Sample records for quality case study

  1. Enhancing the quality of case studies in health services research.

    PubMed Central

    Yin, R K

    1999-01-01

    OBJECTIVE: To provide guidance on improving the quality of case studies in health services research. DATA SOURCES: Secondary data, drawing from previous case study research. RESEARCH DESIGN: Guidance is provided to two audiences: potential case study investigators (eight items) and reviewers of case study proposals (four additional items). PRINCIPAL FINDINGS: The guidance demonstrates that many operational steps can be undertaken to improve the quality of case studies. These steps have been a hallmark of high-quality case studies in related fields but have not necessarily been practiced in health services research. CONCLUSIONS: Given higher-quality case studies, the case study method can become a valuable tool for health services research. Images Figure 3 PMID:10591280

  2. Security Quality Requirements Engineering (SQUARE): Case Study Phase III

    DTIC Science & Technology

    2006-05-01

    Security Quality Requirements Engineering (SQUARE): Case Study Phase III Lydia Chung Frank Hung Eric Hough Don Ojoko-Adams Advisor...Engineering (SQUARE): Case Study Phase III CMU/SEI-2006-SR-003 Lydia Chung Frank Hung Eric Hough Don Ojoko-Adams Advisor Nancy R. Mead...1 1.1 The SQUARE Process ............................................................................... 1 1.2 Case Study Clients

  3. Soil quality: Some basic considerations and case studies

    Treesearch

    Dale W. Johnson

    2010-01-01

    Some fundamental properties of soils that pertain to the concept of soil quality are discussed including a discussion of what can and cannot be changed with management.Case studies showing the effects of N-fixing vegetation and N-enrichment effects on invasive species are provided to illustrate the complications that may arise from applying one soil quality standard to...

  4. Primary Datasets for Case Studies of River-Water Quality

    ERIC Educational Resources Information Center

    Goulder, Raymond

    2008-01-01

    Level 6 (final-year BSc) students undertook case studies on between-site and temporal variation in river-water quality. They used professionally-collected datasets supplied by the Environment Agency. The exercise gave students the experience of working with large, real-world datasets and led to their understanding how the quality of river water is…

  5. Indoor Air Quality and Student Performance [and Case Studies].

    ERIC Educational Resources Information Center

    Environmental Protection Agency, Washington, DC. Office of Radiation and Indoor Air.

    This report examines how indoor air quality (IAQ) affects a child's ability to learn and provides several case studies of schools that have successfully addressed their indoor air problems, the lessons learned from that experience, and what long-term practices and policies emerged from the effort. The report covers the effects from…

  6. Automated surface quality inspection with ARGOS: a case study

    NASA Astrophysics Data System (ADS)

    Kiefhaber, Daniel; Etzold, Fabian; Warken, Arno F.; Asfour, Jean-Michel

    2017-06-01

    The commercial availability of automated inspection systems for optical surfaces specified according to ISO 10110-7 promises unsupervised and automated quality control with reproducible results. In this study, the classification results of the ARGOS inspection system are compared to the decisions by well-trained inspectors based on manual-visual inspection. Both are found to agree in 93.6% of the studied cases. Exemplary cases with differing results are studied, and shown to be partly caused by shortcomings of the ISO 10110-7 standard, which was written for the industry standard manual-visual inspection. Applying it to high resolution images of the whole surface of objective machine vision systems brings with it a few challenges which are discussed.

  7. Case Study on Quality Education

    ERIC Educational Resources Information Center

    Habib, Zahida

    2011-01-01

    Quality of Education, especially at Primary level, is an important issue to be discussed at the International Forum. This study highlights the quality of primary education through a comparison of the quality of Community Model Schools and Govt. Girls Primary Schools in Pakistan. Community Model Schools were established under Girls Primary…

  8. Perspectives on Distance Education. Quality Assurance in Higher Education: Selected Case Studies.

    ERIC Educational Resources Information Center

    Tait, Alan, Ed.

    This publication consists of a set of case studies of quality assurance practices in distance teaching universities. The case studies are particularly relevant at a time when universities in many parts of the world, both new and established distance teaching universities, are placing great emphasis on reviewing and revising what they do in…

  9. Quality Assurance in In-House Continuing Training. Case Studies from Europe.

    ERIC Educational Resources Information Center

    Severing, Eckart; Stahl, Thomas

    Nine European Community Member States (Belgium, Germany, France, Greece, Ireland, Luxembourg, Portugal, Spain, and United Kingdom) conducted national studies that involved case studies of quality assurance in continuing education. Analysis of findings indicated that many firms regarded continuing training as a central instrument for achieving…

  10. Methodological quality of meta-analyses of single-case experimental studies.

    PubMed

    Jamshidi, Laleh; Heyvaert, Mieke; Declercq, Lies; Fernández-Castilla, Belén; Ferron, John M; Moeyaert, Mariola; Beretvas, S Natasha; Onghena, Patrick; Van den Noortgate, Wim

    2017-12-28

    Methodological rigor is a fundamental factor in the validity and credibility of the results of a meta-analysis. Following an increasing interest in single-case experimental design (SCED) meta-analyses, the current study investigates the methodological quality of SCED meta-analyses. We assessed the methodological quality of 178 SCED meta-analyses published between 1985 and 2015 through the modified Revised-Assessment of Multiple Systematic Reviews (R-AMSTAR) checklist. The main finding of the current review is that the methodological quality of the SCED meta-analyses has increased over time, but is still low according to the R-AMSTAR checklist. A remarkable percentage of the studies (93.80% of the included SCED meta-analyses) did not even reach the midpoint score (22, on a scale of 0-44). The mean and median methodological quality scores were 15.57 and 16, respectively. Relatively high scores were observed for "providing the characteristics of the included studies" and "doing comprehensive literature search". The key areas of deficiency were "reporting an assessment of the likelihood of publication bias" and "using the methods appropriately to combine the findings of studies". Although the results of the current review reveal that the methodological quality of the SCED meta-analyses has increased over time, still more efforts are needed to improve their methodological quality. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Improving air quality in megacities: Mexico City case study.

    PubMed

    Molina, Luisa T; Molina, Mario J

    2004-06-01

    The development and effective implementation of solutions to the air pollution problems in the Mexico City Metropolitan Area is essential to guarantee the health and welfare of its inhabitants. To achieve this, it is essential to have the active and informed participation of the civil society, the academic community, the private sector, and the government, because dealing with pollution requires the use of different strategies in multiple fields of action. The Mexico City case study brings together health, transportation, administration, and many other interdisciplinary approaches to understanding and defeating air pollution. Although focused on the Mexico City area, the work conducted under this case study has significance for developing nations generally. Although policies to reduce air pollution should be based on the best available scientific knowledge, political will and capacity must transform this knowledge into action. This case study has developed a series of recommendations emphasizing the interaction between different disciplines that have provided the foundation for the 10-year air quality management program prepared by the Mexican Metropolitan Environmental Commission.

  12. Case studies evaluating the quality of synthetic environments

    NASA Astrophysics Data System (ADS)

    Deisinger, Joachim; Blach, Roland; Simon, Andreas

    1999-03-01

    Multi wall stereo projection systems (MWSP) are an emerging display paradigm, promising a new quality in 3D-real-time interactions. Not much is known about the ergonomics of these systems. In this paper some basics of perception and approaches to improve the visual quality will be discussed and results of four experiments will be presented in order to obtain a better understanding of user interactions with existing projection technology. Due to the limited number of participants the experiments are considered as case-studies only. The first task was the estimation of absolute geometrical dimensions of simple objects. The second task was grabbing simple objects of different sizes. In order to classify MWSP, these tasks were compared to other display devices and compared to physical reality. We conducted two further experiments to compare different viewing devices for virtual reality (VR) like Head Mounted Displays (HMD), monitor, and the MWSP. For all of those experiments quantitative data was collected as a measure of interaction quality. The last two tests were supported by pre- and post questionnaires to obtain subjective judgement of the displays as well.

  13. Remote Sensing of Water Quality in Multipurpose Reservoirs: Case Study Applications in Indonesia, Mexico, and Uruguay

    NASA Astrophysics Data System (ADS)

    Miralles-Wilhelm, F.; Serrat-Capdevila, A.; Rodriguez, D.

    2017-12-01

    This research is focused on development of remote sensing methods to assess surface water pollution issues, particularly in multipurpose reservoirs. Three case study applications are presented to comparatively analyze remote sensing techniquesforo detection of nutrient related pollution, i.e., Nitrogen, Phosphorus, Chlorophyll, as this is a major water quality issue that has been identified in terms of pollution of major water sources around the country. This assessment will contribute to a better understanding of options for nutrient remote sensing capabilities and needs and assist water agencies in identifying the appropriate remote sensing tools and devise an application strategy to provide information needed to support decision-making regarding the targeting and monitoring of nutrient pollution prevention and mitigation measures. A detailed review of the water quality data available from ground based measurements was conducted in order to determine their suitability for a case study application of remote sensing. In the first case study, the Valle de Bravo reservoir in Mexico City reservoir offers a larger database of water quality which may be used to better calibrate and validate the algorithms required to obtain water quality data from remote sensing raw data. In the second case study application, the relatively data scarce Lake Toba in Indonesia can be useful to illustrate the value added of remote sensing data in locations where water quality data is deficient or inexistent. The third case study in the Paso Severino reservoir in Uruguay offers a combination of data scarcity and persistent development of harmful algae blooms. Landsat-TM data was obteined for the 3 study sites and algorithms for three key water quality parameters that are related to nutrient pollution: Chlorophyll-a, Total Nitrogen, and Total Phosphorus were calibrated and validated at the study sites. The three case study applications were developed into capacity building/training workshops

  14. Case study: reconciling the quality and safety gap through strategic planning.

    PubMed

    Jeffs, Lianne; Merkley, Jane; Jeffrey, Jana; Ferris, Ella; Dusek, Janice; Hunter, Catherine

    2006-05-01

    An essential outcome of professional practice environments is the provision of high-quality, safe nursing care. To mitigate the quality and safety chasm, nursing leadership at St. Michael's Hospital undertook a strategic plan to enhance the nursing professional practice environment. This case study outlines the development of the strategic planning process: the driving forces (platform); key stakeholders (process and players); vision, guiding principles, strategic directions, framework for action and accountability (plan); lessons learned (pearls); and next steps to moving forward the vision, strategic directions and accountability mechanisms (passion and perseverance).

  15. Health, Quality of Care and Quality of Life: A Case of Frail Older Adults

    ERIC Educational Resources Information Center

    Hsieh, Chang-Ming

    2009-01-01

    This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two…

  16. Assessment of domestic water quality: case study, Beirut, Lebanon.

    PubMed

    Korfali, Samira Ibrahim; Jurdi, Mey

    2007-12-01

    In urban cities, the environmental services are the responsibility of the public sector, where piped water supply is the norm for urban household. Likewise, in Beirut City (capital of Lebanon) official water authorities are the main supplier of domestic water through a network of piping system that leaks in many areas. Beirut City and its suburbs are overpopulated since it is the residence of 1/3 of the Lebanese citizens. Thus, Beirut suffers deficiency in meeting its water demand. Water rationing, as a remedial action, is firmly established since four decades by the Lebanese Water Authorities. Consumers resorted then to private wells to supplement their domestic water needs. Consequently, household water quality is influenced by external factors relating to well water characteristics and internal factors depending on the types of the pipes of the distribution network and cross connections to sewer pipes. These factors could result in chemical and microbial contamination of drinking water. The objective of this study is to investigate domestic water quality variation in Beirut City emerging form the aforementioned factors. The presented work encircles a typical case study of Beirut City (Ras Beirut). Results showed deterioration pattern in domestic water quality. The predicted metal species and scales within the water pipes of distribution network depended on water pH, hardness, sulfate, chloride, and iron. The corrosion of iron pipes mainly depended on Mg hardness.

  17. The impact of glaucoma on quality of life in Ethiopia: a case-control study.

    PubMed

    Ayele, Fisseha A; Zeraye, Banchamelak; Assefa, Yared; Legesse, Kbrom; Azale, Telake; Burton, Matthew J

    2017-12-13

    Glaucoma is a chronic disease characterized by irreversible optic nerve damage and visual field loss that leads to visual impairment and blindness; ultimately limiting personal independence and compromising overall quality of life of affected individuals. There is paucity of information on how glaucoma affects the quality of life of patients in low and middle-income countries where resources for both diagnosis and treatment of such conditions are limited. In this study we investigate the impact of glaucoma on quality of life in Ethiopian patients. The quality of life of 307 glaucoma patients and 76 normal controls that were frequency matched to the age and sex profiles of the cases was assessed using Amharic version of Glaucoma Quality of Life -15 questionnaire. Linear regression models and the t-test were employed to compare significant differences in GQL-15 scores and to generate mean and mean differences between cases and controls respectively. The mean GQL-15 score in the glaucoma cases was substantially higher (indicating poorer quality of life) than the controls [cases 46.3 (95% CI, 28.8-63.8) and controls 18.6 (95% CI, 15.2-22.0), p < 0.0001]. Cases with normal visual acuity and mild glaucoma had significantly higher scores than the controls. Poorer quality of life was associated with age ≥ 71 years old 51.1 (95%CI, 26.2-75.9), rural residence 55.7 (95%CI, 49.9-61.5), monthly income of <400 Birr (53.1; 95%CI, 50.5-55.6), diagnosis time 1-5 years (49.6; 95%CI, 41.2-57.9), severe visual impairment (70.5; 95%CI, 58.1-82.8), and advanced glaucoma (50.9; 95%CI, 43.6-58.3). These glaucoma patients, including those with normal visual acuity and early disease, had poorer quality of life compared to normal controls. Older age, rural residence, low income and more advanced disease were significantly associated with poorer quality of life. There is a need to increase awareness of the impact of glaucoma among clinicians, patients and their families, for a

  18. Localized Quality Assurance and Certification for Cross-Border Education: A Shanghai Case Study

    ERIC Educational Resources Information Center

    Yadong, Li; Yanqiao, Jiang

    2009-01-01

    The authors present a case study of Sino-foreign cooperation in education to illustrate how developments in the management of licensing and the approval of programs can contribute to better quality assurance. The study demonstrates how the Shanghai municipal education authority has jettisoned traditional dependence on administrative management and…

  19. Sleep quality and the risk of work injury: a Swiss case-control study.

    PubMed

    Uehli, Katrin; Miedinger, David; Bingisser, Roland; Dürr, Selina; Holsboer-Trachsler, Edith; Maier, Sabrina; Mehta, Amar J; Müller, Roland; Schindler, Christian; Zogg, Stefanie; Künzli, Nino; Leuppi, Jörg D

    2014-10-01

    Sleep problems are a well-known risk factor for work injuries, but less is known about which vulnerable populations are most at risk. The aims of this study were to investigate the association between sleep quality and the risk of work injury and to identify factors that may modify the association. A case-control study including 180 cases and 551 controls was conducted at the University Hospital in Basel, Switzerland, from 1 December 2009 to 30 June 2011. Data on work injuries and sleep quality were collected. Adjusted odds ratios and 95% confidence intervals of the association between sleep quality and work injury were estimated in multivariable logistic regression analyses and were stratified by hypothesized effect modifiers (age, gender, job risk, shift work, sleep duration and working hours). Poor sleep quality was associated significantly with work injury of any type (P < 0.05) and with being caught in particular (P < 0.05). The association between poor sleep quality and work injury was significantly higher for workers older than 30 years (odds ratio>30 1.30 versus odds ratio≤30 0.91, P < 0.01), sleeping 7 h or less per night (odds ratio≤7 1.17 versus odds ratio>7 0.79, P < 0.05) and working 50 h or more per week (odds ratio≥50 1.79 versus odd ratio<50 1.10, P < 0.01). Work injury risk increased with increasing severity of sleep problems (P < 0.05). Prior work injury frequency increased with decreasing sleep quality (P < 0.05). Older age, short sleep duration and long working hours may enhance the risk of work injuries associated with sleep quality. © 2014 European Sleep Research Society.

  20. Service quality that improves customer satisfaction in a university: a case study in Institut Teknologi Indonesia

    NASA Astrophysics Data System (ADS)

    Theresia, L.; Bangun, R.

    2017-12-01

    Universities should provide better service quality to get more customers. The purpose of this study was to find service quality which has impact on the increasing of customer satisfaction in a university. This study is a case study in Institut Teknologi Indonesia (ITI). The result of the study will help ITI to improve its service quality to increase customer satisfaction. This study employs path analysis technique. The data were collected through questionnaires developed from the literature. Questionnaires have two parts namely 1) service quality and 2) customer satisfaction. Service quality is measured through 22 questions with five service quality dimensions: 1) Tangibles, 2) Reliability, 3) Responsiveness, 4) Assurance and 5) Empathy. Customer Satisfaction is measured through 4 questions. The data then are processed by SPSS. The results showed that the students preferred to tangible quality improvement than intangible aspect.

  1. Quality and customer satisfaction: A case study in Brazil

    NASA Astrophysics Data System (ADS)

    Barcellos, Paulo Fernando Pinto

    The dissertation deals with the case of CEEE-Companhia Estadual de Energia Eletrica, an electric power utility located in Rio Grande do Sul, the southernmost state of Brazil. Customer satisfaction with the services provided by CEEE is investigated within three groups of consumers: residential, commercial, and industrial. The purpose of the dissertation is to find answers to the following research questions: (1) What is service quality in public utilities, and particularly in an electric power company? (2) What service quality dimensions do customers want to be provided and favor the most? (3) How does the market measure service quality? (4) What should be done by companies, and particularly by an electric utility monopoly, to increase the performance of the rendered service? (5) How does this impact customer satisfaction, retention, and intention to recommend? and (6) How do we start a company-wide quality program provided that the resources are scarce and therefore priorities should be set forth? To investigate the posed questions, the study begins with an exploratory survey of CEEE's Board. The survey is followed by qualitative research of the three customer groups. After qualitative analysis of the data is concluded, questionnaires for the quantitative research, as well as hypothetical models, are developed. Dillman's "Total Design Method" is used to design the questionnaires. The basic ACSI (American Customer Satisfaction Model) is used to approach customer satisfaction. Data are processed by PLS (Partial Least Squares) which follows the procedure developed at the National Quality Research Center of the University of Michigan Business School. In summary, commercial customers are the most dissatisfied with the services provided by CEEE, while residential customers are the most satisfied. To improve quality, priority should be placed on commercial customers and include efforts to improve productivity gains throughout the company. Also, CEEE's image should be

  2. Case mix, quality, and cost relationships in Colorado nursing homes.

    PubMed

    Schlenker, R E; Shaughessy, P W

    1984-01-01

    The analyses reported in this article assessed the cost, case mix, and quality interrelationships among Colorado nursing homes. A unique set of patient-level data was collected specifically to measure case mix and quality. Case mix was found to be strongly associated with cost, accounting for up to 45 percent of the variation in cost per patient day. The relationship between quality and cost was weaker; quality variables accounted for only about 10 percent of the cost per day variation. Case mix was also associated with several facility characteristics found to be significant in other cost studies, suggesting that such facility characteristics serve as partial proxy measures for case mix. The cost-case mix relationships appear to be strong enough to justify incorporating case mix directly in nursing home reimbursement systems. In contrast, the weaker cost-quality association implies that it may not (yet) be appropriate to incorporate quality directly in reimbursement.

  3. Software archeology: a case study in software quality assurance and design

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Macdonald, John M; Lloyd, Jane A; Turner, Cameron J

    2009-01-01

    Ideally, quality is designed into software, just as quality is designed into hardware. However, when dealing with legacy systems, demonstrating that the software meets required quality standards may be difficult to achieve. As the need to demonstrate the quality of existing software was recognized at Los Alamos National Laboratory (LANL), an effort was initiated to uncover and demonstrate that legacy software met the required quality standards. This effort led to the development of a reverse engineering approach referred to as software archaeology. This paper documents the software archaeology approaches used at LANL to document legacy software systems. A case studymore » for the Robotic Integrated Packaging System (RIPS) software is included.« less

  4. Developing a quality by design approach to model tablet dissolution testing: an industrial case study.

    PubMed

    Yekpe, Ketsia; Abatzoglou, Nicolas; Bataille, Bernard; Gosselin, Ryan; Sharkawi, Tahmer; Simard, Jean-Sébastien; Cournoyer, Antoine

    2018-07-01

    This study applied the concept of Quality by Design (QbD) to tablet dissolution. Its goal was to propose a quality control strategy to model dissolution testing of solid oral dose products according to International Conference on Harmonization guidelines. The methodology involved the following three steps: (1) a risk analysis to identify the material- and process-related parameters impacting the critical quality attributes of dissolution testing, (2) an experimental design to evaluate the influence of design factors (attributes and parameters selected by risk analysis) on dissolution testing, and (3) an investigation of the relationship between design factors and dissolution profiles. Results show that (a) in the case studied, the two parameters impacting dissolution kinetics are active pharmaceutical ingredient particle size distributions and tablet hardness and (b) these two parameters could be monitored with PAT tools to predict dissolution profiles. Moreover, based on the results obtained, modeling dissolution is possible. The practicality and effectiveness of the QbD approach were demonstrated through this industrial case study. Implementing such an approach systematically in industrial pharmaceutical production would reduce the need for tablet dissolution testing.

  5. Integrating Quality Matters into Hybrid Course Design: A Principles of Marketing Case Study

    ERIC Educational Resources Information Center

    Young, Mark R.

    2014-01-01

    Previous research supports the idea that the success of hybrid or online delivery modes is more a function of course design than delivery media. This article describes a case study of a hybrid Principles of Marketing course that implemented a comprehensive redesign based on design principles espoused by the Quality Matters Program, a center for…

  6. Implementing a Quality Management Framework in a Higher Education Organisation: A Case Study

    ERIC Educational Resources Information Center

    O'Mahony, Kim; Garavan, Thomas N.

    2012-01-01

    Purpose: This paper aims to report and analyse the lessons learned from a case study on the implementation of a quality management system within an IT Division in a higher education (HE) organisation. Design/methodology/approach: The paper is based on a review of the relevant literatures and the use of primary sources such as document analysis,…

  7. Operational effectiveness and quality assurance mechanisms with stochastic demand of blood supply: blood bank case study.

    PubMed

    Smith, Alan D

    2011-01-01

    A general overview of various blood products operational effectiveness and related strategies that can be utilised by service providers (in particular, healthcare providers) is presented in the present study. In terms of the massive volumes of blood products, the North American blood centres collect more than eight million units of whole blood, which represents appropriately 50% of the US and Quebec, Canada?s volunteer donor blood supply. A case study of the quality inspection and inventory control concerns of the Central Blood Bank, located in the metropolitan area of Pittsburgh, PA, is presented. Initially, brief introduction to its general operating environment is followed by sections describing its general situation, quality-service initiatives, and followed by a fairly detailed discussion of the practical applications of lessons learned from the case study.

  8. Is perception of quality more important than technical quality in patient video cases?

    PubMed

    Roland, Damian; Matheson, David; Taub, Nick; Coats, Tim; Lakhanpaul, Monica

    2015-08-13

    The use of video cases to demonstrate key signs and symptoms in patients (patient video cases or PVCs) is a rapidly expanding field. The aims of this study were to evaluate whether the technical quality, or judgement of quality, of a video clip influences a paediatrician's judgment on acuity of the case and assess the relationship between perception of quality and the technical quality of a selection of video clips. Participants (12 senior consultant paediatricians attending an examination workshop) individually categorised 28 PVCs into one of 3 possible acuities and then described the quality of the image seen. The PVCs had been converted into four different technical qualities (differing bit rates ranging from excellent to low quality). Participants' assessment of quality and the actual industry standard of the PVC were independent (333 distinct observations, spearmans rho = 0.0410, p = 0.4564). Agreement between actual acuity and participants' judgement was generally good at higher acuities but moderate at medium/low acuities of illness (overall correlation 0.664). Perception of the quality of the clip was related to correct assignment of acuity regardless of the technical quality of the clip (number of obs = 330, z = 2.07, p = 0.038). It is important to benchmark PVCs prior to use in learning resources as experts may not agree on the information within, or quality of, the clip. It appears, although PVCs may be beneficial in a pedagogical context, the perception of quality of clip may be an important determinant of an expert's decision making.

  9. What Factors Influence States' Capacity to Report Children's Health Care Quality Measures? A Multiple-Case Study.

    PubMed

    Christensen, Anna L; Petersen, Dana M; Burton, Rachel A; Forsberg, Vanessa C; Devers, Kelly J

    2017-01-01

    Objectives The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services' (CMS) core set of children's health care quality measures (Child Core Set). Methods We conducted a multiple-case study of four high-performing states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program: Illinois, Maine, Pennsylvania, and Oregon. Cases were purposively selected for their diverse measurement approaches and used data from 2010 to 2015, including 154 interviews, semiannual grant progress reports, and annual public reports on Child Core Set measures. We followed Yin's multiple-case study methodology to describe how and why each state increased the number of measures reported to CMS. Results All four states increased the number of Child Core Set measures reported to CMS during the grant period. Each took a different approach to reporting, depending on the available technical, organizational, and behavioral inputs in the state. Reporting capacity was influenced by a state's Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures. These factors were enhanced by CHIPRA Quality Demonstration grant funding and other federal capacity building activities, as hypothesized in our conceptual framework. These and other states have made progress reporting the Child Core Set since 2010. Conclusion With financial support and investment in state data systems and organizational factors, states can overcome challenges to reporting most of the Child Core Set measures.

  10. Quality Tools and TRIZ Based Quality Improvement Case Study at PT ‘X’ A Plastic Moulding Manufacturing Industry

    NASA Astrophysics Data System (ADS)

    Wirawan, Christina; Chandra, Fory

    2016-02-01

    Theory of Inventive Problem Solving (TRIZ) is a creative encouraging problem solving method. TRIZ is prepared by Altshuller for product design. Altshuller prepared contradiction matrix and suggestion to solve contradictions usually occur in product design. This paper try to combine TRIZ with quality tools such as Pareto and Fault Tree Analysis (FTA) to solve contradiction in quality improvement problem, neither than product design problem. Pareto used to identify defect priority, FTA used to analysis and identify root cause of defect. When there is contradiction in solving defect causes, TRIZ used to find creative problem solving. As a case study, PT ’X’, a plastic molding manufacturing industry was taken. PT ‘X’ using traditional press machine to produce plastic thread cone. There are 5 defect types that might occur in plastic thread cone production, incomplete form, dirty, mottle, excessive form, rugged. Research about quality improvement effort using DMAIC at PT ‘X’ have been done by Fory Candra. From this research, defect types, priority, root cause from FTA, recommendation from FMEA. In this research, from FTA reviewed, contradictions found among causes troublesome quality improvement efforts. TRIZ used to solve the contradictions and quality improvement effort can be made effectively.

  11. Color image quality in projection displays: a case study

    NASA Astrophysics Data System (ADS)

    Strand, Monica; Hardeberg, Jon Y.; Nussbaum, Peter

    2005-01-01

    Recently the use of projection displays has increased dramatically in different applications such as digital cinema, home theatre, and business and educational presentations. Even if the color image quality of these devices has improved significantly over the years, it is still a common situation for users of projection displays that the projected colors differ significantly from the intended ones. This study presented in this paper attempts to analyze the color image quality of a large set of projection display devices, particularly investigating the variations in color reproduction. As a case study, a set of 14 projectors (LCD and DLP technology) at Gjovik University College have been tested under four different conditions: dark and light room, with and without using an ICC-profile. To find out more about the importance of the illumination conditions in a room, and the degree of improvement when using an ICC-profile, the results from the measurements was processed and analyzed. Eye-One Beamer from GretagMacbeth was used to make the profiles. The color image quality was evaluated both visually and by color difference calculations. The results from the analysis indicated large visual and colorimetric differences between the projectors. Our DLP projectors have generally smaller color gamut than LCD projectors. The color gamuts of older projectors are significantly smaller than that of newer ones. The amount of ambient light reaching the screen is of great importance for the visual impression. If too much reflections and other ambient light reaches the screen, the projected image gets pale and has low contrast. When using a profile, the differences in colors between the projectors gets smaller and the colors appears more correct. For one device, the average ΔE*ab color difference when compared to a relative white reference was reduced from 22 to 11, for another from 13 to 6. Blue colors have the largest variations among the projection displays and makes them

  12. Color image quality in projection displays: a case study

    NASA Astrophysics Data System (ADS)

    Strand, Monica; Hardeberg, Jon Y.; Nussbaum, Peter

    2004-10-01

    Recently the use of projection displays has increased dramatically in different applications such as digital cinema, home theatre, and business and educational presentations. Even if the color image quality of these devices has improved significantly over the years, it is still a common situation for users of projection displays that the projected colors differ significantly from the intended ones. This study presented in this paper attempts to analyze the color image quality of a large set of projection display devices, particularly investigating the variations in color reproduction. As a case study, a set of 14 projectors (LCD and DLP technology) at Gjøvik University College have been tested under four different conditions: dark and light room, with and without using an ICC-profile. To find out more about the importance of the illumination conditions in a room, and the degree of improvement when using an ICC-profile, the results from the measurements was processed and analyzed. Eye-One Beamer from GretagMacbeth was used to make the profiles. The color image quality was evaluated both visually and by color difference calculations. The results from the analysis indicated large visual and colorimetric differences between the projectors. Our DLP projectors have generally smaller color gamut than LCD projectors. The color gamuts of older projectors are significantly smaller than that of newer ones. The amount of ambient light reaching the screen is of great importance for the visual impression. If too much reflections and other ambient light reaches the screen, the projected image gets pale and has low contrast. When using a profile, the differences in colors between the projectors gets smaller and the colors appears more correct. For one device, the average ΔE*ab color difference when compared to a relative white reference was reduced from 22 to 11, for another from 13 to 6. Blue colors have the largest variations among the projection displays and makes them

  13. E-Service Quality Evaluation on E-Government Website: Case Study BPJS Kesehatan Indonesia

    NASA Astrophysics Data System (ADS)

    Rasyid, A.; Alfina, I.

    2017-01-01

    This research intends to develop a model to evaluate the quality of e-services on e-government. The proposed model consists of seven dimensions: web design, reliability, responsiveness, privacy and security, personalization, information, and ease of use. The model is used to measure the quality of the e-registration of BPJS Kesehatan, an Indonesian government health insurance program. The validation and reliability testing show that of the seven dimensions proposed, only four that suitable for the case study. The result shows that the BPJS Kesehatan e-registration service is good in reliability and responsiveness dimensions, while from web design and ease of use dimensions the e-service still needs to be optimized.

  14. Managing future air quality in megacities: A case study for Delhi

    NASA Astrophysics Data System (ADS)

    Amann, Markus; Purohit, Pallav; Bhanarkar, Anil D.; Bertok, Imrich; Borken-Kleefeld, Jens; Cofala, Janusz; Heyes, Chris; Kiesewetter, Gregor; Klimont, Zbigniew; Liu, Jun; Majumdar, Dipanjali; Nguyen, Binh; Rafaj, Peter; Rao, Padma S.; Sander, Robert; Schöpp, Wolfgang; Srivastava, Anjali; Vardhan, B. Harsh

    2017-07-01

    Megacities in Asia rank high in air pollution at the global scale. In many cities, ambient concentrations of fine particulate matter (PM2.5) have been exceeding both the WHO interim targets as well as respective national air quality standards. This paper presents a systems analytical perspective on management options that could efficiently improve air quality at the urban scale, having Delhi as a case study. We employ the newly developed GAINS-City policy analysis framework, consisting of a bottom up emission calculation combined with atmospheric chemistry-transport calculation, to derive innovative insights into the current sources of pollution and their impacts on ambient PM2.5, both from emissions of primary PM as well as precursors of secondary inorganic and organic aerosols. We outline the likely future development of these sources, quantify the related ambient PM2.5 concentrations and health impacts, and explore potential policy interventions that could effectively reduce environmental pollution and resulting health impacts in the coming years. The analysis demonstrates that effective improvement of Delhi's air quality requires collaboration with neighboring States and must involve sources that are less relevant in industrialized countries. At the same time, many of the policy interventions will have multiple co-benefits on development targets in Delhi and its neighboring States. Outcomes of this study, as well as the modelling tools used herein, are applicable to other urban areas and fast growing metropolitan zones in the emerging Asian regions.

  15. Understanding Quality Assurance: A Cross Country Case Study

    ERIC Educational Resources Information Center

    Choon Boey Lim, Fion

    2008-01-01

    Purpose: The purpose of this paper is to examine the level of understanding between an Australian university and its offshore partner institution, on quality assurance. It attempts to highlight the dynamics of quality assurance policy implementation within and across institutions for an offshore degree. Design/methodology/approach: The study used…

  16. Air Quality Analysis of a Multilevel Complex Interchange : Case Study Using the Improved TSC/EPA Model

    DOT National Transportation Integrated Search

    1976-12-01

    This report describes a case study of an air quality analysis prepared by the U.S. Department of Transportation (DOT), Transportation Systems Center (TSC). The site analyzed was the proposed I-83/I-95 interchange in Baltimore, Maryland. This intercha...

  17. Improving urban air quality in China: Beijing case study

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Jiming Hao; Litao Wang

    2005-09-01

    China is undergoing rapid urbanization because of unprecedented economic growth. As a result, many cities suffer from air pollution. Two-thirds of China's cities have not attained the ambient air quality standards applicable to urban residential areas (Grade II). Particulate matter (PM), rather than sulfur dioxide (SO{sub 2}), is the major pollutant reflecting the shift from coal burning to mixed source pollution. In 2002, 63.2 and 22.4% of the monitored cities have PM and SO{sub 2} concentrations exceeding the Grade II standard, respectively. Nitrogen oxides (NOx) concentration kept a relatively stable level near the Grade II standard in the last decademore » and had an increasing potential in recent years because of the rapid motorization. In general, the air pollutants emission did not increase as quickly as the economic growth and energy consumption, and air quality in Chinese cities has improved to some extent. Beijing, a typical representative of rapidly developing cities, is an example to illustrate the possible options for urban air pollution control. Beijing's case provides hope that the challenges associated with improving air quality can be met during a period of explosive development and motorization. 21 refs., 19 figs., 6 tabs.« less

  18. Medicaid medical directors quality improvement studies: a case study of evolving methods for a research network.

    PubMed

    Fairbrother, Gerry; Trudnak, Tara; Griffith, Katherine

    2014-01-01

    To describe the evolution of methods and share lessons learned from conducting multi-state studies with Medicaid Medical Directors (MMD) using state administrative data. There was a great need for these studies, but also much to be learned about conducting network-based research and ensuring comparability of results. This was a network-level case study. The findings were drawn from the experience developing and executing network analyses with the MMDs, as well as from participant feedback on lessons learned. For the latter, nine interviews with MMD project leads, state data analysts, and outside researchers involved with the projects were conducted. Interviews were transcribed, coded and analyzed using NVivo 10.0 analytic software. MMD study methodology involved many steps: developing research questions, defining data specifications, organizing an aggregated data collection spreadsheet form, assuring quality through review, and analyzing and reporting state data at the national level. State analysts extracted the data from their state Medicaid administrative (claims) databases (and sometimes other datasets). Analysis at the national level aggregated state data overall, by demographics and other sub groups, and displayed descriptive statistics and cross-tabs. Projects in the MMD multi-state network address high-priority clinical issues in Medicaid and impact quality of care through sharing of data and policies among states. Further, these studies contribute not only to high-quality, cost-effective health care for Medicaid beneficiaries, but also add to our knowledge of network-based research. Continuation of these studies requires funding for a permanent research infrastructure nationally, as well as at the state-level to strengthen capacity.

  19. Determinants of Quality of Interview and Impact on Risk Estimates in a Case-Control Study of Bladder Cancer

    PubMed Central

    Silverman, Debra T.; Malats, Núria; Tardon, Adonina; Garcia-Closas, Reina; Serra, Consol; Carrato, Alfredo; Fortuny, Joan; Rothman, Nathaniel; Dosemeci, Mustafa; Kogevinas, Manolis

    2009-01-01

    The authors evaluated potential determinants of the quality of the interview in a case-control study of bladder cancer and assessed the effect of the interview quality on the risk estimates. The analysis included 1,219 incident bladder cancer cases and 1,271 controls recruited in Spain in 1998–2001. Information on etiologic factors for bladder cancer was collected through personal interviews, which were scored as unsatisfactory, questionable, reliable, or high quality by the interviewers. Eight percent of the interviews were unsatisfactory or questionable. Increasing age, lower socioeconomic status, and poorer self-perceived health led to higher proportions of questionable or unreliable interviews. The odds ratio for cigarette smoking, the main risk factor for bladder cancer, was 6.18 (95% confidence interval: 4.56, 8.39) overall, 3.20 (95% confidence interval: 1.13, 9.04) among unsatisfactory or questionable interviews, 6.86 (95% confidence interval: 4.80, 9.82) among reliable interviews, and 7.70 (95% confidence interval: 3.64, 16.30) among high-quality interviews. Similar trends were observed for employment in high-risk occupations, drinking water containing elevated levels of trihalomethanes, and use of analgesics. Higher quality interviews led to stronger associations compared with risk estimation that did not take the quality of interview into account. The collection of quality of interview scores and the exclusion of unreliable interviews probably reduce misclassification of exposure in observational studies. PMID:19478234

  20. Riparian buffer design guidelines for water quality and wildlife habitat functions on agricultural landscapes in the Intermountain West: Case Study

    Treesearch

    Craig W. Johnson; Susan Buffler

    2008-01-01

    This hypothetical case study illustrates how the riparian buffer planning protocol described in the RB handbook is used to plan a buffer for both water quality and wildlife conservation on a specific project site. The case study site includes riparian buffer characteristics typical of the study area-variable topography and soils, flood plain wetlands, seeps, springs,...

  1. Data Management and Data Quality in PERCH, a Large International Case-Control Study of Severe Childhood Pneumonia.

    PubMed

    Watson, Nora L; Prosperi, Christine; Driscoll, Amanda J; Higdon, Melissa M; Park, Daniel E; Sanza, Megan; DeLuca, Andrea N; Awori, Juliet O; Goswami, Doli; Hammond, Emily; Hossain, Lokman; Johnson, Catherine; Kamau, Alice; Kuwanda, Locadiah; Moore, David P; Neyzari, Omid; Onwuchekwa, Uma; Parker, David; Sapchookul, Patranuch; Seidenberg, Phil; Shamsul, Arifin; Siazeele, Kazungu; Srisaengchai, Prasong; Sylla, Mamadou; Levine, Orin S; Murdoch, David R; O'Brien, Katherine L; Wolff, Mark; Deloria Knoll, Maria

    2017-06-15

    The Pneumonia Etiology Research for Child Health (PERCH) study is the largest multicountry etiology study of pediatric pneumonia undertaken in the past 3 decades. The study enrolled 4232 hospitalized cases and 5325 controls over 2 years across 9 research sites in 7 countries in Africa and Asia. The volume and complexity of data collection in PERCH presented considerable logistical and technical challenges. The project chose an internet-based data entry system to allow real-time access to the data, enabling the project to monitor and clean incoming data and perform preliminary analyses throughout the study. To ensure high-quality data, the project developed comprehensive quality indicator, data query, and monitoring reports. Among the approximately 9000 cases and controls, analyzable laboratory results were available for ≥96% of core specimens collected. Selected approaches to data management in PERCH may be extended to the planning and organization of international studies of similar scope and complexity. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  2. Quality Assurance Reconsidered: A Case Study

    ERIC Educational Resources Information Center

    Gynnild, Vidar

    2007-01-01

    This article examines an external evaluation of the quality assurance system at the Norwegian University of Science and Technology (NTNU) conducted by The Norwegian Agency for Quality Assurance in Higher Education (NOKUT). The external audit report along with internal reports provided by the seven faculties of the university served as the major…

  3. Urgent need to improve the quality of case report in traditional Chinese medicine: Assessment on reporting quality of 3,417 cases.

    PubMed

    Fu, Shu-Fei; Kun, Wai; Zeng, Xiao-Xi; Zhang, Li; Cheng, Chung-Wah; Song, Lisa; Zhong, Linda Li-Dan; Lin, Jia; Wang, Yong-Yan; Shang, Hong-Cai; Bian, Zhao-Xia

    2016-06-01

    To survey the reporting quality of traditional Chinese medicine (TCM) case reports published in recent years and understand the common problems. The assessment results would lay the foundation for the development of recommendations for case report in Chinese medicine. This survey determined the reporting quality of cases with Chinese herbal decoction, Chinese proprietary medicine, acupuncture, moxibustion and other traditional therapies published in 20 core medical journals of China by searching the China Academic Journals Full-text Database from 2006 to 2010. Fifty survey items in 16 domains were used to determine the reporting quality. One point was assigned to each item (Yes=1 point; No=0 point), and total score was 50 points. The domain of treatment was assessed independently, ranging from 2 to 9 items for different TCM interventions. The total of 1,858 case reports, covering 3,417 cases were included to analyze from 13 out of 20 core medical journals of China. There were 74.8% of them did not identify the nature of study in title, while 73.9% did not comprise an abstract. Incomplete reporting was found in discussions/ comment, and only 38.9% had made recommendations or take-away messages. Figures and tables were infrequently used. Three cases cited the full names of patients, but without declaring that any consent was obtained. Over 90% reported the symptoms and signs of TCM, and characteristics on tongue and pulse, but less than 50% did mention other medical history and diagnostic rationale. More than 90% treatments of the included cases were herbal decoction, with clear reporting on the ingredients and dosages. However, the reporting rate of the dosages of each ingredient was just 48.4%. Almost none reported the quality control of crude herbs, manufacturers and lot numbers of herbal proprietary medicine. Besides, advices and precautions on diet, emotions and living were rare to be illustrated. Systematic reporting recommendations are urged to develop for

  4. Development and case study of a science-based software platform to support policy making on air quality.

    PubMed

    Zhu, Yun; Lao, Yanwen; Jang, Carey; Lin, Chen-Jen; Xing, Jia; Wang, Shuxiao; Fu, Joshua S; Deng, Shuang; Xie, Junping; Long, Shicheng

    2015-01-01

    This article describes the development and implementations of a novel software platform that supports real-time, science-based policy making on air quality through a user-friendly interface. The software, RSM-VAT, uses a response surface modeling (RSM) methodology and serves as a visualization and analysis tool (VAT) for three-dimensional air quality data obtained by atmospheric models. The software features a number of powerful and intuitive data visualization functions for illustrating the complex nonlinear relationship between emission reductions and air quality benefits. The case study of contiguous U.S. demonstrates that the enhanced RSM-VAT is capable of reproducing the air quality model results with Normalized Mean Bias <2% and assisting in air quality policy making in near real time. Copyright © 2014. Published by Elsevier B.V.

  5. Ecological quality boundary-setting procedures: the Gulf of Riga case study.

    PubMed

    Aigars, Juris; Müller-Karulis, Bärbel; Martin, Georg; Jermakovs, Vadims

    2008-03-01

    Two approaches for setting ecological class boundaries, response curves and a simplified mathematical boundary-setting protocol, were tested for coastal, transitional and open waters in the Gulf of Riga, Baltic Sea. The simplified mathematical boundary-setting protocol defines acceptable ecological status based on expert judgment by a uniform relative deviation from reference conditions. In contrast, response curves derive class boundary definitions from observed changes in biological quality elements along environmental pressure gradients for class boundary definitions. Identification of relevant environmental pressures for the construction of response curves was based on a conceptual model of eutrophication in the Gulf of Riga. Response curves were successfully established for summer chlorophyll a and transparency, as well as for macrozoobenthos abundance in the Central Gulf, macrozoobenthos biotic coefficient in the Southern Gulf, and maximum depth of phytobenthos in the Northern Gulf. In the Gulf of Riga response curves almost always permitted a larger deviation from reference conditions than the 50% deviation applied for the simplified mathematical boundary-setting protocol. The case study clearly demonstrated that class boundary definitions should take into account the sensitivity of the target water body. Also, the class boundaries for different ecological quality elements were internally more consistent than those derived by the simplified mathematical boundary-setting protocol.

  6. Impact of traumatic dental injury on the quality of life of young children: a case-control study.

    PubMed

    Vieira-Andrade, Raquel Gonçalves; Siqueira, Maria Betânia Lins; Gomes, Genara Brum; D'Avila, Sérgio; Pordeus, Isabela Almeida; Paiva, Saul Martins; Granville-Garcia, Ana Flávia

    2015-10-01

    There are no longitudinal studies that assess the impact of traumatic dental injury (TDI) on the oral health-related quality of life (OHRQoL) of preschool children. To investigate the impact of TDI on OHRQoL among preschool children, a population-based case-control study was carried out with a representative sample of 335 children, 3-5 years of age, enrolled at public and private preschools in the city of Campina Grande, Brazil. The case group and the control group were matched for age, gender, type of preschool and monthly household income at a ratio of 1:4 (67 cases and 286 controls). Impact on the OHRQoL of children was assessed through administration of the Early Childhood Oral Health Impact Scale (ECOHIS). The occurrence of TDI was determined through clinical examinations performed by three calibrated dentists. Data analysis involved descriptive statistics, McNemar's test, the chi-square test with linear trend and conditional logistic regression analysis [P≤0.05; 95% confidence interval (95% CI)]. The most frequent responses were 'felt pain' (19.4%) and 'difficulty eating' (16.4%). The prevalence of TDI was 37.3% in the case group and 33.9% in the control group. No statistically significant differences were found between case and control groups regarding the presence of TDI (odds ratio=1.16; 95% CI: 0.66-2.02). TDI had no impact on the quality of life of preschool children. © 2015 FDI World Dental Federation.

  7. Quality Assessment for Placement Centres: A Case Study of the University of Barcelona's Faculty of Education

    ERIC Educational Resources Information Center

    Freixa Niella, Montse; Vilà Baños, Ruth; Rubio Hurtado, M. José

    2015-01-01

    The aim of this research was to identify the factors that could be used for quality assessments of the placement centres used by the University of Barcelona's Faculty of Education. To achieve this, a multiple case study method (bachelor's degrees in Education, Social Education and Social Work) was used, which was based on a survey methodology. A…

  8. Highly Integrated Quality Assurance – An Empirical Case

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Drake Kirkham; Amy Powell; Lucas Rich

    2011-02-01

    Highly Integrated Quality Assurance – An Empirical Case Drake Kirkham1, Amy Powell2, Lucas Rich3 1Quality Manager, Radioisotope Power Systems (RPS) Program, Idaho National Laboratory, P.O. Box 1625 M/S 6122, Idaho Falls, ID 83415-6122 2Quality Engineer, RPS Program, Idaho National Laboratory 3Quality Engineer, RPS Program, Idaho National Laboratory Contact: Voice: (208) 533-7550 Email: Drake.Kirkham@inl.gov Abstract. The Radioisotope Power Systems Program of the Idaho National Laboratory makes an empirical case for a highly integrated Quality Assurance function pertaining to the preparation, assembly, testing, storage and transportation of 238Pu fueled radioisotope thermoelectric generators. Case data represents multiple campaigns including the Pluto/New Horizons mission,more » the Mars Science Laboratory mission in progress, and other related projects. Traditional Quality Assurance models would attempt to reduce cost by minimizing the role of dedicated Quality Assurance personnel in favor of either functional tasking or peer-based implementations. Highly integrated Quality Assurance adds value by placing trained quality inspectors on the production floor side-by-side with nuclear facility operators to enhance team dynamics, reduce inspection wait time, and provide for immediate, independent feedback. Value is also added by maintaining dedicated Quality Engineers to provide for rapid identification and resolution of corrective action, enhanced and expedited supply chain interfaces, improved bonded storage capabilities, and technical resources for requirements management including data package development and Certificates of Inspection. A broad examination of cost-benefit indicates highly integrated Quality Assurance can reduce cost through the mitigation of risk and reducing administrative burden thereby allowing engineers to be engineers, nuclear operators to be nuclear operators, and the cross-functional team to operate more efficiently. Applicability of this

  9. The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a "business case" for quality of diabetes care--a time series study.

    PubMed

    Wilf-Miron, Rachel; Bolotin, Arkadi; Gordon, Nesia; Porath, Avi; Peled, Ronit

    2014-12-01

    In primary health care systems where member's turnover is relatively low, the question, whether investment in quality of care improvement can make a business case, or is cost effective, has not been fully answered.The objectives of this study were: (1) to investigate the relationship between improvement in selected measures of diabetes (type 2) care and patients' health outcomes; and (2) to estimate the association between improvement in performance and direct medical costs. A time series study with three quality indicators - Hemoglobin A1c (HbA1c) testing, HbA1C and LDL- cholesterol (LDL-C) control - which were analyzed in patients with diabetes, insured by a large health fund. Health outcomes measures used: hospitalization days, Emergency Department (ED) visits and mortality. Poisson, GEE and Cox regression models were employed. Covariates: age, gender and socio-economic rank. 96,553 adult (age >18) patients with diabetes were analyzed. The performance of the study indicators, significantly and steadily improved during the study period (2003-2009). Poor HbA1C (>9%) and inappropriate LDL-C control (>100 mg/dl) were significantly associated with number of hospitalization days. ED visits did not achieve statistical significance. Improvement in HbA1C control was associated with an annual average of 2% reduction in hospitalization days, leading to substantial reduction in tertiary costs. The Hazard ratio for mortality, associated with poor HbA1C and LDL-C, control was 1.78 and 1.17, respectively. Our study demonstrates the effect of continuous improvement in quality care indicators, on health outcomes and resource utilization, among patients with diabetes. These findings support the business case for quality, especially in healthcare systems with relatively low enrollee turnover, where providers, in the long term, could "harvest" their investments in improving quality.

  10. Determinants of quality of shared sanitation facilities in informal settlements: case study of Kisumu, Kenya.

    PubMed

    Simiyu, Sheillah; Swilling, Mark; Cairncross, Sandy; Rheingans, Richard

    2017-01-11

    Shared facilities are not recognised as improved sanitation due to challenges of maintenance as they easily can be avenues for the spread of diseases. Thus there is need to evaluate the quality of shared facilities, especially in informal settlements, where they are commonly used. A shared facility can be equated to a common good whose management depends on the users. If users do not work collectively towards keeping the facility clean, it is likely that the quality may depreciate due to lack of maintenance. This study examined the quality of shared sanitation facilities and used the common pool resource (CPR) management principles to examine the determinants of shared sanitation quality in the informal settlements of Kisumu, Kenya. Using a multiple case study design, the study employed both quantitative and qualitative methods. In both phases, users of shared sanitation facilities were interviewed, while shared sanitation facilities were inspected. Shared sanitation quality was a score which was the dependent variable in a regression analysis. Interviews during the qualitative stage were aimed at understanding management practices of shared sanitation users. Qualitative data was analysed thematically by following the CPR principles. Shared facilities, most of which were dirty, were shared by an average of eight households, and their quality decreased with an increase in the number of households sharing. The effect of numbers on quality is explained by behaviour reflected in the CPR principles, as it was easier to define boundaries of shared facilities when there were fewer users who cooperated towards improving their shared sanitation facility. Other factors, such as defined management systems, cooperation, collective decision making, and social norms, also played a role in influencing the behaviour of users towards keeping shared facilities clean and functional. Apart from hardware factors, quality of shared sanitation is largely due to group behaviour of users

  11. Quality Management: An "Essential Attributes" Approach. A Case Study towards a Sustainable Model of Course Effectiveness Evaluation

    ERIC Educational Resources Information Center

    Murphy, Francis S.

    2005-01-01

    Education of potential professional engineers should take account of the type of employment that they will eventually obtain. The quality of an engineering degree course can be judged by assessing whether the correct balance of "essential attributes" has been effectively obtained. This case study is concerned with assessing the balance…

  12. Diet-quality scores and risk of hip fractures in elderly urban Chinese in Guangdong, China: a case-control study.

    PubMed

    Zeng, F F; Xue, W Q; Cao, W T; Wu, B H; Xie, H L; Fan, F; Zhu, H L; Chen, Y M

    2014-08-01

    This case-control study compared the associations of four widely used diet-quality scoring systems with the risk of hip fractures and assessed their utility in elderly Chinese. We found that individuals avoiding a low-quality diet have a lower risk of hip fractures in elderly Chinese. Few studies examined the associations of diet-quality scores on bone health, and no studies were available in Asians and compared their validity and utility in a study. We assessed the associations and utility of four widely used diet-quality scoring systems with the risk of hip fractures. A case-control study of 726 patients with hip fractures (diagnosed within 2 weeks) aged 55-80 years and 726 age- (within 3 years) and gender-matched controls was conducted in Guangdong, China (2009-2013). Dietary intake was assessed using a 79-item food frequency questionnaire with face-to-face interviews, and the Healthy Eating Index-2005 (HEI-2005, 12 items), the alternate Healthy Eating Index (aHEI, 8 items), the Diet Quality Index-International (DQI-I, 17 items), and the alternate Mediterranean Diet Score (aMed, 9 items) (the simplest one) were calculated. All greater values of the diet-quality scores were significantly associated with a similar decreased risk of hip fractures (all p trends <0.001). The multivariate-adjusted odds ratios (ORs) and 95% confidential intervals (95% CIs) comparing the extreme groups of diet-quality scores were 0.29 (0.18, 0.46) (HEI-2005), 0.20 (0.12, 0.33) (aHEI), 0.25 (0.16, 0.39) (DQI-I), and 0.28 (0.18, 0.43) (aMed) in total subjects; and the corresponding ORs ranged from 0.04 to 0.27 for men and from 0.26 to 0.44 for women (all p trends <0.05), respectively. Avoiding a low-quality diet is associated with a lower risk of hip fractures, and the aMed score is the best scoring system due to its equivalent performance and simplicity for the user.

  13. Modeling study of biomass burning plumes and their impact on urban air quality; a case study of Santiago de Chile

    NASA Astrophysics Data System (ADS)

    Cuchiara, Gustavo C.; Rappenglück, Bernhard; Angelica Rubio, Maria; Lissi, Eduardo; Gramsch, Ernesto; Garreaud, Rene D.

    2017-04-01

    Wildfires are a significant direct source of atmospheric pollutants; on a global scale biomass burning is believed to be the largest source of primary fine particles in the atmosphere and the second largest source of trace gases after anthropogenic emission sources. During the summer of 2014, an intense forest and dry pasture wildfire occurred nearby the city of Santiago de Chile. The biomass-burning plume was transported towards the metropolitan area of Santiago and exacerbated the air quality in this region. In this study, we investigated this wildfire event using a forward plume-rise and a chemistry (WRF/Chem) simulation. These data sets provided an opportunity to validate a regional air-quality simulation over Santiago, and a unique case to assess the performance of biomass burning plume modeling in complex topography and validated against an established air quality network. The results from both meteorological and air quality models provide insights about the transport of biomass-burning plumes from the wildfire region towards the metropolitan region of Santiago de Chile. We studied a seven-day period between January 01-07, 2014, and the impact of biomass burning plume emissions estimated by Fire Inventory from NCAR version 1 (FINNv1) on the air quality of Santiago de Chile.

  14. Adopting Quality Assurance Technology in Customer-Vendor Relationships: A Case Study of How Interorganizational Relationships Influence the Process

    NASA Astrophysics Data System (ADS)

    Heeager, Lise Tordrup; Tjørnehøj, Gitte

    Quality assurance technology is a formal control mechanism aiming at increasing the quality of the product exchanged between vendors and customers. Studies of the adoption of this technology in the field of system development rarely focus on the role of the relationship between the customer and vendor in the process. We have studied how the process of adopting quality assurance technology by a small Danish IT vendor developing pharmacy software for a customer in the public sector was influenced by the relationship with the customer. The case study showed that the adoption process was shaped to a high degree by the relationship and vice versa. The prior high level of trust and mutual knowledge helped the parties negotiate mutually feasible solutions throughout the adoption process. We thus advise enhancing trust-building processes to strengthen the relationships and to balance formal control and social control to increase the likelihood of a successful outcome of the adoption of quality assurance technology in a customer-vendor relationship.

  15. Reasoning Based Quality Assurance of Medical Ontologies: A Case Study

    PubMed Central

    Horridge, Matthew; Parsia, Bijan; Noy, Natalya F.; Musenm, Mark A.

    2014-01-01

    The World Health Organisation is using OWL as a key technology to develop ICD-11 – the next version of the well-known International Classification of Diseases. Besides providing better opportunities for data integration and linkages to other well-known ontologies such as SNOMED-CT, one of the main promises of using OWL is that it will enable various forms of automated error checking. In this paper we investigate how automated OWL reasoning, along with a Justification Finding Service can be used as a Quality Assurance technique for the development of large and complex ontologies such as ICD-11. Using the International Classification of Traditional Medicine (ICTM) – Chapter 24 of ICD-11 – as a case study, and an expert panel of knowledge engineers, we reveal the kinds of problems that can occur, how they can be detected, and how they can be fixed. Specifically, we found that a logically inconsistent version of the ICTM ontology could be repaired using justifications (minimal entailing subsets of an ontology). Although over 600 justifications for the inconsistency were initially computed, we found that there were three main manageable patterns or categories of justifications involving TBox and ABox axioms. These categories represented meaningful domain errors to an expert panel of ICTM project knowledge engineers, who were able to use them to successfully determine the axioms that needed to be revised in order to fix the problem. All members of the expert panel agreed that the approach was useful for debugging and ensuring the quality of ICTM. PMID:25954373

  16. Psychosocial Profile and Quality of Life in Children With Type 1 Narcolepsy: A Case-Control Study

    PubMed Central

    Rocca, Francesca Letizia; Finotti, Elena; Pizza, Fabio; Ingravallo, Francesca; Gatta, Michela; Bruni, Oliviero; Plazzi, Giuseppe

    2016-01-01

    Study Objectives: To investigate behavioral aspects and quality of life in children and adolescents with type 1 narcolepsy (NT1). Methods: We performed a case-control study comparing 29 patients with NT1 versus sex- and age-matched patients with idiopathic epilepsy (n = 39) and healthy controls (n = 39). Behavior and quality of life were evaluated by self-administered questionnaires (Child Behavior Checklist, Pediatric Quality of Life Inventory). Patient groups were contrasted and scale results were correlated with clinical and polysomnographic parameters, and cerebrospinal fluid hypocretin-1 levels. Results: Young patients with NT1 showed increased internalizing problems associated with aggressive behavior. Emotional profile in patients with NT1 positively correlated with age at onset, diagnostic delay, and subjective sleepiness, whereas treatment and disease duration were associated with fewer behavioral problems (attention problems, aggressive behavior, and attention deficit/hyperactivity disorder). Psychosocial health domains of pediatric NT1 were worse than in healthy controls, whereas the physical health domains were comparable. Conclusions: Young NT1 patients show a discrete pattern of altered behavioral, thought, and mood profile in comparison with healthy controls and with idiopathic epilepsy patients thus suggesting a direct link with sleepiness. Further studies investigating behavior in patients with idiopathic hypersomnia or type 2 narcolepsy are needed to disentangle the role of REM sleep dysfunction and hypocretin deficiency in psychiatric disorders. Symptoms of withdrawal, depression, somatic complaints, thought problems, and aggressiveness were common, NT1 children perceived lower school competencies than healthy children, and their parents also reported worse psychosocial health. Our data suggest that early effective treatment and disease self-awareness should be promoted in NT1 children for their positive effect on behavior and psychosocial health

  17. Better Data Quality for Better Healthcare Research Results - A Case Study.

    PubMed

    Hart, Robert; Kuo, Mu-Hsing

    2017-01-01

    Electronic Health Records (EHRs) have been identified as a key tool to collect data for healthcare research. However, EHR data must be of sufficient quality to support quality research results. Island Health, BC, Canada has invested and continues to invest in the development of solutions to address the quality of its EHR data and support high quality healthcare studies. This paper examines Island Health's data quality engine, its development and its successful implementation.

  18. Nurses' perceptions of feedback to nursing teams on quality measurements: An embedded case study design.

    PubMed

    Giesbers, A P M Suzanne; Schouteten, Roel L J; Poutsma, Erik; van der Heijden, Beatrice I J M; van Achterberg, Theo

    2016-12-01

    Providing nursing teams with feedback on quality measurements is used as a quality improvement instrument in healthcare organizations worldwide. Previous research indicated contradictory results regarding the effect of such feedback on both nurses' well-being and performance. Building on the Job Demands-Resources model this study explores: (1) whether and how nurses' perceptions of feedback on quality measurements (as a burdening job demand or rather as an intrinsically or extrinsically motivating job resource) are respectively related to nurses' well-being and performance; and (2) whether and how team reflection influences nurses' perceptions. An embedded case study. Four surgical wards within three different acute teaching-hospital settings in the Netherlands. During a period of four months, the nurses on each ward were provided with similar feedback on quality measurements. After this period, interviews with eight nurses and the ward manager for each ward were conducted. Additionally, observational data were collected from three oral feedback moments on each of the participating wards. The data revealed that individual nurses perceive the same feedback on quality measurements differently, leading to different effects on nurses' well-being and performance: 1) feedback can be perceived as a job demand that pressures nurses to improve the results on the quality measurements; 2) feedback can be perceived as an extrinsically motivating job resource, that is instrumental to improve the results on quality measurements; 3) feedback can be perceived as an intrinsically motivating job resource that stimulates nurses to improve the results on the quality measurements; and 4) feedback can be perceived neither as a job demand, nor as a job resource, and has no effect on nurses' well-being and performance. Additionally, this study indicates that team reflection after feedback seems to be very low in practice, while our data also provides evidence that nursing teams using the

  19. Medical education and the quality improvement spiral: A case study from Mpumalanga, South Africa

    PubMed Central

    Bergh, Anne-Marie; Etsane, Mama E.; Hugo, Jannie

    2015-01-01

    Background: The short timeframe of medical students’ rotations is not always conducive to successful, in-depth quality-improvement projects requiring a more longitudinal approach. Aim: To describe the process of inducting students into a longitudinal quality-improvement project, using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies. Setting: Mpumalanga clinical learning centres, where University of Pretoria medical students did their district health rotations. Method: Consecutive student groups had to engage with a hospital's compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n = 42), a written group report (n = 42) and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n = 139). Results: Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator, health advocate, scholar, communicator, manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students, who also acted as catalysts for transforming practice. Conclusion: Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert. More studies could provide insight into the potential of this approach in transforming institutions and student learning. PMID:26245606

  20. Health-related quality of life and satisfaction with case management in cancer survivors.

    PubMed

    Hsu, Ya-Hui; Chai, Hsiu-Ying; Lin, Yu-Fen; Wang, Chao-Hui; Chen, Shu-Ching

    2017-12-01

    To (i) investigate the characteristics of health-related quality of life and satisfaction with case management and (ii) to identify factors associated with health-related quality of life in cancer survivors. The level of health-related quality of life can reflect treatment efficacy and satisfaction with cancer care. A cross-sectional study design was adopted. Subjects from the outpatient setting of a cancer centre in northern Taiwan were recruited by consecutive sampling. A set of questionnaires were employed, including a background information form, case management service satisfaction survey (CMSS) and The European Quality of Life Scale (EQ-5D). Descriptive statistics were used to examine levels of health-related quality of life and satisfaction with case management. Pearson's correlation was used to identify relationships between treatment characteristics, satisfaction with case management and health-related quality of life. Multiple stepwise regression was used to identify factors associated with health-related quality of life. A total of 252 cancer patients were recruited. The three lowest scores for items of health-related quality of life were mobility, self-care and usual activities. Cancer survivors with higher mobility, less pain and discomfort, and lower anxiety and depression were more likely to have better health-related quality of life. Mobility, pain and discomfort, and anxiety and depression are important predictive factors of high health-related quality of life in cancer survivors. In clinical care, patients' physical mobility, pain and discomfort, and anxiety and depression are important indicators of health-related quality of life. Case managers should include self-care and symptom management into survivorship care plans to improve health-related quality of life during survival after treatment concludes. © 2017 John Wiley & Sons Ltd.

  1. Improvement of the customer satisfaction through Quality Assurance Matrix and QC-Story methods: A case study from automotive industry

    NASA Astrophysics Data System (ADS)

    Sicoe, G. M.; Belu, N.; Rachieru, N.; Nicolae, E. V.

    2017-10-01

    Presently, in the automotive industry, the tendency is to adapt permanently to the changes and introduce the market tendency in the new products that leads of the customer satisfaction. Many quality techniques were adopted in this field to continuous improvement of product and process quality and advantages were also gained. The present paper has focused on possibilities that offers the use of Quality Assurance Matrix (QAM) and Quality Control Story (QC Story) to provide largest protection against nonconformities in the production process, throughout a case study in the automotive industry. There is a direct relationship from the QAM to a QC Story analysis. The failures identified using QAM are treated with QC Story methodology. Using this methods, will help to decrease the PPM values and will increase the quality performance and the customer satisfaction.

  2. Remote Sensing Forage Quality for Browsing Herbivores: A Case Study of Cutting Edge Koala Conservation

    NASA Astrophysics Data System (ADS)

    Youngentob, K. N.; Au, J.; Held, A. A.; Foley, W. J.; Possingham, H. P.

    2014-12-01

    Managing landscapes for conservation requires a capacity to measure habitat quality. Although multiple factors are often responsible for the distribution and abundance of herbivores, spatial variations in the quality and quantity of plant forage are known to be important for many species. While we cannot see the chemical complexity of landscapes with our naked-eye, advances in imaging spectroscopy are making it possible to assess the quality of forage on a landscape-scale. Much research in this area has focused on the ability to estimate foliar nitrogen (N), because N is believed to be a limiting nutrient for many leaf eating animals. However, the total quantity of foliar N does not necessarily reflect the amount of N that can be utilized by herbivores. Available nitrogen (AvailN) is an invitro measure of forage quality that integrates the influence of tannins and fibre on the amount of foliar N that is available for digestion by herbivores. This may be a more meaningful measure of forage quality than total N for the many herbivorous species that are sensitive to the effects of tannins. Our previous research has demonstrated that it is possible to estimate this integrated measure of foliar nutritional quality at an individual tree crown level across multiple tree species using imaging spectroscopy (HyMap). Here we present a case study of how this remote sensing data is being used to help inform landscape management and conservation decisions for an iconic Australian species, the koala (Phascolarctos cinereus). We review the methods involved in developing maps of integrated measures of foliar nutritional quality for browsing herbivores with airborne imaging spectroscopy data and discuss their applications for wildlife management.

  3. Do inter-hospital comparisons of in-hospital, acute myocardial infarction case-fatality rates serve the purpose of fostering quality improvement? An evaluative study.

    PubMed

    Aelvoet, Willem; Terryn, Nathalie; Molenberghs, Geert; De Backer, Guy; Vrints, Christiaan; van Sprundel, Marc

    2010-12-08

    In-hospital case-fatality rates in patients, admitted for acute myocardial infarction (AMI-CFRs), are internationally used as a quality indicator. Attempting to encourage the hospitals to assume responsibility, the Belgian Ministry of Health decided to stimulate initiatives of quality improvement by means of a limited set of indicators, among which AMI-CFR, to be routinely analyzed. In this study we aimed, by determining the existence of inter-hospital differences in AMI-CFR, (1) to evaluate to which extent Belgian discharge records allow the assessment of quality of care in the field of AMI, and (2) to identify starting points for quality improvement. Hospital discharge records from all the Belgian short-term general hospitals in the period 2002-2005. The study population (N = 46,287) included patients aged 18 years and older, hospitalized for AMI. No unique patient identifier being present, we tried to track transferred patients. We assessed data quality through a comparison of MCD with data from two registers for acute coronary events and through transfer and sensitivity analyses. We compared AMI-CFRs across hospitals, using multivariable logistic regression models. In the main model hospitals, Charlson's co-morbidity index, age, gender and shock constituted the covariates. We carried out two types of analyses: a first one wherein transferred-out cases were excluded, to avoid double counting of patients when computing rates, and a second one with exclusion of all transferred cases, to allow the study of patients admitted into, treated in and discharged from the same hospital. We identified problems regarding both the CFR's numerator and denominator.Sensitivity analyses revealed differential coding and/or case management practices. In the model with exclusion of transfer-out cases, the main determinants of AMI-CFR were cardiogenic shock (OR(adj) 23.0; 95% CI [20.9;25.2]), and five-year age groups OR(adj) 1.23; 95% CI [1.11;1.36]). Sizable inter-hospital and inter

  4. Do inter-hospital comparisons of in-hospital, acute myocardial infarction case-fatality rates serve the purpose of fostering quality improvement? An evaluative study

    PubMed Central

    2010-01-01

    Background In-hospital case-fatality rates in patients, admitted for acute myocardial infarction (AMI-CFRs), are internationally used as a quality indicator. Attempting to encourage the hospitals to assume responsibility, the Belgian Ministry of Health decided to stimulate initiatives of quality improvement by means of a limited set of indicators, among which AMI-CFR, to be routinely analyzed. In this study we aimed, by determining the existence of inter-hospital differences in AMI-CFR, (1) to evaluate to which extent Belgian discharge records allow the assessment of quality of care in the field of AMI, and (2) to identify starting points for quality improvement. Methods Hospital discharge records from all the Belgian short-term general hospitals in the period 2002-2005. The study population (N = 46,287) included patients aged 18 years and older, hospitalized for AMI. No unique patient identifier being present, we tried to track transferred patients. We assessed data quality through a comparison of MCD with data from two registers for acute coronary events and through transfer and sensitivity analyses. We compared AMI-CFRs across hospitals, using multivariable logistic regression models. In the main model hospitals, Charlson's co-morbidity index, age, gender and shock constituted the covariates. We carried out two types of analyses: a first one wherein transferred-out cases were excluded, to avoid double counting of patients when computing rates, and a second one with exclusion of all transferred cases, to allow the study of patients admitted into, treated in and discharged from the same hospital. Results We identified problems regarding both the CFR's numerator and denominator. Sensitivity analyses revealed differential coding and/or case management practices. In the model with exclusion of transfer-out cases, the main determinants of AMI-CFR were cardiogenic shock (ORadj 23.0; 95% CI [20.9;25.2]), and five-year age groups ORadj 1.23; 95% CI [1.11;1.36]). Sizable

  5. Putting density back into the habitat-quality equation: case study of an open-nesting forest bird.

    PubMed

    Pérot, Aurore; Villard, Marc-André

    2009-12-01

    Ecological traps and other cases of apparently maladaptive habitat selection cast doubt on the relevance of density as an indicator of habitat quality. Nevertheless, the prevalence of these phenomena remains poorly known, and density may still reflect habitat quality in most systems. We examined the relationship between density and two other parameters of habitat quality in an open-nesting passerine species: the Ovenbird (Seiurus aurocapilla). We hypothesized that the average individual bird makes a good decision when selecting its breeding territory and that territory spacing reflects site productivity or predation risk. Therefore, we predicted that density would be positively correlated with productivity (number of young fledged per unit area). Because individual performance is sensitive to events partly determined by chance, such as nest predation, we further predicted density would be weakly correlated or uncorrelated with the proportion of territories fledging young. We collected data in 23 study sites (25 ha each), 16 of which were located in untreated mature northern hardwood forest and seven in stands partially harvested (treated) 1-7 years prior to the survey. Density explained most of the variability in productivity (R(2)= 0.73), and there was no apparent decoupling between density and productivity in treated plots. In contrast, there was no significant relationship between density and the proportion of territories fledging >or=1 young over the entire breeding season. These results suggest that density reflects habitat quality at the plot scale in this study system. To our knowledge this is one of the few studies testing the value of territory density as an indicator of habitat quality in an open-nesting bird species on the basis of a relatively large number of sizeable study plots.

  6. Single-case synthesis tools I: Comparing tools to evaluate SCD quality and rigor.

    PubMed

    Zimmerman, Kathleen N; Ledford, Jennifer R; Severini, Katherine E; Pustejovsky, James E; Barton, Erin E; Lloyd, Blair P

    2018-03-03

    Tools for evaluating the quality and rigor of single case research designs (SCD) are often used when conducting SCD syntheses. Preferred components include evaluations of design features related to the internal validity of SCD to obtain quality and/or rigor ratings. Three tools for evaluating the quality and rigor of SCD (Council for Exceptional Children, What Works Clearinghouse, and Single-Case Analysis and Design Framework) were compared to determine if conclusions regarding the effectiveness of antecedent sensory-based interventions for young children changed based on choice of quality evaluation tool. Evaluation of SCD quality differed across tools, suggesting selection of quality evaluation tools impacts evaluation findings. Suggestions for selecting an appropriate quality and rigor assessment tool are provided and across-tool conclusions are drawn regarding the quality and rigor of studies. Finally, authors provide guidance for using quality evaluations in conjunction with outcome analyses when conducting syntheses of interventions evaluated in the context of SCD. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. CASE STUDY RESEARCH: THE VIEW FROM COMPLEXITY SCIENCE

    PubMed Central

    Anderson, Ruth; Crabtree, Benjamin F.; Steele, David J.; McDaniel, Reuben R.

    2005-01-01

    Many wonder why there has been so little change in care quality, despite substantial quality improvement efforts. Questioning why current approaches are not making true changes draws attention to the organization as a source of answers. We bring together the case study method and complexity science to suggest new ways to study health care organizations. The case study provides a method for studying systems. Complexity theory suggests that keys to understanding the system are contained in patterns of relationships and interactions among the system’s agents. We propose some of the “objects” of study that are implicated by complexity theory and discuss how studying these using case methods may provide useful maps of the system. We offer complexity theory, partnered with case study method, as a place to begin the daunting task of studying a system as an integrated whole. PMID:15802542

  8. How to Critically Evaluate Case Studies in Social Work

    ERIC Educational Resources Information Center

    Lee, Eunjung; Mishna, Faye; Brennenstuhl, Sarah

    2010-01-01

    The purpose of this article is to develop guidelines to assist practitioners and researchers in evaluating and developing rigorous case studies. The main concern in evaluating a case study is to accurately assess its quality and ultimately to offer clients social work interventions informed by the best available evidence. To assess the quality of…

  9. Tulane University School of Continuing Studies: Case Study in Online Quality Improvement

    ERIC Educational Resources Information Center

    McLennan, Kay L.

    2011-01-01

    Online asynchronous courses constitute a significant portion of Tulane University's School of Continuing Studies (SCS) curriculum. Online instruction is sufficiently important to the School of Continuing Studies that it merited special attention in the form of a two-year review to ensure its quality. The review identified and implemented different…

  10. The Quality of Life of a Child with Asperger's Disorder in a General Education Setting: A Pilot Case Study

    ERIC Educational Resources Information Center

    Mayton, Michael R.

    2005-01-01

    This pilot qualitative case study was designed to investigate how the quality of life (QOL) of a child with Asperger's Disorder was impacted by her placement in an inclusive education setting which provided no specialized social skills instruction. Direct and indirect data were gathered and examined regarding themes that centered around QOL…

  11. Negotiating the COAPRT Learning Outcomes Transition Using Quality Management Tools: A Case Study of the COAPRT Beta Test Site

    ERIC Educational Resources Information Center

    Ellis, Gary D.

    2014-01-01

    This paper is a case study. It tells the story of the process that the Council on Accreditation for Parks, Recreation, Tourism and Related Professions beta test site created its learning outcomes assessment program. A planning process was used that has evolved from quality management philosophy and practice: DMADV. Use of DMADV required precise…

  12. Case-control studies in neurosurgery.

    PubMed

    Nesvick, Cody L; Thompson, Clinton J; Boop, Frederick A; Klimo, Paul

    2014-08-01

    Observational studies, such as cohort and case-control studies, are valuable instruments in evidence-based medicine. Case-control studies, in particular, are becoming increasingly popular in the neurosurgical literature due to their low cost and relative ease of execution; however, no one has yet systematically assessed these types of studies for quality in methodology and reporting. The authors performed a literature search using PubMed/MEDLINE to identify all studies that explicitly identified themselves as "case-control" and were published in the JNS Publishing Group journals (Journal of Neurosurgery, Journal of Neurosurgery: Pediatrics, Journal of Neurosurgery: Spine, and Neurosurgical Focus) or Neurosurgery. Each paper was evaluated for 22 descriptive variables and then categorized as having either met or missed the basic definition of a case-control study. All studies that evaluated risk factors for a well-defined outcome were considered true case-control studies. The authors sought to identify key features or phrases that were or were not predictive of a true case-control study. Those papers that satisfied the definition were further evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. The search detected 67 papers that met the inclusion criteria, of which 32 (48%) represented true case-control studies. The frequency of true case-control studies has not changed with time. Use of odds ratios (ORs) and logistic regression (LR) analysis were strong positive predictors of true case-control studies (for odds ratios, OR 15.33 and 95% CI 4.52-51.97; for logistic regression analysis, OR 8.77 and 95% CI 2.69-28.56). Conversely, negative predictors included focus on a procedure/intervention (OR 0.35, 95% CI 0.13-0.998) and use of the word "outcome" in the Results section (OR 0.23, 95% CI 0.082-0.65). After exclusion of nested case-control studies, the negative correlation between focus on a procedure

  13. The business case for quality improvement: oral anticoagulation for atrial fibrillation.

    PubMed

    Rose, Adam J; Berlowitz, Dan R; Ash, Arlene S; Ozonoff, Al; Hylek, Elaine M; Goldhaber-Fiebert, Jeremy D

    2011-07-01

    The potential to save money within a short time frame provides a more compelling "business case" for quality improvement than merely demonstrating cost-effectiveness. Our objective was to demonstrate the potential for cost savings from improved control in patients anticoagulated for atrial fibrillation. Our population consisted of 67 077 Veterans Health Administration patients anticoagulated for atrial fibrillation between October 1, 2006, and September 30, 2008. We simulated the number of adverse events and their associated costs and utilities, both before and after various degrees of improvement in percent time in therapeutic range (TTR). The simulation had a 2-year time horizon, and costs were calculated from the perspective of the payer. In the base-case analysis, improving TTR by 5% prevented 1114 adverse events, including 662 deaths; it gained 863 quality-adjusted life-years and saved $15.9 million compared with the status quo, not accounting for the cost of the quality improvement program. Improving TTR by 10% prevented 2087 events, gained 1606 quality-adjusted life-years, and saved $29.7 million. In sensitivity analyses, costs were most sensitive to the estimated risk of stroke and the expected stroke reduction from improved TTR. Utilities were most sensitive to the estimated risk of death and the expected mortality benefit from improved TTR. A quality improvement program to improve anticoagulation control probably would be cost-saving for the payer, even if it were only modestly effective in improving control and even without considering the value of improved health. This study demonstrates how to make a business case for a quality improvement initiative.

  14. Sustainability in Housing: A Curriculum Case Study.

    ERIC Educational Resources Information Center

    Parrott, Kathleen; Emmel, Joann M.

    2001-01-01

    Explores the influence of environmental issues on the field of housing, from the perspective of sustainable housing. Presents a case study of the development of a college course to address these issues by integrating energy management, air quality, water quality, and waste management. (Author)

  15. Planning and Implementing total Quality Management in an Air Force Service Organization: A Case Study

    DTIC Science & Technology

    1988-09-01

    Quality Management (TQM). Documentation of such implementation methods can provide useful crossfeed to other services organizations attempting similiar efforts. The following research questions were addressed to present the case in a useful context for interpretation: (1) What is TQM and how will it be implemented in AFALC; (2) How can the quality of service organizations be improved and what techniques may be useful for this purpose; (3) How does the environment at AFALC differ from most Air Force organizations implementing TQM and what obstacles must it overcome; (4) How

  16. Guaranteeing the quality and integrity of pork - An Australian case study.

    PubMed

    Channon, H A; D'Souza, D N; Jarrett, R G; Lee, G S H; Watling, R J; Jolley, J Y C; Dunshea, F R

    2018-04-27

    The Australian pork industry is strongly committed to assuring the integrity of its product, with substantial research investment made over the past ten years to develop and implement systems to assure the consistency and quality of fresh pork and to enable accurate tracing of unpackaged fresh pork back to property of origin using trace elemental profiling. These initiatives are pivotal to allow Australian pork of guaranteed eating quality to be successfully positioned as higher value products, across a range of international and domestic markets, whilst managing any threats of product substitution. This paper describes the current status of the development of a predictive eating quality model for Australian pork, utilizing eating quality datasets generated from recent Australian studies. The implementation of trace elemental profiling, by Physi-Trace™, to verify and defend provenance claims and support the supply of consistently high eating quality Australian pork to its customers, is also discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. Symptomatic endometriosis of the posterior cul-de-sac is associated with impaired sleep quality, excessive daytime sleepiness and insomnia: a case-control study.

    PubMed

    Leone Roberti Maggiore, Umberto; Bizzarri, Nicolò; Scala, Carolina; Tafi, Emanuela; Siesto, Gabriele; Alessandri, Franco; Ferrero, Simone

    2017-02-01

    To assess the impact of endometriosis of the posterior cul-de-sac on quality of sleep, average daytime sleepiness and insomnia. This age-matched case-control study was conducted in a tertiary referral centre for the diagnosis and treatment of endometriosis between May 2012 and December 2013. It included 145 women with endometriosis of the posterior cul-de-sac (cases; group E) and 145 patients referred to our Institution because of routine gynaecologic consultations (controls; group C). This study investigated whether sleep is impaired in patients with endometriosis of the posterior cul-de-sac. Sleep quality, daytime sleepiness and insomnia were assessed using the following self-administered questionnaires: the Pittsburgh Sleep Quality Index, the Epworth sleepiness scale and the Insomnia Severity Index, respectively. The primary objective of the study was to evaluate sleep quality in the two study groups. Secondary outcomes of the study were to assess average daytime sleepiness and insomnia in the two study groups. The prevalence of poor sleep quality was significantly higher in group E (64.8%) than in group C (15.1%; p<0.001). The prevalence of excessive daytime sleepiness was significantly higher in group E (23.4%) than in group C (12.9%; p=0.033). Patients of group E experienced subthreshold insomnia (29.0%) and moderate clinical insomnia (16.6%) significantly more frequently than patients in group C (24.4% and 5.0%; p=0.002). A substantial proportion of women with endometriosis of the posterior cul-de-sac experiences poor sleep quality, excessive daytime sleepiness and insomnia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. The business case for quality.

    PubMed

    Boehler, Richard; Hardesty, Daniel; Gonzales, Eva; Kasnetz, Karen

    2009-10-01

    Among the lessons St. Joseph Medical Center learned in implementing a diabetes care management program were that: There is a sound business case for quality with such a program. A sound business plan based on a track record of accomplishments by other organizations is key to gaining clinician buy-in. Deploying dwindling resources to simultaneously improve care and the organization's bottom line requires collaboration between clinicians and finance.

  19. [The influence of attention-deficit hyperactivity disorder on quality of life: case reports].

    PubMed

    Dallos, Gyöngyvér; Balázs, Judit

    2014-06-01

    Recently the concept of Quality of Life has gained increasing importance in Psychiatry. Studies focusing on how much attention-deficit hyperactivity disorder (ADHD) - one of the most prevalent psychiatric disorders among children - affects the every day life found that children with ADHD had significantly lower Quality of Life than healthy controls or children with other psychiatric or physical disorders. In the current paper we present the case of two boys with ADHD and their families. These cases demonstrate that adequate treatment of the symptoms of ADHD can improve Quality of Life of the patients and their families, moreover, different life events can worsen the symptoms of ADHD. Professionals should ensure flexible treatment, which conforms to the above described processes.

  20. What is the quality of the maternal near-miss case reviews in WHO European Region? Cross-sectional study in Armenia, Georgia, Latvia, Republic of Moldova and Uzbekistan

    PubMed Central

    Bacci, Alberta; Hodorogea, Stelian; Khachatryan, Henrik; Babojonova, Shohida; Irsa, Signe; Jansone, Maira; Dondiuc, Iurie; Matarazde, George; Lazdane, Gunta; Lazzerini, Marzia

    2018-01-01

    Objectives The maternal near-miss case review (NMCR) cycle is a type of clinical audit aiming at improving quality of maternal healthcare by discussing near-miss cases. In several countries this approach has been introduced and supported by WHO and partners since 2004, but information on the quality of its implementation is missing. This study aimed at evaluating the quality of the NMCR implementation in selected countries within WHO European Region. Design Cross-sectional study. Settings Twenty-three maternity units in Armenia, Georgia, Latvia, Moldova and Uzbekistan. Assessment tools A predefined checklist including 50 items, according to WHO methodology. Quality in the NMCR implementation was defined by summary scores ranging from 0 (totally inappropriate) to 3 (appropriate). Results Quality of the NMCR implementation was heterogeneous among different countries, and within the same country. Overall, the first part of the audit cycle (from case identification to case analysis) was fairly well performed (mean score 2.00, 95% CI 1.94 to 2.06), with the exception of the ‘inclusion of users’ views’ (mean score 0.66, 95% CI 0.11 to 1.22), while the second part (developing recommendations, implementing them and ensuring quality) was poorly performed (mean score 0.66, 95% CI 0.11 to 1.22). Each country had at least one champion facility, where quality of the NMCR cycle was acceptable. Quality of the implementation was not associated with its duration. Gaps in implementation were of technical, organisational and attitudinal nature. Conclusions Ensuring quality in the NMCR may be difficult but achievable. The high heterogeneity in results within the same country suggests that quality of the NMCR implementation depends, to a large extent, from hospital factors, including staff’s commitment, managerial support and local coordination. Efforts should be put in preventing and mitigating common barriers that hamper successful NMCR implementation. PMID:29654004

  1. Comparison of Quantity Versus Quality Using Performance, Reliability, and Life Cycle Cost Data. A Case Study of the F-15, F-16, and A-10 Aircraft.

    DTIC Science & Technology

    1985-09-01

    CoC S~04 COMPARISON OF QUANTITY VERSUS QUALITY USING PERFORMANCE, RELIABILITY, AND LIFE CYCLE COST DATA. A CASE STUDY OF THE F-15, F-16, AND A-10...CYCLE COSTIATU.AT CAE AIR ORE HEO OG .- jAITR UIVERSITY W right.,Patterson Air Force Base, Ohio .! 5ൔ ,6 198 C.IT. U AF’IT/GSL,4/L3Q/65:S Ŗ J...COMPARISON OF QUANTITY VERSUS QUALITY USING PERFORMANCE, RELIABILITY, AND LIFE CYCLE COST DATA. A CASE STUDY OF THE F-15, F-16, AND A-10 AIRCRAFT THESIS David

  2. Nurse case-manager vs multifaceted intervention to improve quality of osteoporosis care after wrist fracture: randomized controlled pilot study.

    PubMed

    Majumdar, S R; Johnson, J A; Bellerose, D; McAlister, F A; Russell, A S; Hanley, D A; Garg, S; Lier, D A; Maksymowych, W P; Morrish, D W; Rowe, B H

    2011-01-01

    Few outpatients with fractures are treated for osteoporosis in the years following fracture. In a randomized pilot study, we found a nurse case-manager could double rates of osteoporosis testing and treatment compared with a proven efficacious quality improvement strategy directed at patients and physicians (57% vs 28% rates of appropriate care). Few patients with fractures are treated for osteoporosis. An intervention directed at wrist fracture patients (education) and physicians (guidelines, reminders) tripled osteoporosis treatment rates compared to controls (22% vs 7% within 6 months of fracture). More effective strategies are needed. We undertook a pilot study that compared a nurse case-manager to the multifaceted intervention using a randomized trial design. The case-manager counseled patients, arranged bone mineral density (BMD) tests, and prescribed treatments. We included controls from our first trial who remained untreated for osteoporosis 1-year post-fracture. Primary outcome was bisphosphonate treatment and secondary outcomes were BMD testing, appropriate care (BMD test-treatment if bone mass low), and costs. Forty six patients untreated 1-year after wrist fracture were randomized to case-manager (n = 21) or multifaceted intervention (n = 25). Median age was 60 years and 68% were female. Six months post-randomization, 9 (43%) case-managed patients were treated with bisphosphonates compared with 3 (12%) multifaceted intervention patients (relative risk [RR] 3.6, 95% confidence intervals [CI] 1.1-11.5, p = 0.019). Case-managed patients were more likely than multifaceted intervention patients to undergo BMD tests (81% vs 52%, RR 1.6, 95%CI 1.1-2.4, p = 0.042) and receive appropriate care (57% vs 28%, RR 2.0, 95%CI 1.0-4.2, p = 0.048). Case-management cost was $44 (CDN) per patient vs $12 for the multifaceted intervention. A nurse case-manager substantially increased rates of appropriate testing and treatment for osteoporosis in

  3. Improving quality for maternal care - a case study from Kerala, India

    PubMed Central

    Vlad, Ioana; Paily, VP; Sadanandan, Rajeev; Cluzeau, Françoise; Beena, M; Nair, Rajasekharan; Newbatt, Emma; Ghosh, Sujit; Sandeep, K; Chalkidou, Kalipso

    2016-01-01

    Background: The implementation of maternal health guidelines remains unsatisfactory, even for simple, well established interventions. In settings where most births occur in health facilities, as is the case in Kerala, India, preventing maternal mortality is linked to quality of care improvements. Context: Evidence-informed quality standards (QS), including quality statements and measurable structure and process indicators, are one innovative way of tackling the guideline implementation gap. Having adopted a zero tolerance policy to maternal deaths, the Government of Kerala worked in partnership with the Kerala Federation of Obstetricians & Gynaecologists (KFOG) and NICE International to select the clinical topic, develop and initiate implementation of the first clinical QS for reducing maternal mortality in the state. Description of practice: The NICE QS development framework was adapted to the Kerala context, with local ownership being a key principle. Locally generated evidence identified post-partum haemorrhage as the leading cause of maternal death, and as the key priority for the QS. A multidisciplinary group (including policy-makers, gynaecologists and obstetricians, nurses and administrators) was established. Multi-stakeholder workshops convened by the group ensured that the statements, derived from global and local guidelines, and their corresponding indicators were relevant and acceptable to clinicians and policy-makers in Kerala. Furthermore, it helped identify practical methods for implementing the standards and monitoring outcomes. Lessons learned: An independent evaluation of the project highlighted the equal importance of a strong evidence-base and an inclusive development process. There is no one-size-fits-all process for QS development; a principle-based approach might be a better guide for countries to adapt global evidence to their local context. PMID:27441084

  4. Modeling study of biomass burning plumes and their impact on urban air quality; a case study of Santiago de Chile

    NASA Astrophysics Data System (ADS)

    Cuchiara, G. C.; Rappenglück, B.; Rubio, M. A.; Lissi, E.; Gramsch, E.; Garreaud, R. D.

    2017-10-01

    On January 4, 2014, during the summer period in South America, an intense forest and dry pasture wildfire occurred nearby the city of Santiago de Chile. On that day the biomass-burning plume was transported by low-intensity winds towards the metropolitan area of Santiago and impacted the concentration of pollutants in this region. In this study, the Weather Research and Forecasting model coupled with Chemistry (WRF/Chem) is implemented to investigate the biomass-burning plume associated with these wildfires nearby Santiago, which impacted the ground-level ozone concentration and exacerbated Santiago's air quality. Meteorological variables simulated by WRF/Chem are compared against surface and radiosonde observations, and the results show that the model reproduces fairly well the observed wind speed, wind direction air temperature and relative humidity for the case studied. Based on an analysis of the transport of an inert tracer released over the locations, and at the time the wildfires were captured by the satellite-borne Moderate Resolution Imaging Spectroradiometer (MODIS), the model reproduced reasonably well the transport of biomass burning plume towards the city of Santiago de Chile within a time delay of two hours as observed in ceilometer data. A six day air quality simulation was performed: the first three days were used to validate the anthropogenic and biogenic emissions, and the last three days (during and after the wildfire event) to analyze the performance of WRF/Chem plume-rise model within FINNv1 fire emission estimations. The model presented a satisfactory performance on the first days of the simulation when contrasted against data from the well-established air quality network over the city of Santiago de Chile. These days represent the urban air quality base case for Santiago de Chile unimpacted by fire emissions. However, for the last three simulation days, which were impacted by the fire emissions, the statistical indices showed a decrease in

  5. Drinking Water Quality Governance: A Comparative Case Study of Brazil, Ecuador, and Malawi.

    PubMed

    Kayser, Georgia L; Amjad, Urooj; Dalcanale, Fernanda; Bartram, Jamie; Bentley, Margaret E

    2015-04-01

    Human health is greatly affected by inadequate access to sufficient and safe drinking water, especially in low and middle-income countries. Drinking water governance improvements may be one way to better drinking water quality. Over the past decade, many projects and international organizations have been dedicated to water governance; however, water governance in the drinking water sector is understudied and how to improve water governance remains unclear. We analyze drinking water governance challenges in three countries-Brazil, Ecuador, and Malawi-as perceived by government, service providers, and civil society organizations. A mixed methods approach was used: a clustering model was used for country selection and qualitative semi-structured interviews were used with direct observation in data collection. The clustering model integrated political, economic, social and environmental variables that impact water sector performance, to group countries. Brazil, Ecuador and Malawi were selected with the model so as to enhance the generalizability of the results. This comparative case study is important because similar challenges are identified in the drinking water sectors of each country; while, the countries represent diverse socio-economic and political contexts, and the selection process provides generalizability to our results. We find that access to safe water could be improved if certain water governance challenges were addressed: coordination and data sharing between ministries that deal with drinking water services; monitoring and enforcement of water quality laws; and sufficient technical capacity to improve administrative and technical management of water services at the local level. From an analysis of our field research, we also developed a conceptual framework that identifies policy levers that could be used to influence governance of drinking water quality on national and sub-national levels, and the relationships between these levers.

  6. Drinking Water Quality Governance: A Comparative Case Study of Brazil, Ecuador, and Malawi

    PubMed Central

    Kayser, Georgia L.; Amjad, Urooj; Dalcanale, Fernanda; Bartram, Jamie; Bentley, Margaret E.

    2015-01-01

    Human health is greatly affected by inadequate access to sufficient and safe drinking water, especially in low and middle-income countries. Drinking water governance improvements may be one way to better drinking water quality. Over the past decade, many projects and international organizations have been dedicated to water governance; however, water governance in the drinking water sector is understudied and how to improve water governance remains unclear. We analyze drinking water governance challenges in three countries—Brazil, Ecuador, and Malawi—as perceived by government, service providers, and civil society organizations. A mixed methods approach was used: a clustering model was used for country selection and qualitative semi-structured interviews were used with direct observation in data collection. The clustering model integrated political, economic, social and environmental variables that impact water sector performance, to group countries. Brazil, Ecuador and Malawi were selected with the model so as to enhance the generalizability of the results. This comparative case study is important because similar challenges are identified in the drinking water sectors of each country; while, the countries represent diverse socio-economic and political contexts, and the selection process provides generalizability to our results. We find that access to safe water could be improved if certain water governance challenges were addressed: coordination and data sharing between ministries that deal with drinking water services; monitoring and enforcement of water quality laws; and sufficient technical capacity to improve administrative and technical management of water services at the local level. From an analysis of our field research, we also developed a conceptual framework that identifies policy levers that could be used to influence governance of drinking water quality on national and sub-national levels, and the relationships between these levers. PMID:25798068

  7. An approach to describing and analysing bulk biological annotation quality: a case study using UniProtKB.

    PubMed

    Bell, Michael J; Gillespie, Colin S; Swan, Daniel; Lord, Phillip

    2012-09-15

    Annotations are a key feature of many biological databases, used to convey our knowledge of a sequence to the reader. Ideally, annotations are curated manually, however manual curation is costly, time consuming and requires expert knowledge and training. Given these issues and the exponential increase of data, many databases implement automated annotation pipelines in an attempt to avoid un-annotated entries. Both manual and automated annotations vary in quality between databases and annotators, making assessment of annotation reliability problematic for users. The community lacks a generic measure for determining annotation quality and correctness, which we look at addressing within this article. Specifically we investigate word reuse within bulk textual annotations and relate this to Zipf's Principle of Least Effort. We use the UniProt Knowledgebase (UniProtKB) as a case study to demonstrate this approach since it allows us to compare annotation change, both over time and between automated and manually curated annotations. By applying power-law distributions to word reuse in annotation, we show clear trends in UniProtKB over time, which are consistent with existing studies of quality on free text English. Further, we show a clear distinction between manual and automated analysis and investigate cohorts of protein records as they mature. These results suggest that this approach holds distinct promise as a mechanism for judging annotation quality. Source code is available at the authors website: http://homepages.cs.ncl.ac.uk/m.j.bell1/annotation. phillip.lord@newcastle.ac.uk.

  8. Pay-for-performance as a method to establish the business case for quality.

    PubMed

    Wheeler, John R C; White, Bert; Rauscher, Simone; Nahra, Tammie A; Reiter, Kristin L; Curtin, Kathleen M; Damberg, Cheryl L

    2007-01-01

    One of the major reasons providers give for not implementing promising quality-enhancing interventions (QEI) is that no "business case" for quality has been made. This article clarifies the concepts of the business case for quality and the related economic case for quality and identifies the perspectives of the various actors in health care financing, production, and consumption decisions. A methodology to evaluate the business case for quality from the perspective of payers and providers is presented. The article then uses implemented QEIs to show how a pay-for-performance (P4P) program can alter the business cases for payers and providers. Specifically, the P4P programs described in this article allow a provider to implement a QEI with the financial alignment of the payer in order to achieve financial and non-financial benefits. In some cases, providers and payers may be able to establish P4P programs providing net benefits for both parties.

  9. UPMC Prescription for Wellness: A Quality Improvement Case Study for Supporting Patient Engagement and Health Behavior Change.

    PubMed

    Maners, Rebecca J; Bakow, Eric; Parkinson, Michael D; Fischer, Gary S; Camp, Geoffrey R

    Addressing patient health and care behaviors that underlie much of chronic disease continues to challenge providers, medical practices, health systems, and insurers. Improving health and care as described by the Quadruple Aim requires innovation at the front lines of clinical care: the doctor-patient interaction and office practice. This article describes the use of Lean Six Sigma in a quality improvement (QI) effort to design an effective and scalable method for physicians to prescribe health coaching for healthy behaviors in a primary care medical home within a large integrated delivery and financing system. Building on the national Agency for Healthcare Research and Quality and Robert Wood Johnson Foundation-funded Prescription for Health multisite demonstration, this QI case study provides important lessons for transforming patient-physician-practice support systems to better address lifestyle and care management challenges critical to producing better outcomes.

  10. Application of two quality indices as monitoring and management tools of rivers. Case study: the Imera Meridionale River, Italy.

    PubMed

    Bonanno, Giuseppe; Lo Giudice, Rosa

    2010-04-01

    On the basis of the European Water Framework Directive (2000/60), the water resources of the member states of the European Community should reach good quality standards by 2015. Although such regulations illustrate the basic points for a comprehensive and effective policy of water monitoring and management, no practical tools are provided to face and solve the issues concerning freshwater ecosystems such as rivers. The Italian government has developed a set of regulations as adoption of the European Directive but failed to indicate feasible procedures for river monitoring and management. On a local scale, Sicilian authorities have implemented monitoring networks of watersheds, aiming at describing the general conditions of rivers. However, such monitoring programs have provided a relatively fragmentary picture of the ecological conditions of the rivers. In this study, the integrated use of environmental quality indices is proposed as a methodology able to provide a practical approach to river monitoring and management. As a case study, the Imera Meridionale River, Sicily's largest river, was chosen. The water quality index developed by the U.S. National Sanitation Foundation and the floristic quality index based on the Wilhelm method were applied. The former enabled us to describe the water quality according to a spatial-temporal gradient, whereas the latter focused on the ecological quality of riparian vegetation. This study proposes a holistic view of river ecosystems by considering biotic and abiotic factors in agreement with the current European regulations. How the combined use of such indices can guide sustainable management efforts is also discussed.

  11. Environmental control on water quality; cases studies from Battle Mountain mining district, north-central Nevada. Chapter A.

    USGS Publications Warehouse

    Tuttle, Michele L.W.; Wanty, Richard B.; Berger, Byron R.; Stillings, Lisa L.

    2003-01-01

    The environmental controls on water quality were the focus of our study in a portion of the Battle Mountain mining district, north-central Nevada. Samples representing areas outside known mineralized areas, in undisturbed mineralized areas, and in mined areas were chemically and isotopically analyzed. The results are related to geologic, hydrologic, and climatic data. Streams in background areas outside the mineralized zones reflect normal weathering of volcanically derived rocks. The waters are generally dilute, slightly alkaline in pH, and very low in metals. As these streams flow into mineralized zones, their character changes. In undisturbed mineralized areas, discharge into streams of ground water through hydrologically conductive fractures can be traced with chemistry and, even more effectively, with sulfur isotopic composition of dissolved sulfate. Generally, these tracers are much more subtle than in those areas where mining has produced adits and mine-waste piles. The influence of drainage from these mining relicts on water quality is often dramatic, especially in unusually wet conditions. In one heavily mined area, we were able to show that the unusually wet weather in the winter and spring greatly degraded water quality. Addition of calcite to the acid, metalrich mine drainage raised the stream pH and nearly quantitatively removed the metals through coprecipitation and (or) adsorption onto oxyhydroxides. This paper is divided into four case studies used to demonstrate our results. Each addresses the role of geology, hydrology, mining activity and (or) local climate on water quality. Collectively, they provide a comprehensive look at the important factors affecting water quality in this portion of the Battle Mountain mining district.

  12. Improving quality and diffusing best practices: the case of schizophrenia.

    PubMed Central

    Donohue, Julie M.; Domino, Marisa E.; Normand, Sharon-Lise T.

    2009-01-01

    The slow diffusion of empirically supported treatments and the rapid diffusion of treatments lacking empirical support play a significant role in the quality gap in the care of people with severe mental illnesses. Further, the rapid diffusion of treatments of low cost-effectiveness limits the system's ability to provide the full gamut of high-value treatments available to treat this vulnerable population. Using the case of schizophrenia as an illustrative case study, we review the context in which these paradoxical patterns of diffusion have occurred and propose policy solutions. PMID:19414878

  13. Lactation studies of anticonvulsants: a quality review

    PubMed Central

    van der Meer, Douwe H; Wieringa, Andre; Wegner, Ilse; Wilffert, Bob; ter Horst, Peter G J

    2015-01-01

    AIM The aim of this review was to investigate the quality of the current literature on the transfer of anticonvulsants to breast milk to provide an overview of which anticonvulsants are in need of further research. METHODS We reviewed the quality of the available lactation studies for 19 anticonvulsants against the guidelines of the Food and Drug Administration (FDA) and the International Lactation Consultant Association (ILCA). RESULTS Except for one study on lamotrigine and one case report on gabapentin, no study on anticonvulsants had both the absolute infant dose (AID) and milk to plasma ratio (M : P) correctly assessed. Only one study on carbamazepine, phenytoin and vigabatrin was found that correctly assessed the AID. The main cause for this low number is the lack of essential details in published studies, since 25 of 62 studies were case reports, letters or abstracts. Other major shortcomings were the lack of information on sampling methods, the number of samples in a particular dose interval as well as the low number of study participants. CONCLUSION The quality of the current literature on the transfer of anticonvulsants to breast milk is low, except for lamotrigine, which makes it hard to draw conclusions about the safety of the use of anticonvulsants during the lactation period. Therefore, further research is needed. PMID:25291358

  14. Lactation studies of anticonvulsants: a quality review.

    PubMed

    van der Meer, Douwe H; Wieringa, Andre; Wegner, Ilse; Wilffert, Bob; Ter Horst, Peter G J

    2015-04-01

    The aim of this review was to investigate the quality of the current literature on the transfer of anticonvulsants to breast milk to provide an overview of which anticonvulsants are in need of further research. We reviewed the quality of the available lactation studies for 19 anticonvulsants against the guidelines of the Food and Drug Administration (FDA) and the International Lactation Consultant Association (ILCA). Except for one study on lamotrigine and one case report on gabapentin, no study on anticonvulsants had both the absolute infant dose (AID) and milk to plasma ratio (M : P) correctly assessed. Only one study on carbamazepine, phenytoin and vigabatrin was found that correctly assessed the AID. The main cause for this low number is the lack of essential details in published studies, since 25 of 62 studies were case reports, letters or abstracts. Other major shortcomings were the lack of information on sampling methods, the number of samples in a particular dose interval as well as the low number of study participants. The quality of the current literature on the transfer of anticonvulsants to breast milk is low, except for lamotrigine, which makes it hard to draw conclusions about the safety of the use of anticonvulsants during the lactation period. Therefore, further research is needed. © 2014 The British Pharmacological Society.

  15. Higher Education Quality Assessment in China: An Impact Study

    ERIC Educational Resources Information Center

    Liu, Shuiyun

    2015-01-01

    This research analyses an external higher education quality assessment scheme in China, namely, the Quality Assessment of Undergraduate Education (QAUE) scheme. Case studies were conducted in three Chinese universities with different statuses. Analysis shows that the evaluated institutions responded to the external requirements of the QAUE…

  16. Case study: survey of patient satisfaction with prosthesis quality and design among below-knee prosthetic leg socket users.

    PubMed

    Mohd Hawari, Nurhanisah; Jawaid, Mohammad; Md Tahir, Paridah; Azmeer, Raja Ahmad

    2017-11-01

    The aim of this case study was to explore patient satisfaction with the quality of prosthetic leg sockets intended for persons with lower limb amputations. A qualitative study based on in-depth interviews, preceded by a questionnaire session, was carried out with patients from the Rehabilitation Center and Hospital in Malaysia. Twelve out-patient and in-patient amputees with lower limb amputations, specifically below-knee amputations, were chosen randomly. The analysis of patients' narratives aimed to identify the functional and esthetic characteristics of currently used prosthetic leg sockets and any problems related to them. The obtained results indicated that out of the 12 participants, 41.7% and 25% were satisfied and somewhat satisfied with their current prosthetic sockets. Durability and comfort were rated by the participants as the most important characteristics of prosthetic sockets, with 83.3%. As regards the esthetic appearance of the socket, 66.7% of the respondents considered that the most important feature was the material from which the socket was fabricated. Thus, we conclude that current satisfaction levels with the quality of prosthetic sockets among amputees in Malaysia are suitable, prosthesis being preferred by many amputees. The results can be used to direct future research on cosmesis and functionality of prosthetic socket design. Implications for Rehabilitation Case study will help participants to get cost effective prosthetic leg socket. Develop prosthetic leg socket comfortable as comparative to existing one. Help Malaysian government to make policy to develop local prosthetic leg socket at affordable price.

  17. Teaching Quality Matters in Higher Education: A Case Study from Turkey and Slovakia

    ERIC Educational Resources Information Center

    Üstünlüoglu, Evrim

    2017-01-01

    Despite a growing number of studies on the effectiveness of teaching and quality in higher education, reports indicate that more work is needed regarding meeting expectations in teaching quality, in particular, in investigating lecturers' application of pedagogical knowledge when transferring discipline-specific knowledge. This study aimed to…

  18. A retrospective explanatory case study of the implementation of a bleeding management quality initiative, in an Australian cardiac surgery unit.

    PubMed

    Pearse, Bronwyn Louise; Rickard, Claire M; Keogh, Samantha; Lin Fung, Yoke

    2018-03-09

    Bleeding management in cardiac surgery is challenging. Many guidelines exist to support bleeding management; however, literature demonstrates wide variation in practice. In 2012, a quality initiative was undertaken at The Prince Charles Hospital, Australia to improve bleeding management for cardiac surgery patients. The implementation of the quality initiative resulted in significant reductions in the incidence of blood transfusion, re-exploration for bleeding; superficial leg and chest wound infections; length of hospital stay, and cost. Given the success of the initiative, we sought to answer the question; "How and why was the process of implementing a bleeding management quality initiative in the cardiac surgery unit successful, and sustainable?" A retrospective explanatory case study design was chosen to explore the quality initiative. Analysis of the evidence was reviewed through phases of the 'Knowledgeto Action' planned change model. Data was derived from: (1) document analysis, (2) direct observation of the local environment, (3) clinical narratives from interviews, and analysed with a triangulation approach. The study period extended from 10/2011 to 6/2013. Results demonstrated the complexity of changing practice, as well as the significant amount of dedicated time and effort required to support individual, department and system wide change. Results suggest that while many clinicians were aware of the potential to apply improved practice, numerous barriers and challenges needed to be overcome to implement change across multiple disciplines and departments. The key successful components of the QI were revealed through the case study analysis as: (1) an appropriately skilled project manager to facilitate the implementation process; (2) tools to support changes in workflow and decision making including a bleeding management treatment algorithm with POCCTs; (3) strong clinical leadership from the multidisciplinary team and; (4) the evolution of the project

  19. How different technologies can fit nursing processes to empower staff and increase quality of care. An Italian case study.

    PubMed

    Bollini, Giovanna; Lolli, Angela; Zaza, Raffaele; Origgi, Gianni; Bragagia, Silvia; Locatelli, Paolo; Restifo, Nicola

    2009-01-01

    The rapid evolution of healthcare and the need to contain costs, to decrease the time of patients' hospitalization, and to improve the quality of care has led the nursing profession to face new challenges. This paper describes the case study of A.O. Ospedale Niguarda in Milan (Italy), a public healthcare provider where the key role of Nursing is being recognized according to international common practice. Also considering the context of Italian healthcare, attention will be drawn to concrete actions carried out on the organizational side and also for what concerns IT tools supporting nursing activities. This was done aiming with success at rising nurses' knowledge level of the patient, support its activities, increase quality of care, in a precise managerial and methodological framework. We will describe four cases of projects (Intensive Care Unit patient record, First Aid Station care reporting, pressure ulcers management, transfusion traceability) carried out by Niguarda with the support of its partner Fondazione Politecnico di Milano, set up to support bedside nursing activities with the most suitable technology for the purpose.

  20. Ambient air quality and asthma cases in Niğde, Turkey.

    PubMed

    Kara, Ertan; Özdilek, Hasan Göksel; Kara, Emine Erman

    2013-06-01

    Urban air quality is one of the key factors affecting human health. Turkey has transformed itself into an urban society over the last 30 years. At the same time, air pollution has become a serious impairment to health in many urban areas in the country. This is due to many reasons. In this study, a nonparametric evaluation was conducted of health effects that are triggered by urban air pollution. Niğde, the city which is the administrative centre of Nigde province was chosen of the effects of air pollution since, like many central Turkish cities, it is situated on a valley where atmospheric inversion occurs. In this paper, the relationship between ambient urban air quality, namely PM10 and sulphur dioxide (SO2), and human health, specifically asthma, during the winter season is examined. Air pollution data and asthma cases from 2006 to 2010 are covered in this study. The results of our study indicate that total asthma cases reported in Nigde between 2008 and 2010 were highly dependent on ambient SO2 concentration. More asthma cases were recorded when 30 μg m(-3) or higher SO2 was present in the ambient air than those recorded under cleaner ambient air conditions. Moreover, it was determined that in Nigde in 2010, asthma cases reported in males aged between 45 and 64 were closely correlated with ambient SO2 (α=0.05).

  1. Prospects and Problems of Transferring Quality-Improvement Methods from Health Care to Social Services: Two Case Studies

    PubMed Central

    Neubeck, Truls; Elg, Mattias; Schneider, Thomas; Andersson-Gäre, Boel

    2014-01-01

    Introduction: This study examines the use of quality-improvement (QI) methods in social services. Particularly the key aspects—generalizable knowledge, interprofessional teamwork, and measurements—are studied in projects from the QI program Forum for Values in Sweden. Methods: This is a mixed-method case study. Two projects using standard QI methods and tools as used in health care were chosen as critical cases to highlight some problems and prospects with the use of QI in social services. The cases were analyzed through documented results and qualitative interviews with participants one year after the QI projects ended. Results: The social service QI projects led to measurable improvements when they used standard methods and tools for QI in health care. One year after the projects, the improvements were either not continuously measured or not reported in any infrastructure for measurements. The study reveals that social services differ from health care regarding the availability and use of evidence, the role of professional expertise, and infrastructure for measurements. Conclusions: We argue that QI methods as used in health care are applicable in social services and can lead to measurable improvements. The study gives valuable insights for QI, not only in social services but also in health care, on how to assess and sustain improvements when infrastructures for measurements are lacking. In addition, when one forms QI teams, the focus should be on functions instead of professions, and QI methods can be used to support implementation of evidence-based practice. PMID:24867549

  2. Factor selection for service quality evaluation: a hospital case study.

    PubMed

    Ameryoun, Ahmad; Najafi, Seyedvahid; Nejati-Zarnaqi, Bayram; Khalilifar, Seyed Omid; Ajam, Mahdi; Ansarimoghadam, Ahmad

    2017-02-13

    Purpose The purpose of this paper is to develop a systematic approach to predict service quality dimension's influence on service quality using a novel analysis based on data envelopment and SERVQUAL. Design/methodology/approach To assess hospital service quality in Tehran, expectation and perception of those who received the services were evaluated using SERVQUAL. The hospital service quality dimensions were found by exploratory factor analysis (EFA). To compare customer expectation and perception, perceived service quality index (PSQI) was measured using a new method based on common weights. A novel sensitivity approach was used to test the service quality factor's impact on the PSQI. Findings A new service quality dimension named "trust in services" was found using EFA, which is not an original SERVQUAL factor. The approach was applied to assess the hospital's service quality. Since the PSQI value was 0.76 it showed that improvements are needed to meet customer expectations. The results showed the factor order that affect PSQI. "Trust in services" has the strongest influence on PSQI followed by "tangibles," "assurance," "empathy," and "responsiveness," respectively. Practical implications This work gives managers insight into service quality by following a systematic method; i.e., measuring perceived service quality from the customer viewpoint and service factors' impact on customer perception. Originality/value The procedure helps managers to select the required service quality dimensions which need improvement and predict their effects on customer perception.

  3. Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study.

    PubMed

    Miller, James S; English, Lacey; Matte, Michael; Mbusa, Rapheal; Ntaro, Moses; Bwambale, Shem; Kenney, Jessica; Siedner, Mark J; Reyes, Raquel; Lee, Patrick T; Mulogo, Edgar; Stone, Geren S

    2018-02-27

    Village health workers (VHWs) in five villages in Bugoye subcounty (Kasese District, Uganda) provide integrated community case management (iCCM) services, in which VHWs evaluate and treat malaria, pneumonia, and diarrhoea in children under 5 years of age. VHWs use a "Sick Child Job Aid" that guides them through the evaluation and treatment of these illnesses. A retrospective observational study was conducted to measure the quality of iCCM care provided by 23 VHWs in 5 villages in Bugoye subcounty over a 2-year period. Patient characteristics and clinical services were summarized using existing aggregate programme data. Lot quality assurance sampling of individual patient records was used to estimate adherence to the iCCM algorithm, VHW-level quality (based on adherence to the iCCM protocol), and change over time in quality of care (using generalized estimating equations regression modelling). For each of 23 VHWs, 25 patient visits were randomly selected from a 2-year period after iCCM care initiation. In these visits, 97% (150) of patients with diarrhoea were treated with oral rehydration and zinc, 95% (216) of patients with pneumonia were treated with amoxicillin, and 94% (240) of patients with malaria were treated with artemisinin-based combination therapy or rectal artesunate. However, only 44% (44) of patients with a negative rapid test for malaria were appropriately referred to a health facility. Overall, 75% (434) of patients received all the correct evaluation and management steps. Only 9 (39%) of the 23 VHWs met the pre-determined LQAS threshold for high-quality care over the 2-year observation period. Quality of care increased significantly in the first 6 months after initiation of iCCM services (p = 0.003), and then plateaued during months 7-24. Quality of care was high for uncomplicated malaria, pneumonia and diarrhoea. Overall quality of care was lower, in part because VHWs often did not follow the guidelines to refer patients with fever who tested

  4. Temporal water quality response in an urban river: a case study in peninsular Malaysia

    NASA Astrophysics Data System (ADS)

    VishnuRadhan, Renjith; Zainudin, Zaki; Sreekanth, G. B.; Dhiman, Ravinder; Salleh, Mohd. Noor; Vethamony, P.

    2017-05-01

    Ambient water quality is a prerequisite for the health and self-purification capacity of riverine ecosystems. To understand the general water quality situation, the time series data of selected water quality parameters were analyzed in an urban river in Peninsular Malaysia. In this regard, the stations were selected from the main stem of the river as well as from the side channel. The stations located at the main stem of the river are less polluted than that in the side channel. Water Quality Index scores indicated that the side channel station is the most polluted, breaching the Class IV water quality criteria threshold during the monitoring period, followed by stations at the river mouth and the main channel. The effect of immediate anthropogenic waste input is also evident at the side channel station. The Organic Pollution Index of side channel station is (14.99) 3 times higher than at stations at river mouth (4.11) and 6 times higher than at the main channel (2.57). The two-way ANOVA showed significant difference among different stations. Further, the factor analysis on water quality parameters yielded two significant factors. They discriminated the stations into two groups. The land-use land cover classification of the study area shows that the region near the sampling sites is dominated by urban settlements (33.23 %) and this can contribute significantly to the deterioration of ambient river water quality. The present study estimated the water quality condition and response in the river and the study can be an immediate yardstick for base lining river water quality, and a basis for future water quality modeling studies in the region.

  5. Microfinance investments in quality at private clinics in Uganda: a case-control study.

    PubMed

    Seiber, Eric E; Robinson, Amara L

    2007-10-18

    Small private-sector health care providers can play an important role in meeting the developing country health care needs, but a lack of credit can prove major constraint to small-provider expansion. This study examines the potential of small, microfinance loans to strengthen the private health sector and improve access to quality preventive and curative health services in Uganda. This study estimates logistic regressions using 2,387 client exit interviews to assess the impact of microfinance loans on perceived quality and the viability and sustainability of small, private clinics. The study finds perceived quality improved with loan recipients' clients being more likely to choose clinics on the basis of drug availability, fair charges, cleanliness, and confidentiality. In addition, the assessment found evidence of increased client flows, but the changes produced mixed results for sustainability with respondents being only half as likely to "always" visit a particular clinic. The results indicate that the microfinance program improved perceived quality at loan recipient clinics, especially as reliable drug outlets.

  6. Urban air quality forecasting based on multi-dimensional collaborative Support Vector Regression (SVR): A case study of Beijing-Tianjin-Shijiazhuang

    PubMed Central

    Liu, Bing-Chun; Binaykia, Arihant; Chang, Pei-Chann; Tiwari, Manoj Kumar; Tsao, Cheng-Chin

    2017-01-01

    Today, China is facing a very serious issue of Air Pollution due to its dreadful impact on the human health as well as the environment. The urban cities in China are the most affected due to their rapid industrial and economic growth. Therefore, it is of extreme importance to come up with new, better and more reliable forecasting models to accurately predict the air quality. This paper selected Beijing, Tianjin and Shijiazhuang as three cities from the Jingjinji Region for the study to come up with a new model of collaborative forecasting using Support Vector Regression (SVR) for Urban Air Quality Index (AQI) prediction in China. The present study is aimed to improve the forecasting results by minimizing the prediction error of present machine learning algorithms by taking into account multiple city multi-dimensional air quality information and weather conditions as input. The results show that there is a decrease in MAPE in case of multiple city multi-dimensional regression when there is a strong interaction and correlation of the air quality characteristic attributes with AQI. Also, the geographical location is found to play a significant role in Beijing, Tianjin and Shijiazhuang AQI prediction. PMID:28708836

  7. Environmental quality of transitional waters: the lagoon of Venice case study.

    PubMed

    Micheletti, C; Gottardo, S; Critto, A; Chiarato, S; Marcomini, A

    2011-01-01

    The health status of European aquatic environments, including transitional waters such as coastal lagoons, is regulated by the Water Framework Directive (WFD), which requires the classification of the water bodies' environmental quality and the achievement of a good ecological status by 2015. In the Venice lagoon, a transitional water body located in the northeastern part of Italy, the achievement of a good ecological status is hampered by several anthropogenic and natural pressures, such as sediment and water chemical contamination, and sediment erosion. In order to evaluate the lagoon's environmental quality according to the WFD (i.e. 5 quality classes, from High to Bad), an integrated Weight-of-Evidence methodology was developed and applied to classify the quality of the lagoon water bodies, integrating biological, physico-chemical, chemical, ecotoxicological, and hydromorphological data (i.e. Lines of Evidence, LOE). The quality assessment was carried out in two lagoon habitat typologies (previously defined on the basis of morphological, sediment, and hydrodynamic characteristics) which were selected taking into account the ecological gradient from sea to land, and the differences in anthropogenic pressure and contamination levels. The LOE classification was carried out by using indicators scored by comparing site specific conditions to reference conditions measured in lagoon reference sites, or provided by local, national or European regulations (e.g. Environmental Quality Standards, EQS, for chemicals). Finally, the overall quality status for each water body was calculated by a probabilistic approach, i.e. by reporting the final result as the frequency distribution of quality classes. The developed procedure was applied by using data and information concerning selected LOE and collected from monitoring programs and research studies carried out in the last 15 years in the lagoon of Venice. A set of sampling stations characterized by spatially and temporally

  8. End-tidal carbon dioxide output in manual cardiopulmonary resuscitation versus active compression-decompression device during prehospital quality controlled resuscitation: a case series study.

    PubMed

    Setälä, Piritta Anniina; Virkkunen, Ilkka Tapani; Kämäräinen, Antti Jaakko; Huhtala, Heini Sisko Annamari; Virta, Janne Severi; Yli-Hankala, Arvi Mikael; Hoppu, Sanna Elisa

    2018-05-16

    Active compression-decompression (ACD) devices have enhanced end-tidal carbon dioxide (ETCO 2 ) output in experimental cardiopulmonary resuscitation (CPR) studies. However, the results in out-of-hospital cardiac arrest (OHCA) patients have shown inconsistent outcomes, and earlier studies lacked quality control of CPR attempts. We compared manual CPR with ACD-CPR by measuring ETCO 2 output using an audiovisual feedback defibrillator to ensure continuous high quality resuscitation attempts. 10 witnessed OHCAs were resuscitated, rotating a 2 min cycle with manual CPR and a 2 min cycle of ACD-CPR. Patients were intubated and the ventilation rate was held constant during CPR. CPR quality parameters and ETCO 2 values were collected continuously with the defibrillator. Differences in ETCO 2 output between manual CPR and ACD-CPR were analysed using a linear mixed model where ETCO 2 output produced by a summary of the 2 min cycles was included as the dependent variable, the patient as a random factor and method as a fixed effect. These comparisons were made within each OHCA case to minimise confounding factors between the cases. Mean length of the CPR episodes was 37 (SD 8) min. Mean compression depth was 76 (SD 1.3) mm versus 71 (SD1.0) mm, and mean compression rate was 100 per min (SD 6.7) versus 105 per min (SD 4.9) between ACD-CPR and manual CPR, respectively. For ETCO 2 output, the interaction between the method and the patient was significant (P<0.001). ETCO 2 output was higher with manual CPR in 6 of the 10 cases. This study suggests that quality controlled ACD-CPR is not superior to quality controlled manual CPR when ETCO 2 is used as a quantitative measure of CPR effectiveness. NCT00951704; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Qualitative case study methodology in nursing research: an integrative review.

    PubMed

    Anthony, Susan; Jack, Susan

    2009-06-01

    This paper is a report of an integrative review conducted to critically analyse the contemporary use of qualitative case study methodology in nursing research. Increasing complexity in health care and increasing use of case study in nursing research support the need for current examination of this methodology. In 2007, a search for case study research (published 2005-2007) indexed in the CINAHL, MEDLINE, EMBASE, PsychINFO, Sociological Abstracts and SCOPUS databases was conducted. A sample of 42 case study research papers met the inclusion criteria. Whittemore and Knafl's integrative review method guided the analysis. Confusion exists about the name, nature and use of case study. This methodology, including terminology and concepts, is often invisible in qualitative study titles and abstracts. Case study is an exclusive methodology and an adjunct to exploring particular aspects of phenomena under investigation in larger or mixed-methods studies. A high quality of case study exists in nursing research. Judicious selection and diligent application of literature review methods promote the development of nursing science. Case study is becoming entrenched in the nursing research lexicon as a well-accepted methodology for studying phenomena in health and social care, and its growing use warrants continued appraisal to promote nursing knowledge development. Attention to all case study elements, process and publication is important in promoting authenticity, methodological quality and visibility.

  10. Quality Assessment of Family Planning Sterilization Services at Health Care Facilities: Case Record Audit.

    PubMed

    Mathur, Medha; Goyal, Ram Chandra; Mathur, Navgeet

    2017-05-01

    Quality of sterilization services is a matter of concern in India because population control is a necessity. Family Planning Sterilization (FPS) services provided at public health care facilities need to be as per Standard Operating Procedures. To assess the quality of FPS services by audit of case records at selected health care facilities. This cross-sectional study was conducted for two and a half year duration at selected public health care facilities of central India by simple random sampling where FPS services were provided. As per the standards of Government of India, case records were audited and compliance was calculated to assess the quality of services. Results of record audit were satisfactory but important criteria like previous contraceptive history and postoperative counselling were found to be deviated from standards. At Primary Health Centres (PHCs) only 89.5% and at Community Health Centres (CHCs) 58.7% of records were having details of previous contraceptive history. Other criteria like mental illness (only 70% at CHCs) assessment were also inadequate. Although informed consent was found to be having 100% compliance in all records. Quality of care in FPS services is the matter of concern in present scenario for better quality of services. This study may enlighten the policy makers regarding improvements needed for providing quality care.

  11. Quality Indicators for Single-Case Research on Social Skill Interventions for Children with Autistic Spectrum Disorder

    ERIC Educational Resources Information Center

    Wang, Shin-Yi; Parrila, Rauno

    2008-01-01

    In this paper, we describe a quality checklist that parents, teachers, clinicians, and policy-makers with basic research skills can use to systematically evaluate the methodological quality of single-case studies on social skill training of children with autistic spectrum disorder (ASD). We provide a rationale for included quality indicators, and…

  12. Case study: Fixture water use and drinking water quality in a new residential green building.

    PubMed

    Salehi, Maryam; Abouali, Mohammad; Wang, Mian; Zhou, Zhi; Nejadhashemi, Amir Pouyan; Mitchell, Jade; Caskey, Stephen; Whelton, Andrew J

    2018-03-01

    Residential plumbing is critical for the health and safety of populations worldwide. A case study was conducted to understand fixture water use, drinking water quality and their possible link, in a newly plumbed residential green building. Water use and water quality were monitored at four in-building locations from September 2015 through December 2015. Once the home was fully inhabited average water stagnation periods were shortest at the 2nd floor hot fixture (90 percentile of 0.6-1.2 h). The maximum water stagnation time was 72.0 h. Bacteria and organic carbon levels increased inside the plumbing system compared to the municipal tap water entering the building. A greater amount of bacteria was detected in hot water samples (6-74,002 gene copy number/mL) compared to cold water (2-597 gene copy number/mL). This suggested that hot water plumbing promoted greater microbial growth. The basement fixture brass needle valve may have caused maximum Zn (5.9 mg/L), Fe (4.1 mg/L), and Pb (23 μg/L) levels compared to other fixture water samples (Zn ≤ 2.1 mg/L, Fe ≤ 0.5 mg/L and Pb ≤ 8 μg/L). At the basement fixture, where the least amount of water use events occurred (cold: 60-105, hot: 21-69 event/month) compared to the other fixtures in the building (cold: 145-856, hot: 326-2230 event/month), greater organic carbon, bacteria, and heavy metal levels were detected. Different fixture use patterns resulted in disparate water quality within a single-family home. The greatest drinking water quality changes were detected at the least frequently used fixture. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Gynecomastia Surgery-Impact on Life Quality: A Prospective Case-Control Study.

    PubMed

    Kasielska-Trojan, Anna; Antoszewski, Bogusław

    2017-03-01

    To evaluate the results of surgical treatment of gynecomastia in the context of quality of life and satisfaction after the surgery. Fifty male patients (mean age, 25.1 years [SD = 8 years]) who underwent surgery for gynecomastia and completed both (preoperative and postoperative) stages of the study were included in the analysis. The quality-of-life evaluation instrument was The Short Form-36 Health Survey Questionnaire. Additionally, we used a short questionnaire including 2 questions about patient satisfaction with gynecomastia surgery. The overall change in life satisfaction after gynecomastia surgery was 1 point on Likert scale (sign test, P < 0.0001). Participants after gynecomastia surgery scored significantly higher than before the procedure in all Short Form-36 Health Survey Questionnaire domains as well as in 2 main scales Psychical and Physical Health. The changes were especially visible for the domain social functioning and a scale Psychical Health (P < 0.0001). Gynecomastia surgery significantly improved men's life quality in all aspects and especially in the social aspect and psychical health. This indicates that adult men with gynecomastia are a specific group of patients, in which surgery may result in life quality improvement even over the average scores.

  14. Data Quality- and Master Data Management - A Hospital Case.

    PubMed

    Arthofer, Klaus; Girardi, Dominic

    2017-01-01

    Poor data quality prevents the analysis of data for decisions which are critical for business. It also has a negative impact on business processes. Nevertheless the maturity level of data quality- and master data management is still insufficient in many organizations nowadays. This article discusses the corresponding maturity of companies and a management cycle integrating data quality- and master data management in a case dealing with benchmarking in hospitals. In conclusion if data quality and master data are not properly managed, structured data should not be acquired in the first place due to the added expense and complexity.

  15. Beyond Clinical Case Studies in Psychoanalysis: A Review of Psychoanalytic Empirical Single Case Studies Published in ISI-Ranked Journals.

    PubMed

    Meganck, Reitske; Inslegers, Ruth; Krivzov, Juri; Notaerts, Liza

    2017-01-01

    Single case studies are at the origin of both theory development and research in the field of psychoanalysis and psychotherapy. While clinical case studies are the hallmark of psychoanalytic theory and practice, their scientific value has been strongly criticized. To address problems with the subjective bias of retrospective therapist reports and uncontrollability of clinical case studies, systematic approaches to investigate psychotherapy process and outcome at the level of the single case have been developed. Such empirical case studies are also able to bridge the famous gap between academic research and clinical practice as they provide clinically relevant insights into how psychotherapy works. This study presents a review of psychoanalytic empirical case studies published in ISI-ranked journals and maps the characteristics of the study, therapist, patient en therapies that are investigated. Empirical case studies increased in quantity and quality (amount of information and systematization) over time. While future studies could pay more attention to providing contextual information on therapist characteristics and informed consent considerations, the available literature provides a basis to conduct meta-studies of single cases and as such contribute to knowledge aggregation.

  16. Beyond Clinical Case Studies in Psychoanalysis: A Review of Psychoanalytic Empirical Single Case Studies Published in ISI-Ranked Journals

    PubMed Central

    Meganck, Reitske; Inslegers, Ruth; Krivzov, Juri; Notaerts, Liza

    2017-01-01

    Single case studies are at the origin of both theory development and research in the field of psychoanalysis and psychotherapy. While clinical case studies are the hallmark of psychoanalytic theory and practice, their scientific value has been strongly criticized. To address problems with the subjective bias of retrospective therapist reports and uncontrollability of clinical case studies, systematic approaches to investigate psychotherapy process and outcome at the level of the single case have been developed. Such empirical case studies are also able to bridge the famous gap between academic research and clinical practice as they provide clinically relevant insights into how psychotherapy works. This study presents a review of psychoanalytic empirical case studies published in ISI-ranked journals and maps the characteristics of the study, therapist, patient en therapies that are investigated. Empirical case studies increased in quantity and quality (amount of information and systematization) over time. While future studies could pay more attention to providing contextual information on therapist characteristics and informed consent considerations, the available literature provides a basis to conduct meta-studies of single cases and as such contribute to knowledge aggregation. PMID:29046660

  17. Systematic review of the methodological and reporting quality of case series in surgery.

    PubMed

    Agha, R A; Fowler, A J; Lee, S-Y; Gundogan, B; Whitehurst, K; Sagoo, H K; Jeong, K J L; Altman, D G; Orgill, D P

    2016-09-01

    Case series are an important and common study type. No guideline exists for reporting case series and there is evidence of key data being missed from such reports. The first step in the process of developing a methodologically sound reporting guideline is a systematic review of literature relevant to the reporting deficiencies of case series. A systematic review of methodological and reporting quality in surgical case series was performed. The electronic search strategy was developed by an information specialist and included MEDLINE, Embase, Cochrane Methods Register, Science Citation Index and Conference Proceedings Citation index, from the start of indexing to 5 November 2014. Independent screening, eligibility assessments and data extraction were performed. Included articles were then analysed for five areas of deficiency: failure to use standardized definitions, missing or selective data (including the omission of whole cases or important variables), transparency or incomplete reporting, whether alternative study designs were considered, and other issues. Database searching identified 2205 records. Through the process of screening and eligibility assessments, 92 articles met inclusion criteria. Frequencies of methodological and reporting issues identified were: failure to use standardized definitions (57 per cent), missing or selective data (66 per cent), transparency or incomplete reporting (70 per cent), whether alternative study designs were considered (11 per cent) and other issues (52 per cent). The methodological and reporting quality of surgical case series needs improvement. The data indicate that evidence-based guidelines for the conduct and reporting of case series may be useful. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

  18. Comparison of case note review methods for evaluating quality and safety in health care.

    PubMed

    Hutchinson, A; Coster, J E; Cooper, K L; McIntosh, A; Walters, S J; Bath, P A; Pearson, M; Young, T A; Rantell, K; Campbell, M J; Ratcliffe, J

    2010-02-01

    To determine which of two methods of case note review--holistic (implicit) and criterion-based (explicit)--provides the most useful and reliable information for quality and safety of care, and the level of agreement within and between groups of health-care professionals when they use the two methods to review the same record. To explore the process-outcome relationship between holistic and criterion-based quality-of-care measures and hospital-level outcome indicators. Case notes of patients at randomly selected hospitals in England. In the first part of the study, retrospective multiple reviews of 684 case notes were undertaken at nine acute hospitals using both holistic and criterion-based review methods. Quality-of-care measures included evidence-based review criteria and a quality-of-care rating scale. Textual commentary on the quality of care was provided as a component of holistic review. Review teams comprised combinations of: doctors (n = 16), specialist nurses (n = 10) and clinically trained audit staff (n = 3) and non-clinical audit staff (n = 9). In the second part of the study, process (quality and safety) of care data were collected from the case notes of 1565 people with either chronic obstructive pulmonary disease (COPD) or heart failure in 20 hospitals. Doctors collected criterion-based data from case notes and used implicit review methods to derive textual comments on the quality of care provided and score the care overall. Data were analysed for intrarater consistency, inter-rater reliability between pairs of staff using intraclass correlation coefficients (ICCs) and completeness of criterion data capture, and comparisons were made within and between staff groups and between review methods. To explore the process-outcome relationship, a range of publicly available health-care indicator data were used as proxy outcomes in a multilevel analysis. Overall, 1473 holistic and 1389 criterion-based reviews were undertaken in the first part of the study

  19. Does Case-Study Methodology Lack Rigour? The Need for Quality Criteria for Sound Case-Study Research, as Illustrated by a Recent Case in Secondary and Higher Education

    ERIC Educational Resources Information Center

    Kyburz-Graber, Regula

    2004-01-01

    There is a tendency to use case-study research methodology for research issues aiming at simply describing a complex situation, and to draw conclusions with insufficient rigour. Sound case-study research, however, follows discriminate rules which can be described in all the dimensions of a full case-study research process. This paper examines…

  20. Microfinance investments in quality at private clinics in Uganda: a case-control study

    PubMed Central

    Seiber, Eric E; Robinson, Amara L

    2007-01-01

    Background Small private-sector health care providers can play an important role in meeting the developing country health care needs, but a lack of credit can prove major constraint to small-provider expansion. This study examines the potential of small, microfinance loans to strengthen the private health sector and improve access to quality preventive and curative health services in Uganda. Methods This study estimates logistic regressions using 2,387 client exit interviews to assess the impact of microfinance loans on perceived quality and the viability and sustainability of small, private clinics. Results The study finds perceived quality improved with loan recipients' clients being more likely to choose clinics on the basis of drug availability, fair charges, cleanliness, and confidentiality. In addition, the assessment found evidence of increased client flows, but the changes produced mixed results for sustainability with respondents being only half as likely to "always" visit a particular clinic. Conclusion The results indicate that the microfinance program improved perceived quality at loan recipient clinics, especially as reliable drug outlets. PMID:17945024

  1. Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes

    PubMed Central

    Congdon, Peter

    2016-01-01

    Background: Enhanced quality of care and improved access are central to effective primary care management of long term conditions. However, research evidence is inconclusive in establishing a link between quality of primary care, or access, and adverse outcomes, such as unplanned hospitalisation. Methods: This paper proposes a structural equation model for quality and access as latent variables affecting adverse outcomes, such as unplanned hospitalisations. In a case study application, quality of care (QOC) is defined in relation to diabetes, and the aim is to assess impacts of care quality and access on unplanned hospital admissions for diabetes, while allowing also for socio-economic deprivation, diabetes morbidity, and supply effects. The study involves 90 general practitioner (GP) practices in two London Clinical Commissioning Groups, using clinical quality of care indicators, and patient survey data on perceived access. Results: As a single predictor, quality of care has a significant negative impact on emergency admissions, and this significant effect remains when socio-economic deprivation and morbidity are allowed. In a full structural equation model including access, the probability that QOC negatively impacts on unplanned admissions exceeds 0.9. Furthermore, poor access is linked to deprivation, diminished QOC, and larger list sizes. Conclusions: Using a Bayesian inference methodology, the evidence from the analysis is weighted towards negative impacts of higher primary care quality and improved access on unplanned admissions. The methodology of the paper is potentially applicable to other long term conditions, and relevant when care quality and access cannot be measured directly and are better regarded as latent variables. PMID:27598184

  2. Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes.

    PubMed

    Congdon, Peter

    2016-09-01

    Enhanced quality of care and improved access are central to effective primary care management of long term conditions. However, research evidence is inconclusive in establishing a link between quality of primary care, or access, and adverse outcomes, such as unplanned hospitalisation. This paper proposes a structural equation model for quality and access as latent variables affecting adverse outcomes, such as unplanned hospitalisations. In a case study application, quality of care (QOC) is defined in relation to diabetes, and the aim is to assess impacts of care quality and access on unplanned hospital admissions for diabetes, while allowing also for socio-economic deprivation, diabetes morbidity, and supply effects. The study involves 90 general practitioner (GP) practices in two London Clinical Commissioning Groups, using clinical quality of care indicators, and patient survey data on perceived access. As a single predictor, quality of care has a significant negative impact on emergency admissions, and this significant effect remains when socio-economic deprivation and morbidity are allowed. In a full structural equation model including access, the probability that QOC negatively impacts on unplanned admissions exceeds 0.9. Furthermore, poor access is linked to deprivation, diminished QOC, and larger list sizes. Using a Bayesian inference methodology, the evidence from the analysis is weighted towards negative impacts of higher primary care quality and improved access on unplanned admissions. The methodology of the paper is potentially applicable to other long term conditions, and relevant when care quality and access cannot be measured directly and are better regarded as latent variables.

  3. Domains associated with successful quality improvement in healthcare - a nationwide case study.

    PubMed

    Brandrud, Aleidis Skard; Nyen, Bjørnar; Hjortdahl, Per; Sandvik, Leiv; Helljesen Haldorsen, Gro Sævil; Bergli, Maria; Nelson, Eugene C; Bretthauer, Michael

    2017-09-13

    There is a distinct difference between what we know and what we do in healthcare: a gap that is impairing the quality of the care and increasing the costs. Quality improvement efforts have been made worldwide by learning collaboratives, based on recognized continual improvement theory with limited scientific evidence. The present study of 132 quality improvement projects in Norway explores the conditions for improvement from the perspectives of the frontline healthcare professionals, and evaluates the effectiveness of the continual improvement method. An instrument with 25 questions was developed on prior focus group interviews with improvement project members who identified features that may promote or inhibit improvement. The questionnaire was sent to 189 improvement projects initiated by the Norwegian Medical Association, and responded by 70% (132) of the improvement teams. A sub study of their final reports by a validated instrument, made us able to identify the successful projects and compare their assessments with the assessments of the other projects. A factor analysis with Varimax rotation of the 25 questions identified five domains. A multivariate regression analysis was used to evaluate the association with successful quality improvements. Two of the five domains were associated with success: Measurement and Guidance (p = 0.011), and Professional environment (p = 0.015). The organizational leadership domain was not associated with successful quality improvements (p = 0.26). Our findings suggest that quality improvement projects with good guidance and focus on measurement for improvement have increased likelihood of success. The variables in these two domains are aligned with improvement theory and confirm the effectiveness of the continual improvement method provided by the learning collaborative. High performing professional environments successfully engaged in patient-centered quality improvement if they had access to: (a) knowledge of best

  4. Creating patient value in glaucoma care: applying quality costing and care delivery value chain approaches--a five-year case study in the Rotterdam Eye Hospital.

    PubMed

    de Korne, Dirk F; Sol, Kees; Custers, Thomas; van Sprundel, Esther; van Ineveld, B Martin; Lemij, Hans G; Klazinga, Niek S

    2009-01-01

    The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains. In a retrospective case study an in-depth evaluation of the use of a quality cost model (QCM) and the applicability of Porter's care delivery value chain (CDVC) was performed in a specific care process: glaucoma care over the period 2001 to 2006 in the Rotterdam Eye Hospital in The Netherlands. The case study shows a reduction of costs per product by increasing the number of outpatient visits and surgery combined with a higher patient satisfaction. Reduction of costs of non-compliance by using the QCM is small, due to the absence of (external) financial incentives for both the hospital and individual physicians. For CDVC to be supportive to an integrated quality and cost management the notion "patient value" needs far more specification as mutually agreed on by the stakeholders involved and related reimbursement needs to depend on realised outcomes. The case study just focused on one specific care process in one hospital. To determine effects in other areas of health care, it is important to study the use and applicability of the QCM and the CDVC in other care processes and settings. QCM and a CDVC can be useful tools for hospital management to manage the outcomes on both quality and costs, but impact is dependent on the incentives in the context of the existing organisational and reimbursement system and asks for an agreed on operationalisation among the various stakeholders of the notion of patient value.

  5. A new approach to power quality and electricity reliability monitoring-case study illustrations of the capabilities of the I-GridTM system

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Divan, Deepak; Brumsickle, William; Eto, Joseph

    2003-04-01

    This report describes a new approach for collecting information on power quality and reliability and making it available in the public domain. Making this information readily available in a form that is meaningful to electricity consumers is necessary for enabling more informed private and public decisions regarding electricity reliability. The system dramatically reduces the cost (and expertise) needed for customers to obtain information on the most significant power quality events, called voltage sags and interruptions. The system also offers widespread access to information on power quality collected from multiple sites and the potential for capturing information on the impacts ofmore » power quality problems, together enabling a wide variety of analysis and benchmarking to improve system reliability. Six case studies demonstrate selected functionality and capabilities of the system, including: Linking measured power quality events to process interruption and downtime; Demonstrating the ability to correlate events recorded by multiple monitors to narrow and confirm the causes of power quality events; and Benchmarking power quality and reliability on a firm and regional basis.« less

  6. Public Health Nurses in Israel: A Case Study on a Quality Improvement Project of Nurse's Work Life.

    PubMed

    Kagan, Ilya; Shachaf, Sara; Rapaport, Zofia; Livne, Tzipi; Madjar, Batya

    2017-01-01

    Public health nurses (PHNs) working in Well Baby Clinic in Israel's Haifa district were voicing great distress to inspectors-the impossibility of meeting their workload, feeling overwhelmed, poor physical, and technological conditions. They were feeling tired and frustrated and burn-out was rising. The district's nursing management took the decision, together with Tel Aviv University's nursing research unit, to conduct a quality improvement project based on issues that arose from meetings with focus groups on the nurses' difficulties. This paper is a case study of a quality improvement project targeting nurses daily working life. One of its chief contributions is as a study of meeting PHNs' frustration by integrating focus groups and round-table brainstorming (involving nurses, clinic managers and nursing inspectors) in order to identify targets for practical intervention. This strategy has been very successful. It has provided the district's nursing management a battery of forcefully argued and realistically grounded proposals for making the work of Well Baby clinics more relevant to their communities and giving nurses (a) the conditions to meet their assignments and (b) greater professional self-respect. © 2016 Wiley Periodicals, Inc.

  7. River water quality assessment using environmentric techniques: case study of Jakara River Basin.

    PubMed

    Mustapha, Adamu; Aris, Ahmad Zaharin; Juahir, Hafizan; Ramli, Mohammad Firuz; Kura, Nura Umar

    2013-08-01

    Jakara River Basin has been extensively studied to assess the overall water quality and to identify the major variables responsible for water quality variations in the basin. A total of 27 sampling points were selected in the riverine network of the Upper Jakara River Basin. Water samples were collected in triplicate and analyzed for physicochemical variables. Pearson product-moment correlation analysis was conducted to evaluate the relationship of water quality parameters and revealed a significant relationship between salinity, conductivity with dissolved solids (DS) and 5-day biochemical oxygen demand (BOD5), chemical oxygen demand (COD), and nitrogen in form of ammonia (NH4). Partial correlation analysis (r p) results showed that there is a strong relationship between salinity and turbidity (r p=0.930, p=0.001) and BOD5 and COD (r p=0.839, p=0.001) controlling for the linear effects of conductivity and NH4, respectively. Principal component analysis and or factor analysis was used to investigate the origin of each water quality parameter in the Jakara Basin and identified three major factors explaining 68.11 % of the total variance in water quality. The major variations are related to anthropogenic activities (irrigation agricultural, construction activities, clearing of land, and domestic waste disposal) and natural processes (erosion of river bank and runoff). Discriminant analysis (DA) was applied on the dataset to maximize the similarities between group relative to within-group variance of the parameters. DA provided better results with great discriminatory ability using eight variables (DO, BOD5, COD, SS, NH4, conductivity, salinity, and DS) as the most statistically significantly responsible for surface water quality variation in the area. The present study, however, makes several noteworthy contributions to the existing knowledge on the spatial variations of surface water quality and is believed to serve as a baseline data for further studies. Future

  8. Sediment quality assessment using survival and embryo malformation tests in amphipod crustaceans: The Gulf of Riga, Baltic Sea AS case study

    NASA Astrophysics Data System (ADS)

    Strode, Evita; Jansons, Mintauts; Purina, Ingrida; Balode, Maija; Berezina, Nadezhda A.

    2017-08-01

    The aim of this study was to assess the toxicity of bottom sediment and to estimate the potential effects of contaminated sediment on health of benthic organisms in the Gulf of Riga (eastern Baltic Sea). Two endpoints were used: survival rate (acute toxicity test) of five crustacean amphipod species and frequency of embryo malformation (samples were collected from the field) in the two species. Toxic resistance of living animals to sediment quality was measured as survival rate (%) at 25 study sites from 2010-2012. Significant differences in the toxic resistance between species were found: 80-100% for Monoporeia affinis, 70-95% for Corophium volutator, 38-88% for Pontogammarus robustoides, 38-100% for Bathyporeia pilosa and 60-100% for Hyalella azteca. Reproductive disorders, measured as percentage (%) of malformed embryos per female, varied in the ranges of 0.0-9.5% in deep water species M. affinis and 0.3-7.5% in littoral species P. robustoides. Both the acute toxicity test and embryo malformation test (only M. affinis was used) indicated moderate and poor sediment quality at 20% and 12% accordingly in the study sites, low toxicity of sediment was estimated in 64% of cases, and no toxicity was recorded in the rest of the cases (4%). Additionally, sediment toxicity test using aquatic organisms was combined with sediment chemical analysis (trace metals) and the Benthic Quality Index (macrozoobenthos) was based on data collected from 13 sites in the Gulf of Riga in 2010 and used for triad sediment quality assessment. According to this combined approach, 23% of the bottom sediments were classified as likely impacted and 23% as possibly impacted (central and southern part of the Gulf). However, the remaining 54% was identified as likely un-impacted. The sediment quality assessment with single survival test or chemical analyses showed better sediment quality in the Gulf than the triad method. The embryo malformation test appeared to be more sensitive to pollution than

  9. Impact assessment of on-site sanitation system on groundwater quality in alluvial settings: A case study from Lucknow city in North India.

    PubMed

    Jangam, Chandrakant; Ramya Sanam, S; Chaturvedi, M K; Padmakar, C; Pujari, Paras R; Labhasetwar, Pawan K

    2015-10-01

    The present case study has been undertaken to investigate the impact of on-site sanitation on groundwater quality in alluvial settings in Lucknow City in India. The groundwater samples have been collected in the areas of Lucknow City where the on-site sanitation systems have been implemented. The groundwater samples have been analyzed for the major physicochemical parameters and fecal coliform. The results of analysis reveal that none of the groundwater samples exceeded the Bureau of Indian Standards (BIS) limits for all the parameters. Fecal coliform was not found in majority of the samples including those samples which were very close to the septic tank. The study area has a thick alluvium cover as a top layer which acts as a natural barrier for groundwater contamination from the on-site sanitation system. The t test has been performed to assess the seasonal effect on groundwater quality. The statistical t test implies that there is a significant effect of season on groundwater quality in the study area.

  10. Improving quality of life through rehabilitation in palliative care: case report.

    PubMed

    Kasven-Gonzalez, Nicole; Souverain, Regine; Miale, Susan

    2010-09-01

    Occupational and physical therapists can have a significant impact on the quality of life of terminally ill cancer patients. In the critical care setting, rehabilitation is often overlooked. However, occupational and physical therapists work with critically-ill patients to create realistic and meaningful goals for improving comfort, mobility, socialization skills, and ability to care for oneself regardless of disease state and medical status. The following case report describes rehabilitation intervention with a young woman diagnosed with osteosarcoma and leukemia during the final stage of her life. This case report highlights the use of patient-centered goals and the importance of close collaboration between the patient, occupational therapist, and physical therapists to achieve a higher quality of life. A collaborative effort by the occupational and physical therapists yielded positive outcomes as defined by the patient, patient family, and the medical staff in the critical care setting. Palliative care patients may benefit from occupational therapy (OT) and physical therapy (PT) intervention. Rehabilitation specialists are skilled at working with patients to set realistic and meaningful functional goals. Further study on rehabilitation treatment to improve quality of life among patients in palliative care is needed.

  11. Applying Quality Indicators to Single-Case Research Designs Used in Special Education: A Systematic Review

    ERIC Educational Resources Information Center

    Moeller, Jeremy D.; Dattilo, John; Rusch, Frank

    2015-01-01

    This study examined how specific guidelines and heuristics have been used to identify methodological rigor associated with single-case research designs based on quality indicators developed by Horner et al. Specifically, this article describes how literature reviews have applied Horner et al.'s quality indicators and evidence-based criteria.…

  12. Use of multiple sensor technologies for quality control of in situ biogeochemical measurements: A SeaCycler case study

    NASA Astrophysics Data System (ADS)

    Atamanchuk, Dariia; Koelling, Jannes; Lai, Jeremy; Send, Uwe; Wallace, Douglas

    2017-04-01

    Over the last two decades observing capacity for the global ocean has increased dramatically. Emerging sensor technologies for dissolved gases, nutrients and bio-optical properties in seawater are allowing extension of in situ observations beyond the traditionally measured salinity, temperature and pressure (CTD). However the effort to extend observations using autonomous instruments and platforms carries the risk of losing the level of data quality achievable through conventional water sampling techniques. We will present results from a case study with the SeaCycler profiling winch focusing on quality control of the in-situ measurements. A total of 13 sensors were deployed from May 2016 to early 2017 on SeaCycler's profiling sensor float, including CTD, dissolved oxygen (O2, 3 sensors), carbon dioxide (pCO2, 2 sensors), nutrients, velocity sensors, fluorometer, transmissometer, single channel PAR sensor, and others. We will highlight how multiple measurement technologies (e.g. for O2 and CO2) complement each other and result in a high quality data product. We will also present an initial assessment of the bio-optical data, their implications for seasonal phytoplankton dynamics and comparisons to climatologies and ocean-color data products obtained from the MODIS satellite.

  13. Application of advanced data collection and quality assurance methods in open prospective study - a case study of PONS project.

    PubMed

    Wawrzyniak, Zbigniew M; Paczesny, Daniel; Mańczuk, Marta; Zatoński, Witold A

    2011-01-01

    Large-scale epidemiologic studies can assess health indicators differentiating social groups and important health outcomes of the incidence and mortality of cancer, cardiovascular disease, and others, to establish a solid knowledgebase for the prevention management of premature morbidity and mortality causes. This study presents new advanced methods of data collection and data management systems with current data quality control and security to ensure high quality data assessment of health indicators in the large epidemiologic PONS study (The Polish-Norwegian Study). The material for experiment is the data management design of the large-scale population study in Poland (PONS) and the managed processes are applied into establishing a high quality and solid knowledge. The functional requirements of the PONS study data collection, supported by the advanced IT web-based methods, resulted in medical data of a high quality, data security, with quality data assessment, control process and evolution monitoring are fulfilled and shared by the IT system. Data from disparate and deployed sources of information are integrated into databases via software interfaces, and archived by a multi task secure server. The practical and implemented solution of modern advanced database technologies and remote software/hardware structure successfully supports the research of the big PONS study project. Development and implementation of follow-up control of the consistency and quality of data analysis and the processes of the PONS sub-databases have excellent measurement properties of data consistency of more than 99%. The project itself, by tailored hardware/software application, shows the positive impact of Quality Assurance (QA) on the quality of outcomes analysis results, effective data management within a shorter time. This efficiency ensures the quality of the epidemiological data and indicators of health by the elimination of common errors of research questionnaires and medical

  14. Impacts of a flash flood on drinking water quality: case study of areas most affected by the 2012 Beijing flood.

    PubMed

    Sun, Rubao; An, Daizhi; Lu, Wei; Shi, Yun; Wang, Lili; Zhang, Can; Zhang, Ping; Qi, Hongjuan; Wang, Qiang

    2016-02-01

    In this study, we present a method for identifying sources of water pollution and their relative contributions in pollution disasters. The method uses a combination of principal component analysis and factor analysis. We carried out a case study in three rural villages close to Beijing after torrential rain on July 21, 2012. Nine water samples were analyzed for eight parameters, namely turbidity, total hardness, total dissolved solids, sulfates, chlorides, nitrates, total bacterial count, and total coliform groups. All of the samples showed different degrees of pollution, and most were unsuitable for drinking water as concentrations of various parameters exceeded recommended thresholds. Principal component analysis and factor analysis showed that two factors, the degree of mineralization and agricultural runoff, and flood entrainment, explained 82.50% of the total variance. The case study demonstrates that this method is useful for evaluating and interpreting large, complex water-quality data sets.

  15. Total Quality Management in Logistics: A Case Study from the Trucking Industry

    DTIC Science & Technology

    1992-06-01

    Quality Management (TQM) movement on the logistics industry as a whole, and, more specifically, its impact within the trucking industry. Its focus then narrows to study the practical aspects of implementing a W. Edwards Deming-based quality program within a particular trucking company, Mason Transporters, Inc. The effectiveness of the company’s implementation effort is assessed using data collected from a survey questionnaire, formal interviews, and personal observations during an on- site visit. Successes and shortcomings of the implementation process are highlighted

  16. Case Study: Testing with Case Studies

    ERIC Educational Resources Information Center

    Herreid, Clyde Freeman

    2015-01-01

    This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue discusses using case studies to test for knowledge or lessons learned.

  17. The Phases and Paradoxes of Educational Quality Assurance: The Case of the Singapore Education System

    ERIC Educational Resources Information Center

    Ng, Pak Tee

    2008-01-01

    Purpose: The purpose of this paper is to highlight three important insights into educational quality assurance, using Singapore as a case study. It is useful to policy makers and practitioners to understand the phases and paradoxes in their educational quality assurance journey so that they may recognise and manage better the complex dynamics of…

  18. The study of surgical image quality evaluation system by subjective quality factor method

    NASA Astrophysics Data System (ADS)

    Zhang, Jian J.; Xuan, Jason R.; Yang, Xirong; Yu, Honggang; Koullick, Edouard

    2016-03-01

    GreenLightTM procedure is an effective and economical way of treatment of benign prostate hyperplasia (BPH); there are almost a million of patients treated with GreenLightTM worldwide. During the surgical procedure, the surgeon or physician will rely on the monitoring video system to survey and confirm the surgical progress. There are a few obstructions that could greatly affect the image quality of the monitoring video, like laser glare by the tissue and body fluid, air bubbles and debris generated by tissue evaporation, and bleeding, just to name a few. In order to improve the physician's visual experience of a laser surgical procedure, the system performance parameter related to image quality needs to be well defined. However, since image quality is the integrated set of perceptions of the overall degree of excellence of an image, or in other words, image quality is the perceptually weighted combination of significant attributes (contrast, graininess …) of an image when considered in its marketplace or application, there is no standard definition on overall image or video quality especially for the no-reference case (without a standard chart as reference). In this study, Subjective Quality Factor (SQF) and acutance are used for no-reference image quality evaluation. Basic image quality parameters, like sharpness, color accuracy, size of obstruction and transmission of obstruction, are used as subparameter to define the rating scale for image quality evaluation or comparison. Sample image groups were evaluated by human observers according to the rating scale. Surveys of physician groups were also conducted with lab generated sample videos. The study shows that human subjective perception is a trustworthy way of image quality evaluation. More systematic investigation on the relationship between video quality and image quality of each frame will be conducted as a future study.

  19. Case Studies Nested in Fuzzy-Set QCA on Sufficiency: Formalizing Case Selection and Causal Inference

    ERIC Educational Resources Information Center

    Schneider, Carsten Q.; Rohlfing, Ingo

    2016-01-01

    Qualitative Comparative Analysis (QCA) is a method for cross-case analyses that works best when complemented with follow-up case studies focusing on the causal quality of the solution and its constitutive terms, the underlying causal mechanisms, and potentially omitted conditions. The anchorage of QCA in set theory demands criteria for follow-up…

  20. Stakeholder analysis: theAndalusian Agency For Healthcare Quality case.

    PubMed

    Reyes-Alcázar, Víctor; Casas-Delgado, Marta; Herrera-Usagre, Manuel; Torres-Olivera, Antonio

    2012-01-01

    The aim of this study was to identify the different groups that can affect or be affected by an agency charged with the promoting and guaranteeing of health care quality in Andalusian region (Spain) and to provide a framework with the stakeholders included in different categories. The study adopted a cross-sectional research design. A case study with structured interviews among Andalusian Agency for Healthcare Quality Steering Committee members was carried out in 2010 to define stakeholders' categories and map the interest groups using 5 attributes: influence, importance, legitimacy, power, and urgency. After identification and categorization, stakeholders were weighted qualitatively according to the attributes of importance and influence using 4 possible levels. A matrix was made with the collected data relating both attributes. Furthermore, 8 different types of stakeholders were identified according to attributes power, legitimacy, and urgency. The study concludes that identifying and classifying stakeholders are fundamental to ensuring the success of an organization that must respond to needs and expectations, especially those of its clients. Moreover, knowing stakeholder linkages can contribute to increase organizational worth. This is essential for organizations basically directed to the provision of services in the scope of health care.

  1. The role of seasonal water scarcity on water quality: a global analysis with case study in the Magdalena, Colombia

    NASA Astrophysics Data System (ADS)

    Burke, Sophia; Mulligan, Mark

    2017-04-01

    Water scarcity is not just a problem of its own right (hydrological drought) but cascades the hydro-economic system to create problems for crop growth and livestock (agricultural drought) and thus for wellbeing and economic productivity (economic drought). One of these cascades is the impact of reduced water quantity on water quality as a result of non-point source pollutant concentration in water bodies such as rivers, lakes and wetlands. This paper investigates the impact of seasonal water shortages on the quality of supplied water to urban centres with a view to better understanding how land use management can reduce dry-season pollutant spikes. We apply a widely used spatial hydrological model (WaterWorld) and its water quality index (the human footprint on water quality, HFWQ) to examine to what extent HFWQ of water flowing into urban water intakes is affected by flow seasonality and by typical "dry year" events. A global analysis shows trends across climatic and land use gradients and is followed by a regional analysis of the Magdalena basin in Colombia: a large basin with 79% of the countries population and a mixture of intensively farmed and protected lands along a seasonality gradient from South to North. The Magdalena is a case study basin of the EartH2Observe project.

  2. Integrated Application of Quality-by-Design Principles to Drug Product Development: A Case Study of Brivanib Alaninate Film-Coated Tablets.

    PubMed

    Badawy, Sherif I F; Narang, Ajit S; LaMarche, Keirnan R; Subramanian, Ganeshkumar A; Varia, Sailesh A; Lin, Judy; Stevens, Tim; Shah, Pankaj A

    2016-01-01

    Modern drug product development is expected to follow quality-by-design (QbD) paradigm. At the same time, although there are several issue-specific examples in the literature that demonstrate the application of QbD principles, a holistic demonstration of the application of QbD principles to drug product development and control strategy, is lacking. This article provides an integrated case study on the systematic application of QbD to product development and demonstrates the implementation of QbD concepts in the different aspects of product and process design for brivanib alaninate film-coated tablets. Using a risk-based approach, the strategy for development entailed identification of product critical quality attributes (CQAs), assessment of risks to the CQAs, and performing experiments to understand and mitigate identified risks. Quality risk assessments and design of experiments were performed to understand the quality of the input raw materials required for a robust formulation and the impact of manufacturing process parameters on CQAs. In addition to the material property and process parameter controls, the proposed control strategy includes use of process analytical technology and conventional analytical tests to control in-process material attributes and ensure quality of the final product. Copyright © 2016. Published by Elsevier Inc.

  3. Application of CCME Water Quality Index to monitor water quality: a case study of the Mackenzie River Basin, Canada.

    PubMed

    Lumb, Ashok; Halliwell, Doug; Sharma, Tribeni

    2006-02-01

    All six ecosystem initiatives evolved from many years of federal, provincial, First Nation, local government and community attention to the stresses on sensitive habitats and species, air and water quality, and the consequent threats to community livability. This paper assesses water quality aspect for the ecosystem initiatives and employs newly developed Canadian Council of Ministers of the Environment Water Quality Index (CCME WQI) which provides a convenient mean of summarizing complex water quality data that can be easily understood by the public, water distributors, planners, managers and policy makers. The CCME WQI incorporates three elements: Scope - the number of water quality parameters (variables) not meeting water quality objectives (F(1)); Frequency - the number of times the objectives are not met (F(2)); and Amplitude. the extent to which the objectives are not met (F(3)). The index produces a number between 0 (worst) to 100 (best) to reflect the water quality. This study evaluates water quality of the Mackenzie - Great Bear sub-basin by employing two modes of objective functions (threshold values): one based on the CCME water quality guidelines and the other based on site-specific values that were determined by the statistical analysis of the historical data base. Results suggest that the water quality of the Mackenzie-Great Bear sub-basin is impacted by high turbidity and total (mostly particulate) trace metals due to high suspended sediment loads during the open water season. Comments are also provided on water quality and human health issues in the Mackenzie basin based on the findings and the usefulness of CCME water quality guidelines and site specific values.

  4. Maintaining quality of health services after abolition of user fees: A Uganda case study

    PubMed Central

    Nabyonga-Orem, Juliet; Karamagi, Humphrey; Atuyambe, Lynn; Bagenda, Fred; Okuonzi, Sam A; Walker, Oladapo

    2008-01-01

    Background It has been argued that quality improvements that result from user charges reduce their negative impact on utilization especially of the poor. In Uganda, because there was no concrete evidence for improvements in quality of care following the introduction of user charges, the government abolished user fees in all public health units on 1st March 2001. This gave us the opportunity to prospectively study how different aspects of quality of care change, as a country changes its health financing options from user charges to free services, in a developing country setting. The outcome of the study may then provide insights into policy actions to maintain quality of care following removal of user fees. Methods A population cohort and representative health facilities were studied longitudinally over 3 years after the abolition of user fees. Quantitative and qualitative methods were used to obtain data. Parameters evaluated in relation to quality of care included availability of drugs and supplies and; health worker variables. Results Different quality variables assessed showed that interventions that were put in place were able to maintain, or improve the technical quality of services. There were significant increases in utilization of services, average drug quantities and stock out days improved, and communities reported health workers to be hardworking, good and dedicated to their work to mention but a few. Communities were more appreciative of the services, though expectations were lower. However, health workers felt they were not adequately motivated given the increased workload. Conclusion The levels of technical quality of care attained in a system with user fees can be maintained, or even improved without the fees through adoption of basic, sustainable system modifications that are within the reach of developing countries. However, a trade-off between residual perceptions of reduced service quality, and the welfare gains from removal of user fees should

  5. Measuring Service Quality in Higher Education: A South African Case Study

    ERIC Educational Resources Information Center

    Green, Paul

    2014-01-01

    The goal of this paper is to report on the SERVQUAL gap which causes unsuccessful service delivery at a University of Technology in South Africa. Using a quantitative research design, the study adopts a SERVQUAL model adapted to a tertiary environment containing five dimensions of service quality (tangibles, responsiveness, empathy, assurance, and…

  6. Hypnotherapy for persistent genital arousal disorder: a case study.

    PubMed

    Elkins, Gary R; Ramsey, Derek; Yu, Yimin

    2014-01-01

    Persistent genital arousal disorder (PGAD) is characterized by intrusive sexual arousal that is unresolvable via sexual activity and persists for an extended period of time. PGAD's etiology is unknown, and it has no established treatments. This case study reports on a 71-year-old female patient diagnosed with PGAD who received 9 sessions of hypnotherapy. The following measures were administered at baseline and follow-up: Hospital Anxiety and Depression Scale, Center for Epidemiologic Studies Depression Scale, Pittsburgh Sleep Quality Index, and visual analogue measurements of quality of life, intensity of symptoms, and marital interference. At follow-up, there were significant improvements in all measures. Given the currently limited alternatives for treatment, this case study suggests that hypnotherapy may be beneficial for some patients with PGAD.

  7. Spinal cord injury and women's sexual life: case-control study.

    PubMed

    Merghati-Khoei, E; Emami-Razavi, S H; Bakhtiyari, M; Lamyian, M; Hajmirzaei, S; Ton-Tab Haghighi, S; Korte, J E; Maasoumi, R

    2017-03-01

    Study design :This is a case-control study. The objective of this study was to estimate the magnitude of association between spinal cord injury (SCI) and women's quality of sexual life and sexual function. This study was conducted in the Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran. From the referral university-based clinics, we used simple random sampling to recruit 62 women: 31 women with SCI and 31 women without SCI. Socio-demographic and reproductive traits questionnaire, Sexual Quality of life-Female (SQOL-F), Female Sexual Function Index (FSFI) and Spinal Cord Independence Measure (SCIM) were completed using telephone and face-to-face interviews in the cases and controls. After univariate analyses, multivariate linear and proportional odds regression models were conducted to investigate the relation between SCI and women's quality of sexual life, as well as sexual function. The mean age of cases and controls was 35.42±6.51 and 33.77±4.02 years. Most women were high school-educated and housewives. Adjusting for probable confounders, the proportional odds regression model showed a significant relationship between the spinal cord injury (AOR=4.2, 95% CI: 1.8-9.2), non-college-educated (AOR=3.1, 95% CI: 1.2-5.9) and employed (AOR=1.8, 95% CI: 1.1-1.8) variables and being in one of the moderate or poor quality of life classes. Scores of SQOL-F and FSFI domains, except satisfaction, were significantly worse in cases versus controls (P<0.001). Although our participants showed low sexual dysfunction, they tended to report moderate to poor quality of sexual life. Our findings support the implication that sexual rehabilitation must be provided for women with SCI soon after injury.

  8. An Observational and modeling strategy to investigate the impact of remote sources on local air quality: A Houston, Texas case study from the Second Texas Air Quality Study (TEXAQS II)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    McMillan, W. W.; Pierce, R.; Sparling, L. C.

    2010-01-05

    Quantifying the impacts of remote sources on individual air quality exceedances remains a significant challenge for air quality forecasting. One goal of the 2006 Texas Air Quality Study (TEXAQS II) was to assess the impact of distant sources on air quality in east Texas. From 23-30 August 2006, retrievals of tropospheric carbon monoxide (CO) from NASA’s Atmospheric InfraRed Sounder (AIRS) reveal the transport of CO from fires in the United States Pacific Northwest to Houston, Texas. This transport occurred behind a cold front and contributed to the worst ozone exceedance period of the summer in the Houston area. We presentmore » supporting satellite observations from the NASA A-Train constellation of the vertical distribution of smoke aerosols and CO. Ground-based in situ CO measurements in Oklahoma and Texas track the CO plume as it moves south and indicate mixing of the aloft plume to the surface by turbulence in the nocturnal boundary layer and convection during the day. Ground-based aerosol speciation and lidar observations do not find appreciable smoke aerosol transport for this case. However, MODIS aerosol optical depths and model simulations indicate some smoke aerosols were transported from the Pacific Northwest through Texas to the Gulf of Mexico. Chemical transport and forward trajectory models confirm the three major observations: (1) the AIRS envisioned CO transport, (2) the satellite determined smoke plume height, and (3) the timing of the observed surface CO increases. Further, the forward trajectory simulations find two of the largest Pacific Northwest fires likely had the most significant impact.« less

  9. Case study of lean manufacturing application in a die casting manufacturing company

    NASA Astrophysics Data System (ADS)

    Ching, Ng Tan; Hoe, Clarence Chan Kok; Hong, Tang Sai; Ghobakhloo, Morteza; Pin, Chen Kah

    2015-05-01

    The case study of lean manufacturing aims to study the application of lean manufacturing in a die casting manufacturing company located in Pulau Penang, Malaysia. This case study describes mainly about the important concepts and applications of lean manufacturing which could gradually help the company in increasing the profit by studying and analyzing their current manufacturing process and company culture. Many approaches of lean manufacturing are studied in this project which includes: 5S housekeeping, Kaizen, and Takt Time. Besides, the lean tools mentioned, quality tool such as the House of Quality is being used as an analysis tool to continuously improve the product quality. In short, the existing lean culture in the company is studied and analyzed, with recommendations written at the end of this paper.

  10. Building Perinatal Case Manager Capacity Using Quality Improvement.

    PubMed

    Fitzgerald, Elaine

    2015-01-01

    Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum.

  11. Evaluating Quality of Life in Urban Areas (Case Study: Noorabad City, Iran)

    ERIC Educational Resources Information Center

    Rezvani, Mohammad Reza; Mansourian, Hossain; Sattari, Mohammad Hossain

    2013-01-01

    Quality of urban life (QOUL) has become an important field within urban studies. The increased level of attention to this topic is due to the increasing importance of QoL studies in monitoring public policies and in the role they can play as effective tools in urban management and planning. The main objective of this study is to measure the QOUL…

  12. Acute myocardial infarction quality of care: the Strong Heart Study.

    PubMed

    Best, Lyle G; Butt, Amir; Conroy, Britt; Devereux, Richard B; Galloway, James M; Jolly, Stacey; Lee, Elisa T; Silverman, Angela; Yeh, Jeun-Liang; Welty, Thomas K; Kedan, Ilan

    2011-01-01

    Evaluate the quality of care provided patients with acute myocardial infarction and compare with similar national and regional data. Case series. The Strong Heart Study has extensive population-based data related to cardiovascular events among American Indians living in three rural regions of the United States. Acute myocardial infarction cases (72) occurring between 1/1/2001 and 12/31/2006 were identified from a cohort of 4549 participants. The proportion of cases that were provided standard quality of care therapy, as defined by the Healthcare Financing Administration and other national organizations. The provision of quality services, such as administration of aspirin on admission and at discharge, reperfusion therapy within 24 hours, prescription of beta blocker medication at discharge, and smoking cessation counseling were found to be 94%, 91%, 92%, 86% and 71%, respectively. The unadjusted, 30 day mortality rate was 17%. Despite considerable challenges posed by geographic isolation and small facilities, process measures of the quality of acute myocardial infarction care for participants in this American Indian cohort were comparable to that reported for Medicare beneficiaries nationally and within the resident states of this cohort.

  13. Reflection of a therapeutic touch experience: case study 2.

    PubMed

    Green, C A

    1998-02-01

    The purpose of this case study was to explore the experience of both giving and receiving Therapeutic Touch. A subjective account of the Therapeutic Touch experience is given in an attempt to throw light on its unique creative and therapeutic qualities. In most instances it was shown that the experience of both giving and receiving Therapeutic Touch was a parallel experience. This case study explores the effects of Therapeutic Touch on a client experiencing pain and associated anxiety. Whilst a response to treatment was observed, the need for further case studies and research studies in this area was identified.

  14. EVALUATION OF THE EFFECTS OF PROCESSING DELAYS AND PROTECTIVE PLASTIC CASES ON IMAGE QUALITY OF A PHOTOSTIMULABLE PHOSPHOR PLATE SYSTEM

    PubMed Central

    Bramante, Clóvis Monteiro; Bramante, Alexandre Silva; de Souza, Rogério Emílio; Moraes, Ivaldo Gomes; Bernardineli, Norberti; Garcia, Roberto Brandão

    2008-01-01

    This ex vivo study evaluated the quality of digital radiographic images obtained with the photostimulable phosphor plate system (Digora) according to the processing delay and maintenance of optical plates in either opaque (supplied with the system) or transparent protective plastic cases during this period. Five radiographs were obtained from the mandibular molar region of a dry human mandible using optical plates. These plates were placed in the protective plastic cases before obtaining the radiographs and were processed immediately or after processing delays of 5, 60 and 120 min, when the case was removed. The results revealed a reduction in image quality when processing was delay 120 min compared to the other times. The opaque case provided better protection to the sensor than the transparent case. In conclusion, a 120-min processing delay for the Digora system caused a reduction in image quality, yet without interfering with the quality of diagnosis. The opaque case supplied by the system's manufacturer provided better protection to the optical plate than the transparent case. PMID:19089233

  15. Software for improving the quality of project management, a case study: international manufacture of electrical equipment

    NASA Astrophysics Data System (ADS)

    Preradović, D. M.; Mićić, Lj S.; Barz, C.

    2017-05-01

    Production conditions in today’s world require software support at every stage of production and development of new products, for quality assurance and compliance with ISO standards. In addition to ISO standards such as usual metrics of quality, companies today are focused on other optional standards, such as CMMI (Capability Maturity Model Integrated) or prescribing they own standards. However, while there is intensive progress being made in the PM (project management), there is still a significant number of projects, at the global level, that are failures. These have failed to achieve their goals, within budget or timeframe. This paper focuses on checking the role of software tools through the rate of success in projects implemented in the case of internationally manufactured electrical equipment. The results of this research show the level of contribution of the project management software used to manage and develop new products to improve PM processes and PM functions, and how selection of the software tools affects the quality of PM processes and successfully completed projects.

  16. Building Perinatal Case Manager Capacity Using Quality Improvement

    PubMed Central

    Fitzgerald, Elaine

    2015-01-01

    ABSTRACT Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum. PMID:26937160

  17. On the quality of climate proxies derived from newspaper reports - a case study

    NASA Astrophysics Data System (ADS)

    Gallego, D.; García-Herrera, R.; Prieto, R.; Peña-Ortiz, C.

    2008-02-01

    One of the main problems in climate reconstruction from documentary sources is the evaluation of the quality of non instrumental meteorological records in absence of instrumental observations to perform a calibration. In these cases it is mandatory to envision different approaches to assess the climatic signal in a reconstruction. This work is aimed to test the consistency of a snow frequency reconstruction in the central Argentinean Andes by studying the synoptic patterns related to the occurrence of precipitation in this area. While the original reconstruction covers the period between 1885 and 1996, the insufficiency of overlapping instrumental data limited the calibration to a short 15-year interval. In this paper we evaluate the performance of the reconstructed series for the entire 45-year period between 1958 and 1996 by analyzing the displacement in the jet stream and the patterns of geopotential height related to anomalies in the reconstructed snow frequency series. Previous works have linked the precipitation in the central Andes to the ENSO through the Pacific South American mode. We also have found this connection between ENSO and the reconstructed precipitation. Finally, it is shown that the ENSO relationship is the cause of a significant link between the precipitation anomalies in the central Argentinean Andes and the ice extent around the Antarctic Peninsula.

  18. Case-Cohort Studies: Design and Applicability to Hand Surgery.

    PubMed

    Vojvodic, Miliana; Shafarenko, Mark; McCabe, Steven J

    2018-04-24

    Observational studies are common research strategies in hand surgery. The case-cohort design offers an efficient and resource-friendly method for risk assessment and outcomes analysis. Case-cohorts remain underrepresented in upper extremity research despite several practical and economic advantages over case-control studies. This report outlines the purpose, utility, and structure of the case-cohort design and offers a sample research question to demonstrate its value to risk estimation for adverse surgical outcomes. The application of well-designed case-cohort studies is advocated in an effort to improve the quality and quantity of observational research evidence in hand and upper extremity surgery. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Evaluation of total workstation CT interpretation quality: a single-screen pilot study

    NASA Astrophysics Data System (ADS)

    Beard, David V.; Perry, John R.; Muller, Keith E.; Misra, Ram B.; Brown, P.; Hemminger, Bradley M.; Johnston, Richard E.; Mauro, J. Matthew; Jaques, P. F.; Schiebler, M.

    1991-07-01

    An interpretation report, generated with an electronic viewbox, is affected by two factors: image quality, which encompasses what can be seen on the display, and computer human interaction (CHI), which accounts for the cognitive load effect of locating, moving, and manipulating images with the workstation controls. While a number of subject experiments have considered image quality, only recently has the affect of CHI on total interpretation quality been measured. This paper presents the results of a pilot study conducted to evaluate the total interpretation quality of the FilmPlane2.2 radiology workstation for patient folders containing single forty-slice CT studies. First, radiologists interpreted cases and dictated reports using FilmPlane2.2. Requisition forms were provided. Film interpretation was provided by the original clinical report and interpretation forms generated from a previous experiment. Second, an evaluator developed a list of findings for each case based on those listed in all the reports for each case and then evaluated each report for its response on each finding. Third, the reports were compared to determine how well they agreed with one another. Interpretation speed and observation data was also gathered.

  20. Efficiency and quality of care in nursing homes: an Italian case study.

    PubMed

    Garavaglia, Giulia; Lettieri, Emanuele; Agasisti, Tommaso; Lopez, Silvano

    2011-03-01

    This study investigates efficiency and quality of care in nursing homes. By means of Data Envelopment Analysis (DEA), the efficiency of 40 nursing homes that deliver their services in the north-western area of the Lombardy Region was assessed over a 3-year period (2005-2007). Lombardy is a very peculiar setting, since it is the only Region in Italy where the healthcare industry is organised as a quasi-market, in which the public authority buys health and nursing services from independent providers-establishing a reimbursement system for this purpose. The analysis is conducted by generating bootstrapped DEA efficiency scores for each nursing home (stage one), then regressing those scores on explanatory variables (stage two). Our DEA model employed two input (i.e. costs for health and nursing services and costs for residential services) and three output variables (case mix, extra nursing hours and residential charges). In the second-stage analysis, Tobit regressions and the Kruskall-Wallis tests of hypothesis to the efficiency scores were applied to define what are the factors that affect efficiency: (a) the ownership (private nursing houses outperform their public counterparts); and (b) the capability to implement strategies for labour cost and nursing costs containment, since the efficiency heavily depends upon the alignment of the costs to the public reimbursement system. Lastly, even though the public institutions are less efficient than the private ones, the results suggest that public nursing homes are moving towards their private counterparts, and thus competition is benefiting efficiency.

  1. Reconciling quality and cost: A case study in interventional radiology.

    PubMed

    Zhang, Li; Domröse, Sascha; Mahnken, Andreas

    2015-10-01

    To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 € to 294 €, and marginal delay costs from approximately 2000 € to 500 €, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 €. The yearly delay cost saved was approximately 150,000 €. With increased revenue of 10,000 € in project phase 2, the yearly total cost saved was approximately 290,000 €. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. • Improving quality in terms of safety, outcome, efficiency and timeliness reduces cost. • Mismatch of demand and capacity is detrimental to quality and cost. • Full system utilization with random demand results in long waiting periods and increased cost.

  2. Case Study: Writing a Journal Case Study

    ERIC Educational Resources Information Center

    Prud'homme-Genereux, Annie

    2016-01-01

    This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue describes incorporating a journal article into the classroom by first converting it into a case study.

  3. Case studies in organic contaminant hydrogeology

    NASA Astrophysics Data System (ADS)

    Baker, John A.

    1989-07-01

    The effective management of domestic solid waste and hazardous, toxic, and radioactive waste is a major problem in the area of environmental geology and water sciences over the world. This series of case studies of organic contaminants from both solid and hazardous waste disposal facilities provides examples of these problems. The facilities were investigated to determine risks and liabilities before acquisition, to determine the site hydrogeologic conditions for design of appropriate groundwater monitoring plans, and/or to determine the potential for groundwater contamination. The results of these studies and investigations by Waste Management Inc. (WMI) and its consultants have shown certain relationships in the distribution of organic pollutants to the different geologic and hydrogeologic charac teristics of each facility. In each of the case studies, all 129 priority pollutants were analyzed in private wells and/or monitoring wells at the request of regulatory agencies. The 31 volatile organic compounds (VOCs) of the priority pollutant list were the majority of the organic compounds detected and these data are evaluated in each case study. The case studies are on disposal facilities located in glacial tills, carbonaceous weathered clay soils, weathered shale, limestone bedrock, dolomite bedrock, and alluvial and sedimentary deposits. A brief discussion of groundwater quality impacts and remedial measures also is included.

  4. Ten tools of continuous quality improvement: a review and case example of hospital discharge.

    PubMed

    Ziegenfuss, J T; McKenna, C K

    1995-01-01

    Concepts and methods of continuous quality improvement have been endorsed by quality specialists in American Health care, and their use has convinced CEOs that industrial methods can make a contribution to health and medical care. For all the quality improvement publications, there are still few that offer a clear, concise definition and an explanation of the primary tools for teaching purposes. This report reviews ten continuous quality improvement methods including: problem solving cycle, affinity diagrams, cause and effect diagrams, Pareto diagrams, histograms, bar charts, control charts, scatter diagrams, checklists, and a process decision program chart. These do not represent an exhaustive list, but a set of commonly used tools. They are applied to a case study of bed utilization in a university hospital.

  5. Case management in oncology rehabilitation (CAMON): the effect of case management on the quality of life in patients with cancer after one year of ambulant rehabilitation. a study protocol for a randomized controlled clinical trial in oncology rehabilitation.

    PubMed

    Bachmann-Mettler, Irene; Steurer-Stey, Claudia; Senn, Oliver; Wang, Mathyas; Bardheci, Katarina; Rosemann, Thomas

    2011-04-28

    Cancer diseases and their therapies have negative effects on the quality of life. The aim of this study is to assess the effectiveness of case management in a sample of oncological outpatients with the intent of rehabilitation after cancer treatment. Case management wants to support the complex information needs of the patients in addition to the segmented structure of the health care system. Emphasis is put on support for self-management in order to enhance health - conscious behaviour, learning to deal with the burden of the illness and providing the opportunity for regular contacts with care providers. We present a study protocol to investigate the efficacy of a case management in patients following oncology rehabilitation after cancer treatment. The trial is a multicentre, two-arm randomised controlled study. Patients are randomised parallel in either 'usual care' plus case management or 'usual care' alone. Patients with all types of cancer can be included in the study, if they have completed the therapy with chemo- and/or radiotherapy/surgery with curative intention and are expected to have a survival time >1 year. To determine the health-related quality of life the general questionnaire FACT G is used. The direct correlation between self-management and perceived self-efficacy is measured with the Jerusalem & Schwarzer questionnaire. Patients satisfaction with the care received is measured using the Patient Assessment of Chronic Illness Care 5 As (PACIC-5A). Data are collected at the beginning of the trial and after 3, 6 and 12 months. The power analysis revealed a sample size of 102 patients. The recruitment of the centres began in 2009. The inclusion of patients began in May 2010. Case management has proved to be effective regarding quality of life of patients with chronic diseases. When it comes to oncology, case management is mainly used in cancer treatment, but it is not yet common in the rehabilitation of cancer patients. Case management in oncology

  6. Sleep quality in patients with xerostomia: a prospective and randomized case-control study.

    PubMed

    Lopez-Jornet, Pia; Lucero Berdugo, Maira; Fernandez-Pujante, Alba; C, Castillo Felipe; Lavella C, Zamora; A, Pons-Fuster; J, Silvestre Rangil; Silvestre, Francisco Javier

    2016-01-01

    Objectives To investigate sleep quality, anxiety/depression and quality-of-life in patients with xerostomia. Materials and methods This prospective, observational, cross-sectional study was conducted among a group of xerostomia patients (n = 30) compared with 30 matched control subjects. The following evaluation scales were used to assess the psychological profile of each patient: the Hospital Anxiety and Depression Scale, the Oral Health Impact Profile-14 (OHIP-14), the Xerostomia Inventory, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Results The PSQI obtained 5.3 3 ± 1.78 for patients with xerostomia compared with 4.26 ± 1.01 for control subjects (p = 0.006); ESS obtained 5.7 ± 2.1 for test patients vs 4.4 0 ± 1 for control subjects (p = 0.010). Statistical regression analysis showed that xerostomia was significantly associated with depression (p = 0.027). Conclusions Patients with xerostomia exhibited significant decreases in sleep quality compared with control subjects.

  7. Quality in translation: case management in the international marketplace.

    PubMed

    Beichl, Lisa; Craig, Kathy

    2009-01-01

    This article identifies three categories of case management (CM), in-country, international, and micro, that are poised to serve as the quality proxy for the international medical patient in the rapidly emerging globalized healthcare marketplace. The content concentrates on describing in-country CM and international CM (ICM). Because CM professionals are the providers of patient-centered quality and safety improvements, they are capable of filling the chasm between the travel industry and the regulators who specialize in accrediting hospital systems. In-country and ICM case managers are equipped to perform surveillance and intervention at the level of the international patient's bedside, activate network connections, and use culture-sensitive communication skills to safeguard patients in their individual sojourns abroad. The article discusses useful concepts and sources, including an algorithmic tool under development that is geared to identify and quantify risks for lay and business individuals who seek to engage the global medical market. The article's information is provided for front-line and front-office healthcare practitioners to understand or enter the worldwide medical marketplace. Content is targeted to CM generalists, specialists, and business developers interested in learning about safeguarding the patients who travel internationally to receive medical care. It can also be applied by those within and outside the healthcare practice arena, particularly those interested in the development of quality initiatives. All research and syntheses were executed by the authors. Sources included scholarly treatises, business correspondence, medical tourism literature, corporate Internet profiles, news releases, and healthcare industry investigative and monitoring agencies. International health insurance, economics, and financing expertise stems from one author (L.B.). Clinical competencies stem from the international practice experiences of one author (K.C.). This

  8. A case study on the influences of long-range transport to Taiwan`s acid deposition using Taiwan air quality model

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ken-Hui Chang; Fu-Tien Jeng

    1996-12-31

    The long-range and transboundary transport of precursors of add deposition in East Asia became important due to the industrial development around this area. We started to develop Taiwan Air Quality Model (TAQM) system since 1992, which is based on regional Acid Deposition Model (RADM) system. A typical episode in Mei-Yu season has been selected to study. A case considering all emissions within simulated domain has been run as a reference case, and another perturbed case, not including Taiwan`s emission, has been also run for analyzing quantitatively the influence of long-range transport to Taiwan`s wet deposition during the episode are 31%more » and 24% for total sulfur compounds and total nitrogen compounds respectively; but for dry deposition, only 6% is contributed by long range transport for sulfur compounds and 29% for total nitrogen compounds. Therefore, the percentages of total acid deposition contributed by long-range transport are 27% and 25% for total sulfur compounds and total nitrogen compounds, respectively.« less

  9. HIV quality report cards: impact of case-mix adjustment and statistical methods.

    PubMed

    Ohl, Michael E; Richardson, Kelly K; Goto, Michihiko; Vaughan-Sarrazin, Mary; Schweizer, Marin L; Perencevich, Eli N

    2014-10-15

    There will be increasing pressure to publicly report and rank the performance of healthcare systems on human immunodeficiency virus (HIV) quality measures. To inform discussion of public reporting, we evaluated the influence of case-mix adjustment when ranking individual care systems on the viral control quality measure. We used data from the Veterans Health Administration (VHA) HIV Clinical Case Registry and administrative databases to estimate case-mix adjusted viral control for 91 local systems caring for 12 368 patients. We compared results using 2 adjustment methods, the observed-to-expected estimator and the risk-standardized ratio. Overall, 10 913 patients (88.2%) achieved viral control (viral load ≤400 copies/mL). Prior to case-mix adjustment, system-level viral control ranged from 51% to 100%. Seventeen (19%) systems were labeled as low outliers (performance significantly below the overall mean) and 11 (12%) as high outliers. Adjustment for case mix (patient demographics, comorbidity, CD4 nadir, time on therapy, and income from VHA administrative databases) reduced the number of low outliers by approximately one-third, but results differed by method. The adjustment model had moderate discrimination (c statistic = 0.66), suggesting potential for unadjusted risk when using administrative data to measure case mix. Case-mix adjustment affects rankings of care systems on the viral control quality measure. Given the sensitivity of rankings to selection of case-mix adjustment methods-and potential for unadjusted risk when using variables limited to current administrative databases-the HIV care community should explore optimal methods for case-mix adjustment before moving forward with public reporting. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  10. An intelligent case-adjustment algorithm for the automated design of population-based quality auditing protocols.

    PubMed

    Advani, Aneel; Jones, Neil; Shahar, Yuval; Goldstein, Mary K; Musen, Mark A

    2004-01-01

    We develop a method and algorithm for deciding the optimal approach to creating quality-auditing protocols for guideline-based clinical performance measures. An important element of the audit protocol design problem is deciding which guide-line elements to audit. Specifically, the problem is how and when to aggregate individual patient case-specific guideline elements into population-based quality measures. The key statistical issue involved is the trade-off between increased reliability with more general population-based quality measures versus increased validity from individually case-adjusted but more restricted measures done at a greater audit cost. Our intelligent algorithm for auditing protocol design is based on hierarchically modeling incrementally case-adjusted quality constraints. We select quality constraints to measure using an optimization criterion based on statistical generalizability coefficients. We present results of the approach from a deployed decision support system for a hypertension guideline.

  11. Assessing Family Planning Service Quality And User Experiences In Social Franchising Programme - Case Studies From Two Rural Districts In Pakistan.

    PubMed

    Azmat, Syed Khurram; Ali, Moazzam; Hameed, Waqas; Awan, Muhammad Ali

    2018-01-01

    Studies have documented the impact of quality family planning services on improved contraceptive uptake and continuation, however, relatively little is known about their quality of service provision especially in the context of social franchising. This study examined the quality of clinical services and user experiences among two models in franchised service providers in rural Pakistan. This facility-based assessment was carried out during May-June 2015 at the 20 randomly selected social franchise providers from Chakwal and Faisalabad. In our case, a franchise health facility was a private clinic (mostly) run by a single provider, supported by an assistant. Within the selected health facilities, a total 39 user-provider interactions were observed and same users were interviewed separately. Most of the health facilities were in the private sector. Comparatively, service providers at Greenstar Social Marketing/Population Services International (GSM/PSI) model franchised facilities had higher number of rooms and staff employed, with more providers' ownership. Quality of service indices showed high scores for both Marie Stopes Society (MSS) and GSM/PSI franchised providers. MSS franchised providers demonstrated comparative edge in terms of clinical governance, better method mix and they were more user-focused, while PSI providers offered broader range of non-FP services. Quality of counselling services were similar among both models. Service providers performed well on all indicators of interpersonal care however overall low scores were noted in technical care. For both models, service providers attained an average score of 6.7 (out of the maximum value of 8) on waste disposal mechanism, supplies 12.5 (out of the maximum value of 15), user-centred facility 2.7 (out of the maximum value of 4), and clinical governance 6.5 (out of the maximum value of 11) and respecting clients' privacy. The exit interviews yielded high user satisfaction in both service models. The

  12. SU-E-T-617: Plan Quality Estimation of Intensity-Modulated Radiotherapy Cases for Lung Cancer

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Koo, J; Yoon, M; Chung, W

    Purpose: To estimate the planning quality of intensity-modulated radiotherapy in lung cancer cases and to provide preliminary data for the development of a planning quality assurance algorithm. Methods: 42 IMRT plans previously used in cases of solitary lung cancers were collected. Organs in or near the thoracic cavity, such as lung (ipsilateral, contralateral), heart, liver, esophagus, cord and bronchus were considered as organs at risk (OARs) in this study. The coverage index (CVI), conformity index (CI), homogeneity index (HI), volume, irregularity (standard deviation of center-surface distance) were used to compare PTV dose characteristics. The effective uniform dose (EUD), V10Gy, andmore » V20Gy of the OARs were used to compare OAR dose characteristics. Results: Average CVI, CI, HI values were 0.9, 0.8, 0.1, respectively. CVI and CI had narrow Gaussian distribution curves without a singular value, but one case had a relatively high (0.25) HI because of location and irregular shape (Irregularity of 18.5 when average was 12.5) of PTV. EUDs tended to decrease as OAR-PTV distance increased and OAR-PTV overlap volume decreased. Conclusion: This work indicates the potential for significant plan quality deviation of similar lung cancer cases. Considering that this study were from a single department, differences in the treatment results for a given patient would be much more pronounced if multiple departments (and therefore more planners) were involved. Therefore, further examination of QA protocols is needed to reduce deviations in radiation treatment planning.« less

  13. Service Quality in Higher Education--A Case Study of Universiti Brunei Darussalam

    ERIC Educational Resources Information Center

    Alani, Farooq; Yaqoub, Yasir; Hamdan, Mahani

    2015-01-01

    No one doubts the value and importance of quality education, and quality assurance is one major driving force to achieve this. Measuring the performance of service quality of education services of Universiti Brunei Darussalam (UBD), as part of the quality assessment, was assessed based on Parasuraman's five Servqual dimensions. The assessment was…

  14. Impact of Windows and Daylight Exposure on Overall Health and Sleep Quality of Office Workers: A Case-Control Pilot Study

    PubMed Central

    Boubekri, Mohamed; Cheung, Ivy N.; Reid, Kathryn J.; Wang, Chia-Hui; Zee, Phyllis C.

    2014-01-01

    Study Objective: This research examined the impact of daylight exposure on the health of office workers from the perspective of subjective well-being and sleep quality as well as actigraphy measures of light exposure, activity, and sleep-wake patterns. Methods: Participants (N = 49) included 27 workers working in windowless environments and 22 comparable workers in workplaces with significantly more daylight. Windowless environment is defined as one without any windows or one where workstations were far away from windows and without any exposure to daylight. Well-being of the office workers was measured by Short Form-36 (SF-36), while sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). In addition, a subset of participants (N = 21; 10 workers in windowless environments and 11 workers in workplaces with windows) had actigraphy recordings to measure light exposure, activity, and sleep-wake patterns. Results: Workers in windowless environments reported poorer scores than their counterparts on two SF-36 dimensions—role limitation due to physical problems and vitality—as well as poorer overall sleep quality from the global PSQI score and the sleep disturbances component of the PSQI. Compared to the group without windows, workers with windows at the workplace had more light exposure during the workweek, a trend toward more physical activity, and longer sleep duration as measured by actigraphy. Conclusions: We suggest that architectural design of office environments should place more emphasis on sufficient daylight exposure of the workers in order to promote office workers' health and well-being. Citation: Boubekri M, Cheung IN, Reid KJ, Wang CH, Zee PC. Impact of windows and daylight exposure on overall health and sleep quality of office workers: a case-control pilot study. J Clin Sleep Med 2014;10(6):603-611. PMID:24932139

  15. Framing quality improvement tools and techniques in healthcare the case of improvement leaders' guides.

    PubMed

    Millar, Ross

    2013-01-01

    The purpose of this paper is to present a study of how quality improvement tools and techniques are framed within healthcare settings. The paper employs an interpretive approach to understand how quality improvement tools and techniques are mobilised and legitimated. It does so using a case study of the NHS Modernisation Agency Improvement Leaders' Guides in England. Improvement Leaders' Guides were framed within a service improvement approach encouraging the use of quality improvement tools and techniques within healthcare settings. Their use formed part of enacting tools and techniques across different contexts. Whilst this enactment was believed to support the mobilisation of tools and techniques, the experience also illustrated the challenges in distributing such approaches. The paper provides an important contribution in furthering our understanding of framing the "social act" of quality improvement. Given the ongoing emphasis on quality improvement in health systems and the persistent challenges involved, it also provides important information for healthcare leaders globally in seeking to develop, implement or modify similar tools and distribute leadership within health and social care settings.

  16. A Case Study Showing Parameters Affecting the Quality of Education: Faculty Perspective

    ERIC Educational Resources Information Center

    Kumari, Neeraj

    2014-01-01

    The study aims to examine the faculty members' perspective (age Wise, Gender Wise and Work Experience wise) of parameters affecting the quality of education in an affiliated Undergraduate Engineering Institution in Haryana. It is a descriptive type of research. The data has been collected with the help of 'Questionnaire Based Survey'. The sample…

  17. Quantitative Research Methods, Study Quality, and Outcomes: The Case of Interaction Research

    ERIC Educational Resources Information Center

    Plonsky, Luke; Gass, Susan

    2011-01-01

    This article constitutes the first empirical assessment of methodological quality in second language acquisition (SLA). We surveyed a corpus of 174 studies (N = 7,951) within the tradition of research on second-language interaction, one of the longest and most influential traditions of inquiry in SLA. Each report was coded for methodological…

  18. Case Studies in Modelling, Control in Food Processes.

    PubMed

    Glassey, J; Barone, A; Montague, G A; Sabou, V

    This chapter discusses the importance of modelling and control in increasing food process efficiency and ensuring product quality. Various approaches to both modelling and control in food processing are set in the context of the specific challenges in this industrial sector and latest developments in each area are discussed. Three industrial case studies are used to demonstrate the benefits of advanced measurement, modelling and control in food processes. The first case study illustrates the use of knowledge elicitation from expert operators in the process for the manufacture of potato chips (French fries) and the consequent improvements in process control to increase the consistency of the resulting product. The second case study highlights the economic benefits of tighter control of an important process parameter, moisture content, in potato crisp (chips) manufacture. The final case study describes the use of NIR spectroscopy in ensuring effective mixing of dry multicomponent mixtures and pastes. Practical implementation tips and infrastructure requirements are also discussed.

  19. DATA QUALITY OBJECTIVES IN RESEARCH PLANNING AT MED: THREE CASE STUDIES

    EPA Science Inventory

    This course will give a quality assurance perspective to research planning by describing the Data Quality Objective Process....Written plans are mandatory for all EPA environmental data collection activities according to EPA Order 5360.1 CHG 1 and Federal Acquisition Regulations,...

  20. Characterization of shallow groundwater quality in the Lower St. Johns River Basin: a case study

    Treesearch

    Ying Ouyang; Jia-En Zhang; Prem Parajuli

    2013-01-01

    Characterization of groundwater quality allows the evaluation of groundwater pollution and provides information for better management of groundwater resources. This study characterized the shallow groundwater quality and its spatial and seasonal variations in the Lower St. Johns River Basin, Florida, USA, under agricultural, forest, wastewater, and residential land...

  1. Geospatial Water Quality Analysis of Dilla Town, Gadeo Zone, Ethiopia - A Case Study

    NASA Astrophysics Data System (ADS)

    Pakhale, G. K.; Wakeyo, T. B.

    2015-12-01

    Dilla is a socio-economically important town in Ethiopia, established on the international highway joining capital cities of Ethiopia and Kenya. It serves as an administrative center of the Gedeo Zone in SNNPR region of Ethiopia accommodating around 65000 inhabitants and also as an important trade centre for coffee. Due to the recent developments and urbanization in town and surrounding area, waste and sewage discharge has been raised significantly into the water resources. Also frequent rainfall in the region worsens the problem of water quality. In this view, present study aims to analyze water quality profile of Dilla town using 12 physico-chemical parameters. 15 Sampling stations are identified amongst the open wells, bore wells and from surface water, which are being extensively used for drinking and other domestic purposes. Spectrophotometer is used to analyze data and Gaussian process regression is used to interpolate the same in GIS environment to represent spatial distribution of parameters. Based on observed and desirable values of parameters, water quality index (WQI); an indicator of weighted estimate of the quantities of various parameters ranging from 1 to 100, is developed in GIS. Higher value of WQI indicates better while low value indicates poor water quality. This geospatial analysis is carried out before and after rainfall to understand temporal variation with reference to rainfall which facilitates in identifying the potential zones of drinking water. WQI indicated that 8 out of 15 locations come under acceptable category indicating the suitability of water for human use, however remaining locations are unfit. For example: the water sample at main_campus_ustream_1 (site name) site has very low WQI after rainfall, making it unfit for human usage. This suggests undertaking of certain measures in town to enhance the water quality. These results are useful for town authorities to take corrective measures and ameliorate the water quality for human

  2. Improvement of a stability-indicating method by Quality-by-Design versus Quality-by-Testing: a case of a learning process.

    PubMed

    Hubert, C; Lebrun, P; Houari, S; Ziemons, E; Rozet, E; Hubert, Ph

    2014-01-01

    The understanding of the method is a major concern when developing a stability-indicating method and even more so when dealing with impurity assays from complex matrices. In the presented case study, a Quality-by-Design approach was applied in order to optimize a routinely used method. An analytical issue occurring at the last stage of a long-term stability study involving unexpected impurities perturbing the monitoring of characterized impurities needed to be resolved. A compliant Quality-by-Design (QbD) methodology based on a Design of Experiments (DoE) approach was evaluated within the framework of a Liquid Chromatography (LC) method. This approach allows the investigation of Critical Process Parameters (CPPs), which have an impact on Critical Quality Attributes (CQAs) and, consequently, on LC selectivity. Using polynomial regression response modeling as well as Monte Carlo simulations for error propagation, Design Space (DS) was computed in order to determine robust working conditions for the developed stability-indicating method. This QbD compliant development was conducted in two phases allowing the use of the Design Space knowledge acquired during the first phase to define the experimental domain of the second phase, which constitutes a learning process. The selected working condition was then fully validated using accuracy profiles based on statistical tolerance intervals in order to evaluate the reliability of the results generated by this LC/ESI-MS stability-indicating method. A comparison was made between the traditional Quality-by-Testing (QbT) approach and the QbD strategy, highlighting the benefit of this QbD strategy in the case of an unexpected impurities issue. On this basis, the advantages of a systematic use of the QbD methodology were discussed. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. Family Dog-Assisted Adapted Physical Activity: A Case Study

    PubMed Central

    Tepfer, Amanda; Ross, Samantha; MacDonald, Megan; Udell, Monique A. R.; Ruaux, Craig; Baltzer, Wendy

    2017-01-01

    Simple Summary Understanding how family dogs aid in aspects of daily living such as quality of life, physical activity and human animal interaction is critical towards better understanding child health. Using questionnaires and direct assessment we aimed to better understand the role of the family dog in an animal assisted adapted physical activity intervention. Findings were positive in respect to all primary outcomes in this case study. Generally, the role of the family dog in an adapted physical activity animal assisted intervention had positive results for child health, when the family dog assisted a child with cerebral palsy in this type of intervention. Abstract Purpose: The aim of this case study was to examine the individual effects of an adapted physical activity, animal-assisted intervention (APA-AAI) with the family dog on motor skills, physical activity, and quality of life of a child with cerebral palsy (CP). Method: This study used an A-B-A single-subject design. The assessment phase (phase A) occurred pre- and post-intervention. This consisted of standardized assessments of motor skills, quality of life questionnaires, physical activity (measured using the GT3X+ accelerometer) and the human-animal bond. The intervention (phase B) lasted 8 weeks and consisted of adapted physical activities performed with the family dog once a week for 60 min in a lab setting. In addition, the participant had at-home daily activities to complete with the family dog. Results: Visual analysis was used to analyze the data. Motor skill performance, physical activity, quality of life and human animal interaction gains were observed in each case. Conclusions: These preliminary results provided initial evidence that the family-dog can play a role in healthy lifestyles through APA-AAI in children with CP. PMID:28448430

  4. Evolving the ECSS Standards and their Use: Experience Based on Industrial Case Studies

    NASA Astrophysics Data System (ADS)

    Feldt, R.; Ahmad, E.; Raza, B.; Hult, E.; Nordebäck, T.

    2009-05-01

    This paper introduces two case studies conducted at two Swedish companies developing software for the space industry. The overall goal of the project is to evaluate if current use of ECSS is cost efficient and if there are ways to make the process leaner while maintaining quality. The case studies reported on here focused on how the ECSS standard was used by the companies and how that affected software development processes and software quality. This paper describes the results and recommendations based on identified challenges.

  5. A case-control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture.

    PubMed

    Hall, S E; Criddle, R A; Comito, T L; Prince, R L

    1999-01-01

    There have been several studies of the impact of vertebral osteoporotic fracture on the quality of life and functionality of individual subjects. To date, however, no direct comparisons with age-matched normal subjects without vertebral fracture have been made. The radiographs of 145 female clinic patients with vertebral fractures were reviewed by the study physicians. The controls were recruited from the electoral role and by media appeal. One hundred and sixty-seven women had radiographs taken to determine those without vertebral fracture. Fracture subjects and controls had to be ambulant and were excluded if they had significant radiologic evidence of degenerative disk or joint disease of the spine. One hundred cases and one hundred controls were matched by 5-year age groups. The number, position and severity of the vertebral fracture on the lateral radiographs of the cases was recorded. Quality of life was measured using the Short Form-36 (SF-36) (maximum score 100) and a utility score calculated from these results (maximum score 1). Two measurements of functionality were employed: the Modified Barthel Index (MBI) to assess the activities of daily living (maximum score 100) and the Timed 'Up & Go' (TUG) that measured the time taken for the subject to rise from sitting in a chair, walk 3 m along a line, return to the chair and sit down. The fracture subjects had 2.9 +/- 1.6 (mean +/- SD) vertebral fractures and the time since last fracture was 5.1 +/- 4.8 years. The SF-36 physical function component summary index results were: fracture subjects 36 +/- 11, controls 48 +/- 9 (p < 0.001). The SF-36 mental health component summary index results were: fracture subjects 50 +/- 11, controls 54 +/- 8 (p < 0.05). The utility scores were: fracture subjects 0.64 +/- 0.08, controls 0.72 +/- 0.07 (p < 0.001). The MBI results were: fracture subjects 97 +/- 5, controls 99 +/- 1 (p < 0.01). The TUG results were: fracture subjects 13.8 +/- 7.3 s, controls 10.1 +/- 4.1 s (p < 0

  6. The effect of land use change on water quality: A case study in Ciliwung Watershed

    NASA Astrophysics Data System (ADS)

    Ayu Permatasari, Prita; Setiawan, Yudi; Nur Khairiah, Rahmi; Effendi, Hefni

    2017-01-01

    Ciliwung is the biggest river in Jakarta. It is 119 km long with a catchment area of 476 km2. It flows from Bogor Regency and crosses Bogor City, Depok City, and Jakarta before finally flowing into Java Sea through Jakarta Bay. The water quality in Ciliwung River has degraded. Many factors affect water quality. Understanding the relationship between land use and surface water quality is necessary for effective water management. It has been widely accepted that there is a close relationship between the land use type and water quality. This study aims to analyze the influence of various land use types on the water quality within the Ciliwung Watershed based on the water quality monitoring data and remote sensing data in 2010 and 2014. Water quality parameters exhibited significant variations between the urban-dominated and forest-dominated sites. The proportion of urban land was strongly positively associated with total nitrogen and ammonia nitrogen concentrations. The result can provide scientific reference for the local land use optimization and water pollution control and guidance for the formulation of policies to coordinate the exploitation and protection of the water resource.

  7. Process quality of decision-making in multidisciplinary cancer team meetings: a structured observational study.

    PubMed

    Hahlweg, Pola; Didi, Sarah; Kriston, Levente; Härter, Martin; Nestoriuc, Yvonne; Scholl, Isabelle

    2017-11-17

    The quality of decision-making in multidisciplinary team meetings (MDTMs) depends on the quality of information presented and the quality of team processes. Few studies have examined these factors using a standardized approach. The aim of this study was to objectively document the processes involved in decision-making in MDTMs, document the outcomes in terms of whether a treatment recommendation was given (none vs. singular vs. multiple), and to identify factors related to type of treatment recommendation. An adaptation of the observer rating scale Multidisciplinary Tumor Board Metric for the Observation of Decision-Making (MDT-MODe) was used to assess the quality of the presented information and team processes in MDTMs. Data was analyzed using descriptive statistics and mixed logistic regression analysis. N = 249 cases were observed in N = 29 MDTMs. While cancer-specific medical information was judged to be of high quality, psychosocial information and information regarding patient views were considered to be of low quality. In 25% of the cases no, in 64% one, and in 10% more than one treatment recommendations were given (1% missing data). Giving no treatment recommendation was associated with duration of case discussion, duration of the MDTM session, quality of case history, quality of radiological information, and specialization of the MDTM. Higher levels of medical and treatment uncertainty during discussions were found to be associated with a higher probability for more than one treatment recommendation. The quality of different aspects of information was observed to differ greatly. In general, we did not find MDTMs to be in line with the principles of patient-centered care. Recommendation outcome varied substantially between different specializations of MDTMs. The quality of certain information was associated with the recommendation outcome. Uncertainty during discussions was related to more than one recommendation being considered. Time constraints

  8. Quality of life psychosocial characteristics in Greek patients with leg ulcers: a case control study.

    PubMed

    Kouris, Anargyros; Armyra, Kalliopi; Christodoulou, Christos; Sgontzou, Themis; Karypidis, Dimitrios; Kontochristopoulos, George; Liordou, Fotini; Zakopoulou, Nikoletta; Zouridaki, Eftychia

    2016-10-01

    Chronic leg ulcers are a public health problem that can have a significant impact on the patient's physical, socioeconomic and psychological status. The aim of this study is to evaluate the quality of life, anxiety and depression, self-esteem and loneliness in patients suffering from leg ulcers. A total of 102 patients were enrolled in the study. The quality of life, anxiety and depression, self-esteem and loneliness of the patient were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg's Self-esteem Scale (RSES) and the UCLA Loneliness Scale (UCLA-Version 3), respectively. The mean DLQI score was 13·38 ± 2·59, suggesting a serious effect on the quality of life of patients. Those with leg ulcers had statistically significant higher scores according to the HADS-total scale (P = 0·031) and HADS-anxiety subscale (P = 0·015) compared with healthy volunteers. Moreover, a statistically significant difference was found between the two groups concerning the UCLA-scale (P = 0·029). Female patients presented with a higher score of anxiety (P = 0·027) and social isolation (P = 0·048), and worse quality of life (P = 0·018) than male patients. A severe quality of life impairment was documented, reflecting a significant psychosocial impact on patients with leg ulcers. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  9. A comprehensive grid to evaluate case management's expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study.

    PubMed

    Van Durme, Thérèse; Schmitz, Olivier; Cès, Sophie; Anthierens, Sibyl; Maggi, Patrick; Delye, Sam; De Almeida Mello, Johanna; Declercq, Anja; Macq, Jean; Remmen, Roy; Aujoulat, Isabelle

    2015-06-18

    Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. The process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner's Chronic Care Model and the theory of complexity. The study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more "socially-oriented" type towards a more "clinically-oriented" type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types. The study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.

  10. Poststroke agitation and aggression and social quality of life: a case control study.

    PubMed

    Lau, Chieh Grace; Tang, Wai Kwong; Liu, Xiang Xin; Liang, Hua Jun; Liang, Yan; Wong, Adrian; Mok, Vincent; Ungvari, Gabor S; Wong, Ka Sing; Kim, Jong S; Paradiso, Sergio

    2017-03-01

    Aggression and agitation are common after a stroke. The association between agitation/aggression following stroke and Health-Related Quality of Life (HRQoL) in stroke survivors is unknown. This study aimed to examine the association between agitation/aggression and HRQoL in Chinese stroke survivors. Three hundred and twenty-four stroke patients entered this cross-sectional study. Agitation/aggression was assessed using the Chinese version of Neuropsychiatric Inventory (CNPI). HRQoL was measured with the Stroke Specific Quality of Life (SSQoL). Three months after the index stroke, agitation/aggression was found in 60 (18.5%) patients. In the agitation/aggression group, 44 patients (73.3%) showed passive agitation/aggression, whereas 16 (26.7%) displayed passive and active agitation/aggression. No patients showed only active agitation/aggression. Patients with agitation/aggression were more likely to have history of diabetes and greater severity of depression, as well as lower SSQoL total score and Personality Changes and Social Role scores. Controlling for diabetes and depression severity did not alter the above results. The Energy and Thinking scores of the SSQoL were significantly lower in the passive/active agitation/aggression group relative to the passive agitation/aggression group (adjusted for CNPI aggression/agitation score). In this study sample, agitation/aggression was preponderantly of the passive type and was associated with poorer HRQoL independently from depression or medical conditions. Patients with both passive and active agitation/aggression had lower Quality of Life (QoL) than patients with only passive agitation/aggression. The causality of the association between low QoL and agitation/aggression needs to be explored in future studies.

  11. Online Case Studies as a Professional Development Opportunity for Teachers of Elementary Reading

    ERIC Educational Resources Information Center

    Vereb, Anita; Carlisle, Joanne F.; Mihocko-Bowling, Emily

    2015-01-01

    This study explores teachers' response to a professional development program called Case Studies of Reading Lessons (CSRL) that uses case studies of reading instruction to provide opportunities for elementary teachers to learn to analyze features that affect the quality of reading lessons. One important question is whether analyzing others'…

  12. Characterization of shallow groundwater quality in the Lower St. Johns River Basin: a case study.

    PubMed

    Ouyang, Ying; Zhang, Jia-En; Parajuli, Prem

    2013-12-01

    Characterization of groundwater quality allows the evaluation of groundwater pollution and provides information for better management of groundwater resources. This study characterized the shallow groundwater quality and its spatial and seasonal variations in the Lower St. Johns River Basin, Florida, USA, under agricultural, forest, wastewater, and residential land uses using field measurements and two-dimensional kriging analysis. Comparison of the concentrations of groundwater quality constituents against the US EPA's water quality criteria showed that the maximum nitrate/nitrite (NO x ) and arsenic (As) concentrations exceeded the EPA's drinking water standard limits, while the maximum Cl, SO 4 (2-) , and Mn concentrations exceeded the EPA's national secondary drinking water regulations. In general, high kriging estimated groundwater NH 4 (+) concentrations were found around the agricultural areas, while high kriging estimated groundwater NO x concentrations were observed in the residential areas with a high density of septic tank distribution. Our study further revealed that more areas were found with high estimated NO x concentrations in summer than in spring. This occurred partially because of more NO x leaching into the shallow groundwater due to the wetter summer and partially because of faster nitrification rate due to the higher temperature in summer. Large extent and high kriging estimated total phosphorus concentrations were found in the residential areas. Overall, the groundwater Na and Mg concentration distributions were relatively more even in summer than in spring. Higher kriging estimated groundwater As concentrations were found around the agricultural areas, which exceeded the EPA's drinking water standard limit. Very small variations in groundwater dissolved organic carbon concentrations were observed between spring and summer. This study demonstrated that the concentrations of groundwater quality constituents varied from location to location

  13. Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China.

    PubMed

    Shi, Leiyu; Lee, De-Chih; Liang, Hailun; Zhang, Luwen; Makinen, Marty; Blanchet, Nathan; Kidane, Ruth; Lindelow, Magnus; Wang, Hong; Wu, Shaolong

    2015-11-30

    Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the 'gate-keeper' CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness. The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients' demographic and health status characteristics. Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by

  14. Application of cooperative and non-cooperative games in large-scale water quantity and quality management: a case study.

    PubMed

    Mahjouri, Najmeh; Ardestani, Mojtaba

    2011-01-01

    In this paper, two cooperative and non-cooperative methodologies are developed for a large-scale water allocation problem in Southern Iran. The water shares of the water users and their net benefits are determined using optimization models having economic objectives with respect to the physical and environmental constraints of the system. The results of the two methodologies are compared based on the total obtained economic benefit, and the role of cooperation in utilizing a shared water resource is demonstrated. In both cases, the water quality in rivers satisfies the standards. Comparing the results of the two mentioned approaches shows the importance of acting cooperatively to achieve maximum revenue in utilizing a surface water resource while the river water quantity and quality issues are addressed.

  15. Evolution of Internal Quality Assurance at One University--A Case Study

    ERIC Educational Resources Information Center

    O'Sullivan, David

    2017-01-01

    Purpose: Quality assurance (QA) at one University has evolved over the past 15 years through emerging National and European standards, various leadership initiatives and through the engagement of key stakeholders in co-designing and implementing internal QA processes. In 2000, the QA process was focussed mainly on quality review (QR) that involved…

  16. Improving the quality of science reporting: a case study of Metcalf's Annual Science Immersion Workshop for Journalists

    NASA Astrophysics Data System (ADS)

    Murray, Cara

    need for different group divisions based on media format in future analysis. The data analysis of survey participants disaggregated by media type generated few statistically significant differences of note. This case study relates to larger trends, questions and changes in today's media landscape. Because information flows from the media to the public and into policy, the quality and quantity of marine reporting impacts the quality and quantity of marine policy. In a media environment that has become increasingly interactive, where information flow is less hierarchical, now more than ever environmental journalists must be equipped to filter, interpret and evaluate information in order to communicate effectively.

  17. Examining angler behavior using contingent behavior modeling: A case study of water quality change at a Wisconsin lake

    NASA Astrophysics Data System (ADS)

    Eiswerth, Mark E.; Kashian, Russell D.; Skidmore, Mark

    2008-11-01

    We use contingent behavior (CB) analysis to examine the potential impacts of a hypothetical change in the clarity of a lake. We collect and use both CB and revealed preference data to estimate a pooled negative binomial count data travel cost model. From this analysis we calculate the consumer surplus per angling party day for our case study lake to be about $104, or a total annual consumer surplus of $1.4 million. Using this consumer surplus measure and changes in the intended number of visits obtained from the CB survey, we estimate the loss in consumer surplus associated with a decline in water clarity from 10 to 3 feet (1 foot = 0.3048 m) to be about $522,000 annually (a 38% decrease). Since this is the first such application of CB analysis to estimate the effects of a water clarity change, the study may illustrate a method well suited to analyzing changes in water quality attributes that are easily observable and well understood by recreators.

  18. Evaluation of Quality of Lower Limb Arthroplasty Observational Studies Using the Assessment of Quality in Lower Limb Arthroplasty (AQUILA) Checklist.

    PubMed

    Cowan, James B; Mlynarek, Ryan A; Nelissen, Rob G H H; Pijls, Bart G C W; Gagnier, Joel J

    2015-09-01

    This study used the assessment of quality in lower limb arthroplasty (AQUILA) checklist to assess the quality of lower limb arthroplasty observational studies. Among 132 studies the mean reporting quality score was 5.4 (SD=1.2) out of 8 possible points. Most studies adequately reported reasons for revisions (98%) and prosthesis brand and fixation (95%) in sufficient detail. Only 3% of studies adequately reported the number of patients unwilling to participate, 15% stated a clear primary research question or hypothesis, 11% reported a worst-case analysis or competing risk analysis for endpoints, and 42% reported more than 5% of patients were lost to follow-up. There is significant room for improvement in the reporting and methodology of lower limb arthroplasty observational studies. Level III. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. [Health information on the Internet and trust marks as quality indicators: vaccines case study].

    PubMed

    Mayer, Miguel Angel; Leis, Angela; Sanz, Ferran

    2009-10-01

    To find out the prevalence of quality trust marks present in websites and to analyse the quality of these websites displaying trust marks compared with those that do not display them, in order to put forward these trust marks as a quality indicator. Cross-sectional study. Internet. Websites on vaccines. Using "vacunas OR vaccines" as key words, the features of 40 web pages were analysed. These web pages were selected from the page results of two search engines, Google and Yahoo! Based on a total of 9 criteria, the average score of criteria fulfilled was 7 (95% CI 3.96-10.04) points for the web pages offered by Yahoo! and 7.3 (95% CI 3.86-10.74) offered by Google. Amongst web pages offered by Yahoo!, there were three with clearly inaccurate information, while there were four in the pages offered by Google. Trust marks were displayed in 20% and 30% medical web pages, respectively, and their presence reached statistical significance (P=0.033) when fulfilling the quality criteria compared with web pages where trust marks were not displayed. A wide variety of web pages was obtained by search engines and a large number of them with useless information. Although the websites analysed had a good quality, between 15% and 20% showed inaccurate information. Websites where trust marks were displayed had more quality than those that did not display one and none of them were included amongst those where inaccurate information was found.

  20. Geospatial modelling for groundwater quality mapping: a case study of Rupnagar district, Punjab, India

    NASA Astrophysics Data System (ADS)

    Sahoo, S.; Kaur, A.; Litoria, P.; Pateriya, B.

    2014-11-01

    Over period of time, the water usage and management is under stress for various reasons including pollution in both surface and subsurface. The groundwater quality decreases due to the solid waste from urban and industrial nodes, rapid use of insecticides and pesticides in agricultural practices. In this study, ground water quality maps for Rupnagar district of Punjab has been prepared using geospatial interpolation technique through Inverse Distance Weighted (IDW) approach. IDW technique has been used for major ground water quality parameters observed from the field samples like Arsenic, Hardness, pH, Iron, Fluoride, TDS, and Sulphate. To assess the ground water quality of the Rupnagar district, total 280 numbers of samples from various sources of tubewells for both pre and post monsoon have collected. Out of which, 80 to 113 samples found Iron with non potable limits ranging 0.3-1.1mg/l and 0.3-1.02mg/l according to BIS standard for both the seasons respectively. Chamkaur Sahib, Rupnagar, Morinda blocks have been found non potable limit of iron in both pre & post-monsoon. 11 to 52 samples in this region have sulphate with permissible limits in both the season ranging 200-400mg/l and 201-400mg/l. But arsenic had acceptable limit in both the season. Various parameters-wise ground water quality map is generated using the range values of drinking water quality to know the distribution of different parameters and diversification in the concentration of different elements. These maps are very much needful for human being to expand awareness among the people to maintain the Cleanness of water at their highest quality and purity levels to achieve a healthy life.

  1. Quality assurance in non-interventional studies.

    PubMed

    Theobald, Karlheinz; Capan, Müge; Herbold, Marlis; Schinzel, Stefan; Hundt, Ferdinand

    2009-11-09

    Nowadays, drug research and surveillance after authorisation becomes more and more important for several reasons. Non-interventional studies (NIS) investigate various aspects of drug use including efficacy and safety under real life conditions. Such kind of health services research should be on a high scientific, methodological and organisational level. Therefore accompanying measures to improve or to keep the quality are highly recommended. The aim of quality management is: first to avoid bias of results by using an appropriate study design and an adequate data analysis, second to assure authenticity, completeness and validity of the data and third to identify and resolve deficiencies at an early stage. Basic principles are laid down in corresponding guidelines and recommendations of authorities, institutes and societies. Various guidelines for good epidemiological practice (GEP) were published by the U.S. Food and Drug Administration (FDA) and international and regional societies for epidemiology. In addition in Germany the Federal Institute for Drugs and Medical Devices (BfArM) together with the Paul Ehrlich Institute (PEI) and the German Association of Research-Based Pharmaceutical Companies (VFA) have published respectively recommendations dealing with quality aspects of non-interventional observational studies. Key points are the advanced publishing of information about the project, developing of a study plan/protocol containing the scientific objectives, a sample size justification and a description of the planned analyses and the publishing of a summary of the results timely after completion of the study. The quality of the data can be improved by using standardized case report forms (CRF) and the CRF should be reviewed and tested before start of study by some participants. A source data verification (SDV) should be performed in randomly selected centres - in between 2% and 5% of the centres depending on the number of participating centres. Before start of

  2. Quality assurance in non-interventional studies

    PubMed Central

    Theobald, Karlheinz; Capan, Müge; Herbold, Marlis; Schinzel, Stefan; Hundt, Ferdinand

    2009-01-01

    Nowadays, drug research and surveillance after authorisation becomes more and more important for several reasons. Non-interventional studies (NIS) investigate various aspects of drug use including efficacy and safety under real life conditions. Such kind of health services research should be on a high scientific, methodological and organisational level. Therefore accompanying measures to improve or to keep the quality are highly recommended. The aim of quality management is: first to avoid bias of results by using an appropriate study design and an adequate data analysis, second to assure authenticity, completeness and validity of the data and third to identify and resolve deficiencies at an early stage. Basic principles are laid down in corresponding guidelines and recommendations of authorities, institutes and societies. Various guidelines for good epidemiological practice (GEP) were published by the U.S. Food and Drug Administration (FDA) and international and regional societies for epidemiology. In addition in Germany the Federal Institute for Drugs and Medical Devices (BfArM) together with the Paul Ehrlich Institute (PEI) and the German Association of Research-Based Pharmaceutical Companies (VFA) have published respectively recommendations dealing with quality aspects of non-interventional observational studies. Key points are the advanced publishing of information about the project, developing of a study plan/protocol containing the scientific objectives, a sample size justification and a description of the planned analyses and the publishing of a summary of the results timely after completion of the study. The quality of the data can be improved by using standardized case report forms (CRF) and the CRF should be reviewed and tested before start of study by some participants. A source data verification (SDV) should be performed in randomly selected centres – in between 2% and 5% of the centres depending on the number of participating centres. Before start

  3. CASE STUDY CRITIQUE; UPPER CLINCH CASE STUDY

    EPA Science Inventory

    Case study critique: Upper Clinch case study (from Research on Methods for Integrating Ecological Economics and Ecological Risk Assessment: A Trade-off Weighted Index Approach to Integrating Economics and Ecological Risk Assessment). This critique answers the questions: 1) does ...

  4. Complex Controls on Groundwater Quality in Growing Mid-sized Cities: A Case Study Focused on Nitrate and Emerging Contaminants

    NASA Astrophysics Data System (ADS)

    Ohr, C. A.; Godsey, S.; Welhan, J. A.; Larson, D. M.; Lohse, K. A.; Finney, B.; Derryberry, D.

    2015-12-01

    Many regions rely on quality groundwater to support urban growth. Groundwater quality often responds in a complex manner to stressors such as land use change, climate change, or policy decisions. Urban growth patterns in mid-sized cities, especially ones that are growing urban centers in water-limited regions in the western US, control and are controlled by water availability and its quality. We present a case study from southeastern Idaho where urban growth over the past 20 years has included significant ex-urban expansion of houses that rely on septic systems rather than city sewer lines for their wastewater treatment. Septic systems are designed to mitigate some contaminants, but not others. In particular, nitrates and emerging contaminants, such as pharmaceuticals, are not removed by most septic systems. Thus, even well-maintained septic systems at sufficiently high densities can impact down gradient water quality. Here we present patterns of nitrate concentrations over the period from 1985-2015 from the Lower Portneuf River Valley in southeastern Idaho. Concentrations vary from 0.03 to 27.09 nitrate-nitrogen mg/L, with average values increasing significantly over the 30 year time period from 3.15 +/- 0.065 to 3.57 +/- 0.43 mg/L. We examine temporal changes in locations of nitrate hotspots, and present pilot data on emerging contaminants of concern. Initial results suggest that high nitrate levels are generally associated with higher septic densities, but that this pattern is influenced by legacy agricultural uses and strongly controlled by underlying aquifer properties. Future work will include more detailed hydrological modeling to predict changes in hotspot locations under potential climate change scenarios.

  5. A Nigerian Case-Study of Perceptions of Science.

    ERIC Educational Resources Information Center

    Bajah, Samuel Tunde

    1985-01-01

    Case study and survey evidence is presented which shows that many Nigerians view science mainly as a body of knowledge imported by the white man. The concept of "African science" is explained and related to an emerging consciousness which, it is hoped, will influence the nature and quality of science instruction in Nigeria. (JDH)

  6. Impact of wearing fixed orthodontic appliances on quality of life among adolescents: Case-control study.

    PubMed

    Costa, Andréa A; Serra-Negra, Júnia M; Bendo, Cristiane B; Pordeus, Isabela A; Paiva, Saul M

    2016-01-01

    To investigate the impact of wearing a fixed orthodontic appliance on oral health-related quality of life (OHRQoL) among adolescents. A case-control study (1 ∶ 2) was carried out with a population-based randomized sample of 327 adolescents aged 11 to 14 years enrolled at public and private schools in the City of Brumadinho, southeast of Brazil. The case group (n  =  109) was made up of adolescents with a high negative impact on OHRQoL, and the control group (n  =  218) was made up of adolescents with a low negative impact. The outcome variable was the impact on OHRQoL measured by the Brazilian version of the Child Perceptions Questionnaire (CPQ 11-14) - Impact Short Form (ISF:16). The main independent variable was wearing fixed orthodontic appliances. Malocclusion and the type of school were identified as possible confounding variables. Bivariate and multiple conditional logistic regressions were employed in the statistical analysis. A multiple conditional logistic regression model demonstrated that adolescents wearing fixed orthodontic appliances had a 4.88-fold greater chance of presenting high negative impact on OHRQoL (95% CI: 2.93-8.13; P < .001) than those who did not wear fixed orthodontic appliances. A bivariate conditional logistic regression demonstrated that malocclusion was significantly associated with OHRQoL (P  =  .017), whereas no statistically significant association was found between the type of school and OHRQoL (P  =  .108). Adolescents who wore fixed orthodontic appliances had a greater chance of reporting a negative impact on OHRQoL than those who did not wear such appliances.

  7. Economic feasibility study for improving drinking water quality: a case study of arsenic contamination in rural Argentina.

    PubMed

    Molinos-Senante, María; Perez Carrera, Alejo; Hernández-Sancho, Francesc; Fernández-Cirelli, Alicia; Sala-Garrido, Ramón

    2014-12-01

    Economic studies are essential in evaluating the potential external investment support and/or internal tariffs available to improve drinking water quality. Cost-benefit analysis (CBA) is a useful tool to assess the economic feasibility of such interventions, i.e. to take some form of action to improve the drinking water quality. CBA should involve the market and non-market effects associated with the intervention. An economic framework was proposed in this study, which estimated the health avoided costs and the environmental benefits for the net present value of reducing the pollutant concentrations in drinking water. We conducted an empirical application to assess the economic feasibility of removing arsenic from water in a rural area of Argentina. Four small-scale methods were evaluated in our study. The results indicated that the inclusion of non-market benefits was integral to supporting investment projects. In addition, the application of the proposed framework will provide water authorities with more complete information for the decision-making process.

  8. Value of information analysis for groundwater quality monitoring network design Case study: Eocene Aquifer, Palestine

    NASA Astrophysics Data System (ADS)

    Khader, A.; McKee, M.

    2010-12-01

    Value of information (VOI) analysis evaluates the benefit of collecting additional information to reduce or eliminate uncertainty in a specific decision-making context. It makes explicit any expected potential losses from errors in decision making due to uncertainty and identifies the “best” information collection strategy as one that leads to the greatest expected net benefit to the decision-maker. This study investigates the willingness to pay for groundwater quality monitoring in the Eocene Aquifer, Palestine, which is an unconfined aquifer located in the northern part of the West Bank. The aquifer is being used by 128,000 Palestinians to fulfill domestic and agricultural demands. The study takes into account the consequences of pollution and the options the decision maker might face. Since nitrate is the major pollutant in the aquifer, the consequences of nitrate pollution were analyzed, which mainly consists of the possibility of methemoglobinemia (blue baby syndrome). In this case, the value of monitoring was compared to the costs of treating for methemoglobinemia or the costs of other options like water treatment, using bottled water or importing water from outside the aquifer. And finally, an optimal monitoring network that takes into account the uncertainties in recharge (climate), aquifer properties (hydraulic conductivity), pollutant chemical reaction (decay factor), and the value of monitoring is designed by utilizing a sparse Bayesian modeling algorithm called a relevance vector machine.

  9. Expectation-Based Efficiency and Quality Improvements in Research Administration: Multi-Institutional Case Studies

    ERIC Educational Resources Information Center

    Saha, Dhanonjoy C.; Ahmed, Abrar; Hanumandla, Shailaja

    2011-01-01

    Conventional wisdom may support the presumed notion that higher expectations increase efficiency and improve quality. However, this claim may only be validated when workers are equipped with appropriate tools, training, and a conducive work environment. This study implements various interventions, observes outcomes, and analyzes data collected in…

  10. WETLANDS AND WATER QUALITY TRADING: REVIEW OF CURRENT SCIENCE AND ECONOMIC PRACTICES WITH SELECTED CASE STUDIES

    EPA Science Inventory

    The study evaluates the technical, economic, and administrative aspects of establishing water quality trading (WQT) programs where the nutrient removal capacity of wetlands is used to improve water quality. WQT is a potentially viable approach for wastewater dischargers to cost-e...

  11. A case study of deer-vehicle accidents on I-64.

    DOT National Transportation Integrated Search

    1971-01-01

    This case study of interstate fencing has indicated several findings which should be reviewed by the Virginia Department of Highways Environmental Quality Division. The major findings are: 1. Approximately 55 deer-vehicle collisions occurred on I-64 ...

  12. Six sigma in action. Case studies in quality put theory into practice.

    PubMed

    Scalise, Dagmara

    2003-05-01

    Case studies of four hospitals show how Six Sigma can be used for everything from reducing ED hold time to cutting down on medical errors. Our examples pinpoint the costs of implementation and the savings and other benefits derived.

  13. Water quality assessment in terms of water quality index (WQI): case study of the Kolong River, Assam, India

    NASA Astrophysics Data System (ADS)

    Bora, Minakshi; Goswami, Dulal C.

    2017-10-01

    The Kolong River of Nagaon district, Assam has been facing serious degradation leading to its current moribund condition due to a drastic human intervention in the form of an embankment put across it near its take-off point from the Brahmaputra River in the year 1964. The blockage of the river flow was adopted as a flood control measure to protect its riparian areas, especially the Nagaon town, from flood hazard. The river, once a blooming distributary of the mighty Brahmaputra, had high navigability and rich riparian biodiversity with a well established agriculturally productive watershed. However, the present status of Kolong River is highly wretched as a consequence of the post-dam effects thus leaving it as stagnant pools of polluted water with negligible socio-economic and ecological value. The Central Pollution Control Board, in one of its report has placed the Kolong River among 275 most polluted rivers of India. Thus, this study is conducted to analyze the seasonal water quality status of the Kolong River in terms of water quality index (WQI). The WQI scores shows very poor to unsuitable quality of water samples in almost all the seven sampling sites along the Kolong River. The water quality is found to be most deteriorated during monsoon season with an average WQI value of 122.47 as compared to pre-monsoon and post-monsoon season having average WQI value of 85.73 and 80.75, respectively. Out of the seven sampling sites, Hatimura site (S1) and Nagaon Town site (S4) are observed to be the most polluted sites.

  14. [Study on procedure of seed quality testing and seed grading scale of Phellodendron amurense].

    PubMed

    Liu, Yanlu; Zhang, Zhao; Dai, Lingchao; Zhang, Bengang; Zhang, Xiaoling; Wang, Han

    2011-12-01

    To study the procedure of seed quality testing and seed grading scale of Phellodendron amurense. Seed quality testing methods were developed, which included the test of sampling, seed purity, weight per 1 000 seeds, seed moisture, seed viability and germination rate. The related data from 62 cases of seed specimens of P. amurense were analyzed by cluster analysis. The seed quality test procedure was developed, and the seed quality grading scale was formulated.

  15. Ensuring quality in studies linking cancer registries and biobanks.

    PubMed

    Langseth, Hilde; Luostarinen, Tapio; Bray, Freddie; Dillner, Joakim

    2010-04-01

    The Nordic countries have a long tradition of providing comparable and high quality cancer data through the national population-based cancer registries and the capability to link the diverse large-scale biobanks currently in operation. The joining of these two infrastructural resources can provide a study base for large-scale studies of etiology, treatment and early detection of cancer. Research projects based on combined data from cancer registries and biobanks provides great opportunities, but also presents major challenges. Biorepositories have become an important resource in molecular epidemiology, and the increased interest in performing etiological, clinical and gene-environment-interaction studies, involving information from biological samples linked to population-based cancer registries, warrants a joint evaluation of the quality aspects of the two resources, as well as an assessment of whether the resources can be successfully combined into a high quality study. While the quality of biospecimen handling and analysis is commonly considered in different studies, the logistics of data handling including the linkage of the biobank with the cancer registry is an overlooked aspect of a biobank-based study. It is thus the aim of this paper to describe recommendations on data handling, in particular the linkage of biobank material to cancer registry data and the quality aspects thereof, based on the experience of Nordic collaborative projects combining data from cancer registries and biobanks. We propose a standard documentation with respect to the following topics: the quality control aspects of cancer registration, the identification of cases and controls, the identification and use of data confounders, the stability of serum components, historical storage conditions, aliquoting history, the number of freeze/thaw cycles and available volumes.

  16. A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QUASER study protocol.

    PubMed

    Robert, Glenn B; Anderson, Janet E; Burnett, Susan J; Aase, Karina; Andersson-Gare, Boel; Bal, Roland; Calltorp, Johan; Nunes, Francisco; Weggelaar, Anne-Marie; Vincent, Charles A; Fulop, Naomi J

    2011-10-26

    although there is a wealth of information available about quality improvement tools and techniques in healthcare there is little understanding about overcoming the challenges of day-to-day implementation in complex organisations like hospitals. The 'Quality and Safety in Europe by Research' (QUASER) study will investigate how hospitals implement, spread and sustain quality improvement, including the difficulties they face and how they overcome them. The overall aim of the study is to explore relationships between the organisational and cultural characteristics of hospitals and how these impact on the quality of health care; the findings will be designed to help policy makers, payers and hospital managers understand the factors and processes that enable hospitals in Europe to achieve-and sustain-high quality services for their patients. in-depth multi-level (macro, meso and micro-system) analysis of healthcare quality policies and practices in 5 European countries, including longitudinal case studies in a purposive sample of 10 hospitals. The project design has three major features: • a working definition of quality comprising three components: clinical effectiveness, patient safety and patient experience • a conceptualisation of quality as a human, social, technical and organisational accomplishment • an emphasis on translational research that is evidence-based and seeks to provide strategic and practical guidance for hospital practitioners and health care policy makers in the European Union. Throughout the study we will adopt a mixed methods approach, including qualitative (in-depth, narrative-based, ethnographic case studies using interviews, and direct non-participant observation of organisational processes) and quantitative research (secondary analysis of safety and quality data, for example: adverse incident reporting; patient complaints and claims). the protocol is based on the premise that future research, policy and practice need to address the

  17. Colorado air quality impacted by long-range-transported aerosol: a set of case studies during the 2015 Pacific Northwest fires

    NASA Astrophysics Data System (ADS)

    Creamean, Jessie M.; Neiman, Paul J.; Coleman, Timothy; Senff, Christoph J.; Kirgis, Guillaume; Alvarez, Raul J.; Yamamoto, Atsushi

    2016-09-01

    Biomass burning plumes containing aerosols from forest fires can be transported long distances, which can ultimately impact climate and air quality in regions far from the source. Interestingly, these fires can inject aerosols other than smoke into the atmosphere, which very few studies have evidenced. Here, we demonstrate a set of case studies of long-range transport of mineral dust aerosols in addition to smoke from numerous fires (including predominantly forest fires and a few grass/shrub fires) in the Pacific Northwest to Colorado, US. These aerosols were detected in Boulder, Colorado, along the Front Range using beta-ray attenuation and energy-dispersive X-ray fluorescence spectroscopy, and corroborated with satellite-borne lidar observations of smoke and dust. Further, we examined the transport pathways of these aerosols using air mass trajectory analysis and regional- and synoptic-scale meteorological dynamics. Three separate events with poor air quality and increased mass concentrations of metals from biomass burning (S and K) and minerals (Al, Si, Ca, Fe, and Ti) occurred due to the introduction of smoke and dust from regional- and synoptic-scale winds. Cleaner time periods with good air quality and lesser concentrations of biomass burning and mineral metals between the haze events were due to the advection of smoke and dust away from the region. Dust and smoke present in biomass burning haze can have diverse impacts on visibility, health, cloud formation, and surface radiation. Thus, it is important to understand how aerosol populations can be influenced by long-range-transported aerosols, particularly those emitted from large source contributors such as wildfires.

  18. Quality of Inpatient Pediatric Case Management for Four Leading Causes of Child Mortality at Six Government-Run Ugandan Hospitals

    PubMed Central

    Sears, David; Mpimbaza, Arthur; Kigozi, Ruth; Sserwanga, Asadu; Chang, Michelle A.; Kapella, Bryan K.; Yoon, Steven; Kamya, Moses R.; Dorsey, Grant; Ruel, Theodore

    2015-01-01

    Background A better understanding of case management practices is required to improve inpatient pediatric care in resource-limited settings. Here we utilize data from a unique health facility-based surveillance system at six Ugandan hospitals to evaluate the quality of pediatric case management and the factors associated with appropriate care. Methods All children up to the age of 14 years admitted to six district or regional hospitals over 15 months were included in the study. Four case management categories were defined for analysis: suspected malaria, selected illnesses requiring antibiotics, suspected anemia, and diarrhea. The quality of case management for each category was determined by comparing recorded treatments with evidence-based best practices as defined in national guidelines. Associations between variables of interest and the receipt of appropriate case management were estimated using multivariable logistic regression. Results A total of 30,351 admissions were screened for inclusion in the analysis. Ninety-two percent of children met criteria for suspected malaria and 81% received appropriate case management. Thirty-two percent of children had selected illnesses requiring antibiotics and 89% received appropriate antibiotics. Thirty percent of children met criteria for suspected anemia and 38% received appropriate case management. Twelve percent of children had diarrhea and 18% received appropriate case management. Multivariable logistic regression revealed large differences in the quality of care between health facilities. There was also a strong association between a positive malaria diagnostic test result and the odds of receiving appropriate case management for comorbid non-malarial illnesses - children with a positive malaria test were more likely to receive appropriate care for anemia and less likely for illnesses requiring antibiotics and diarrhea. Conclusions Appropriate management of suspected anemia and diarrhea occurred infrequently

  19. Building Citywide Systems for Quality: A Guide and Case Studies for Afterschool Leaders

    ERIC Educational Resources Information Center

    Yohalem, Nicole; Devaney, Elizabeth; Smith, Charles; Wilson-Ahlstrom, Alicia

    2012-01-01

    A quality improvement system (QIS) is an intentional effort to raise the quality of afterschool programming in an ongoing, organized fashion. There are a number of reasons the QIS is gaining popularity. The main reasons community leaders are drawn to improving quality is that they know that 1) higher quality programs will mean better experiences…

  20. Assessment of compost quality and usage for agricultural use: a case study of Hebron, Palestine.

    PubMed

    Al-Sari, Majed I; Sarhan, Mohammed A A; Al-Khatib, Issam A

    2018-03-15

    Complying with the technical specifications of compost production is of high importance not only for environmental protection but also for increasing the productivity and promotion of compost use by farmers in agriculture. This study focuses on the compost quality of the Palestinian market and farmers' attitudes toward agricultural use of compost. The quality is assessed through selection of 20 compost samples of different suppliers and producers and lab testing for quality parameters, while the farmers' attitudes to compost use for agriculture are evaluated through survey questionnaire of 321 farmers in the Hebron area. The results showed that the compost in the Palestinian markets is of medium quality due to partial or non-compliance with the quality standards and guidelines. The Palestinian farmers showed a positive attitude since 91.2% of them have the desire to use compost in agriculture. The results also showed that knowledge of difference between compost and chemical fertilizers, perception of compost benefits, and previously experiencing problems in compost use are significant factors affecting the farmers' attitude toward the use of compost as an organic fertilizer.

  1. SetonWorldWide: A Case Study of Student Success

    ERIC Educational Resources Information Center

    DiSalvio, Philip

    2009-01-01

    This case study offers a strategic model of methods and services resulting in relatively high student success rates as defined by course completion of introductory first and second semester online courses. This strategic model is presented in the context of Sloan-C's "Five Pillars of Quality Online Education."

  2. [Fitness and quality of life in kidney transplant recipients: case-control study].

    PubMed

    Hernández Sánchez, Sonsoles; Carrero, Juan J; García López, David; Herrero Alonso, Juan Azael; Menéndez Alegre, Héctor; Ruiz, Jonatan R

    2016-04-15

    We analyzed the levels of fitness, muscle structure and quality of life of adults after kidney transplant and healthy adults. A total of 16 kidney transplant patients and 21 healthy controls performed several fitness test, isokinetic evaluation of knee flexion and extension and ultrasonography muscle thickness assessment. They also completed the quality of life questionnaire SF-36. Physical fitness, muscle structure and quality of life of the kidney transplant recipients were significantly poorer than the controls. The transplant patients performed less well in the "get up and go" and "sit to stand" test (p<.001) as well as in assessments of muscle structure, strength and power. The patients had a poorer score in their quality of life assessments, differing from the controls in domains of physical function, physical role, general health and social function (p<.001). Fitness, strength and muscle mass are diminished in kidney transplant patients, resulting in a poorer quality of life which might entail an increased risk to their health. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  3. Childhood maltreatment and adulthood poor sleep quality: a longitudinal study.

    PubMed

    Abajobir, Amanuel A; Kisely, Steve; Williams, Gail; Strathearn, Lane; Najman, Jake M

    2017-08-01

    Available evidence from cross-sectional studies suggests that childhood maltreatment may be associated with a range of sleep disorders. However, these studies have not controlled for potential individual-, familial- and environmental-level confounders. To determine the association between childhood maltreatment and lower sleep quality after adjusting for potential confounders. Data for the present study were obtained from a pre-birth cohort study of 3778 young adults (52.6% female) of the Mater Hospital-University of Queensland Study of Pregnancy follow up at a mean age of 20.6 years. The Mater Hospital-University of Queensland Study of Pregnancy is a prospective Australian pre-birth cohort study of mothers consecutively recruited during their first obstetric clinic visit at Brisbane's Mater Hospital in 1981-1983. Participants completed the Pittsburgh Sleep Quality Index at the 21-year follow up. We linked this dataset to agency-recorded substantiated cases of childhood maltreatment. A series of separate logistic regression models was used to test whether childhood maltreatment predicted lower sleep quality after adjustment for selected confounders. Substantiated physical abuse significantly predicted lower sleep quality in males. Single and multiple forms of childhood maltreatment, including age of maltreatment and number of substantiations, did not predict lower sleep quality in either gender in both crude and adjusted models. Not being married, living in a residential problem area, cigarette smoking and internalising were significantly associated with lower sleep quality in a fully adjusted model for the male-female combined sample. Childhood maltreatment does not appear to predict young adult poor sleep quality, with the exception of physical abuse for males. While childhood maltreatment has been found to predict a range of mental health problems, childhood maltreatment does not appear to predict sleep problems occurring in young adults. Poor sleep quality was

  4. Quality Assessment of Studies Published in Open Access and Subscription Journals: Results of a Systematic Evaluation.

    PubMed

    Pastorino, Roberta; Milovanovic, Sonja; Stojanovic, Jovana; Efremov, Ljupcho; Amore, Rosarita; Boccia, Stefania

    2016-01-01

    Along with the proliferation of Open Access (OA) publishing, the interest for comparing the scientific quality of studies published in OA journals versus subscription journals has also increased. With our study we aimed to compare the methodological quality and the quality of reporting of primary epidemiological studies and systematic reviews and meta-analyses published in OA and non-OA journals. In order to identify the studies to appraise, we listed all OA and non-OA journals which published in 2013 at least one primary epidemiologic study (case-control or cohort study design), and at least one systematic review or meta-analysis in the field of oncology. For the appraisal, we picked up the first studies published in 2013 with case-control or cohort study design from OA journals (Group A; n = 12), and in the same time period from non-OA journals (Group B; n = 26); the first systematic reviews and meta-analyses published in 2013 from OA journals (Group C; n = 15), and in the same time period from non-OA journals (Group D; n = 32). We evaluated the methodological quality of studies by assessing the compliance of case-control and cohort studies to Newcastle and Ottawa Scale (NOS) scale, and the compliance of systematic reviews and meta-analyses to Assessment of Multiple Systematic Reviews (AMSTAR) scale. The quality of reporting was assessed considering the adherence of case-control and cohort studies to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist, and the adherence of systematic reviews and meta-analyses to Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. Among case-control and cohort studies published in OA and non-OA journals, we did not observe significant differences in the median value of NOS score (Group A: 7 (IQR 7-8) versus Group B: 8 (7-9); p = 0.5) and in the adherence to STROBE checklist (Group A, 75% versus Group B, 80%; p = 0.1). The results did not change after adjustment

  5. Quality Assessment of Studies Published in Open Access and Subscription Journals: Results of a Systematic Evaluation

    PubMed Central

    Pastorino, Roberta; Milovanovic, Sonja; Stojanovic, Jovana; Efremov, Ljupcho; Amore, Rosarita; Boccia, Stefania

    2016-01-01

    Introduction Along with the proliferation of Open Access (OA) publishing, the interest for comparing the scientific quality of studies published in OA journals versus subscription journals has also increased. With our study we aimed to compare the methodological quality and the quality of reporting of primary epidemiological studies and systematic reviews and meta-analyses published in OA and non-OA journals. Methods In order to identify the studies to appraise, we listed all OA and non-OA journals which published in 2013 at least one primary epidemiologic study (case-control or cohort study design), and at least one systematic review or meta-analysis in the field of oncology. For the appraisal, we picked up the first studies published in 2013 with case-control or cohort study design from OA journals (Group A; n = 12), and in the same time period from non-OA journals (Group B; n = 26); the first systematic reviews and meta-analyses published in 2013 from OA journals (Group C; n = 15), and in the same time period from non-OA journals (Group D; n = 32). We evaluated the methodological quality of studies by assessing the compliance of case-control and cohort studies to Newcastle and Ottawa Scale (NOS) scale, and the compliance of systematic reviews and meta-analyses to Assessment of Multiple Systematic Reviews (AMSTAR) scale. The quality of reporting was assessed considering the adherence of case-control and cohort studies to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist, and the adherence of systematic reviews and meta-analyses to Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. Results Among case-control and cohort studies published in OA and non-OA journals, we did not observe significant differences in the median value of NOS score (Group A: 7 (IQR 7–8) versus Group B: 8 (7–9); p = 0.5) and in the adherence to STROBE checklist (Group A, 75% versus Group B, 80%; p = 0.1). The

  6. Exploring the business case for improving the quality of health care for children.

    PubMed

    Homer, Charles

    2004-01-01

    A recent examination of the business case for improving quality in health care found few financial incentives (and sizable barriers) for health care organizations interested in investing in quality improvement. That analysis did not consider the special case of children's health care. To address this gap, an expert panel delineated aspects of children's health care-such as the need for care, patterns of use, and how care is organized and financed-that differ from adult care. It then identified barriers and solutions specific to children's health care, to ensure that children's unique needs are not lost in the debate.

  7. Functional Impairment in Adult Sleepwalkers: A Case-Control Study

    PubMed Central

    Lopez, Regis; Jaussent, Isabelle; Scholz, Sabine; Bayard, Sophie; Montplaisir, Jacques; Dauvilliers, Yves

    2013-01-01

    Study Objectives: To investigate the restorative quality of sleep and daytime functioning in sleepwalking adult patients in comparison with controls. Design: Prospective case-control study. Setting: Data were collected at the Sleep Disorders Center, Hôpital-Gui-de Chauliac, Montpellier, France between June 2007 and January 2011. Participants: There were 140 adult sleepwalkers (100 (median age 30 y, 55% male) in whom primary SW was diagnosed) who underwent 1 night of video polysomnography. All patients participated in a standardized clinical interview and completed a battery of questionnaires to assess clinical characteristics of parasomnia, daytime sleepiness, fatigue, insomnia, depressive and anxiety symptoms, and health-related quality of life. Results were compared with those of 100 sex- and age-matched normal controls. Interventions: N/A. Measurements and Results: Of the sleepwalkers, 22.3% presented with daily episodes and 43.5% presented with weekly episodes. Median age at sleepwalking onset was 9 y. Familial history of sleepwalking was reported in 56.6% of sleepwalkers and violent sleep related behaviors in 57.9%, including injuries requiring medical care for at least one episode in 17%. Significant associations were found between sleepwalking and daytime sleepiness, fatigue, insomnia, depressive and anxiety symptoms, and altered quality of life. Early-onset sleepwalkers had higher frequency of violent behaviors and injuries. Sleepwalkers with violent behaviors had higher frequency of sleep terrors and triggering factors, with greater alteration in health-related quality of life. Conclusion: Adult sleepwalking is a potentially serious condition that may induce violent behaviors, self-injury or injury to bed partners, sleep disruption, excessive daytime sleepiness, fatigue, and psychological distress, all of which affect health-related quality of life. Citation: Lopez R; Jaussent I; Scholz S; Bayard S; Montplaisir J; Dauvilliers Y. Functional impairment in

  8. Quality Assurance Strategies of Higher Education in Iraq and Kurdistan: A Case Study

    ERIC Educational Resources Information Center

    Kaghed, Nabeel; Dezaye, Ahmed

    2009-01-01

    This paper reports on two different strategies that have been implemented in Iraq to improve quality assurance in the higher education sector in Iraq. One strategy has been developed by the Ministry of Higher Education and Scientific Research in Baghdad. It involved conducting a pilot study at the University of Babylon. This pilot included…

  9. Using Six Sigma for Performance Improvement in Business Curriculum: A Case Study

    ERIC Educational Resources Information Center

    Kukreja, Anil; Ricks, Joe M., Jr.; Meyer, Jean A.

    2009-01-01

    During the last few decades, a number of quality improvement methodologies have been used by organizations. This article provides a brief review of the quality improvement literature related to academia and a case study using Six Sigma methodology to analyze students' performance in a standardized examination. We found Six Sigma to be an effective…

  10. A pharmacoeconomic approach to assessing the costs and benefits of air quality interventions that improve health: a case study

    PubMed Central

    Lomas, James; Schmitt, Laetitia; Jones, Sally; McGeorge, Maureen; Bates, Elizabeth; Holland, Mike; Cooper, Duncan; Crowther, Richard; Ashmore, Mike; Rojas-Rueda, David; Weatherly, Helen; Richardson, Gerry; Bojke, Laura

    2016-01-01

    Objective This paper explores the use of pharmacoeconomic methods of valuation to health impacts resulting from exposure to poor air quality. In using such methods, interventions that reduce exposure to poor air quality can be directly compared, in terms of value for money (or cost-effectiveness), with competing demands for finite resources, including other public health interventions. Design Using results estimated as part of a health impact assessment regarding a West Yorkshire Low Emission Zone strategy, this paper quantifies cost-saving and health-improving implications of transport policy through its impact on air quality. Data source Estimates of health-related quality of life and the National Health Service (NHS)/Personal Social Services (PSS) costs for identified health events were based on data from Leeds and Bradford using peer-reviewed publications or Office for National Statistics releases. Population Inhabitants of the area within the outer ring roads of Leeds and Bradford. Main outcomes measures NHS and PSS costs and quality-adjusted life years (QALYs). Results Averting an all-cause mortality death generates 8.4 QALYs. Each coronary event avoided saves £28 000 in NHS/PSS costs and generates 1.1 QALYs. For every fewer case of childhood asthma, there will be NHS/PSS cost saving of £3000 and a health benefit of 0.9 QALYs. A single term, low birthweight birth avoided saves £2000 in NHS/PSS costs. Preventing a preterm birth saves £24 000 in NHS/PSS costs and generates 1.3 QALYs. A scenario modelled in the West Yorkshire Low Emission Zone Feasibility Study, where pre-EURO 4 buses and HGVs are upgraded to EURO 6 by 2016 generates an annual benefit of £2.08 million and a one-off benefit of £3.3 million compared with a net present value cost of implementation of £6.3 million. Conclusions Interventions to improve air quality and health should be evaluated and where improvement of population health is the primary objective, cost-effectiveness analysis

  11. A pharmacoeconomic approach to assessing the costs and benefits of air quality interventions that improve health: a case study.

    PubMed

    Lomas, James; Schmitt, Laetitia; Jones, Sally; McGeorge, Maureen; Bates, Elizabeth; Holland, Mike; Cooper, Duncan; Crowther, Richard; Ashmore, Mike; Rojas-Rueda, David; Weatherly, Helen; Richardson, Gerry; Bojke, Laura

    2016-06-21

    This paper explores the use of pharmacoeconomic methods of valuation to health impacts resulting from exposure to poor air quality. In using such methods, interventions that reduce exposure to poor air quality can be directly compared, in terms of value for money (or cost-effectiveness), with competing demands for finite resources, including other public health interventions. Using results estimated as part of a health impact assessment regarding a West Yorkshire Low Emission Zone strategy, this paper quantifies cost-saving and health-improving implications of transport policy through its impact on air quality. Estimates of health-related quality of life and the National Health Service (NHS)/Personal Social Services (PSS) costs for identified health events were based on data from Leeds and Bradford using peer-reviewed publications or Office for National Statistics releases. Inhabitants of the area within the outer ring roads of Leeds and Bradford. NHS and PSS costs and quality-adjusted life years (QALYs). Averting an all-cause mortality death generates 8.4 QALYs. Each coronary event avoided saves £28 000 in NHS/PSS costs and generates 1.1 QALYs. For every fewer case of childhood asthma, there will be NHS/PSS cost saving of £3000 and a health benefit of 0.9 QALYs. A single term, low birthweight birth avoided saves £2000 in NHS/PSS costs. Preventing a preterm birth saves £24 000 in NHS/PSS costs and generates 1.3 QALYs. A scenario modelled in the West Yorkshire Low Emission Zone Feasibility Study, where pre-EURO 4 buses and HGVs are upgraded to EURO 6 by 2016 generates an annual benefit of £2.08 million and a one-off benefit of £3.3 million compared with a net present value cost of implementation of £6.3 million. Interventions to improve air quality and health should be evaluated and where improvement of population health is the primary objective, cost-effectiveness analysis using a NHS/PSS costs and QALYs framework is an appropriate methodology. Published

  12. An employer's experience with infertility coverage: a case study.

    PubMed

    Silverberg, Kaylen; Meletiche, Dennis; Del Rosario, Gina

    2009-12-01

    A case study of Southwest Airlines, a Fortune 500 company, demonstrates that a well-designed infertility coverage plan can control resource use. This successful model could be used by employers who wish to ensure that their employees have access to high-quality, cost-effective infertility services in a managed-care environment.

  13. Identification of regional soil quality factors and indicators: a case study on an alluvial plain (central Turkey)

    NASA Astrophysics Data System (ADS)

    Şeker, Cevdet; Hüseyin Özaytekin, Hasan; Negiş, Hamza; Gümüş, İlknur; Dedeoğlu, Mert; Atmaca, Emel; Karaca, Ümmühan

    2017-05-01

    Sustainable agriculture largely depends on soil quality. The evaluation of agricultural soil quality is essential for economic success and environmental stability in rapidly developing regions. In this context, a wide variety of methods using vastly different indicators are currently used to evaluate soil quality. This study was conducted in one of the most important irrigated agriculture areas of Konya in central Anatolia, Turkey, to analyze the soil quality indicators of Çumra County in combination with an indicator selection method, with the minimum data set using a total of 38 soil parameters. We therefore determined a minimum data set with principle component analysis to assess soil quality in the study area and soil quality was evaluated on the basis of a scoring function. From the broad range of soil properties analyzed, the following parameters were chosen: field capacity, bulk density, aggregate stability, and permanent wilting point (from physical soil properties); electrical conductivity, Mn, total nitrogen, available phosphorus, pH, and NO3-N (from chemical soil properties); and urease enzyme activity, root health value, organic carbon, respiration, and potentially mineralized nitrogen (from biological properties). According to the results, the chosen properties were found as the most sensitive indicators of soil quality and they can be used as indicators for evaluating and monitoring soil quality at a regional scale.

  14. Rapid core measure improvement through a "business case for quality".

    PubMed

    Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M

    2014-01-01

    Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p < .001), and SCIP (p = .015). This program demonstrated that presentation of the financial implications of quality, transparency in performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance. © 2012 National Association for Healthcare Quality.

  15. Sacroiliac joint dysfunction: a case study.

    PubMed

    Murray, William

    2011-01-01

    Pain is a widespread issue in the United States. Nine of 10 Americans regularly suffer from pain, and nearly every person will experience low back pain at one point in their lives. Undertreated or unrelieved pain costs more than $60 billion a year from decreased productivity, lost income, and medical expenses. The ability to diagnose and provide appropriate medical treatment is imperative. This case study examines a 23-year-old Active Duty woman who is preparing to be involuntarily released from military duty for an easily correctable medical condition. She has complained of chronic low back pain that radiates into her hip and down her leg since experiencing a work-related injury. She has been seen by numerous providers for the previous 11 months before being referred to the chronic pain clinic. Upon the first appointment to the chronic pain clinic, she has been diagnosed with sacroiliac joint dysfunction. This case study will demonstrate the importance of a quality lower back pain assessment.

  16. Case management to increase quality of life after cancer treatment: a randomized controlled trial.

    PubMed

    Scherz, Nathalie; Bachmann-Mettler, Irène; Chmiel, Corinne; Senn, Oliver; Boss, Nathalie; Bardheci, Katarina; Rosemann, Thomas

    2017-03-28

    Case management has been shown to be beneficial in phases of cancer screening and treatment. After treatment is completed, patients experience a loss of support due to reduced contact with medical professionals. Case management has the potential to offer continuity of care and ease re-entry to normal life. We therefore aim to investigate the effect of case management on quality of life in early cancer survivors. Between 06/2010 and 07/2012, we randomized 95 patients who had just completed cancer treatment in 11 cancer centres in the canton of Zurich, Switzerland. Patients in the case management group met with a case manager at least three times over 12 months. Patient-reported outcomes were assessed after 3, 6 and 12 months using the Functional Assessment of Cancer Therapy (FACT-G) scale, the Patient Assessment of Chronic Illness Care (PACIC) and the Self-Efficacy scale. The change in FACT-G over 12 months was significantly greater in the case management group than in the control group (16.2 (SE 2.0) vs. 9.2 (SE 1.5) points, P = 0.006). The PACIC score increased by 0.20 (SE 0.14) in the case management group and decreased by 0.29 (SE 0.12) points in the control group (P = 0.009). Self-Efficacy increased by 3.1 points (SE 0.9) in the case management group and by 0.7 (SE 0.8) points in the control group (P = 0.049). Case management has the potential to improve quality of life, to ease re-entry to normal life and to address needs for continuity of care in early cancer survivors. The study has been submitted to the ISRCTN register under the name "Case Management in Oncology Rehabilitation" on the 12th of October 2010 and retrospectively registered under the number ISRCTN41474586 on the 24th of November 2010.

  17. Summarising climate and air quality (ozone) data on self-organising maps: a Sydney case study.

    PubMed

    Jiang, Ningbo; Betts, Alan; Riley, Matt

    2016-02-01

    This paper explores the classification and visualisation utility of the self-organising map (SOM) method in the context of New South Wales (NSW), Australia, using gridded NCEP/NCAR geopotential height reanalysis for east Australia, together with multi-site meteorological and air quality data for Sydney from the NSW Office of Environment and Heritage Air Quality Monitoring Network. A twice-daily synoptic classification has been derived for east Australia for the period of 1958-2012. The classification has not only reproduced the typical synoptic patterns previously identified in the literature but also provided an opportunity to visualise the subtle, non-linear change in the eastward-migrating synoptic systems influencing NSW (including Sydney). The summarisation of long-term, multi-site air quality/meteorological data from the Sydney basin on the SOM plane has identified a set of typical air pollution/meteorological spatial patterns in the region. Importantly, the examination of these patterns in relation to synoptic weather types has provided important visual insights into how local and synoptic meteorological conditions interact with each other and affect the variability of air quality in tandem. The study illustrates that while synoptic circulation types are influential, the within-type variability in mesoscale flows plays a critical role in determining local ozone levels in Sydney. These results indicate that the SOM can be a useful tool for assessing the impact of weather and climatic conditions on air quality in the regional airshed. This study further promotes the use of the SOM method in environmental research.

  18. Situated Teacher Quality: A Case Study of an Experienced Elementary School Teacher

    ERIC Educational Resources Information Center

    Kolman, Joni S.

    2017-01-01

    This case study examines how an experienced teacher's practice and pedagogy differs across two high-accountability urban charter schools in the United States of America (USA). Drawing on semi-structured interviews and participant observations, the findings describe variances in Rebecca's planning, use of classroom time, and curriculum flexibility,…

  19. A business case for quality improvement in addiction treatment: evidence from the NIATx collaborative.

    PubMed

    Quanbeck, Andrew R; Madden, Lynn; Edmundson, Eldon; Ford, James H; McConnell, K John; McCarty, Dennis; Gustafson, David H

    2012-01-01

    The Network for the Improvement of Addiction Treatment (NIATx) promotes treatment access and retention through a customer-focused quality improvement model. This paper explores the issue of the "business case" for quality improvement in addiction treatment from the provider's perspective. The business case model developed in this paper is based on case examples of early NIATx participants coupled with a review of the literature. Process inefficiencies indicated by long waiting times, high no-show rates, and low continuation rates cause underutilization of capacity and prevent optimal financial performance. By adopting customer-focused practices aimed at removing barriers to treatment access and retention, providers may be able to improve financial performance, increase staff retention, and gain long-term strategic advantage.

  20. A quality-of-life study of cutaneous lupus erythematosus.

    PubMed

    Batalla, A; García-Doval, I; Peón, G; de la Torre, C

    2013-11-01

    The study of quality of life in patients with skin disorders has become more important in recent decades. In the case of lupus erythematosus, most quality-of-life studies have focused on the systemic form of the disease, with less attention being paid to the cutaneous form. The main objective of this study was to evaluate quality of life in patients with cutaneous lupus erythematosus (CLE) using a dermatology-specific questionnaire: the Dermatology Life Quality Index (DLQI). Our secondary objective was to investigate associations between DLQI scores and other aspects of the disease. Thirty-six patients with CLE completed the DLQI questionnaire. Other factors assessed were disease severity (measured using the Cutaneous Lupus Erythematosus Disease Area and Severity Index), time since diagnosis, body surface area affected, previous and current treatments, and the presence of criteria for systemic lupus erythematosus (SLE). According to the DLQI, CLE had a moderate, very large, or extremely large effect on quality of life in 50% of the patients analyzed (18/36). No significant associations were found between DLQI scores and disease severity, time since diagnosis, body surface area affected, number, type, or duration of pharmacologic treatments, or the presence or absence of SLE criteria. CLE has a significant and lasting effect on patient quality of life. This effect is probably primarily due to multiple factors, including the chronic nature of the disease, the visibility of the lesions, and the fact that they can cause disfigurement. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.

  1. Multidrug Resistance among New Tuberculosis Cases: Detecting Local Variation through Lot Quality-Assurance Sampling

    PubMed Central

    Lynn Hedt, Bethany; van Leth, Frank; Zignol, Matteo; Cobelens, Frank; van Gemert, Wayne; Viet Nhung, Nguyen; Lyepshina, Svitlana; Egwaga, Saidi; Cohen, Ted

    2012-01-01

    Background Current methodology for multidrug-resistant TB (MDR TB) surveys endorsed by the World Health Organization provides estimates of MDR TB prevalence among new cases at the national level. On the aggregate, local variation in the burden of MDR TB may be masked. This paper investigates the utility of applying lot quality-assurance sampling to identify geographic heterogeneity in the proportion of new cases with multidrug resistance. Methods We simulated the performance of lot quality-assurance sampling by applying these classification-based approaches to data collected in the most recent TB drug-resistance surveys in Ukraine, Vietnam, and Tanzania. We explored three classification systems—two-way static, three-way static, and three-way truncated sequential sampling—at two sets of thresholds: low MDR TB = 2%, high MDR TB = 10%, and low MDR TB = 5%, high MDR TB = 20%. Results The lot quality-assurance sampling systems identified local variability in the prevalence of multidrug resistance in both high-resistance (Ukraine) and low-resistance settings (Vietnam). In Tanzania, prevalence was uniformly low, and the lot quality-assurance sampling approach did not reveal variability. The three-way classification systems provide additional information, but sample sizes may not be obtainable in some settings. New rapid drug-sensitivity testing methods may allow truncated sequential sampling designs and early stopping within static designs, producing even greater efficiency gains. Conclusions Lot quality-assurance sampling study designs may offer an efficient approach for collecting critical information on local variability in the burden of multidrug-resistant TB. Before this methodology is adopted, programs must determine appropriate classification thresholds, the most useful classification system, and appropriate weighting if unbiased national estimates are also desired. PMID:22249242

  2. Multidrug resistance among new tuberculosis cases: detecting local variation through lot quality-assurance sampling.

    PubMed

    Hedt, Bethany Lynn; van Leth, Frank; Zignol, Matteo; Cobelens, Frank; van Gemert, Wayne; Nhung, Nguyen Viet; Lyepshina, Svitlana; Egwaga, Saidi; Cohen, Ted

    2012-03-01

    Current methodology for multidrug-resistant tuberculosis (MDR TB) surveys endorsed by the World Health Organization provides estimates of MDR TB prevalence among new cases at the national level. On the aggregate, local variation in the burden of MDR TB may be masked. This paper investigates the utility of applying lot quality-assurance sampling to identify geographic heterogeneity in the proportion of new cases with multidrug resistance. We simulated the performance of lot quality-assurance sampling by applying these classification-based approaches to data collected in the most recent TB drug-resistance surveys in Ukraine, Vietnam, and Tanzania. We explored 3 classification systems- two-way static, three-way static, and three-way truncated sequential sampling-at 2 sets of thresholds: low MDR TB = 2%, high MDR TB = 10%, and low MDR TB = 5%, high MDR TB = 20%. The lot quality-assurance sampling systems identified local variability in the prevalence of multidrug resistance in both high-resistance (Ukraine) and low-resistance settings (Vietnam). In Tanzania, prevalence was uniformly low, and the lot quality-assurance sampling approach did not reveal variability. The three-way classification systems provide additional information, but sample sizes may not be obtainable in some settings. New rapid drug-sensitivity testing methods may allow truncated sequential sampling designs and early stopping within static designs, producing even greater efficiency gains. Lot quality-assurance sampling study designs may offer an efficient approach for collecting critical information on local variability in the burden of multidrug-resistant TB. Before this methodology is adopted, programs must determine appropriate classification thresholds, the most useful classification system, and appropriate weighting if unbiased national estimates are also desired.

  3. Best Practices Case Study: Tommy Williams Homes -Gainesville, FL

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    none,

    2011-04-01

    Case study of Tommy Williams Homes who has continued to outsell the competition with sales increasing despite the recession thanks to a systems-engineering approach developed with DOE’s Building America that yields high energy efficiency, comfort, and indoor air quality. The company offers to pay buyers’ energy bills for the first year.

  4. Development of a Premium Quality Plasma-derived IVIg (IQYMUNE®) Utilizing the Principles of Quality by Design-A Worked-through Case Study.

    PubMed

    Paolantonacci, Philippe; Appourchaux, Philippe; Claudel, Béatrice; Ollivier, Monique; Dennett, Richard; Siret, Laurent

    2018-01-01

    Polyvalent human normal immunoglobulins for intravenous use (IVIg), indicated for rare and often severe diseases, are complex plasma-derived protein preparations. A quality by design approach has been used to develop the Laboratoire Français du Fractionnement et des Biotechnologies new-generation IVIg, targeting a high level of purity to generate an enhanced safety profile while maintaining a high level of efficacy. A modular approach of quality by design was implemented consisting of five consecutive steps to cover all the stages from the product design to the final product control strategy.A well-defined target product profile was translated into 27 product quality attributes that formed the basis of the process design. In parallel, a product risk analysis was conducted and identified 19 critical quality attributes among the product quality attributes. Process risk analysis was carried out to establish the links between process parameters and critical quality attributes. Twelve critical steps were identified, and for each of these steps a risk mitigation plan was established.Among the different process risk mitigation exercises, five process robustness studies were conducted at qualified small scale with a design of experiment approach. For each process step, critical process parameters were identified and, for each critical process parameter, proven acceptable ranges were established. The quality risk management and risk mitigation outputs, including verification of proven acceptable ranges, were used to design the process verification exercise at industrial scale.Finally, the control strategy was established using a mix, or hybrid, of the traditional approach plus elements of the quality by design enhanced approach, as illustrated, to more robustly assign material and process controls and in order to securely meet product specifications.The advantages of this quality by design approach were improved process knowledge for industrial design and process

  5. Randomization and Data-Analysis Items in Quality Standards for Single-Case Experimental Studies

    ERIC Educational Resources Information Center

    Heyvaert, Mieke; Wendt, Oliver; Van den Noortgate, Wim; Onghena, Patrick

    2015-01-01

    Reporting standards and critical appraisal tools serve as beacons for researchers, reviewers, and research consumers. Parallel to existing guidelines for researchers to report and evaluate group-comparison studies, single-case experimental (SCE) researchers are in need of guidelines for reporting and evaluating SCE studies. A systematic search was…

  6. Quality assessment of SPR sensor chips; case study on L1 chips.

    PubMed

    Olaru, Andreea; Gheorghiu, Mihaela; David, Sorin; Polonschii, Cristina; Gheorghiu, Eugen

    2013-07-15

    Surface quality of the Surface Plasmon Resonance (SPR) chips is a major limiting issue in most SPR analyses, even more for supported lipid membranes experiments, where both the organization of the lipid matrix and the subsequent incorporation of the target molecule depend on the surface quality. A novel quantitative method to characterize the quality of SPR sensors chips is described for L1 chips subject to formation of lipid films, injection of membrane disrupting compounds, followed by appropriate regeneration procedures. The method consists in analysis of the SPR reflectivity curves for several standard solutions (e.g. PBS, HEPES or deionized water). This analysis reveals the decline of sensor surface as a function of the number of experimental cycles (consisting in biosensing assay and regeneration step) and enables active control of surface regeneration for enhanced reproducibility. We demonstrate that quantitative evaluation of the changes in reflectivity curves (shape of the SPR dip) and of the slope of the calibration curve provides a rapid and effective procedure for surface quality assessment. Whereas the method was tested on L1 SPR sensors chips, we stress on its amenability to assess the quality of other types of SPR chips, as well. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Data Quality: 1979 Southeastern Virginia Urban Plume Study (SEV-UPS): Surface and Airborne studies

    NASA Technical Reports Server (NTRS)

    White, J. H.; Strong, R. B.; Saeger, M. L.; Eaton, W. C.; Lommerdahl, J. B.

    1981-01-01

    The SEV-UPS field study conducted during August 1979 involved the coordinated air quality data collection efforts of three different organizations operating a total of four aircraft and 12 ground stations. Incorporated into plans for that program were numerous quality assurance activities designed to identify potential hazards for data quality in time for their correction and to take data to allow assessment of the consistency of the data from different stations. The purpose of this study was to document QA procedures that were performed by participating agencies and revise data from all platforms for mutual compatibility. For the latter effort, cases were identified on 21 occasions on seven different days where two or more monitoring systems were operating in the same location at nearly the same time. Data from the systems involved were tabulated in 200 m altitude segments, averaged and compared to detect any bias between measurements made from different systems. The results of these comparisons along with the results of independent performance audits are presented.

  8. Quality Education in Idaho: A Case Study of Academic Achievement in Three High-Poverty Rural Schools

    ERIC Educational Resources Information Center

    Brown, Christine

    2017-01-01

    The focus of this research is bridging the achievement gap for students living in poverty through quality education. Such a study is important because the percentage of students affected by poverty is increasing and the persistent gap in achievement evidences that the right to quality education for students in poverty is not being met. This is…

  9. Impact of weak social ties and networks on poor sleep quality: A case study of Iranian employees.

    PubMed

    Masoudnia, Ebrahim

    2015-12-01

    The poor sleep quality is one of the major risk factors of somatic, psychiatric and social disorders and conditions as well as the major predictors of quality of employees' performance. The previous studies in Iran had neglected the impacts of social factors including social networks and ties on adults sleep quality. Thus, the aim of the current research was to determine the relationship between social networks and adult employees' sleep quality. This study was conducted with a correlational and descriptive design. Data were collected from 360 participants (183 males and 177 females) who were employed in Yazd public organizations in June and July of 2014. These samples were selected based on random sampling method. In addition, the measuring tools were the Pittsburgh Sleep Quality Index (PSQI) and Social Relations Inventory (SRI). Based on the results, the prevalence rate of sleep disorder among Iranian adult employees was 63.1% (total PSQI>5). And, after controlling for socio-demographic variables, there was significant difference between individuals with strong and poor social network and ties in terms of overall sleep quality (p<.01), subjective sleep quality (p<.01), habitual sleep efficiency (p<.05), and daytime dysfunction (p<.01). The results also revealed that the employees with strong social network and ties had better overall sleep quality, had the most habitual sleep efficiency, and less daytime dysfunction than employees with poor social network and ties. It can be implied that the weak social network and ties serve as a risk factor for sleep disorders or poor sleep quality for adult employees. Therefore, the social and behavioral interventions seem essential to improve the adult's quality sleep. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Evaluation on Living Public Spaces and Their Qualities - Case Study from Ankara Konur, Karanfil and Yüksel Streets

    NASA Astrophysics Data System (ADS)

    Gürer, Nilüfer; Imren Güzel, Burcu; Kavak, Ibrahim

    2017-10-01

    Public spaces constitute one of the main elements of the living cities. They stand out as places reflecting the social structure of the society and the past values. They appear as the places one can observe the changes and modernity of the society as well as socializing places. Following to private and semi-private spaces, public spaces such as streets, squares and parks provide people a chance to be together and contact with each other. In living and vibrant places with these random appointments they feel that they belong to social urban life. Therefore, well-designed living public spaces are important indicators of the quality of life and user satisfaction. In the scope of this paper the basic principles and design criteria that create living public spaces and their effects on user satisfaction are discussed. By analysing the spatial reflections of used design criteria it is aimed to relate the existing arrangements to user satisfaction. For these analysis, Yüksel Street located at Kızılay Square in Ankara centre and side streets of Karanfil and Konur (all car-free) were selected as case study area. This area is one of the most important and most densely used pedestrian zone of the capital with its green pattern, location and crossroads. At the beginning, basic design criteria and implementation methods are detailed with the literature survey. Then basic criteria and design principles are verified by using field studies including a survey with randomly asked 270 questionnaires. For defining the user satisfaction and bringing out the qualifications and failures in the case study area user surveys are analysed by field study observations and SPSS Statistics software. Finally, practical suggestions which are believed to be useful for this type of public places in developing and less developed countries are proposed

  11. Data Envelopment Analysis in the Presence of Measurement Error: Case Study from the National Database of Nursing Quality Indicators® (NDNQI®)

    PubMed Central

    Gajewski, Byron J.; Lee, Robert; Dunton, Nancy

    2012-01-01

    Data Envelopment Analysis (DEA) is the most commonly used approach for evaluating healthcare efficiency (Hollingsworth, 2008), but a long-standing concern is that DEA assumes that data are measured without error. This is quite unlikely, and DEA and other efficiency analysis techniques may yield biased efficiency estimates if it is not realized (Gajewski, Lee, Bott, Piamjariyakul and Taunton, 2009; Ruggiero, 2004). We propose to address measurement error systematically using a Bayesian method (Bayesian DEA). We will apply Bayesian DEA to data from the National Database of Nursing Quality Indicators® (NDNQI®) to estimate nursing units’ efficiency. Several external reliability studies inform the posterior distribution of the measurement error on the DEA variables. We will discuss the case of generalizing the approach to situations where an external reliability study is not feasible. PMID:23328796

  12. Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study.

    PubMed

    Swinglehurst, Deborah; Greenhalgh, Trisha; Russell, Jill; Myall, Michelle

    2011-11-03

    To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Ethnographic case study. Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Potential threats to patient safety and characteristics of good practice. Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as "exceptions" by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge. Clinicians were often unaware of this input and it did not feature in policy

  13. Working Together with Children and Families: Case Studies in Early Intervention.

    ERIC Educational Resources Information Center

    McWilliam, P. J., Ed.; Bailey, Donald B., Jr., Ed.

    This book presents 21 case studies of young children with disabilities in a variety of family situations and settings, for early interventionists to study in planning and applying recommended practices. Section I, "Defining and Delivering Quality Services in Early Intervention," provides two introductory chapters: "The Search for Quality…

  14. Case management in an acute-care hospital: collaborating for quality, cost-effective patient care.

    PubMed

    Grootveld, Kim; Wen, Victoria; Bather, Michelle; Park, Joan

    2014-01-01

    Case management has recently been advanced as a valuable component in achieving quality patient care that is also cost-effective. At St. Michael's Hospital, in Toronto, Ontario, case managers from a variety of professional backgrounds are central to a new care initiative--Rapid Assessment and Planning to Inform Disposition (RAPID)--in the General Internal Medicine (GIM) Unit that is designed to improve patient care and reconcile high emergency department volumes through "smart bed spacing." Involved in both planning and RAPID, GIM's case managers are the link between patient care and utilization management. These stewards of finite resources strive to make the best use of dollars spent while maintaining a commitment to quality care. Collaborating closely with physicians and others across the hospital, GIM's case managers have been instrumental in bringing about significant improvements in care coordination, utilization management and process redesign. Copyright © 2014 Longwoods Publishing.

  15. The determinations of remote sensing satellite data delivery service quality: A positivistic case study in Chinese context

    NASA Astrophysics Data System (ADS)

    Jin, Jiahua; Yan, Xiangbin; Tan, Qiaoqiao; Li, Yijun

    2014-03-01

    With the development of remote sensing technology, remote-sensing satellite has been widely used in many aspects of national construction. Big data with different standards and massive users with different needs, make the satellite data delivery service to be a complex giant system. How to deliver remote-sensing satellite data efficiently and effectively is a big challenge. Based on customer service theory, this paper proposes a hierarchy conceptual model for examining the determinations of remote-sensing satellite data delivery service quality in the Chinese context. Three main dimensions: service expectation, service perception and service environment, and 8 sub-dimensions are included in the model. Large amount of first-hand data on the remote-sensing satellite data delivery service have been obtained through field research, semi-structured questionnaire and focused interview. A positivist case study is conducted to validate and develop the proposed model, as well as to investigate the service status and related influence mechanisms. Findings from the analysis demonstrate the explanatory validity of the model, and provide potentially helpful insights for future practice.

  16. Biological indices of soil quality: an ecosystem case study of their use

    Treesearch

    Jennifer D. Knoepp; David C. Coleman; D.A. Crossley; James S. Clark

    2000-01-01

    Soil quality indices can help ensure that site productivity and soil function are maintained. Biological indices yield evidence of how a soil functions and interacts with the plants, animals, and climate that comprise an ecosystem. Soil scientists can identify and quantify both chemical and biological soil-quality indicators for ecosystems with a single main function,...

  17. Community exposure and vulnerability to water quality and availability: a case study in the mining-affected Pazña Municipality, Lake Poopó Basin, Bolivian Altiplano.

    PubMed

    French, Megan; Alem, Natalie; Edwards, Stephen J; Blanco Coariti, Efraín; Cauthin, Helga; Hudson-Edwards, Karen A; Luyckx, Karen; Quintanilla, Jorge; Sánchez Miranda, Oscar

    2017-10-01

    Assessing water sources for drinking and irrigation along with community vulnerability, especially in developing and rural regions, is important for reducing risk posed by poor water quality and limited water availability and accessibility. We present a case study of rural mining-agricultural communities in the Lake Poopó Basin, one of the poorest regions on the Bolivian Altiplano. Here, relatively low rainfall, high evaporation, salinization and unregulated mining activity have contributed to environmental degradation and water issues, which is a situation facing many Altiplano communities. Social data from 72 households and chemical water quality data from 27 surface water and groundwater sites obtained between August 2013 and July 2014 were used to develop locally relevant vulnerability assessment methodologies and ratings with respect to water availability and quality, and Chemical Water Quality Hazard Ratings to assess water quality status. Levels of natural and mining-related contamination in many waters (CWQHR ≥ 6; 78% of assessed sites) mean that effective remediation would be challenging and require substantial investment. Although waters of fair to good chemical quality (CWQHR ≤ 5; 22% of assessed sites) do exist, treatment may still be required depending on use, and access issues remain problematic. There is a need to comply with water quality legislation, improve and maintain basic water supply and storage infrastructure, build and operate water and wastewater treatment plants, and adequately and safely contain and treat mine waste. This study serves as a framework that could be used elsewhere for assessing and mitigating water contamination and availability affecting vulnerable populations.

  18. Community exposure and vulnerability to water quality and availability: a case study in the mining-affected Pazña Municipality, Lake Poopó Basin, Bolivian Altiplano

    NASA Astrophysics Data System (ADS)

    French, Megan; Alem, Natalie; Edwards, Stephen J.; Blanco Coariti, Efraín; Cauthin, Helga; Hudson-Edwards, Karen A.; Luyckx, Karen; Quintanilla, Jorge; Sánchez Miranda, Oscar

    2017-10-01

    Assessing water sources for drinking and irrigation along with community vulnerability, especially in developing and rural regions, is important for reducing risk posed by poor water quality and limited water availability and accessibility. We present a case study of rural mining-agricultural communities in the Lake Poopó Basin, one of the poorest regions on the Bolivian Altiplano. Here, relatively low rainfall, high evaporation, salinization and unregulated mining activity have contributed to environmental degradation and water issues, which is a situation facing many Altiplano communities. Social data from 72 households and chemical water quality data from 27 surface water and groundwater sites obtained between August 2013 and July 2014 were used to develop locally relevant vulnerability assessment methodologies and ratings with respect to water availability and quality, and Chemical Water Quality Hazard Ratings to assess water quality status. Levels of natural and mining-related contamination in many waters (CWQHR ≥ 6; 78% of assessed sites) mean that effective remediation would be challenging and require substantial investment. Although waters of fair to good chemical quality (CWQHR ≤ 5; 22% of assessed sites) do exist, treatment may still be required depending on use, and access issues remain problematic. There is a need to comply with water quality legislation, improve and maintain basic water supply and storage infrastructure, build and operate water and wastewater treatment plants, and adequately and safely contain and treat mine waste. This study serves as a framework that could be used elsewhere for assessing and mitigating water contamination and availability affecting vulnerable populations.

  19. The case for restraint in spinal surgery: does quality management have a role to play?

    PubMed Central

    Mirza, Sohail K.

    2009-01-01

    Most quality improvement efforts in surgery have focused on the technical quality of care provided, rather than whether the care was indicated, or could have been provided with a safer procedure. Because risk is inherent in any procedure, reducing the number of unnecessary operations is an important issue in patient safety. In the case of lumbar spine surgery, several lines of evidence suggest that, in at least some locations, there may be excessively high surgery rates. This evidence comes from international comparisons of surgical rates; study of small area variations within countries; increasing surgical rates in the absence of new indications; comparisons of surgical outcomes between geographic areas with high or low surgical rates; expert opinion; the preferences of well-informed patients; and increasing rates of repeat surgery. From a population perspective, reducing unnecessary surgery may have a greater impact on complication rates than improving the technical quality of surgery that is performed. Evidence suggests this may be true for coronary bypass surgery in the US and hysterectomy rates in Canada. Though similar studies have not been done for spine surgery, wide geographic variations in surgical rates suggest that this could be the case for spine surgery as well. We suggest that monitoring geographic variations in surgery rates may become an important aspect of quality improvement, and that rates of repeat surgery may bear special attention. Patient registries can help in this regard, if they are very complete and rigorously maintained. They can provide data on surgical rates; offer post-marketing surveillance for new surgical devices and techniques; and help to identify patient subgroups that may benefit most from certain procedures. PMID:19266220

  20. The case for restraint in spinal surgery: does quality management have a role to play?

    PubMed

    Deyo, Richard A; Mirza, Sohail K

    2009-08-01

    Most quality improvement efforts in surgery have focused on the technical quality of care provided, rather than whether the care was indicated, or could have been provided with a safer procedure. Because risk is inherent in any procedure, reducing the number of unnecessary operations is an important issue in patient safety. In the case of lumbar spine surgery, several lines of evidence suggest that, in at least some locations, there may be excessively high surgery rates. This evidence comes from international comparisons of surgical rates; study of small area variations within countries; increasing surgical rates in the absence of new indications; comparisons of surgical outcomes between geographic areas with high or low surgical rates; expert opinion; the preferences of well-informed patients; and increasing rates of repeat surgery. From a population perspective, reducing unnecessary surgery may have a greater impact on complication rates than improving the technical quality of surgery that is performed. Evidence suggests this may be true for coronary bypass surgery in the US and hysterectomy rates in Canada. Though similar studies have not been done for spine surgery, wide geographic variations in surgical rates suggest that this could be the case for spine surgery as well. We suggest that monitoring geographic variations in surgery rates may become an important aspect of quality improvement, and that rates of repeat surgery may bear special attention. Patient registries can help in this regard, if they are very complete and rigorously maintained. They can provide data on surgical rates; offer post-marketing surveillance for new surgical devices and techniques; and help to identify patient subgroups that may benefit most from certain procedures.

  1. Functional impairment in adult sleepwalkers: a case-control study.

    PubMed

    Lopez, Regis; Jaussent, Isabelle; Scholz, Sabine; Bayard, Sophie; Montplaisir, Jacques; Dauvilliers, Yves

    2013-03-01

    To investigate the restorative quality of sleep and daytime functioning in sleepwalking adult patients in comparison with controls. Prospective case-control study. Data were collected at the Sleep Disorders Center, Hôpital-Gui-de Chauliac, Montpellier, France between June 2007 and January 2011. There were 140 adult sleepwalkers (100 (median age 30 y, 55% male) in whom primary SW was diagnosed) who underwent 1 night of video polysomnography. All patients participated in a standardized clinical interview and completed a battery of questionnaires to assess clinical characteristics of parasomnia, daytime sleepiness, fatigue, insomnia, depressive and anxiety symptoms, and health-related quality of life. Results were compared with those of 100 sex- and age-matched normal controls. N/A. Of the sleepwalkers, 22.3% presented with daily episodes and 43.5% presented with weekly episodes. Median age at sleepwalking onset was 9 y. Familial history of sleepwalking was reported in 56.6% of sleepwalkers and violent sleep related behaviors in 57.9%, including injuries requiring medical care for at least one episode in 17%. Significant associations were found between sleepwalking and daytime sleepiness, fatigue, insomnia, depressive and anxiety symptoms, and altered quality of life. Early-onset sleepwalkers had higher frequency of violent behaviors and injuries. Sleepwalkers with violent behaviors had higher frequency of sleep terrors and triggering factors, with greater alteration in health-related quality of life. Adult sleepwalking is a potentially serious condition that may induce violent behaviors, self-injury or injury to bed partners, sleep disruption, excessive daytime sleepiness, fatigue, and psychological distress, all of which affect health-related quality of life. Lopez R; Jaussent I; Scholz S; Bayard S; Montplaisir J; Dauvilliers Y. Functional impairment in adult sleepwalkers: a case-control study. SLEEP 2013;36(3):345-351.

  2. Quality Education for All? A Case Study of a New Delhi Government School

    ERIC Educational Resources Information Center

    Sarin, Meera Nath

    2015-01-01

    This article is based on a case study conducted at a government (state-run), girls' secondary school in a low-income neighbourhood in New Delhi that was conducted in March, 2012, two years after the Right of Children to Free and Compulsory Education Act (RTE) came into force. The study examined how RTE and its related reforms were being…

  3. The Quality of Teaching Staff: Higher Education Institutions' Compliance with the European Standards and Guidelines for Quality Assurance--The Case of Portugal

    ERIC Educational Resources Information Center

    Cardoso, Sónia; Tavares, Orlanda; Sin, Cristina

    2015-01-01

    In recent years, initiatives for the improvement of teaching quality have been pursued both at European and national levels. Such is the case of the European Standards and Guidelines for Quality Assurance (ESG) and of legislation passed by several European countries, including Portugal, in response to European policy developments driven by the…

  4. School Nurse Case Management for Children with Chronic Illness: Health, Academic, and Quality of Life Outcomes

    ERIC Educational Resources Information Center

    Engelke, Martha Keehner; Guttu, Martha; Warren, Michelle B.; Swanson, Melvin

    2008-01-01

    More children with chronic illnesses are attending school, and some of them struggle academically because of issues related to their health. School-based case management has been suggested as one strategy to improve the academic success of these children. This study tracked the academic, health, and quality of life outcomes for 114 children with…

  5. Building a business case for colorectal surgery quality improvement.

    PubMed

    Lee, Ken K H; Berenholtz, Sean M; Hobson, Deborah B; Demski, Renee J; Yang, Ting; Wick, Elizabeth C

    2013-11-01

    Improving surgical quality is a priority, but building a business case for the efforts could be challenging. Bridging the gap between the clinicians and hospital leaders is the first step to align quality and financial priorities within health care. The aim of this study was to evaluate the financial impact of the surgical comprehensive unit-based safety program on colorectal surgery procedures. This a retrospective cohort study. This study was conducted at a university-based tertiary care hospital. All patients undergoing colectomy or proctectomy between July 2010 and June 2012 were included. A comprehensive unit-based safety program focused on colorectal surgical site infection reduction was implemented. Three surgeons participated in the program in year 1, and 5 surgeons participated in year 2. Patients were categorized as participating or nonparticipating based on the surgeon who performed the procedure. Resource utilization and cost were the main outcome measures. During the 2 years, there were 626 patients who met the selection criteria. Participating surgeons operated on 444 patients (70.9%), and the nonparticipating surgeons operated on 182 patients (29.1%). After adjusting for covariates, the variable direct cost was significantly lower for the participating surgeons in laboratory work by $191 (p = 0.009), operating room utilization by $149 (p = 0.05), and supplies by $615 (p = 0.003). The surgical site infection rates, need for an intensive care unit stay, and length of stay were not significantly different between the 2 groups. The multiple biases related to surgeon self-selection for program participation and surgeon training and clinical skills were not addressed in this study owing to the limitations in sample size and data collection. A comprehensive unit-based safety program implementation, including dedicated frontline providers who focused on the standardization of protocols, was able to reduce the variation in resource utilization and costs in

  6. Adiposity and Quality of Life: A Case Study from an Urban Center in Nigeria

    ERIC Educational Resources Information Center

    Akinpelu, Aderonke O.; Akinola, Odunayo T.; Gbiri, Caleb A.

    2009-01-01

    Objective: To determine relationship between adiposity indices and quality of life (QOL) of residents of a housing estate in Lagos, Nigeria. Design: Cross-sectional survey employing multistep random sampling method. Setting: Urban residential estate. Participants: This study involved 900 randomly selected residents of Abesan Housing Estate, Lagos,…

  7. The Relationship between Case-Volume, Care Quality, and Outcomes of Complex Cancer Surgery

    PubMed Central

    Auerbach, Andrew D; Maselli, Judith; Carter, Jonathan; Pekow, Penelope S; Lindenauer, Peter K

    2010-01-01

    Background How case volume and quality of care relate to each other and to results of complex cancer surgery is not well understood. Study Design Observational cohort of 14,170 patients 18 or older who underwent pneumonectomy, esophagectomy, pancreatectomy, or pelvic surgery for cancer between 10/1/2003 and 9/1/2005 at a United States hospital participating in a large benchmarking database. Case volumes were estimated within our dataset. Quality was measured by determining whether ideal patients did not receive appropriate perioperative medications (such as antibiotics to prevent surgical site infections) both as individual ‘missed’ measures, as well as the overall number missed. We used hierarchical models to estimate effects of volume and quality on 30-day readmission, in-hospital mortality, length of stay, and costs. Results After adjustment, we noted no consistent associations between higher hospital or surgeon volume and mortality, readmission, length of stay, or costs. Adherence to individual measures was not consistently associated with improvement in readmission, mortality, or other outcomes. For example, continuing antimicrobials past 24 hours was associated with longer length of stay (21.5% higher, 95% CI 19.5% to 23.6%) and higher costs (17% higher, 95% CI 16% to 19%). In contrast, overall adherence, while not not associated with differences in mortality or readmission, was consistently associated with longer length of stay (7.4% longer with one missed measure and 16.4% longer with 2 or more) and higher costs (5% higher with one missed measure, and 11% higher with 2 or more). Conclusions While hospital and surgeon volume were not associated with outcomes, lower overall adherence to quality measures is associated with higher costs, but not improved outcomes. This finding may provide a rationale for improving care systems by maximizing care consistency, even if outcomes are not affected. PMID:20829079

  8. External tank program productivity and quality enhancements - A case study

    NASA Technical Reports Server (NTRS)

    Locke, S. R.

    1988-01-01

    The optimization of the Manned Space Systems productivity and quality enhancement program is described. The guidelines and standards of the program and the roles played in it by various employee groups are addressed. Aspects of the program involving job/organization redefinition, production and planning in automation, and artificial intelligence and robotics are examined.

  9. Using technology to enhance the quality of home health care: three case studies of health information technology initiatives at the visiting nurse service of New York.

    PubMed

    Russell, David; Rosenfeld, Peri; Ames, Sylvia; Rosati, Robert J

    2010-01-01

    There is a growing recognition among health services researchers and policy makers that Health Information Technology (HIT) has the potential to address challenging issues that face patients and providers of healthcare. The Visiting Nurse Service of New York (VNSNY), a large not-for-profit home healthcare agency, has integrated technology applications into the service delivery model of several programs. Case studies, including the development and implementation, of three informatics initiatives at VNSNY are presented on: (1) Quality Scorecards that utilize process, outcomes, cost, and satisfaction measures to assess performance among clinical staff and programs; (2) a tool to identify patients at risk of being hospitalized, and (3) a predictive model that identifies patients who are eligible for physical rehabilitation services. Following a description of these initiatives, we discuss their impact on quality and process indicators, as well as the opportunities and challenges to implementation. © 2010 National Association for Healthcare Quality.

  10. Case-Mix and Quality Indicators in Chinese Elder Care Homes: Are There Differences between Government-owned and Private-sector Facilities?

    PubMed Central

    Liu, Chang

    2015-01-01

    Objective To assess the association between ownership of Chinese elder care facilities and their performance quality; and to compare the case-mix profile of residents and facility characteristics in government-owned and private-sector homes. Design Cross-sectional study. Setting Census of elder care homes surveyed in Nanjing (in 2009) and Tianjin (in 2010). Population 140 (or 95% of all) elder care facilities located in urban Nanjing, and 157 (or 97% of all) facilities in urban Tianjin. Main study outcome measures We created a summary case-mix index based on activities of daily living (ADL) limitations and cognitive impairment to measure levels of care needs among residents in each facility. We selected structure, process, and outcome measures to assess facility-level quality of care. We also developed a structural quality measure, under-staffing relative to residents’ levels of care needs, which indicates potentially inadequate staffing given the residents’ case-mix. Results Government-owned homes have significantly higher occupancy rates, presumably reflecting popular demand for publicly subsidized beds, but they serve residents who, on average, have fewer ADL and cognitive functioning limitations than do private-sector facilities. Across a range of structure, process, and outcome measures of quality, there is no clear evidence suggesting advantages or disadvantages to either ownership type. However, when staffing to resident ratio is gauged relative to residents’ case-mix, private-sector facilities were more likely to be under-staffed than government-owned facilities. Conclusions In Nanjing and Tianjin, private-sector homes were more likely to be understaffed, although their residents were sicker and frailer, on average, than those in government facilities. The case-mix differences are likely the result of selective admission policies that favor relatively healthier residents in government facilities than in private-sector homes. PMID:24433350

  11. The German Quality Network Sepsis: study protocol for the evaluation of a quality collaborative on decreasing sepsis-related mortality in a quasi-experimental difference-in-differences design.

    PubMed

    Schwarzkopf, Daniel; Rüddel, Hendrik; Gründling, Matthias; Putensen, Christian; Reinhart, Konrad

    2018-01-18

    While sepsis-related mortality decreased substantially in other developed countries, mortality of severe sepsis remained as high as 44% in Germany. A recent German cluster randomized trial was not able to improve guideline adherence and decrease sepsis-related mortality within the participating hospitals, partly based on lacking support by hospital management and lacking resources for documentation of prospective data. Thus, more pragmatic approaches are needed to improve quality of sepsis care in Germany. The primary objective of the study is to decrease sepsis-related hospital mortality within a quality collaborative relying on claims data. The German Quality Network Sepsis (GQNS) is a quality collaborative involving 75 hospitals. This study protocol describes the conduction and evaluation of the start-up period of the GQNS running from March 2016 to August 2018. Democratic structures assure participatory action, a study coordination bureau provides central support and resources, and local interdisciplinary quality improvement teams implement changes within the participating hospitals. Quarterly quality reports focusing on risk-adjusted hospital mortality in cases with sepsis based on claims data are provided. Hospitals committed to publish their individual risk-adjusted mortality compared to the German average. A complex risk-model is used to control for differences in patient-related risk factors. Hospitals are encouraged to implement a bundle of interventions, e.g., interdisciplinary case analyses, external peer-reviews, hospital-wide staff education, and implementation of rapid response teams. The effectiveness of the GQNS is evaluated in a quasi-experimental difference-in-differences design by comparing the change of hospital mortality of cases with sepsis with organ dysfunction from a retrospective baseline period (January 2014 to December 2015) and the intervention period (April 2016 to March 2018) between the participating hospitals and all other German

  12. Quality of health news disseminated in the print media in developing countries: a case study in Iran.

    PubMed

    Ashorkhani, Mahnaz; Gholami, Jaleh; Maleki, Katayoun; Nedjat, Sima; Mortazavi, Jalaledin; Majdzadeh, Reza

    2012-08-09

    Mass media play an important role in keeping people up-to-date with the latest health news. This study aims at investigating the quality of health news disseminated in the print media, its course of production and factors affecting its quality. In the quantitative section of the study, 410 health-related news items, published during a six-month span in the Iranian public press, underwent content analysis. In the qualitative section, focus group discussions were held with journalists, editors-in-chief and news gatekeepers. The quantitative phase showed that 18% of the news articles were not fit for dissemination in public. The qualitative phase illustrated that multiple factors at various levels affect the quality of news, namely poor knowledge, inadequate motivations and context-related barriers. The quality of health news reporting is not desirable. Educational interventions need to be carried out to raise awareness among researchers and journalists. Also, certain steps should be taken to increase motivations and strengthen infrastructures, including designing guidelines and monitoring news.

  13. Feedback using an ePortfolio for medicine long cases: quality not quantity.

    PubMed

    Bleasel, Jane; Burgess, Annette; Weeks, Ruth; Haq, Inam

    2016-10-21

    The evidence for the positive impact of an electronic Portfolio (ePortfolio) on feedback in medicine is mixed. An ePortfolio for medical long cases in a Graduate Medical Program was developed. The purpose of this study was to explore the perceptions of medical students and faculty of the impact of the ePortfolio on the feedback process. In total, 130 Year 3 medical students, and six faculty participated in the study. This is a mixed methods study, using a combination of both quantitative and qualitative approaches. Quantitative methods were used to quantify the number of long cases performed. Qualitative methods were used to explore the relationship between quantity and quality of feedback, and provide a rich understanding of both students' and faculty's experience and perceptions of the ePortfolio. Students received a variable quantity of feedback at each of the three studied clinical schools, with an average of between 4 - 5.4 feedback episodes per student. Feedback that was constructive, specific and timely and delivered by a senior academic was important. Quantity was not an essential factor, with two episodes of detailed feedback reported to be adequate. The barriers to the use of the ePortfolio were technical aspects of the platform that interfered with student engagement. Feedback using the ePortfolio for medical long cases is a valuable tool providing a senior clinician delivers detailed, constructive and personalized feedback in a timely fashion. The ePortfolio system needs to be user-friendly to engage students.

  14. Applying the CONSORT and STROBE statements to evaluate the reporting quality of neovascular age-related macular degeneration studies.

    PubMed

    Fung, Anne E; Palanki, Ram; Bakri, Sophie J; Depperschmidt, Eric; Gibson, Andrea

    2009-02-01

    To evaluate the quality of reporting in the neovascular age-related macular degeneration (nvAMD) literature by applying the Consolidated Standards for Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement writing standards. CONSORT and STROBE impact analysis; literature review. Phase III randomized controlled trials (RCTs) of verteporfin photodynamic therapy, pegaptanib, and ranibizumab, and interventional case studies of bevacizumab for nvAMD. A literature search identified eligible articles published before October 31, 2007. We assessed the report quality of Phase III RCTs using the CONSORT statement and case series publications using the STROBE statement, both with indicators relevant to nvAMD. Presence or absence of CONSORT or STROBE statement indicators. Seven publications of Phase III RCTs and 29 publications on bevacizumab interventional case studies for nvAMD met our inclusion criteria. Of 37 possible CONSORT writing guideline items, the mean report quality for RCTs was 30.6 (83%), with a range from 23 to 35 (65%-95%). Of 35 possible STROBE writing guideline items, the mean report quality grade for intravitreal bevacizumab case series was 23 (70%), with a range from 16 to 31 (46%-94%). Among the bevacizumab studies, more than 90% reported scientific background, drug dose and administration, baseline characteristics, unadjusted results, and adverse events. Fewer than 20% reported study size calculations, handling of missing data, or a discussion of bias. Since the adoption of the CONSORT standards by Ophthalmology and other journals in 1996, the reporting quality for RCTs has further improved among this cohort of nvAMD articles. On the other hand, no reporting standards for case series have existed until the recent publication of the STROBE statement. In this first application of the STROBE standards to ophthalmology, we found that the small interventional studies in our series had an average

  15. Assessing ecological water quality with macroinvertebrates and fish: a case study from a small Mediterranean river.

    PubMed

    Cheimonopoulou, Maria Th; Bobori, Dimitra C; Theocharopoulos, Ioannis; Lazaridou, Maria

    2011-02-01

    Biological elements, such as benthic macroinvertebrates and fish, have been used in assessing the ecological quality of rivers according to the requirements of the Water Framework Directive. However, the concurrent use of multiple organism groups provides a broader perspective for such evaluations, since each biological element may respond differently to certain environmental variables. In the present study, we assessed the ecological quality of a Greek river (RM4 type), during autumn 2003 and spring 2004 at 10 sites, with benthic macroinvertebrates and fish. Hydromorphological and physicochemical parameters, habitat structure, and riparian vegetation were also considered. Pollution sensitive macroinvertebrate taxa were more abundant at headwaters, which had good/excellent water quality according to the Hellenic Evaluation System (HES). The main river reaches possessed moderate water quality, while downstream sites were mainly characterised as having bad or poor water quality, dominated by pollution-tolerant macroinvertebrate taxa. Macroinvertebrates related strongly to local stressors as chemical degradation (ordination analysis CCA) and riparian quality impairment (bivariate analysis) while fish did not. Fish were absent from the severely impacted lower river reaches. Furthermore, external pathological signs were observed in fish caught at certain sites. A combined use of both macroinvertebrates and fish in biomonitoring programs is proposed for providing a safer assessment of local and regional habitat impairment.

  16. Case Numbers and Process Quality in Breast Surgery in Germany: A Retrospective Analysis of Over 150,000 Patients From 2013 to 2014.

    PubMed

    Köster, Christina; Heller, Günther; Wrede, Stephanie; König, Thomas; Handstein, Steffen; Szecsenyi, Joachim

    2015-08-31

    Numerous studies from around the world have shown a positive association between case numbers and the quality of medical care. The evidence to date suggests that conformity to guidelines for the treatment of patients with breast cancer is better in German hospitals that have higher case numbers. We used data obtained by an external program for quality assurance in inpatient care (externe stationäre Qualitätssicherung, esQS) for the years 2013 and 2014 to investigate seven process indicators in the area of breast surgery, including histologic confirmation of the diagnosis before definitive treatment, axillary dissection as recommended by the guidelines, and an appropriate temporal interval between diagnosis and operation. Case numbers were categorized with the aid of various threshold values. Moreover, subgroup analyses were carried out for patients under age 65, patients in good general health, patients without lymph-node involvement, and patients with a tumor size pT0 or pT1 or an overall tumor size less than 5 cm. Data on 153,475 patients from 939 hospitals were analyzed. Six of seven indicators had values that were better overall, to a statistically significant extent, in hospitals with higher case numbers. Although this relationship was not consistently seen, the worst results were generally found in the category with the lowest case numbers. Similar though less striking results were obtained in the subgroup analyses. An exception to the general finding was that, in hospitals with higher case numbers, the interval between diagnosis and operation was more often longer than three weeks. Guideline adherence is higher in hospitals that treat more cases. The present study does not address the question whether this, in turn, affects morbidity or mortality. To improve process quality in peripheral hospitals, the quality assurance program should be continued.

  17. Clinical aspects of foot health and their influence on quality of life among breast cancer survivors: a case-control study.

    PubMed

    Palomo-López, Patricia; Rodríguez-Sanz, David; Becerro-de-Bengoa-Vallejo, Ricardo; Losa-Iglesias, Marta Elena; Guerrero-Martín, Jorge; Calvo-Lobo, Cesar; López-López, Daniel

    2017-01-01

    The aim of this study was to analyze and compare foot health and general health in a sample of women divided into two groups: 1) those with breast cancer and undergoing chemotherapy treatment and 2) healthy women without breast cancer and with normalized reference values. A case-control observational study was performed. Two-hundred women with a mean age of 51.00±8.75 years were recruited from podiatric medicine and surgery clinics from the University of Extremadura (Plasencia, Spain) and the Hospital Infanta Cristina (Badajoz, Spain). The women were divided into case and control groups (undergoing chemotherapy treatment and healthy women, respectively). The Foot Health Status Questionnaire was used to assess foot health domain scores. Significant differences between both groups were seen for foot pain ( P =0.003), foot function ( P <0.001), physical activity ( P <0.001), social capacity ( P <0.001), and vigor ( P =0.001). The remaining domains (footwear, general health, and foot health) did not show significant differences between the two groups ( P ≥0.01). Women with breast cancer presented a lower foot health-related quality of life. Clinical aspects with emphasis on foot pain and disability were increased. Furthermore, physical activity, social capacity, and vigor were affected. Therefore, general health care and foot problem prevention for breast cancer survivors should be given more consideration.

  18. The Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality Demonstration: a descriptive overview.

    PubMed

    Reilly, Karen E; Mueller, Christine; Zimmerman, David R

    2007-01-01

    This paper presents the first comprehensive account of a major national demonstration designed to integrate skilled nursing facilities (SNF) prospective case-mix payment and quality of care. It describes the Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality (NHCMQ) Demonstration-the template for Medicare's SNF Prospective Payment System (PPS) implemented July 1998. The NHCMQ Demonstration provided the basis for one of the most significant changes in SNF reimbursement and quality monitoring policies to date. Prospective reimbursement policies created positive incentive for providers to admit Medicare residents under more equitable payment rates. However, controversy regarding unanticipated perverse provider incentives remains. The quality management system designed under the NHCMQDemonstration is currently used in over 17,000 nursing homes. Furthermore, under the NHCMQ Demonstration, one standardized assessment tool-the MDS-was used to assess a resident's clinical condition, to monitor quality, and to calculate provider reimbursement. Experiences from the NHCMQ Demonstration and continued evaluation of the current national PPS, along with state systems, provide a rich information source regarding prospective, case-mix reimbursement, and provider incentives.

  19. Exploring Issues of Quality of Service in a Next Generation Internet Testbed: A Case Study Using PathMaster

    PubMed Central

    Shifman, Mark A.; Sayward, Frederick G.; Mattie, Mark E.; Miller, Perry L.

    2002-01-01

    This case study describes a project that explores issues of quality of service (QoS) relevant to the next-generation Internet (NGI), using the PathMaster application in a testbed environment. PathMaster is a prototype computer system that analyzes digitized cell images from cytology specimens and compares those images against an image database, returning a ranked set of “similar” cell images from the database. To perform NGI testbed evaluations, we used a cluster of nine parallel computation workstations configured as three subclusters using Cisco routers. This architecture provides a local “simulated Internet” in which we explored the following QoS strategies: (1) first-in-first-out queuing, (2) priority queuing, (3) weighted fair queuing, (4) weighted random early detection, and (5) traffic shaping. The study describes the results of using these strategies with a distributed version of the PathMaster system in the presence of different amounts of competing network traffic and discusses certain of the issues that arise. The goal of the study is to help introduce NGI QoS issues to the Medical Informatics community and to use the PathMaster NGI testbed to illustrate concretely certain of the QoS issues that arise. PMID:12223501

  20. Playing the Literacy Game: A Case Study in Adult Education

    ERIC Educational Resources Information Center

    Kambouri, Maria; Thomas, Siobhan; Mellar, Harvey

    2006-01-01

    Runner is a high-quality educational game designed by the University for Industry (UfI/"learndirect") to attract young adults who find learning in formal educational contexts difficult. A case study evaluation of this novel application of an adventure game genre to literacy learning is discussed, based on observations and interviews in…

  1. Constructing Affective Security in Children: Case Study in Educational Environments

    ERIC Educational Resources Information Center

    Margenat, Montserrat; Dalmau, Mariona; Vendrell, Roser; Ibarz, Lidia

    2016-01-01

    In line with Bowlby's theoretical approach, where he established a relationship between the quality of experiences lived in the first relationships and subsequent behaviours, we are carrying out a case study research project. The objectives are as follows: (1) To describe interactive patterns as observed in natural contexts and focusing on the…

  2. [Assessment of biological sampling's quality in a medical laboratory: case of Côte d' Ivoire Institute Pasteur].

    PubMed

    Kouassi-M'Bengue, Alphonsine; Koffi, Stephane; Manizan, Pascale; Ouattara, Abdoulaye; N'Douba, Adele Kacou; Dosso, Mireille

    2008-01-01

    Assurance quality is important in medical laboratory, but in Africa, few laboratories are involved in this process. The aim of this study was to assess biological sampling's quality in a bacteriological laboratory. A cross sectional study was undertaken in medical bacteriological laboratory of Côte d' Ivoire Institute Pasteur during 6 months. All urines, saddles, and bronchial expectorations collected from ambulatory patients during this period were included in the study. The quality of urine's, saddles and bronchial expectorations' sampling for a bacteriological analysis was evaluated. An interview based on Guidelines of good laboratories practices and referential ISO 15189 was used. A total of 300 samples were indexed. On a total of 300 recorded biological samples, 224 (74.7%) were not in conformity. In 87.5% of the cases of nonconformities, an antibiotic's treatment were preliminary instituted before the sampling. Corrective actions were carried in the laboratory on 30 samples with 56.6% for the urines, 26.7% for the saddles and 16.7% for the bronchial expectorations. At the end of this study, it arises that the quality of the biological sampling received at the medical bacteriology laboratory need to be improved.

  3. Giving Effect to Quality Audit Recommendations: A Case Study from an Organisational Culture Perspective

    ERIC Educational Resources Information Center

    Boswell, Martin

    2015-01-01

    This article summarises the results of a study of the effects of quality audit at an institution over time. The findings from four academic audit reports, prepared for one New Zealand university between 1996 and 2009, yielded a large dataset. Once grouped thematically for analysis, the data were analysed in terms of how well the institution…

  4. Perceptions of the Quality of School Life: A Case Study of Schools and Students.

    ERIC Educational Resources Information Center

    Batten, Margaret; Girling-Butcher, Sue

    In order to test the validity of a measure of Australian students' views on the quality of life within their schools, a small-scale study was conducted in seven secondary schools, including both public and private institutions. The 52-item survey instrument was administered to 651 students in grades 9-12. Followup interviews of students were held…

  5. Quality of health news disseminated in the print media in developing countries: a case study in Iran

    PubMed Central

    2012-01-01

    Background Mass media play an important role in keeping people up-to-date with the latest health news. This study aims at investigating the quality of health news disseminated in the print media, its course of production and factors affecting its quality. Methods In the quantitative section of the study, 410 health-related news items, published during a six-month span in the Iranian public press, underwent content analysis. In the qualitative section, focus group discussions were held with journalists, editors-in-chief and news gatekeepers. Results The quantitative phase showed that 18% of the news articles were not fit for dissemination in public. The qualitative phase illustrated that multiple factors at various levels affect the quality of news, namely poor knowledge, inadequate motivations and context-related barriers. Conclusions The quality of health news reporting is not desirable. Educational interventions need to be carried out to raise awareness among researchers and journalists. Also, certain steps should be taken to increase motivations and strengthen infrastructures, including designing guidelines and monitoring news. PMID:22873836

  6. Searching for a business case for quality in Medicaid managed care.

    PubMed

    Greene, Sandra B; Reiter, Kristin L; Kilpatrick, Kerry E; Leatherman, Sheila; Somers, Stephen A; Hamblin, Allison

    2008-01-01

    Despite the prevalence of evidence-based interventions to improve quality in health care systems, there is a paucity of documented evidence of a financial return on investment (ROI) for these interventions from the perspective of the investing entity. To report on a demonstration project designed to measure the business case for selected quality interventions in high-risk high-cost patient populations in 10 Medicaid managed care organizations across the United States. Using claims and enrollment data gathered over a 3-year period and data on the costs of designing, implementing, and operating the interventions, ROIs were computed for 11 discrete evidence-based quality-enhancing interventions. A complex case management program to treat adults with multiple comorbidities achieved the largest ROI of 12.21:1. This was followed by an ROI of 6.35:1 for a program which treated children with asthma with a history of high emergency room (ER) use and/or inpatient admissions for their disease. An intervention for high-risk pregnant mothers produced a 1.26:1 ROI, and a program for adult patients with diabetes resulted in a 1.16:1 return. The remaining seven interventions failed to show positive returns, although four sites came close to realizing sufficient savings to offset investment costs. Evidence-based interventions designed to improve the quality of patient care may have the best opportunity to yield a positive financial return if it is focused on high-risk high-cost populations and conditions associated with avoidable emergency and inpatient utilization. Developing the necessary tracking systems for the claims and financial investments is critical to perform accurate financial ROI analyses.

  7. Quality assurance in transnational higher education: a case study of the tropEd network

    PubMed Central

    2013-01-01

    Introduction Transnational or cross-border higher education has rapidly expanded since the 1980s. Together with that expansion issues on quality assurance came to the forefront. This article aims to identify key issues regarding quality assurance of transnational higher education and discusses the quality assurance of the tropEd Network for International Health in Higher Education in relation to these key issues. Methods Literature review and review of documents. Results From the literature the following key issues regarding transnational quality assurance were identified and explored: comparability of quality assurance frameworks, true collaboration versus erosion of national education sovereignty, accreditation agencies and transparency. The tropEd network developed a transnational quality assurance framework for the network. The network accredits modules through a rigorous process which has been accepted by major stakeholders. This process was a participatory learning process and at the same time the process worked positive for the relations between the institutions. Discussion The development of the quality assurance framework and the process provides a potential example for others. PMID:23537108

  8. Case Study Teaching

    ERIC Educational Resources Information Center

    Herreid, Clyde Freeman

    2011-01-01

    This chapter describes the history of case study teaching, types of cases, and experimental data supporting their effectiveness. It also describes a model for comparing the efficacy of the various case study methods. (Contains 1 figure.)

  9. Assessment of water quality: a case study of the Seybouse River (North East of Algeria)

    NASA Astrophysics Data System (ADS)

    Guettaf, M.; Maoui, A.; Ihdene, Z.

    2017-03-01

    The assessment of water quality has been carried out to determine the concentrations of different ions present in the surface waters. The Seybouse River constitutes a dump of industrial and domestic rejections which contribute to the degradation of water quality. A total of 48 surface water samples were collected from different stations. The first objective of this study is the use of water quality index (WQI) to evaluate the state of the water in this river. The second aim is to calculate the parameters of the quality of water destined for irrigation such as sodium adsorption ratio , sodium percentage, and residual sodium carbonate. A high mineralization and high concentration of major chemical elements and nutrients indicate inevitably a high value of WQI index. The mean value of electrical conductivity is about 945.25 µs/cm in the station 2 (Bouhamdane) and exceeds 1,400 µs/cm in station 12 of Nador. The concentration of sulfates is above 250 mg/l in the stations 8 (Zimba) and 11 (Helia). A concentration of orthophosphate over 2 mg/l was observed in the station 11. The comparison of the obtained and the WHO standards indicates a before using it use in agricultural purposes.

  10. Management Science in Higher Education Institutions: Case Studies from Greece

    ERIC Educational Resources Information Center

    Saiti, Anna

    2010-01-01

    Regardless of the source of funding, university quality is based on knowledge, teaching, and research, and hence cannot be run like private enterprises as they are expert organisations that provide solely a public service. The purpose of this paper is to investigate, through the analysis of case studies, whether or not management theory,…

  11. Educational Innovation from Distributed Leadership: Case Study Spanish Public School

    ERIC Educational Resources Information Center

    García, Ingrid

    2017-01-01

    The purpose of the communication is to present a case study of distributed leadership practices and the performances of the Principal of a public school in Madrid. Educational leadership can be considered one of the most important elements of the education system to be effective, achieve quality results, and develop processes of change and…

  12. Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study

    PubMed Central

    Greenhalgh, Trisha; Russell, Jill; Myall, Michelle

    2011-01-01

    Objective To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Design Ethnographic case study. Setting Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. Participants 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Main outcome measures Potential threats to patient safety and characteristics of good practice. Methods Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as “exceptions” by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge

  13. Sensory modulation and sleep quality among adults with learning disabilities: a quasi-experimental case-control design study.

    PubMed

    Sharfi, Kineret; Rosenblum, Sara

    2015-01-01

    Following the International Classification of Functioning, Disability and Health (ICF) concepts, this study examines body functions such as sensory modulation and sleep quality among adults with learning disabilities (LD). One hundred and ten participants, 55 adults with LD and 55 matched controls (mean age 30 years) filled in a socio-demographic questionnaire, the Adults/Adolescents Sensory Profile (AASP), and the Mini Sleep Questionnaire (MSQ). Chi-tests, Mann-Whitney tests, and Kolmogorov-Smirnov tests were conducted to examine group differences related to socio-demographic characteristics and body functions. Correlation and regression analyses were conducted to examine relationships between body functions. Significant differences were found between the groups in: (a) unique socio-demographic variables: high-schools attended, family status and number of children; (b) body functions: low registration and sensory sensitivity (p < .001), sensory avoiding (p = .002), sensory seeking (p = .021) and sleep quality (p < .001). Significant correlations were found between AASP subscale scores and the MSQ final score in each group. Regression analysis revealed that for the entire sample (N = 108), low registration accounted for 10.2% of the variance of sleep quality above group membership (p < .001), while in a separate examination of adults with LD (n = 53), low registration accounted for 19.9% of the variance of sleep quality (p < .001). Adults with LD need to be studied through a health-related perspective such as the ICF model to gain further understanding of their unique characteristics and daily needs. Sensory and sleep functions of adults with LD should be further studied in the context of health related quality of life.

  14. Incidence of Temperature Inversion and their Impact on Air Quality: A Case Study of Delhi

    NASA Astrophysics Data System (ADS)

    Singh, V. P.

    2016-12-01

    In troposphere, an increase in temperature with the altitude produces stable atmosphere which prohibits the air pollutants dispersion. This study investigates the phenomenon of temperature inversion (TI), Lapse rate (LR) and its effects on air quality in respect of Ozone (O3), CO2, CO & PM2.5 over a megacity- Delhi (Study Time Period: 2006-2012). Because of huge population, urban sprawl and orographic location, this study can be very helpful for Delhi and cities like Delhi. Radiosonde observations for temperature was used for TI calculations over the region. Results indicate that TI generally occurs at 975-850 hPa. Also, the maximum number of inversions occur during winter months (December and January) especially at night time and early mornings. Furthermore, during winter months, the incidence of inversion is highest at both 00UTC and 12UTC while it is least during the monsoon months (July and August) at 00UTC. The LR is maximum in terms of magnitude (i.e. highly negative) during the summer months (May & June) every year indicating the strong heating effects that takes place during the day time in summer and also because the sensible heat flux from the surface to the atmosphere is significant even at 12UTC (i.e. around 5.30 P.M.) The bivariate correlation analysis for air quality variables reveals negative relationship of all air quality variables except O3 with rainfall. A positive relationship of LR with all air quality variables, except O3, was observed indicating the increase in pollutants' concentrations with an increase in LR. The correlation coefficient between LR and air pollutants CO, NO, NO2, PM2.5 were found to be 0.463, 0.346, 0.249 and 0.673 respectively. A negative correlation was found between wind speed and most of the air pollutants. Also, significantly, O3 had been the only air pollutant having a negative relationship with LR (both at 00UTC &12UTC).

  15. [The case-case-time-control study design].

    PubMed

    Wang, Jing; Zhuo, Lin; Zhan, Siyan

    2014-12-01

    Although the 'self-matched case-only studies' (such as the case-cross-over or self-controlled case-series method) can control the time-invariant confounders (measured or unmeasured) through design of the study, however, they can not control those confounders that vary with time. A bidirectional case-crossover design can be used to adjust the exposure-time trends. In the areas of pharmaco-epidemiology, illness often influence the future use of medications, making a bidirectional study design problematic. Suissa's case-time-control design combines the case-crossover and the case-control design which could adjust for exposure-trend bias, but the control group may reintroduce selection bias, if the matching does not go well. We propose a "case-case-time-control" design which is an extension of the case-time-control design. However, rather than using a sample of external controls, we choose those future cases as controls for current cases to counter the bias that arising from temporal trends caused by exposure to the target of interest. In the end of this article we will discuss the strength and limitations of this design based on an applied example.

  16. Indoor air quality during renovation actions: a case study.

    PubMed

    Abdel Hameed, A A; Yasser, I H; Khoder, I M

    2004-09-01

    A temporary renovation activity releases considerably high concentrations of particulate matter, viable and non-viable, into air. These pollutants are a potential contributor to unacceptable indoor air quality (IAQ). Particulate matter and its constituents lead, sulfate, nitrate, chloride, ammonium and fungi as well as fungal spores in air were evaluated in a building during renovation action. Suspended dust was recorded at a mean value of 6.1 mg m(-3) which exceeded the Egyptian limit values for indoor air (0.15 mg m(-3)) and occupational environments (5 mg m(-3)). The highest particle frequency (23%) of aerodynamic diameter (dae) was 1.7 microm. Particulate sulfate (SO(4)(2-)), nitrate (NO(3)(-)), chloride (Cl(-)), ammonium (NH(4)(+)) and lead components of suspended dust averaged 2960, 28, 1350, 100 and 13.3 microg m(-3), respectively. Viable fungi associated with suspended dust and that in air averaged 1.11 x 10(6) colony forming unit per gram (cfu g(-1)) and 92 colony forming unit per plate per hour (cfu p(-1) h(-1)), respectively. Cladosporium(33%), Aspergillus(25.6%), Alternaria(11.2%) and Penicillium(6.6%) were the most frequent fungal genera in air, whereas Aspergillus(56.8%), Penicillium(10.3%) and Eurotium(10.3%) were the most common fungal genera associated with suspended dust. The detection of Aureobasidium, Epicoccum, Exophiala, Paecilomyces, Scopulariopsis, Ulocladium and Trichoderma is an indication of moisture-damaged building materials. Alternaria, Aureobasidium, Cladosporium, Scopulariopsis and Nigrospora have dae > 5 microm whereas Aspergillus, Penicillium and Verticillium have dae < 5 microm which are suited to penetrate deeply into lungs. Particulate matter from the working area infiltrates the occupied zones if precautionary measures are inadequate. This may cause deterioration of IAQ, discomfort and acute health problems. Renovation should be carefully designed and managed, in order to minimize degradation of the indoor and outdoor air

  17. Assessment of quality and relevance of curricula development in health training institutions: a case study of Kenya.

    PubMed

    Mumbo, Hazel M; Kinaro, Joyce W

    2015-08-13

    The World Health Organization lists Kenya among African countries experiencing health workforce crisis catalysed through immigration, underproduction, inconsistent quality of production and unequal distribution. Strengthening health training institutions to increase production of high-quality health workers is acknowledged as a measure to mitigate the crisis.IntraHealth International's USAID-funded FUNZOKenya Project (2012-2017) undertook an assessment to identify the bottlenecks to increasing the number and quality of pre-service graduates in Kenya. The assessment, a cross-sectional descriptive study, collected data through structured respondent interviews among faculty, students in health training institutions, key informants and desk review. The assessment purposively selected 14 institutions from 18 institutions identified for initial collaboration with the project towards strengthening health workforce training. The statistical package for social sciences (SPSS) application helped analyse quantitative data and quotes used to illustrate perceptions on the quality of curricula.The findings revealed major gaps in quality and adequacy of curricula in the training institutions. A national standard framework to guide curricula review process is lacking. Further, curricula did not adequately prepare students for clinical placement, as most failed to directly respond to national health needs. The study recommended reviews of curricula to ensure their responsiveness to emerging issues in the health sector, the formation of curriculum committees to review curricula, development of official curricula review standards and an integrated mechanism to disseminate policies and guidelines.

  18. Making a business case for small medical practices to maintain quality while addressing racial healthcare disparities.

    PubMed

    Dunston, Frances J; Eisenberg, Andrew C; Lewis, Evelyn L; Montgomery, John M; Ramos, Diana; Elster, Arthur

    2008-11-01

    Various reports have documented variations in quality of care that occur among racial and ethnic populations, even after accounting for socioeconomic factors and health insurance status. Although quality improvement initiatives are often touted as the answer to healthcare disparities, researchers have questioned whether a business case exists that supports this notion. We assess various barriers and incentives for using quality improvement to address racial and ethnic healthcare disparities in small-to-medium-sized practices. We believe that although both indirect and direct cost incentives may exist, a favorable business case for small private practices cannot be made unless there are additional financial incentives. The business community can work with health plans to provide these incentives.

  19. Dance Talent Development: Case Studies of Successful Dancers in Finland and Singapore

    ERIC Educational Resources Information Center

    Chua, Joey

    2014-01-01

    Though anchored in cross-cultural comparisons, this study aims to identify the key factors that impacted the talent development of successful dancers from childhood through adulthood. Case studies of eight Finnish and Singaporean ballet and contemporary dancers exemplify the qualities of successful dancers in terms of their career achievements and…

  20. Intrapartum electrocardiogram alteration in fetuses with congenital heart disease: a case-control study.

    PubMed

    Gay, Estelle; Bornallet, Géraldine; Gaucherand, Pascal; Doret, Muriel

    2015-11-01

    To assess if the fetal electrocardiogram especially ST segment is modified by congenital heart diseases: modifications in frequencies of the different ST events and modifications in signal quality. A retrospective case-control study, comparing frequencies of the different ST events and the quality of the signal between fetuses with congenital heart diseases and fetuses without congenital heart disease. From 2000 to 2011, fifty-eight fetuses with congenital heart disease had their heart rate recording using a STAN device during labor. Control group was fetuses who were born just before a case and had a STAN as a second line for intrapartum surveillance. Cases and controls were matched on parity, gestational age at birth, presence of growth restriction and umbilical artery pH. Frequencies of the different ST event and quality of the signal were first analyzed for the global labor recording, and then separately for the first and the second phase of labor. No statistically significant difference in ST event frequencies between fetuses with congenital heart disease and the control group was found. Regarding the quality of the signal, 11.49% (±18.82) of recording time is a signal loss for fetus with congenital heart disease whereas only 5.18% (±10.67) for the control group (p=0.028). This is the first study investigating for intrapartum electrocardiogram modification in fetus with congenital heart disease. Congenital heart diseases do not modify frequencies of ST events. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Quality of life among residents in a sub-urban area. Case study: Puncak Alam, Selangor, Malaysia.

    NASA Astrophysics Data System (ADS)

    Leh, Oliver Ling Hoon; Mahbot, Norseha Mohd; Asma Aqmalina Hadzaman, Nur; Azyyati Marzukhi, Marlyana; Abdullah, Jamalunlaili

    2018-02-01

    Along with the sub-urbanisation, people working in urban can stay in the sub-urban areas. Sub-urban housing areas provide cheaper and larger houses and more greenery environment. However, the residents are required to travel in longer distance. The effect on Quality of Life (QOL) due to the migration to sub-urban areas may not be positive even with the better environmental quality and lower direct housing cost. Puncak Alam, a new sub-urban area in Selangor, Malaysia had been chosen as the study area to examine the change of QOL among the residents after they moved into the study area. Through a questionnaire survey, the satisfaction of residents on the various aspects/indicators of QOL were examined. Through the statistical analysis, it is found that slightly more than half of the respondents felt that the QOL was dropped after they were moved to the study area. The sub-urban area did provide better quality for their residents. It had increased respondents’ satisfaction on most of the indicators in the aspects of economic, social and physical. However, due to the decreasing of satisfaction in job opportunities, family life, social activities, safety, and transportation system, most of the respondents were felt that their QOL were dropped.

  2. Overall quality of life and difficulty paying for ostomy supplies in the Veterans Affairs ostomy health-related quality of life study: an exploratory analysis.

    PubMed

    Coons, Stephen Joel; Chongpison, Yuda; Wendel, Christopher S; Grant, Marcia; Krouse, Robert S

    2007-09-01

    To explore whether there was a significant relationship between difficulty paying for ostomy supplies and overall quality of life among a sample of ostomates receiving care from the Veterans Health Administration (VHA). The data were collected as part of the Veterans Affairs (VA) Ostomy Health-Related Quality of Life Study, in which 511 respondents (239 cases, 272 controls) completed a survey instrument that included the modified City of Hope Quality of Life (mCOH-QOL) Ostomy questionnaire, SF-36V, and sociodemographic items. Responses from the 239 cases (ie, patients with intestinal stomas) were used in this analysis. The modified City of Hope Quality of Life Ostomy questionnaire item, "How good is your overall quality of life?," was the dependent variable for this analysis. The primary independent variable was the response (yes/no) to the item, "If you pay for any of the (ostomy) costs, is it difficult for you?" A hierarchical regression model was used to examine whether difficulty paying was significantly related to overall quality of life after adjusting for age, income, race/ethnicity, and physical health. After accounting for the proportion of variance explained by age, income, race/ethnicity, and physical health, the additional proportion of variance explained by difficulty paying was statistically significant. Individuals reporting difficulty paying had a roughly 1 point lower (ie, beta-coefficient = -1.052; SE = 0.481) overall quality of life score on the 11-point scale. We found a significant association between difficulty paying for ostomy supplies and overall quality of life. Although the cross-sectional study design does not allow causal inference, the results suggest a relationship that merits further examination.

  3. Indoor environmental quality (IEQ) of school classrooms: Case study in Malaysia

    NASA Astrophysics Data System (ADS)

    Samad, Muna Hanim Abdul; Aziz, Zalena Abdul; Isa, Mohd Hafizal Mohd

    2017-10-01

    Thermal Comfort is one of the key criteria for occupants' comfort and productivity in a building. In schools, it is vital for a conduciveness for teaching and learning environment. Thermal comfort is dependent on air temperature, humidity, radiation, internal lighting, air movement, activities, clothing and climatic change and is part of the Indoor Environmental Quality (IEQ) components which have has significant effects on occupants. The main concern over energy and running cost has meant that most public schools in Malaysia are designed for natural ventilation and not air-conditioning. The building envelope plays a significant role in reducing the radiant heat and keeps the interior cooler than the outdoor temperature for acceptable thermal comfort level. The requirement of Industrial Building System (IBS) as the envelope system for school building in Malaysia could affect the role of envelope as a climate moderator. This paper is based on a research conducted on two schools in Malaysia of varied construction materials as the building envelopes to ascertain the thermal comfort level of the classrooms. Elements of IEQ such as air temperature, air movement, daylighting and noise level were taken of various classrooms to fulfill the required objectives of determining the level of quality. The data collected and analysed from the study shows that in terms of air temperature which range from 28°C to 34.5°C, the schools do not achieve the recommended comfort level for tropical climate. As for daylighting element, results also show that some classrooms suffered with too much glare whilst others had insufficient daylighting. The findings also show the unsatisfactory level of air movement in the classrooms as well as an unacceptable noise level exceeding the allowable threshold. This research also concluded that the use of materials and orientation in the school design are the major determinant factors towards good IEQ levels in school buildings.

  4. Decision Maker Perception of Information Quality: A Case Study of Military Command and Control

    ERIC Educational Resources Information Center

    Morgan, Grayson B.

    2013-01-01

    Decision maker perception of information quality cues from an "information system" (IS) and the process which creates such meta cueing, or data about cues, is a critical yet un-modeled component of "situation awareness" (SA). Examples of common information quality meta cueing for quality criteria include custom ring-tones for…

  5. Meeting EFA: Bangladesh Rural Advancement Committee (BRAC) Primary Schools. Case Study

    ERIC Educational Resources Information Center

    Chaboux, Collette

    2006-01-01

    This case study describes the Bangladesh Rural Advancement Committee (BRAC), which was formed to explore ways to help children from its rural development program gain access to improved education. Working mainly in rural areas, BRAC focused on improved quality through improved education service delivery, management detail, and finance. While…

  6. Rice Grain Quality and Consumer Preferences: A Case Study of Two Rural Towns in the Philippines

    PubMed Central

    Velarde, Orlee; Demont, Matty

    2016-01-01

    Hedonic pricing analysis is conducted to determine the implicit values of various attributes in the market value of a good. In this study, hedonic pricing analysis was applied to measure the contribution of grain quality search and experience attributes to the price of rice in two rural towns in the Philippines. Rice samples from respondents underwent quantitative routine assessments of grain quality. In particular, gelatinization temperature and chalkiness, two parameters that are normally assessed through visual scores, were evaluated by purely quantitative means (differential scanning calorimetry and by digital image analysis). Results indicate that rice consumed by respondents had mainly similar physical and chemical grain quality attributes. The respondents’ revealed preferences were typical of what has been previously reported for Filipino rice consumers. Hedonic regression analyses showed that grain quality characteristics that affected price varied by income class. Some of the traits or socioeconomic factors that affected price were percent broken grains, gel consistency, and household per capita rice consumption. There is an income effect on rice price and the characteristics that affect price vary between income classes. PMID:26982587

  7. Rice Grain Quality and Consumer Preferences: A Case Study of Two Rural Towns in the Philippines.

    PubMed

    Cuevas, Rosa Paula; Pede, Valerien O; McKinley, Justin; Velarde, Orlee; Demont, Matty

    2016-01-01

    Hedonic pricing analysis is conducted to determine the implicit values of various attributes in the market value of a good. In this study, hedonic pricing analysis was applied to measure the contribution of grain quality search and experience attributes to the price of rice in two rural towns in the Philippines. Rice samples from respondents underwent quantitative routine assessments of grain quality. In particular, gelatinization temperature and chalkiness, two parameters that are normally assessed through visual scores, were evaluated by purely quantitative means (differential scanning calorimetry and by digital image analysis). Results indicate that rice consumed by respondents had mainly similar physical and chemical grain quality attributes. The respondents' revealed preferences were typical of what has been previously reported for Filipino rice consumers. Hedonic regression analyses showed that grain quality characteristics that affected price varied by income class. Some of the traits or socioeconomic factors that affected price were percent broken grains, gel consistency, and household per capita rice consumption. There is an income effect on rice price and the characteristics that affect price vary between income classes.

  8. Study on a pattern classification method of soil quality based on simplified learning sample dataset

    USGS Publications Warehouse

    Zhang, Jiahua; Liu, S.; Hu, Y.; Tian, Y.

    2011-01-01

    Based on the massive soil information in current soil quality grade evaluation, this paper constructed an intelligent classification approach of soil quality grade depending on classical sampling techniques and disordered multiclassification Logistic regression model. As a case study to determine the learning sample capacity under certain confidence level and estimation accuracy, and use c-means algorithm to automatically extract the simplified learning sample dataset from the cultivated soil quality grade evaluation database for the study area, Long chuan county in Guangdong province, a disordered Logistic classifier model was then built and the calculation analysis steps of soil quality grade intelligent classification were given. The result indicated that the soil quality grade can be effectively learned and predicted by the extracted simplified dataset through this method, which changed the traditional method for soil quality grade evaluation. ?? 2011 IEEE.

  9. Telepractice for Pediatric Dysphagia: A Case Study

    PubMed Central

    Malandraki, Georgia A.; Roth, Melissa; Sheppard, Justine Joan

    2014-01-01

    A closed-ended intensive pediatric swallowing telepractice program was developed and piloted in one pediatric patient with Opitz BBB/G and Asperger’s Syndromes, oropharyngeal dysphagia and aerophagia. The present study is a case report. Outcome variables included behavioral, swallowing and quality of life variables, and were assessed at baseline and at the end of the four-week program. Selective variables were also assessed at a follow-up family interview four weeks post program completion. Over the four-week intervention period, the patient demonstrated substantial improvements in: oral acceptance of eating-related objects and a variety of foods (behavioral variable), timing of voluntary saliva swallows and aerophagia levels (swallowing variables) and quality of life. Follow-up interview analysis showed that most skills were retained or improved one-month post intervention. This intensive telepractice program proved to be feasible and effective for this pediatric patient with dysphagia. PMID:25945217

  10. Transformational change in healthcare: an examination of four case studies.

    PubMed

    Charlesworth, Kate; Jamieson, Maggie; Davey, Rachel; Butler, Colin D

    2016-04-01

    Objectives Healthcare leaders around the world are calling for radical, transformational change of our health and care systems. This will be a difficult and complex task. In this article, we examine case studies in which transformational change has been achieved, and seek to learn from these experiences. Methods We used the case study method to investigate examples of transformational change in healthcare. The case studies were identified from preliminary doctoral research into the transition towards future sustainable health and social care systems. Evidence was collected from multiple sources, key features of each case study were displayed in a matrix and thematic analysis was conducted. The results are presented in narrative form. Results Four case studies were selected: two from the US, one from Australia and one from the UK. The notable features are discussed for each case study. There were many common factors: a well communicated vision, innovative redesign, extensive consultation and engagement with staff and patients, performance management, automated information management and high-quality leadership. Conclusions Although there were some notable differences between the case studies, overall the characteristics of success were similar and collectively provide a blueprint for transformational change in healthcare. What is known about the topic? Healthcare leaders around the world are calling for radical redesign of our systems in order to meet the challenges of modern society. What does this paper add? There are some remarkable examples of transformational change in healthcare. The key factors in success are similar across the case studies. What are the implications for practitioners? Collectively, these key factors can guide future attempts at transformational change in healthcare.

  11. Exploring Adult Basic Education--Quality Services with Limited Funding: Qualitative Multiple Case Study

    ERIC Educational Resources Information Center

    Calaf, Dolores C.

    2017-01-01

    English for Speakers of Other Languages (ESOL) classes are in great demand by immigrant adults in the Boston area. The problem investigated in this study was the limited funding to implement ESOL programs in Boston, which has resulted in waiting lists for many contracted community-based programs. The purpose of this qualitative multiple case study…

  12. Evolution of physician-hospital alignment models: a case study of comanagement.

    PubMed

    Sowers, Kevin W; Newman, Paul R; Langdon, Jeffrey C

    2013-06-01

    Recently, quality, financial, and regulatory demands have driven physicians to seek alignment opportunities with hospitals. The motivation for alignment on the part of physicians and hospitals is now accelerating because the new paradigm under healthcare reform requires an increased focus on improving quality, cost, and efficiency. We (1) identify the key drivers for physician-hospital alignment models; (2) summarize comanagement as a physician-hospital alignment model; and (3) explore a detailed case study of comanagement as an option to better align physicians with hospital goals on quality, safety, and outcomes. A Medline abstract review was performed that identified 45 references that discuss options for physician-hospital alignment. None of the articles identified provide a detailed example of successful alignment structures. A detailed case study of a successful comanagement alignment program is reviewed. The key drivers for alignment are inpatient growth rates, declining reimbursements, and the opportunity to improve quality, decrease costs, and increase efficiency. Two general strategies of alignment involve noneconomic and/or economic integration. In our example, comanagement with economic integration was chosen as the preferred structure for physician-hospital alignment. The choice of structure will vary depending on the existing relationships and governance of the hospital and the physicians in the targeted area of focus. The measure of success in building physician-hospital alignment is measured in improvements in care for the patient, reduced cost of care delivery, and improved relations between physicians and hospital leadership.

  13. Six Sigma Approach to Improve Stripping Quality of Automotive Electronics Component – a case study

    NASA Astrophysics Data System (ADS)

    Razali, Noraini Mohd; Murni Mohamad Kadri, Siti; Con Ee, Toh

    2018-03-01

    Lacking of problem solving skill techniques and cooperation between support groups are the two obstacles that always been faced in actual production line. Inadequate detail analysis and inappropriate technique in solving the problem may cause the repeating issues which may give impact to the organization performance. This study utilizes a well-structured six sigma DMAIC with combination of other problem solving tools to solve product quality problem in manufacturing of automotive electronics component. The study is concentrated at the stripping process, a critical process steps with highest rejection rate that contribute to the scrap and rework performance. The detail analysis is conducted in the analysis phase to identify the actual root cause of the problem. Then several improvement activities are implemented and the results show that the rejection rate due to stripping defect decrease tremendously and the process capability index improved from 0.75 to 1.67. This results prove that the six sigma approach used to tackle the quality problem is substantially effective.

  14. Data collection automation and total quality management: case studies in the health-service industry.

    PubMed

    Smith, Alan D; Offodile, O Felix

    2008-01-01

    The limitations, immeasurable, and seemly unquantifiable aspects of the healthcare service industry, make it imperative that quality assurance programs include total quality management (TQM) and automatic identification and data capture (AIDC)-related technologies. Most of standards used in TQM and AIDC require data, to measure improvement and achieve standardization. Major difference between managing a service firm and managing a product-manufacturing firm is the difficulty of achieving consistently high quality. Examination of two different healthcare service providers in the Pittsburgh, Pennsylvania area offers different views as to the implementation and practice of total quality management techniques and AIDC integration. Since the healthcare service industry must take into account its high customization needs, there are positive steps to make the hospital structure itself more patient friendly and quality related; hence improving its heath-marketing strategies to the general public.

  15. Improving spinach quality and reducing energy costs by retrofitting retail open refrigerated cases with doors

    USDA-ARS?s Scientific Manuscript database

    The prevalence of open-refrigerated display cases is ubiquitous in retail supermarkets, even in the face of the non-uniform temperature conditions present in these cases that may affect the quality and safety of the stored products. In this paper, the temperature variations ('T) of packaged ready-t...

  16. Fuel quality processing study, volume 1

    NASA Astrophysics Data System (ADS)

    Ohara, J. B.; Bela, A.; Jentz, N. E.; Syverson, H. T.; Klumpe, H. W.; Kessler, R. E.; Kotzot, H. T.; Loran, B. L.

    1981-04-01

    A fuel quality processing study to provide a data base for an intelligent tradeoff between advanced turbine technology and liquid fuel quality, and also, to guide the development of specifications of future synthetic fuels anticipated for use in the time period 1985 to 2000 is given. Four technical performance tests are discussed: on-site pretreating, existing refineries to upgrade fuels, new refineries to upgrade fuels, and data evaluation. The base case refinery is a modern Midwest refinery processing 200,000 BPD of a 60/40 domestic/import petroleum crude mix. The synthetic crudes used for upgrading to marketable products and turbine fuel are shale oil and coal liquids. Of these syncrudes, 50,000 BPD are processed in the existing petroleum refinery, requiring additional process units and reducing petroleum feed, and in a new refinery designed for processing each syncrude to produce gasoline, distillate fuels, resid fuels, and turbine fuel, JPGs and coke. An extensive collection of synfuel properties and upgrading data was prepared for the application of a linear program model to investigate the most economical production slate meeting petroleum product specifications and turbine fuels of various quality grades. Technical and economic projections were developed for 36 scenarios, based on 4 different crude feeds to either modified existing or new refineries operated in 2 different modes to produce 7 differing grades of turbine fuels. A required product selling price of turbine fuel for each processing route was calculated. Procedures and projected economics were developed for on-site treatment of turbine fuel to meet limitations of impurities and emission of pollutants.

  17. Fuel quality processing study, volume 1

    NASA Technical Reports Server (NTRS)

    Ohara, J. B.; Bela, A.; Jentz, N. E.; Syverson, H. T.; Klumpe, H. W.; Kessler, R. E.; Kotzot, H. T.; Loran, B. L.

    1981-01-01

    A fuel quality processing study to provide a data base for an intelligent tradeoff between advanced turbine technology and liquid fuel quality, and also, to guide the development of specifications of future synthetic fuels anticipated for use in the time period 1985 to 2000 is given. Four technical performance tests are discussed: on-site pretreating, existing refineries to upgrade fuels, new refineries to upgrade fuels, and data evaluation. The base case refinery is a modern Midwest refinery processing 200,000 BPD of a 60/40 domestic/import petroleum crude mix. The synthetic crudes used for upgrading to marketable products and turbine fuel are shale oil and coal liquids. Of these syncrudes, 50,000 BPD are processed in the existing petroleum refinery, requiring additional process units and reducing petroleum feed, and in a new refinery designed for processing each syncrude to produce gasoline, distillate fuels, resid fuels, and turbine fuel, JPGs and coke. An extensive collection of synfuel properties and upgrading data was prepared for the application of a linear program model to investigate the most economical production slate meeting petroleum product specifications and turbine fuels of various quality grades. Technical and economic projections were developed for 36 scenarios, based on 4 different crude feeds to either modified existing or new refineries operated in 2 different modes to produce 7 differing grades of turbine fuels. A required product selling price of turbine fuel for each processing route was calculated. Procedures and projected economics were developed for on-site treatment of turbine fuel to meet limitations of impurities and emission of pollutants.

  18. [Case and studies].

    PubMed

    Schubert, András

    2015-11-15

    Case studies and case reports form an important and ever growing part of scientific and scholarly literature. The paper deals with the share and citation rate of these publication types on different fields of research. In general, evidence seems to support the opinion that an excessive number of such publications may negatively influence the impact factor of the journal. In the literature of scientometrics, case studies (at least the presence of the term "case study" in the titles of the papers) have a moderate share, but their citation rate is practically equal to that of other publication types.

  19. Determinants of Quality Education in Private Universities from Student Perspectives: A Case Study in Bangladesh

    ERIC Educational Resources Information Center

    Ashraf, Mohammad A.; Osman, Abu Zafar Rashed; Ratan, Sarker Rafij Ahmed

    2016-01-01

    Purpose: The purpose of the present study is to identify the determinants that potentially influence quality education in private universities in Bangladesh. Design/methodology/approach: To attain this objective, 234 data were collected through face-to-face interviews on campus during February-March 2013 from Bachelor of Business Administration…

  20. Communication Coaching: A Case Study of Family Caregiver Burden.

    PubMed

    Wittenberg, Elaine; Ferrell, Betty; Koczywas, Marianna; Ferraro, Catherine

    2017-04-01

    Problematic communication among providers, patients, and their family members can affect the quality of patient care, causing stress to all parties involved and decreased opportunities for collaborative decision making.
. The purpose of this article is to present one case from a pilot study of a family caregiver intervention focused on communication. 
. The nurse-delivered communication intervention includes a written communication guide for family caregivers, as well as a one-time nurse communication coaching call. The call is aimed at identifying caregiver communication concerns, providing communication education, and role playing problematic communication.
. Psychological distress and caregiver confidence in communication were improved for the caregiver. Data presented from the case study demonstrate the need for family caregiver communication support and training and the potential benefits of such training.

  1. Quality Assurance and Continuous Improvement: A Case Study of the University of Bahrain

    ERIC Educational Resources Information Center

    Al-Alawi, Yaser; Al-Kaabi, Dheya; Rashdan, Suad; Al-Khaleefa, Lobna

    2009-01-01

    In recent years, Bahrain has taken serious actions to diversify its sources of income and solve major national problems such as unemployment. Through this process it discovered that one of the main factors for its economic problems was the quality of higher education on offer. This led to the creation of a national Quality Assurance Authority that…

  2. Commitment to Quality Education Services through ISO 9000: A Case Study of Romania

    ERIC Educational Resources Information Center

    Paunescu, Carmen; Fok, Wing

    2005-01-01

    The paper discusses a model of quality management system for higher education. One of the main objectives of this paper is to highlight the challenges facing the school during implementation of the ISO 9001 standard and the benefits of successfully implementing such a quality system can bring to higher education. Based on the experience of a…

  3. [Lean logistics management in healthcare: a case study].

    PubMed

    Aguilar-Escobar, V G; Garrido-Vega, P

    2013-01-01

    To study the applicability of the principles of Lean Production to manage the supply chain of a hospital. In particular, to determine which Lean practices and principles are applicable, the benefits obtained and the main barriers for its implementation. Managing the hospital supply chain is an important issue, both for its effect on the quality of care and its impact on costs. This study is based on a case study. 2005-10. Hospital Virgen Macarena in Seville. Process of implementing a comprehensive logistics management plan based on Lean principles and technological investments. The implementation of the comprehensive plan has reduced inventory, decreased lead times and improved service quality. Also, there have been other important improvements: enhanced employee satisfaction and increased staff productivity, both dedicated to health and the logistics. The experience analysed has shown the applicability and appropriateness of Lean principles and some of its techniques in managing the logistics of hospitals. It also identifies some of the main difficulties that may arise. Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.

  4. Spatial and temporal air quality pattern recognition using environmetric techniques: a case study in Malaysia.

    PubMed

    Syed Abdul Mutalib, Sharifah Norsukhairin; Juahir, Hafizan; Azid, Azman; Mohd Sharif, Sharifah; Latif, Mohd Talib; Aris, Ahmad Zaharin; Zain, Sharifuddin M; Dominick, Doreena

    2013-09-01

    The objective of this study is to identify spatial and temporal patterns in the air quality at three selected Malaysian air monitoring stations based on an eleven-year database (January 2000-December 2010). Four statistical methods, Discriminant Analysis (DA), Hierarchical Agglomerative Cluster Analysis (HACA), Principal Component Analysis (PCA) and Artificial Neural Networks (ANNs), were selected to analyze the datasets of five air quality parameters, namely: SO2, NO2, O3, CO and particulate matter with a diameter size of below 10 μm (PM10). The three selected air monitoring stations share the characteristic of being located in highly urbanized areas and are surrounded by a number of industries. The DA results show that spatial characterizations allow successful discrimination between the three stations, while HACA shows the temporal pattern from the monthly and yearly factor analysis which correlates with severe haze episodes that have happened in this country at certain periods of time. The PCA results show that the major source of air pollution is mostly due to the combustion of fossil fuel in motor vehicles and industrial activities. The spatial pattern recognition (S-ANN) results show a better prediction performance in discriminating between the regions, with an excellent percentage of correct classification compared to DA. This study presents the necessity and usefulness of environmetric techniques for the interpretation of large datasets aiming to obtain better information about air quality patterns based on spatial and temporal characterizations at the selected air monitoring stations.

  5. A methodological review of qualitative case study methodology in midwifery research.

    PubMed

    Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

    2016-10-01

    To explore the use and application of case study research in midwifery. Case study research provides rich data for the analysis of complex issues and interventions in the healthcare disciplines; however, a gap in the midwifery research literature was identified. A methodological review of midwifery case study research using recognized templates, frameworks and reporting guidelines facilitated comprehensive analysis. An electronic database search using the date range January 2005-December 2014: Maternal and Infant Care, CINAHL Plus, Academic Search Complete, Web of Knowledge, SCOPUS, Medline, Health Collection (Informit), Cochrane Library Health Source: Nursing/Academic Edition, Wiley online and ProQuest Central. Narrative evaluation was undertaken. Clearly worded questions reflected the problem and purpose. The application, strengths and limitations of case study methods were identified through a quality appraisal process. The review identified both case study research's applicability to midwifery and its low uptake, especially in clinical studies. Many papers included the necessary criteria to achieve rigour. The included measures of authenticity and methodology were varied. A high standard of authenticity was observed, suggesting authors considered these elements to be routine inclusions. Technical aspects were lacking in many papers, namely a lack of reflexivity and incomplete transparency of processes. This review raises the profile of case study research in midwifery. Midwives will be encouraged to explore if case study research is suitable for their investigation. The raised profile will demonstrate further applicability; encourage support and wider adoption in the midwifery setting. © 2016 John Wiley & Sons Ltd.

  6. A supply chain model to improve the beef quality distribution using investment analysis: A case study

    NASA Astrophysics Data System (ADS)

    Lupita, Alessandra; Rangkuti, Sabrina Heriza; Sutopo, Wahyudi; Hisjam, Muh.

    2017-11-01

    There are significant differences related to the quality and price of the beef commodity in traditional market and modern market in Indonesia. Those are caused by very different treatments of the commodity. The different treatments are in the slaughter lines, the transportation from the abattoir to the outlet, the display system, and the control system. If the problem is not solved by the Government, the gap will result a great loss of the consumer regarding to the quality and sustainability of traditional traders business because of the declining interest in purchasing beef in the traditional markets. This article aims to improve the quality of beef in traditional markets. This study proposed A Supply Chain Model that involves the schemes of investment and government incentive for improving the distribution system. The supply chain model is can be formulated using the Mix Integer Linear Programming (MILP) and solved using the IBM®ILOG®CPLEX software. The results show that the proposed model can be used to determine the priority of programs for improving the quality and sustainability business of traditional beef merchants. By using the models, The Government can make a decision to consider incentives for improving the condition.

  7. eHealth in Denmark: a case study.

    PubMed

    Kierkegaard, Patrick

    2013-12-01

    Denmark is widely regarded as a leading country in terms of eHealth integration and healthcare delivery services. The push for eHealth adoption over that past 20 years in the Danish health sector has led to the deployment of multiple eHealth technologies. However, in reality the Danish healthcare suffers from eHealth system fragmentation which has led to eHealth's inability to reach full potential in delivering quality healthcare service. This paper will presents a case study of the current state of eHealth in the Danish healthcare system and discuss the current challenges the country is facing today.

  8. Successful Mathematics Lessons in Remote Communities: A Case Study of Balargo

    ERIC Educational Resources Information Center

    Jorgensen, Robyn

    2015-01-01

    This paper describes the lesson practices at one very remote school that has been highly successful in numeracy. Drawing on a significant body of diverse research that promotes quality teaching and learning, this case study describes the features of the practice that have been implemented across the school. Teachers' voices provide both…

  9. Developing quality indicators for community services: the case of district nursing.

    PubMed

    Davies, Philippa; Wye, Lesley; Horrocks, Sue; Salisbury, Chris; Sharp, Debbie

    2011-01-01

    Quality indicators exist for the acute and primary care sectors in the National Health Service (NHS), but until recently little attention has been given to measuring the quality of community services. The innovative project described in this paper attempted to address that gap. To produce a framework for developing quality indicators for Bristol Community Health services. To develop a set of initial indicators for Bristol Community Health services using the proposed framework. After familiarising ourselves with community services and NHS policy, gathering the views of stakeholders and consulting the literature on quality indicators, we designed a framework for indicator development, using the 'test' case of the district nursing service. The long list of possible indicators came from best practice guidelines for wound, diabetes and end of life care, the three conditions most commonly treated by district nurses. To narrow down this list we surveyed and held workshops with district nurses, interviewed service users by telephone and met with commissioners and senior community health managers. The final set of quality indicators for district nurses included 23 organisational and clinical process and outcome indicators and eight patient experience indicators. These indicators are now being piloted, together with two potential tools identified to capture patient reported outcomes. Developing quality indicators for community services is time consuming and resource intensive. A range of skills are needed including clinical expertise, project management and skills in evidence-based medicine. The commitment and involvement of front-line professionals is crucial.

  10. Assessment and Quality Social Studies

    ERIC Educational Resources Information Center

    Savage, Tom V.

    2003-01-01

    Those anonymous individuals who develop high-stakes tests by which educational quality is measured exercise great influence in defining educational quality. In this article, the author examines the impact of high-stakes testing on the welfare of the children and the quality of social studies instruction. He presents the benefits and drawbacks of…

  11. Multivariate statistical process control in product quality review assessment - A case study.

    PubMed

    Kharbach, M; Cherrah, Y; Vander Heyden, Y; Bouklouze, A

    2017-11-01

    According to the Food and Drug Administration and the European Good Manufacturing Practices (GMP) guidelines, Annual Product Review (APR) is a mandatory requirement in GMP. It consists of evaluating a large collection of qualitative or quantitative data in order to verify the consistency of an existing process. According to the Code of Federal Regulation Part 11 (21 CFR 211.180), all finished products should be reviewed annually for the quality standards to determine the need of any change in specification or manufacturing of drug products. Conventional Statistical Process Control (SPC) evaluates the pharmaceutical production process by examining only the effect of a single factor at the time using a Shewhart's chart. It neglects to take into account the interaction between the variables. In order to overcome this issue, Multivariate Statistical Process Control (MSPC) can be used. Our case study concerns an APR assessment, where 164 historical batches containing six active ingredients, manufactured in Morocco, were collected during one year. Each batch has been checked by assaying the six active ingredients by High Performance Liquid Chromatography according to European Pharmacopoeia monographs. The data matrix was evaluated both by SPC and MSPC. The SPC indicated that all batches are under control, while the MSPC, based on Principal Component Analysis (PCA), for the data being either autoscaled or robust scaled, showed four and seven batches, respectively, out of the Hotelling T 2 95% ellipse. Also, an improvement of the capability of the process is observed without the most extreme batches. The MSPC can be used for monitoring subtle changes in the manufacturing process during an APR assessment. Copyright © 2017 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

  12. Drivers of microbiological quality of household drinking water - a case study in rural Ethiopia.

    PubMed

    Usman, Muhammed A; Gerber, Nicolas; Pangaribowo, Evita H

    2018-04-01

    This study aims at assessing the determinants of microbiological contamination of household drinking water under multiple-use water systems in rural areas of Ethiopia. For this analysis, a random sample of 454 households was surveyed between February and March 2014, and water samples from community sources and household storage containers were collected and tested for fecal contamination. The number of Escherichia coli (E. coli) colony-forming units per 100 mL water was used as an indicator of fecal contamination. The microbiological tests demonstrated that 58% of household stored water samples and 38% of protected community water sources were contaminated with E. coli. Moreover, most improved water sources often considered to provide safe water showed the presence of E. coli. The result shows that households' stored water collected from unprotected wells/springs had higher levels of E. coli than stored water from alternative sources. Distance to water sources and water collection containers are also strongly associated with stored water quality. To ensure the quality of stored water, the study suggests that there is a need to promote water safety from the point-of-source to point-of-use, with due considerations for the linkages between water and agriculture to advance the Sustainable Development Goal 6 of ensuring access to clean water for everyone.

  13. Case-mix and quality indicators in Chinese elder care homes: are there differences between government-owned and private-sector facilities?

    PubMed

    Liu, Chang; Feng, Zhanlian; Mor, Vincent

    2014-02-01

    To assess the association between ownership of Chinese elder care facilities and their performance quality and to compare the case-mix profile of residents and facility characteristics in government-owned and private-sector homes. Cross-sectional study. Census of elder care homes surveyed in Nanjing (2009) and Tianjin (2010). Elder care facilities located in urban Nanjing (n = 140, 95% of all) and urban Tianjin (n = 157, 97% of all). A summary case-mix index based on activity of daily living (ADL) limitations and cognitive impairment was created to measure levels of care needs of residents in each facility. Structure, process, and outcome measures were selected to assess facility-level quality of care. A structural quality measure, understaffing relative to resident levels of care needs, which indicates potentially inadequate staffing given resident case-mix, was also developed. Government-owned homes had significantly higher occupancy rates, presumably reflecting popular demand for publicly subsidized beds, but served residents who, on average, have fewer ADL and cognitive functioning limitations than those in private-sector facilities. Across a range of structure, process, and outcome measures of quality, there is no clear evidence suggesting advantages or disadvantages of either ownership type, although when staffing-to-resident ratio is gauged relative to resident case-mix, private-sector facilities were more likely to be understaffed than government-owned facilities. In Nanjing and Tianjin, private-sector homes were more likely to be understaffed, although their residents were sicker and frailer on average than those in government facilities. It is likely that the case-mix differences are the result of selective admission policies that favor healthier residents in government facilities than in private-sector homes. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  14. Identification of Important Parameter from Leachate Solid Waste Landfill on Water Quality, Case Study of Pesanggrahan River

    NASA Astrophysics Data System (ADS)

    Yanidar, R.; Hartono, D. M.; Moersidik, S. S.

    2018-03-01

    Cipayung Landfill takes waste generation from Depok City approximately ± 750 tons/day of solid waste. The south and west boundaries of the landfill is Pesanggarahan River which 200m faraway. The objectives of this study are to indicate an important parameter which greatly affects the water quality of Pesanggrahan River and purpose the dynamic model for improving our understanding of the dynamic behavior that captures the interactions and feedbacks important parameter in river in order to identify and assess the effects of the treated leachate from final solid waste disposal activity as it responds to changes over time in the river. The high concentrations of BOD and COD are not the only cause significantly affect the quality of the pesanggrahan water, it also because the river has been contaminated in the upstream area. It need the water quality model to support the effectiveness calculation of activities for preventing a selected the pollutant sources the model should be developed for simulating and predicting the trend of water quality performance in Pesanggrahan River which can potentially be used by policy makers in strategic management to sustain river water quality as raw drinking water.

  15. Air quality measurements in urban green areas - a case study

    NASA Astrophysics Data System (ADS)

    Kuttler, W.; Strassburger, A.

    The influence of traffic-induced pollutants (e.g. CO, NO, NO 2 and O 3) on the air quality of urban areas was investigated in the city of Essen, North Rhine-Westphalia (NRW), Germany. Twelve air hygiene profile measuring trips were made to analyse the trace gas distribution in the urban area with high spatial resolution and to compare the air hygiene situation of urban green areas with the overall situation of urban pollution. Seventeen measurements were made to determine the diurnal concentration courses within urban parks (summer conditions: 13 measurements, 530 30 min mean values, winter conditions: 4 measurements, 128 30 min mean values). The measurements were carried out during mainly calm wind and cloudless conditions between February 1995 and March 1996. It was possible to establish highly differentiated spatial concentration patterns within the urban area. These patterns were correlated with five general types of land use (motorway, main road, secondary road, residential area, green area) which were influenced to varying degrees by traffic emissions. Urban parks downwind from the main emission sources show the following typical temporal concentration courses: In summer rush-hour-dependent CO, NO and NO 2 maxima only occurred in the morning. A high NO 2/NO ratio was established during weather conditions with high global radiation intensities ( K>800 W m -2), which may result in a high O 3 formation potential. Some of the values measured found in one of the parks investigated (Gruga Park, Essen, area: 0.7 km 2), which were as high as 275 μg m -3 O 3 (30-min mean value) were significantly higher than the German air quality standard of 120 μg m -3 (30-min mean value, VDI Guideline 2310, 1996) which currently applies in Germany and about 20% above the maximum values measured on the same day by the network of the North Rhine-Westphalian State Environment Agency. In winter high CO and NO concentrations occur in the morning and during the afternoon rush-hour. The

  16. The effect of case mix and quality on cost differences between hospital-based and freestanding nursing homes.

    PubMed

    Schlenker, R; Shaughnessy, P; Yslas, I

    1983-01-01

    The considerably higher cost per patient day in hospital-based compared with freestanding nursing homes is well known. In this study, data from a random sample of 1,843 patients from 78 freestanding and hospital-based nursing homes in Colorado were used to explore the extent to which this higher cost can be explained by differences in case mix and quality of care. These differences were found to be associated with approximately 40% of the difference in cost, with case mix accounting for the majority of this effect. Although these findings are based on data from one state, they strongly suggest that Medicare and Medicaid nursing home policies should take case mix into account in reimbursing hospital-based and freestanding nursing homes.

  17. A workforce in crisis: a case study to expand allied ophthalmic personnel.

    PubMed

    Astle, William; Simms, Craig; Anderson, Lynn

    2016-08-01

    To examine how the development of allied ophthalmic personnel training programs affects human resource capacity. Using a qualitative case study method conducted at a single Ontario institution, this article describes 6 years of establishing a 2-tiered allied ophthalmic personnel training program. The Kingston Ophthalmic Training Centre participated in the study with 8 leadership and program graduate interviews. To assess regional eye health workforce needs, a case study and iterative process used triangulations of the literature, case study, and qualitative interviews with stakeholders. This research was used to develop a model for establishing allied ophthalmic personnel training programs that would result in expanding human resource capacity. Current human resource capacity development and deployment is inadequate to provide the needed eye care services in Canada. A competency-based curriculum and accreditation model as the platform to develop formal academic training programs is essential. Access to quality eye care and patient services can be met by task-shifting from ophthalmologists to appropriately trained allied ophthalmic personnel. Establishing formal training programs is one important strategy to supplying a well-skilled, trained, and qualified ophthalmic workforce. This initiative meets the criteria required for quality, relevance, equity, and cost-effectiveness to meet the future demands for ophthalmic patient care. Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  18. Attributes of quality programs in universities in developing countries: Case studies of two private universities in Ecuador and beyond

    NASA Astrophysics Data System (ADS)

    Uriguen, Monica I.

    This study sought to identify the key attributes of high-quality programs with an eye toward helping developing countries such as Ecuador advance program quality. The dissertation is divided into five chapters: (1) introduction to high-quality programs; (2) literature review of attributes of high-quality programs; (3) grounded theory method (including interviews with 60 individuals) used to identify program attributes that enhance student learning; (4) findings; and (5) conclusions and recommendations. Following are the five clusters and thirteen attributes of high-quality programs that I identified: Cluster One: Highly Qualified Participants: (1) Highly Qualified Faculty, and (2) Highly Qualified Students; Cluster Two: Learning-Centered Cultures: (3) Shared Program Direction Focused on Learning, (4) Real-World Learning Experiences, (5) Reading-Centered Culture, and (6) Supportive and Risk-Taking Environment; Cluster Three: Interactive Teaching and Learning: (7) Integrative learning: Theory with Practice, Self with Subject, and (8) Exclusive Tutoring and Mentoring; Cluster Four: Connected Program Requirements: (9) Planned Breadth and Depth Course Work, and (10) Tangible Products; and Cluster Five: Adequate Resources: (11) Support for Students, (12) Support for Faculty, and (13) Support for Campus Infrastructure. The study was guided by Haworth and Conrad's (1997) "Engagement Theory of High-Quality Programs." Eleven of the attributes of high-quality programs are closely connected to Haworth and Conrad's theory and the other two attributes---real-world learning experiences and a reading-centered culture---make the signature theoretical contributions of the study. Real-world learning experiences encourage the active involvement of stakeholders in designing curricula with real-world learning experiences. The second attribute---a reading-centered culture---has never before been identified in the literature. There are four key differences between Haworth and Conrad

  19. No effect of user fee exemption on perceived quality of delivery care in Burkina Faso: a case-control study.

    PubMed

    Philibert, Aline; Ridde, Valéry; Bado, Aristide; Fournier, Pierre

    2014-03-11

    Although many developing countries have developed user fee exemption policies to move towards universal health coverage as a priority, very few studies have attempted to measure the quality of care. The present paper aims at assessing whether women's satisfaction with delivery care is maintained with a total fee exemption in Burkina Faso. A quasi-experimental design with both intervention and control groups was carried out. Six health centres were selected in rural health districts with limited resources. In the intervention group, delivery care is free of charge at health centres while in the control district women have to pay 900 West African CFA francs (U$2). A total of 870 women who delivered at the health centre were interviewed at home after their visit over a 60-day range. A series of principal component analyses (PCA) were carried out to identify the dimension of patients' satisfaction. Women's satisfaction loaded satisfactorily on a three-dimension principal component analysis (PCA): 1-provider-patient interaction; 2-nursing care services; 3-environment. Women in both the intervention and control groups were satisfied or very satisfied in 90% of cases (in 31 of 34 items). For each dimension, average satisfaction was similar between the two groups, even after controlling for socio-demographic factors (p = 0.436, p = 0.506, p = 0.310, respectively). The effects of total fee exemption on satisfaction were similar for any women without reinforcing inequalities between very poor and wealthy women (p ≥ 0.05). Although the wealthiest women were more dissatisfied with the delivery environment (p = 0.017), the poorest were more highly satisfied with nursing care services (p = 0.009). Contrary to our expectations, total fee exemption at the point of service did not seem to have a negative impact on quality of care, and women's perceptions remained very positive. This paper shows that the policy of completely abolishing user fees with

  20. Using Faculty Evaluation to Improve Teaching Quality: A Longitudinal Case Study of Higher Education in Southeast Asia

    ERIC Educational Resources Information Center

    Hallinger, Philip

    2010-01-01

    This paper presents a case study of implementation of a new system of faculty teaching evaluation at a graduate school of business in Thailand. The research employed a non-experimental, longitudinal case study design in the analysis of student course evaluation data gathered over a period of 21 terms during a seven-year period. The report…

  1. Is Low-field NMR a Complementary Tool to GC-MS in Quality Control of Essential Oils? A Case Study: Patchouli Essential Oil.

    PubMed

    Krause, Andre; Wu, Yu; Tian, Runtao; van Beek, Teris A

    2018-04-24

    High-field NMR is an expensive and important quality control technique. In recent years, cheaper and simpler low-field NMR has become available as a new quality control technique. In this study, 60 MHz 1 H-NMR was compared with GC-MS and refractometry for the detection of adulteration of essential oils, taking patchouli essential oil as a test case. Patchouli essential oil is frequently adulterated, even today. In total, 75 genuine patchouli essential oils, 10 commercial patchouli essential oils, 10 other essential oils, 17 adulterants, and 1 patchouli essential oil, spiked at 20% with those adulterants, were measured. Visual inspection of the NMR spectra allowed for easy detection of 14 adulterants, while gurjun and copaiba balsams proved difficult and one adulterant could not be detected. NMR spectra of 10 random essential oils differed not only strongly from patchouli essential oil but also from one another, suggesting that fingerprinting by low-field NMR is not limited to patchouli essential oil. Automated chemometric evaluation of NMR spectra was possible by similarity analysis (Mahalanobis distance) based on the integration from 0.1 - 8.1 ppm in 0.01 ppm increments. Good quality patchouli essential oils were recognised as well as 15 of 17 deliberate adulterations. Visual qualitative inspection by GC-MS allowed for the detection of all volatile adulterants. Nonvolatile adulterants, and all but one volatile adulterant, could be detected by semiquantitation. Different chemometric approaches showed satisfactory results. Similarity analyses were difficult with nonvolatile adulterants. Refractive index measurements could detect only 8 of 17 adulterants. Due to advantages such as simplicity, rapidity, reproducibility, and ability to detect nonvolatile adulterants, 60 MHz 1 H-NMR is complimentary to GC-MS for quality control of essential oils. Georg Thieme Verlag KG Stuttgart · New York.

  2. E-Learning Quality Standards for Consumer Protection and Consumer Confidence: A Canadian Case Study in E-Learning Quality Assurance

    ERIC Educational Resources Information Center

    Barker, Kathryn Chang

    2007-01-01

    Emerging concerns about quality of e-learning products and services animated a project in Canada to create quality standards that derived primarily from the needs of consumer, that could be used to guide the development and choice of e-learning at all levels of education and training, and that could be implemented in a simple manner. A set of…

  3. Open-Source Software in Computational Research: A Case Study

    DOE PAGES

    Syamlal, Madhava; O'Brien, Thomas J.; Benyahia, Sofiane; ...

    2008-01-01

    A case study of open-source (OS) development of the computational research software MFIX, used for multiphase computational fluid dynamics simulations, is presented here. The verification and validation steps required for constructing modern computational software and the advantages of OS development in those steps are discussed. The infrastructure used for enabling the OS development of MFIX is described. The impact of OS development on computational research and education in gas-solids flow, as well as the dissemination of information to other areas such as geophysical and volcanology research, is demonstrated. This study shows that the advantages of OS development were realized inmore » the case of MFIX: verification by many users, which enhances software quality; the use of software as a means for accumulating and exchanging information; the facilitation of peer review of the results of computational research.« less

  4. Assessment of aggregate quality and petrographic properties' influence on rock quality: A case study from Nordland county, Norway

    NASA Astrophysics Data System (ADS)

    Kløve Keiding, Jakob; Erichsen, Eyolf; Heldal, Tom; Aslaksen Aasly, Kari

    2017-04-01

    Good access to construction materials is crucial for future infrastructure development and continued economic growth. In Norway >80 % of construction materials come from crushed aggregates and represent an growing share of the consumption. Although recycling to some extend can cover the need for construction materials, economic growth, increasing population and urbanization necessitates exploitation of new rock resources in Norway as well as many other parts of the world. Aggregates must fulfill a number of technical requirements to ensure high quality and long life expectancy of new roads, buildings and structures. Aggregates also have to be extracted near the consumer market. Particularly for road construction strict criteria are in place for wearing course for roads with high traffic density. Thus knowledge of mechanical rock quality is paramount for both exploitation as well as future resource and land-use planning but is often not assessed or mapped beyond the quarry scale. The Geological survey of Norway runs a database with information about crushed aggregate deposits from >1500 Norwegian quarries and sample sites. Here we use mechanical test analyses from the database to assess the aggregate quality in the Nordland county, Norway. Maps have been produced linking bed rock geology with rock quality parameters. The survey documents that the county is challenged in meeting the requirements for roads with high traffic density and especially in the middle parts of the county many samples have weak mechanical properties. This to some degree reflect that weak Cambro-Silurian rocks like phyllite, schist, carbonate and greenstone are abundant in Nordland. Typically mechanically stronger rock types such as gabbro, monzonite and granite are also exposed in large parts of the county, but are also characterized by relative poor or very variable mechanical test quality. Preliminary results indicate that many intrinsic parameters influence the mechanical rock strength, but

  5. An Exploratory Use of the Stakeholder Approach to Defining and Measuring Quality: The Case of a Cypriot Higher Education Institution

    ERIC Educational Resources Information Center

    Iacovidou, Melpo; Gibbs, Paul; Zopiatis, Anastasios

    2009-01-01

    Cyprus has recently adopted laws to allow for the provision of private higher education. This case study concerns one such institution that is developing its understanding of quality through the eyes of two of its key stakeholders, staff and students. This empirical study is nested within the literature that advocates community-wide acceptance of…

  6. Is the economic value of hydrological forecasts related to their quality? Case study of the hydropower sector.

    NASA Astrophysics Data System (ADS)

    Cassagnole, Manon; Ramos, Maria-Helena; Thirel, Guillaume; Gailhard, Joël; Garçon, Rémy

    2017-04-01

    The improvement of a forecasting system and the evaluation of the quality of its forecasts are recurrent steps in operational practice. However, the evaluation of forecast value or forecast usefulness for better decision-making is, to our knowledge, less frequent, even if it might be essential in many sectors such as hydropower and flood warning. In the hydropower sector, forecast value can be quantified by the economic gain obtained with the optimization of operations or reservoir management rules. Several hydropower operational systems use medium-range forecasts (up to 7-10 days ahead) and energy price predictions to optimize hydropower production. Hence, the operation of hydropower systems, including the management of water in reservoirs, is impacted by weather, climate and hydrologic variability as well as extreme events. In order to assess how the quality of hydrometeorological forecasts impact operations, it is essential to first understand if and how operations and management rules are sensitive to input predictions of different quality. This study investigates how 7-day ahead deterministic and ensemble streamflow forecasts of different quality might impact the economic gains of energy production. It is based on a research model developed by Irstea and EDF to investigate issues relevant to the links between quality and value of forecasts in the optimisation of energy production at the short range. Based on streamflow forecasts and pre-defined management constraints, the model defines the best hours (i.e., the hours with high energy prices) to produce electricity. To highlight the link between forecasts quality and their economic value, we built several synthetic ensemble forecasts based on observed streamflow time series. These inputs are generated in a controlled environment in order to obtain forecasts of different quality in terms of accuracy and reliability. These forecasts are used to assess the sensitivity of the decision model to forecast quality

  7. Effect of alteration zones on water quality: a case study from Biga Peninsula, Turkey.

    PubMed

    Baba, Alper; Gunduz, Orhan

    2010-04-01

    Widespread and intense zones of silicified, propylitic, and argillic alteration can be found in the Can volcanics of Biga Peninsula, northwest Turkey. Most of the springs in the study area surface out from the boundary between fractured aquifer (silicified zone) and impervious boundary (argillic zone). This study focuses on two such springs in Kirazli area (Kirazli and Balaban springs) with a distinct quality pattern. Accordingly, field parameters (temperature, pH, and electrical conductivity), major anion and cation (sodium, potassium, calcium, magnesium, chloride, bicarbonate, and sulfate), heavy metals (aluminum, arsenic, barium, chromium, cobalt, cupper, iron, lithium, manganese, nickel, lead, and zinc), and isotopes (oxygen-18, deuterium, and tritium) were determined in water samples taken from these springs during 2005 through 2007. The chemical analyses showed that aluminum concentrations were found to be two orders of magnitude greater in Kirazli waters (mean value 13813.25 microg/L). The levels of this element exceeded the maximum allowable limits given in national and international standards for drinking-water quality. In addition, Balaban and Kirazli springs are >55 years old according to their tritium levels; Kirazli spring is older than Balaban spring. Kirazli spring is also more enriched than Balaban spring based in oxygen-18 and deuterium values. Furthermore, Kirazli spring water has been in contact with altered rocks longer than Balaban spring water, according to its relatively high chloride and electrical conductivity values.

  8. Using Plant Clinic Registers to Assess the Quality of Diagnoses and Advice Given to Farmers: A Case Study from Uganda

    ERIC Educational Resources Information Center

    Danielsen, Solveig; Boa, Eric; Mafabi, Moses; Mutebi, Emmanuel; Reeder, Robert; Kabeere, Flavia; Karyeija, Robert

    2013-01-01

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant doctors. Assessment of quality of diagnoses was based…

  9. Evaluation of the Impacts of Land Use on Water Quality: A Case Study in The Chaohu Lake Basin

    PubMed Central

    Yan, Haiming; Wu, Feng; Deng, Xiangzheng

    2013-01-01

    It has been widely accepted that there is a close relationship between the land use type and water quality. There have been some researches on this relationship from the perspective of the spatial configuration of land use in recent years. This study aims to analyze the influence of various land use types on the water quality within the Chaohu Lake Basin based on the water quality monitoring data and RS data from 2000 to 2008, with the small watershed as the basic unit of analysis. The results indicated that there was significant negative correlation between forest land and grassland and the water pollution, and the built-up area had negative impacts on the water quality, while the influence of the cultivated land on the water quality was very complex. Besides, the impacts of the landscape diversity on the indicators of water quality within the watershed were also analyzed, the result of which indicated there was a significant negative relationship between them. The results can provide important scientific reference for the local land use optimization and water pollution control and guidance for the formulation of policies to coordinate the exploitation and protection of the water resource. PMID:23970833

  10. Alternate approaches for assessing impacts of oil sands development on air quality: A case study using the First Nation Community of Fort McKay.

    PubMed

    Davidson, Carla; Spink, David

    2018-04-01

    Previous analyses of continuously measured compounds in Fort McKay, an indigenous community in the Athabasca Oil Sands, have detected increasing concentrations of nitrogen dioxide (NO 2 ) and total hydrocarbons (THC), but not of sulfur dioxide (SO 2 ), ozone (O 3 ), total reduced sulfur compounds (TRS), or particulate matter (aerodynamic diameter <2.5 μm; PM 2.5 ). Yet the community frequently experiences odors, dust, and reduced air quality. The authors used Fort McKay's continuously monitored air quality data (1998-2014) as a case study to assess techniques for air quality analysis that make no assumptions regarding type of change. Linear trend analysis detected increasing concentrations of higher percentiles of NO 2 , nitric oxide (NO), and nitrogen oxides (NO x ), and THC. However, comparisons of all compounds between an early industrial expansion period (1998-2001) and current day (2011-2014) show that concentrations of NO 2 , SO 2 , THC, TRS, and PM 2.5 have significantly increased, whereas concentrations of O 3 are significantly lower. An assessment of the frequency and duration of periods when concentrations of each compound were above a variety of thresholds indicated that the frequency of air quality events is increasing for NO 2 and THC. Assessment of change over time with odds ratios of the 25th, 50th, 75th, and 90th percentile concentrations for each compound compared with an estimate of natural background variability showed that concentrations of TRS, SO 2 , and THC are dynamic, higher than background, and changes are nonlinear and nonmonotonic. An assessment of concentrations as a function of wind direction showed a clear and generally increasing influence of industry on air quality. This work shows that evaluating air quality without assumptions of linearity reveals dynamic changes in air quality in Fort McKay, and that it is increasingly being affected by oil sands operations. Understanding the nature and types of air quality changes occurring in

  11. Air quality in Moscow megacity: basic level and extreme cases

    NASA Astrophysics Data System (ADS)

    Pankratova, N.; Skorokhod, A.; Moiseenko, K.

    2012-04-01

    Moscow is one of the largest megacities in the world. Total annual emissions of polluting substances into the atmosphere in Moscow is likely to be about 2,0 mln. t. More than 90% of pollutants are emitted by traffic. Problem of air quality assessment is very urgent for Moscow both to alarm population and to compare with other world megacities. To study contemporary structure of atmospheric pollution over Moscow megacity data on air composition (including CO, NO, NO2, O3, CH4, CO2, SO2, NMHC, aerosol) obtained since 2002 has been analyzed. The monitoring site is located at Moscow State University meteorological observatory on South-West of Moscow. All observations are provided by A.M. Obukhov Institute of Atmospheric Physics RAS. Due to these continuous measurements typical (basic) level of pollution as well as extreme cases have been studied. The relationship between O3, NOx and VOCs were analyzed as well. Due to weather conditions (cyclonic regime is dominated) concentrations of pollutants usually do not reach dangerous levels but sometimes they are high. The case of abnormal hot and dry weather in the summer of 2010 was investigated. Many Russians were suffering from the record-breaking heat and the worst drought in 40 years. The heat was caused by very intensive and stable blocking anticyclone that established in Moscow since June, 18 till August, 18. Anticyclone of such strength has been never observed before. During 33 days in succession surface air temperature exceeded 30°C. During these 2 months troposphere over ETR was almost closed for western winds. Hot weather led to numerous forest and peat fires (about 29,000 cases) with total covered area about 12,000 km2. One of aftermaths was significant change of atmospheric composition. Many cities and settlements were covered by dense haze from fires. Evident presence of high amount of aerosol in the ambient air caused anxiety and application of safeguards. Meanwhile, less obvious increase of concentrations of

  12. Scaffolding Interprofessional Education: Unfolding Case Studies, Virtual World Simulations, and Patient-Centered Care.

    PubMed

    Zook, Sharon Strang; Hulton, Linda J; Dudding, Carol C; Stewart, Anne L; Graham, Amy C

    Fragmentation of health care negatively impacts quality; one of the contributing factors may be ineffective collaboration among health care professionals. This article describes the implementation of an interprofessional education curriculum for graduate students enrolled in nursing, psychology, and speech-language pathology programs. Over 3 semesters, students engaged in interprofessional collaboration modules, unfolding case studies, virtual simulation, and shared case planning experiences. The curriculum's impact on students' attitudes and values toward interprofessional collaborative practice was measured.

  13. Quality Standards Matter: A Comparative Case Study Examining Interactive Writing in the Preschool Setting

    ERIC Educational Resources Information Center

    Hall, Anna H.

    2017-01-01

    Interactive writing is a research-based early literacy strategy that has been found effective at increasing young children's oral language skills, alphabet knowledge, phonemic awareness, concepts of print, and early writing skills. This paper reports on a case study which explored the feasibility and fidelity of implementing interactive writing in…

  14. Impact of Case Mix Severity on Quality Improvement in a Patient-centered Medical Home (PCMH) in the Maryland Multi-Payor Program.

    PubMed

    Khanna, Niharika; Shaya, Fadia T; Chirikov, Viktor V; Sharp, David; Steffen, Ben

    2016-01-01

    We present data on quality of care (QC) improvement in 35 of 45 National Quality Forum metrics reported annually by 52 primary care practices recognized as patient-centered medical homes (PCMHs) that participated in the Maryland Multi-Payor Program from 2011 to 2013. We assigned QC metrics to (1) chronic, (2) preventive, and (3) mental health care domains. The study used a panel data design with no control group. Using longitudinal fixed-effects regressions, we modeled QC and case mix severity in a PCMH. Overall, 35 of 45 quality metrics reported by 52 PCMHs demonstrated improvement over 3 years, and case mix severity did not affect the achievement of quality improvement. From 2011 to 2012, QC increased by 0.14 (P < .01) for chronic, 0.15 (P < .01) for preventive, and 0.34 (P < .01) for mental health care domains; from 2012 to 2013 these domains increased by 0.03 (P = .06), 0.04 (P = .05), and 0.07 (P = .12), respectively. In univariate analyses, lower National Commission on Quality Assurance PCMH level was associated with higher QC for the mental health care domain, whereas case mix severity did not correlate with QC. In multivariate analyses, higher QC correlated with larger practices, greater proportion of older patients, and readmission visits. Rural practices had higher proportions of Medicaid patients, lower QC, and higher QC improvement in interaction analyses with time. The gains in QC in the chronic disease domain, the preventive care domain, and, most significantly, the mental health care domain were observed over time regardless of patient case mix severity. QC improvement was generally not modified by practice characteristics, except for rurality. © Copyright 2016 by the American Board of Family Medicine.

  15. Case-control study on uveal melanoma (RIFA): rational and design

    PubMed Central

    Schmidt-Pokrzywniak, Andrea; Jöckel, Karl-Heinz; Bornfeld, Norbert; Stang, Andreas

    2004-01-01

    Background Although a rare disease, uveal melanoma is the most common primary intraocular malignancy in adults, with an incidence rate of up to 1.0 per 100,000 persons per year in Europe. Only a few consistent risk factors have been identified for this disease. We present the study design of an ongoing incident case-control study on uveal melanoma (acronym: RIFA study) that focuses on radiofrequency radiation as transmitted by radio sets and wireless telephones, occupational risk factors, phenotypical characteristics, and UV radiation. Methods/Design We conduct a case-control study to identify the role of different exposures in the development of uveal melanoma. The cases of uveal melanoma were identified at the Division of Ophthalmology, University of Essen, a referral centre for tumours of the eye. We recruit three control groups: population controls, controls sampled from those ophthalmologists who referred cases to the Division of Ophthalmology, University of Duisburg-Essen, and sibling controls. For each case the controls are matched on sex and age (five year groups), except for sibling controls. The data are collected from the study participants by short self-administered questionnaire and by telephone interview. During and at the end of the field phase, the data are quality-checked. To estimate the effect of exposures on uveal melanoma risk, we will use conditional logistic regression that accounts for the matching factors and allows to control for potential confounding. PMID:15318944

  16. Consideration of rainwater quality parameters for drinking purposes: A case study in rural Vietnam.

    PubMed

    Lee, Minju; Kim, Mikyeong; Kim, Yonghwan; Han, Mooyoung

    2017-09-15

    Rainwater, which is used for drinking purposes near Hanoi, Vietnam, was analysed for water quality based on 1.5 years of monitoring data. In total, 23 samples were collected from different points within two rainwater harvesting systems (RWHSs). Most parameters met the standard except micro-organisms. Coliform and Escherichia coli (E. coli) were detected when the rainwater was not treated with ultraviolet (UV) light; however, analysis of rainwater after UV sterilisation showed no trace of micro-organisms. The RWHSs appear to provide drinking water of relatively good quality compared with surface water and groundwater. The superior quality of the rainwater suggests the necessity for new drinking rainwater standards because applying all of the drinking water quality standards to rainwater is highly inefficient. The traditionally implemented standards could cause more difficulties for developing countries using RWHSs installed decentralized as a source of drinking water, particularly in areas not well supplied with testing equipment, because such countries must bear the expense and time for these measures. This paper proposes the necessity of rainwater quality guideline, which could serve as a safe and cost-effective alternative to provide an access to safe drinking water. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Disorders Affecting Quality of Life During Pregnancy: A Qualitative Study

    PubMed Central

    Kazemi, Farideh; Kariman, Nourossadat

    2017-01-01

    Introduction Pregnancy is a special condition which results in unique physiological responses which is more than any other physiological event and it increase stress in women’s body. Information about the changes experienced by pregnant women in physical, psychological, and social areas is limited, indicating that the quality of life and changeable areas in pregnant women require more attention. Aim This study was aimed to identify the disorders affecting the quality of life during pregnancy. Materials and Methods A qualitative study was performed with the conventional content analysis approach. Participants included 16 pregnant women who were recruited using purposive sampling and performed with maximum variety. The semi-structured in depth interview started face to face with the general question and was followed with specific questions. The interviews were conducted in Fatemieh Hospital in Hamadan, Iran. Data analysis and data collection were conducted concurrently and the interviews were continued until achieving data saturation. Results Five main categories emerged in this study including “psychological disorders of pregnancy”, “disorders of activities”, “body-image disorder”, “disorders in sexual intercourse” and “physical disorders” that were analyzed revolves common around of disorders affecting quality of life. Conclusion Pregnancy can have undesirable effects on various aspects of women’s lives in their point of view and lead to a decreased life quality. Therefore, it is essential in prenatal care. In addition to addressing the physical aspects of maternal health, other aspects are also evaluated, and in case of any disorder, the necessary consultation should be done. PMID:28571212

  18. Promoting student case creation to enhance instruction of clinical reasoning skills: a pilot feasibility study.

    PubMed

    Chandrasekar, Hamsika; Gesundheit, Neil; Nevins, Andrew B; Pompei, Peter; Bruce, Janine; Merrell, Sylvia Bereknyei

    2018-01-01

    It is a common educational practice for medical students to engage in case-based learning (CBL) exercises by working through clinical cases that have been developed by faculty. While such faculty-developed exercises have educational strengths, there are at least two major drawbacks to learning by this method: the number and diversity of cases is often limited; and students decrease their engagement with CBL cases as they grow accustomed to the teaching method. We sought to explore whether student case creation can address both of these limitations. We also compared student case creation to traditional clinical reasoning sessions in regard to tutorial group effectiveness, perceived gains in clinical reasoning, and quality of student-faculty interaction. Ten first-year medical students participated in a feasibility study wherein they worked in small groups to develop their own patient case around a preassigned diagnosis. Faculty provided feedback on case quality afterwards. Students completed pre- and post-self-assessment surveys. Students and faculty also participated in separate focus groups to compare their case creation experience to traditional CBL sessions. Students reported high levels of team engagement and peer learning, as well as increased ownership over case content and understanding of clinical reasoning nuances. However, students also reported decreases in student-faculty interaction and the use of visual aids ( P < 0.05). The results of our feasibility study suggest that student-generated cases can be a valuable adjunct to traditional clinical reasoning instruction by increasing content ownership, encouraging student-directed learning, and providing opportunities to explore clinical nuances. However, these gains may reduce student-faculty interaction. Future studies may be able to identify an improved model of faculty participation, the ideal timing for incorporation of this method in a medical curriculum, and a more rigorous assessment of the impact

  19. Promoting student case creation to enhance instruction of clinical reasoning skills: a pilot feasibility study

    PubMed Central

    Chandrasekar, Hamsika; Gesundheit, Neil; Nevins, Andrew B; Pompei, Peter; Bruce, Janine; Merrell, Sylvia Bereknyei

    2018-01-01

    Background It is a common educational practice for medical students to engage in case-based learning (CBL) exercises by working through clinical cases that have been developed by faculty. While such faculty-developed exercises have educational strengths, there are at least two major drawbacks to learning by this method: the number and diversity of cases is often limited; and students decrease their engagement with CBL cases as they grow accustomed to the teaching method. We sought to explore whether student case creation can address both of these limitations. We also compared student case creation to traditional clinical reasoning sessions in regard to tutorial group effectiveness, perceived gains in clinical reasoning, and quality of student–faculty interaction. Methods Ten first-year medical students participated in a feasibility study wherein they worked in small groups to develop their own patient case around a preassigned diagnosis. Faculty provided feedback on case quality afterwards. Students completed pre- and post-self-assessment surveys. Students and faculty also participated in separate focus groups to compare their case creation experience to traditional CBL sessions. Results Students reported high levels of team engagement and peer learning, as well as increased ownership over case content and understanding of clinical reasoning nuances. However, students also reported decreases in student–faculty interaction and the use of visual aids (P < 0.05). Conclusion The results of our feasibility study suggest that student-generated cases can be a valuable adjunct to traditional clinical reasoning instruction by increasing content ownership, encouraging student-directed learning, and providing opportunities to explore clinical nuances. However, these gains may reduce student–faculty interaction. Future studies may be able to identify an improved model of faculty participation, the ideal timing for incorporation of this method in a medical curriculum, and

  20. Academic Staff Views of Quality Systems for Teaching and Learning: A Hong Kong Case Study

    ERIC Educational Resources Information Center

    Jones, John; Saram, Don Darshi De

    2005-01-01

    The "Teaching and Learning Quality Process Review" (TLQPR) recently completed in Hong Kong had an emphasis on education quality work. This paper analyses how, from the perspective of academic staff in one university in Hong Kong, the good intentions embedded in that idea are enhanced or subverted by the broader ?quality system setting in…

  1. Publishing Single-Case Research Design Studies That Do Not Demonstrate Experimental Control

    ERIC Educational Resources Information Center

    Tincani, Matt; Travers, Jason

    2018-01-01

    Demonstration of experimental control is considered a hallmark of high-quality single-case research design (SCRD). Studies that fail to demonstrate experimental control may not be published because researchers are unwilling to submit these papers for publication and journals are unlikely to publish negative results (i.e., the file drawer effect).…

  2. Effects of Case Manager Feedback on the Quality of Individual Habilitation Plan Objectives.

    ERIC Educational Resources Information Center

    Horner, Robert H.; And Others

    1990-01-01

    The functional relation between feedback and improved writing of Individual Habilitation Plan objectives in four adult service agencies serving the retarded was assessed. The agencies improved the quality of their written objectives after receiving feedback from the case manager and maintained those gains 18 months after feedback was terminated.…

  3. High Spicy Food Intake and Risk of Cancer: A Meta-analysis of Case-control Studies.

    PubMed

    Chen, Yu-Heng; Zou, Xiao-Nong; Zheng, Tong-Zhang; Zhou, Qi; Qiu, Hui; Chen, Yuan-Li; He, Mei; Du, Jia; Lei, Hai-Ke; Zhao, Ping

    2017-09-20

    Studies on the association between spicy food intake and cancer risk have reported inconsistent results. We quantitatively assessed this association by conducting a meta-analysis based on evidence from case-control studies. PubMed, EMBASE, and the Cochrane Library were searched for eligible publications. Combined odds ratios (OR s) with their 95% confidence interval (CI) were calculated using a random- or fixed-effects model. The methodological quality of the included articles was assessed using the Newcastle-Ottawa scale (NOS). All data were analyzed using STATA 11.0 software (version 11.0; StataCorp., College Station, TX, USA). Subgroup analyses were also performed with stratification by region, sex, number of cases, cancer subtype, source of the control group, and NOS score. A total 39 studies from 28 articles fulfilled the inclusion criteria for the meta-analysis (7884 patients with cancer and 10,142 controls). Comparison of the highest versus lowest exposure category in each study revealed a significant OR of 1.76 (95% CI = 1.35-2.29) in spite of significant heterogeneity (P < 0.001). In the subgroup analyses, this positive correlation was still found for gastric cancer, different regions, different numbers of cases, different sources of the control group, and high-quality articles (NOS score of ≥ 7). However, no statistically significant association was observed for women, esophageal cancer, gallbladder cancer, or low-quality articles (NOS score of <7). No evidence of publication bias was found. Evidence from case-control studies suggested that a higher level of spicy food intake may be associated with an increased incidence of cancer despite significant heterogeneity. More studies are warranted to clarify our understanding of the association between high spicy food intake and the risk of cancer.

  4. Impact of nocturnal heartburn on quality of life, sleep, and productivity: the SINERGE study.

    PubMed

    Calleja, José Luis; Bixquert, M; Maldonado, J

    2007-10-01

    The aim of the SINERGE study was to assess the impact of nocturnal heartburn on quality of life, sleep, and productivity. Ambulatory patients >/=18 years old and classified as defined cases of nocturnal heartburn (n=337), nonnocturnal heartburn (n=139), uncontrolled hypertension (n=198), and symptomatic depression (n=104) were included in this cross-sectional study. Information on age, gender, body mass index, and comorbidity was collected and the following validated questionnaires were applied: SF-12, Pittsburgh Sleep Quality Index, and Work Productivity and Activity Impairment questionnaire. The prevalence of primary care consultation for heartburn and nocturnal heartburn was 4.7% and 1.9%, respectively. Health-related quality of life, sleep, and productivity were significantly impaired in patients with frequent nocturnal heartburn symptoms as compared with those of the patients without nocturnal symptoms or patients with hypertension. Nocturnal heartburn poses a considerable burden for the sufferer because of the impact on quality of life, sleep, and daily activities.

  5. Quality of life in children with infantile hemangioma: a case control study.

    PubMed

    Wang, Chuan; Li, Yanan; Xiang, Bo; Xiong, Fei; Li, Kai; Yang, Kaiying; Chen, Siyuan; Ji, Yi

    2017-11-16

    Infantile hemangioma (IH) is the most common vascular tumor in children. It is controversial whether IHs has effects on the quality of life (QOL) in patients of whom IH poses no threat or potential for complication. Thus, we conducted this study to evaluate the q QOL in patients with IH and find the predictors of poor QOL. The PedsQL 4.0 Genetic Core Scales and the PedsQL family information form were administered to parents of children with IH and healthy children both younger than 2-year-old. The quality-of-life instrument for IH (IH-QOL) and the PedsQL 4.0 family impact module were administered to parents of children with IH. We compared the PedsQL 4.0 Genetic Core Scales (GCIS) scores of the two groups. Multiple step-wise regression analysis was used to determine factors that influenced QOL in children with IH and their parents. Except for physical symptom, we found no significant difference in GCIS between patient group and healthy group (P = 0.409). The internal reliability of IH-QOL was excellent with the Cronbach's alpha coefficient for summary scores being 0.76. Multiple step-wise regression analysis showed that the predictors of poor IH-QOL total scores were hemangioma size, location, and mother's education level. The predictors of poor FIM total scores were hemangioma location and father's education level. The predictors of poor GCIS total scores were children's age, hemangioma location and father's education level. The findings support the feasibility and reliability of the Chinese version of IH-QOL to evaluate the QOL in children with IH and their parents. Hemangioma size, location and education level of mother are important impact factors for QOL in children with IH and their parents.

  6. Case study for implementing RECIPPE as a quality control in construction projects.

    DOT National Transportation Integrated Search

    2008-04-01

    The quality of construction is a very important factor in the life-cycle performance of flexible pavements. This is particularly true of the individual characteristics of construction and their relative effect on life-cycle performance of the pavemen...

  7. Achieving the sustainable development goals: a case study of the complexity of water quality health risks in Malawi.

    PubMed

    Holm, Rochelle; Wandschneider, Philip; Felsot, Allan; Msilimba, Golden

    2016-07-15

    Suppose 35 % of the households with children under 5 years of age in a low-income suburban neighborhood in a developing country have diarrhea where improved water sources are available. Clearly, something is amiss-but what? In addition to focusing on the need to examine water quality among water sources that meet the 'improved' category when assessing health risk, the relative importance of the range of transmission routes for diarrhea is unknown. In Malawi, relevant baseline data affecting human health are simply not available, and acquiring data is hampered by a lack of local analytical capacity for characterizing drinking water quality. The objective of this work is to develop a risk communication program with partnership among established regional development professionals for effectively meeting the sustainable development goals. A field study was conducted in the city of Mzuzu, Malawi, to study water quality (total coliform and Escherichia coli) and human dimensions leading to development of a public health risk communication strategy in a peri-urban area. A structured household questionnaire was administered to adult residents of 51 households, encompassing 284 individuals, who were using the 30 monitored shallow wells. The water quality data and human dimension questionnaire results were used to develop a household risk presentation. Sixty-seven percent and 50 % of well water and household drinking water samples, respectively, exceeded the WHO health guideline of zero detections of E. coli. Technology transfer was advanced by providing knowledge through household risk debriefing/education, establishing a water quality laboratory at the local university, and providing training to local technicians. Communicating the science of water quality and health risks in developing countries requires sample collection and analysis by knowledgeable personnel trained in the sciences, compiling baseline data, and, ultimately, an effective risk presentation back to

  8. Social and economic impact of diabetics in Bangladesh: protocol for a case-control study.

    PubMed

    Shariful Islam, Sheikh Mohammed; Lechner, Andreas; Ferrari, Uta; Froeschl, Guenter; Niessen, Louis W; Seissler, Jochen; Alam, Dewan Shamsul

    2013-12-21

    Diabetes affects both individuals and their families and has an impact on economic and social development of a country. Information on the availability, cost, and quality of medical care for diabetes is mostly not available for many low- and middle-income countries including Bangladesh. Complications from diabetes, which can be devastating, could largely be prevented by wider use of several inexpensive generic medicines, simple tests and monitoring and can be a cost saving intervention. This study will provide an in-depth and comprehensive picture of social and economic impacts of diabetes in Bangladesh and propose clear recommendations for improving prevention and management of diabetes. The objectives of the study are: 1) To study the association between diabetes and other health problems and its social impacts. 2) To estimate the economic impact of diabetes including total direct and indirect costs. 3) To measure the impact of diabetes on quality of life among diabetes patients in Bangladesh. 4) To study the impact of diabetes on the health care system This is a case-control study comparing cases with type 2 diabetes to controls without diabetes matched on age, sex and place of residence. 564 cases and 564 controls will be selected from the outpatient department of a tertiary hospital in Dhaka, Bangladesh. Data on socioeconomic status, health utility index, direct and indirect costs for diabetes, medication adherence, quality of life, treatment satisfaction, diet, physical activity, mental state examination, weight, height, hip and waist circumference, blood pressure, pulse, medication history, laboratory data and physical examination will be conducted. The primary outcome measures will be association between diabetes and other health problems, cost of diabetes, impact of diabetes on quality of life and secondary outcome measures are impact of diabetes on healthcare systems in Bangladesh. This study will provide an in-depth and comprehensive picture of social

  9. Constructing Ecological Networks Based on Habitat Quality Assessment: A Case Study of Changzhou, China

    NASA Astrophysics Data System (ADS)

    Gao, Yu; Ma, Lei; Liu, Jiaxun; Zhuang, Zhuzhou; Huang, Qiuhao; Li, Manchun

    2017-04-01

    Fragmentation and reduced continuity of habitat patches threaten the environment and biodiversity. Recently, ecological networks are increasingly attracting the attention of researchers as they provide fundamental frameworks for environmental protection. This study suggests a set of procedures to construct an ecological network. First, we proposed a method to construct a landscape resistance surface based on the assessment of habitat quality. Second, to analyze the effect of the resistance surface on corridor simulations, we used three methods to construct resistance surfaces: (1) the method proposed in this paper, (2) the entropy coefficient method, and (3) the expert scoring method. Then, we integrated habitat patches and resistance surfaces to identify potential corridors using graph theory. These procedures were tested in Changzhou, China. Comparing the outputs of using different resistance surfaces demonstrated that: (1) different landscape resistance surfaces contribute to how corridors are identified, but only slightly affect the assessment of the importance of habitat patches and potential corridors; (2) the resistance surface, which is constructed based on habitat quality, is more applicable to corridor simulations; and (3) the assessment of the importance of habitat patches is fundamental for ecological network optimization in the conservation of critical habitat patches and corridors.

  10. Variable infiltration and river flooding resulting in changing groundwater quality - A case study from Central Europe

    NASA Astrophysics Data System (ADS)

    Miotliński, Konrad; Postma, Dieke; Kowalczyk, Andrzej

    2012-01-01

    SummaryThe changes in groundwater quality occurring in a buried valley aquifer following a reduction in groundwater exploitation and enhanced infiltration due to extensive flooding of the Odra River in 1997 were investigated. Long-time series data for the chemical composition of groundwater in a large well field for drinking water supply indicated the deterioration of groundwater quality in the wells capturing water from the flooded area, which had been intensively cultivated since the 1960s. Infiltration of flooded river water into the aquifer is suggested by an elevated chloride concentration, although salt flushing from the rewatered unsaturated zone due to the enhanced recharge event is much more feasible. Concomitantly with chloride increases in the concentrations of sulphate, ferrous iron, manganese, and nickel imply the oxidation of pyrite (FeS 2) which is abundant in the aquifer. The proton production resulting from pyrite oxidation is buffered by the dissolution of calcite, while the Ca:SO 4 stoichiometry of the groundwater indicates that pyrite oxidation coupled with nitrate reduction is the dominant process occurring in the aquifer. The pyritic origin of SO42- is confirmed by the sulphur isotopic composition. The resultant Fe 2+ increase induces Mn-oxide dissolution and the mobilisation of Ni 2+ previously adsorbed to Mn-oxide surfaces. The study has a major implication for groundwater quality prediction studies where there are considerable variations in water level associated with groundwater management and climate change issues.

  11. Soil-plant water status and wine quality: the case study of Aglianico wine (the ZOViSA project)

    NASA Astrophysics Data System (ADS)

    Bonfante, Antonello; Manna, Piero; Albrizio, Rossella; Basile, Angelo; Agrillo, Antonietta; De Mascellis, Roberto; Caputo, Pellegrina; Delle Cave, Aniello; Gambuti, Angelita; Giorio, Pasquale; Guida, Gianpiero; Minieri, Luciana; Moio, Luigi; Orefice, Nadia; Terribile, Fabio

    2014-05-01

    The terroir analysis, aiming to achieve a better use of environmental features with respect to plant requirement and wine production, needs to be strongly rooted on hydropedology. In fact, the relations between wine quality and soil moisture regime during the cropping season is well established. The ZOViSA Project (Viticultural zoning at farm scale) tests a new physically oriented approach to terroir analysis based on the relations between the soil-plant water status and wine quality. The project is conducted in southern Italy in the farm Quintodecimo of Mirabella Eclano (AV) located in the Campania region, devoted to quality Aglianico red wine production (DOC). The soil spatial distribution of study area (about 3 ha) was recognized by classical soil survey and geophysics scan by EM38DD; then the soil-plant water status was monitored for three years in two experimental plots from two different soils (Cambisol and Calcisol). Daily climate variables (temperature, solar radiation, rainfall, wind), daily soil water variables (through TDR probes and tensiometers), crop development (biometric and physiological parameters), and grape must and wine quality were monitored. The agro-hydrological model SWAP was calibrated and applied in the two experimental plots to estimate soil-plant water status in different crop phenological stages. The effects of crop water status on crop response and wine quality was evaluated in two different pedo-systems, comparing the crop water stress index with both: crop physiological measurements (leaf gas exchange, leaf water potential, chlorophyll content, LAI measurement), grape bunches measurements (berry weight, sugar content, titratable acidity, etc.) and wine quality (aromatic response). Finally a "spatial application" of the model was carried out and different terroirs defined.

  12. Construction activity, emissions, and air quality impacts : real-world observations from an Arizona road-widening case study.

    DOT National Transportation Integrated Search

    2010-10-22

    The Arizona Department of Transportation (ADOT) sponsored this investigation, a field : study of emissions and air quality impacts generated from a road widening project, to gain : insight into construction-related emissions of particulate matter (PM...

  13. Hydrochemical Characterization of Groundwater Quality for Drinking and Agricultural Purposes: A Case Study in Rafsanjan Plain, Iran.

    PubMed

    Hosseinifard, Seyed Javad; Mirzaei Aminiyan, Milad

    One of the important purposes of hydrology is to ensure water supply in accordance with the quality criteria for agricultural, industrial, and drinking water uses. The groundwater is the main source of water supply in arid and semi-arid regions. This study was conducted to evaluate factors regulating groundwater quality in Rafsanjan plain. A total of 1040 groundwater samples randomly were collected from different areas of Rafsanjan. Then, each sample was analyzed for the major ions based on standard methods. The pH, SAR, EC, and TDS parameters and concentrations of Ca 2+ , Mg 2+ , and Na + cations, and Cl - , [Formula: see text], [Formula: see text] and [Formula: see text] anions were measured. Also boron concentration in each sample was determined. Although, maximum and minimum values of EC and TDS linked to the Anar-Beyaz area and Eastern Urban, respectively, irrigation water EC condition, however, was critical in the study areas. The pH value in Western Urban was higher than the other areas, and its value for Anar-Beyaz area was lower than the other areas, but pH value is at the optimal level in all the study areas. The results showed that hazard state with respect to Mg was critical except in Koshkoueiyeh and Anar-Beyaz areas, that these areas are marginal for irrigation use with little harm with reference to Mg. From the results, it was concluded that the status of boron concentration in study areas was critical. According to the hydrochemistry diagrams, the main groundwater type in different study areas was NaCl. Groundwater quality was not appropriate for drinking usage, and its status for agricultural practices was unsuitable in these areas.

  14. Improving the Accuracy of Extracting Surface Water Quality Levels (SWQLs) Using Remote Sensing and Artificial Neural Network: a Case Study in the Saint John River, Canada

    NASA Astrophysics Data System (ADS)

    Sammartano, G.; Spanò, A.

    2017-09-01

    Delineating accurate surface water quality levels (SWQLs) always presents a great challenge to researchers. Existing methods of assessing surface water quality only provide individual concentrations of monitoring stations without providing the overall SWQLs. Therefore, the results of existing methods are usually difficult to be understood by decision-makers. Conversely, the water quality index (WQI) can simplify surface water quality assessment process to be accessible to decision-makers. However, in most cases, the WQI reflects inaccurate SWQLs due to the lack of representative water samples. It is very challenging to provide representative water samples because this process is costly and time consuming. To solve this problem, we introduce a cost-effective method which combines the Landsat-8 imagery and artificial intelligence to develop models to derive representative water samples by correlating concentrations of ground truth water samples to satellite spectral information. Our method was validated and the correlation between concentrations of ground truth water samples and predicted concentrations from the developed models reached a high level of coefficient of determination (R2) > 0.80, which is trustworthy. Afterwards, the predicted concentrations over each pixel of the study area were used as an input to the WQI developed by the Canadian Council of Ministers of the Environment to extract accurate SWQLs, for drinking purposes, in the Saint John River. The results indicated that SWQL was observed as 67 (Fair) and 59 (Marginal) for the lower and middle basins of the river, respectively. These findings demonstrate the potential of using our approach in surface water quality management.

  15. A Historical Case Study of P. W. Moore High School from 1960-1970

    ERIC Educational Resources Information Center

    Andrews, Valerie Griffin

    2016-01-01

    The purpose of this qualitative, historical case study is to explore former living administrators', teachers', and students' opinions of their personal experiences while working at or attending P. W. Moore High School in North Carolina. The school's culture and leadership qualities of administrators will be examined through participants'…

  16. Characteristics of Leachate and Their Effect on Shallow Groundwater Quality (Case Study : TPA Cipayung, Depok)

    NASA Astrophysics Data System (ADS)

    Widiastuti, Atika; Hartono, Djoko M.; Moersidik, Setyo S.; Gusniani, Irma

    2018-03-01

    The problems arising from landfill activity is leaked leachate that is not absorbed well into leachate stabilization pond which furthermore contaminates shallow groundwater around landfill, include Cipayung landfill. The aims of this study is to determine the characteristics of leachate and their effect on shallow groundwater quality around landfill based on temperature, pH, Total Suspended Solids (TSS), Biological Oxygen Demand (BOD), Chemical Oxygen Demand (COD), Total Nitrogen (TN), Mercury (Hg), and fecal coliform. Data were analyzed based on leachate samples at influent point, effluent point, and 7 sampling points of residents’s well with distance variation every 100 meters within 300 meters radius having leachate stabilization pond as benchmark. According to the standard of Indonesia’s Ministry of Environment and Forestry law No. 59 of 2016, the results showed that leachate quality was still above the standard of BOD, COD, and Total Nitrogen parameters; 4178.0 mg/L, 70556.0 mg/L and 373.3 mg/L for influent point, and 3142.0 mg/L, 9055.2 mg/L, and 350 mg/L for the effluent point. Pollution Index of shallow groundwater is between lightly and moderately contaminated. This study showed that the further the distance between sampling point and leachate stabilization pond is, the lower the Polution Index is.

  17. [Case-non case studies: Principles, methods, bias and interpretation].

    PubMed

    Faillie, Jean-Luc

    2017-10-31

    Case-non case studies belongs to the methods assessing drug safety by analyzing the disproportionality of notifications of adverse drug reactions in pharmacovigilance databases. Used for the first time in the 1980s, the last few decades have seen a significant increase in the use of this design. The principle of the case-non case study is to compare drug exposure in cases of a studied adverse reaction with that of cases of other reported adverse reactions and called "non cases". Results are presented in the form of a reporting odds ratio (ROR), the interpretation of which makes it possible to identify drug safety signals. This article describes the principle of the case-non case study, the method of calculating the ROR and its confidence interval, the different modalities of analysis and how to interpret its results with regard to the advantages and limitations of this design. Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  18. Phoenix: Quantum Quality at Maricopa: TQM on Campus, Case Study Number Two.

    ERIC Educational Resources Information Center

    Assar, Kathleen E.

    1993-01-01

    Implementation of the Total Quality Management approach in the Maricopa County Community College District (Arizona), a large 10-campus system, is described. The program's current early stages are reported noting the serious administrative commitment and thorough training, seen as key factors in potential success. (MSE)

  19. Perspectives on Quality and Quality Assurance in Learner Support Areas at Three Southeast Asian Open Universities

    ERIC Educational Resources Information Center

    Darojat, Ojat; Nilson, Michelle; Kaufman, David

    2015-01-01

    While quality measures in higher education in general have gained significant and growing attention over the past 30 years, questions remain about quality in open universities. This research was an international comparative case study focusing on perceptions of quality and quality assurance (QA) in learner support areas at open universities. The…

  20. The contribution of case study design to supporting research on Clubhouse psychosocial rehabilitation.

    PubMed

    Raeburn, Toby; Schmied, Virginia; Hungerford, Catherine; Cleary, Michelle

    2015-10-01

    Psychosocial Clubhouses provide recovery-focused psychosocial rehabilitation to people with serious mental illness at over 300 sites in more than 30 countries worldwide. To deliver the services involved, Clubhouses employ a complex mix of theory, programs and relationships, with this complexity presenting a number of challenges to those undertaking Clubhouse research. This paper provides an overview of the usefulness of case study designs for Clubhouse researchers; and suggests ways in which the evaluation of Clubhouse models can be facilitated. The paper begins by providing a brief explanation of the Clubhouse model of psychosocial rehabilitation, and the need for ongoing evaluation of the services delivered. This explanation is followed by an introduction to case study design, with consideration given to the way in which case studies have been used in past Clubhouse research. It is posited that case study design provides a methodological framework that supports the analysis of either quantitative, qualitative or a mixture of both types of data to investigate complex phenomena in their everyday contexts, and thereby support the development of theory. As such, case study approaches to research are well suited to the Clubhouse environment. The paper concludes with recommendations for future Clubhouse researchers who choose to employ a case study design. While the quality of case study research that explores Clubhouses has been variable in the past, if applied in a diligent manner, case study design has a valuable contribution to make in future Clubhouse research.

  1. Sedimentation and Its Impacts/Effects on River System and Reservoir Water Quality: case Study of Mazowe Catchment, Zimbabwe

    NASA Astrophysics Data System (ADS)

    Tundu, Colleta; Tumbare, Michael James; Kileshye Onema, Jean-Marie

    2018-04-01

    Sediment delivery into water sources and bodies results in the reduction of water quantity and quality, increasing costs of water purification whilst reducing the available water for various other uses. The paper gives an analysis of sedimentation in one of Zimbabwe's seven rivers, the Mazowe Catchment, and its impact on water quality. The Revised Universal Soil Loss Equation (RUSLE) model was used to compute soil lost from the catchment as a result of soil erosion. The model was used in conjunction with GIS remotely sensed data and limited ground observations. The estimated annual soil loss in the catchment indicates soil loss ranging from 0 to 65 t ha yr-1. Bathymetric survey at Chimhanda Dam showed that the capacity of the dam had reduced by 39 % as a result of sedimentation and the annual sediment deposition into Chimhanda Dam was estimated to be 330 t with a specific yield of 226 t km-2 yr-1. Relationship between selected water quality parameters, TSS, DO, NO3, pH, TDS, turbidity and sediment yield for selected water sampling points and Chimhanda Dam was analyzed. It was established that there is a strong positive relationship between the sediment yield and the water quality parameters. Sediment yield showed high positive correlation with turbidity (0.63) and TDS (0.64). Water quality data from Chimhanda treatment plant water works revealed that the quality of water is deteriorating as a result of increase in sediment accumulation in the dam. The study concluded that sedimentation can affect the water quality of water sources.

  2. Rethinking Indicators of Microbial Drinking Water Quality for Health Studies in Tropical Developing Countries: Case Study in Northern Coastal Ecuador

    PubMed Central

    Levy, Karen; Nelson, Kara L.; Hubbard, Alan; Eisenberg, Joseph N. S.

    2012-01-01

    To address the problem of the health impacts of unsafe drinking water, methods are needed to assess microbiologic contamination in water. However, indicators of water quality have provided mixed results. We evaluate five assays (three for Escherichia coli and one each for enterococci and somatic coliphage) of microbial contamination in villages in rural Ecuador that rely mostly on untreated drinking water. Only membrane filtration for E. coli using mI agar detected a significant association with household diarrheal disease outcome (odds ratio = 1.29, 95% confidence interval = 1.02–1.65 in household containers and odds ratio = 1.18, 95% confidence interval = 1.02–1.37) in source samples. Our analysis and other published research points to the need for further consideration of study design factors, such as sample size and variability in measurements, when using indicator organisms, especially when relating water quality exposure to health outcomes. Although indicator organisms are used extensively in health studies, we argue that their use requires a full understanding of their purposes and limitations. PMID:22403326

  3. Rethinking indicators of microbial drinking water quality for health studies in tropical developing countries: case study in northern coastal Ecuador.

    PubMed

    Levy, Karen; Nelson, Kara L; Hubbard, Alan; Eisenberg, Joseph N S

    2012-03-01

    To address the problem of the health impacts of unsafe drinking water, methods are needed to assess microbiologic contamination in water. However, indicators of water quality have provided mixed results. We evaluate five assays (three for Escherichia coli and one each for enterococci and somatic coliphage) of microbial contamination in villages in rural Ecuador that rely mostly on untreated drinking water. Only membrane filtration for E. coli using mI agar detected a significant association with household diarrheal disease outcome (odds ratio = 1.29, 95% confidence interval = 1.02-1.65 in household containers and odds ratio = 1.18, 95% confidence interval = 1.02-1.37) in source samples. Our analysis and other published research points to the need for further consideration of study design factors, such as sample size and variability in measurements, when using indicator organisms, especially when relating water quality exposure to health outcomes. Although indicator organisms are used extensively in health studies, we argue that their use requires a full understanding of their purposes and limitations.

  4. Case Studies on the Impact of Concentrated Animal Feeding Operations (CAFOs) on Ground Water Quality

    EPA Science Inventory

    This report describes a series of case studies involving commercial swine, poultry, dairy, and beef CAFO operations where ground water contamination by nitrate and ammonia has occurred to ascertain whether other stressors in CAFO wastes are also being transported through the vado...

  5. The Study of an Integrated Rating System for Supplier Quality Performance in the Semiconductor Industry

    NASA Astrophysics Data System (ADS)

    Lee, Yu-Cheng; Yen, Tieh-Min; Tsai, Chih-Hung

    This study provides an integrated model of Supplier Quality Performance Assesment (SQPA) activity for the semiconductor industry through introducing the ISO 9001 management framework, Importance-Performance Analysis (IPA) Supplier Quality Performance Assesment and Taguchi`s Signal-to-Noise Ratio (S/N) techniques. This integrated model provides a SQPA methodology to create value for all members under mutual cooperation and trust in the supply chain. This method helps organizations build a complete SQPA framework, linking organizational objectives and SQPA activities to optimize rating techniques to promote supplier quality improvement. The techniques used in SQPA activities are easily understood. A case involving a design house is illustrated to show our model.

  6. Prediction of Water Quality Parameters Using Statistical Methods: A Case Study in a Specially Protected Area, Ankara, Turkey

    NASA Astrophysics Data System (ADS)

    Alp, E.; Yücel, Ö.; Özcan, Z.

    2014-12-01

    Turkey has been making many legal arrangements for sustainable water management during the harmonization process with the European Union. In order to make cost effective and efficient decisions, monitoring network in Turkey has been expanding. However, due to time and budget constraints, desired number of monitoring campaigns can not be carried. Hence, in this study, independent parameters that can be measured easily and quickly are used to estimate water quality parameters in Lake Mogan and Eymir using linear regression. Nonpoint sources are one of the major pollutant components in Eymir and Mogan lakes. In this paper, a correlation between easily measurable parameters, DO, temperature, electrical conductivity, pH, precipitation and dependent variables, TN, TP, COD, Chl-a, TSS, Total Coliform is investigated. Simple regression analysis is performed for each season in Eymir and Mogan lakes by using SPSS Statistical program using the water quality data collected between 2006-2012. Regression analysis demonstrated significant linear relationship between measured and simulated concentrations for TN (R2=0.86), TP (R2=0.85), TSS (R2=0.91), Chl-a (R2=0.94), COD (R2=0.99), T. Coliform (R2=0.97) which are the best results in each season for Eymir and Mogan Lakes. The overall results of this study shows that by using easily measurable parameters even in ungauged situation the water quality of lakes can be predicted. Moreover, the outputs obtained from the regression equations can be used as an input for water quality models such as phosphorus budget model which is used to calculate the required reduction in the external phosphorus load to Lake Mogan to meet the water quality standards.

  7. Case reports and case series in prehospital emergency care research.

    PubMed

    Patterson, P Daniel; Weaver, Matthew; Clark, Sunday; Yealy, Donald M

    2010-11-01

    Research begins with a clearly stated question, problem or hypothesis. The selection of a study design appropriate to the task is the next key step. This paper provides guidance for the use of case report and case series designs by describing the 'what', 'when' and 'how' of both designs. Also described is the use of case reports and case series study designs in prehospital emergency research and the quality of published literature from 2000 to mid-2008.

  8. Feasibility of evaluating quality cancer care using registry data and electronic health records: a population-based study.

    PubMed

    Caldarella, Adele; Amunni, Gianni; Angiolini, Catia; Crocetti, Emanuele; Di Costanzo, Francesco; Di Leo, Angelo; Giusti, Francesco; Pegna, Andrea Lopes; Mantellini, Paola; Luzzatto, Lucio; Paci, Eugenio

    2012-08-01

    To evaluate the quality of patients care, a set of indicators of the standards of cancer care were defined. We developed a set of indicators to assess the implementation in daily practice of recommendation produced by a regional network (Istituto Toscano Tumori). This set was tested in a retrospective study in the resident population of the Tuscany Region; the regional health system is organized on 12 local health authorities which refer to three macro areas (Area Vasta). The study included incident colorectal, lung and breast cancer cases listed in 2004 for the Tuscan Cancer Registry, a population-based registry which collected tumor cases diagnosed in all residents in Tuscany. Electronic data from registry database were used to determine the compliance with each indicator for patients in 2004. To validate the results, an ad hoc clinical survey including the same geographical area for the year 2006 was performed. None. The proportion of patients who fulfilled each of the indicators. Our study showed the feasibility of the evaluation of the quality of cancer care using cancer registry population-based data and major computerized information systems. The estimation of the selected indicators confirmed a good homogeneity among areas, and globally revealed a good intraregional performance. Further work is needed to develop specific quality measures, particularly about structural data and to continually revise indicators of quality of care. Data from a cancer registry, however, can be useful to evaluate quality of cancer care.

  9. Constructing Ecological Networks Based on Habitat Quality Assessment: A Case Study of Changzhou, China

    PubMed Central

    Gao, Yu; Ma, Lei; Liu, Jiaxun; Zhuang, Zhuzhou; Huang, Qiuhao; Li, Manchun

    2017-01-01

    Fragmentation and reduced continuity of habitat patches threaten the environment and biodiversity. Recently, ecological networks are increasingly attracting the attention of researchers as they provide fundamental frameworks for environmental protection. This study suggests a set of procedures to construct an ecological network. First, we proposed a method to construct a landscape resistance surface based on the assessment of habitat quality. Second, to analyze the effect of the resistance surface on corridor simulations, we used three methods to construct resistance surfaces: (1) the method proposed in this paper, (2) the entropy coefficient method, and (3) the expert scoring method. Then, we integrated habitat patches and resistance surfaces to identify potential corridors using graph theory. These procedures were tested in Changzhou, China. Comparing the outputs of using different resistance surfaces demonstrated that: (1) different landscape resistance surfaces contribute to how corridors are identified, but only slightly affect the assessment of the importance of habitat patches and potential corridors; (2) the resistance surface, which is constructed based on habitat quality, is more applicable to corridor simulations; and (3) the assessment of the importance of habitat patches is fundamental for ecological network optimization in the conservation of critical habitat patches and corridors. PMID:28393879

  10. Sustainable Improvement of Urban River Network Water Quality and Flood Control Capacity by a Hydrodynamic Control Approach-Case Study of Changshu City

    NASA Astrophysics Data System (ADS)

    Xie, Chen; Yang, Fan; Liu, Guoqing; Liu, Yang; Wang, Long; Fan, Ziwu

    2017-01-01

    Water environment of urban rivers suffers degradation with the impacts of urban expansion, especially in Yangtze River Delta. The water area in cites decreased sharply, and some rivers were cut off because of estate development, which brings the problems of urban flooding, flow stagnation and water deterioration. The approach aims to enhance flood control capability and improve the urban river water quality by planning gate-pump stations surrounding the cities and optimizing the locations and functions of the pumps, sluice gates, weirs in the urban river network. These gate-pump stations together with the sluice gates and weirs guarantee the ability to control the water level in the rivers and creating hydraulic gradient artificially according to mathematical model. Therefore the flow velocity increases, which increases the rate of water exchange, the DO concentration and water body self-purification ability. By site survey and prototype measurement, the river problems are evaluated and basic data are collected. The hydrodynamic model of the river network is established and calibrated to simulate the scenarios. The schemes of water quality improvement, including optimizing layout of the water distribution projects, improvement of the flow discharge in the river network and planning the drainage capacity are decided by comprehensive Analysis. Finally the paper introduces the case study of the approach in Changshu City, where the approach is successfully implemented.

  11. Amalgamation, Expansion, Quality Assurance and Innovations: A Case Study on a Key University in China

    ERIC Educational Resources Information Center

    Zhang, Jingning

    2010-01-01

    The Chinese higher education reform policies since 1993 have been pursued in a centralized, top-down manner, which some theorists characterize as "centralized decentralization" or governmental "steering at distance." This case-study dissertation has two purposes. First, is to evaluate the implementation or the "situated…

  12. COMPARISON OF GEOCODING METHODS USED IN CASE-CONTROL STUDY OF AIR QUALITY AND BIRTH DEFECTS

    EPA Science Inventory

    Introduction: Accurate geocoding of maternal residence is critical to the success of an ongoing case-control study of exposure to five criteria air pollutants and the risk of selected birth defects in seven Texas counties between 1997 and 2000. The geocoded maternal residence a...

  13. Collection of wood quality data by X-ray densitometry: a case study with three southern pines

    Treesearch

    Thomas L. Eberhardt; Lisa J. Samuelson

    2015-01-01

    X-ray densitometry is a technique often used in tree growth and wood quality studies to incrementally measure density (specific gravity) along a radial strip of wood. Protocols for this technique vary between laboratories because of differences in species, equipment, tree age, and other factors. Here, the application of X-ray densitometry is discussed in terms of a...

  14. Creating Quality Improvement Culture in Public Health Agencies

    PubMed Central

    Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

    2014-01-01

    Objectives. We conducted case studies of 10 agencies that participated in early quality improvement efforts. Methods. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007–2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Results. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Conclusions. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies’ ability to create and sustain a quality improvement culture. PMID:24228680

  15. Creating quality improvement culture in public health agencies.

    PubMed

    Davis, Mary V; Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

    2014-01-01

    We conducted case studies of 10 agencies that participated in early quality improvement efforts. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007-2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.

  16. Use of existing systematic reviews for evidence assessments in infectious disease prevention: a comparative case study.

    PubMed

    Harder, Thomas; Remschmidt, Cornelius; Haller, Sebastian; Eckmanns, Tim; Wichmann, Ole

    2016-10-11

    Given limited resources and time constraints, the use of existing systematic reviews (SR) for the development of evidence-based public health recommendations has become increasingly important. Recently, a five-step approach for identifying, analyzing, appraising and using existing SRs based on recent guidance by the US Agency for Healthcare Research and Quality (AHRQ) was proposed within the Project on a Framework for Rating Evidence in Public Health (PRECEPT). However, case studies are needed to test whether this approach is useful, what challenges arise and how problems can be solved. In two case studies, the five-step approach was applied to integrate existing SRs in the development of evidence-based public health recommendations. Case study A focused on the role of neonatal sepsis as a risk factor for adverse neurodevelopmental outcome. Case study B examined the efficacy, effectiveness and safety of influenza vaccination during pregnancy. For each step, we report the approach of the review team, discuss challenges and describe solutions. For case study A, one existing SR was identified, while in case study B four SRs were eligible for analysis. We found that comparison of inclusion criteria alone was sufficient to judge on relevance of SRs in case study A, but not B. Although methodological quality of all identified SRs was acceptable, risk of bias assessments of individual studies included in the SRs had to be repeated in both case studies. Particular challenges appeared in case study B where multiple SRs addressed the same research question. With the help of spreadsheets comparing the characteristics of the existing SR we decided to use the most comprehensive one for our evidence synthesis and supplemented the results with those from the other SRs. In both case studies using the complete SR was not possible. The five-step approach provided useful and structured guidance and should be routinely applied when using existing SRs as a basis for evidence

  17. Quality of laboratory studies assessing effects of Bt-proteins on non-target organisms: minimal criteria for acceptability.

    PubMed

    De Schrijver, Adinda; Devos, Yann; De Clercq, Patrick; Gathmann, Achim; Romeis, Jörg

    2016-08-01

    The potential risks that genetically modified plants may pose to non-target organisms and the ecosystem services they contribute to are assessed as part of pre-market risk assessments. This paper reviews the early tier studies testing the hypothesis whether exposure to plant-produced Cry34/35Ab1 proteins as a result of cultivation of maize 59122 is harmful to valued non-target organisms, in particular Arthropoda and Annelida. The available studies were assessed for their scientific quality by considering a set of criteria determining their relevance and reliability. As a case-study, this exercise revealed that when not all quality criteria are met, weighing the robustness of the study and its relevance for risk assessment is not obvious. Applying a worst-case expected environmental concentration of bioactive toxins equivalent to that present in the transgenic crop, confirming exposure of the test species to the test substance, and the use of a negative control were identified as minimum criteria to be met to guarantee sufficiently reliable data. This exercise stresses the importance of conducting studies meeting certain quality standards as this minimises the probability of erroneous or inconclusive results and increases confidence in the results and adds certainty to the conclusions drawn.

  18. Assessment of data quality and reporting systems for underserved populations: the case of integrated community case management programs in Nigeria.

    PubMed

    Nyangara, Florence M; Hai, Tajrina; Zalisk, Kirsten; Ozor, Lynda; Ufere, Joy; Isiguzo, Chinwoke; Abubakar, Ibrahim Ndaliman

    2018-05-01

    Decision makers are searching for reliable data and best practices to support the implementation and scale-up of the integrated community case management (iCCM) programs in underserved areas to reduce under-five mortality in low-income countries. This study assesses data quality and reporting systems of the World Health Organization supported Rapid Access Expansion program implementing iCCM in Abia and Niger States, Nigeria. This cross-sectional study used data from 16 primary health facilities in both states. Data were collected through review of registers and monthly summary reports of 140 community-oriented resource persons (CORPs), assessments of the five dimensions of the data reporting systems and 46 key informant interviews with stakeholders. Data quality was assessed by availability, completeness and consistency. Each component of the reporting system was assessed on a 3-point scale (weak, satisfactory and strong). Results show that both the structure, functions and capabilities, as well as data collection and reporting tools dimensions of the reporting system were strong, scoring (2.80, 2.73) for Abia and (2.88, 2.75) for Niger, respectively. Data management processes and links with national reporting system components scored low 2 s, indicating fair strength. Data availability, completeness and consistency were found to be good, an indication of adequate training and supervision of CORPs and community health extension workers. Indicator definitions and reporting guidelines were the weakest dimension of the system due to lack of data reporting guidelines in both states. In conclusion, the results indicate satisfactory data reporting systems and good quality data during early implementation of iCCM programs in the two states. Hence, countries planning to adopt and implement iCCM programs should first develop structures, establish national standardized tools for collecting and reporting data, provide for adequate training and supervision of community

  19. Practical Functional Approach to Quality Assessment in Subtitling: "Pocahontas II--Case Study"

    ERIC Educational Resources Information Center

    Hussain, Alaa Eddin; Khuddro, Ahmad

    2016-01-01

    The present research work deals with subtitling errors encountered by simulators and proof-readers. The resultant work is of significant contribution to problem decision makings in the field of quality assessment of audiovisual translation (AVT). The outcome of this paper is the result of accumulated working experience in this domain. The relevant…

  20. Perioperative Care and the Importance of Continuous Quality Improvement—A Controlled Intervention Study in Three Tanzanian Hospitals

    PubMed Central

    Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus–Dieter; Spies, Claudia

    2015-01-01

    Introduction Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. Methods All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Results Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, p<0.001). Postoperative Inpatient Care initially improved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p <0.001), while postoperative care did not significantly change. Anaesthetic Complication Rate in the intervention hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (p<0.0010). Surgical Case Fatality Rate in the control group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Discussion Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program

  1. Perioperative Care and the Importance of Continuous Quality Improvement--A Controlled Intervention Study in Three Tanzanian Hospitals.

    PubMed

    Bosse, Goetz; Abels, Wiltrud; Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus-Dieter; Spies, Claudia

    2015-01-01

    Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, p<0.001). Postoperative Inpatient Care initially improved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p <0.001), while postoperative care did not significantly change. Anaesthetic Complication Rate in the intervention hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (p<0.0010). Surgical Case Fatality Rate in the control group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Specific interventions as part of

  2. Wellness coaching and health-related quality of life: a case-control difference-in-differences analysis.

    PubMed

    Menon, Jyothi; Paulet, Mindy; Thomas, Joseph

    2012-10-01

    Association between wellness coaching and changes in health-related quality of life over 1 year and 2 years was assessed. Difference-in-differences analysis of covariance assessed association between coaching and change in 8-item short-form health survey (SF-8) summary scores. Ordered logistic models assessed coaching and change in SF-8 individual domain scores. This was a case-control study. Participants in at least one coaching program were more likely to have increases in social functioning after 1 year and less likely to have increases in role physical after 2 years. Participants in nutrition coaching had more positive change in mental component summary scores after 1 year. Participants in stress management had more negative change in mental component summary scores after 1 year and after 2 years and had more negative change in physical component summary scores after 2 years. Findings were mixed regarding association between coaching and change in health-related quality of life.

  3. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study

    PubMed Central

    Lovink, Marleen Hermien; Persoon, Anke; van Vught, Anneke JAH; Schoonhoven, Lisette; Koopmans, Raymond TCM; Laurant, Miranda GH

    2017-01-01

    Introduction In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. Methods and analysis This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context–mechanism–outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. Ethics and dissemination The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. PMID

  4. Equity in Reform: Case Studies of Five Middle Schools Involved in Systemic Reform

    NASA Astrophysics Data System (ADS)

    Kahle, Jane Butler; Kelly, Mary Kay

    Science and mathematics education reform documents of the last decade have called for improved teaching and learning for all children. To overcome inequalities, a systemic approach to reform has been adopted. The case studies synthesized in this analysis arc part of a larger effort to reform science and mathematics education systemically and assess the progress of systemic reform. The purpose of this study was to assess the progress toward achieving equitable systemic reform in five middle schools. A multiple-case study design was used, and qualitative data were collected. Kahle's Equity Metric was used to analyze the schools' progress toward achieving equitable systemic reform of mathematics and science. Two results occurred: Various equity issues were identified in the five case studies, and the metric proved efficacious in identifying barriers to or facilitators of equitable reform in the schools. Overall, the study illustrates how schools might assess their commitments to providing high-quality science and mathematics education to all students.

  5. A social marketing approach to quality improvement in family planning services: a case study from Rawalpindi, Pakistan.

    PubMed

    Gulzar, Jamshaid; Ali, Moazzam; Kuroiwa, Chushi

    2008-02-01

    In the 1990s, social marketing approach was introduced in Pakistan to improve the quality and accessibility of family planning methods involving private practitioners. This study measured six quality elements using a Bruce-Jain framework. Cross-sectional survey data were collected from 29 randomly selected Green Star clinics. The study's four components were 1) an inventory of each outlet (infrastructure, equipment, and supplies); 2) an observation guide for interaction between family planning clients and service providers; 3) exit interviews with clients attending the outlet; and 4) interviews with providers at the outlet. Of the 29 clients participating in the exit interviews, 72% were new users of family planning. The clients' mean age was 32 years; all clients were married; 93% had received formal education. Housework was the principal activity of 93% of clients. The mean number of children reported was three. Both hormonal and intrauterine contraceptives (IUCDs) were available in all facilities; 86% of the clients reported being able to obtain their contraceptive of choice. Most facilities had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; the service outlets emphasized mechanisms to ensure continuity of use. Notable shortcomings included a shortage of information on alternative methods, contraindications, and side-effect management, as well as a dearth of registration records. In conclusion, this is a good example of public-private partnership involving private practitioners using a social marketing approach. The quality components of a Bruce-Jain framework were achieved, resulting in a satisfied clientele. Involvement of private service outlets increased the accessibility and enhanced the use of services. Social marketing may be expanded to improve quality and access by involving further components of health care.

  6. Sleep disturbance in psoriasis - a case-controlled study.

    PubMed

    Jensen, P; Zachariae, C; Skov, L; Zachariae, R

    2018-04-28

    Sleep is essential for daytime functioning and health. Given the physical symptoms of psoriasis, a higher prevalence of sleep disorders could be expected. So far, the studies examining sleep disturbance in psoriasis have been of less-than-optimal methodological quality and with mixed results. We aimed to: 1) examine the prevalence of sleep disturbance in patients with plaque psoriasis compared to controls, 2) evaluate associations with health-related quality of life (HRQoL), and 3) examine possible disease-related predictors of disturbed sleep. We used a cross-sectional, case-controlled design. Participants included 179 consecutively recruited patients with plaque psoriasis and 105 controls. Measures included psoriasis severity (Psoriasis Area and Severity index [PASI]); HRQoL (Dermatology Life Quality Index [DLQI]); insomnia severity (Insomnia Severity Index [ISI]); sleep quality (Pittsburgh Sleep Quality Index [PSQI]); stress (Perceived Stress Scale [PSS]); Itch (Itch Severity Scale [ISS]); and depressive symptoms (Beck Depression Inventory [BDI]). Analyses included group comparisons and regression analyses to identify predictors of sleep disturbance. Twenty-five per cent of patients with psoriasis reported clinical insomnia (ISI > 15), compared with 10.5% of controls. In all, 53.9% of patients with psoriasis were poor sleepers (PSQI > 5), compared with 21.9% of controls. Itch was statistically significantly associated with all sleep-related outcomes. A higher proportion of patients with psoriasis suffer from poor sleep than controls from the general population. Itch was the main predictor of impaired sleep. Improved control of psoriasis with decreased itch may improve sleep disturbance in psoriasis. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  7. Case study approach to modeling historical disinfection by-product exposure in Iowa drinking waters.

    PubMed

    Krasner, Stuart W; Cantor, Kenneth P; Weyer, Peter J; Hildesheim, Mariana; Amy, Gary

    2017-08-01

    In the 1980s, a case-control epidemiologic study was conducted in Iowa (USA) to analyze the association between exposure to disinfection by-products (DBPs) and bladder cancer risk. Trihalomethanes (THMs), the most commonly measured and dominant class of DBPs in drinking water, served as a primary metric and surrogate for the full DBP mixture. Average THM exposure was calculated, based on rough estimates of past levels in Iowa. To reduce misclassification, a follow-up study was undertaken to improve estimates of past THM levels and to re-evaluate their association with cancer risk. In addition, the risk associated with haloacetic acids, another class of DBPs, was examined. In the original analysis, surface water treatment plants were assigned one of two possible THM levels depending on the point of chlorination. The re-assessment considered each utility treating surface or groundwater on a case-by-case basis. Multiple treatment/disinfection scenarios and water quality parameters were considered with actual DBP measurements to develop estimates of past levels. The highest annual average THM level in the re-analysis was 156μg/L compared to 74μg/L for the original analysis. This allowed the analysis of subjects exposed at higher levels (>96μg/L). The re-analysis established a new approach, based on case studies and an understanding of the water quality and operational parameters that impact DBP formation, for determining historical exposure. Copyright © 2017. Published by Elsevier B.V.

  8. Improving healthcare services using web based platform for management of medical case studies.

    PubMed

    Ogescu, Cristina; Plaisanu, Claudiu; Udrescu, Florian; Dumitru, Silviu

    2008-01-01

    The paper presents a web based platform for management of medical cases, support for healthcare specialists in taking the best clinical decision. Research has been oriented mostly on multimedia data management, classification algorithms for querying, retrieving and processing different medical data types (text and images). The medical case studies can be accessed by healthcare specialists and by students as anonymous case studies providing trust and confidentiality in Internet virtual environment. The MIDAS platform develops an intelligent framework to manage sets of medical data (text, static or dynamic images), in order to optimize the diagnosis and the decision process, which will reduce the medical errors and will increase the quality of medical act. MIDAS is an integrated project working on medical information retrieval from heterogeneous, distributed medical multimedia database.

  9. Enhancing mathematics teachers' quality through Lesson Study.

    PubMed

    Lomibao, Laila S

    2016-01-01

    The efficiency and effectivity of the learning experience is dependent on the teacher quality, thus, enhancing teacher's quality is vital in improving the students learning outcome. Since, the usual top-down one-shot cascading model practice for teachers' professional development in Philippines has been observed to have much information dilution, and the Southeast Asian Ministers of Education Organization demanded the need to develop mathematics teachers' quality standards through the Southeast Asia Regional Standards for Mathematics Teachers (SEARS-MT), thus, an intensive, ongoing professional development model should be provided to teachers. This study was undertaken to determine the impact of Lesson Study on Bulua National High School mathematics teachers' quality level in terms of SEARS-MT dimensions. A mixed method of quantitative-qualitative research design was employed. Results of the analysis revealed that Lesson Study effectively enhanced mathematics teachers' quality and promoted teachers professional development. Teachers positively perceived Lesson Study to be beneficial for them to become a better mathematics teacher.

  10. Designing image segmentation studies: Statistical power, sample size and reference standard quality.

    PubMed

    Gibson, Eli; Hu, Yipeng; Huisman, Henkjan J; Barratt, Dean C

    2017-12-01

    Segmentation algorithms are typically evaluated by comparison to an accepted reference standard. The cost of generating accurate reference standards for medical image segmentation can be substantial. Since the study cost and the likelihood of detecting a clinically meaningful difference in accuracy both depend on the size and on the quality of the study reference standard, balancing these trade-offs supports the efficient use of research resources. In this work, we derive a statistical power calculation that enables researchers to estimate the appropriate sample size to detect clinically meaningful differences in segmentation accuracy (i.e. the proportion of voxels matching the reference standard) between two algorithms. Furthermore, we derive a formula to relate reference standard errors to their effect on the sample sizes of studies using lower-quality (but potentially more affordable and practically available) reference standards. The accuracy of the derived sample size formula was estimated through Monte Carlo simulation, demonstrating, with 95% confidence, a predicted statistical power within 4% of simulated values across a range of model parameters. This corresponds to sample size errors of less than 4 subjects and errors in the detectable accuracy difference less than 0.6%. The applicability of the formula to real-world data was assessed using bootstrap resampling simulations for pairs of algorithms from the PROMISE12 prostate MR segmentation challenge data set. The model predicted the simulated power for the majority of algorithm pairs within 4% for simulated experiments using a high-quality reference standard and within 6% for simulated experiments using a low-quality reference standard. A case study, also based on the PROMISE12 data, illustrates using the formulae to evaluate whether to use a lower-quality reference standard in a prostate segmentation study. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  11. Assessment of groundwater quality at a MSW landfill site using standard and AHP based water quality index: a case study from Ranchi, Jharkhand, India.

    PubMed

    Chakraborty, Shubhrasekhar; Kumar, R Naresh

    2016-06-01

    Landfill leachate generated from open MSW dumpsite can cause groundwater contamination. The impact of open dumping of MSW on the groundwater of adjacent area was studied. To assess the spatial and temporal variations in groundwater quality, samples were collected around an open MSW dumping site in Ranchi city, Jharkhand, India. Groundwater samples were analysed for various physicochemical and bacteriological parameters for 1 year. Results indicated that the groundwater is getting contaminated due to vertical and horizontal migration of landfill leachate. Extent of contamination was higher in areas closer to the landfill as indicated by high alkalinity, total dissolved solids and ammonia concentration. Metals such as lead, iron, and manganese were present at concentrations of 0.097, 0.97 and 0.36 mg/L, respectively exceeding the Bureau of Indian Standards (BIS) 10,500 for drinking water. Enterobacteriaceae were also detected in several groundwater samples and highest coliform count of 2.1×10(4) CFU/mL was recorded from a dug well. In order to determine the overall groundwater quality, water quality index (WQI) was calculated using weighted arithmetic index method and this index was further modified by coupling with the analytical hierarchy process (AHP) to get specific information. WQI values indicated that the overall groundwater quality of the region came under "poor" category while zone wise classification indicated the extent of impact of landfill leachate on groundwater.

  12. Quality and learning aspects of the first 9000 spirometries of the LifeGene study.

    PubMed

    Qvarfordt, Mikaela; Anderson, Martin; Svartengren, Magnus

    2018-02-19

    Spirometry requires the patient to cooperate and do the manoeuvre 'right' for reliable results. Algorithms to assess test quality as well as educational recommendations for personnel are defined in guidelines. We compared the quality of forced spirometry tests performed by spirometry technicians with little or no previous experience of spirometry using spirometry systems with different modes of feedback. In both cases, the spirometry technician received general feedback on the screen based on ATS/ERS guidelines, such as 'exhale faster' and 'exhale longer'. The major difference was whether quality grading system of the complete session was available simultaneously on screen, or in the printed report afterwards. Two parts of the same population-based study (LifeGene), the pilot (LG1) and the first part (LG2) of the subsequent study, were compared retrospectively. In LG1 (on-screen grading) approved examination quality was achieved for 88% of the 10 first subjects for each spirometry technician compared to 70% in LG2 (printed grading afterwards). The corresponding values after 40 subjects was 94 % in LG1, compared to 73% in LG2, and after the first ten subjects there was no apparent quality improvement in either LG1 or LG2. The quality for LG1 is among the highest reported in the literature even though the spirometry technician were relatively inexperienced. We conclude that on-screen grading in addition to general technical quality feedback is powerful in enhancing the spirometry test session quality.

  13. Improving Quality and Safety of Care Using “Technovigilance”: An Ethnographic Case Study of Secondary Use of Data from an Electronic Prescribing and Decision Support System

    PubMed Central

    Dixon-Woods, Mary; Redwood, Sabi; Leslie, Myles; Minion, Joel; Martin, Graham P; Coleman, Jamie J

    2013-01-01

    Context “Meaningful use” of electronic health records to improve quality of care has remained understudied. We evaluated an approach to improving patients’ safety and quality of care involving the secondary use of data from a hospital electronic prescribing and decision support system (ePDSS). Methods We conducted a case study of a large English acute care hospital with a well-established ePDSS. Our study was based on ethnographic observations of clinical settings (162 hours) and meetings (28 hours), informal conversations with clinical staff, semistructured interviews with ten senior executives, and the collection of relevant documents. Our data analysis was based on the constant comparative method. Findings This hospital's approach to quality and safety could be characterized as “technovigilance.” It involved treating the ePDSS as a warehouse of data on clinical activity and performance. The hospital converted the secondary data into intelligence about the performance of individuals, teams, and clinical services and used this as the basis of action for improvement. Through a combination of rapid audit, feedback to clinical teams, detailed and critical review of apparent omissions in executive-led meetings, a focus on personal professional responsibility for patients’ safety and quality care, and the correction of organizational or systems defects, technovigilance was—based on the hospital's own evidence—highly effective in improving specific indicators. Measures such as the rate of omitted doses of medication showed marked improvement. As do most interventions, however, technovigilance also had unintended consequences. These included the risk of focusing attention on aspects of patient safety made visible by the system at the expense of other, less measurable but nonetheless important, concerns. Conclusions The secondary use of electronic data can be effective for improving specific indicators of care if accompanied by a range of interventions to

  14. Case Study: Mini-Case Studies: Small Infusions of Active Learning for Large-Lecture Courses

    ERIC Educational Resources Information Center

    Carloye, Lisa

    2017-01-01

    In this article, the author introduces the usage of case studies to be an excellent method for engaging students through stories. The author notes she developed a series of mini-case studies that can be implemented, with a little advance preparation, within a 10- to 15-minute window during lecture. What makes them "mini" case studies?…

  15. Increased capture of pediatric surgical complications utilizing a novel case-log web application to enhance quality improvement.

    PubMed

    Fisher, Jason C; Kuenzler, Keith A; Tomita, Sandra S; Sinha, Prashant; Shah, Paresh; Ginsburg, Howard B

    2017-01-01

    Documenting surgical complications is limited by multiple barriers and is not fostered in the electronic health record. Tracking complications is essential for quality improvement (QI) and required for board certification. Current registry platforms do not facilitate meaningful complication reporting. We developed a novel web application that improves accuracy and reduces barriers to documenting complications. We deployed a custom web application that allows pediatric surgeons to maintain case logs. The program includes a module for entering complication data in real time. Reminders to enter outcome data occur at key postoperative intervals to optimize recall of events. Between October 1, 2014, and March 31, 2015, frequencies of surgical complications captured by the existing hospital reporting system were compared with data aggregated by our application. 780 cases were captured by the web application, compared with 276 cases registered by the hospital system. We observed an increase in the capture of major complications when compared to the hospital dataset (14 events vs. 4 events). This web application improved real-time reporting of surgical complications, exceeding the accuracy of administrative datasets. Custom informatics solutions may help reduce barriers to self-reporting of adverse events and improve the data that presently inform pediatric surgical QI. Diagnostic study/Retrospective study. Level III - case control study. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Open-refrigerated retail display case temperature profile and its impact on product quality and microbiota of stored baby spinach

    USDA-ARS?s Scientific Manuscript database

    Open-refrigerated display cabinets are widely used in supermarkets and grocery chains around the globe. However, the temperature conditions in these display cases are variable which may impact product quality and safety. Therefore, we investigated the quality and microbiological populations of bagge...

  17. Questionnaire-based assessment of executive functioning: Case studies.

    PubMed

    Kronenberger, William G; Castellanos, Irina; Pisoni, David B

    2018-01-01

    Delays in the development of executive functioning skills are frequently observed in pediatric neuropsychology populations and can have a broad and significant impact on quality of life. As a result, assessment of executive functioning is often relevant for the development of formulations and recommendations in pediatric neuropsychology clinical work. Questionnaire-based measures of executive functioning behaviors in everyday life have unique advantages and complement traditional neuropsychological measures of executive functioning. Two case studies of children with spina bifida are presented to illustrate the clinical use of a new questionnaire measure of executive and learning-related functioning, the Learning, Executive, and Attention Functioning Scale (LEAF). The LEAF emphasizes clinical utility in assessment by incorporating four characteristics: brevity in administration, breadth of additional relevant content, efficiency of scoring and interpretation, and ease of availability for use. LEAF results were consistent with another executive functioning checklist in documenting everyday behavior problems related to working memory, planning, and organization while offering additional breadth of assessment of domains such as attention, processing speed, and novel problem-solving. These case study results demonstrate the clinical utility of questionnaire-based measurement of executive functioning in pediatric neuropsychology and provide a new measure for accomplishing this goal.

  18. Early recognition of Cushing's disease: a case study.

    PubMed

    Iuliano, Sherry L; Laws, Edward R

    2013-08-01

    To present a case study of a 34-year-old woman with Cushing's disease and provide nurse practitioners (NPs) with the understanding of the clinical presentation needed for early recognition and treatment of the disease. A comprehensive review of published literature on Cushing's disease. Findings from history, physical examination, and diagnostic studies of a woman presenting to primary care NPs, physicians and other healthcare providers with multiple symptoms of Cushing's disease. Cushing's disease is the result of the pituitary gland producing excess amounts of adrenocorticotropic hormone (ACTH) causing the overproduction of cortisol. The disease is fairly rare and is seen mostly in women. Common chief complaints include increased facial hair, weight gain, amenorrhea, changes in the face, neck, and abdomen, with muscle wasting of the lower extremities. Untreated, diabetes mellitus and hypertension can occur and increase the patient's morbidity and mortality. Early recognition and appropriate referral can reverse the signs and symptoms over time and lead to a significantly improved quality of life. This case presented the challenges faced by NPs and physicians in diagnosing patients with Cushing's disease. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  19. A case study of a team-based, quality-focused compensation model for primary care providers.

    PubMed

    Greene, Jessica; Hibbard, Judith H; Overton, Valerie

    2014-06-01

    In 2011, Fairview Health Services began replacing their fee-for-service compensation model for primary care providers (PCPs), which included an annual pay-for-performance bonus, with a team-based model designed to improve quality of care, patient experience, and (eventually) cost containment. In-depth interviews and an online survey of PCPs early after implementation of the new model suggest that it quickly changed the way many PCPs practiced. Most PCPs reported a shift in orientation toward quality of care, working more collaboratively with their colleagues and focusing on their full panel of patients. The majority reported that their quality of care had improved because of the model and that their colleagues' quality had to. The comprehensive change did, however, result in lower fee-for-service billing and reductions in PCP satisfaction. While Fairview's compensation model is still a work in progress, their early experiences can provide lessons for other delivery systems seeking to reform PCP compensation.

  20. Sleep disturbances in fibromyalgia: A meta-analysis of case-control studies.

    PubMed

    Wu, Yu-Lin; Chang, Ling-Yin; Lee, Hsin-Chien; Fang, Su-Chen; Tsai, Pei-Shan

    2017-05-01

    Sleep disturbances are common in fibromyalgia, but the features of sleep disturbances are not well understood. We performed a systematic review and meta-analysis of case-control studies to compare the sleep outcomes of individuals with fibromyalgia and healthy controls. We systematically searched eight databases (PubMed, Ovid MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, Airiti Library and Wanfang Data) for articles published before April 2016. Twenty-five case-controlled studies and a total of 2086 participants were included in the meta-analysis. Sleep was assessed using polysomnography and the Pittsburgh Sleep Quality Index. When sleep was assessed using polysomnography (19 studies), significant differences were observed in wake time after sleep onset (g=0.81, 95% confidence interval [CI] 0.21-1.41), total sleep time (g=-0.78, 95% CI=-1.34 to -0.15), sleep efficiency (g=-0.78, 95% CI=-1.23 to -0.32), percentage of stage 1 sleep (g=0.55, 95% CI=0.15-0.95), and percentage of slow-wave sleep (g=-0.66, 95% CI=-1.21 to -0.12) between participants with fibromyalgia and healthy controls. When sleep was assessed using the Pittsburgh Sleep Quality Index (7 studies), significant differences were observed in global scores (g=2.19, 95% CI 1.58-2.79), sleep onset latency (g=1.75, 95% CI 0.80-2.70), and sleep efficiency (g=-1.08, 95% CI -1.65 to -0.51) between participants with fibromyalgia and healthy controls. Individuals with fibromyalgia experience lower sleep quality and sleep efficiency; longer wake time after sleep onset, short sleep duration, and light sleep when objectively assessed and more difficulty in initiating sleep when subjectively assessed. Sleep difficulties in fibromyalgia appear to be more when reported subjectively than when assessed objectively. This study received no funding from any source. All authors declare that they have no conflict of interest. This article does not contain any studies with human participants performed by any of the authors

  1. Engaging Employers to Develop Quality in Higher Education: The Case of Communication Studies in Italy

    ERIC Educational Resources Information Center

    Romenti, Stefania; Invernizzi, Emanuele; Biraghi, Silvia

    2012-01-01

    This paper explores how employer engagement can enhance potential employability of graduates, which represents a fundamental institutional achievement to ameliorate quality of higher education. While the role of student and staff engagement in quality improvement has received in-depth research attention, the need for listening to expectations of…

  2. Nanomaterial synthesis and characterization for toxicological studies: TiO2 case study

    USGS Publications Warehouse

    Valsami-Jones, E.; Berhanu, D.; Dybowska, A.; Misra, S.; Boccaccini, A.R.; Tetley, T.D.; Luoma, S.N.; Plant, J.A.

    2008-01-01

    In recent years it has become apparent that the novel properties of nanomaterials may predispose them to a hitherto unknown potential for toxicity. A number of recent toxicological studies of nanomaterials exist, but these appear to be fragmented and often contradictory. Such discrepancies may be, at least in part, due to poor description of the nanomaterial or incomplete characterization, including failure to recognise impurities, surface modifications or other important physicochemical aspects of the nanomaterial. Here we make a case for the importance of good quality, well-characterized nanomaterials for future toxicological studies, combined with reliable synthesis protocols, and we present our efforts to generate such materials. The model system for which we present results is TiO2 nanoparticles, currently used in a variety of commercial products. ?? 2008 The Mineralogical Society.

  3. A case-control study of self-reported health, quality-of-life and general functioning among recent immigrants and age- and sex-matched Swedish-born controls.

    PubMed

    Löfvander, Monica; Rosenblad, Andreas; Wiklund, Tony; Bennström, Halina; Leppert, Jerzy

    2014-12-01

    To examine whether new immigrants had inferior quality-of-life, well-being and general functioning compared with Swedish age- and sex-matched controls. A prospective case-control study was designed including immigrants from non-European countries, 18-65 years of age, with recent Permanent Permits to Stay (PPS) in Sweden, and age- and sex-matched Swedish-born (SB) persons from the general population in Västmanland County, Sweden. The General Health Questionnaire (GHQ-12), the brief version of the World Health Organization Quality-of-Life (WHOQOL-BREF) Scale and the General Activity Functioning Assessment Scale (GAF) from DSM-IV were posted (SB), or applied in personal interviews (PPS) with interpreters. Differences between the PPS and SB groups were measured using McNemar's test and Wilcoxon signed-rank test conducted separately for observations at baseline, 6- and 12-month follow-up. There were 93 pairs (mean age 36 years). Persons from Somalia (67%) and Iraq (27%) dominated the PPS group. The differences between the groups were statistically significant for all time points for the Psychological health and Social relationship domains of WHOQOL-BREF, and for the baseline and 6-month follow-up time points of GHQ-12 where the PPS-group had a higher degree of well-being, health and quality-of-life than the SB. This tendency applied for both sexes in the immigrant group. These new immigrants did not have inferior physical or psychological health, quality-of-life, well-being or social functioning compared with their age- and sex-matched Swedish born pairs during a 1-year follow-up. Thus, there is reason to advocate immigrants' fast integration into society. © 2014 the Nordic Societies of Public Health.

  4. Case Study: South Texas Veterans Health Care System’s Communication Center

    DTIC Science & Technology

    2008-07-14

    appropriate access to health care; technical quality is providing world-class care to our veterans; customer satisfaction is ensuring the STVHCS patients and...were not called. These results not only improved access to health care, but also positively affected customer service. 111 Case Study: South Texas...increased waiting times for the patient . With current regulatory requirements calling for improved access to health care services, many hospital and

  5. Comparative Case Studies on Indonesian Higher Education Rankings

    NASA Astrophysics Data System (ADS)

    Kurniasih, Nuning; Hasyim, C.; Wulandari, A.; Setiawan, M. I.; Ahmar, A. S.

    2018-01-01

    The quality of the higher education is the result of a continuous process. There are many indicators that can be used to assess the quality of a higher education. The existence of different indicators makes the different result of university rankings. This research aims to find variables that can connect ranking indicators that are used by Indonesian Ministry of Research, Technology, and Higher Education with indicators that are used by international rankings by taking two kind of ranking systems i.e. Webometrics and 4icu. This research uses qualitative research method with comparative case studies approach. The result of the research shows that to bridge the indicators that are used by Indonesian Ministry or Research, Technology, and Higher Education with web-based ranking system like Webometrics and 4icu so that the Indonesian higher education institutions need to open access towards either scientific or non-scientific that are publicly used into web-based environment. One of the strategies that can be used to improve the openness and access towards scientific work of a university is by involving in open science and collaboration.

  6. Study on regional air quality impact from a chemical plant emergency shutdown.

    PubMed

    Ge, Sijie; Wang, Sujing; Xu, Qiang; Ho, Thomas

    2018-06-01

    Emergency shutdowns of chemical plants (ESCP) inevitably generate intensive and huge amounts of VOCs and NO x emissions through flaring that can cause highly localized and transient air pollution events with elevated ozone concentrations. However, quantitative studies of regional ozone impact due to ESCP, in terms of how ESCP would affect and to what extent ESCP could impact, are still lacking. This paper reports a systematic study on regional air quality impact from an olefin plant emergency shutdown due to the sudden failure of its cracked gas compressor (CGC). It demonstrates that emergency shutdown may cause significant ozone increment subject to different factors such as the starting time of emergency shutdown, flare destruction and removal efficiency (DRE) and plant location. In our studied case, the 8-hr ozone increment ranges from 0.4 to 3.3 ppb under different starting time, from 3.3 to 24.8 ppb under different DRE, and from 1.6 to 3.3 ppb under different locations. The results enable us to understand how and to what extent emergency operating activities of the chemical process will affect local air quality, which might be beneficial for decision makings on emergency air-quality response and control in the future. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. Evaluation of quality of precipitation products: A case study using WRF and IMERG data over the central United States

    NASA Astrophysics Data System (ADS)

    Zhang, J.; Lin, L. F.; Bras, R. L.

    2017-12-01

    Hydrological applications rely on the availability and quality of precipitation products, specially model- and satellite-based products for use in areas without ground measurements. It is known that the quality of model- and satellite-based precipitation products are complementary—model-based products exhibiting high quality during winters while satellite-based products seem to be better during summers. To explore that behavior, this study uses 2-m air temperature as auxiliary information to evaluate high-resolution (0.1°×0.1° every hour) precipitation products from Weather Research and Forecasting (WRF) simulations and from version-4 Integrated Multi-satellite Retrievals for GPM (IMERG) early and final runs. The products are evaluated relative to the reference NCEP Stage IV precipitation estimates over the central United States in 2016. The results show that the WRF and IMERG final-run estimates are nearly unbiased while the IMERG early-run estimates positively biased. The results also show that the WRF estimates exhibit high correlations with the reference data when the temperature falls below 280°K and the IMERG estimates (i.e., both early and final runs) do so when the temperature exceeds 280°K. Moreover, the temperature threshold of 280°K, which distinguishes the quality of the WRF and the IMERG products, does not vary significantly with either season or location. This study not only adds insight into current precipitation research on the quality of precipitation products but also suggests a simple way for choosing either a model- or satellite-based product or a hybrid model/satellite product for applications.

  8. Case Studies Behavior Modification.

    ERIC Educational Resources Information Center

    Wark, David M.

    The case histories of five students enrolled in a university course in how to study are reported. The students ranged in age from 18 to 35, included two males and three females, and varied in school experience from no college in one case and some college in two cases to college degrees in two cases. Students were initially taught to chart their…

  9. Mentoring for Quality Improvement: A Case Study of a Mentor Teacher in the Reform Process

    ERIC Educational Resources Information Center

    Ryan, Sharon; Hornbeck, Amy

    2004-01-01

    As qualified teachers are central to children receiving a high-quality preschool education, many policy initiatives aimed at improving program quality are thwarted when insufficient attention is paid to the professional development of the workforce. One response to this issue has been to create teacher leadership roles so that teachers mentor…

  10. Robust Decision Making to Support Water Quality Climate Adaptation: a Case Study in the Chesapeake Bay Watershed

    NASA Astrophysics Data System (ADS)

    Fischbach, J. R.; Lempert, R. J.; Molina-Perez, E.

    2017-12-01

    The U.S. Environmental Protection Agency (USEPA), together with state and local partners, develops watershed implementation plans designed to meet water quality standards. Climate uncertainty, along with uncertainty about future land use changes or the performance of water quality best management practices (BMPs), may make it difficult for these implementation plans to meet water quality goals. In this effort, we explored how decision making under deep uncertainty (DMDU) methods such as Robust Decision Making (RDM) could help USEPA and its partners develop implementation plans that are more robust to future uncertainty. The study focuses on one part of the Chesapeake Bay watershed, the Patuxent River, which is 2,479 sq km in area, highly urbanized, and has a rapidly growing population. We simulated the contribution of stormwater contaminants from the Patuxent to the overall Total Maximum Daily Load (TMDL) for the Chesapeake Bay under multiple scenarios reflecting climate and other uncertainties. Contaminants considered included nitrogen, phosphorus, and sediment loads. The assessment included a large set of scenario simulations using the USEPA Chesapeake Bay Program's Phase V watershed model. Uncertainties represented in the analysis included 18 downscaled climate projections (based on 6 general circulation models and 3 emissions pathways), 12 land use scenarios with different population projections and development patterns, and alternative assumptions about BMP performance standards and efficiencies associated with different suites of stormwater BMPs. Finally, we developed cost estimates for each of the performance standards and compared cost to TMDL performance as a key tradeoff for future water quality management decisions. In this talk, we describe how this research can help inform climate-related decision support at USEPA's Chesapeake Bay Program, and more generally how RDM and other DMDU methods can support improved water quality management under climate

  11. Changes in health-related quality of life and quality of care among terminally ill cancer patients and survival prediction: Multicenter prospective cohort study.

    PubMed

    Lee, Myung Kyung; Lee, Woo Jin; Do, Young Rok; Lee, Keun Seok; Jung, Kyung Hae; Heo, Dae Seog; Kim, Sam Yong; Park, Sang Yoon; Jeong, Hyun Sik; Kang, Jung Hun; Kim, Si-Young; Park, Sook Ryun; Yun, Young Ho

    2015-08-01

    This study examined changes in health-related quality of life (HRQoL) and quality of care (QoC) as perceived by terminally ill cancer patients and a stratified set of HRQoL or QoC factors that are most likely to influence survival at the end of life (EoL). We administered questionnaires to 619 consecutive patients immediately after they were diagnosed with terminal cancer by physicians at 11 university hospitals and at the National Cancer Center in Korea. Subjects were followed up over 161.2 person-years until their deaths. We measured HRQoL using the core 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and QoC using the Quality Care Questionnaire-End of Life (QCQ-EoL). We evaluated changes in HRQoL and QoC issues during the first three months after enrollment, performing sensitivity analysis by using data generated via four methods (complete case analysis, available case analysis, the last observation carried forward, and multiple imputation). Emotional and cognitive functioning decreased significantly over time, while dyspnea, constipation, and pain increased significantly. Dignity-conserving care, care by healthcare professionals, family relationships, and QCQ-EoL total score decreased significantly. Global QoL, appetite loss, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores were significantly associated with survival. Future standardization of palliative care should be focused on assessment of these deteriorated types of quality. Accurate estimates of the length of life remaining for terminally ill cancer patients by such EoL-enhancing factors as global QoL, appetite loss, and ECOG-PS are needed to help patients experience a dignified and comfortable death.

  12. Indoor air quality in green buildings: A case-study in a residential high-rise building in the northeastern United States.

    PubMed

    Xiong, Youyou; Krogmann, Uta; Mainelis, Gediminas; Rodenburg, Lisa A; Andrews, Clinton J

    2015-01-01

    Improved indoor air quality (IAQ) is one of the critical components of green building design. Green building tax credit (e.g., New York State Green Building Tax Credit (GBTC)) and certification programs (e.g., Leadership in Energy & Environmental Design (LEED)) require indoor air quality measures and compliance with allowable maximum concentrations of common indoor air pollutants. It is not yet entirely clear whether compliance with these programs results in improved IAQ and ultimately human health. As a case in point, annual indoor air quality measurements were conducted in a residential green high-rise building for five consecutive years by an industrial hygiene contractor to comply with the building's GBTC requirements. The implementation of green design measures resulted in better IAQ compared to data in references of conventional homes for some parameters, but could not be confirmed for others. Relative humidity and carbon dioxide were satisfactory according to existing standards. Formaldehyde levels during four out of five years were below the most recent proposed exposure limits found in the literature. To some degree, particulate matter (PM) levels were lower than that in studies from conventional residential buildings. Concentrations of Volatile Organic Compounds (VOCs) with known permissible exposure limits were below levels known to cause chronic health effects, but their concentrations were inconclusive regarding cancer health effects due to relatively high detection limits. Although measured indoor air parameters met all IAQ maximum allowable concentrations in GBTC and applicable LEED requirements at the time of sampling, we argue that these measurements were not sufficient to assess IAQ comprehensively because more sensitive sampling/analytical methods for PM and VOCs are needed; in addition, there is a need for a formal process to ensure rigor and adequacy of sampling and analysis methods. Also, we suggest that a comprehensive IAQ assessment should

  13. The impact of type 2 diabetes on health related quality of life in Bangladesh: results from a matched study comparing treated cases with non-diabetic controls.

    PubMed

    Safita, Novie; Islam, Sheikh Mohammed Shariful; Chow, Clara K; Niessen, Louis; Lechner, Andreas; Holle, Rolf; Laxy, Michael

    2016-09-13

    Little is known about the association between diabetes and health related quality of life (HRQL) in lower-middle income countries. This study aimed to investigate HRQL among individuals with and without diabetes in Bangladesh. The analysis is based on data of a case-control study, including 591 patients with type 2 diabetes (cases) who attended an outpatient unit of a hospital in Dhaka and 591 age -and sex-matched individuals without diabetes (controls). Information about socio-demographic characteristics, health conditions, and HRQL were assessed in a structured interview. HRQL was measured with the EuroQol (EQ) visual analogue scale (VAS) and the EQ five-dimensional (5D) descriptive system. The association between diabetes status and quality of life was examined using multiple linear and logistic regression models. Mean EQ-VAS score of patients with diabetes was 11.5 points lower (95 %-CI: -13.5, -9.6) compared to controls without diabetes. Patients with diabetes were more likely to report problems in all EQ-5D dimensions than controls, with the largest effect observed in the dimensions 'self-care' (OR = 5.9; 95 %-CI: 2.9, 11.8) and 'mobility' (OR = 4.5; 95 %-CI: 3.0, -6.6). In patients with diabetes, male gender, high education, and high-income were associated with higher VAS score and diabetes duration and foot ulcer associated with lower VAS scores. Other diabetes-related complications were not significantly associated with HRQL. Our findings suggest that the impact of diabetes on HRQL in the Bangladeshi population is much higher than what is known from western populations and that unlike in western populations comorbidities/complications are not the driving factor for this effect.

  14. Promoting Student Achievement: A Case Study of Change Actions Employed by an Urban School Superintendent

    ERIC Educational Resources Information Center

    Bealer, David E.

    2010-01-01

    The purpose of this study was to examine the change strategies and actions taken by an urban district superintendent to improve student achievement. In a qualitative case study of a large urban school district, one research question and three subquestions focused on: 10 specific reform strategies to improve student achievement, how the quality and…

  15. How To Set Up Your Own Small Business. Service Company Case Study. Manufacturing Firm Case Study. Retail Store Case Study.

    ERIC Educational Resources Information Center

    Fallek, Max

    This collection of case studies is intended for use in a course in setting up a small business. The first, a case study of the process of setting up a service company, covers analyzing the pros and cons of starting one's own business, assessing the competition and local market, and selecting a site for and financing the business. The principal…

  16. Natural Learning Case Study Archives

    ERIC Educational Resources Information Center

    Lawler, Robert W.

    2015-01-01

    Natural Learning Case Study Archives (NLCSA) is a research facility for those interested in using case study analysis to deepen their understanding of common sense knowledge and natural learning (how the mind interacts with everyday experiences to develop common sense knowledge). The database comprises three case study corpora based on experiences…

  17. [Breast cancer screening process indicators in Mexico: a case study].

    PubMed

    Uscanga-Sánchez, Santos; Torres-Mejía, Gabriela; Ángeles-Llerenas, Angélica; Domínguez-Malpica, Raúl; Lazcano-Ponce, Eduardo

    2014-01-01

    To identify, measure and compare the performance indicators of productivity, effective access and quality service for the early detection breast cancer program in Mexico. By means of a study case based on the 2011 Women Cancer Information System (SICAM), the indicators were measured and compared with the Mexican official standard NOM-041-SSA2-2011 and international standards. The analysis showed insufficient installed capacity (37%), low coverage in screening (15%), diagnostic evaluation (16%), biopsy (44%) and treatment (57%), and very low effectiveness in confirmed cases by the total number of screening mammograms performed (0.04%). There was no information available, from SICAM, to estimate the rest of the indicators proposed. Efficient health information systems are required in order to monitor indicators and generate performance observatories of screening programs.

  18. Studies on effect of additives on protein profile, microstructure and quality characteristics of pasta.

    PubMed

    Purnima, C; Ramasarma, P R; Prabhasankar, P

    2012-02-01

    Wheat storage proteins play a vital role in pasta making quality. In the present study, SDS-PAGE, Gel filtration chromatography and Scanning electron microscopy techniques were employed to understand the changes in the wheat protein fractions and their interactions with additives namely Sodium Steroyl Lactate (SSL), Glycerol Monostearate (GMS) and Hydroxy Propyl Methyl Cellulose (HPMC) during processing of pasta. SDS-PAGE studies indicated changes in High Molecular Weight Glutenin (HMW) fractions during drying stages of pasta preparation and in cooked pasta samples. In uncooked pasta, gel filtration patterns showed four peaks corresponding to different storage proteins whereas in the case of cooked pasta, these peaks were merged into three peaks. Pasta quality characteristics studies indicated that pasta with HPMC was found to have minimum percentage of cooking loss (5.6%), increased cooked weight (82 g), firmness (2.97 N) and high overall quality score (27) than GMS, SSL and control. Microstructure studies confirm the beneficial effect of HPMC. The present study indicated that HPMC is better additive for pasta manufacture followed by GMS. This could be due to interaction of HPMC with starch and protein matrix is different from that of GMS and SSL.

  19. Biological Water Quality Criteria

    EPA Pesticide Factsheets

    Page contains links to Technical Documents pertaining to Biological Water Quality Criteria, including, technical assistance documents for states, tribes and territories, program overviews, and case studies.

  20. Organisational readiness and Lean Thinking implementation: findings from three emergency department case studies in New Zealand.

    PubMed

    Rees, Gareth H

    2014-01-01

    This paper describes and contrasts the implementation of Lean Thinking – a quality methodology that emphasises waste reduction and performing at higher levels of productivity with the same or less resources – into New Zealand's healthcare system. As the field is relatively new, three literature-based exemplar cases were developed to provide an analysis framework to analyse the three New Zealand research sites, which had activities, teamwork, leadership and sustainability as its core themes. Each research site's case was developed from primary data gathered through interviews, augmented by secondary data from project reports, District Health Board websites and media stories. The results highlight the benefits of a supportive quality-focussed organisational culture, executive management involvement and cross-functional teams as enablers. Further, work intensification and workplace resistance were also evident in varying levels within the sites. The study, while reiterating the problems of introducing quality methods from other domains into healthcare, presents the New Zealand context and reinforces that organisational preparedness as a significant factor which contributes to implementation success. This study goes beyond investigations of the use of Lean tools, changing improvement metrics and descriptive statistics to identify the contexts and variables which surround quality and process improvement implementations. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. High quality transmission Kikuchi diffraction analysis of deformed alloys - Case study

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Tokarski, Tomasz, E-mail: tokarski@agh.edu.pl

    Modern scanning electron microscopes (SEM) equipped with thermally assisted field emission guns (Schottky FEG) are capable of imaging with a resolution in the range of several nanometers or better. Simultaneously, the high electron beam current can be used, which enables fast chemical and crystallographic analysis with a higher resolution than is normally offered by SEM with a tungsten cathode. The current resolution that limits the EDS and EBSD analysis is related to materials' physics, particularly to the electron-specimen interaction volume. The application of thin, electron-transparent specimens, instead of bulk samples, improves the resolution and allows for the detailed analysis ofmore » very fine microstructural features. Beside the typical imaging mode, it is possible to use a standard EBSD camera in such a configuration that only transmitted and scattered electrons are detected. This modern approach was successfully applied to various materials giving rise to significant resolution improvement, especially for the light element magnesium based alloys. This paper presents an insight into the application of the transmission Kikuchi diffraction (TKD) technique applied to the most troublesome, heavily-deformed materials. In particular, the values of the highest possible acquisition rates for high resolution and high quality mapping were estimated within typical imaging conditions of stainless steel and magnesium-yttrium alloy. - Highlights: •Monte Carlo simulations were used to simulate EBSD camera intensity for various measuring conditions. •Transmission Kikuchi diffraction parameters were evaluated for highly deformed, light and heavy elements based alloys. •High quality maps with 20 nm spatial resolution were acquired for Mg and Fe based alloys. •High speed TKD measurements were performed at acquisition rates comparable to the reflection EBSD.« less

  2. What happens to quality in integrated homecare? A 15-year follow-up study

    PubMed Central

    Paljärvi, Soili; Rissanen, Sari; Sinkkonen, Sirkka; Paljärvi, Leo

    2011-01-01

    Objectives To explore the impact of structural integration on homecare quality. Methods A case study in an organisation comprising a before–after comparison with baseline and four follow-up measurements during 1994–2009, using interviews with clients (n=66–84) and postal inquiries to relatives (n=73–78) and staff (n=68–136). Results Despite the organisational reform involving extensive mergers of health and social care organisations and cuts in staff and service provision, homecare quality remained at almost the same level throughout the 15-year follow-up. According to the clients, it even slightly improved in some homecare areas. Conclusions The results show that despite the structural integration and cuts in staff and service provision, the quality of homecare remained at a good level. Assuming that the potential confounders did have inhibiting effects, the results suggest that structural integration had a positive impact on homecare quality. To obtain firmer evidence to support this tentative conclusion, further research with a randomised comparison design is needed. PMID:21949487

  3. Achieving Quality Learning in Higher Education.

    ERIC Educational Resources Information Center

    Nightingale, Peggy; O'Neil, Mike

    This volume on quality learning in higher education discusses issues of good practice particularly action learning and Total Quality Management (TQM)-type strategies and illustrates them with seven case studies in Australia and the United Kingdom. Chapter 1 discusses issues and problems in defining quality in higher education. Chapter 2 looks at…

  4. Effects of Doctorate Program on a Novice Teacher's Conceptualization of an Effective Teacher: A Case Study

    ERIC Educational Resources Information Center

    Ilin, Gülden

    2016-01-01

    This case study, the framework of which is provided by Kelly's Personal Construct Theory, investigates how a female novice ELT teacher structures her constructs on the qualities of an effective teacher. Repertory grid, a cognitive mapping approach, based on Kelly's theory was used as an elicitation technique in the study. The study focused on four…

  5. Integrated catchment modelling within a strategic planning and decision making process: Werra case study

    NASA Astrophysics Data System (ADS)

    Dietrich, Jörg; Funke, Markus

    Integrated water resources management (IWRM) redefines conventional water management approaches through a closer cross-linkage between environment and society. The role of public participation and socio-economic considerations becomes more important within the planning and decision making process. In this paper we address aspects of the integration of catchment models into such a process taking the implementation of the European Water Framework Directive (WFD) as an example. Within a case study situated in the Werra river basin (Central Germany), a systems analytic decision process model was developed. This model uses the semantics of the Unified Modeling Language (UML) activity model. As an example application, the catchment model SWAT and the water quality model RWQM1 were applied to simulate the effect of phosphorus emissions from non-point and point sources on water quality. The decision process model was able to guide the participants of the case study through the interdisciplinary planning and negotiation of actions. Further improvements of the integration framework include tools for quantitative uncertainty analyses, which are crucial for real life application of models within an IWRM decision making toolbox. For the case study, the multi-criteria assessment of actions indicates that the polluter pays principle can be met at larger scales (sub-catchment or river basin) without significantly compromising cost efficiency for the local situation.

  6. Effects of future climate change on grape and wine quality: a case study for the Aglianico grape, Campania. Italy.

    NASA Astrophysics Data System (ADS)

    Bonfante, Antonello; Gambuti, Angelita; Monaco, Eugenia; Langella, Giuliano; Manna, Piero; Orefice, Nadia; Albrizio, Rossella; Basile, Angelo; Terribile, Fabio

    2016-04-01

    Water deficits limit yields and this is one of the negative aspects of climate change. However, this applies particularly when emphasis is on biomass production (e.g. for crops like maize, wheat, etc.) but not for plants where quality, not quantity is most relevant. For example, water stress occurring during specific phenological phases of grapevine development is an important factor when producing good quality wines. It induces, for example, the production of anthocyanins and aroma precursors. Water stress due to future increases of temperature and decreases of rainfall due to climate change can, therefore, represent an opportunity to increase winegrowers' incomes. This study was carried out in Campania region (Southern Italy), an area well known for high quality wine production. Growth of the Aglianico grapevine cultivar, with a standard clone population on 1103 Paulsen rootstocks, was studied on two different types of soil: Calcisols and Cambisols occurring along a slope of 90 m length with 11% gradient. The agro-hydrological model SWAP was calibrated and applied to estimate soil-plant water status at the various crop phenological phases for three vintages (2011-2013). Then, the Crop water stress index (CWSI), as estimated by the model, was related to physiological measurements (e.g. leaf water potential), grape bunches measurements (e.g. sugar content) and wine quality (e.g. tannins). For both soils, the correlation between measurements and CWSI were high (e.g. -0.97** with sugar; 0.895* with anthocyanins in the skins). Next, the model was applied to future climate conditions (2021-2051) obtained from statistical downscaling of Global Circulation Models (AOGCM) in order to estimate the effect of the climate on CWSI and hence on vine quality. Results show that the effects of climate change on grape and wine quality are not expected to be significant for this particular grape variety when grown on these Calcisols and Cambisols. However, significant differences

  7. Air quality impacted by local pollution sources and beyond - Using a prominent petro-industrial complex as a study case.

    PubMed

    Chen, Sheng-Po; Wang, Chieh-Heng; Lin, Wen-Dian; Tong, Yu-Huei; Chen, Yu-Chun; Chiu, Ching-Jui; Chiang, Hung-Chi; Fan, Chen-Lun; Wang, Jia-Lin; Chang, Julius S

    2018-05-01

    The present study combines high-resolution measurements at various distances from a world-class gigantic petrochemical complex with model simulations to test a method to assess industrial emissions and their effect on local air quality. Due to the complexity in wind conditions which were highly seasonal, the dominant wind flow patterns in the coastal region of interest were classified into three types, namely northeast monsoonal (NEM) flows, southwest monsoonal (SEM) flows and local circulation (LC) based on six years of monitoring data. Sulfur dioxide (SO 2 ) was chosen as an indicative pollutant for prominent industrial emissions. A high-density monitoring network of 12 air-quality stations distributed within a 20-km radius surrounding the petrochemical complex provided hourly measurements of SO 2 and wind parameters. The SO 2 emissions from major industrial sources registered by the monitoring network were then used to validate model simulations and to illustrate the transport of the SO 2 plumes under the three typical wind patterns. It was found that the coupling of observations and modeling was able to successfully explain the transport of the industrial plumes. Although the petrochemical complex was seemingly the only major source to affect local air quality, multiple prominent sources from afar also played a significant role in local air quality. As a result, we found that a more complete and balanced assessment of the local air quality can be achieved only after taking into account the wind characteristics and emission factors of a much larger spatial scale than the initial (20 km by 20 km) study domain. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. [Which one is more important, raw materials or productive technology?--a case study for quality consistency control of Gegen Qinlian decoction].

    PubMed

    Zhong, Wen; Chen, Sha; Zhang, Jun; Wang, Yu-Sheng; Liu, An

    2016-03-01

    To investigate the effect of Chinese medicine raw materials and production technology on quality consistency of Chinese patent medicines with Gegen Qinlian decoction as an example, and establish a suitable method for the quality consistency control of Chinese patent medicines. The results showed that the effect of production technology on the quality consistency was generally not more than 5%, while the effect of raw materials was even more than 30%, indicating that the effect of raw materials was much greater than that of the production technology. In this study, blend technology was used to improve the quality consistency of raw materials. As a result, the difference between the product produced by raw materials and reference groups was less than 5%, thus increasing the quality consistence of finished products. The results showed that under the current circumstances, the main factor affecting the quality consistency of Chinese patent medicines was raw materials, so we shall pay more attention to the quality of Chinese medicine's raw materials. Finally, a blend technology can improve the quality consistency of Chinese patent medicines. Copyright© by the Chinese Pharmaceutical Association.

  9. Fuzzy-Set Case Studies

    ERIC Educational Resources Information Center

    Mikkelsen, Kim Sass

    2017-01-01

    Contemporary case studies rely on verbal arguments and set theory to build or evaluate theoretical claims. While existing procedures excel in the use of qualitative information (information about kind), they ignore quantitative information (information about degree) at central points of the analysis. Effectively, contemporary case studies rely on…

  10. SETDA Case Studies 2012

    ERIC Educational Resources Information Center

    State Educational Technology Directors Association, 2012

    2012-01-01

    The State Educational Technology Directors Association (SETDA) published a series of case studies from 28 states to showcase examples of how ARRA EETT ("American Recovery and Reinvestment Act of 2009 Enhancing Education Through Technology") grant funds have impacted teaching and learning. SETDA collected data for the case studies through…

  11. The Bologna Process in Higher Education: An Exploratory Case Study in a Russian Context

    ERIC Educational Resources Information Center

    Esyutina, Maria; Fearon, Colm; Leatherbarrow, Nicky

    2013-01-01

    Purpose: The aim of the current article is to discuss the role of the Bologna process in enabling quality of educational change, internationalisation and greater mobility using an example case study of a Russian university. Some discussion is provided to offer insights and inform future research and practice. Design/methodology/approach: The…

  12. Integrated Hydrographical Basin Management. Study Case - Crasna River Basin

    NASA Astrophysics Data System (ADS)

    Visescu, Mircea; Beilicci, Erika; Beilicci, Robert

    2017-10-01

    Hydrographical basins are important from hydrological, economic and ecological points of view. They receive and channel the runoff from rainfall and snowmelt which, when adequate managed, can provide fresh water necessary for water supply, irrigation, food industry, animal husbandry, hydrotechnical arrangements and recreation. Hydrographical basin planning and management follows the efficient use of available water resources in order to satisfy environmental, economic and social necessities and constraints. This can be facilitated by a decision support system that links hydrological, meteorological, engineering, water quality, agriculture, environmental, and other information in an integrated framework. In the last few decades different modelling tools for resolving problems regarding water quantity and quality were developed, respectively water resources management. Watershed models have been developed to the understanding of water cycle and pollution dynamics, and used to evaluate the impacts of hydrotechnical arrangements and land use management options on water quantity, quality, mitigation measures and possible global changes. Models have been used for planning monitoring network and to develop plans for intervention in case of hydrological disasters: floods, flash floods, drought and pollution. MIKE HYDRO Basin is a multi-purpose, map-centric decision support tool for integrated hydrographical basin analysis, planning and management. MIKE HYDRO Basin is designed for analyzing water sharing issues at international, national and local hydrographical basin level. MIKE HYDRO Basin uses a simplified mathematical representation of the hydrographical basin including the configuration of river and reservoir systems, catchment hydrology and existing and potential water user schemes with their various demands including a rigorous irrigation scheme module. This paper analyzes the importance and principles of integrated hydrographical basin management and develop a case

  13. A case study of SMART attributes: a qualitative assessment of generalizability, retention rate, and trial quality.

    PubMed

    Moodie, Erica E M; Karran, James C; Shortreed, Susan M

    2016-05-14

    Personalizing medical care is becoming increasingly popular, particularly mental health care. There is growing interest in formalizing medical decision making based on evolving patient symptoms in an evidence-based manner. To determine optimal sequencing of treatments, the sequences themselves must be studied; this may be accomplished by using a sequential multiple assignment randomized trial (SMART). It has been hypothesized that SMART studies may improve participant retention and generalizability. We examine the hypotheses that SMART studies are more generalizable and have better retention than traditional randomized clinical trials via a case study of a SMART study of antipsychotic medications. We considered the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia study, comparing the trial participant characteristics and overall retention to those of comparable trials found via a review of all related trials conducted from 2000 onwards. A MEDLINE search returned 6435 results for primary screening; ultimately, 48 distinct trials were retained for analysis. The study population in CATIE was similar to, although perhaps less symptomatic than, the study populations of traditional randomized clinical trials (RCTs), suggesting no large gains in generalizability despite the pragmatic nature of the trial. However, CATIE did see good month-by-month retention. SMARTs offer the possibility of studying treatment sequences in a way that a series of traditional RCTs cannot. SMARTs may offer improved retention; however, this case study did not find evidence to suggest greater generalizability using this trial design. ClinicalTrials.gov NCT00014001 . Registered on 6 April 2001.

  14. IVHS institutional issues and case studies : ADVANCE case study

    DOT National Transportation Integrated Search

    1994-04-01

    This operational test case study is one of six performed in response to a Volpe National Transportation Systems Center technical task directive (TTD) to Science Applications International Corporation (SAIC) entitled, IVHS Institutional Issues and ...

  15. Assessing Complex Emergency Management with Clinical Case-Vignettes: A Validation Study

    PubMed Central

    2015-01-01

    Objective To evaluate whether responses to dynamic case-vignettes accurately reflect actual practices in complex emergency situations. We hypothesized that when obstetricians were faced with vignette of emergency situation identical to one they previously managed, they would report the management strategy they actually used. On the other hand, there is no reason to suppose that their response to a vignette based on a source case managed by another obstetrician would be the same as the actual management. Methods A multicenter vignette-based study was used in 7 French maternity units. We chose the example of severe postpartum hemorrhage (PPH) to study the use of case-vignettes for assessing the management of complex situations. We developed dynamic case-vignettes describing incidents of PPH in several steps, using documentation in patient files. Vignettes described the postpartum course and included multiple-choice questions detailing proposed clinical care. Each participating obstetrician was asked to evaluate 4 case-vignettes: 2 directly derived from cases they previously managed and 2 derived from other obstetricians’ cases. We compared the final treatment decision in vignette responses to those documented in the source-case by the overall agreement and the Kappa coefficient, both for the cases the obstetricians previously managed and the cases of others. Results Thirty obstetricians participated. Overall agreement between final treatment decisions in case-vignettes and documented care for cases obstetricians previously managed was 82% (Kappa coefficient: 0.75, 95% CI [0.62–0.88]). Overall agreement between final treatment decisions in case-vignettes and documented care in vignettes derived from other obstetricians’ cases was only 48% (Kappa coefficient: 0.30, 95% CI [0.12–0.48]). Final agreement with documented care was significantly better for cases based on their own previous cases than for others (p<0.001). Conclusions Dynamic case-vignettes accurately

  16. Short-term variation in air quality associated with firework events: a case study.

    PubMed

    Ravindra, Khaiwal; Mor, Suman; Kaushik, C P

    2003-04-01

    The effect of fireworks on air quality was assessed from the ambient concentrations of various air pollutants (SO2, NO2, PM10 and TSP) during Diwali festival in Hisar city (India), in November 1999. The extensive use of fireworks was found to be related to short-term variation in air quality. During the festival the concentration of SO2 was observed to be increased approximately 10-fold at few sites, whereas the concentrations of NO2, PM10 and TSP increased 2-3 times, compared to the data collected on a typical winter day in December 1999. The maximum NO2 concentration was observed a day after the festival. The diurnal pattern of the above pollutants showed a slight increase in the night. The levels of these pollutants observed during Diwali were found to be moderately high, which can be associated with serious health impacts.

  17. Case Study: Guidelines for Producing Videos to Accompany Flipped Cases

    ERIC Educational Resources Information Center

    Prud'homme-Généreux, Annie; Schiller, Nancy A.; Wild, John H.; Herreid, Clyde Freeman

    2017-01-01

    Three years ago, the "National Center for Case Study Teaching in Science" (NCCSTS) was inspired to merge the case study and flipped classroom approaches. The resulting project aimed to create the materials required to teach a flipped course in introductory biology by assigning videos as homework and case studies in the classroom. Three…

  18. Competition in collaborative clothing: a qualitative case study of influences on collaborative quality improvement in the ICU.

    PubMed

    Dainty, Katie N; Scales, Damon C; Sinuff, Tasnim; Zwarenstein, Merrick

    2013-04-01

    Multiorganisational quality improvement (QI) collaborative networks are promoted for improving quality within healthcare. Recently, several large-scale QI initiatives have been conducted in the intensive care unit (ICU) environment with successful quantitative results. However, the mechanisms through which such networks lead to QI success remain uncertain. We aim to understand ICU staff perspectives on collaborative QI based on involvement in a multiorganisational improvement network and hypothesise about theoretical constructs that might explain the effect of collaboration in such networks. Qualitative study using a modified grounded theory approach. Key informant interviews were conducted with staff from 12 community hospital ICUs that participated in a cluster randomized control trial (RCT) of a QI intervention using a collaborative approach between 2006 and 2008. Data analysis followed the standard procedure for grounded theory using constant comparative methodology. The collaborative network was perceived to promote increased intrateam cooperation over interorganisational cooperation, but friendly competition with other ICUs appeared to be a prominent driver of behaviour change. Bedsides, clinicians reported that belonging to a collaborative network provided recognition for the high-quality patient care that they already provided. However, the existing communication structure was perceived to be ineffective for staff engagement since it was based on a hierarchical approach to knowledge transfer and project awareness. QI collaborative networks may promote behaviour change by improving intrateam communication, fostering competition with other institutions, and increasing recognition for providing high-quality care. Other commonly held assumptions about their potential impact, for instance, increasing interorganisational legitimisation, communication and collaboration, may be less important.

  19. The Contribution of GIS to Display and Analyze the Water Quality Data Collected by a Wireless Sensor Network: Case of Bouregreg Catchment, Morocco

    NASA Astrophysics Data System (ADS)

    Boubakri, S.; Rhinane, H.

    2017-11-01

    The monitoring of water quality is, in most cases, managed in the laboratory and not on real time bases. Besides this process being lengthy, it doesn't provide the required specifications to describe the evolution of the quality parameters that are of interest. This study presents the integration of Geographic Information Systems (GIS) with wireless sensor networks (WSN) aiming to create a system able to detect the parameters like temperature, salinity and conductivity in a Moroccan catchment scale and transmit information to the support station. This Information is displayed and evaluated in a GIS using maps and spatial dashboard to monitor the water quality in real time.

  20. Freedom of information: a case study.

    PubMed

    Worsfold, Denise

    2006-09-01

    The purpose of this case study was to find out how easy it was to access information on the hygiene standards of eating places open to the public. Using the Freedom of Information (FOI) Act 2000, four adjacent local authorities in South Wales were asked to provide the last food hygiene report of an eating place in their area. The disclosed reports were assessed to determine how useful they would be to an individual seeking more information on a food premise. It was relatively easy to obtain information from two authorities and difficult if not impossible with the others. One local authority refused to release information despite the intervention of the FOI Commissioner. The quality of the information released was variable. This ranged from a completed comprehensive inspection protocol to a hand-written, illegible, incomplete report that failed to adequately differentiate between requirements and recommendations. Without some training in food law and food hygiene it would be difficult to interpret the reports. There was no evidence from the information provided of inspection scoring. The case study raises concerns about the effectiveness of the Act for consumers who wish to obtain information about the hygiene standards of food premises. While the specialist information provided by hygiene inspection reports may be useful to businesses it is not helpful for the lay public. Consumers must be prepared to exercise patience and tenacity if they want this information. Concerns must be raised about the consistency of the inspection process and about the willingness of some local authorities to be transparent about the inspection and enforcement process.

  1. Rocky-shore communities as indicators of water quality: a case study in the Northwestern Mediterranean.

    PubMed

    Pinedo, Susana; García, María; Satta, Maria Paola; de Torres, Mariona; Ballesteros, Enric

    2007-01-01

    The collection of 152 samples from the upper sublittoral zone along the rocky coasts of Catalonia (Northwestern Mediterranean) was carried out in 1999 in order to test the suitability of littoral communities to be used as indicators of water quality in the frame of the European Water Framework Directive. Detrended correspondence analysis were performed to distinguish between different communities and to relate communities composition to water quality. Samples collected in reference sites were included in the analysis. Mediterranean rocky shore communities situated in the upper sublittoral zone can be used as indicators of the water quality: there is a gradient from high to bad status that comprises from dense Cystoseira mediterranea forests to green algae dominated communities. The geographical patterns in the distribution of these communities show that the best areas are situated in the Northern coast, where tourism is the main economic resource of the area, and the worst area is situated close to the metropolitan zone of Barcelona with high population and industrial development. Thus, Mediterranean sublittoral rocky shore communities are useful indicators of water quality and multivariate analysis are a suitable statistical tool for the assessment of the ecological status.

  2. Revision of Viable Environmental Monitoring in a Development Pilot Plant Based on Quality Risk Assessment: A Case Study.

    PubMed

    Ziegler, Ildikó; Borbély-Jakab, Judit; Sugó, Lilla; Kovács, Réka J

    2017-01-01

    In this case study, the principles of quality risk management were applied to review sampling points and monitoring frequencies in the hormonal tableting unit of a formulation development pilot plant. In the cleanroom area, premises of different functions are located. Therefore a general method was established for risk evaluation based on the Hazard Analysis and Critical Control Points (HACCP) method to evaluate these premises (i.e., production area itself and ancillary clean areas) from the point of view of microbial load and state in order to observe whether the existing monitoring program met the emerged advanced monitoring practice. LAY ABSTRACT: In pharmaceutical production, cleanrooms are needed for the manufacturing of final dosage forms of drugs-intended for human or veterinary use-in order to protect the patient's weakened body from further infections. Cleanrooms are premises with a controlled level of contamination that is specified by the number of particles per cubic meter at a specified particle size or number of microorganisms (i.e. microbial count) per surface area. To ensure a low microbial count over time, microorganisms are detected and counted by environmental monitoring methods regularly. It is reasonable to find the easily infected places by risk analysis to make sure the obtained results really represent the state of the whole room. This paper presents a risk analysis method for the optimization of environmental monitoring and verification of the suitability of the method. © PDA, Inc. 2017.

  3. Good-quality social care for people with Parkinson’s disease: a qualitative study

    PubMed Central

    Kennedy, Fiona; Stocks, Amanda-Jayne; McDonnell, Ann; Ramaswamy, Bhanu; Wood, Brendan; Whitfield, Malcolm

    2016-01-01

    Objectives The study examines the meaning of good-quality social care for people with Parkinson's disease and their carers. It identifies, from their perspective, the impact of good-quality social care on health and well-being. Design Qualitative case study methodology, interview and framework analysis techniques were used. Setting: community locations in the north and midlands of England. Participants Data were collected from 43 participants including individual interviews with people with Parkinson's disease (n=4), formal and informal social care providers (n=13), 2 focus groups, 1 with people with Parkinson's disease and their carers (n=17), and 1 with professionals (n=8), plus a telephone interview with a former commissioner. Findings Good-quality social care, delivered in a timely fashion, was reported to have a positive impact on health. Furthermore, there is an indication that good-quality social care can prevent untoward events, such as infections, symptom deterioration and deterioration in mental health. The concept of the ‘Impact Gap’ developed from the findings, illustrates how the costs of care may be reduced by delivering good-quality social care. Control, choice and maintaining independence emerged as indicators of good-quality social care, irrespective of clinical condition. Participants identified characteristics indicative of good-quality social care specific to Parkinson's disease, including understanding Parkinson's disease, appropriate administration of medication, timing of care and reassessment. ‘Parkinson's aware’ social care was seen to generate psychological, physical and social benefits that were inter-related. Conclusions The findings indicate how maximising quality in social care delivery for people with Parkinson's disease can impact on health and well-being. Long-term or short-term benefits may result in prevented events and reductions in health and social care resource. Health professionals can be instrumental in early

  4. Work Sharing Case Studies.

    ERIC Educational Resources Information Center

    McCarthy, Maureen E.; And Others

    Designed to provide private sector employers with the practical information necessary to select and then to design and implement work sharing arrangements, this book presents case studies of some 36 work sharing programs. Topics covered in the case studies include the circumstances leading to adoption of the program, details of compensation and…

  5. QUIT EMR trial: a prospective, observational, multicentre study to evaluate quality and 24 hours post-transport morbidity of interhospital transportation of critically ill patients: study protocol.

    PubMed

    Strauch, Ulrich; Bergmans, Dennis C J J; Habers, Joachim; Jansen, Jochen; Winkens, Bjorn; Veldman, Dirk J; Roekaerts, Paul M H J; Beckers, Stefan K

    2017-03-10

    It is widely accepted that transportation of critically ill patients is high risk. Unfortunately, however, there are currently no evidence-based criteria with which to determine the quality of various interhospital transport systems and their impact on the outcomes for patients. We aim to rectify this by assessing 2 scores which were developed in our hospital in a prospective, observational study. Primarily, we will be examining the Quality of interhospital critical care transportation in the Euregion Meuse-Rhine (QUIT EMR) score, which focuses on the quality of the transport system, and secondarily the SEMROS (Simplified EMR outcome score) which detects changes in the patient's clinical condition in the 24 hours following their transportation. A web-based application will be used to document around 150 pretransport, intratransport and post-transport items of each patient case.To be included, patients must be at least 18-years of age and should have been supervised by a physician during an interhospital transport which was started in the study region.The quality of the QUIT EMR score will be assessed by comparing 3 predefined levels of transport facilities: the high, medium and low standards. Subsequently, SEMROS will be used to determine the effect of transport quality on the morbidity 24 hours after transportation.It is estimated that there will be roughly 3000 appropriate cases suitable for inclusion in this study per year. Cases shall be collected from 1 April 2015 until 31 December 2017. This trial was approved by the Ethics committees of the university hospitals of Maastricht (Netherlands) and Aachen (Germany). The study results will be published in a peer reviewed journal. Results of this study will determine if a prospective randomised trial involving patients of various categories being randomly assigned to different levels of transportation system shall be conducted. NTR4937. Published by the BMJ Publishing Group Limited. For permission to use (where

  6. Case Complexity and Quality Attestation for Clinical Ethics Consultants.

    PubMed

    Spielman, Bethany; Craig, Jana; Gorka, Christine; Miller, Keith

    2015-01-01

    A proposal by the American Society for Bioethics and Humanities (ASBH) to identify individuals who are qualified to perform ethics consultations neglects case complexity in candidates' portfolios. To protect patients and healthcare organizations, and to be fair to candidates, a minimum case complexity level must be clearly and publicly articulated. This proof-of-concept study supports the feasibility of assessing case complexity. Using text analytics, we developed a complexity scoring system, and retrospectively analyzed more than 500 ethics summaries of consults performed at an academic medical center during 2013. We demonstrate its use with seven case summaries that range in complexity from uncomplicated to very complicated. We encourage the ASBH to require a minimum level of case complexity, and recommend that attestation portfolios include several cases of moderate complexity and at least one very complex case. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

  7. Quantitative image quality evaluation of MR images using perceptual difference models

    PubMed Central

    Miao, Jun; Huo, Donglai; Wilson, David L.

    2008-01-01

    The authors are using a perceptual difference model (Case-PDM) to quantitatively evaluate image quality of the thousands of test images which can be created when optimizing fast magnetic resonance (MR) imaging strategies and reconstruction techniques. In this validation study, they compared human evaluation of MR images from multiple organs and from multiple image reconstruction algorithms to Case-PDM and similar models. The authors found that Case-PDM compared very favorably to human observers in double-stimulus continuous-quality scale and functional measurement theory studies over a large range of image quality. The Case-PDM threshold for nonperceptible differences in a 2-alternative forced choice study varied with the type of image under study, but was ≈1.1 for diffuse image effects, providing a rule of thumb. Ordering the image quality evaluation models, we found in overall Case-PDM ≈ IDM (Sarnoff Corporation) ≈ SSIM [Wang et al. IEEE Trans. Image Process. 13, 600–612 (2004)] > mean squared error ≈ NR [Wang et al. (2004) (unpublished)] > DCTune (NASA) > IQM (MITRE Corporation). The authors conclude that Case-PDM is very useful in MR image evaluation but that one should probably restrict studies to similar images and similar processing, normally not a limitation in image reconstruction studies. PMID:18649487

  8. Spatial and temporal variations in the relationship between lake water surface temperatures and water quality - A case study of Dianchi Lake.

    PubMed

    Yang, Kun; Yu, Zhenyu; Luo, Yi; Yang, Yang; Zhao, Lei; Zhou, Xiaolu

    2018-05-15

    Global warming and rapid urbanization in China have caused a series of ecological problems. One consequence has involved the degradation of lake water environments. Lake surface water temperatures (LSWTs) significantly shape water ecological environments and are highly correlated with the watershed ecosystem features and biodiversity levels. Analysing and predicting spatiotemporal changes in LSWT and exploring the corresponding impacts on water quality is essential for controlling and improving the ecological water environment of watersheds. In this study, Dianchi Lake was examined through an analysis of 54 water quality indicators from 10 water quality monitoring sites from 2005 to 2016. Support vector regression (SVR), Principal Component Analysis (PCA) and Back Propagation Artificial Neural Network (BPANN) methods were applied to form a hybrid forecasting model. A geospatial analysis was conducted to observe historical LSWTs and water quality changes for Dianchi Lake from 2005 to 2016. Based on the constructed model, LSWTs and changes in water quality were simulated for 2017 to 2020. The relationship between LSWTs and water quality thresholds was studied. The results show limited errors and highly generalized levels of predictive performance. In addition, a spatial visualization analysis shows that from 2005 to 2020, the chlorophyll-a (Chla), chemical oxygen demand (COD) and total nitrogen (TN) diffused from north to south and that ammonia nitrogen (NH 3 -N) and total phosphorus (TP) levels are increases in the northern part of Dianchi Lake, where the LSWT levels exceed 17°C. The LSWT threshold is 17.6-18.53°C, which falls within the threshold for nutritional water quality, but COD and TN levels fall below V class water quality standards. Transparency (Trans), COD, biochemical oxygen demand (BOD) and Chla levels present a close relationship with LSWT, and LSWTs are found to fundamentally affect lake cyanobacterial blooms. Copyright © 2017 Elsevier B.V. All

  9. An Alternative View of Quality Assurance and Enhancement

    ERIC Educational Resources Information Center

    Wong, Viola Yuk-Yue

    2012-01-01

    This paper attempts to deal with the elusive nature of quality in quality management, using a case study to examine quality control measures implemented in an academic context and to show an emergent framework for quality enhancement. This paper introduces the concept of the ecology of quality assurance and examines efforts to maintain and advance…

  10. Use of MODIS Terra Imagery to Estimate Surface Water Quality Standards, Using Lake Thonotosassa, Florida, as a Case Study

    NASA Technical Reports Server (NTRS)

    Moreno, Max J.; Al-Hamdan, Mohammad Z.; Estes, Maurice G., Jr.; Rickman, Douglas L.

    2010-01-01

    Lake Thonotosassa is a highly eutrophied lake located in an area with rapidly growing population in the Tampa Bay watershed, Florida. The Florida Administrative Code has designated its use for "recreation, propagation and maintenance of a healthy, well-balanced population of fish and wildlife." Although this lake has been the subject of efforts to improve water quality since 1970, overall water quality has remained below the acceptable state standards, and has a high concentration of nutrients. This condition is of great concern to public health since it has favored episodic blooms of Cyanobacteria. Some Cyanobacterial species release toxins that can reach humans through drinking water, fish consumption, and direct contact with contaminated water. The lake has been historically popular for fishing and water sports, and its overflow water drains into the Hillsborough River, the main supply of municipal water for the City of Tampa, this explains why it has being constantly monitored in situ for water quality by the Environmental Protection Commission of Hillsborough County (EPC). Advances in remote sensing technology, however, open the possibility of facilitating similar types of monitoring in this and similar lakes, further contributing to the implementation of surveillance systems that would benefit not just public health, but also tourism and ecosystems. Although traditional application of this technology to water quality has been focused on much larger coastal water bodies like bays and estuaries, this study evaluates the feasibility of its application on a 46.6 km2 freshwater lake. Using surface reflectance products from Moderate-Resolution Imaging Spectroradiometer (MODIS) Terra, this study evaluates associations between remotely sensed data and in situ data from the EPC. The parameters analyzed are the surface water quality standards used by the State of Florida and general indicators of trophic status.

  11. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study.

    PubMed

    Lovink, Marleen Hermien; Persoon, Anke; van Vught, Anneke J A H; Schoonhoven, Lisette; Koopmans, Raymond T C M; Laurant, Miranda G H

    2017-06-08

    In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. © Article author(s) (or their employer(s) unless otherwise stated

  12. Campania Region (Italy) spontaneous reporting system and preventability assessment through a case-by-case approach: a pilot study on psychotropic drugs.

    PubMed

    Sessa, Maurizio; Rafaniello, Concetta; Sportiello, Liberata; Mascolo, Annamaria; Scavone, Cristina; Maccariello, Alessandra; Iannaccone, Teresa; Fabrazzo, Michele; Berrino, Liberato; Rossi, Francesco; Capuano, Annalisa

    2016-12-01

    We conducted the first pilot Italian study to assess the preventability of adverse drug reactions involving psychotropic drugs reported through spontaneous reporting system from 01/07/2012 to 31/12/2014 in Campania Region. Preventability was assessed, case-by-case, using an adapted version of the P-method. The evaluation was performed only for those reports that had, as suspected drug, antipsychotics, mood stabilizers, antidepressants, anxiolytic and/or sedative-hypnotic. Eighty-one cases (19.2%) out of 421 reported during the study period were preventable. In seventy-seven (95.1%) out of 81 preventable cases, the underlying mechanism of the adverse drug reactions was dose-related, in four (4.9%) preventable cases the underlying mechanism of the adverse drug reactions was respectively susceptibility- (1; 1.2%), unknown- (1; 1.2%) and time-related (2; 2.5%). In the 81 preventable cases, 97 critical criteria were detected of which 29/97 (29.9%) related to healthcare professionals' practices, 0/97 (0.0%) to drug quality and 68/97 (70.1%) to patient behaviour. We proved that it was possible to apply and adapt the P-Method to assess the preventability of the adverse drug reactions involving psychotropic drugs, analysing individual case safety report sent through Campania Region spontaneous reporting system. Information acquired will be used to organize educational activities for both physicians and patients to promote a more appropriate drug use.

  13. Where is information quality lost at clinical level? A mixed-method study on information systems and data quality in three urban Kenyan ANC clinics

    PubMed Central

    Hahn, Daniel; Wanjala, Pepela; Marx, Michael

    2013-01-01

    Background Well-working health information systems are considered vital with the quality of health data ranked of highest importance for decision making at patient care and policy levels. In particular, health facilities play an important role, since they are not only the entry point for the national health information system but also use health data (and primarily) for patient care. Design A multiple case study was carried out between March and August 2012 at the antenatal care (ANC) clinics of two private and one public Kenyan hospital to describe clinical information systems and assess the quality of information. The following methods were developed and employed in an iterative process: workplace walkthroughs, structured and in-depth interviews with staff members, and a quantitative assessment of data quality (completeness and accurate transmission of clinical information and reports in ANC). Views of staff and management on the quality of employed information systems, data quality, and influencing factors were captured qualitatively. Results Staff rated the quality of information higher in the private hospitals employing computers than in the public hospital which relies on paper forms. Several potential threats to data quality were reported. Limitations in data quality were common at all study sites including wrong test results, missing registers, and inconsistencies in reports. Feedback was seldom on content or quality of reports and usage of data beyond individual patient care was low. Conclusions We argue that the limited data quality has to be seen in the broader perspective of the information systems in which it is produced and used. The combination of different methods has proven to be useful for this. To improve the effectiveness and capabilities of these systems, combined measures are needed which include technical and organizational aspects (e.g. regular feedback to health workers) and individual skills and motivation. PMID:23993022

  14. Where is information quality lost at clinical level? A mixed-method study on information systems and data quality in three urban Kenyan ANC clinics.

    PubMed

    Hahn, Daniel; Wanjala, Pepela; Marx, Michael

    2013-08-29

    Well-working health information systems are considered vital with the quality of health data ranked of highest importance for decision making at patient care and policy levels. In particular, health facilities play an important role, since they are not only the entry point for the national health information system but also use health data (and primarily) for patient care. A multiple case study was carried out between March and August 2012 at the antenatal care (ANC) clinics of two private and one public Kenyan hospital to describe clinical information systems and assess the quality of information. The following methods were developed and employed in an iterative process: workplace walkthroughs, structured and in-depth interviews with staff members, and a quantitative assessment of data quality (completeness and accurate transmission of clinical information and reports in ANC). Views of staff and management on the quality of employed information systems, data quality, and influencing factors were captured qualitatively. Staff rated the quality of information higher in the private hospitals employing computers than in the public hospital which relies on paper forms. Several potential threats to data quality were reported. Limitations in data quality were common at all study sites including wrong test results, missing registers, and inconsistencies in reports. Feedback was seldom on content or quality of reports and usage of data beyond individual patient care was low. We argue that the limited data quality has to be seen in the broader perspective of the information systems in which it is produced and used. The combination of different methods has proven to be useful for this. To improve the effectiveness and capabilities of these systems, combined measures are needed which include technical and organizational aspects (e.g. regular feedback to health workers) and individual skills and motivation.

  15. External Accountability of Collaborative Arrangements; A Case Study of a Multi Academy Trust in England

    ERIC Educational Resources Information Center

    Ehren, Melanie C. M.; Godfrey, David

    2017-01-01

    This paper explores the impact of external accountability on four mechanisms of network-internal quality control and the properties of (mandated) inter-organizational networks. An explorative case study approach examines the external accountability of a newly established educational network (MAT) and how schools and the Trust are held accountable…

  16. CASE-CONTROL STUDY OF AIR QUALITY AND BIRTH DEFECTS: COMPARISON OF GEOCODED AND NON-GEOCODED POPULATIONS

    EPA Science Inventory

    Unbiased geocoding of maternal residence is critical to the success of an ongoing case-control study of exposure to five criteria air pollutants and the risk of selected birth defects in seven Texas counties between 1997 and 2000. The geocoded residence at delivery will be used ...

  17. Does quality of drinking water matter in kidney stone disease: A study in West Bengal, India.

    PubMed

    Mitra, Pubali; Pal, Dilip Kumar; Das, Madhusudan

    2018-05-01

    The combined interaction of epidemiology, environmental exposure, dietary habits, and genetic factors causes kidney stone disease (KSD), a common public health problem worldwide. Because a high water intake (>3 L daily) is widely recommended by physicians to prevent KSD, the present study evaluated whether the quantity of water that people consume daily is associated with KSD and whether the quality of drinking water has any effect on disease prevalence. Information regarding residential address, daily volume of water consumption, and source of drinking water was collected from 1,266 patients with kidney stones in West Bengal, India. Drinking water was collected by use of proper methods from case (high stone prevalence) and control (zero stone prevalence) areas thrice yearly. Water samples were analyzed for pH, alkalinity, hardness, total dissolved solutes, electrical conductivity, and salinity. Average values of the studied parameters were compared to determine if there were any statistically significant differences between the case and control areas. We observed that as many as 53.6% of the patients consumed <3 L of water daily. Analysis of drinking water samples from case and control areas, however, did not show any statistically significant alterations in the studied parameters. All water samples were found to be suitable for consumption. It is not the quality of water, rather the quantity of water consumed that matters most in the occurrence of KSD.

  18. Case Study: A Picture Worth a Thousand Words? Making a Case for Video Case Studies

    ERIC Educational Resources Information Center

    Pai, Aditi

    2014-01-01

    A picture, they say, is worth a thousand words. If a mere picture is worth a thousand words, how much more are "moving pictures" or videos worth? The author poses this not merely as a rhetorical question, but because she wishes to make a case for using videos in the traditional case study method. She recommends four main approaches of…

  19. Urban simulation evaluation with study case of the Singapore Management University, Singapore

    NASA Astrophysics Data System (ADS)

    Seanders, O.

    2018-01-01

    This paper reports and discusses about the urban simulation evaluation with a study case, The Singapore Managemant University (SMU), the first major university to be located in the city centre. It is located in Bras Basah District, with some controversy on the geographical establishment, the physical realization of the University in the original plan required some demolishes, urban historical building, a public park and in the end will impact the lose of some certain qualities of the urban space. From this case we can see that the urban design and cultural heritage principles could come into conflicts with the more practical concerns of space constraints and transportation efficiency. This SMU case reflect the problem of the developing countries that have to decide between conservation of buildings and green spaces and space demands. In this case, for Singapore, it marks a progress in the step of greater community involvement in the planning process.

  20. The cleanroom case study in the Software Engineering Laboratory: Project description and early analysis

    NASA Technical Reports Server (NTRS)

    Green, Scott; Kouchakdjian, Ara; Basili, Victor; Weidow, David

    1990-01-01

    This case study analyzes the application of the cleanroom software development methodology to the development of production software at the NASA/Goddard Space Flight Center. The cleanroom methodology emphasizes human discipline in program verification to produce reliable software products that are right the first time. Preliminary analysis of the cleanroom case study shows that the method can be applied successfully in the FDD environment and may increase staff productivity and product quality. Compared to typical Software Engineering Laboratory (SEL) activities, there is evidence of lower failure rates, a more complete and consistent set of inline code documentation, a different distribution of phase effort activity, and a different growth profile in terms of lines of code developed. The major goals of the study were to: (1) assess the process used in the SEL cleanroom model with respect to team structure, team activities, and effort distribution; (2) analyze the products of the SEL cleanroom model and determine the impact on measures of interest, including reliability, productivity, overall life-cycle cost, and software quality; and (3) analyze the residual products in the application of the SEL cleanroom model, such as fault distribution, error characteristics, system growth, and computer usage.

  1. Recognizing the clinical manifestations of acromegaly: case studies.

    PubMed

    Iuliano, Sherry L; Laws, Edward R

    2014-03-01

    To present case studies of a 36-year-old woman and a 73-year-old man who presented with the syndrome of acromegaly, and to provide primary care nurse practitioners (NPs) with the understanding of the clinical and laboratory features needed for early recognition and treatment of this fascinating disease. A comprehensive review of published literature on acromegaly is presented. The findings discussed include the history, physical examination, and diagnostic studies of two patients presenting in different ways. They both saw multiple healthcare providers, and had symptoms and signs eventually leading to the diagnosis of acromegaly. Acromegaly is the result of excessive amounts of growth hormone (GH) and insulin-like growth factor type 1 (IGF-1), almost always caused by a benign adenoma of the pituitary gland. This leads to coarse facial features, soft tissue swelling (including the tongue), enlargement of the hands and feet, respiratory problems, hypertension, diabetes mellitus, carpal tunnel syndrome, and osteoarthritis. Early recognition and appropriate referral can reverse some of the signs and symptoms over time, and lead to decreased mortality and a markedly improved quality of life. These cases exemplify the challenges faced by NPs and other healthcare providers in diagnosing patients with acromegaly. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  2. Quality Assurance in University Guidance Services

    ERIC Educational Resources Information Center

    Simon, Alexandra

    2014-01-01

    In Europe there is no common quality assurance framework for the delivery of guidance in higher education. Using a case study approach in four university career guidance services in England, France and Spain, this article aims to study how quality is implemented in university career guidance services in terms of strategy, standards and models,…

  3. A Quality System for Education: Using Quality and Productivity Techniques To Save Our Schools.

    ERIC Educational Resources Information Center

    Spanbauer, Stanley J.; Hillman, Jo

    This book provides a case study of the implementation of a quality improvement model to improve educational services at Fox Valley Technical College (FVTC), in Appleton, Wisconsin. Chapter 1 describes the early stages of the implementation of the quality processes at FVTC. Chapter 2 discusses the role of the chief administrator as mentor and…

  4. The use of microblog-based case studies in a pharmacotherapy introduction class in China.

    PubMed

    Wang, Tiansheng; Wang, Fei; Shi, Luwen

    2013-09-08

    Microblog is a Web 2.0 technology that provides an online social networking platform for communicating and sharing information among web users. Pharmacy educators have previously used microblog to promote active engagement of students. However, there is very little research to demonstrate how to use microblogging effectively to enhance pedagogy in a blended or face-to-face classroom environment. We used the most popular microblog website in China to create a "space" within the classroom to evaluate an interactive microblogging forum for the integration of pharmacotherapy case studies. This study is aimed to determine students' attitudes toward microblog-based case studies (MBC) in a pharmacotherapy class. We created a group on Sina Weibo, the most popular microblog website in China, to explore the possibilities of using microblog-based case discussions in pharmacy education to promote and motivate student learning. The class teaching activities began in November 2011; individual group assignments to a single case study were administered to 21 groups with a total of 126 participating pharmacy students. Each group was required to share a discussion care plan on the microblogging platform. Individual students were expected to participate in an online discussion related to at least two other group cases by posting their comments on the microblog platform. All postings were tracked and analyzed, and then a post MBC survey was administered anonymously to determine students' opinions towards MBC. A total of 126 students posted 592 messages and 112 students (89%) completed the survey. More than 80% of students agreed that MBC improved communication; nearly 70% agreed that MBC increased the amount of interaction, and over 50% found value in reading other students' messages. However, 25% students believed the collaborative learning was not effective and 22% indicated the quality of interaction was low. MBC appears to be well-accepted learning method to students in this study

  5. Improving the Textbook Selection Process: Case Studies of the Textbook Adoption Guidelines Project. Technical Report No. 478.

    ERIC Educational Resources Information Center

    Dole, Janice; And Others

    A study followed three textbook adoption committees as they evaluated basal reading programs. The committees used "A Guide to Selecting Basal Reading Programs" (developed at the Center for the Study of Reading) to help them evaluate the quality of instruction in existing programs. Case studies of the three committees sought to address the…

  6. Quality by design in formulation and process development for a freeze-dried, small molecule parenteral product: a case study.

    PubMed

    Mockus, Linas N; Paul, Timothy W; Pease, Nathan A; Harper, Nancy J; Basu, Prabir K; Oslos, Elizabeth A; Sacha, Gregory A; Kuu, Wei Y; Hardwick, Lisa M; Karty, Jacquelyn J; Pikal, Michael J; Hee, Eun; Khan, Mansoor A; Nail, Steven L

    2011-01-01

    A case study has been developed to illustrate one way of incorporating a Quality by Design approach into formulation and process development for a small molecule, freeze-dried parenteral product. Sodium ethacrynate was chosen as the model compound. Principal degradation products of sodium ethacrynate result from hydrolysis of the unsaturated ketone in aqueous solution, and dimer formation from a Diels-Alder condensation in the freeze-dried solid state. When the drug crystallizes in a frozen solution, the eutectic melting temperature is above -5°C. Crystallization in the frozen system is affected by pH in the range of pH 6-8 and buffer concentration in the range of 5-50 mM, where higher pH and lower buffer concentration favor crystallization. Physical state of the drug is critical to solid state stability, given the relative instability of amorphous drug. Stability was shown to vary considerably over the ranges of pH and buffer concentration examined, and vial-to-vial variability in degree of crystallinity is a potential concern. The formulation design space was constructed in terms of pH and drug concentration, and assuming a constant 5 mM concentration of buffer. The process design space is constructed to take into account limitations on the process imposed by the product and by equipment capability.

  7. A case study of evaluating informatics impact on diffusion of scientific knowledge.

    PubMed

    Katz, Susan B

    2008-11-06

    This case study poster uses a newly developed framework to evaluate an informatics effort in its public health context. The electronic clearance system being evaluated provides the potential for increasing the speed and quality of scientific diffusion of knowledge, and thus translation of research into practice. A graphical logic model and tabular results of the evaluation are presented. Public health history suggests potential benefits of more timely and coordinated diffusion of scientific information.

  8. Assessing Consumer Emotional Responses in the Presence and Absence of Critical Quality Attributes: A Case Study with Chicken Eggs.

    PubMed

    Wardy, Wisdom; Sae-Eaw, Amporn; Sriwattana, Sujinda; No, Hong Kyoon; Prinyawiwatkul, Witoon

    2015-07-01

    offer valuable insights for differentiation of competing or otherwise similar products. Affective consumer responses to food products with varying sensory and quality attributes are influenced by several factors including psychographics, demographics, product category, and test design. In this study, a scenario is depicted where product developers can identify critical product features based on emotional assessment of products with and without quality attributes. This study is beneficial to product developers and the egg industry, as it identifies opportunities to better understand consumer needs, thereby, designing products destined for success in the marketplace. © 2015 Institute of Food Technologists®

  9. Developing Practice Oriented Undergraduate Courses in a Quality Framework. A Case Study: Bachelor of Event Management

    ERIC Educational Resources Information Center

    Whitelaw, Paul A.; Wrathall, Jeffrey

    2015-01-01

    Purpose: The purpose of this paper is to reflect upon the stakeholder, scholarly, academic and jurisdictional influences on course development for a vocationally oriented bachelor's degree. Design/methodology/approach: This paper takes the form of a case study. Findings: Vocationally oriented bachelor's courses can be developed, especially when…

  10. Lean practices for quality results: a case illustration.

    PubMed

    Hwang, Pauline; Hwang, David; Hong, Paul

    2014-01-01

    Increasingly, healthcare providers are implementing lean practices to achieve quality results. Implementing lean healthcare practices is unique compared to manufacturing and other service industries. The purpose of this paper is to present a model that identifies and defines the lean implementation key success factors in healthcare organisations. The model is based on an extant literature review and a case illustration that explores actual lean implementation in a major USA hospital located in a Midwestern city (approximately 300,000 people). An exploratory/descriptive study using observation and follow-up interviews was conducted to identify lean practices in the hospital. Lean practice key drivers include growing elderly populations, rising medical expenses, decreasing insurance coverage and decreasing management support. Effectively implementing lean practices to increase bottom-line results and improve organisational integrity requires sharing goals and processes among healthcare managers and professionals. An illustration explains the model and the study provides a sound foundation for empirical work. Practical implications are included. Lean practices minimise waste and unnecessary hospital stays while simultaneously enhancing customer values and deploying resources in supply systems. Leadership requires clear project targets based on sound front-end planning because initial implementation steps involve uncertainty and ambiguity (i.e. fuzzy front-end planning). Since top management support is crucial for implementing lean practices successfully, a heavyweight manager, who communicates well both with top managers and project team members, is an important success factor when implementing lean practices. Increasingly, green orientation and sustainability initiatives are phrases that replaced lean practices. Effective results; e.g. waste reduction, employee satisfaction and customer values are applicable to bigger competitive challenges arising both in specific

  11. Quality of Extension Advice: A Gendered Case Study from Ghana and Sri Lanka

    ERIC Educational Resources Information Center

    Lamontagne-Godwin, Julien; Williams, Frances; Bandara, Willoru Mudiyansele Palitha Thilakasiri; Appiah-Kubi, Ziporah

    2017-01-01

    Purpose: Women farmers have less access to extension services than male farmers, even though they make up almost half of the global agricultural workforce. Gender-focused international development programmes have focused on how ensuring women receive better access to advice. However, the quality of the technical advice and the service women…

  12. Does high flexion after total knee replacement really improve our patients' quality of life at a short-term follow-up? : a comparative case-control study with hyperflex PFC Sigma versus a Triathlon knee series.

    PubMed

    Mencière, Maxime L; Epinette, Jean-Alain; Gabrion, Antoine; Arnalsteen, Damien; Mertl, Patrice

    2014-10-01

    A full range of motion after total knee arthroplasty has become more and more requested by our patients, leading to novel designs of knee implants, the so-called "hyperflex" knees. The aim of the present study was to confirm whether or not hyperflexion of operated knees really improves the patients' quality of life. A retrospective comparative case-control study has been carried out to compare clinical results shown in two types of knee prosthesis, from two homogeneous paired groups of patients including 45 cases of a "hyperflex" model (RP-F), while the control group consisted of 43 cases of a "regular design" model (Triathlon) in terms of expected postoperative flexion. The hyperflex group demonstrated significant higher mean values of passive flexion at 119.9° in the RP-F group versus 111.1° in the Triathlon group. However, global results in the "regular" control group were significantly better than the "hyperflex" study group, in both IKS knee and functional scores at 84.4 points (RP-F) vs. 89.8 points (Triathlon), and 84.6 points (RP-F) vs. 89.5 points (Triathlon), respectively. Moreover, the self-administered KOOS questionnaire was significantly in favor of the control group, with 73.5 points in RP-F knees versus 86.0 points for Triathlon knees at global KOOS postoperative scores. The quality of life of operated patients after TKA obviously would be considered as the main priority, which was better obtained by a "regular design" in our study. Hence "high flexion" cannot be considered as an absolute target when choosing a model for total knee arthroplasty.

  13. Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies

    PubMed Central

    2012-01-01

    Background Case management has been applied in community aged care to meet frail older people’s holistic needs and promote cost-effectiveness. This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes. Methods We searched Web of Science, Scopus, Medline, CINAHL (EBSCO) and PsycINFO (CSA) from inception to 2011 July. Inclusion criteria were: no restriction on date, English language, community-dwelling older people and/or carers, case management in community aged care, published in refereed journals, randomized control trials (RCTs) or comparative observational studies, examining client or carer outcomes. Quality of studies was assessed by using such indicators as quality control, randomization, comparability, follow-up rate, dropout, blinding assessors, and intention-to-treat analysis. Two reviewers independently screened potentially relevant studies, extracted information and assessed study quality. A narrative summary of findings were presented. Results Ten RCTs and five comparative observational studies were identified. One RCT was rated high quality. Client outcomes included mortality (7 studies), physical or cognitive functioning (6 studies), medical conditions (2 studies), behavioral problems (2 studies) , unmet service needs (3 studies), psychological health or well-being (7 studies) , and satisfaction with care (4 studies), while carer outcomes included stress or burden (6 studies), satisfaction with care (2 studies), psychological health or well-being (5 studies), and social consequences (such as social support and relationships with clients) (2 studies). Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group, while all the three studies consistently reported fewer unmet service needs among the intervention participants. In contrast, available studies reported mixed

  14. Water Quality Protection from Nutrient Pollution: Case ...

    EPA Pesticide Factsheets

    Water bodies and coastal areas around the world are threatened by increases in upstream sediment and nutrient loads, which influence drinking water sources, aquatic species, and other ecologic functions and services of streams, lakes, and coastal water bodies. For example, increased nutrient fluxes from the Mississippi River Basin have been linked to increased occurrences of seasonal hypoxia in northern Gulf of Mexico. Lake Erie is another example where in the summer of 2014 nutrients, nutrients, particularly phosphorus, washed from fertilized farms, cattle feedlots, and leaky septic systems; caused a severe algae bloom, much of it poisonous; and resulted in the loss of drinking water for a half-million residents. Our current management strategies for point and non-point source nutrient loadings need to be improved to protect and meet the expected increased future demands of water for consumption, recreation, and ecological integrity. This presentation introduces management practices being implemented and their effectiveness in reducing nutrient loss from agricultural fields, a case analysis of nutrient pollution of the Grand Lake St. Marys and possible remedies, and ongoing work on watershed modeling to improve our understanding on nutrient loss and water quality. Presented at the 3rd International Conference on Water Resource and Environment.

  15. When environmental action does not activate concern: the case of impaired water quality in two rural watersheds.

    PubMed

    Stough-Hunter, Anjel; Lekies, Kristi S; Donnermeyer, Joseph F

    2014-12-01

    Little research has considered how residents' perceptions of their local environment may interact with efforts to increase environmental concern, particularly in areas in need of remediation. This study examined the process by which local environmental action may affect environmental concern. A model was presented for exploring the effects of community-based watershed organizations (CWOs) on environmental concern that also incorporates existing perceptions of the local environment. Survey data were collected from area residents in two watersheds in southwestern Pennsylvania, USA, an area affected by abandoned mine drainage. The findings suggest that residents' perceptions of local water quality and importance of improving water quality are important predictors of level of environmental concern and desire for action; however, in this case, having an active or inactive CWO did not influence these perceptions. The implications of these findings raise important questions concerning strategies and policy making around environmental remediation at the local level.

  16. Metropolitan transportation management center : a case study : Milwaukee MONITOR : addressing congestion while improving safety and air quality

    DOT National Transportation Integrated Search

    1999-10-01

    The following case study provides a snapshot of Milwaukee's MONITOR transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting Stu...

  17. An Integrated model for Product Quality Development—A case study on Quality functions deployment and AHP based approach

    NASA Astrophysics Data System (ADS)

    Maitra, Subrata; Banerjee, Debamalya

    2010-10-01

    Present article is based on application of the product quality and improvement of design related with the nature of failure of machineries and plant operational problems of an industrial blower fan Company. The project aims at developing the product on the basis of standardized production parameters for selling its products in the market. Special attention is also being paid to the blower fans which have been ordered directly by the customer on the basis of installed capacity of air to be provided by the fan. Application of quality function deployment is primarily a customer oriented approach. Proposed model of QFD integrated with AHP to select and rank the decision criterions on the commercial and technical factors and the measurement of the decision parameters for selection of best product in the compettitive environment. The present AHP-QFD model justifies the selection of a blower fan with the help of the group of experts' opinion by pairwise comparison of the customer's and ergonomy based technical design requirements. The steps invoved in implementation of the QFD—AHP and selection of weighted criterion may be helpful for all similar purpose industries maintaining cost and utility for competitive product.

  18. Quality Assurance Strategies in Higher Education: The Case of Ghanaian Polytechnics

    ERIC Educational Resources Information Center

    Swanzy, Patrick; Potts, Anthony

    2017-01-01

    This study investigated the internal quality assurance strategies Ghanaian polytechnics enacted in order to improve graduate outcomes. A qualitative methodological approach via in-depth interviewing of twenty key informants and document analysis was used to establish how polytechnics in Ghana addressed problematic situations in quality assurance.…

  19. Theoretical pluralism in psychoanalytic case studies.

    PubMed

    Willemsen, Jochem; Cornelis, Shana; Geerardyn, Filip M; Desmet, Mattias; Meganck, Reitske; Inslegers, Ruth; Cauwe, Joachim M B D

    2015-01-01

    The aim of this study is to provide an overview of the scientific activity of different psychoanalytic schools of thought in terms of the content and production of case studies published on ISI Web of Knowledge. Between March 2013 and November 2013, we contacted all case study authors included in the online archive of psychoanalytic and psychodynamic case studies (www.singlecasearchive.com) to inquire about their psychoanalytic orientation during their work with the patient. The response rate for this study was 45%. It appears that the two oldest psychoanalytic schools, Object-relations psychoanalysis and Ego psychology or "Classical psychoanalysis" dominate the literature of published case studies. However, most authors stated that they feel attached to two or more psychoanalytic schools of thought. This confirms that the theoretical pluralism in psychoanalysis stretches to the field of single case studies. The single case studies of each psychoanalytic school are described separately in terms of methodology, patient, therapist, or treatment features. We conclude that published case studies features are fairly similar across different psychoanalytic schools. The results of this study are not representative of all psychoanalytic schools, as some do not publish their work in ISI ranked journals.

  20. Theoretical pluralism in psychoanalytic case studies

    PubMed Central

    Willemsen, Jochem; Cornelis, Shana; Geerardyn, Filip M.; Desmet, Mattias; Meganck, Reitske; Inslegers, Ruth; Cauwe, Joachim M. B. D.

    2015-01-01

    The aim of this study is to provide an overview of the scientific activity of different psychoanalytic schools of thought in terms of the content and production of case studies published on ISI Web of Knowledge. Between March 2013 and November 2013, we contacted all case study authors included in the online archive of psychoanalytic and psychodynamic case studies (www.singlecasearchive.com) to inquire about their psychoanalytic orientation during their work with the patient. The response rate for this study was 45%. It appears that the two oldest psychoanalytic schools, Object-relations psychoanalysis and Ego psychology or “Classical psychoanalysis” dominate the literature of published case studies. However, most authors stated that they feel attached to two or more psychoanalytic schools of thought. This confirms that the theoretical pluralism in psychoanalysis stretches to the field of single case studies. The single case studies of each psychoanalytic school are described separately in terms of methodology, patient, therapist, or treatment features. We conclude that published case studies features are fairly similar across different psychoanalytic schools. The results of this study are not representative of all psychoanalytic schools, as some do not publish their work in ISI ranked journals. PMID:26483725