToF camera acts as the receiver by observing and recording a time-varying depth. We show a complete implementation of a 3×3 prototype array with custom hardware and demonstrating average bit accuracy as high as 97.8%. The prototype data rate with this approach is 1 Kbps that can be extended to approximately 10 Mbps., National Science Foundation (U.S.) (grant CNS-106546#)

Objectives—To describe a surgical procedure for urinary bladder marsupialization and to report the results obtained from its use in the treatment of obstructive urolithiasis in male goats. Study Design—Retrospective evaluation. Animals or Sample Population—Male goats with obstructive urolithiasis. Methods—Medical records of male goats that had urinary bladder marsupialization for the treatment of obstructive urolithiasis were reviewed. Data retrieved from the medical records included signalment, postoperative treatment, duration of hospitalization, and short-term and long-term complications. Median values for measured variables were calculated. Results—A total of 18 of 19 goats survived. Urinary flow was re-established in all 19 goats at the conclusion of surgery. Short-term postoperative complications (bladder mucosal prolapse and death) were observed in 2 goats. Long-term postoperative complications (cystitis and fibrotic stomal closure) occurred in 2 animals. Median duration of hospitalization was 4 days. At the time of follow-up, mild urine scald was reported for all goats. Clinical signs of upper urinary tract disease or obstruction were not reported. A total of 15 of 17 owners were satisfied with the procedure. Conclusions—Urinary bladder marsupialization provided long-term resolution of urinary outflow obstruction in all goats with acceptable morbidity. Clinical Relevance—Urinary bladder marsupialization is a procedure that provides a good prognosis for long-term resolution of obstructive urolithiasis in male goats.

The development of a novel, impedance-based, fieldable biosensor system is described. The portable biosensor system uses a variety of disposable analyte-specific sensor modules, each of which can be used to quantitatively measure the presence of specific analytes. The response for each sensor is rapid, and stable readings can be obtained in less than 1 min. Initial efforts have extended the use of the blosensor system to the detection of the foodborne pathogens E. coli O157:H7 and Salmonella spp. Potential applications are expected to be broad, Including possible class detection of environmental endocrine disrupters, detection of the foodborne pathogen Listeria monocytogenies, and quantitative assessment of biological warfare agents.

To determine the effect of nasogastric (NG) feeding compared with oral feeding on morphine requirements after primary cleft palate repair, and secondarily on enteral intake.This was a pilot study involving 50 infants, aged five to ten months, who were randomised to receive NG or oral feeding after palate repair. All infants received the same anaesthetic and analgesic management. Post-operatively, paracetamol and ibuprofen were administered regularly and intravenous (IV) morphine was given on demand using a nurse-controlled analgesia device. The primary outcome measure was the total morphine consumption in the first 24 hours. Secondary outcome measures included the numbers of painful episodes and the volumes of IV fluid and enteral feed administered.Of the 50 infants enrolled, 18 and 23 received either NG or oral feeding, respectively, and completed the study. Numbers of painful episodes and morphine consumption in the first 24 hours were similar in each group. Volumes of feed administered in the first 24 hours were significantly different: the NG group received approximately three times more than the oral group. Nine of the oral group required IV fluids in the 24 hours compared with none in the NG group.NG feeding was more effective than oral feeding in the first 24 hours after surgery, but numbers of painful episodes recorded were similar. Further research is required.

The transition to Internet of Things depends on the ability to create small, simple applications that are easily written and can be flexibly combined into larger, more powerful systems. We have designed an infrastructure to meet this need and report on a year's experience expanding and using it in an open-plan academic office space with up to a hundred sensors enabling nearly a dozen applications ranging from announcing tea time in the break room, notifying users that the conference room is in use, to printing documents from a web-based map. Applications are simple to write, modular, easily reused, and can incorporate diverse data inputs in a heterogeneous sensing environment. We discuss our efforts to incrementally improve user interfaces and system management.

Developing Internet of Things (IoT) applications can be a complex task for many developers, requiring knowledge of sensor hardware, deployment characteristics, network limitations, and multiple protocols. Because of this, IoT development has been largely centered around research scientists and domain experts, with only a limited number of simple applications coming from the broader community. We present a software architecture that seeks to simplify and accelerate the development of IoT applications, making them accessible to a larger community of developers. To keep the system simple yet flexible, it focuses on a limited number of abstractions, relying on the developers and administrators to enforce additional constraints where necessary. We present a model system and a prototype implementation, along with experiences developing applications.

Augmented Reality (AR) applications benefit from accurate detection of the objects that are within a person's view. Typically, it is not only desirable to identify what is currently within view, but also to navigate the users view to the item of interest - for example, finding a misplaced object. In this paper we demonstrate a low-power hybrid radio-optical beaconing system, where objects of interest are tagged with battery-powered RFID-like tags equipped with infrared light emitting diodes (LED) that emit periodic infrared beacons. These beacons are used for accurately estimating the angle and distance from the object to the receiver so as to locate it. The beacons are synchronized using the radio link that is also used to convey the object's unique ID.

Radio frequency based device-free passive (DfP) localization techniques have shown great potentials in localizing individual human subjects, without requiring them to carry any radio devices. In this study, we extend the DfP technique to count and localize multiple subjects in indoor environments. To address the impact of multipath on indoor radio signals, we adopt a fingerprinting based approach to infer subject locations from observed signal strengths through profiling the environment. When multiple subjects are present, our objective is to use the profiling data collected by a single subject to count and localize multiple subjects without any extra effort. In order to address the non-linearity of the impact of multiple subjects, we propose a successive cancellation based algorithm to iteratively determine the number of subjects. We model indoor human trajectories as a state transition process, exploit indoor human mobility constraints and integrate all information into a conditional random field (CRF) to simultaneously localize multiple subjects. As a result, we call the proposed algorithm SCPL -- sequential counting, parallel localizing. We test SCPL with two different indoor settings, one with size 150 m2 and the other 400 m2. In each setting, we have four different subjects, walking around in the deployed areas, sometimes with overlapping trajectories. Through extensive experimental results, we show that SCPL can count the present subjects with 86% counting percentage when their trajectories are not completely overlapping. Our localization algorithms are also highly accurate, with an average localization error distance of 1.3 m.

Injuries have the potential to influence individual behaviour, reproduction and/or survival. One of the least frequently observed and least known injuries in birds is sublingual fistulation, which has only been reported in four species to date. Audouin's Gull Larus audouinii is now added to this list. Based on periodical re-sightings of darvic-ringed gulls at four Mediterranean sites, the prevalence of this injury in Audouin's Gulls was estimated to be 0.13%. No negative effects of fistulas on short-term survival of injured birds were reported; the minimum survival period was 999 days. However, our findings should be treated cautiously because of the low detected incidence of this injury in free-living birds.

Device-free passive localization (DfP) techniques can localize human subjects without wearing a radio tag. Being convenient and private, DfP can find many applications in ubiquitous/pervasive computing. Unfortunately, DfP techniques need frequent manual recalibration of the radio signal values, which can be cumbersome and costly. We present SenCam, a sensor-camera collaboration solution that conducts automatic recalibration by leveraging existing surveillance camera(s). When the camera detects a subject, it can periodically trigger recalibration and update the radio signal data accordingly. This technique requires camera access occasionally each month, minimizing computational costs and reducing privacy concerns when compared to localization techniques solely based on cameras. Through experiments in an open indoor space, we show that this scheme can retain good localization results while avoiding manual recalibration.

As we are surrounded by an ever-larger variety of post-PC devices, the traditional methods for identifying and authenticating users have become cumbersome and time-consuming. In this paper, we present a capacitive communication method through which a device can recognize who is interacting with it. This method exploits the capacitive touchscreens, which are now used in laptops, phones, and tablets, as a signal receiver. The signal that identifies the user can be generated by a small transmitter embedded into a ring, watch, or other artifact carried on the human body. We explore two example system designs with a low-power continuous transmitter that communicates through the skin and a signet ring that needs to be touched to the screen. Experiments with our prototype transmitter and tablet receiver show that capacitive communication through a touchscreen is possible, even without hardware or firmware modifications on a receiver. This latter approach imposes severe limits on the data rate, but the rate is sufficient for differentiating users in multiplayer tablet games or parental control applications. Controlled experiments with a signal generator also indicate that future designs may be able to achieve datarates that are useful for providing less obtrusive authentication with similar assurance as PIN codes or swipe patterns commonly used on smartphones today.

Today's identification and authentication mechanisms for touchscreen-enabled devices are cumbersome and do not support brief usage and device sharing. To address this challenge, this work explores a novel form of "wireless" communication that exploits the capacitive touchscreens which are now used in laptops, phones, and tablets, as a signal receiver. Using a custom built hardware token, in the form of a wearable ring, we show a proof-of-concept system that transmits a user identification code to the mobile device through the touchscreen. This mechanism works without any modification to the hardware or the firmware of the mobile device.

Device-free passive (DfP) localization is proposed to localize human subjects indoors by observing how the subject disturbs the pattern of the radio signals without having the subject wear a tag. In our previous work, we have proposed a probabilistic classification based DfP technique, which we call PC-DfP in short, and demonstrated that PC-DfP can classify which cell (32 cells in total) is occupied by the stationary subject with an accuracy as high as 97.2% in a one-bedroom apartment. In this poster, we focus on extending PC-DfP to track a mobile subject in indoor environments by taking into consideration that a human subject's locations should form a continuous trajectory. Through experiments in a 10 × 15 meters open plan office, we show that we can achieve better accuracies by exploiting the property of continuous mobility trajectories.

Radio frequency based device-free passive localization has been proposed as an alternative to indoor localization because it does not require subjects to wear a radio device. This technique observes how people disturb the pattern of radio waves in an indoor space and derives their positions accordingly. The well-known multipath effect makes this problem very challenging, because in a complex environment it is impractical to have enough knowledge to be able to accurately model the effects of a subject on the surrounding radio links. In addition, even minor changes in the environment over time change radio propagation sufficiently to invalidate the datasets needed by simple fingerprint-based methods. In this paper, we develop a fingerprinting-based method using probabilistic classification approaches based on discriminant analysis. We also devise ways to mitigate the error caused by multipath effect in data collection, further boosting the classification likelihood. We validate our method in a one-bedroom apartment that has 8 transmitters, 8 receivers, and a total of 32 cells that can be occupied. We show that our method can correctly estimate the occupied cell with a likelihood of 97.2%. Further, we show that the accuracy remains high, even when we significantly reduce the training overhead, consider fewer radio devices, or conduct a test one month later after the training. We also show that our method can be used to track a person in motion and to localize multiple people with high accuracies. Finally, we deploy our method in a completely different commercial environment with two times the area achieving a cell estimation accuracy of 93.8% as an evidence of applicability to multiple environments.

Device-free passive (DfP) localization is proposed to localize human subjects indoors by observing how the subject disturbs the pattern of the radio signals without having the subject wear a tag. In our previous work, we have proposed a probabilistic classification based DfP technique, which we call PC-DfP in short, and demonstrated that PC-DfP can classify which cell (32 cells in total) is occupied by the stationary subject with an accuracy as high as 97.2% in a one-bedroom apartment. In this poster, we focus on extending PC-DfP to track a mobile subject in indoor environments by taking into consideration that a human subject's locations should form a continuous trajectory. Through experiments in a 10 × 15 meters open plan office, we show that we can achieve better accuracies by exploiting the property of continuous mobility trajectories.

The AIDS epidemic is concentrated in persons participating in certain high-risk behaviors; among these are teenagers who engage in unprotected sexual encounters. The knowledge and attitudes of four hundred Salt Lake City, Utah seventh and eighth graders were assessed. The results indicate that intermediate-school students are generally well informed about AIDS, knowing much about at-risk behaviors; however, a large percentage still do not believe in the safety of the blood supply for transfusions nor in the safety of donating blood. Students who had received AIDS education knew much about AIDS than those who had not. Whites and girls knew much more than non-whites and boys, and students who had discussed AIDS with their parents were somewhat better informed about AIDS than those who had not. Overall knowledge about AIDS was not significantly affected by the major source of information about AIDS, whereas, responses to some individual questions were. These students showed encouraging attitudes regarding aids. The felt it is important that they be informed about AIDS, and do not see themselves at great risk, and do not blame homosexuals for AIDS. Black students were less blaming than whites, and Asians were more fearful of AIDS than other ethnic groups. Hispanic students did not differ from white students in their attitudes. Knowledge of what our young people know should serve as the basis for what we need to teach them so they can act rationally with respect to the disease and those who have it.

In contrast to traditional sensor networks, the "Internet of Things" focuses on interactions between humans and physical objects rather than on sensing and reporting low level information. While several middle-ware systems have been created to simplify the task of managing and aggregating data from multiple sensor networks that use different hardware and software, management of the data is not sufficient to build an Internet of Things.To build a smart home or office application, information from sensors and existing infrastructure, such as networked power supplies and printers, need to be associated with physical objects. As low-level data is processed, it can be fed back into the system to support higher-level results. In this paper we introduce Octopus, an open-source, dynamically extensible system that supports data management and fusion for Internet of Things applications.

In this paper, we present the design, implementation and evaluation of a RF-based device-free passive localization strategy using active RFID nodes. Patterns of the measured power on multiple radio links are used to determine the location of a person in a room in a home environment. We develop an adaptive algorithm and training technique to minimize multi-path effects. With experimental deployment in a 5 x 8 meters room, we demonstrate that our system can successfully localize an individual to a 30-inch grid square with an 97.2% accuracy and 0.36 meters average error distance.

Extremadura is the fifth largest region in Spain, with certainly one of the most diverse eco-systems and abundant natural resources. Extremadura launched a series of initiatives to facilitate the transition to a green economy which means a model that takes into consideration economic, social and environmental aspects with one core objective: create jobs. How can Extremadura exploit its capacities to broaden the employment basis while moving to a green economy? What actions and priorities should the regional government take into account to move an economic development and employment agenda forward in this new context? How can Extremadura pursue its efforts to remain one of the least polluting regions in Spain while supporting job creation? Which are the economic sectors with potential for job creation in Extremadura? This study sought to provide guidance and policy recommendation to Extremadura on these and other issues related to the transition of the labour market to the green economy. The study on "Climate Change, Employment and Local Development in Extremadura", was undertaken by the Local Economic and Employment Development (LEED) Programme of the Organisation for Economic Co-operation and Development (OECD) in collaboration with the Regional Ministry of Equality and Employment of Extremadura

The purpose of this dissertation is to examine and evaluate Arthur Schopenhauer's aesthetic as it relates to the concept of Sabbath in order to see how and to what extent this aspect of his thought might correspond to a Christian view of Sabbath and thereby inform a Christian aesthetic. Chapter 1 sets the context for the discussion of art and Sabbath within the framework of Christianity and the Arts. Chapter 2 offers an overview and analysis of Schopenhauer's metaphysic, placing his thought in the context of transcendental idealism and explaining his concept of Sabbath. Chapter 3 demonstrates the significant role that Schopenhauer’s aesthetic plays in his philosophy, explaining how the arts provide a “Sabbath” rest for Schopenhauer. Chapter 4 analyzes the empirical evidence that seems to affirm a sabbatical aspect of the arts. The chapter focuses on the fields of music and art therapy in order to provide examples of the positive effects that the arts have on the emotional and physical well-being of individuals, thereby suggesting that at least part of Schopenhauer’s aesthetic theory seems to correspond to real life in measurable ways. Chapter 5 compares and contrasts Schopenhauer’s concept of Sabbath with a biblical concept of Sabbath. The chapter concludes that while the scriptural and the Schopenhauerian Sabbaths have several points of similarity, major distinctions exist between them. Thus, a biblical approach to understanding the arts through a sabbatical lens will significantly diverge from Schopenhauer’s system. Chapter 6 highlights various Christian thinkers who have spoken of the arts in a manner consistent with a sabbatical approach to the arts. The chapter focuses on Augustine, Martin Luther, Jonathan Edwards, Karl Barth, Dietrich Bonhoeffer, and C. S. Lewis. Moreover, the chapter examines several biblical passages that seem to affirm that the arts serve a rehabilitative function. Chapter 7 demonstrates how the arts can function in a manner consistent with a biblical Sabbath. The chapter also notes the limitations of viewing art as Sabbath. Chapter 8 summarizes the main points of the dissertation and reiterates the value of Sabbath in a Christian aesthetic. The chapter also offers some areas for additional research.

A typical wireless sensor network consists of many small sensors that collect instrument data around their locations and forward it to a central location for data processing. These networks can be deployed to monitor livestock and agricultural assets, products in a store, patients in a hospital, and so on. In many cases sensors have to be densely deployed, and collisions or overhead due to collision avoidance will considerably degrade the system performance below an application's required levels. With the decreasing cost of radio devices the obvious solution to this problem is the use of multiple receivers on different radio channels. However, we show that if receivers can be placed in different locations then increasing the number of receivers on a single channel will increase the rate of the capture effect and decrease collision losses, while also increasing the fairness of the transmitters' radio links. Not only can this single channel approach be more effective than using multiple channels, it is also required for some techniques, such as localization, where each receiver must be able to detect a transmission from any transmitter. We also show that the optimal choice between these two solutions is influenced by the radio attenuation rate and the number of receivers in the system.

We explore the problem of detecting whether a device has moved within a room. Our approach relies on comparing summaries of received signal strength measurements over time, which we call descriptors. We consider descriptors based on the differences in the mean, standard deviation, and histogram comparison. In close to 1000 mobility events we conducted, our approach delivers perfect recall and near perfect precision for detecting mobility at a granularity of a few seconds. It is robust to the movement of dummy objects near the transmitter as well as people moving within the room. The detection is successful because true mobility causes fast fading, while environmental mobility causes shadow fading, which exhibit considerable difference in signal distributions. The ability to produce good detection accuracy throughout the experiments also demonstrates that our approach can be applied to varying room environments and radio technologies, thus enabling novel security, health care, and inventory control applications.

This paper reviews two custom electronic circuits that implement some simple models of neural function. The circuits include a thin-film array of read-only resistive synapses and an array of programmable synapses and amplifiers serving as electronic neurons. Circuit performance and architecture are discussed.

Electronic neural networks can perform the function of associative memory. Given an input pattern, the network searches through its stored memories to find which of them best matches the input. Thus the network does a combination of content-addressable search and error correction. The number of random memories that a network can store is limited to a fraction of the number of electronic neurons in the circuit. We propose a method for building a hierarchy of networks that allows the fast parallel search through a list of memories that is too large to store in a single network. We have demonstrated the principle of this approach by an example in image vector quantization.

Asset tracking is an important application domain for wireless sensor networks. However, continuous tracking of a large number of items at the individual item level over a significant period of time is still not feasible. There are two main obstacles. The first is the need for efficient, low-power communication protocols. Many current protocols employ energy-expensive methods to achieve reliable communication for arbitrary traffic situations. Such protocols are not suitable for continuous asset tracking applications. The second challenge is the lack of a robust presence detection algorithm that can differentiate packet losses caused by a missing item from packet losses caused by the ambient radio environment. In this paper, we designed a simple communication protocol, Uni-HB, and demonstrated it can lead to longer system lifetime and higher communication reliability than several popular protocols. We also devised two robust detection algorithms that can yield low false alarm rates while achieving timely loss notification. We took an experimental approach, and evaluated protocols on a generic embedded hardware platform that has an similar architecture to motes. We also derived analytical models to validate our experimental measurements.

An equation has been derived which will permit plane-strain fracture toughness, K I c , to be calculated from a knowledge of uniaxial tensile properties. After corrections for constraint and strain hardening the plane-stress rigid plastic crack opening displacement expression was found to describe accurately experimental crack opening displacement for the plane-strain condition. The crack tip strain distribution was measured and found to be compatible with an r - 1 strain distribution within a small region ahead of the crack tip. A length parameter was identified and shown to be proportional to mean-free ferrite path in steels. From the proposed behavior of crack tip instability, it was possible to better understand the observed trend of decreasing fracture toughness with increasing yield strength and how this trend can be altered by control of the microstructure.

The surface resistance and surface reactance of high-quality YBa/sub 2/Cu/sub 3/O/sub 7/ superconducting films were determined from 10 GHz to 500 GHz using time-domain propagation measurements of picosecond electrical pulses on coplanar transmission lines. For the surface resistance, the authors find a square law dependence with frequency almost up to 500 GHz and a crossover of the losses of gold and YBa/sub 2/Cu/sub 3/O/sub 7/ films at 77 K at roughly 100 GHz. The pulse propagation is successfully modeled using the Mattis-Bardeen theory for the frequency-dependent conductivity of YBa/sub 2/Cu/sub 3/O/sub 7/. Good quantitative agreement of the surface resistance and surface reactance with this theory is obtained. The potential of YBa/sub 2/Cu/sub 3/O/sub 7/ superconducting films and equivalent gold and superconducting films for high-speed applications is studied theoretically.

The design and fabrication of high-T/sub c/ chirp-response tapped delay line filters are discussed. The key components in this development were long delay lines with more than 10 ns of delay, impedance transformers, and backward-wave couplers. All of the typical transmission line geometries were examined, including microstrip, coplanar and stripline. Designs were developed using microwave CAD routines and superconducting niobium delay line prototypes. Tapped delay line chirp filters with up to 12 ns of total delay have been successfully fabricated in YBaCuO.

The authors discuss some of the effects quantum mechanics has on the performance of nanometer-scale devices. At low temperature, the confinement and the coherence of the electronic motion on the scale of the electron wavelength give rise to gross deviations from classical charge transport that describes the resistance found in large conventional devices. The authors examine three examples of the quantum mechanical nature of the resistance of a split-gate MODFET, that are not accounted for in conventional classical models of a FET, and yet may influence device speed, noise performance and device isolation. The authors consider the temperature and electric field ranges where quantum mechanical effects are manifested in the charge transport, and speculate about the conditions in which parasitic quantum mechanical effects might be found in a conventional device. >

A novel series of [4-[4-(methylsulfonyl)phenyl]-6-(trifluoromethyl)-2-pyrimidine-based cyclooxygenase-2 (COX-2) inhibitors, which have a different arrangement of substituents compared to the more common 1,2-diarylheterocycle based molecules, have been discovered. For example, 2-(butyloxy)-4-[4-(methylsulfonyl)phenyl]-6-(trifluoromethyl)pyrimidine (47), a member of the 2-pyrimidinyl ether series, has been shown to be a potent and selective inhibitor with a favourable pharmacokinetic profile, high brain penetration and good efficacy in rat models of hypersensitivity.

We describe herein the medicinal chemistry approach which led to the discovery of a novel pyridine-3-carboxamide series of CB2 receptor agonists. The SAR of this new template was evaluated and culminated in the identification of analogue 14a which demonstrated efficacy in an in vivo model of inflammatory pain.

We have measured the resistance of a junction, comprised of four variable-width, ballistic constrictions in a high mobility, two-dimensional electron gas. When the width of each of the constrictions comprising the junction is 140 nm or less, the four terminal Hall resistance, Rxy, at 280 mK is quantized at (he2)/i where i denotes certain odd-denominator fractions, and surprisingly for (he2)/ 0.55 < Rxy < (he2)/0.45, as well.

Article-at-a-Glance Background An integrated health care systemdeployed Six Sigma in four clinical projects. The selected projects targeted Medicare profitability, emergency department cycle time reduction, clinic patient preparation, and medication safety. Cross-Project Analysis The six-month start-up period yielded several lessons. For example, the selection and sequence for implementing strategic performance improvement (PI) projects, and the decision to use Six Sigma methods, should be guided by an overall system of project portfolio management. Implementing Six Sigma Fairview Health Services (FHS) had begun with a partial deployment with the intent of using the experience to inform subsequent full deployment. Yet even before completing analyses of project outcomes, FHS decided to proceed with full deployment. Leaders developed strategic and communication plans, allocated resources, and provided for further training. In 2005, three years after the initial implementation period, Six Sigma implementation has continued. A systemwide method for setting priorities for PI projects is in place, supported by a Web-based system for managing, tracking, monitoring, and communicating results. Final Reflections Cultural change is a challenge in any environment where staff is rooted in a single PI methodology and is skeptical about the credibility of Six Sigma because of its tie to manufacturing. Health care organizations will need to find better ways to engage physicians, especially community physicians whose patients and clinical practices could be affected by Six Sigma projects.