Science.gov

Sample records for accessibility quality guidelines

  1. Web Accessibility and Guidelines

    NASA Astrophysics Data System (ADS)

    Harper, Simon; Yesilada, Yeliz

    Access to, and movement around, complex online environments, of which the World Wide Web (Web) is the most popular example, has long been considered an important and major issue in the Web design and usability field. The commonly used slang phrase ‘surfing the Web’ implies rapid and free access, pointing to its importance among designers and users alike. It has also been long established that this potentially complex and difficult access is further complicated, and becomes neither rapid nor free, if the user is disabled. There are millions of people who have disabilities that affect their use of the Web. Web accessibility aims to help these people to perceive, understand, navigate, and interact with, as well as contribute to, the Web, and thereby the society in general. This accessibility is, in part, facilitated by the Web Content Accessibility Guidelines (WCAG) currently moving from version one to two. These guidelines are intended to encourage designers to make sure their sites conform to specifications, and in that conformance enable the assistive technologies of disabled users to better interact with the page content. In this way, it was hoped that accessibility could be supported. While this is in part true, guidelines do not solve all problems and the new WCAG version two guidelines are surrounded by controversy and intrigue. This chapter aims to establish the published literature related to Web accessibility and Web accessibility guidelines, and discuss limitations of the current guidelines and future directions.

  2. Total quality management implementation guidelines

    SciTech Connect

    Not Available

    1993-12-01

    These Guidelines were designed by the Energy Quality Council to help managers and supervisors in the Department of Energy Complex bring Total Quality Management to their organizations. Because the Department is composed of a rich mixture of diverse organizations, each with its own distinctive culture and quality history, these Guidelines are intended to be adapted by users to meet the particular needs of their organizations. For example, for organizations that are well along on their quality journeys and may already have achieved quality results, these Guidelines will provide a consistent methodology and terminology reference to foster their alignment with the overall Energy quality initiative. For organizations that are just beginning their quality journeys, these Guidelines will serve as a startup manual on quality principles applied in the Energy context.

  3. Removing the Barriers: Accessibility Guidelines and Specifications.

    ERIC Educational Resources Information Center

    Cotler, Stephen R.

    This guide provides guidelines for meeting the accessibility requirements of the Americans with Disabilities (ADA) Act in college and university buildings. The publication is divided into 10 chapters, the first 7 of which present construction drawings, evaluation criteria, and specifications for: (1) site accessibility (external path of travel,…

  4. 24 CFR 200.929a - Fair Housing Accessibility Guidelines.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... with the Fair Housing Act. The Guidelines may be found in the 24 CFR Chapter I, Subchapter A, Appendix... Fair Housing Accessibility Guidelines. Builders and developers may use the Department's Fair...

  5. 24 CFR 200.929a - Fair Housing Accessibility Guidelines.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... with the Fair Housing Act. The Guidelines may be found in the 24 CFR Chapter I, Subchapter A, Appendix... Fair Housing Accessibility Guidelines. Builders and developers may use the Department's Fair...

  6. 24 CFR 200.929a - Fair Housing Accessibility Guidelines.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... with the Fair Housing Act. The Guidelines may be found in the 24 CFR Chapter I, Subchapter A, Appendix... Fair Housing Accessibility Guidelines. Builders and developers may use the Department's Fair...

  7. 24 CFR 200.929a - Fair Housing Accessibility Guidelines.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... with the Fair Housing Act. The Guidelines may be found in the 24 CFR Chapter I, Subchapter A, Appendix... Fair Housing Accessibility Guidelines. Builders and developers may use the Department's Fair...

  8. 24 CFR 200.929a - Fair Housing Accessibility Guidelines.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... with the Fair Housing Act. The Guidelines may be found in the 24 CFR Chapter I, Subchapter A, Appendix... Fair Housing Accessibility Guidelines. Builders and developers may use the Department's Fair...

  9. Guidelines for Making Web Content Accessible to All Users

    ERIC Educational Resources Information Center

    Thompson, Terrill; Primlani, Saroj; Fiedor, Lisa

    2009-01-01

    The main goal of accessibility standards and guidelines is to design websites everyone can use. The "IT Accessibility Constituent Group" developed this set of draft guidelines to help EQ authors, reviewers, and staff and the larger EDUCAUSE community ensure that web content is accessible to all users, including those with disabilities. This…

  10. British Columbia water quality guidelines, criteria

    SciTech Connect

    1998-12-31

    This publication contains tables summarizing approved water quality guidelines for various contaminants that may be present in British Columbia water supplies. It begins with a section in question and answer format that explains certain aspects of the guidelines. Contaminants covered by the guidelines include particulate matter, nutrients and algae, aluminium, lead, mercury, nitrogen, dissolved oxygen, copper, chlorine, fluoride, hydrocarbons, pH, and silver.

  11. [From clinical practice guidelines towards quality assurance].

    PubMed

    Kopp, I B

    2011-02-01

    Clinical practice guidelines have been introduced to assist decision making at the bedside of individual patients. Guidelines are also increasingly regarded as being an indispensable part of professional quality systems. Guidelines are important tools to improve knowledge-management, processes and outcomes in healthcare. They aim to assist professional and patient decisions especially in those areas of healthcare where considerable variation or potential for improvement exist and they can provide a foundation for assessing and evaluating the quality and effectiveness of healthcare in terms of measuring processes and outcomes. Quality indicators or performance measures based on guideline recommendations are necessary to evaluate the usefulness of guidelines and the appropriateness of healthcare delivery. Guideline recommendations are the tools for healthcare professionals to develop strategies for quality improvement in case deviations from desired processes or outcomes are identified by the measurement of quality indicators.

  12. Chiropractic quality assurance: standards and guidelines

    PubMed Central

    Gatterman, Meridel I; Dobson, Thomas P; LeFevbre, Ron

    2001-01-01

    Chiropractic quality assurance involves development of both clinical guidelines and standards. Confusion generated by poor differentiation of guidelines from standards contributes to mistrust of the guideline development process. Guidelines are considered to be recommendations that allow for flexibility and individual patient differences. Standards are more binding and require a high level of supporting evidence. While guidelines serve as educational tools to improve the quality of practice, standards that outline minimum competency are used more as administrative tools on which to base policy. Barriers to development of clinical guidelines and standards include fear that they will create prescriptive “cookbook” practice, and the distrust that guidelines are developed primarily for cost containment. Clinicians also criticize guidelines developed by academics that don't relate to practice, and those based on evidence that lacks clinical relevance. Conflicting guidelines perceived to be based on strong bias or conflict of interest are also suspect. To reduce barriers to acceptance and implementation, guidelines should be inclusive, patient-centered, and based on a variety of evidence and clinical experience.

  13. Indoor Air Quality Guidelines for Pennsylvania Schools.

    ERIC Educational Resources Information Center

    Zimmerman, Robert S., Jr.

    This report provides information and practical guidance on how to prevent indoor air quality (IAQ) problems in schools, and it describes how to implement a practical plan of action using a minimal amount of resources. It includes general guidelines to prevent or help resolve IAQ problems, guidelines on specific indoor contaminants, recommendations…

  14. Guidelines for Access: A Report by NCTA.

    ERIC Educational Resources Information Center

    National Cable Television Association, Inc., Washington, DC.

    Cable Television operators must fulfill the new (1972) Federal Communications Commission's requirements that cable systems provide non-broadcast designated access channels for public, educational, government and other uses. Because of the varying requirements for each of the four categories of access channels, each is reviewed separately here. The…

  15. 78 FR 39649 - Passenger Vessels Accessibility Guidelines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-02

    ... From the Federal Register Online via the Government Publishing Office ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD 36 CFR Part 1196 RIN 3014-AA11 Passenger Vessels Accessibility... Tuesday, June 25, 2013, make the following correction: PART 1196--PASSENGER VESSELS...

  16. MedlinePlus: Quality Guidelines

    MedlinePlus

    ... reviewed/quality-filtered. The primary purpose of the Web page is educational and not to sell a ... in the directories. Availability and maintenance of the Web page The Web site is available consistently and ...

  17. [Guidelines for quality management of dialysis solutions].

    PubMed

    Pérez García, R; González Parra, E; Ceballos, F; Escallada Cotero, R; Gómez-Reino, Ma I; Martín-Rabadán, P; Pérez García, A; Ramírez Chamond, R; Sobrino, P E; Solozábal, C

    2004-01-01

    A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: [table: see text] Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (Anexos). For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org PMID:15083969

  18. 78 FR 49248 - Passenger Vessels Accessibility Guidelines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-13

    ... additional time to submit comments. DATES: For the proposed rule published June 25, 2013 (78 FR 38102... passengers with disabilities. See 78 FR 38102, June 25, 2013. In that notice, the Access Board requested... TRANSPORTATION BARRIERS COMPLIANCE BOARD 36 CFR Part 1196 RIN 3014-AA11 Passenger Vessels...

  19. 78 FR 38101 - Passenger Vessels Accessibility Guidelines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-25

    ... vessels present greater challenges due to space constraints and other considerations. The proposed...; accessible means of escape; doorways and coamings; toilet rooms; wheelchair spaces in assembly areas and.... See 69 FR 69244 and 69245, November 26, 2004. The ANPRM requested comment on whether and how...

  20. Canadian water quality guidelines. Appendix 22: Interim marine and estuarine water quality guidelines for general variables

    SciTech Connect

    1996-12-31

    This document has been prepared in response to the need for marine water quality guidelines for general water quality variables. It presents interim guidelines, summaries of existing guidelines if any, the rationale for the guidelines, and variable-specific background information, and notes gaps in data, for the following variables: Debris, including floating or submerged litter, and settleable matter; dissolved oxygen; pH; salinity; temperature; and suspended solids and turbidity. For the purpose of this document, the marine environment includes shorelines, estuaries up to the freshwater limit, and nearshore and offshore waters.

  1. Guidelines for a Quality Career Guidance Program.

    ERIC Educational Resources Information Center

    Vocational Guidance Quarterly, 1979

    1979-01-01

    This position paper on quality career guidance programs outlines basic assumptions, guidelines, a comprehensive program development model, and recommended uses. Highlights of the program development model include management questions, information, and program standards. This represents NVGA/AVA Guidance Divisions efforts to establish standards for…

  2. Making our offices universally accessible: guidelines for physicians

    PubMed Central

    Jones, K E; Tamari, I E

    1997-01-01

    OBJECTIVE: To develop recommendations for office-based physicians who wish to make their offices accessible to all patients. OPTIONS: Include taking steps to make offices more accessible, or not; offices may be accessible to varying degrees. OUTCOMES: Outcomes of accessibility involve patient-care, economic, ethical and legal issues. Stakeholders in these outcomes include patients, physicians, government and society. EVIDENCE: Data were obtained from a series of searches of MEDLINE, CINAHL and Healthstar (previously Health) databases for articles on disability and family medicine, primary (health) care and family practice, and on access and offices, and health services accessibility, and from a telephone survey of 50 stakeholders. VALUES: A high value was placed on services to persons with disabilities and on stakeholder input. Universal accessibility was valued as an overall goal; improved accessibility was also highly valued. BENEFITS, HARMS AND COSTS: Benefits to patients include improved access to care as guaranteed by the Canada Health Act and in keeping with provincial Human Rights Codes. Benefits to physicians include contact with a broader patient population and freedom from fear of litigation. Costs of improved accessibility vary depending on individual circumstances and on whether an office is being built or renovated; some improvement costs are minimal. RECOMMENDATIONS: All physicians should take measures to improve practice accessibility. Improved access should be considered in each of the following areas: transportation and entrance to the facility, entrance to the office, waiting rooms, rest rooms, examination rooms, general building features and other features. VALIDATION: No similar guidelines exist. To assess the content validity of these guidelines, the authors had a draft document reviewed by 18 stakeholders. All specific recommendations met the minimum criterion of adherence to current legislation, including national and provincial building

  3. Guidelines on the use of ultrasound guidance for vascular access.

    PubMed

    Bouaziz, Hervé; Zetlaoui, Paul J; Pierre, Sébastien; Desruennes, Eric; Fritsch, Nicolas; Jochum, Denis; Lapostolle, Frédéric; Pirotte, Thierry; Villiers, Stéphane

    2015-02-01

    Insertion of vascular access is a common procedure with potential for iatrogenic events, some of which can be serious. The spread of ultrasound scanners in operating rooms, intensive care units and emergency departments has made ultrasound-guided catheterisation possible. The first guidelines were published a decade ago but are not always followed in France. The French Society of Anaesthesia and Intensive Care has decided to adopt a position on this issue through its Guidelines Committee in order to propose a limited number of simple guidelines. The method used was the GRADE(®) method using the most recently published meta-analyses as the source of references. The level of evidence found ranged from low to high and all the positive aspects associated with ultrasound guidance, i.e. fewer traumatic complications at puncture, probably or definitely outweigh the potential adverse consequences regardless of whether an adult or child is involved and regardless of the site of insertion. PMID:25829319

  4. Guidelines and Quality Standards for Adults with Epilepsy.

    PubMed

    Pugh, Mary Jo; McMillan, Katharine K

    2016-05-01

    Guidelines and quality measures for epilepsy care have the potential to improve the quality of epilepsy care. Quality measures are increasingly used for pay-for-performance. This article describes different guidelines and quality measures that have been used to identify best practices, types of best practices for use in clinical care developed using each of these approaches, and information on how to interpret the recommendations in specific guidelines and quality measures described elsewhere in this issue. PMID:27086980

  5. 75 FR 16088 - Proposed Information Quality Guidelines Policy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-31

    ... COMMISSION Proposed Information Quality Guidelines Policy AGENCY: U.S. Election Assistance Commission (EAC). ACTION: Notice and request for public comment on Proposed Information Quality Guidelines Policy. SUMMARY... Disseminated by Federal Agencies, 67 FR 8452 (``OMB Guidelines''). The EAC developed the Proposed...

  6. 13 point video tape quality guidelines

    SciTech Connect

    Gaunt, R.

    1997-05-01

    Until high definition television (ATV) arrives, in the U.S. we must still contend with the National Television Systems Committee (NTSC) video standard (or PAL or SECAM-depending on your country). NTSC, a 40-year old standard designed for transmission of color video camera images over a small bandwidth, is not well suited for the sharp, full-color images that todays computers are capable of producing. PAL and SECAM also suffers from many of NTSC`s problems, but to varying degrees. Video professionals, when working with computer graphic (CG) images, use two monitors: a computer monitor for producing CGs and an NTSC monitor to view how a CG will look on video. More often than not, the NTSC image will differ significantly from the CG image, and outputting it to NTSC as an artist works enables the him or her to see the images as others will see it. Below are thirteen guidelines designed to increase the quality of computer graphics recorded onto video tape. Viewing your work in NTSC and attempting to follow the below tips will enable you to create higher quality videos. No video is perfect, so don`t expect to abide by every guideline every time.

  7. Accessing Quality Online Health Information: What Is the Solution?

    PubMed

    Boyer, Célia

    2016-01-01

    The majority of the adult population in both Europe and North America have access to the internet. Over 70% state that they have used the internet to look for health information and the majority started their search at a search engine. Given that search engines list sites according to popularity and not quality, it is imperative that users have a means of discerning trustworthy and honest information from non-reliable health information. The HONcode, a set of eight quality guidelines, ensures access to standardized trustworthy health information which can be used as a tool to guide consumers. PMID:27332317

  8. Web Content Accessibility Guidelines 2.0: A Further Step towards Accessible Digital Information

    ERIC Educational Resources Information Center

    Ribera, Mireia; Porras, Merce; Boldu, Marc; Termens, Miquel; Sule, Andreu; Paris, Pilar

    2009-01-01

    Purpose: The purpose of this paper is to explain the changes in the Web Content Accessibility Guidelines (WCAG) 2.0 compared with WCAG 1.0 within the context of its historical development. Design/methodology/approach: In order to compare WCAG 2.0 with WCAG 1.0 a diachronic analysis of the evolution of these standards is done. Known authors and…

  9. Guidelines for appraisal and publication of PDSA quality improvement.

    PubMed

    Speroff, Theodore; James, Brent C; Nelson, Eugene C; Headrick, Linda A; Brommels, Mats

    2004-01-01

    Plan-do-study-act (PDSA) quality improvement is the application of the scientific method to implement and test the effects of change ideas on the performance of the health care system. Users of quality improvement could benefit with markers to gauge the "best" science. Four core questions can determine the value of a quality improvement study: Is the quality improvement study pertinent and relevant? Are the results valid? Are appropriate criteria used to interpret the results? Will the study help you with your practice or organization of care? A set of guidelines is provided to help answer these questions. Similar guidelines exist for randomized clinical trials and clinical-epidemiologic observational studies. Analogous to these existing research guidelines, the PDSA quality improvement guidelines will provide researchers and reviewers with succinct standards of methodological rigor to assist in critical appraisal of quality improvement protocols and publications.

  10. The quality of European dermatological guidelines: critical appraisal of the quality of EDF guidelines using the AGREE II instrument.

    PubMed

    Werner, R N; Marinović, B; Rosumeck, S; Strohal, R; Haering, N S; Weberschock, T; Dreher, A C; Nast, A

    2016-03-01

    Clinical practice guidelines are systematically developed tools to assist clinicians and health policy makers in decision making for clearly defined clinical situations. In the light of the demand for evidence-based medicine and quality in health care and the increasing methodological requirements concerning guidelines development, it is important to evaluate existing practice guidelines to systematically identify strengths and weaknesses. Currently, the most accepted tool for the methodological evaluation of guidelines is the Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument. Intention of this assessment is to identify and critically appraise clinical practice guidelines commissioned by the European Dermatology Forum (EDF). A quality assessment of a predefined set of guidelines, including all available clinical practice guidelines published on the EDF guidelines internet site, was performed using the AGREE II instrument. To assure an objective assessment, four independent assessments were performed by evaluators situated in different European countries. Twenty-five EDF guidelines covering different dermatological topics were identified and evaluated. The assessment included seven guidelines developed on the highest methodological standard (systematic literature search and structured consensus conference, S3). Eighteen guidelines were identified that were based on either a structured consensus process (S2k), a systematic literature assessment (S2e) or on informal consensus only (S1). The methodological and reporting quality among the evaluated guidelines was heterogeneous. S3 guidelines generally received the highest scores. The domains 'clarity of presentation' and 'scope and purpose' achieved the highest mean ratings within the different domains of assessment, whereas the domains of 'applicability', 'stakeholder involvement' and 'editorial independence' scored poorly. Considering the large variations in the achieved scores, there is need for

  11. The Importance of Process-Oriented Accessibility Guidelines for Web Developers.

    PubMed

    Steen-Hansen, Linn; Fagernes, Siri

    2016-01-01

    Current accessibility research shows that in the web development, the process itself may lead to inaccessible web sites and applications. Common practices typically do not allow sufficient testing. The focus is mainly on complying with minimum standards, and treating accessibility compliance as a sort of bug-fixing process, missing the user perspective. In addition, there is an alarming lack of knowledge and experience with accessibility issues. It has also been argued that bringing accessibility into the development process at all stages is the only way to achieve the highest possible level of accessibility. The work presented in this paper is based on a previous project focusing on guidelines for developing accessible rich Internet applications. The guidelines were classified as either process-oriented or technology-oriented. In this paper, we examine the process-oriented guidelines and give a practical perspective on how these guidelines will make the development process more accessibility-friendly. PMID:27534339

  12. Guidelines for Inclusion: Ensuring Access to Education for All

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific and Cultural Organization (UNESCO), 2005

    2005-01-01

    These guidelines were created by UNESCO to assist countries in making National Plans for Education more inclusive, recognizing that there was a lack of guidelines to assist in this important process. This document thus provides guidelines and concepts for rendering National Education Plans / Education for All (EFA) more inclusive, with the…

  13. Americans with Disabilities Act: Accessibility Guidelines for Buildings and Facilities, Transportation Facilities, Transportation Vehicles.

    ERIC Educational Resources Information Center

    Architectural and Transportation Barriers Compliance Board, Washington, DC.

    Guidelines are presented regarding accessibility to buildings and facilities, transportation facilities, and transportation vehicles by individuals with disabilities, under the Americans with Disabilities Act of 1990. These guidelines are to be applied during building design, construction, and alteration. Part 1 offers detailed facility…

  14. 76 FR 44663 - Accessibility Guidelines for Pedestrian Facilities in the Public Right-of-Way

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-26

    ... II and III of the Americans with Disabilities Act (DOJ 2010 Standards). See 75 FR 56164 (September 15... Guidelines'').\\11\\ 69 FR 44083 (July 23, 2004). The 2004 ADA and ABA Accessibility Guidelines revised and... Board in 1991 (hereinafter referred to as ``1991 ADAAG''). 56 FR 35408 (July 26, 1991). The...

  15. How to Develop State Guidelines for Access Assistants: Scribes, Readers, and Sign Language Interpreters

    ERIC Educational Resources Information Center

    Clapper, Ann T.; Morse, Amanda B.; Thurlow, Martha L.; Thompson, Sandra J.

    2006-01-01

    This manual offers states a tool to assist in the development or enhancement of guidelines for access assistants. Whether a state already has guidelines or is just in the process of establishing them, this manual will provide structure to the process and many examples of criteria already included by states. This manual was developed to accompany…

  16. Quality Assessment of Clinical Practice Guidelines Developed by Professional Societies in Turkey

    PubMed Central

    Yaşar, Ilknur; Kahveci, Rabia; Baydar Artantaş, Aylin; Ayhan Başer, Duygu; Gökşin Cihan, Fatma; Şencan, Irfan; Koç, Esra Meltem; Özkara, Adem

    2016-01-01

    Background Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. There is a limited number of studies on guidelines in Turkey. The quality of Ministry of Health guidelines have formerly been assessed whereas there is no information on the other guidelines developed in the country. Aim This study aims to assess the quality of CPGs that are developed by professional societies that work for the health sector in Turkey, and compare the findings with international guidelines. Methodology Professional societies that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. Inclusion and exclusion criteria were defined for selecting the CPGs. Guidelines containing recommendations about disease management to the doctors, accessible online, developed within the past 5 years, citing references for recommendations, about the diseases over 1% prevalence according to the “Statistical Yearbook of Turkey 2012” were included in the study. The quality of CPGs were assessed with the AGREE II instrument, which is an internationally recognized tool for this purpose. Four independent reviewers, who did not participate in the development of the selected guidelines and were trained in CPG appraisal, used the AGREE instrument for assessment of the selected guidelines. Findings 47 professional societies were defined which provided access to CPGs in their websites; 3 of them were only open to members so these could not be reached. 8 CPGs from 7 societies were selected from a total of 401 CPGs from 44 societies. The mean scores of the domains of the guidelines which were assessed by the AGREE II tool were; Scope and purpose: 64%, stakeholder involvement: 37.9%, rigour of development: 35.3%, clarity and presentation: 77.9%, applicability: 49.0% and editorial independence: 46.0%. Conclusion This is the first

  17. Management of common gastrointestinal disorders: quality criteria based on patients' views and practice guidelines

    PubMed Central

    Jones, Roger; Hunt, Claire; Stevens, Richard; Dalrymple, Jamie; Driscoll, Richard; Sleet, Sarah; Smith, Jonathan Blanchard

    2009-01-01

    Background Although gastrointestinal disorders are common in general practice, clinical guidelines are not always implemented, and few patient-generated quality criteria are available to guide management. Aim To develop quality criteria for the management of four common gastrointestinal disorders: coeliac disease, gastro-oesophageal reflux disease (GORD), inflammatory bowel disease, and irritable bowel syndrome. Design of study Qualitative study including thematic analysis of transcripts from patient focus groups and content analysis of published clinical practice guidelines. Emergent themes were synthesised by a consensus panel, into quality criteria for each condition. Setting Community-based practice in England, UK. Methods Fourteen focus groups were conducted (four for coeliac disease, irritable bowel syndrome, and inflammatory bowel disease, and two for GORD) involving a total of 93 patients (64 females, 29 males; mean age 55.4 years). Quality criteria were based on patients' views and expectations, synthesised with an analysis of clinical practice guidelines. Results A chronic disease management model was developed for each condition. Key themes included improving the timeliness and accuracy of diagnosis, appropriate use of investigations, better provision of information for patients, including access to patient organisations, better communication with, and access to, secondary care providers, and structured follow-up and regular review, particularly for coeliac disease and inflammatory bowel disease. Conclusion This study provides a model for the development of quality markers for chronic disease management in gastroenterology, which is likely to be applicable to other chronic conditions. PMID:19520018

  18. Formulating Independent School K-12 Quality Physical Education Program Guidelines

    ERIC Educational Resources Information Center

    Currie, Stuart M.; Phillips, Michael B.; Jubenville, Colby B.

    2012-01-01

    The purpose of this study was to formulate Tennessee independent school K-12 quality physical education program guidelines. A panel of 18 physical education representatives from Tennessee independent schools K-12 participated in a three-phase Delphi study and completed three opinionnaires via e-mail. In Phase One, Opinionnaire One solicited panel…

  19. USING SEDIMENT QUALITY GUIDELINES IN DREDGED MATERIAL ASSESSMENTS

    EPA Science Inventory

    Sediment quality guidelines (SQGs) are not formally included in the frameworks described in the Inland Testing manual and the Green Book because these frameworks are biologically based. The SQGs are often used informally, however, to help put the results of biological testing in ...

  20. Strategy Guideline: Quality Management in Existing Homes; Cantilever Floor Example

    SciTech Connect

    Taggart, J.; Sikora, J.; Wiehagen, J.; Wood, A.

    2011-12-01

    This guideline is designed to highlight the QA process that can be applied to any residential building retrofit activity. The cantilevered floor retrofit detailed in this guideline is included only to provide an actual retrofit example to better illustrate the QA activities being presented. The goal of existing home high performing remodeling quality management systems (HPR-QMS) is to establish practices and processes that can be used throughout any remodeling project. The research presented in this document provides a comparison of a selected retrofit activity as typically done versus that same retrofit activity approached from an integrated high performance remodeling and quality management perspective. It highlights some key quality management tools and approaches that can be adopted incrementally by a high performance remodeler for this or any high performance retrofit. This example is intended as a template and establishes a methodology that can be used to develop a portfolio of high performance remodeling strategies.

  1. Quality assurance guidelines for organic analysis. Technical report

    SciTech Connect

    Karn, R.A.; Strong, A.B.

    1989-12-01

    The US Army Corps of Engineers has a fundamental responsibility to produce analytical data that are precise and accurate and meet environmental regulations imposed by the Clean Water Act, the Resource Conservation and Recovery Act, the Comprehensive Environmental Response, Compensation and Recovery act, the Superfund Amendments and Reauthorization Act, the Safe Drinking Water Act, and the Toxic Substances Control Act. Numerous analytical methods for organic analysis are promulgated to provide the same basic information with only slight variations in procedure. This report was written to provide general quality assurance guidelines for organic analysis with specific quality assurance/quality control requirements for the various methods.

  2. 76 FR 75844 - Accessibility Guidelines for Pedestrian Facilities in the Public Right-of-Way; Reopening of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-05

    ... (76 FR 44664). In that notice, the Access Board proposed guidelines for accessible public rights-of... TRANSPORTATION BARRIERS COMPLIANCE BOARD 36 CFR Part 1190 RIN 3014-AA26 Accessibility Guidelines for Pedestrian... Barriers Compliance Board. ACTION: Notice of proposed rulemaking; reopening of comment period. SUMMARY:...

  3. Derivation of water quality guidelines for priority pharmaceuticals.

    PubMed

    Kumar, Anupama; Batley, Graeme E; Nidumolu, Bhanu; Hutchinson, Thomas H

    2016-07-01

    Pharmaceuticals can enter freshwater and affect aquatic ecosystem health. Although toxicity tests have been carried out for the commonly used pharmaceuticals, evidence-based water quality guidelines have not been derived. High-reliability water quality guideline values have been derived for 4 pharmaceuticals-carbamazepine, diclofenac, fluoxetine, and propranolol-in freshwaters using a Burr type III distribution applied to species sensitivity distributions of chronic toxicity data. Data were quality-assured and had to meet acceptability criteria for "chronic" no-observed-effect concentrations or concentrations affecting 10% of species, endpoints of population relevance (namely, effect endpoints based on development, growth, reproduction, and survival). Biomarker response data (e.g., biochemical, histological, or molecular responses) were excluded from the derivation because they are typically not directly relevant to wildlife population-related impacts. The derived guideline values for 95% species protection were 9.2 μg/L, 770 μg/L, 1.6 μg/L, and 14 μg/L for carbamazepine, diclofenac, fluoxetine, and propranolol, respectively. These values are significantly higher than the unknown reliability values derived for the European Commission, Switzerland, or Germany that are based on the application of assessment factors to the most sensitive experimental endpoint (which may include biochemical, histological, or molecular biomarker responses) of a limited data set. The guideline values derived in the present study were not exceeded in recent data for Australian rivers and streams receiving pharmaceutical-containing effluents from wastewater-treatment plants. Environ Toxicol Chem 2016;35:1815-1824. © 2015 SETAC. PMID:26660719

  4. Impact of air quality guidelines on COPD sufferers

    PubMed Central

    Liu, Youcheng; Yan, Shuang; Poh, Karen; Liu, Suyang; Iyioriobhe, Emanehi; Sterling, David A

    2016-01-01

    Background COPD is one of the leading causes of morbidity and mortality in both high- and low-income countries and a major public health burden worldwide. While cigarette smoking remains the main cause of COPD, outdoor and indoor air pollution are important risk factors to its etiology. Although studies over the last 30 years helped reduce the values, it is not very clear if the current air quality guidelines are adequately protective for COPD sufferers. Objective This systematic review was to summarize the up-to-date literature on the impact of air pollution on the COPD sufferers. Methods PubMed and Google Scholar were utilized to search for articles related to our study’s focus. Search terms included “COPD exacerbation”, “air pollution”, “air quality guidelines”, “air quality standards”, “COPD morbidity and mortality”, “chronic bronchitis”, and “air pollution control” separately and in combination. We focused on articles from 1990 to 2015. We also used articles prior to 1990 if they contained relevant information. We focused on articles written in English or with an English abstract. We also used the articles in the reference lists of the identified articles. Results Both short-term and long-term exposures to outdoor air pollution around the world are associated with the mortality and morbidity of COPD sufferers even at levels below the current air quality guidelines. Biomass cooking in low-income countries was clearly associated with COPD morbidity in adult nonsmoking females. Conclusion There is a need to continue to improve the air quality guidelines. A range of intervention measures could be selected at different levels based on countries’ socioeconomic conditions to reduce the air pollution exposure and COPD burden. PMID:27143874

  5. 75 FR 43747 - Americans With Disabilities Act (ADA) Accessibility Guidelines for Transportation Vehicles

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-26

    ...., buses characterized by an elevated passenger deck located over a baggage compartment). 56 FR 45530, September 6, 1991; 63 FR 51694, September 28, 1998. The Access Board's transportation vehicle guidelines are... transportation provisions of the ADA in 1991. 56 FR 45621 and 45756, September 6, 1991. The Department...

  6. Canadian soil quality guidelines for copper: Environmental and human health

    SciTech Connect

    1997-12-31

    This report begins with background information on the physical and chemical properties of copper, the production and use of copper in Canada, its levels in the Canadian environment, and existing guidelines and criteria regarding copper concentrations in various media. It then reviews the environmental fate and behaviour of copper, notably in the soil; the behavior and effects of copper in biota, including soil microbial processes, terrestrial plants and invertebrates, livestock and wildlife, and bioaccumulation; and the pharmacokinetics and toxicology of copper in mammals and humans, concluding with an overall toxicological evaluation and human exposure estimates. This information is used to derive environmental and human health soil quality guidelines for copper to protect environmental and human health receptors, for agricultural, residential/parkland, commercial, and industrial land uses.

  7. Guidelines for the microbiological quality of treated wastewater used in agriculture: recommendations for revising WHO guidelines.

    PubMed Central

    Blumenthal, U. J.; Mara, D. D.; Peasey, A.; Ruiz-Palacios, G.; Stott, R.

    2000-01-01

    Three different approaches for establishing guidelines for the microbiological quality of treated wastewater that is reused for agriculture are reviewed. These approaches have different objectives as their outcomes: the absence of faecal indicator organisms in the wastewater, the absence of a measurable excess of cases of enteric disease in the exposed population and a model-generated estimated risk below a defined acceptable risk. If the second approach (using empirical epidemiological studies supplemented by microbiological studies of the transmission of pathogens) is used in conjunction with the third approach (using a model-based quantitative risk assessment for selected pathogens) a powerful tool is produced that aids the development of regulations. This combined approach is more cost-effective than the first approach and adequately protects public health. The guideline limit for faecal coliform bacteria in unrestricted irrigation (< or = 1000 faecal coliform bacteria/ 100 ml) is valid, but for restricted irrigation < or = 10(5) faecal coliform bacteria/100 ml is recommended when adult farmworkers are exposed to spray irrigation. A limit of < or = 10(3) faecal coliform bacteria/100 ml is recommended if flood irrigation is used or children are exposed. The guideline limit for nematode eggs for both types of irrigation is adequate except when conditions favour the survival of nematode eggs and where children are exposed; in these cases it should be reduced from < or = 1 egg/l to < or = 0.1 egg/l. PMID:11019459

  8. Survive On Call - A QI Project to Improve Access to Hospital Clinical Guidelines

    PubMed Central

    Penders, Robert; Mallet, Mark

    2016-01-01

    Accessing clinical guidelines and telephone numbers can be time consuming for junior doctors, particularly during a busy on-call shift. Smartphones allow instant access to this information, without leaving a patient's bedside. This overcomes the relative paucity of fixed desktop computers available in most clinical areas. In this project, a trainee doctor developed a clinical smartphone app to improve the access of clinical and hospital-specific information. A representative sample of ten junior doctors were recruited to quantify the amount of time spent accessing guidelines using desktop computers, versus the App. The average time to access a common guideline (Hypokalaemia management) with the App was 12.4 seconds (95% CI 2.3), versus 76.8 seconds (95% CI 30.6) using a computer. A difference of 64.4 seconds (p < 0.001). The average time to access an Amiodarone prescribing guideline with the App was 25.9 seconds (95% CI 12.9), versus 142.0 seconds (95% CI 44.8) using a computer. A difference of 116.1 seconds (p < 0.001). User feedback was collected after each stage of release within the hospital. Following final release, users rated how much time they felt it saved them. 96.1% of respondents felt it either saved them time a ‘few times a week’ (53.85%) or ‘significantly saved time every day’ (42.31%). The project has significantly improved staff satisfaction with how easily they can access clinical guidelines and telephone numbers. They clearly feel it has improved their working efficiency. This has been supported by quantitative measures of actual time saved using the App. The ability to access such information in as little time as possible may be even more pertinent where decision-making is time-critical - for example in Anaesthesia and Emergency Medicine. Further study into these specialties is warranted to determine whether mobile information can impact upon patient safety and clinical outcomes. PMID:27239310

  9. A Quality of Context-Aware Approach to Access Control in Pervasive Environments

    NASA Astrophysics Data System (ADS)

    Toninelli, Alessandra; Corradi, Antonio; Montanari, Rebecca

    The widespread diffusion of wireless-enabled portable devices creates novel opportunities for users to share resources anywhere and anytime, but makes access control a crucial issue. User/device mobility and heterogeneity, together with network topology and conditions variability, complicate access control and call for novel solutions to dynamically adapt access decisions to the different operating conditions. Several research efforts have emerged in recent years that propose to exploit context-awareness to control access to resources based on context visibility and changes. Context-based access control requires, however, to take into account the quality of context information used to drive access decisions (QoC). Quality of context has in fact a profound impact on the correct behavior of any context-aware access control framework. Using context information with insufficient quality might increase the risk of incorrect access control decisions, thus leading to dangerous security breaches in resource sharing. In this paper we propose a QoC-aware approach to access control for anywhere, anytime resource sharing. The paper describes the design, implementation and evaluation of the Proteus policy framework, which combines two design guidelines to enable dynamic adaptation of policies depending on context changes: context-awareness with QoC guarantees and semantic technologies to allow high-level description of context/policy specification and reasoning about context/policies.

  10. [Quality indicators for National Disease Management Guidelines using the example of the National Disease Management Guideline for "Chronic Heart Failure"].

    PubMed

    Nothacker, Monika Judith; Langer, Thomas; Weinbrenner, Susanne

    2011-01-01

    Together with an expert committee a structured approach to determining quality indicators for National Disease Management Guidelines has been developed. The key steps of this approach include: introducing guideline authors to the methodology at an early stage of the process of guideline development, pre-selecting recommendations of the guideline which are potentially measurable by means of quality indicators, assessing the potentially measurable quality indicators in written form using five criteria (including their importance for the health care system and clarity of definitions) and approving them in a formal consensus process. For lack of a database these quality indicators must be regarded as preliminary. For the National Disease Management Guideline "Chronic Heart Failure" nine rate-based indicators have been chosen. The indicators correspond to important strong recommendations (grade of recommendation: A) from the fields of diagnosis (two), general therapeutic strategy (two), specific treatment (three), clinical monitoring (one) and co-ordination of care (one). In a second step, the quality indicators have to be validated within a pilot project. The determination and assessment of the potential quality indicators have revealed room for improvement of guideline development. In particular, there is a need for more health care data and for specification of recommendations.

  11. The Impact Factor: Implications of Open Access on Quality

    ERIC Educational Resources Information Center

    Grozanick, Sara E.

    2010-01-01

    There has been debate about the extent to which open access affects the quality of scholarly work. At the same time, researchers have begun to look for ways to evaluate the quality of open access publications. Dating back to the growth of citation indexes during the 1960s and 1970s, citation analysis--examining citation statistics--has since been…

  12. 76 FR 8753 - Final Information Quality Guidelines Policy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-15

    ... Federal Agencies'' 67 FR 8452 (Feb. 22, 2002). The guidelines are not intended to be, and should not be... these guidelines affects any available judicial review of agency action. These guidelines will serve as... any medium including textual, graphic, narrative, numerical, or audiovisual forms,...

  13. 75 FR 37819 - Proposed Information Quality Guidelines Policy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-30

    ..., Objectivity, Utility, and Integrity of the Information Disseminated by Federal Agencies'' 67 FR 8452 (Feb. 22... requirements or obligations on the agency or the public. Nothing in these guidelines affects any available... guidelines. The guidelines apply to information disseminated to the public in any medium including...

  14. Guidelines for quality assurance in multicenter trials: a position paper.

    PubMed

    Knatterud, G L; Rockhold, F W; George, S L; Barton, F B; Davis, C E; Fairweather, W R; Honohan, T; Mowery, R; O'Neill, R

    1998-10-01

    In the wake of reports of falsified data in one of the trials of the National Surgical Adjuvant Project for Breast and Bowel Cancer supported by the National Cancer Institute, clinical trials came under close scrutiny by the public, the press, and Congress. Questions were asked about the quality and integrity of the collected data and the analyses and conclusions of trials. In 1995, the leaders of the Society for Clinical Trials (the Chair of the Policy Committee, Dr. David DeMets, and the President of the Society, Dr. Sylvan Green) asked two members of the Society (Dr. Genell Knatterud and Dr. Frank Rockhold) to act as co-chairs of a newly formed subcommittee to discuss the issues of data integrity and auditing. In consultation with Drs. DeMets and Green, the co-chairs selected other members (Ms. Franca Barton, Dr. C.E. Davis, Dr. Bill Fairweather, Dr. Stephen George, Mr. Tom Honohan, Dr. Richard Mowery, and Dr. Robert O'Neill) to serve on the subcommittee. The subcommittee considered "how clean clinical trial data should be, to what extent auditing procedures are required, and who should conduct audits and how often." During the initial discussions, the subcommittee concluded that data auditing was insufficient to achieve data integrity. Accordingly, the subcommittee prepared this set of guidelines for standards of quality assurance for multicenter clinical trials. We include recommendations for appropriate action if problems are detected.

  15. Teaching skills for accessing and interpreting information from systematic reviews/meta-analyses, practice guidelines, and the Internet.

    PubMed

    Wolf, F M; Miller, J G; Gruppen, L D; Ensminger, W D

    1997-01-01

    Skills and practice related to accessing and interpreting clinical information from systematic reviews/meta-analyses, practice guidelines, and the Internet have been integrated into a new senior year elective designed to teach medical students how to critically appraise information from a variety of sources and evaluate it's applicability to patient care. Small groups of senior medical students under the direction of a multidisciplinary team (behavioral scientist, information specialist, physician) facilitate discussions of clinical articles using checklists designed to evaluate their quality. The central feature of the course is a demonstration of the Cochrane Database of Systematic Reviews (CDSR), an electronic journal distributed by BMJ Publishing, and the requirement that students conduct a literature review on a topic of their choice and present an oral and written summary in the form of a "draft" meta-analysis. Students are provided with strategies to "surf" the Internet/WWW for information, e.g., practice guidelines/treatment protocols, descriptions of on-going clinical trials. A total of 52 students have participated to date. Students have selected project topics across a wide range of medical disciplines, including internal medicine, family practice, OB/GYN, pediatrics, surgery, neurology, emergency medicine, and psychiatry. The course is one of the most favorably evaluated of all senior electives and rated more favorably than the overall mean ratings for all electives combined on 8 of 9 scales, including "Quality of course overall" (4.39 vs. 3.92 on 5-point scale). PMID:9357708

  16. Inequality in Preschool Quality? Community-Level Disparities in Access to High-Quality Learning Environments

    ERIC Educational Resources Information Center

    Bassok, Daphna; Galdo, Eva

    2016-01-01

    In recent years, unequal access to high-quality preschool has emerged as a growing public policy concern. Because of data limitations, it is notoriously difficult to measure disparities in access to early learning opportunities across communities and particularly challenging to quantify gaps in access to "high-quality" programs. Research…

  17. Distance Education: Access, Quality, Cautions, and Opportunities

    ERIC Educational Resources Information Center

    Edelson, Paul Jay

    2013-01-01

    Assessing the impact of widely distributed learning opportunities now accessible through distance education must take into account the re-imposition of values and motives long associated with traditional education. The expectations of new higher education consumers should be tempered by institutional acknowledgement of pre-existing value…

  18. Quality of guidelines on the management of diabetes in pregnancy: a systematic review

    PubMed Central

    2012-01-01

    Background Diabetes during pregnancy can lead to severe risks for both mother and fetus when it is not managed properly. The use of rigorously developed guidelines with a robust implementation process can have a positive influence on the management of diabetes during pregnancy. This study aims to compare recommendations and assess the quality of clinical guidelines on gestational diabetes mellitus (GDM) and pre-existing diabetes mellitus during pregnancy. Methods Guidelines were selected by searching PubMed, the Guideline Clearing House and Google. All guidelines developed since 2000 on diabetes during pregnancy in English or Dutch were considered. Recommendations of the guidelines were compared. Furthermore, the quality was assessed by two authors independently, using the AGREE instrument. Results Eight guidelines were included. According to the AGREE instrument, the quality of most guidelines was low. The domains editorial independence, stakeholder involvement and rigour of development had the lowest scores. Recommendations were mainly comparable on glycemic control, preconceptional counseling and prenatal care and labour. Differences between recommendations were found for screening on GDM and induction of labour. Conclusions The quality of most guidelines concerning the management of diabetes during pregnancy needs to be improved. A more systematic approach in the development of these guidelines, more attention for updating procedures and piloting of the guidelines and involvement of target users and patients is recommended. PMID:22741571

  19. QUALITY ASSURANCE GUIDELINES FOR LABORATORIES PERFORMING FORENSIC ANALYSIS OF CHEMICAL TERRORISM

    EPA Science Inventory

    The Scientific Working Group on Forensic Analysis of Chemical Terrorism (SWGFACT) has developed the following quality assurance guidelines to provide laboratories engaged in forensic analysis of chemical evidence associated with terrorism a framework to implement a quality assura...

  20. Quality Improvement Guidelines for Radiofrequency Ablation of Liver Tumours

    SciTech Connect

    Crocetti, Laura; Baere, Thierry de; Lencioni, Riccardo

    2010-02-15

    The development of image-guided percutaneous techniques for local tumour ablation has been one of the major advances in the treatment of liver malignancies. Among these methods, radiofrequency ablation (RFA) is currently established as the primary ablative modality at most institutions. RFA is accepted as the best therapeutic choice for patients with early-stage hepatocellular carcinoma (HCC) when liver transplantation or surgical resection are not suitable options [1, 2]. In addition, RFA is considered a viable alternate to surgery (1) for inoperable patients with limited hepatic metastatic disease, especially from colorectal cancer, and (2) for patients deemed ineligible for surgical resection because of extent and location of the disease or concurrent medical conditions [3]. These guidelines were written to be used in quality-improvement programs to assess RFA of HCC and liver metastases. The most important processes of care are (1) patient selection, (2) performing the procedure, and (3) monitoring the patient. The outcome measures or indicators for these processes are indications, success rates, and complication rates.

  1. Response to open access endoscopy findings by general practitioners guidelines need education for implementation.

    PubMed

    Todd, J A; Zubir, M A; Goudie, B M; Johnston, D A

    2000-04-01

    General practitioners may gain valuable information from the use of open access endoscopy. The benefit to the individual patient depends on the interpretation of the endoscopy findings and the subsequent action. The aim of the study was to determine GPs response to open access endoscopy findings of three conditions with possible malignant complications: Barrett's oesophagus, gastric ulcer and colonic adenomatous polyps. The study took place at Ninewells Hospital, Dundee. Using the endoscopy unit's records for the year, 1 January 1995 to 31 December 1995, all patients having had an open access upper gastro-intestinal endoscopy or sigmoidoscopy were identified. Case-notes were reviewed of patients who had Barrett's oesophagus, gastric ulcer or colonic polyps diagnosed. During the year, 1158 upper gastro-intestinal endoscopies and 293 sigmoidoscopies were performed by the open access service. The referral rates for the conditions were as follows: Barrett's oesophagus 56%; Gastric ulcers 56%; Adenomatous polyps 88%; Non adenomatous polyps 12.5%. The provision of guidelines does not ensure a high referral rate, education is a vital partner. PMID:10862438

  2. Strategy Guideline: Quality Management in Existing Homes - Cantilever Floor Example

    SciTech Connect

    Taggart, J.; Sikora, J.; Wiehagen, J.; Wood, A.

    2011-12-01

    This guideline is designed to highlight the QA process that can be applied to any residential building retrofit activity. The cantilevered floor retrofit detailed in this guideline is included only to provide an actual retrofit example to better illustrate the QA activities being presented.

  3. Quality Improvement Strategies and Best Practices in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Casey, Michelle M.; Moscovice, Ira

    2004-01-01

    Critical access hospitals (CAHs) face many challenges in implementing quality improvement (QI) initiatives, which include limited resources, low volume of patients, small staffs, and inadequate information technology. A primary goal of the Medicare Rural Hospital Flexibility Program is to improve the quality of care provided by CAHs. This article…

  4. European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

    PubMed Central

    von Karsa, L.; Patnick, J.; Segnan, N.; Atkin, W.; Halloran, S.; Lansdorp-Vogelaar, I.; Malila, N.; Minozzi, S.; Moss, S.; Quirke, P.; Steele, R. J.; Vieth, M.; Aabakken, L.; Altenhofen, L.; Ancelle-Park, R.; Antoljak, N.; Anttila, A.; Armaroli, P.; Arrossi, S.; Austoker, J.; Banzi, R.; Bellisario, C.; Blom, J.; Brenner, H.; Bretthauer, M.; Camargo Cancela, M.; Costamagna, G.; Cuzick, J.; Dai, M.; Daniel, J.; Dekker, E.; Delicata, N.; Ducarroz, S.; Erfkamp, H.; Espinàs, J. A.; Faivre, J.; Faulds Wood, L.; Flugelman, A.; Frkovic-Grazio, S.; Geller, B.; Giordano, L.; Grazzini, G.; Green, J.; Hamashima, C.; Herrmann, C.; Hewitson, P.; Hoff, G.; Holten, I.; Jover, R.; Kaminski, M. F.; Kuipers, E. J.; Kurtinaitis, J.; Lambert, R.; Launoy, G.; Lee, W.; Leicester, R.; Leja, M.; Lieberman, D.; Lignini, T.; Lucas, E.; Lynge, E.; Mádai, S.; Marinho, J.; Maučec Zakotnik, J.; Minoli, G.; Monk, C.; Morais, A.; Muwonge, R.; Nadel, M.; Neamtiu, L.; Peris Tuser, M.; Pignone, M.; Pox, C.; Primic-Zakelj, M.; Psaila, J.; Rabeneck, L.; Ransohoff, D.; Rasmussen, M.; Regula, J.; Ren, J.; Rennert, G.; Rey, J.; Riddell, R. H.; Risio, M.; Rodrigues, V.; Saito, H.; Sauvaget, C.; Scharpantgen, A.; Schmiegel, W.; Senore, C.; Siddiqi, M.; Sighoko, D.; Smith, R.; Smith, S.; Suchanek, S.; Suonio, E.; Tong, W.; Törnberg, S.; Van Cutsem, E.; Vignatelli, L.; Villain, P.; Voti, L.; Watanabe, H.; Watson, J.; Winawer, S.; Young, G.; Zaksas, V.; Zappa, M.; Valori, R.

    2015-01-01

    Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines. PMID:23212726

  5. Developing Quality Indicators and Auditing Protocols from Formal Guideline Models: Knowledge Representation and Transformations

    PubMed Central

    Advani, Aneel; Goldstein, Mary; Shahar, Yuval; Musen, Mark A.

    2003-01-01

    Automated quality assessment of clinician actions and patient outcomes is a central problem in guideline- or standards-based medical care. In this paper we describe a model representation and algorithm for deriving structured quality indicators and auditing protocols from formalized specifications of guidelines used in decision support systems. We apply the model and algorithm to the assessment of physician concordance with a guideline knowledge model for hypertension used in a decision-support system. The properties of our solution include the ability to derive automatically (1) context-specific and (2) case-mix-adjusted quality indicators that (3) can model global or local levels of detail about the guideline (4) parameterized by defining the reliability of each indicator or element of the guideline. PMID:14728124

  6. ASVCP quality assurance guidelines: control of general analytical factors in veterinary laboratories.

    PubMed

    Flatland, Bente; Freeman, Kathy P; Friedrichs, Kristen R; Vap, Linda M; Getzy, Karen M; Evans, Ellen W; Harr, Kendal E

    2010-09-01

    Owing to lack of governmental regulation of veterinary laboratory performance, veterinarians ideally should demonstrate a commitment to self-monitoring and regulation of laboratory performance from within the profession. In response to member concerns about quality management in veterinary laboratories, the American Society for Veterinary Clinical Pathology (ASVCP) formed a Quality Assurance and Laboratory Standards (QAS) committee in 1996. This committee recently published updated and peer-reviewed Quality Assurance Guidelines on the ASVCP website. The Quality Assurance Guidelines are intended for use by veterinary diagnostic laboratories and veterinary research laboratories that are not covered by the US Food and Drug Administration Good Laboratory Practice standards (Code of Federal Regulations Title 21, Chapter 58). The guidelines have been divided into 3 reports on 1) general analytic factors for veterinary laboratory performance and comparisons, 2) hematology and hemostasis, and 3) clinical chemistry, endocrine assessment, and urinalysis. This report documents recommendations for control of general analytical factors within veterinary clinical laboratories and is based on section 2.1 (Analytical Factors Important In Veterinary Clinical Pathology, General) of the newly revised ASVCP QAS Guidelines. These guidelines are not intended to be all-inclusive; rather, they provide minimum guidelines for quality assurance and quality control for veterinary laboratory testing. It is hoped that these guidelines will provide a basis for laboratories to assess their current practices, determine areas for improvement, and guide continuing professional development and education efforts.

  7. ITC Guidelines on Quality Control in Scoring, Test Analysis, and Reporting of Test Scores

    ERIC Educational Resources Information Center

    Allalouf, Avi

    2014-01-01

    The Quality Control (QC) Guidelines are intended to increase the efficiency, precision, and accuracy of the scoring, analysis, and reporting process of testing. The QC Guidelines focus on large-scale testing operations where multiple forms of tests are created for use on set dates. However, they may also be used for a wide variety of other testing…

  8. George M. Low Trophy NASA's Quality and Excellence Award, 1992. Application guidelines: Small business

    NASA Technical Reports Server (NTRS)

    1992-01-01

    Guidelines are given for the selection of small business candidates for the George M. Low Trophy, NASA's Quality and Excellence Award, 1992. Topics covered include candidate eligibility, the selection process milestone schedule, the nomination letter, and the application report.

  9. Regulatory framework for access to safe, effective quality medicines.

    PubMed

    Rägo, Lembit; Sillo, Hiiti; 't Hoen, Ellen; Zweygarth, Monika

    2014-01-01

    Medicines of uncertain quality, safety and efficacy can be worse than no treatment at all. It is the responsibility of national medicines regulatory authorities to protect patients from harm. Yet, there are great disparities in regulatory capacity globally, preventing large populations from accessing the benefits of advances in the pharmaceutical field. This article describes the main regulatory functions and how they are applied to assure the quality, safety and efficacy of different types of medicines in different environments. It gives examples of initiatives that have increased access to good quality medicines worldwide and - more importantly - are laying the groundwork for collaborative approaches aiming to ensure that pharmaceutical products meet the same, stringent quality standards in all parts of the world. PMID:25310085

  10. Educational Intervention Improves Compliance With AAN Guidelines for Return Epilepsy Visits: A Quality Improvement Project.

    PubMed

    Nelson, Gary R; Filloux, Francis M; Kerr, Lynne M

    2016-10-01

    In 2011, the American Academy of Neurology (AAN) released guidelines for return seizure visits detailing 8 points that should be addressed during such visits. These guidelines are designed to improve routine follow-up care for epilepsy patients. The authors performed a quality improvement project aimed at increasing compliance with these guidelines after educating providers about them. The authors performed a chart review before and after an intervention which included: education regarding the guidelines, providing materials to remind providers of the guidelines, and templates to facilitate compliance. The authors reviewed charts at 2 and 6 months after the intervention. Significant improvement in documentation of 4 of the 8 measures was observed after this educational intervention. This suggests that simple educational interventions may help providers change practice and can improve compliance with new guidelines while requiring minimal time and resources to implement. PMID:27306884

  11. [Development and Quality Evaluation of Evidence-based Clinical Practice Guidelines of Chinese Medicine].

    PubMed

    Jiang, Yue-rong; Chen, Ke-ji

    2016-01-01

    More attentions have been paid to the development of evidence-based clinical practice guidelines (ECPGs) of Chinese medicine (CM). International guideline evaluation instruments such as Appraisal of Guidelines for Research and Evaluation (AGREE I) has been gradually applied in ECPGs quality evaluation of CM. Nowadays, there are some certain methodological defects in partial ECPGs of Chinese medicine, with relatively low applicability and slowly update. It is suggested to establish technical specifications of CM-ECPGs in accordance with the characteristics of CM and international general specification, strengthen the quality evaluation of CM-ECPGs, attach great importance to the regularly update as well as popularization and application of CM-ECPGs.

  12. Publication guidelines for quality improvement studies in health care: evolution of the SQUIRE project

    PubMed Central

    Batalden, Paul; Stevens, David; Ogrinc, Greg; Mooney, Susan E

    2009-01-01

    In 2005 we published draft guidelines for reporting studies of quality improvement, as the initial step in a consensus process for development of a more definitive version. The current article contains the revised version, which we refer to as standards for quality improvement reporting excellence (SQUIRE). This narrative progress report summarises the special features of improvement that are reflected in SQUIRE, and describes major differences between SQUIRE and the initial draft guidelines. It also briefly describes the guideline development process; considers the limitations of and unresolved questions about SQUIRE; describes ancillary supporting documents and alternative versions under development; and discusses plans for dissemination, testing, and further development of SQUIRE. PMID:19153129

  13. Faculty Work and the Cost/Quality/Access Collision.

    ERIC Educational Resources Information Center

    Mingle, James R.

    This report examines the issue of faculty workload within the context of rising educational costs and educational demand and its impact on quality and access. Research on the questions of how hard faculty work, what they do with that working time, and especially how much time is spent in the classroom is discussed. Faculty workload studies are…

  14. Lateral-Directional Eigenvector Flying Qualities Guidelines for High Performance Aircraft

    NASA Technical Reports Server (NTRS)

    Davidson, John B.; Andrisani, Dominick, II

    1996-01-01

    This report presents the development of lateral-directional flying qualities guidelines with application to eigenspace (eigenstructure) assignment methods. These guidelines will assist designers in choosing eigenvectors to achieve desired closed-loop flying qualities or performing trade-offs between flying qualities and other important design requirements, such as achieving realizable gain magnitudes or desired system robustness. This has been accomplished by developing relationships between the system's eigenvectors and the roll rate and sideslip transfer functions. Using these relationships, along with constraints imposed by system dynamics, key eigenvector elements are identified and guidelines for choosing values of these elements to yield desirable flying qualities have been developed. Two guidelines are developed - one for low roll-to-sideslip ratio and one for moderate-to-high roll-to-sideslip ratio. These flying qualities guidelines are based upon the Military Standard lateral-directional coupling criteria for high performance aircraft - the roll rate oscillation criteria and the sideslip excursion criteria. Example guidelines are generated for a moderate-to-large, an intermediate, and low value of roll-to-sideslip ratio.

  15. 78 FR 10110 - Accessibility Guidelines for Pedestrian Facilities in the Public Right-of-Way; Shared Use Paths

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-13

    ... on July 26, 2011. See 76 FR 44664 (July 26, 2011). A copy of the proposed accessibility guidelines... for trails and other outdoor developed areas in 2007. See 72 FR 34074 (June 20, 2007). A trail would... for outdoor recreational purposes. A pedestrian route developed primarily to connect elements,...

  16. Clinical Practice Guidelines and Consensus Statements in Oncology – An Assessment of Their Methodological Quality

    PubMed Central

    Jacobs, Carmel; Graham, Ian D.; Makarski, Julie; Chassé, Michaël; Fergusson, Dean; Hutton, Brian; Clemons, Mark

    2014-01-01

    Background Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine’s standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. Findings Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice guidelines. One journal

  17. Developing Local Board of Health Guidelines to Promote Healthy Food Access — King County, Washington, 2010–2012

    PubMed Central

    Johnson, Donna B.; Krieger, James; MacDougall, Erin; Payne, Elizabeth; Chan, Nadine L.

    2015-01-01

    Policies that change environments are important tools for preventing chronic diseases, including obesity. Boards of health often have authority to adopt such policies, but few do so. This study assesses 1) how one local board of health developed a policy approach for healthy food access through vending machine guidelines (rather than regulations) and 2) the impact of the approach. Using a case study design guided by “three streams” policy theory and RE-AIM, we analyzed data from a focus group, interviews, and policy documents. The guidelines effectively supported institutional policy development in several settings. Recognition of the problem of chronic disease and the policy solution of vending machine guidelines created an opening for the board to influence nutrition environments. Institutions identified a need for support in adopting vending machine policies. Communities could benefit from the study board’s approach to using nonregulatory evidence-based guidelines as a policy tool. PMID:25927606

  18. Developing local board of health guidelines to promote healthy food access - King County, Washington, 2010-2012.

    PubMed

    Quinn, Emilee; Johnson, Donna B; Krieger, James; MacDougall, Erin; Payne, Elizabeth; Chan, Nadine L

    2015-04-30

    Policies that change environments are important tools for preventing chronic diseases, including obesity. Boards of health often have authority to adopt such policies, but few do so. This study assesses 1) how one local board of health developed a policy approach for healthy food access through vending machine guidelines (rather than regulations) and 2) the impact of the approach. Using a case study design guided by "three streams" policy theory and RE-AIM, we analyzed data from a focus group, interviews, and policy documents. The guidelines effectively supported institutional policy development in several settings. Recognition of the problem of chronic disease and the policy solution of vending machine guidelines created an opening for the board to influence nutrition environments. Institutions identified a need for support in adopting vending machine policies. Communities could benefit from the study board's approach to using nonregulatory evidence-based guidelines as a policy tool.

  19. Practice improvement requires more than guidelines and quality measures.

    PubMed

    Sigsbee, Bruce; Bever, Christopher T; Jones, Lyell K

    2016-01-12

    Increasing emphasis on improving health care quality has led to a variety of programs that require neurologists to be familiar with the concept of systematic quality improvement. While they vary in extent, these quality improvement programs and their attendant costs now have implications for physician payment and certification. In response to these factors, the American Academy of Neurology is establishing a clinical quality data registry. This article reviews evidence demonstrating the ability of quality improvement initiatives to improve care, the role of clinical quality data registries in the identification and mitigation of gaps in care, and the principles to be considered in development of registry-based quality improvement programs. It addresses the key question: Is the effort worthwhile?

  20. Guideline for dialysate quality of Spanish Society of Nephrology (second edition, 2015).

    PubMed

    Pérez-García, Rafael; García Maset, Rafael; Gonzalez Parra, Emilio; Solozábal Campos, Carlos; Ramírez Chamond, Rafael; Martín-Rabadán, Pablo; Sobrino Pérez, Pedro Enrique; Gallego Pereira, Ovidio; Dominguez, Jon; de la Cueva Matute, Enrique; Ferllen, Ricardo

    2016-01-01

    A Best Practice Guideline about Dialysis fluid purity was developed under the leadership of the Spanish Society of Nephrology in 2004. The second edition revised Guideline considered new evidences and International Standard. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. This Guideline is based on the ISO13959, European Pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis, literature reviews, according to their level of evidence, and the opinion of the expert Spanish group. Two levels of quality of water were defined: purified water and high purified water (ultra pure) and for dialysate: ultra pure dialysate. Regular use of ultra pure dialysate is recommended for all type of hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anaemia and amiloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (4.1.2), conductivity, microbial and endotoxins (4.1.1): Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (anexos). For microbiological monitoring, R2A medium is recommended, incubated during 7-14 days at a temperature of 17-23°C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org.

  1. Guideline for dialysate quality of Spanish Society of Nephrology (second edition, 2015).

    PubMed

    Pérez-García, Rafael; García Maset, Rafael; Gonzalez Parra, Emilio; Solozábal Campos, Carlos; Ramírez Chamond, Rafael; Martín-Rabadán, Pablo; Sobrino Pérez, Pedro Enrique; Gallego Pereira, Ovidio; Dominguez, Jon; de la Cueva Matute, Enrique; Ferllen, Ricardo

    2016-01-01

    A Best Practice Guideline about Dialysis fluid purity was developed under the leadership of the Spanish Society of Nephrology in 2004. The second edition revised Guideline considered new evidences and International Standard. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. This Guideline is based on the ISO13959, European Pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis, literature reviews, according to their level of evidence, and the opinion of the expert Spanish group. Two levels of quality of water were defined: purified water and high purified water (ultra pure) and for dialysate: ultra pure dialysate. Regular use of ultra pure dialysate is recommended for all type of hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anaemia and amiloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (4.1.2), conductivity, microbial and endotoxins (4.1.1): Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (anexos). For microbiological monitoring, R2A medium is recommended, incubated during 7-14 days at a temperature of 17-23°C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org. PMID:26988922

  2. Total quality in acute care hospitals: guidelines for hospital managers.

    PubMed

    Holthof, B

    1991-08-01

    Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.

  3. A Critical Analysis of the INQAAHE Guidelines of Good Practice for Higher Education Quality Assurance Agencies

    ERIC Educational Resources Information Center

    Blackmur, Douglas

    2008-01-01

    The International Network of Quality Assurance Agencies in Higher Education's Guidelines of Good Practice by higher education quality assurance agencies need substantial revision before they can be considered adequate by stakeholders in any national higher education system. Various revisions are proposed in this article. But the International…

  4. Guidelines for Professional Development of Online Teachers: Based on the SREB "Standards for Quality Online Teaching"

    ERIC Educational Resources Information Center

    Glowa, Elizabeth

    2009-01-01

    Working with member states, SREB developed the nation's first Standards for "Quality Online Teaching," which define the qualifications of a quality online teacher and the standards needed for academic preparation, content knowledge, online skills and delivery. Building on those standards, this report presents extensive guidelines that…

  5. Design Guidelines: Study of Handicapped Accessibility in South Carolina State Parks.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Parks, Recreation, and Tourism, Columbia. Div. of Engineering and Planning.

    The publication provides guidelines for the design of new facilities or rehabilitation of existing facilities to accommodate physically handicapped persons in the South Carolina State Parks system. The guidelines are also recommended for use in regional, special district, county, and municipal parks within the state. The guidelines were developed…

  6. Elevating the quality of disability and rehabilitation research: mandatory use of the reporting guidelines.

    PubMed

    Chan, Leighton; Heinemann, Allen W; Roberts, Jason

    2014-01-01

    Note from the AJOT Editor-in-Chief: Since 2010, the American Journal of Occupational Therapy (AJOT) has adopted reporting standards based on the Consolidated Standards of Reporting Trials (CONSORT) Statement and American Psychological Association (APA) guidelines in an effort to publish transparent clinical research that can be easily evaluated for methodological and analytical rigor (APA Publications and Communications Board Working Group on Journal Article Reporting Standards, 2008; Moher, Schulz, & Altman, 2001). AJOT has now joined 28 other major rehabilitation and disability journals in a collaborative initiative to enhance clinical research reporting standards through adoption of the EQUATOR Network reporting guidelines, described below. Authors will now be required to use these guidelines in the preparation of manuscripts that will be submitted to AJOT. Reviewers will also use these guidelines to evaluate the quality and rigor of all AJOT submissions. By adopting these standards we hope to further enhance the quality and clinical applicability of articles to our readers.

  7. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition--Communication.

    PubMed

    Austoker, J; Giordano, L; Hewitson, P; Villain, P

    2012-09-01

    Multidisciplinary, evidence-based guidelines for quality assurance in colorectal cancer screening and diagnosis have been developed by experts in a project coordinated by the International Agency for Research on Cancer. The full guideline document covers the entire process of population-based screening. It consists of 10 chapters and over 250 recommendations, graded according to the strength of the recommendation and the supporting evidence. The 450-page guidelines and the extensive evidence base have been published by the European Commission. The chapter on communication includes 35 graded recommendations. The content of the chapter is presented here to promote international discussion and collaboration by making the principles and standards recommended in the new EU Guidelines known to a wider professional and scientific community. Following these recommendations has the potential to enhance the control of colorectal cancer through improvement in the quality and effectiveness of screening programmes and services.

  8. GENERAL GUIDELINES FOR USING THE SEDIMENT QUALITY TRIAD

    EPA Science Inventory

    The Sediment Quality Triad(Fig. 1),developed in the mid-1980s (Long and Chapman, 1985), is now widely used for conducting integrated assessments of sediment quality based on measures of chemistry,toxicity and benthos(e.g.,Canfield et al., 1994,1996,submitted; Carr et al., 1996;Ch...

  9. A comparison of inpatient glucose management guidelines: implications for patient safety and quality.

    PubMed

    Mathioudakis, Nestoras; Golden, Sherita Hill

    2015-03-01

    Inpatient glucose management guidelines and consensus statements play an important role in helping to keep hospitalized patients with diabetes and hyperglycemia safe and in optimizing the quality of their glycemic control. In this review article, we compare and contrast seven prominent US guidelines on recommended glycemic outcome measures and processes of care, with the goal of highlighting how variation among them might influence patient safety and quality. The outcome measures of interest include definitions of glucose abnormalities and glycemic targets. The relevant process measures include detection and documentation of diabetes/hyperglycemia, methods of and indications for insulin therapy, management of non-insulin agents, blood glucose monitoring, management of special situations (e.g., parenteral/enteral nutrition, glucocorticoids, surgery, insulin pumps), and appropriate transitions of care. In addition, we address elements of quality improvement, such as glycemic control program infrastructure, glucometrics, insulin safety, and professional education. While most of these guidelines align with respect to outcome measures such as glycemic targets, there is significant heterogeneity among process measures, which we propose might introduce variation or even confusion in clinical practice and possibly affect quality of care. Guideline-related factors, such as rigor of development, clarity, and presentation, may also affect provider trust in and adherence to guidelines. There is a need for high-quality research to address knowledge gaps in optimal glucose management practice approaches in the hospital setting. PMID:25690724

  10. Clinical practice guideline development manual: A quality-driven approach for translating evidence into action

    PubMed Central

    Rosenfeld, Richard M.; Shiffman, Richard N.

    2010-01-01

    Background Guidelines translate best evidence into best practice. A well-crafted guideline promotes quality by reducing healthcare variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective – or potentially harmful – interventions. Despite a plethora of published guidelines, methodology is often poorly defined and varies greatly within and among organizations. Purpose This manual describes the principles and practices used successfully by the American Academy of Otolaryngology – Head and Neck Surgery to produce quality-driven, evidence-based guidelines using efficient and transparent methodology for action-ready recommendations with multi-disciplinary applicability. The development process, which allows moving from conception to completion in twelve months, emphasizes a logical sequence of key action statements supported by amplifying text, evidence profiles, and recommendation grades that link action to evidence. Conclusions As clinical practice guidelines become more prominent as a key metric of quality healthcare, organizations must develop efficient production strategies that balance rigor and pragmatism. Equally important, clinicians must become savvy in understanding what guidelines are – and are not – and how they are best utilized to improve care. The information in this manual should help clinicians and organizations achieve these goals. PMID:19464525

  11. Guidelines for use of water-quality monitors

    USGS Publications Warehouse

    Gordon, A. Brice; Katzenbach, Max S.

    1983-01-01

    This manual contains methods and procedures used by the U.S. Geological Survey (USGS) for collecting specific conductance, dissolved oxygen, water temperature, and pH data for ground water, streams, lakes, reservoirs, and estuaries by means of permanently installed, continuously recording, water quality monitors. The topics discussed include the selection of monitoring sites, selection and installation of shelters and equipment, and standard methods of calibration, operation and maintenance of water-quality monitors.

  12. Guidelines of the International Federation of Red Cross and Red Crescent Societies: an overview and quality appraisal using AGREE II

    PubMed Central

    Vande veegaete, Axel; Borra, Vere; De Buck, Emmy; Vandekerckhove, Philippe

    2016-01-01

    Objectives To appraise the quality of guidelines developed by the International Federation of Red Cross and Red Crescent Societies (IFRC) between 2001 and 2015. Study design Cross-sectional. Methods 2 authors independently assessed the quality of IFRC guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Average domain scores were calculated and overall quality scores and recommendation for use were determined. Results Out of 77 identified guidelines, 27 met the inclusion criteria and were assessed. The domains with the highest average scores across guidelines were ‘scope and purpose’, ‘clarity of presentation’ and ‘applicability’. The lowest scoring domains were ‘rigour of development’ and ‘editorial independence’. No guideline can be ‘recommended for immediate use’, 23 guidelines are ‘recommended with modifications’ and 4 guidelines are ‘not recommended’. Conclusions The IFRC produces guidelines that should be adhered to by millions of staff and volunteers in 190 countries. These guidelines should therefore be of high quality. Up until now, the IFRC had no uniform guideline development process. The results of the AGREE II appraisal indicate that the quality of the guidelines needs to be improved. PMID:27678534

  13. Development of Quality Management Systems for Clinical Practice Guidelines in Korea.

    PubMed

    Jo, Heui-Sug; Kim, Dong Ik; Chang, Sung-Goo; Shin, Ein-Soon; Oh, Moo-Kyung

    2015-11-01

    This study introduces the Clinical practice guidelines (CPGs) appraisal system by the Korean Academy of Medical Sciences (KAMS). Quality management policies for CPGs vary among different countries, which have their own cultures and health care systems. However, supporting developers in guideline development and appraisals using standardized tools are common practices. KAMS, an organization representing the various medical societies of Korea, has been striving to establish a quality management system for CPGs, and has established a CPGs quality management system that reflects the characteristics of the Korean healthcare environment and the needs of its users. KAMS created a foundation for the development of CPGs, set up an independent appraisal organization, enacted regulations related to the appraisals, and trained appraisers. These efforts could enhance the ability of each individual medical society to develop CPGs, to increase the quality of the CPGs, and to ultimately improve the quality of the information available to decision-makers.

  14. Drinking water sources, availability, quality, access and utilization for goats in the Karak Governorate, Jordan.

    PubMed

    Al-Khaza'leh, Ja'far Mansur; Reiber, Christoph; Al Baqain, Raid; Valle Zárate, Anne

    2015-01-01

    Goat production is an important agricultural activity in Jordan. The country is one of the poorest countries in the world in terms of water scarcity. Provision of sufficient quantity of good quality drinking water is important for goats to maintain feed intake and production. This study aimed to evaluate the seasonal availability and quality of goats' drinking water sources, accessibility, and utilization in different zones in the Karak Governorate in southern Jordan. Data collection methods comprised interviews with purposively selected farmers and quality assessment of water sources. The provision of drinking water was considered as one of the major constraints for goat production, particularly during the dry season (DS). Long travel distances to the water sources, waiting time at watering points, and high fuel and labor costs were the key reasons associated with the problem. All the values of water quality (WQ) parameters were within acceptable limits of the guidelines for livestock drinking WQ with exception of iron, which showed slightly elevated concentration in one borehole source in the DS. These findings show that water shortage is an important problem leading to consequences for goat keepers. To alleviate the water shortage constraint and in view of the depleted groundwater sources, alternative water sources at reasonable distance have to be tapped and monitored for water quality and more efficient use of rainwater harvesting systems in the study area is recommended. PMID:25307764

  15. Drinking water sources, availability, quality, access and utilization for goats in the Karak Governorate, Jordan.

    PubMed

    Al-Khaza'leh, Ja'far Mansur; Reiber, Christoph; Al Baqain, Raid; Valle Zárate, Anne

    2015-01-01

    Goat production is an important agricultural activity in Jordan. The country is one of the poorest countries in the world in terms of water scarcity. Provision of sufficient quantity of good quality drinking water is important for goats to maintain feed intake and production. This study aimed to evaluate the seasonal availability and quality of goats' drinking water sources, accessibility, and utilization in different zones in the Karak Governorate in southern Jordan. Data collection methods comprised interviews with purposively selected farmers and quality assessment of water sources. The provision of drinking water was considered as one of the major constraints for goat production, particularly during the dry season (DS). Long travel distances to the water sources, waiting time at watering points, and high fuel and labor costs were the key reasons associated with the problem. All the values of water quality (WQ) parameters were within acceptable limits of the guidelines for livestock drinking WQ with exception of iron, which showed slightly elevated concentration in one borehole source in the DS. These findings show that water shortage is an important problem leading to consequences for goat keepers. To alleviate the water shortage constraint and in view of the depleted groundwater sources, alternative water sources at reasonable distance have to be tapped and monitored for water quality and more efficient use of rainwater harvesting systems in the study area is recommended.

  16. 75 FR 13457 - Americans With Disabilities Act (ADA) Accessibility Guidelines for Buildings and Facilities...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-22

    ... guidelines periodically. The Board published the guidelines on February 3, 1998. 63 FR 5608 (February 3, 1998... 21, 2000. 65 FR 80500 (December 21, 2000); 36 CFR part 1194. The standards were based on... kiosks. 73 FR 27614 (May 13, 2008). There have also been numerous settlement agreements and...

  17. [Treatment adherence, access and AIDS assistance quality in Brazil. ].

    PubMed

    Nemes, Maria Inês Batistella; Castanheira, Elen Rose Lodeiro; Helena, Ernani Tiaraju de Santa; Melchior, Regina; Caraciolo, Joselita Magalhães; Basso, Cáritas Relva; Alves, Maria Teresa Seabra Soares de Britto E; Alencar, Tatianna Meireles Dantas de; Ferraz, Dulce Aurélia de Souza

    2009-01-01

    The patient adherence to highly active antiretroviral therapy (HAART) is a crucial matter to AIDS treatment effectiveness and its' impact. This article aims to discuss the association between adherence and quality of health service providing care to people living with AIDS (PLWA), highlighting quality of the services as a central point to adherence and access. It is based on results of our previous studies about the health care to PLWA in Brazil. Our studies point out that the groups of patients who are followed-up in health services providing care for less than 100 patients presented greater estimated risk of non-adherence than services following more than 500 patients. Also, smaller health services showed greater estimated risk to be ranged in the worst quality of services groups. This is related to the low complexity of smaller health care services, such as: lack of minimum human resources and material structures, poor organization on work process, medical-centered care and poor technical management. New studies in adherence and quality of services are needed. Nevertheless, the existent findings have already pointed out the need to review the current distribution of AIDS care services as well as to make the quality of services more homogenous thorough the country. These are high priorities in order to keep acceptable levels of adherence to HAART in Brazil.

  18. 38 CFR 17.508 - Access to quality assurance records and documents within the agency.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Access to quality...' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review Records § 17.508 Access to quality assurance records and documents within the agency. (a) Access...

  19. 38 CFR 17.508 - Access to quality assurance records and documents within the agency.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Access to quality...' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review Records § 17.508 Access to quality assurance records and documents within the agency. (a) Access...

  20. 38 CFR 17.508 - Access to quality assurance records and documents within the agency.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Access to quality...' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review Records § 17.508 Access to quality assurance records and documents within the agency. (a) Access...

  1. 38 CFR 17.508 - Access to quality assurance records and documents within the agency.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Access to quality...' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review Records § 17.508 Access to quality assurance records and documents within the agency. (a) Access...

  2. 38 CFR 17.508 - Access to quality assurance records and documents within the agency.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Access to quality...' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review Records § 17.508 Access to quality assurance records and documents within the agency. (a) Access...

  3. Medical guidelines, physician density, and quality of care: evidence from German SHARE data.

    PubMed

    Jürges, Hendrik; Pohl, Vincent

    2012-10-01

    We use German SHARE data to study the relationship between district general practitioner density and the quality of preventive care provided to older adults. We measure physician quality of care as the degree of adherence to medical guidelines (for the management of risk factors for cardiovascular disease and the prevention of falls) as reported by patients. Contrary to theoretical expectations, we find only weak and insignificant effects of physician density on quality of care. Our results shed doubt on the notion that increasing physician supply will increase the quality of care provided in Germany's present health care system. PMID:22203268

  4. THE UNITED STATES EPA CONCEPT FOR DERIVING WATER QUALITY GUIDELINES FOR RECREATIONAL WATERS

    EPA Science Inventory

    The guidelines developed by the US EPA for controlling the quality of recreational waters are based on protecting the health of swimmers and other recreationists who may be exposed to waters contaminated by human and animal excreta. Risks to swimmers were determined through a se...

  5. Design guidelines for an umbilical cord blood stem cell therapy quality assessment model

    NASA Astrophysics Data System (ADS)

    Januszewski, Witold S.; Michałek, Krzysztof; Yagensky, Oleksandr; Wardzińska, Marta

    The paper enlists the pivotal guidelines for producing an empirical umbilical cord blood stem cell therapy quality assessment model. The methodology adapted was single equation linear model with domain knowledge derived from MEDAFAR classification. The resulting model is ready for therapeutical application.

  6. 77 FR 22282 - Draft Guidelines on Biologics Quality Monitoring: Testing for the Detection of Mycoplasma...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-13

    ... Animal and Plant Health Inspection Service Draft Guidelines on Biologics Quality Monitoring: Testing for... master seed/cell testing in veterinary vaccines regulated by the Animal and Plant Health Inspection... veterinary vaccines regulated by the APHIS under the Virus-Serum-Toxin Act (VSTA), we are requesting...

  7. Preventing Indoor Air Quality Problems in Educational Facilities: Guidelines for Hot, Humid Climates. Revised.

    ERIC Educational Resources Information Center

    Odom, J. David; DuBose, George

    This manual addresses the errors that occur during new construction that subsequently contribute to indoor air quality (IAQ) problems in newly constructed buildings in hot and humid climates, and offers guidelines for preventing them during the design and construction phases. It defines the roles and responsibilities of the design team, the…

  8. 76 FR 51060 - Guidelines for Ensuring and Maximizing the Quality, Objectivity, Utility, and Integrity of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-17

    ... FR 8452-8460), pursuant to section 515 of the Treasury and General Government Appropriations Act for... FR 8452-8460) that direct each federal agency to (1) Issue its own guidelines ensuring and maximizing... June 2011 (76 FR 37376) intended to ensure and maximize the quality, objectivity, utility,...

  9. Quality Chemical Dependency Treatment in an Era of Cost Containment: Clinical Guidelines for Practitioners.

    ERIC Educational Resources Information Center

    Pacione, Tony; Jaskula, Diane

    1994-01-01

    Offers three clinical guidelines designed to deliver quality chemical dependency care that is cost effective: use least restrictive level of care most likely to initiate abstinence; assess likelihood of treatment failure at level of care chosen and risks to client if treatment fails; and identify treatment failure quickly and move client to more…

  10. REVISING EPA'S GUIDELINES FOR THE DERIVATIONS OF AQUATIC LIFE AMBIENT WATER QUALITY CRITERIA

    EPA Science Inventory

    Henry, T.R., H.E. Bell, C.G. Delos, R.J. Erickson, K.M. Kubena and F.L. Mayer. In press. Revising EPA's Guidelines for the Derivation of Aquatic Life Ambient Water Quality Criteria (Abstract). To be presented at the SETAC Fourth World Congress, 14-18 November 2004, Portland, OR. ...

  11. ASVCP quality assurance guidelines: external quality assessment and comparative testing for reference and in-clinic laboratories.

    PubMed

    Camus, Melinda S; Flatland, Bente; Freeman, Kathleen P; Cruz Cardona, Janice A

    2015-12-01

    The purpose of this document is to educate providers of veterinary laboratory diagnostic testing in any setting about comparative testing. These guidelines will define, explain, and illustrate the importance of a multi-faceted laboratory quality management program which includes comparative testing. The guidelines will provide suggestions for implementation of such testing, including which samples should be tested, frequency of testing, and recommendations for result interpretation. Examples and a list of vendors and manufacturers supplying control materials and services to veterinary laboratories are also included.

  12. Critical Appraisal of the Quality of Clinical Practice Guidelines for Stress Ulcer Prophylaxis

    PubMed Central

    Ye, Zhi-Kang; Liu, Ying; Cui, Xiang-Li; Liu, Li-Hong

    2016-01-01

    Background and Objective Inappropriate use of stress ulcer prophylaxis (SUP) is common in many hospitals. High-quality clinical practice guidelines (CPGs) produce better patient outcomes and promote cost-effective clinical care. Thus, the objective of this study was to evaluate the quality of CPGs for SUP. Methods A search was conducted for SUP CPGs using PubMed, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature database (CBM), guideline websites and Google (until March 1, 2015). The quality of CPGs was independently assessed by two assessors using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument, and the specific recommendations in the CPGs were summarized and evaluated. Results A total of 7 CPGs for SUP were included. The highest median scores were in the clarity of presentation domain (89%), and the lowest median scores were in the editorial independence domain (0%). The rigor of development, stakeholder involvement, and applicability domains all scored below 40%. The specific recommendations for SUP varied, and the recommendations were inconsistent with the supporting evidence. Conclusions The overall quality of CPGs for SUP was relatively low, and no specific SUP CPG can be recommended. Not only should the AGREE II instrument be used to determine the quality of CPGs, but also the recommendations should be appraised based on supporting evidence, which would contribute to the development of high-quality CPGs. PMID:27152836

  13. [From library to clinical decision support systems: access of general practitioner to quality information].

    PubMed

    Fauquert, B

    2012-09-01

    Since 2003, the following tools have been implemented in Belgium for improving the access of general practioners to the EBM literature: the Digital Library for Health and the evidence-linker of the CEBAM, the portal EBMPracticeNet.be and the multidimensional electronic clinical decision support EBMeDS. The aim of this article is to show the progress achieved in the information dissemination toward the belgian general practioners, particularly the access from the electronic health record. From the literature published these last years, the opportunities cited by the users are for using EBM and the strong willingness for using these literature access in the future; the limits are the medical data coding, the irrelevance of the search results, the alerts fatigue induced by EBMeDS. The achievements done and planned for the new EBMPracticeNet guidelines portal and the EBMeDS system are explained in the aim of informing belgian healthcare professionals. These projects are claiming for lauching a participatory process in the production and dissemination of EBM information. The discussion is focused on the belgian healthcare system advantages, the solutions for a reasonable implementation of these projects and for increasing the place of an evidence-based information in the healthcare decision process. Finally the input of these projects to the continuing medical education and to the healthcare quality are discussed, in a context of multifactorial interaction healthcare design (complexity design).

  14. [Measuring quality in the German Guideline Programme in Oncology (GGPO)—methodology and implementation].

    PubMed

    Nothacker, Monika; Muche-Borowski, Cathleen; Kopp, Ina B

    2014-01-01

    The German Guideline Programme in Oncology (GGPO) is a joint initiative between the German Cancer Society, the Association of the Scientific Medical Societies in Germany and German Cancer Aid. In accordance with the aims of the German National Cancer Plan, the GGPO supports the systematic development of high-quality guidelines. To enhance implementation and evaluation, the suggestion of performance measures (PMs) derived from guideline recommendations following a standardised methodology is obligatory within the GGPO. For this purpose, PM teams are convened representing the multidisciplinary guideline development groups including clinical experts, methodologists and patient representatives as well as those organisations that take an active part in and share responsibility for documentation and quality improvement, i.e., clinical cancer registries, certified cancer centres and, if appropriate, the institution responsible for external quality assurance according to the German Social Code (SGB). The primary selection criteria for PMs include strength of the underlying recommendation (strong, grade A), existing potential for improvement of care and measurability. The premises of data economy and standardised documentation are taken into account. Between May 2008 and July 2014, 12 guidelines with suggestions for 100 PMs have been published. The majority of the suggested performance measures is captured by the specific documentation requirements of the clinical cancer registries and certified cancer centres. This creates a solid basis for an active quality management and re-evaluation of the suggested PMs. In addition, the suspension of measures should be considered if improvement has been achieved on a broad scale and for a longer period in order to concentrate on a quality-oriented, economic documentation.

  15. From Postpartum Haemorrhage Guideline to Local Protocol: A Study of Protocol Quality.

    PubMed

    Woiski, Mallory D; van Vugt, Helena C; Dijkman, Anneke; Grol, Richard P; Marcus, Abraham; Middeldorp, Johanna M; Mol, Ben W; Mols, Femke; Oudijk, Martijn A; Porath, Martina; Scheepers, Hubertina J; Hermens, Rosella P

    2016-10-01

    Objective Postpartum hemorrhage (PPH) has a continuously rising incidence worldwide, suggesting suboptimal care. An important step in optimizing care is the translation of evidence-based guidelines into comprehensive hospital protocols. However, knowledge about the quality of these protocols is lacking. The objective of this study was to evaluate the quality of PPH-protocols on structure and content in the Netherlands. Methods We performed an observational multicenter study. Eighteen PPH-protocols from 3 University Hospitals (UH), 8 Teaching Hospitals (TH) and 7 Non-Teaching hospitals (NTH) throughout the Netherlands were acquired. The structure of the PPH-protocols was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) Instrument. The content was appraised using previously developed quality indicators, based on international guidelines and Advance-Trauma-Life-Support (ATLS)-based course instructions. Results The quality of the protocols for postpartum hemorrhage for both structure and content varied widely between different hospitals, but all of them showed room for improvement. The protocols scored mainly below average on the different items of the AGREE-II instrument (8 of the 10 items scored <4 on a 1-7 scale). Regarding the content, adoption of guideline recommendations in protocols was 46 %. In addition, a timely indication of 'when to perform' a recommendation was lacking in three-fourths of the items. Conclusion This study shows that the quality of the PPH-protocols for both structure and content in the Netherlands is suboptimal. This makes adherence to the guideline and ATLS-based course instructions difficult. PMID:27395381

  16. Quality Assessment of Clinical Practice Guidelines on the Treatment of Hepatocellular Carcinoma or Metastatic Liver Cancer

    PubMed Central

    Wang, Yingqiang; Luo, Qianqian; Li, Youping; Wang, Haiqing; Deng, Shaolin; Wei, Shiyou; Li, Xianglian

    2014-01-01

    Objectives To assess the quality of the currently available clinical practice guidelines (CPGs) for hepatocellular carcinoma, and provide a reference for clinicians in selecting the best available clinical protocols. Methods The databases of PubMed, MEDLINE, Web of Science, Chinese Biomedical Literature database (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and relevant CPGs websites were systematically searched through March 2014. CPGs quality was appraised using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument, and data analysis was performed using SPSS 13.0 software. Results A total of 20 evidence-based and 20 expert consensus-based guidelines were included. The mean percentage of the domain scores were: scope and purpose 83% (95% confidence interval (CI), 81% to 86%), clarity of presentation 79% (95% CI, 73% to 86%), stakeholder involvement 39% (95% CI, 30% to 49%), editorial independence 58% (95% CI, 52% to 64%), rigor of development 39% (95% CI, 31% to 46%), and applicability 16% (95% CI, 10% to 23%). Evidence-based guidelines were superior to those established by consensus for the domains of rigor of development (p<0.001), clarity of presentation (p = 0.01) and applicability (p = 0.021). Conclusions The overall methodological quality of CPGs for hepatocellular carcinoma and metastatic liver cancer is moderate, with poor applicability and potential conflict of interest issues. The evidence-based guidelines has become mainstream for high quality CPGs development; however, there is still need to further increase the transparency and quality of evidence rating, as well as the recommendation process, and to address potential conflict of interest. PMID:25105961

  17. [Measuring quality in the German Guideline Programme in Oncology (GGPO)—methodology and implementation].

    PubMed

    Nothacker, Monika; Muche-Borowski, Cathleen; Kopp, Ina B

    2014-01-01

    The German Guideline Programme in Oncology (GGPO) is a joint initiative between the German Cancer Society, the Association of the Scientific Medical Societies in Germany and German Cancer Aid. In accordance with the aims of the German National Cancer Plan, the GGPO supports the systematic development of high-quality guidelines. To enhance implementation and evaluation, the suggestion of performance measures (PMs) derived from guideline recommendations following a standardised methodology is obligatory within the GGPO. For this purpose, PM teams are convened representing the multidisciplinary guideline development groups including clinical experts, methodologists and patient representatives as well as those organisations that take an active part in and share responsibility for documentation and quality improvement, i.e., clinical cancer registries, certified cancer centres and, if appropriate, the institution responsible for external quality assurance according to the German Social Code (SGB). The primary selection criteria for PMs include strength of the underlying recommendation (strong, grade A), existing potential for improvement of care and measurability. The premises of data economy and standardised documentation are taken into account. Between May 2008 and July 2014, 12 guidelines with suggestions for 100 PMs have been published. The majority of the suggested performance measures is captured by the specific documentation requirements of the clinical cancer registries and certified cancer centres. This creates a solid basis for an active quality management and re-evaluation of the suggested PMs. In addition, the suspension of measures should be considered if improvement has been achieved on a broad scale and for a longer period in order to concentrate on a quality-oriented, economic documentation. PMID:25523845

  18. Guidelines for Quality Provision in Cross-Border Higher Education: Where Do We Strand? OECD Education Working Papers, No. 70

    ERIC Educational Resources Information Center

    Vincent-Lancrin, Stephan; Pfotenhauer, Sebastian

    2012-01-01

    The "Guidelines for Quality Provision in Cross-Border Higher Education" were developed and adopted to support and encourage international cooperation and enhance the understanding of the importance of quality provision in cross-border higher education. The purposes of the "Guidelines" are to protect students and other stakeholders from low-quality…

  19. Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy

    PubMed Central

    Armstrong, David; Barkun, Alan; Bridges, Ron; Carter, Rose; de Gara, Chris; Dubé, Catherine; Enns, Robert; Hollingworth, Roger; MacIntosh, Donald; Borgaonkar, Mark; Forget, Sylviane; Leontiadis, Grigorios; Meddings, Jonathan; Cotton, Peter; Kuipers, Ernst J; Valori, Roland

    2012-01-01

    BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy. OBJECTIVE: To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery. METHODS: A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants. RESULTS: Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified. DISCUSSION: The consensus process identified a clear need for high-quality clinical and outcomes research to support quality

  20. Evaluation of the Quality of Guidelines for Myasthenia Gravis with the AGREE II Instrument

    PubMed Central

    Zhang, Zhenchang; Guo, Jia; Su, Gang; Li, Jiong; Wu, Hua; Xie, Xiaodong

    2014-01-01

    Background Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners in making decisions about appropriate healthcare in specific clinical circumstances. The methodological quality of CPGs for myasthenia gravis (MG) are unclear. Objective To critically evaluate the methodological quality of CPGs for MG using AGREE II instrument. Method A systematical search strategy on PubMed, EMBASE, DynaMed, the National Guideline Clearinghouse (NGC) and the Chinese Biomedical Literature database (CBM) was performed on September 20th 2013. All guidelines related to MG were evaluated with AGREE II. The software used for analysis was SPSS 17.0. Results A total of 15 CPGs for MG met the inclusion criteria (12 CPGs in English, 3 CPGs in Chinese). The overall agreement among reviews was moderate or high (ICC >0.70). The mean scores (mean ± SD) for al six domains were presented as follows: scope and purpose (60.93% ±16.62%), stakeholder involvement (40.93% ±20.04%), rigor of development (37.22% ±30.46%), clarity of presentation (64.26% ±16.36%), applicability (28.19% ±20.56%) and editorial independence (27.78% ±28.28%). Compared with non-evidence-based CPGs, evidence-based CPGs had statistically significant higher quality scores for all AGREE II domains (P<0.05). All domain scores appear slightly higher for CPGs published after AGREE II instrument development and validation (P>0.05). The quality scores of CPGs developed by NGC/AAN were higher than the quality scores of CPGs developed by other organizations for all domains. The difference was statistically significant for all domains with the exception of clarity of presentation (P = 0.07). Conclusions The qualities of CPGs on MG were generally acceptable with several flaws. The AGREE II instrument should be adopted by guideline developers, particularly in China. PMID:25402504

  1. Recent Advances in Point-of-Access Water Quality Monitoring

    NASA Astrophysics Data System (ADS)

    Korostynska, O.; Arshak, K.; Velusamy, V.; Arshak, A.; Vaseashta, Ashok

    Clean water is one of our most valuable natural resources. In addition to providing safe drinking water it assures functional ecosystems that support fisheries and recreation. Human population growth and its associated increased demands on water pose risks to maintaining acceptable water quality. It is vital to assess source waters and the aquatic systems that receive inputs from industrial waste and sewage treatment plants, storm water systems, and runoff from urban and agricultural lands. Rapid and confident assessments of aquatic resources form the basis for sound environmental management. Current methods engaged in tracing the presence of various bacteria in water employ bulky laboratory equipment and are time consuming. Thus, real-time water quality monitoring is essential for National and International Health and Safety. Environmental water monitoring includes measurements of physical characteristics (e.g. pH, temperature, conductivity), chemical parameters (e.g. oxygen, alkalinity, nitrogen and phosphorus compounds), and abundance of certain biological taxa. Monitoring could also include assays of biological activity such as alkaline phosphatase, tests for toxins such as microcystins and direct measurements of pollutants such as heavy metals or hydrocarbons. Real time detection can significantly reduce the level of damage and also the cost to remedy the problem. This paper presents overview of state-of-the-art methods and devices used for point-of-access water quality monitoring and suggest further developments in this area.

  2. Experience with the European quality assurance guidelines for digital mammography systems in a national screening programme.

    PubMed

    McCullagh, J; Keavey, E; Egan, G; Phelan, N

    2013-02-01

    The transition to a fully digital breast screening programme, utilising three different full-field digital mammography (FFDM) systems has presented many challenges to the implementation of the European guidelines for physico-technical quality assurance (QA) testing. An analysis of the QA results collected from the FFDM systems in the screening programme over a 2-y period indicates that the three different systems have similar QA performances. Generally, the same tests were failed by all systems and failure rates were low. The findings provide some assurance that the QA guidelines are being correctly implemented. They also suggest that there is more scope for the development of the relevance of the guidelines with respect to modern FFDM systems. This study has also shown that a summary review of the QA data can be achieved by simple organisation of the QA data storage and by automation of data query and retrieval using commonly available software.

  3. Guidelines in the Register of the Association of Scientific Medical Societies in Germany – A Quality Improvement Campaign

    PubMed Central

    Nothacker, M. J.; Muche-Borowski, C.; Kopp, I. B.

    2014-01-01

    The Association of Scientific Medical Societies in Germany (AWMF) is the umbrella organization of medical scientific societies in Germany. The development of guidelines goes back to an initiative of the medical scientific societies and is coordinated by the AWMF. Rules for the inclusion of guidelines in the AWMF Guideline Register have been defined including how guidelines are classified. S1 guidelines are based only on recommendations by experts, whereas S2 guidelines require a structured consensus process or a systematic literature review. S3 guidelines include both elements. In addition to compulsory disclosure of any potential conflict of interest, transparent handling of potential conflicts of interest is an important confidence-building measure. For years, the trend has been to develop higher order (S2/S3) guidelines, and the German Society for Gynecology and Obstetrics (DGGG) has been no exception to the trend. In addition to its responsibility for specific S2 and S3 guidelines, the DGGG is also involved in numerous other interdisciplinary guidelines. When developing a guideline, it is essential to define the guidelineʼs scope, identify aspects which require improvement and agree on the goals. Target groups affected by the guidelines should be involved if they are interested. Different formats (long and short versions, practical instructions, conventional or electronic decision aids, patient versions) are useful to disseminate the guideline. The guideline can be adapted to local circumstances to encourage implementation of its recommendations. Implementation can be measured using quality indicators. Feedback from practitioners is important as this highlights areas which require improvement. The medical scientific societies in Germany can look back on almost two decades of work spent on developing guidelines, most of it done by unpaid voluntary contributors, making this a very successful quality initiative. PMID:25061235

  4. ARM User Survey Report: Data Access, Quality, and Delivery

    SciTech Connect

    Mather, JH; Roeder, LR; Sivaraman, C

    2012-06-28

    The objective of this survey was to obtain user feedback to determine how users of the Atmospheric Radiation Measurement (ARM) Climate Research Facility Data Archive interact with the more than 2000 available types of datastreams. The survey also gathered information about data discovery and data quality. The Market and Competitive Analysis group at Pacific Northwest National Laboratory worked with web administrators to develop a landing page from which users could access the survey. A survey invitation was sent by ARM via email to about 6100 users on February 22, 2012. The invitation was also posted on the ARM website and Facebook page. Reminders were sent via e-mail and posted on Facebook while the survey was open, February 22-March 23, 2012.

  5. Clinical guidelines in pediatric headache: evaluation of quality using the AGREE II instrument

    PubMed Central

    2014-01-01

    Background The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool is a validated questionnaire used to assess the methodological quality of clinical guidelines (CGs). We used the AGREE II tool to assess the development process, the methodological quality, and the quality of reporting of available pediatric CGs for the management of headache in children. We also studied the variability in responses related to the characteristics of eleven Italian neuropediatric centers, showing similarities and differences in the main recommendations reported in CGs. Methods A systematic literature search was conducted from January 2002 to June 2013 on Mediline, the Cochrane database, the National Guideline Clearinghouse website and the NHS evidence search tool, using the following terms: headache, cephalalgia, guidelines and children (MESH or text words). Six CGs providing information on the diagnosis and management of headache and specific recommendations for children were selected. Eleven neuropediatric centers assessed the overall quality and the appropriateness of all available CGs using of the AGREE II instrument. Results Six CGs meeting the inclusion and exclusion criteria were identified and assessed by 11 reviewers. Our study showed that the NICE CGs was “strongly recommended” while the French and Danish CGs were mainly “not recommended”. The comparison between the overall quality score of the French CGs and the NICE CGs was statistically significant (6.54 ± 0.69 vs 4.18 ± 1.08; p =0.001). The correlation analysis between quality domain score and guideline publication date showed a statistically significant association only for the “editorial independence” domain (r = 0.842 p = 0.035). The intra-class coefficients showed that the 11 reviewers had the highest agreement for the Lewis CGs (r = 0.857), and the lowest one for the NICE CGs (r = 0.656). Statistical analyses showed that professionals from outpatient services

  6. How To Promote Data Quality And Access? Publish It!

    NASA Astrophysics Data System (ADS)

    Carlson, D. J.; Pfeiffenberger, H.

    2011-12-01

    Started during IPY 2007-2008, the Earth System Science Data journal (Copernicus) has now 'tested the waters' of earth system data publishing for approximately 2 years with some success. The journal has published more than 30 data sets, of remarkable breadth and variety, all under a Creative Commons Attribution license. Users can now find well-described, quality-controlled and freely accessible data on soils, permafrost, sediment transport, ice sheets, surface radiation, ocean-atmosphere fluxes, ocean chemistry, gravity fields, and combined radar and web cam observations of the Eyjafjallajökull eruption plume. Several of the data sets derive specifically from IPY or from polar regions, but a large portion, including a substantial special issue on ocean carbon, cover broad temporal and geographic domains; the contributors themselves come from leading science institutions around the world. ESSD has attracted the particular interest of international research teams, particularly those who, as in the case of ocean carbon data, have spent many years gathering, collating and calibrating global data sets under long-term named programs, but who lack within those programs the mechanisms to distribute those data sets widely outside their specialist teams and to ensure proper citation credit for those remarkable collaborative data processing efforts. An in-progress special issue on global ocean plankton function types, again representing years of international data collaboration, provides a further example of ESSD utility to large research programs. We anticipate an interesting test case of parallel special issues with companion science journals - data sets in ESSD to accompany science publications in a prominent research journal. We see the ESSD practices and products as useful steps to increase quality of and access to important data sets.

  7. Water quality and health in the new millennium: the role of the World Health Organization Guidelines for Drinking-Water Quality.

    PubMed

    Sobsey, Mark D; Bartram, S

    2003-01-01

    In this report the role of the WHO Guidelines for Drinking Water Quality in promoting safe drinking water for the world's population is briefly described. The guidelines are being revised in a third edition to emphasize an integrated approach to water quality assessment and management from source to consumer. The forthcoming guidelines will: be risk-based and quantitative, emphasize quality protection and prevention of contamination, be proactive and participatory, and address the needs of those in developing countries who have no access to piped community water supplies. The guidelines emphasize the maintenance of microbial quality to prevent waterborne infectious disease as an essential goal. In addition, they address protection from chemical toxicants and other contaminants of public health concern. The forthcoming 3rd edition of the WHO GDWQ intend to be responsive to the under-served in developing countries by inclusion of non-piped supplies and addressing practical systems for their collection, treatment and storage at household level to provide safe water. Beyond the inclusion of these and possibly additional household water collection, treatment and storage systems, what is needed is to achieve their widespread use is an education and dissemination campaign that promotes and explains them and their benefits. Such a communication and marketing campaign is best done by including as many different sectors and stakeholders as possible in the process. It will be important to acknowledge that safe water is one of essential components or needs for healthy living, along with adequate sanitation and proper nutrition. Together, these are the essential health needs to be met in the developing and the developed world. All three contribute to reduced disease and increased health, and the lack of one can degrade the beneficial impact of the others. The importance of safe water, sanitation and nutrition to human health and well-being can be stated no better than it was by

  8. Water quality and health in the new millennium: the role of the World Health Organization Guidelines for Drinking-Water Quality.

    PubMed

    Sobsey, Mark D; Bartram, S

    2003-01-01

    In this report the role of the WHO Guidelines for Drinking Water Quality in promoting safe drinking water for the world's population is briefly described. The guidelines are being revised in a third edition to emphasize an integrated approach to water quality assessment and management from source to consumer. The forthcoming guidelines will: be risk-based and quantitative, emphasize quality protection and prevention of contamination, be proactive and participatory, and address the needs of those in developing countries who have no access to piped community water supplies. The guidelines emphasize the maintenance of microbial quality to prevent waterborne infectious disease as an essential goal. In addition, they address protection from chemical toxicants and other contaminants of public health concern. The forthcoming 3rd edition of the WHO GDWQ intend to be responsive to the under-served in developing countries by inclusion of non-piped supplies and addressing practical systems for their collection, treatment and storage at household level to provide safe water. Beyond the inclusion of these and possibly additional household water collection, treatment and storage systems, what is needed is to achieve their widespread use is an education and dissemination campaign that promotes and explains them and their benefits. Such a communication and marketing campaign is best done by including as many different sectors and stakeholders as possible in the process. It will be important to acknowledge that safe water is one of essential components or needs for healthy living, along with adequate sanitation and proper nutrition. Together, these are the essential health needs to be met in the developing and the developed world. All three contribute to reduced disease and increased health, and the lack of one can degrade the beneficial impact of the others. The importance of safe water, sanitation and nutrition to human health and well-being can be stated no better than it was by

  9. Increasing access to quality health care for the poor: Community perceptions on quality care in Uganda.

    PubMed

    Kiguli, Julie; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Mutebi, Aloysius; Macgregor, Hayley; Pariyo, George William

    2009-01-01

    This paper examines the community's perspectives and perceptions on quality of health care delivery in two Uganda districts. The paper addresses community concerns on service quality. It focuses on the poor because they are a vulnerable group and often bear a huge burden of disease. Community views were solicited and obtained using eight focus group discussions, six in-depth and 12 key informant interviews. User perceptions and definitions of the quality of health services depended on a number of variables related to technical competence, accessibility to services, interpersonal relations and presence of adequate drugs, supplies, staff, and facility amenities. Results indicate that service delivery to the poor in the general population is perceived to be of low quality. The factors that were mentioned as affecting the quality of services delivered were inadequate trained health workers, shortage of essential drugs, poor attitude of the health workers, and long distances to health facilities. This paper argues that there should be an improvement in the quality of health services with particular attention being paid to the poor. Despite wide focus on improvement of the existing infrastructure and donor funding, there is still low satisfaction with health services and poor perceived accessibility. PMID:19936148

  10. Developing Guidelines for Evaluating the Adaptation of Accessible Web-Based Learning Materials

    ERIC Educational Resources Information Center

    Radovan, Marko; Perdih, Mojca

    2016-01-01

    E-learning is a rapidly developing form of education. One of the key characteristics of e-learning is flexibility, which enables easier access to knowledge for everyone. Information and communications technology (ICT), which is e-learning's main component, enables alternative means of accessing the web-based learning materials that comprise the…

  11. Improving accessibility of trust guidelines and protocols at the Great Western Hospital, Swindon

    PubMed Central

    Robertson, Ian; Smith, Abigail; Tucker, Jennifer; Cilia, Erica; Chen, Kangni; Marion, Rose; Nesbitt, Julian; Ramcharitar, Steve; Cathiavadi Greamspet, Mala

    2014-01-01

    Trust guidelines and policies outline recommendations for the management of common clinical and non-clinical situations, serving to standardise best practice. Prior to this project, there was no consolidated location for these documents. Lack of organisational structure and inadequate search functionality within the trust intranet led to time wasted locating information, acting outside of recognised best practice, and ultimately potentially compromising patient safety. We surveyed 55 junior doctors, 95% of respondents were dependent on guidelines on a daily basis. 20% spending greater than 5 minutes to locate protocols and 38% unable to locate some relevant documents at all. We analysed the time taken for junior doctors to locate six randomly selected protocols. Pre-intervention mean time was 133 seconds (on six occasions doctors were unable to locate the guideline). All trust guidelines and protocols currently available on the intranet were collated, consolidated, and renamed according to content. These were then re-alphabetised and new search terms linked to each document. Existing links were then uploaded and a single web page made available via the trust intranet homepage. The new page was publicised by email, posters and interdepartmental presentations. In our post intervention survey, 97% of respondents were aware of the project and had made use of the page. All protocols were located during re-testing with 90% of those resurveyed stating it was easier to locate protocols. Overall, a reduction in the time and number of clicks required to locate protocols was demonstrated: mean time 16 seconds vs 133 seconds pre-intervention (n=60). 53% of guidelines located in <30s and 86% <2 minutes. PMID:26732607

  12. 40 CFR Appendix W to Part 51 - Guideline on Air Quality Models

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... and Deposition 7.2.8Complex Winds 7.2.9Calibration of Models 8.0Model Input Data 8.1Source Data 8.1....0Bibliography 12.0References Appendix A to Appendix W of 40 CFR Part 51—Summaries of Preferred Air Quality... Times for Site Specific Wind and Turbulence Measurements. 1.0 Introduction a. The Guideline...

  13. ASVCP guidelines: quality assurance for point-of-care testing in veterinary medicine.

    PubMed

    Flatland, Bente; Freeman, Kathleen P; Vap, Linda M; Harr, Kendal E

    2013-12-01

    Point-of-care testing (POCT) refers to any laboratory testing performed outside the conventional reference laboratory and implies close proximity to patients. Instrumental POCT systems consist of small, handheld or benchtop analyzers. These have potential utility in many veterinary settings, including private clinics, academic veterinary medical centers, the community (eg, remote area veterinary medical teams), and for research applications in academia, government, and industry. Concern about the quality of veterinary in-clinic testing has been expressed in published veterinary literature; however, little guidance focusing on POCT is available. Recognizing this void, the ASVCP formed a subcommittee in 2009 charged with developing quality assurance (QA) guidelines for veterinary POCT. Guidelines were developed through literature review and a consensus process. Major recommendations include (1) taking a formalized approach to POCT within the facility, (2) use of written policies, standard operating procedures, forms, and logs, (3) operator training, including periodic assessment of skills, (4) assessment of instrument analytical performance and use of both statistical quality control and external quality assessment programs, (5) use of properly established or validated reference intervals, (6) and ensuring accurate patient results reporting. Where possible, given instrument analytical performance, use of a validated 13s control rule for interpretation of control data is recommended. These guidelines are aimed at veterinarians and veterinary technicians seeking to improve management of POCT in their clinical or research setting, and address QA of small chemistry and hematology instruments. These guidelines are not intended to be all-inclusive; rather, they provide a minimum standard for maintenance of POCT instruments in the veterinary setting.

  14. Linking water quality guidelines to the natural characteristics of catchments in order to support distinct aquatic ecosystems: Water quality guidelines for suspended particulate matter

    NASA Astrophysics Data System (ADS)

    Bilotta, G. S.; Grove, M. K.; Harrison, C.; Joyce, C. B.; Peacock, C.

    2012-12-01

    The natural characteristics of a catchment provide a template that controls the background rates of geomorphological processes operating within that catchment, which in-turn determines the background physico-chemical and hydro-morphological characteristics of the catchment's surface waters. Large differences in the natural characteristics of catchments (e.g. geology, topography, climate), lead to unique physico-chemical and hydro-morphological conditions that support unique freshwater communities. However, this uniqueness is not always recognised in international water quality guidelines, which often attempt to apply blanket water-quality guidelines to 'protect' a wide range of ecosystems. In this paper we investigate the natural characteristics that control background concentrations of suspended particulate matter (SPM - including nano-scale particles to sand-sized sediments), which is a well-known cause of ecological degradation. At present, the management of SPM is hampered by a lack of understanding of the SPM conditions that water quality managers should aim to achieve in contrasting environments in order to support good ecological status. To address this, in this paper we examine the SPM preferences of contrasting biological communities that are in reference condition (minimal anthropogenic disturbance and high ecological status). We analyse historical SPM data collected on a monthly basis from a wide range of reference-condition temperate environments (638 stream/river sites comprising 42 different biological community-types). This analysis reveals that there are statistically significant differences (One-way ANOVA p < 0.001) between the background SPM concentrations observed in contrasting communities that are in reference condition. Mean background SPM concentrations for contrasting communities ranged from 1.7 to 26.2 mg L-1 (i.e. more than a 15-fold difference). We propose a model for predicting environment-specific water quality guidelines for SPM. In

  15. 41 CFR 102-79.115 - What guidelines must an agency follow if it elects to establish a public access defibrillation...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SPACE Assignment and Utilization of Space Public Access Defibrillation Programs § 102-79.115 What... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false What guidelines must an agency follow if it elects to establish a public access defibrillation program in a Federal facility?...

  16. Historical review on development of environmental quality standards and guideline values for air pollutants in Japan.

    PubMed

    Kawamoto, Toshihiro; Pham, Thi-Thu-Phuong; Matsuda, Takayuki; Oyama, Tsunehiro; Tanaka, Masayuki; Yu, Hsu-Sheng; Uchiyama, Iwao

    2011-07-01

    Environmental quality standards (EQSs) have been established as desirable levels to be maintained for protection of human health and the conservation of the living environment by Basic Environment Law. EQSs in ambient air had been set for 10 substances (sulfur dioxide (SO(2)), carbon monoxide (CO), suspended particulate matter (SPM), nitrogen dioxide (NO(2)) and photochemical oxidants (Ox), benzene, tetrachloroethylene, trichloroethylene, dioxins and dichloromethane) and guideline values for 7 (acrylonitorile, vinyl chloride monomer, mercury, nickel compounds, 1,3-butadiene, chloroform and 1,2-dichloromethane) in Japan by 2009. EQSs for the classical (or traditional) air pollutants, SO(2), CO, SPM, NO(2) and Ox, were set according to the minimal requirement to protect human health, based on evidence from epidemiological studies conducted before the 1970s. In 1996, the Central Environment Council designated substances which may be hazardous air pollutants and substances requiring priority action, and adopted the concept of risk assessment to set EQSs and guideline values. A life-long risk level (virtually safe dose) of 10(-5) was used to set EQS for benzene, and guideline values for vinyl chloride monomer, nickel compounds, and 1,3-butadiene. EQSs for trichloroethylene, tetrachloroethylene and dichloromethane, and guideline values for acrylonitorile and mercury were set using uncertain factors and lowest observed adverse effect (LOAEL)/no observed adverse effect level (NOAEL). The results of animal experiments were utilized to set guideline values for chloroform and 1,2-dichloroethane. The benchmark approach and human equivalent concentration (HEC) were adopted for 1,2-dichloroethane. The history of setting EQSs and guideline values for hazardous air pollutants is one of adopting new concepts into risk assessment.

  17. 76 FR 45481 - Accessibility Guidelines for Pedestrian Facilities in the Public Right-of-Way

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-29

    ..., Are They Detectable?'' (2010) available at: http://theihe.org/knowledge-network/uploads/Shared%20Space... site at: http://www.access-board.gov/prowac/nprm.htm . Correction In the proposed rule FR Doc....

  18. Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

    SciTech Connect

    Kelekis, Alexis D. Filippiadis, Dimitris K.; Martin, Jean-Baptiste; Brountzos, Elias

    2010-10-15

    Percutaneous treatments are used in the therapy of small- to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy- and/or computed tomography-guided percutaneous intervertebral disc ablative techniques.

  19. Improving food composition data quality: Three new FAO/INFOODS guidelines on conversions, data evaluation and food matching.

    PubMed

    Charrondiere, U Ruth; Rittenschober, Doris; Nowak, Verena; Stadlmayr, Barbara; Wijesinha-Bettoni, Ramani; Haytowitz, David

    2016-02-15

    Food composition data play a key role in many sectors and the availability of quality data is critically important. Since 1984, the International Network of Food Data Systems (INFOODS) has been working towards improving food composition data quality and availability, including the development and updating of standards, guidelines and tools for food composition. FAO/INFOODS has recently published three comprehensive guidelines to improve and harmonise the compilation of data: (1) Guidelines for Food Matching, (2) Guidelines for Checking Food Composition Data prior to Publication of a User Table/Database, and (3) Guidelines for Converting Units, Denominators and Expressions. This article describes their content and development processes. Their adoption, along with additional ones planned for the future by FAO/INFOODS, should further improve the quality of published food composition data, which in turn can lead to more accurate nutrient intake estimates and more precise food labels, as well as better-targeted programs and policies. PMID:26433290

  20. Improving food composition data quality: Three new FAO/INFOODS guidelines on conversions, data evaluation and food matching.

    PubMed

    Charrondiere, U Ruth; Rittenschober, Doris; Nowak, Verena; Stadlmayr, Barbara; Wijesinha-Bettoni, Ramani; Haytowitz, David

    2016-02-15

    Food composition data play a key role in many sectors and the availability of quality data is critically important. Since 1984, the International Network of Food Data Systems (INFOODS) has been working towards improving food composition data quality and availability, including the development and updating of standards, guidelines and tools for food composition. FAO/INFOODS has recently published three comprehensive guidelines to improve and harmonise the compilation of data: (1) Guidelines for Food Matching, (2) Guidelines for Checking Food Composition Data prior to Publication of a User Table/Database, and (3) Guidelines for Converting Units, Denominators and Expressions. This article describes their content and development processes. Their adoption, along with additional ones planned for the future by FAO/INFOODS, should further improve the quality of published food composition data, which in turn can lead to more accurate nutrient intake estimates and more precise food labels, as well as better-targeted programs and policies.

  1. [European community guidelines and standards in indoor air quality: what proposals for Italy].

    PubMed

    Settimo, Gaetano; D'Alessandro, Daniela

    2014-01-01

    Indoor air quality is an issue on which to focus because of the increasing number of exposed population and in view of the strong public feeling on this issue. This paper reports the rules of EU and several European countries about indoor air quality, focusing on the initiatives performed in Italy to respond to WHO recommendations. Several EU countries have introduced in their legislation rules relating to indoor air quality. At the moment, in Italy, a reference rule has not been issued. For this reason, up to date main informations concerning some guidelines or reference values in indoor air, to be used for a first comparison, are those obtained by the scientific literature, or by the guidelines issued by other European countries or, for analogy, by other standard values such as limit or reference values regarding outdoor air. Even the EU, while reaffirming the priority of energy efficiency measures, recommends healthier indoor environments and the development of a specific European strategy on the issue of indoor air quality. The National Study Group on indoor pollution of the Italian National Health Institute (ISS), is working for the development of shared technical and scientific documents, in order to provide greater uniformity of actions at national level, waiting for a legal framework for indoor air quality, in the light of the indication already produced by the WHO.

  2. ASVCP guidelines: quality assurance for portable blood glucose meter (glucometer) use in veterinary medicine.

    PubMed

    Gerber, Karen L; Freeman, Kathleen P

    2016-03-01

    Portable blood glucose meters (PBGM, glucometers) are a convenient, cost effective, and quick means to assess patient blood glucose concentration. The number of commercially available PBGM is constantly increasing, making it challenging to determine whether certain glucometers may have benefits over others for veterinary testing. The challenge in selection of an appropriate glucometer from a quality perspective is compounded by the variety of analytic methods used to quantify glucose concentrations and disparate statistical analysis in many published studies. These guidelines were developed as part of the ASVCP QALS committee response to establish recommendations to improve the quality of testing using point-of-care testing (POCT) handheld and benchtop devices in veterinary medicine. They are intended for clinical pathologists and laboratory professionals to provide them with background knowledge and specific recommendations for quality assurance (QA) and quality control (QC), and to serve as a resource to assist the provision of advice to veterinarians and technicians to improve the quality of results obtained when using PBGM. These guidelines are not intended to be all-inclusive; rather they provide a minimum standard for management of PBGM in the veterinary setting.

  3. KRAS Mutations Testing in Colorectal Carcinoma Patients in Italy: From Guidelines to External Quality Assessment

    PubMed Central

    Normanno, Nicola; Pinto, Carmine; Castiglione, Francesca; Bardelli, Alberto; Gambacorta, Marcello; Botti, Gerardo; Nappi, Oscar; Siena, Salvatore; Ciardiello, Fortunato; Taddei, GianLuigi; Marchetti, Antonio

    2011-01-01

    Background Monoclonal antibodies directed against the epidermal growth factor receptor (EGFR) have been approved for the treatment of patients with metastatic colorectal carcinoma (mCRC) that do not carry KRAS mutations. Therefore, KRAS testing has become mandatory to chose the most appropriate therapy for these patients. Methodology/Principal Findings In order to guarantee the possibility for mCRC patients to receive an high quality KRAS testing in every Italian region, the Italian Association of Medical Oncology (AIOM) and the Italian Society of Pathology and Cytopathology -Italian division of the International Academy of Pathology (SIAPEC-IAP) started a program to improve KRAS testing. AIOM and SIAPEC identified a large panel of Italian medical oncologists, pathologists and molecular biologists that outlined guidelines for KRAS testing in mCRC patients. These guidelines include specific information on the target patient population, the biological material for molecular analysis, the extraction of DNA, and the methods for the mutational analysis that are summarized in this paper. Following the publication of the guidelines, the scientific societies started an external quality assessment scheme for KRAS testing. Five CRC specimens with known KRAS mutation status were sent to the 59 centers that participated to the program. The samples were validated by three referral laboratories. The participating laboratories were allowed to use their own preferred method for DNA extraction and mutational analysis and were asked to report the results within 4 weeks. The limit to pass the quality assessment was set at 100% of true responses. In the first round, only two centers did not pass (3%). The two centers were offered to participate to a second round and both centers failed again to pass. Conclusions The results of this first Italian quality assessment for KRAS testing suggest that KRAS mutational analysis is performed with good quality in the majority of Italian centers

  4. Relationship between Conditions Addressed by Hemodialysis Guidelines and Non-ESRD-Specific Conditions Affecting Quality of Life

    PubMed Central

    Leinau, Lisa; Murphy, Terrence E.; Bradley, Elizabeth; Fried, Terri

    2009-01-01

    Background and objectives: Persons with ESRD identify non-disease-specific conditions as negatively affecting their quality of life. It is unknown how these non-ESRD-specific conditions correlate with each other and with ESRD-specific conditions such as anemia, renal osteodystrophy, dialysis access, and dialysis adequacy. The objectives of this study were to determine the prevalence and inter-relatedness of selected conditions among persons receiving hemodialysis and to analyze the relationship between non-ESRD-specific and ESRD-specific conditions. Design, setting, participants, & measurements: This was an observational cohort study of persons with ESRD that included standardized assessments for pain, fatigue, depression, cognitive impairment, and impaired physical performance. The study was conducted at three dialysis clinics in one urban geographic area. Of the 134 persons who met exclusion criteria, 25 declined participation, yielding a sample size of 109. Results: Pain was present in >81% of participants, fatigue and impaired physical performance in >60% participants, and cognitive impairment and depression in >25% of participants. Pain, fatigue, and depression were highly correlated, but had no correlation with use of a catheter for access, hemoglobin (Hgb), intact parathyroid hormone (iPTH), phosphorous, or Kt/V values outside of the range of guidelines. There was a modest correlation between cognitive function and both Hgb and iPTH. Conclusions: Non-ESRD-specific conditions such as fatigue, pain, and depression are as prevalent as ESRD-specific conditions, and the magnitude of the correlations between the non-ESRD-specific conditions is greater than the correlations between non-ESRD-specific and ESRD-specific conditions. Current guidelines may be failing to address a substantial component of the disease burden for persons with ESRD. PMID:19261828

  5. Open-access colonoscopy in Ontario: Associated factors and quality

    PubMed Central

    Hadlock, Shane; Rabeneck, Linda; Paszat, Lawrence F; Sutradhar, Rinku; Wilton, Andrew S; Tinmouth, Jill

    2013-01-01

    BACKGROUND Open-access (OA) colonoscopy may increase efficiency and decrease wait times; however, because the patient is seen for the first time at the endoscopy appointment, previous processes, such as information about the procedure, preparation and appropriate triage, may be suboptimal. OBJECTIVE: To identify factors associated with OA colonoscopy and to determine the relationship between OA colonoscopy and an important quality measure, incomplete colonoscopy. METHODS: A population-based analysis of all adult outpatients undergoing a first-time colonoscopy between 1997 and 2007 in Ontario was performed. Colonoscopy was considered to be OA if there were no visits in the preceding five years with the physician performing the colonoscopy. Using logistic regression, patient, physician and institution factors associated with OA colonoscopy were identified. Using propensity score matching, the relationship between OA colonoscopy and incomplete colonoscopy in 2006 was examined. RESULTS: A total of 1,079,259 colonoscopies were performed. Of these, 14% were OA in 1997 compared with 26% in 2007. Patients 50 to 69 years of age, those from higher-income neighbourhoods and those with less comorbidity were more likely to undergo OA colonoscopy. The odds of receiving OA colonoscopy were six times greater in a nonhospital clinic compared with a community hospital. Colonoscopy was more likely to be complete if the procedure was OA (OR 1.3 [95% CI 1.2 to 1.4]; P<0.0001). CONCLUSIONS: Rates of OA colonoscopy have increased substantially since 1997. Institution type was most strongly associated with OA colonoscopy. Colonoscopy completeness, a recognized quality indicator, does not appear to be compromised by OA colonoscopy. PMID:23781517

  6. Reporting Quality of Social and Psychological Intervention Trials: A Systematic Review of Reporting Guidelines and Trial Publications

    PubMed Central

    Grant, Sean P.; Mayo-Wilson, Evan; Melendez-Torres, G. J.; Montgomery, Paul

    2013-01-01

    Background Previous reviews show that reporting guidelines have improved the quality of trial reports in medicine, yet existing guidelines may not be fully suited for social and psychological intervention trials. Objective/Design We conducted a two-part study that reviewed (1) reporting guidelines for and (2) the reporting quality of social and psychological intervention trials. Data Sources (1) To identify reporting guidelines, we systematically searched multiple electronic databases and reporting guideline registries. (2) To identify trials, we hand-searched 40 journals with the 10 highest impact factors in clinical psychology, criminology, education, and social work. Eligibility (1) Reporting guidelines consisted of articles introducing a checklist of reporting standards relevant to social and psychological intervention trials. (2) Trials reported randomised experiments of complex interventions with psychological, social, or health outcomes. Results (1) We identified 19 reporting guidelines that yielded 147 reporting standards relevant to social and psychological interventions. Social and behavioural science guidelines included 89 standards not found in CONSORT guidelines. However, CONSORT guidelines used more recommended techniques for development and dissemination compared to other guidelines. (2) Our review of trials (n = 239) revealed that many standards were poorly reported, such as identification as a randomised trial in titles (20% reported the information) and abstracts (55%); information about blinding (15%), sequence generation (23%), and allocation concealment (17%); and details about actual delivery of experimental (43%) and control interventions (34%), participant uptake (25%), and service environment (28%). Only 11 of 40 journals referenced reporting guidelines in “Instructions to Authors.” Conclusion Existing reporting guidelines have important limitations in content, development, and/or dissemination. Important details are routinely

  7. Quality improvement for neonatal nurses, part II: using a PDSA quality improvement cycle approach to implement an oral feeding progression guideline for premature infants.

    PubMed

    Marcellus, Lenora; Harrison, Adele; Mackinnon, Kathleen

    2012-01-01

    The development of clinical practice guidelines involving multiple health care providers presents a challenge in the neonatal intensive care unit (NICU). Implementation and evaluation of the guideline is as important as the development of the guideline itself. We explored the use of a quality improvement approach in the implementation of a feeding framework. A Plan-Do-Study-Act (PDSA) quality improvement cycle model was used to implement and evaluate a stepwise oral infant feeding guideline with emphasis on parent and care provider satisfaction. Three PDSA cycles were conducted, with each cycle resulting in modifications to use of the framework and development of knowledge translation and parent education techniques and tools. A PDSA cycle approach can be used effectively in guideline implementation and evaluation involving multidisciplinary health care professionals. This is Part II of a two-part series. Part I introduced the concept of quality improvement and tools for advancing practice changes.

  8. BMUS guidelines for the regular quality assurance testing of ultrasound scanners by sonographers

    PubMed Central

    Russell, Stephen; Ward, Barry; Hoskins, Peter

    2013-01-01

    Quality Assurance of ultrasound systems is necessary to ensure the reliability of results and to check for deterioration in performance; a number of bodies have produced guidelines. Testing has traditionally been the responsibility of Medical Physics Departments but the important role of sonographers has been recognised and recent publications have included tests to be performed by ultrasound users. Since there are differences in approach between these publications the BMUS QA Working Party was established to provide a consistent set of guidelines specifically for sonographers. Three levels of testing are recommended, to include infection control and inspections for scanner and probe damage, basic display checks and further tests to assess drop-out, sensitivity and noise. These tests should form part of a programme that includes more comprehensive testing at longer intervals, perhaps by a Medical Physics Department. PMID:27433187

  9. 76 FR 76640 - Telecommunications Act Accessibility Guidelines; Electronic and Information Technology...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-08

    ... Information Technology Accessibility Standards (standards) were issued in December 2000, 65 FR 80500 (December... telecommunications equipment and customer premises equipment were issued in February 1998, 63 FR 5608 (February 3...) based on the TEITAC report. The ANPRM was published in the Federal Register in March 2010, 75 FR...

  10. 78 FR 59475 - Architectural Barriers Act Accessibility Guidelines; Outdoor Developed Areas

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-26

    ..., which were published in the Federal Register on July 23, 2004 (69 FR 44151) and are codified in... provided in camping units with mobility features: Parking spaces for recreational vehicles and other... connect: Accessible elements, spaces, and facilities provided within camping units and picnic units...

  11. 77 FR 50068 - Americans With Disabilities Act (ADA) Accessibility Guidelines for Transportation Vehicles

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-20

    ... Compliance Board. ACTION: Notice of public information meeting and reopening of comment period. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) is holding a public information... issues related to the design and slope of bus ramps and the space needed at the top of ramps...

  12. 78 FR 67303 - Americans With Disabilities Act (ADA) Accessibility Guidelines for Buildings and Facilities...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-12

    ... document that appeared in the Federal Register of September 26, 2013 (78 FR 59476). The document issued a... (TTY). Email address: board.gov ">raggio@access- board.gov . SUPPLEMENTARY INFORMATION: In FR Doc. 2013-22876 appearing on page 59476 in the Federal Register of Thursday, September 26, 2013 (78 FR 59476),...

  13. Access to the Archives of United Nations Agencies: A RAMP Study with Guidelines.

    ERIC Educational Resources Information Center

    Ulate-Segura, Bodil

    Prepared under contract with the International Council on Archives (ICA), this study reviews expanded applications of archival research, the growing popular demand for information, and the resultant effect on the role of archives and archivists, especially in terms of access to records. Following an introductory discussion of the concept and role…

  14. The significance of water quality guidelines in environmental decision making: Ethylene glycol -- A case example

    SciTech Connect

    Craig, G.R.; Gilron, G.L.; Bishop, J.; Cerf, J.; Williams, J.

    1995-12-31

    Ethylene glycol is a principal component of deicing and anti-icing products commonly applied to aircraft in winter prior to take-off. Many airports do not have efficient collection systems in place surrounding aquatic environments and biota are often exposed to ethylene glycol contained in direct runoff and snowmelt. This study was designed to fulfill the minimum ecotoxicity data requirements for the development of a water quality guideline for ethylene glycol. Ecotoxicity testing was conducted using reagent-grade ethylene glycol and exposure concentrations were confirmed by GC/FID direct aqueous injection, or based on spectrophotometric measurement of the purpene-glycol reaction. The highest ethylene glycol NOEC values for the organisms tested included rainbow trout fry growth 14,692 mg/L, fathead minnow fry growth 12,531 mg/l, Ceriodaphnia dubia reproduction 3,469 mg/L, the ciliate Colpidium campylum 28,090 mg/L, and the rotifer Brachionus calyciflorus 12,800 mg/L. The highest non-lethal level for rainbow trout and the for the frog Xenopus laevis was 12,500 mg/L. Results indicated that the 48-hr LC50 for Xenopus laevis reported in an earlier study (and which was used in the derivation of some interim guidelines) could not be reproduced. However, results of the fish and invertebrate tests compared favorably with other literature values for similar species and with QSAR estimates. A number of water quality derivation protocols (CCME, Ontario MOE, and US EPA) were applied to the data set for the comparison of generated guideline values. Differences in values demonstrate the economic need for using a common approach in developing guidelines that are used to assess hazard to similar ecosystems in different jurisdictions within a global marketplace.

  15. Quality of the Development of Traumatic Brain Injury Clinical Practice Guidelines: A Systematic Review.

    PubMed

    Patel, Anjni; Vieira, Mateus Mazorra Coelho; Abraham, John; Reid, Nick; Tran, Tu; Tomecsek, Kevin; Vissoci, João Ricardo N; Eucker, Stephanie; Gerardo, Charles J; Staton, Catherine A

    2016-01-01

    Traumatic brain injury (TBI) is a leading cause of death worldwide and is increasing exponentially particularly in low and middle income countries (LMIC). To inform the development of a standard Clinical Practice Guideline (CPG) for the acute management of TBI that can be implemented specifically for limited resource settings, we conducted a systematic review to identify and assess the quality of all currently available CPGs on acute TBI using the AGREE II instrument. In accordance with PRISMA guidelines, from April 2013 to December 2015 we searched MEDLINE, EMBASE, Google Scholar and the Duke University Medical Center Library Guidelines for peer-reviewed published Clinical Practice Guidelines on the acute management of TBI (less than 24 hours), for any level of traumatic brain injury in both high and low income settings. A comprehensive reference and citation analysis was performed. CPGs found were assessed using the AGREE II instrument by five independent reviewers and scores were aggregated and reported in percentage of total possible score. An initial 2742 articles were evaluated with an additional 98 articles from the citation and reference analysis, yielding 273 full texts examined. A total of 24 final CPGs were included, of which 23 were from high income countries (HIC) and 1 from LMIC. Based on the AGREE II instrument, the best score on overall assessment was 100.0 for the CPG from the National Institute for Health and Clinical Excellence (NIHCE, 2007), followed by the New Zealand Guidelines Group (NZ, 2006) and the National Clinical Guideline (SIGN, 2009) both with a score of 96.7. The CPG from a LMIC had lower scores than CPGs from higher income settings. Our study identified and evaluated 24 CPGs with the highest scores in clarity and presentation, scope and purpose, and rigor of development. Most of these CPGs were developed in HICs, with limited applicability or utility for resource limited settings. Stakeholder involvement, Applicability, and

  16. Quality of the Development of Traumatic Brain Injury Clinical Practice Guidelines: A Systematic Review

    PubMed Central

    Patel, Anjni; Vieira, Mateus Mazorra Coelho; Abraham, John; Reid, Nick; Tran, Tu; Tomecsek, Kevin; Vissoci, João Ricardo N.; Eucker, Stephanie; Gerardo, Charles J.; Staton, Catherine A.

    2016-01-01

    Traumatic brain injury (TBI) is a leading cause of death worldwide and is increasing exponentially particularly in low and middle income countries (LMIC). To inform the development of a standard Clinical Practice Guideline (CPG) for the acute management of TBI that can be implemented specifically for limited resource settings, we conducted a systematic review to identify and assess the quality of all currently available CPGs on acute TBI using the AGREE II instrument. In accordance with PRISMA guidelines, from April 2013 to December 2015 we searched MEDLINE, EMBASE, Google Scholar and the Duke University Medical Center Library Guidelines for peer-reviewed published Clinical Practice Guidelines on the acute management of TBI (less than 24 hours), for any level of traumatic brain injury in both high and low income settings. A comprehensive reference and citation analysis was performed. CPGs found were assessed using the AGREE II instrument by five independent reviewers and scores were aggregated and reported in percentage of total possible score. An initial 2742 articles were evaluated with an additional 98 articles from the citation and reference analysis, yielding 273 full texts examined. A total of 24 final CPGs were included, of which 23 were from high income countries (HIC) and 1 from LMIC. Based on the AGREE II instrument, the best score on overall assessment was 100.0 for the CPG from the National Institute for Health and Clinical Excellence (NIHCE, 2007), followed by the New Zealand Guidelines Group (NZ, 2006) and the National Clinical Guideline (SIGN, 2009) both with a score of 96.7. The CPG from a LMIC had lower scores than CPGs from higher income settings. Our study identified and evaluated 24 CPGs with the highest scores in clarity and presentation, scope and purpose, and rigor of development. Most of these CPGs were developed in HICs, with limited applicability or utility for resource limited settings. Stakeholder involvement, Applicability, and

  17. RTOG quality assurance guidelines for clinical trials using hyperthermia for deep-seated malignancy.

    PubMed

    Sapozink, M D; Corry, P M; Kapp, D S; Myerson, R J; Dewhirst, M W; Emami, B; Herman, T; Prionas, S; Ryan, T; Samulski, T

    1991-05-01

    Quality assurance has been vague or lacking in many previous hyperthermia trials. Recent publications by the Hyperthermia Physics Center, the Center for Devices and Regulatory Health, and the Radiation Therapy Oncology Group have described general guidelines for quality assurance in equipment reliability and reproducibility, superficial applications, and microwave techniques. The present report details quality assurance factors that are believed to be important for hyperthermia of deep clinical sites, defined as extending at least 3 cm beyond the skin surface. This document will discuss patient and physician factors, as well as thermometric accuracy, assessment of specific absorption rates (SAR), assurance of adequate coverage of tumors by the energy deposition pattern of the treatment device, and recommended documentation of the location, quantity, and frequency of treatment, specifically oriented to deep hyperthermia. The recommendations are structured to facilitate compliance in multiinstitutional trials.

  18. Guidelines for preparing a quality assurance plan for district offices of the U.S. Geological Survey

    USGS Publications Warehouse

    Schroder, L.J.; Shampine, W.J.

    1992-01-01

    The U.S. Geological Survey has a policy that requires each District office to prepare a Quality Assurance Plan. This plan is a combination of a District's management principles and quality assurance processes. The guidelines presented in this report provide a framework or expanded outline that a District can use to prepare a plan. Parti- cular emphasis is given to a District's: (1) quality assurance policies; (2) organization and staff responsibilities; and (3) program and project planning. The guidelines address the 'how', 'what', and 'who' questions that need to be answered when a District Quality Assurance Plan is prepared.

  19. [Quality guidelines for presurgical epilepsy diagnosis and operative epilepsy therapy: 1st revised version].

    PubMed

    Rosenow, F; Bast, T; Czech, T; Hans, V; Helmstaedter, C; Huppertz, H-J; Seeck, M; Trinka, E; Wagner, K

    2014-06-01

    In patients with pharmacorefractory epilepsy, preoperative epilepsy evaluation and subsequent epilepsy surgery lead to a significant improvement of seizure control, proportion of seizure-free patients, quality of life and social participation. The aims of preoperative epilepsy evaluation are to define the chance of complete seizure freedom and the likelihood of inducing new neurological deficits in a given patient. As epilepsy surgery is an elective procedure quality standards are particularly high. As detailed in the first edition of these practice guidelines, quality control relates to seven different domains: (1) establishing centres with a sufficient number of sufficiently and specifically trained personnel, (2) minimum technical standards and equipment, (3) continuing medical education of employees, (4) surveillance by trained personnel during the video electroencephalography (EEG) monitoring (VEM), (5) systematic acquisition of clinical and outcome data, (6) the minimum number of preoperative evaluations and epilepsy surgery procedures and (7) cooperation of epilepsy centres. In the first edition of these practice guidelines published in 2000 it was defined which standards were desirable and that their implementation should be aimed for. These standards related especially to the certification required for different groups of medical doctors involved and to the minimum numbers of procedures required. In the subsequent decade quite a number of colleagues have been certified by the trinational Working Group (Arbeitsgemeinschaft, AG) for Presurgical Epilepsy Diagnosis and Operative Epilepsy Treatment (http://www.ag-epilepsiechirurgie.de) and therefore, on 8 May 2013 the executive board of the AG decided to now make these standards obligatory. PMID:24861193

  20. Site-specific water quality guidelines: 1. Derivation approaches based on physicochemical, ecotoxicological and ecological data.

    PubMed

    van Dam, R A; Humphrey, C L; Harford, A J; Sinclair, A; Jones, D R; Davies, S; Storey, A W

    2014-01-01

    Generic water quality guidelines (WQGs) are developed by countries/regions as broad scale tools to assist with the protection of aquatic ecosystems from the impacts of toxicants. However, since generic WQGs cannot adequately account for the many environmental factors that may affect toxicity at a particular site, site-specific WQGs are often needed, especially for high environmental value ecosystems. The Australian and New Zealand Guidelines for Fresh and Marine Water Quality provide comprehensive guidance on methods for refining or deriving WQGs for site-specific purposes. This paper describes three such methods for deriving site-specific WQGs, namely: (1) using local reference water quality data, (2) using biological effects data from laboratory-based toxicity testing, and (3) using biological effects data from field surveys. Two case studies related to the assessment of impacts arising from mining operations in northern Australia are used to illustrate the application of these methods. Finally, the potential of several emerging methods designed to assess thresholds of ecological change from field data for deriving site-specific WQGs is discussed. Ideally, multiple lines of evidence approaches, integrating both laboratory and field data, are recommended for deriving site-specific WQGs. PMID:23846952

  1. Medication Initiation Burden Required to Comply with Heart Failure Guideline Recommendations and Hospital Quality Measures

    PubMed Central

    Allen, Larry A.; Fonarow, Gregg C.; Liang, Li; Schulte, Phillip J.; Masoudi, Frederick A.; Rumsfeld, John S.; Michael Ho, P.; Eapen, Zubin J.; Hernandez, Adrian F.; Heidenreich, Paul A.; Bhatt, Deepak L.; Peterson, Eric D.; Krumholz, Harlan M.

    2016-01-01

    Background Guidelines for heart failure (HF) recommend prescription of guideline-directed medical therapy before hospital discharge; some of these therapies are included in publicly reported performance measures. The burden of new medications for individual patients has not been described. Methods and Results Get With The Guidelines-HF registry 2008–2013 collected prescribing, indications, and contraindications for angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), beta-blockers (BB), aldosterone antagonists (AldA), hydralazine/isosorbide dinitrate (H/ISDN), and anticoagulants. The difference between a patient’s medication regimen at hospital admission and that recommended by HF quality measures at discharge was calculated. Among 158,922 patients from 271 hospitals with a primary discharge diagnosis of HF, initiation of ACEI/ARB was indicated in 18.1% of all patients (55.5% of those eligible at discharge were not receiving ACEI/ARB at admission), BB in 20.3% (50.5% of eligible), AldA in 24.1% (87.4% of eligible), H/ISDN in 8.6% (93.1% of eligible), and anticoagulant in 18.0% (58.0% of eligible). Cumulatively, 0.4% of patients were eligible for 5 new medication groups, 4.1% for 4, 9.4% for 3, 10.1% for 2, and 22.7% for 1; 15.0% were not eligible for new medications because of adequate prescribing at admission; and 38.4% were not eligible for any medications recommended by HF quality measures. Compared with newly indicated medications (mean 1.45±1.23), actual new prescriptions were lower (mean 1.16±1.00). Conclusions A quarter of patients hospitalized with HF need to start more than 1 medication to meet HF quality measures. Systems for addressing medication initiation and managing polypharmacy are central to HF transitional care. PMID:26316616

  2. Managing Both Quality and Access at Higher Educational Institutions in Tobago

    ERIC Educational Resources Information Center

    Julien Sealey, Beverley

    2011-01-01

    This paper will focus on the island of Tobago and indicate what practical solutions are best suited for administrators to manage quality and access at higher educational institutions on the island. The key areas to managing quality identified are the inclusiveness of a quality plan, administrators desire to see quality as an institutional culture…

  3. Implementing distress management guidelines in ambulatory oncology: a quality improvement project.

    PubMed

    Hammelef, Karen J; Friese, Christopher R; Breslin, Tara M; Riba, Michelle; Schneider, Susan M

    2014-01-01

    Distress assessment and referral to psychosocial services is an essential component of evidence-based oncologic nursing care. Oncology nurses have an opportunity to address patient distress needs through leadership of implementation programs and support for the positive outcomes that engaging in psychosocial services provides. This quality improvement project was conducted to evaluate the feasibility and utility of the National Comprehensive Cancer Network's distress management clinical practice guidelines in ambulatory oncology. A theoretical framework guided the process design that included staff education, screening, and management in a cohort implementation project with historical control. PMID:24480661

  4. The SQUIRE guidelines and how can they help you report on quality in health.

    PubMed

    Davidoff, Frank

    2014-03-07

    Published in 2008, the SQUIRE guidelines are a set of 19 descriptive items that identify the information readers want and need to know about making and studying improvements in healthcare delivery. They were created over a period of several years, largely in response to earlier concerns about the limited quantity and inadequate quality of published reports of work in this new discipline. They have proven useful in writing about improvement interventions, as well as in designing and implementing them. As improvement concepts and methods continue to develop, SQUIRE is also evolving as part of its continuing effort to contribute to the advancement of the "science of improvement."

  5. The Water Quality Portal: a single point of access for water quality data

    NASA Astrophysics Data System (ADS)

    Kreft, J.

    2015-12-01

    The Water Quality Portal (WQP) is a cooperative project between the U.S. Geological Survey (USGS) and the U.S. Environmental Protection Agency (EPA) overseen by the National Water Quality Monitoring Council (NWQMC). It was launched in April of 2012 as a single point of access for discrete water quality samples stored in the USGS NWIS and EPA STORET systems. Since launch thousands of users have visited the Water Quality Portal to download billions of results that are pertinent to their interests. Numerous tools have also been developed that use WQP web services as a source of data for further analysis. Since the launch of the Portal, the WQP development team at the USGS Center for Integrated Data Analytics has worked with USGS and EPA stakeholders as well as the wider user community to add significant new features to the WQP. WQP users can now directly plot sites of interest on a web map based on any of the 164 WQP query parameters, and then download data of interest directly from that map. In addition, the WQP has expanded beyond just serving out NWIS and STORET data, and provides data from the US Department of Agriculture's Agricultural Research Service STEWARDS system, the USGS BioData system and is working with others to bring in additional data. Finally, the WQP is linked to another NWQMC-supported project, the National Environmental Methods Index (NEMI), so WQP users can easily find the method behind the data that they are using. Future work is focused on incorporating additional biological data from the USGS BioData system, broadening the scope of discrete water quality sample types from STORET, and developing approaches to make the data in the WQP more visible and usable. The WQP team is also exploring ways to further integrate with other systems, such as those operated the U.S. Department of Agriculture Forest Service and other federal agencies to facilitate the overarching goal of improving access to water quality data for all users.

  6. Derivation of a water quality guideline for aluminium in marine waters.

    PubMed

    Golding, Lisa A; Angel, Brad M; Batley, Graeme E; Apte, Simon C; Krassoi, Rick; Doyle, Chris J

    2015-01-01

    Metal risk assessment of industrialized harbors and coastal marine waters requires the application of robust water quality guidelines to determine the likelihood of biological impacts. Currently there is no such guideline available for aluminium in marine waters. A water quality guideline of 24 µg total Al/L has been developed for aluminium in marine waters based on chronic 10% inhibition or effect concentrations (IC10 or EC10) and no-observed-effect concentrations (NOECs) from 11 species (2 literature values and 9 species tested including temperate and tropical species) representing 6 taxonomic groups. The 3 most sensitive species tested were a diatom Ceratoneis closterium (formerly Nitzschia closterium; IC10 = 18 µg Al/L, 72-h growth rate inhibition) < mussel Mytilus edulis plannulatus (EC10 = 250 µg Al/L, 72-h embryo development) < oyster Saccostrea echinata (EC10 = 410 µg Al/L, 48-h embryo development). Toxicity to these species was the result of the dissolved aluminium forms of aluminate (Al(OH4 (-) ) and aluminium hydroxide (Al(OH)3 (0) ) although both dissolved, and particulate aluminium contributed to toxicity in the diatom Minutocellus polymorphus and green alga Dunaliella tertiolecta. In contrast, aluminium toxicity to the green flagellate alga Tetraselmis sp. was the result of particulate aluminium only. Four species, a brown macroalga (Hormosira banksii), sea urchin embryo (Heliocidaris tuberculata), and 2 juvenile fish species (Lates calcarifer and Acanthochromis polyacanthus), were not adversely affected at the highest test concentration used.

  7. ASVCP quality assurance guidelines: control of preanalytical, analytical, and postanalytical factors for urinalysis, cytology, and clinical chemistry in veterinary laboratories.

    PubMed

    Gunn-Christie, Rebekah G; Flatland, Bente; Friedrichs, Kristen R; Szladovits, Balazs; Harr, Kendal E; Ruotsalo, Kristiina; Knoll, Joyce S; Wamsley, Heather L; Freeman, Kathy P

    2012-03-01

    In December 2009, the American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards committee published the updated and peer-reviewed ASVCP Quality Assurance Guidelines on the Society's website. These guidelines are intended for use by veterinary diagnostic laboratories and veterinary research laboratories that are not covered by the US Food and Drug Administration Good Laboratory Practice standards (Code of Federal Regulations Title 21, Chapter 58). The guidelines have been divided into 3 reports: (1) general analytical factors for veterinary laboratory performance and comparisons; (2) hematology, hemostasis, and crossmatching; and (3) clinical chemistry, cytology, and urinalysis. This particular report is one of 3 reports and documents recommendations for control of preanalytical, analytical, and postanalytical factors related to urinalysis, cytology, and clinical chemistry in veterinary laboratories and is adapted from sections 1.1 and 2.2 (clinical chemistry), 1.3 and 2.5 (urinalysis), 1.4 and 2.6 (cytology), and 3 (postanalytical factors important in veterinary clinical pathology) of these guidelines. These guidelines are not intended to be all-inclusive; rather, they provide minimal guidelines for quality assurance and quality control for veterinary laboratory testing and a basis for laboratories to assess their current practices, determine areas for improvement, and guide continuing professional development and education efforts.

  8. Guidelines for External Reviews of Quality Assurance Agencies in the European Higher Education Area. ENQA Occasional Papers 19

    ERIC Educational Resources Information Center

    ENQA (European Association for Quality Assurance in Higher Education), 2012

    2012-01-01

    In accordance with the ENQA (European Association for Quality Assurance in Higher Education) membership criteria laid down in the Statutes of ENQA, member agencies are required to undergo external reviews against the membership criteria, and thereby the Standards and Guidelines for Quality Assurance in the European Higher Education Area (ESG) as…

  9. Dilemma of Access and Provision of Quality Basic Education in Central Region, Ghana

    ERIC Educational Resources Information Center

    Amakyi, Michael; Ampah-Mensah, Alfred

    2016-01-01

    A survey research was conducted to find out if reported improvements in access to education in Ghana are reflected in comparable improvements in delivery of quality education. The study examined theoretical constructs on adequacy and quality assurance in education to ascertain the state of quality provision in education, and whether there is a…

  10. Quality Matters[TM] Accessibility Survey: Institutional Practices and Policies for Online Courses

    ERIC Educational Resources Information Center

    Frey, Barbara A.; King, Denise K.

    2011-01-01

    Quality Matters (QM) is a professional organization that offers a faculty-centered, peer review process to certify the quality of online and blended courses. The purpose of this white paper is to share the results of a Quality Matters accessibility benchmarking study administered to 84 subscriber institutions. The primary goal of the survey was to…

  11. Guidelines for the Design of Computers and Information Processing Systems to Increase Their Access by Persons with Disabilities. Version 2.0.

    ERIC Educational Resources Information Center

    Vanderheiden, Gregg C.; Lee, Charles C.

    Many low-cost and no-cost modifications to computers would greatly increase the number of disabled individuals who could use standard computers without requiring custom modifications, and would increase the ability to attach special input and output systems. The purpose of the Guidelines is to provide an awareness of these access problems and a…

  12. 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…

  13. Transportation Accessibility and Quality of Life for the Urban Elderly.

    ERIC Educational Resources Information Center

    Belnap, Judith A.

    The barriers to physical mobility of the elderly are explained in this study which concentrated on spatial-temporal accessibility, and the use of mass transit to urban services and resources. The first area of concern dealt with the amount and extent of free time available to the elderly who are perceived as having large blocks of descretionary…

  14. Matching Students to Opportunity: Expanding College Choice, Access, and Quality

    ERIC Educational Resources Information Center

    Kelly, Andrew P., Ed.; Howell, Jessica S., Ed.; Sattin-Bajaj, Carolyn, Ed.

    2016-01-01

    "Matching Students to Opportunity" expands on the discussion of a critical issue in college access and success: the match between prospective students and the colleges in which they enroll. Research indicates that ensuring a good match significantly increases a student's chance of graduating. The contributors to this volume argue that…

  15. Peer Review Quality and Transparency of the Peer-Review Process in Open Access and Subscription Journals

    PubMed Central

    Wicherts, Jelte M.

    2016-01-01

    Background Recent controversies highlighting substandard peer review in Open Access (OA) and traditional (subscription) journals have increased the need for authors, funders, publishers, and institutions to assure quality of peer-review in academic journals. I propose that transparency of the peer-review process may be seen as an indicator of the quality of peer-review, and develop and validate a tool enabling different stakeholders to assess transparency of the peer-review process. Methods and Findings Based on editorial guidelines and best practices, I developed a 14-item tool to rate transparency of the peer-review process on the basis of journals’ websites. In Study 1, a random sample of 231 authors of papers in 92 subscription journals in different fields rated transparency of the journals that published their work. Authors’ ratings of the transparency were positively associated with quality of the peer-review process but unrelated to journal’s impact factors. In Study 2, 20 experts on OA publishing assessed the transparency of established (non-OA) journals, OA journals categorized as being published by potential predatory publishers, and journals from the Directory of Open Access Journals (DOAJ). Results show high reliability across items (α = .91) and sufficient reliability across raters. Ratings differentiated the three types of journals well. In Study 3, academic librarians rated a random sample of 140 DOAJ journals and another 54 journals that had received a hoax paper written by Bohannon to test peer-review quality. Journals with higher transparency ratings were less likely to accept the flawed paper and showed higher impact as measured by the h5 index from Google Scholar. Conclusions The tool to assess transparency of the peer-review process at academic journals shows promising reliability and validity. The transparency of the peer-review process can be seen as an indicator of peer-review quality allowing the tool to be used to predict academic

  16. Disk diffusion quality control guidelines for NVP-PDF 713: a novel peptide deformylase inhibitor.

    PubMed

    Anderegg, Tamara R; Jones, Ronald N

    2004-01-01

    NVP-PDF713 is a peptide deformylase inhibitor that has emerged as a candidate for treating Gram-positive infections and selected Gram-negative species that commonly cause community-acquired respiratory tract infections. This report summarizes the results of a multi-center (seven participants) disk diffusion quality control (QC) investigation for NVP PDF-713 using guidelines of the National Committee for Clinical Laboratory Standards and the standardized disk diffusion method. A total of 420 NVP-PDF 713 zone diameter values were generated for each QC organism. The proposed zone diameter ranges contained 97.6-99.8% of the reported participant results and were: Staphylococcus aureus ATCC 25923 (25-35 mm), Streptococcus pneumoniae ATCC 49619 (30-37 mm), and Haemophilus influenzae ATCC 49247 (24-32 mm). These QC criteria for the disk diffusion method should be applied during the NVP-PDF 713 clinical trials to maximize test accuracy.

  17. Applying sediment quality guidelines on soft sediments of the Gulf of Finland, Baltic Sea.

    PubMed

    Vallius, Henry

    2015-09-15

    The Gulf of Finland is known to have been rather largely contaminated by heavy metals during the last half of the 20th century, but indications of recovery have been reported. In order to investigate the recent levels of heavy metals and arsenic in the uppermost soft sediments of the off-shore Gulf of Finland coring of altogether 23 sites were performed. The subsamples of the cores are 605 in total and thus give a good picture of heavy metal levels in the surface sediments during the first decade of this century. In order to evaluate methods and predict sediment toxicity the sediment concentrations are compared to American SQG:s. Majority of the subsamples exceeded the threshold levels of both used SQG:s, but some exceeded also the midrange effects quality guidelines. As, Cd, Hg, and Zn concentrations still occur at unacceptably high levels in sediments of the off-shore Gulf of Finland.

  18. Response of the freshwater bivalve Anodonta grandis to Cd near the Canadian Water Quality Guideline

    SciTech Connect

    Stewart, A.R.; Malley, D.F. |

    1994-12-31

    The bivalve population inhabiting Lake 382 in the Experimental Lakes Area, northwestern Ontario, receiving experimental additions of cadmium (Cd) near the Canadian Water Quality Guideline (CWQG) was monitored for effects during 1987 to 1992. the purpose of the study was to determine if the CWQG of 0.2 {mu}g Cd/L would adequately protect the biota of the Precambrian Shield Lakes. Mussels accumulated Cd to whole body levels 30X background. Cd levels in the mussels did not plateau by the end of 1992 and continues to increase. Metal-binding proteins metallothioneins (MTs) were induced in all tissues to levels significantly higher than in tissues of mussels from a pristine lake. Although mussel growth rates differed from site to site within Lake 382, there was no change in growth rates with the addition of Cd.

  19. Development and evaluation of consensus-based sediment quality guidelines for freshwater ecosystems

    USGS Publications Warehouse

    MacDonald, D.D.; Ingersoll, C.G.; Berger, T.A.

    2000-01-01

    Numerical sediment quality guidelines (SQGs) for freshwater ecosystems have previously been developed using a variety of approaches. Each approach has certain advantages and limitations which influence their application in the sediment quality assessment process. In an effort to focus on the agreement among these various published SQGs, consensus-based SQGs were developed for 28 chemicals of concern in freshwater sediments (i.e., metals, polycyclic aromatic hydrocarbons, polychlorinated biphenyls, and pesticides). For each contaminant of concern, two SQGs were developed from the published SQGs, including a threshold effect concentration (TEC) and a probable effect concentration (PEC). The resultant SQGs for each chemical were evaluated for reliability using matching sediment chemistry and toxicity data from field studies conducted throughout the United States. The results of this evaluation indicated that most of the TECs (i.e., 21 of 28) provide an accurate basis for predicting the absence of sediment toxicity. Similarly, most of the PECs (i.e., 16 of 28) provide an accurate basis for predicting sediment toxicity. Mean PEC quotients were calculated to evaluate the combined effects of multiple contaminants in sediment. Results of the evaluation indicate that the incidence of toxicity is highly correlated to the mean PEC quotient (R2 = 0.98 for 347 samples). It was concluded that the consensus-based SQGs provide a reliable basis for assessing sediment quality conditions in freshwater ecosystems.

  20. Development and evaluation of consensus-based sediment quality guidelines for freshwater ecosystems.

    PubMed

    MacDonald, D D; Ingersoll, C G; Berger, T A

    2000-07-01

    Numerical sediment quality guidelines (SQGs) for freshwater ecosystems have previously been developed using a variety of approaches. Each approach has certain advantages and limitations which influence their application in the sediment quality assessment process. In an effort to focus on the agreement among these various published SQGs, consensus-based SQGs were developed for 28 chemicals of concern in freshwater sediments (i.e., metals, polycyclic aromatic hydrocarbons, polychlorinated biphenyls, and pesticides). For each contaminant of concern, two SQGs were developed from the published SQGs, including a threshold effect concentration (TEC) and a probable effect concentration (PEC). The resultant SQGs for each chemical were evaluated for reliability using matching sediment chemistry and toxicity data from field studies conducted throughout the United States. The results of this evaluation indicated that most of the TECs (i.e., 21 of 28) provide an accurate basis for predicting the absence of sediment toxicity. Similarly, most of the PECs (i.e., 16 of 28) provide an accurate basis for predicting sediment toxicity. Mean PEC quotients were calculated to evaluate the combined effects of multiple contaminants in sediment. Results of the evaluation indicate that the incidence of toxicity is highly correlated to the mean PEC quotient (R(2) = 0.98 for 347 samples). It was concluded that the consensus-based SQGs provide a reliable basis for assessing sediment quality conditions in freshwater ecosystems. PMID:10790498

  1. Canadian experiences in telehealth: equalizing access to quality care.

    PubMed

    Jennett, P A; Person, V L; Watson, M; Watanabe, M

    2000-01-01

    The Canadian Conference "TExpo'98: Interactive Health" focused on four telehealth themes: community needs, Canadian experiences, industry perspectives, and access/security/interoperability issues. Health and socioeconomic needs have been the driving force behind telehealth initiatives; telelearning is one of the major Canadian initiatives. To encourage Canadian telehealth initiatives, the federal government is building a national health infrastructure. One element in this framework is concerned with empowering the public, strengthening health care services, and ensuring accountability. Technological advancements and innovative partnerships among health communities, government, users, professional bodies, and industry are critical to continued growth. Key issues including access, evaluation, implementation, privacy, confidentiality, security, and interoperability are of universal concern to participants. Research that examines the benefits and costs of telehealth is needed.

  2. Derivation of South African water quality guidelines for Roundup(®) using species sensitivity distribution.

    PubMed

    Mensah, Paul K; Palmer, Caroline G; Muller, Wilhelmine J

    2013-10-01

    Glyphosate-based herbicides are among the leading products used in South Africa to control weeds and invading alien plant species. Although these herbicides ultimately find their way into aquatic ecosystems, South Africa has no water quality guideline based on indigenous species to protect the country's aquatic biota against these biocides. In this study, South African water quality guidelines (SAWQGs) for Roundup(®) based on species sensitivity distribution (SSD) using indigenous aquatic biota were developed. Short-term and long-term toxicity tests were conducted with eight different aquatic species belonging to five different taxonomic groups. Static non-renewal experimental methods were employed for short-term lethal tests (≤4 days), and static renewal for long-term sublethal tests (≥4 days ≤21 days). LC50 values for animal exposure and EC50 values for algae were calculated using probit analysis and linear regression of transformed herbicide concentration as natural logarithm data against percentage growth inhibition, respectively. No effect concentration (NEC) was determined based on the dynamic energy budget model, using survival data. The LC50, EC50 and NEC values were used to develop species sensitivity distribution (SSD) concentrations for Roundup(®). Based on the SSD concentrations, the short-term and long-term SAWQGs for Roundup(®) were derived as 0.250 (0.106-0.589) mg/L, and 0.002 (0.000-0.021) mg/L, respectively. These WQGs may be useful in protecting South African aquatic life against transient or long-term exposure to glyphosate-based chemicals as part of integrated water resources management.

  3. Derivation of South African water quality guidelines for Roundup(®) using species sensitivity distribution.

    PubMed

    Mensah, Paul K; Palmer, Caroline G; Muller, Wilhelmine J

    2013-10-01

    Glyphosate-based herbicides are among the leading products used in South Africa to control weeds and invading alien plant species. Although these herbicides ultimately find their way into aquatic ecosystems, South Africa has no water quality guideline based on indigenous species to protect the country's aquatic biota against these biocides. In this study, South African water quality guidelines (SAWQGs) for Roundup(®) based on species sensitivity distribution (SSD) using indigenous aquatic biota were developed. Short-term and long-term toxicity tests were conducted with eight different aquatic species belonging to five different taxonomic groups. Static non-renewal experimental methods were employed for short-term lethal tests (≤4 days), and static renewal for long-term sublethal tests (≥4 days ≤21 days). LC50 values for animal exposure and EC50 values for algae were calculated using probit analysis and linear regression of transformed herbicide concentration as natural logarithm data against percentage growth inhibition, respectively. No effect concentration (NEC) was determined based on the dynamic energy budget model, using survival data. The LC50, EC50 and NEC values were used to develop species sensitivity distribution (SSD) concentrations for Roundup(®). Based on the SSD concentrations, the short-term and long-term SAWQGs for Roundup(®) were derived as 0.250 (0.106-0.589) mg/L, and 0.002 (0.000-0.021) mg/L, respectively. These WQGs may be useful in protecting South African aquatic life against transient or long-term exposure to glyphosate-based chemicals as part of integrated water resources management. PMID:23856119

  4. Using research metrics to evaluate the International Atomic Energy Agency guidelines on quality assurance for R&D

    SciTech Connect

    Bodnarczuk, M.

    1994-06-01

    The objective of the International Atomic Energy Agency (IAEA) Guidelines on Quality Assurance for R&D is to provide guidance for developing quality assurance (QA) programs for R&D work on items, services, and processes important to safety, and to support the siting, design, construction, commissioning, operation, and decommissioning of nuclear facilities. The standard approach to writing papers describing new quality guidelines documents is to present a descriptive overview of the contents of the document. I will depart from this approach. Instead, I will first discuss a conceptual framework of metrics for evaluating and improving basic and applied experimental science as well as the associated role that quality management should play in understanding and implementing these metrics. I will conclude by evaluating how well the IAEA document addresses the metrics from this conceptual framework and the broader principles of quality management.

  5. Variation in cooking and eating quality traits in Japanese rice germplasm accessions.

    PubMed

    Hori, Kiyosumi; Suzuki, Keitaro; Iijima, Ken; Ebana, Kaworu

    2016-03-01

    The eating quality of cooked rice is important and determines its market price and consumer acceptance. To comprehensively describe the variation of eating quality in 183 rice germplasm accessions, we evaluated 33 eating-quality traits including amylose and protein contents, pasting properties of rice flour, and texture of cooked rice grains. All eating-quality traits varied widely in the germplasm accessions. Principal-components analysis (PCA) revealed that allelic differences in the Wx gene explained the largest proportion of phenotypic variation of the eating-quality traits. In 146 accessions of non-glutinous temperate japonica rice, PCA revealed that protein content and surface texture of the cooked rice grains significantly explained phenotypic variations of the eating-quality traits. An allelic difference based on simple sequence repeats, which was located near a quantitative trait locus (QTL) on the short arm of chromosome 3, was associated with differences in the eating quality of non-glutinous temperate japonica rice. These results suggest that eating quality is controlled by genetic factors, including the Wx gene and the QTL on chromosome 3, in Japanese rice accessions. These genetic factors have been consciously selected for eating quality during rice breeding programs in Japan. PMID:27162502

  6. Variation in cooking and eating quality traits in Japanese rice germplasm accessions

    PubMed Central

    Hori, Kiyosumi; Suzuki, Keitaro; Iijima, Ken; Ebana, Kaworu

    2016-01-01

    The eating quality of cooked rice is important and determines its market price and consumer acceptance. To comprehensively describe the variation of eating quality in 183 rice germplasm accessions, we evaluated 33 eating-quality traits including amylose and protein contents, pasting properties of rice flour, and texture of cooked rice grains. All eating-quality traits varied widely in the germplasm accessions. Principal-components analysis (PCA) revealed that allelic differences in the Wx gene explained the largest proportion of phenotypic variation of the eating-quality traits. In 146 accessions of non-glutinous temperate japonica rice, PCA revealed that protein content and surface texture of the cooked rice grains significantly explained phenotypic variations of the eating-quality traits. An allelic difference based on simple sequence repeats, which was located near a quantitative trait locus (QTL) on the short arm of chromosome 3, was associated with differences in the eating quality of non-glutinous temperate japonica rice. These results suggest that eating quality is controlled by genetic factors, including the Wx gene and the QTL on chromosome 3, in Japanese rice accessions. These genetic factors have been consciously selected for eating quality during rice breeding programs in Japan. PMID:27162502

  7. Comparison of test specific sediment effect concentrations with marine sediment quality assessment guidelines

    SciTech Connect

    Carr, R.S.; Biedenbach, J.M.; Long, E.R.; MacDonald, D.D.

    1995-12-31

    As part of NOAA`s National Status and Trends (NS and T) Bioeffects Assessment program and studies conducted by the National Biological Service, numerous sediment quality assessment surveys have recently been conducted along the Atlantic and Gulf coasts of the US using the sea urchin (Arbacia punctulata) fertilization and embryological development tests with pore water. Additional toxicity tests were also conducted in conjunction with most of these studies. The areas that have been sampled include Boston harbor, Massachusetts; Charleston Harbor, Winyah Bay, and Savannah River, South Carolina; St. Simon Sound, Georgia; Biscayne Bay, Tampa Bay, Choctawhatchee Bay, Apalachicola Bay, St. Andrew Bay, and Pensacola Bay, Florida; Galveston Bay, Lavaca Bay, and Sabine Lake, Texas, and 200 stations in the vicinity of offshore oil and gas production platforms in the Gulf of Mexico. Sufficient data are now available from this series of surveys to calculate test specific sediment effect concentrations (SECs). Based on these recent studies, SECs were developed for the sea urchin porewater and amphipod tests and compared with existing marine sediment quality assessment guidelines.

  8. Gestational Diabetes and Preeclampsia in Association with Air Pollution at Levels below Current Air Quality Guidelines

    PubMed Central

    Jakobsson, Kristina; Tinnerberg, Håkan; Rignell-Hydbom, Anna; Rylander, Lars

    2013-01-01

    Background: Several studies have estimated associations between air pollution and birth outcomes, but few have evaluated potential effects on pregnancy complications. Objective: We investigated whether low-level exposure to air pollution is associated with gestational diabetes and preeclampsia. Methods: High-quality registry information on 81,110 singleton pregnancy outcomes in southern Sweden during 1999–2005 was linked to individual-level exposure estimates with high spatial resolution. Modeled exposure to nitrogen oxides (NOx), expressed as mean concentrations per trimester, and proximity to roads of different traffic densities were used as proxy indicators of exposure to combustion-related air pollution. The data were analyzed by logistic regression, with and without adjusting for potential confounders. Results: The prevalence of gestational diabetes increased with each NOx quartile, with an adjusted odds ratio (OR) of 1.69 (95% CI: 1.41, 2.03) for the highest (> 22.7 µg/m3) compared with the lowest quartile (2.5–8.9 µg/m3) of exposure during the second trimester. The adjusted OR for acquiring preeclampsia after exposure during the third trimester was 1.51 (1.32, 1.73) in the highest quartile of NOx compared with the lowest. Both outcomes were associated with high traffic density, but ORs were significant for gestational diabetes only. Conclusion: NOx exposure during pregnancy was associated with gestational diabetes and preeclampsia in an area with air pollution levels below current air quality guidelines. PMID:23563048

  9. Hearing Parents' and Carers' Voices: Experiences of Accessing Quality Long Day Care in Northern Regional Australia

    ERIC Educational Resources Information Center

    Harris, Nonie; Tinning, Beth

    2012-01-01

    This article explores parents' and carers' experiences of accessing quality long day care in northern regional Australia. The data was gathered in 2009, after the collapse of ABC Developmental Learning Centres (herein referred to as ABC Learning) and before the implementation of the "National Quality Framework," and provides a snapshot of…

  10. Overcoming Exclusion through Quality Schooling. Pathways to Access. Research Monograph No. 65

    ERIC Educational Resources Information Center

    Govinda, R.; Bandyopadhyay, Madhumita

    2011-01-01

    In the era of globalisation, provision of quality education is increasingly gaining importance across the world. Like elsewhere, it has already been realised in India that equal attention is needed simultaneously on access, equity and quality to achieve the goal of universalisation of elementary education. It has also been experienced that…

  11. Ready, Set, Grow: Illinois Preschool. A Framework for Universal Access to Quality Preschool in Illinois.

    ERIC Educational Resources Information Center

    Wallen, Margie

    The Illinois Governor's Task Force on Universal Access to Preschool is part of a broad-based effort to increase the quality of life for all children in Illinois. This report presents the action plan developed by this task force and calls for the creation of Illinois Preschool, a program giving all Illinois families quality preschool options for 3-…

  12. Does Accelerating Access to Higher Education Lower Its Quality? The Australian Experience

    ERIC Educational Resources Information Center

    Pitman, Tim; Koshy, Paul; Phillimore, John

    2015-01-01

    In the pursuit of mass higher education, fears are often expressed that the quality of higher education suffers as access is increased. This quantitative study considers three proxies of educational quality: (1) prior academic achievement of the student, (2) attrition and retention rates and (3) progression rates, to establish whether educational…

  13. Application of phytotoxicity data to a new Australian soil quality guideline framework for biosolids.

    PubMed

    Heemsbergen, Diane A; Warne, Michael St J; Broos, Kris; Bell, Mike; Nash, David; McLaughlin, Mike; Whatmuff, Mark; Barry, Glenn; Pritchard, Deb; Penney, Nancy

    2009-04-01

    To protect terrestrial ecosystems and humans from contaminants many countries and jurisdictions have developed soil quality guidelines (SQGs). This study proposes a new framework to derive SQGs and guidelines for amended soils and uses a case study based on phytotoxicity data of copper (Cu) and zinc (Zn) from field studies to illustrate how the framework could be applied. The proposed framework uses normalisation relationships to account for the effects of soil properties on toxicity data followed by a species sensitivity distribution (SSD) method to calculate a soil added contaminant limit (soil ACL) for a standard soil. The normalisation equations are then used to calculate soil ACLs for other soils. A soil amendment availability factor (SAAF) is then calculated as the toxicity and bioavailability of pure contaminants and contaminants in amendments can be different. The SAAF is used to modify soil ACLs to ACLs for amended soils. The framework was then used to calculate soil ACLs for copper (Cu) and zinc (Zn). For soils with pH of 4-8 and OC content of 1-6%, the ACLs range from 8 mg/kg to 970 mg/kg added Cu. The SAAF for Cu was pH dependant and varied from 1.44 at pH 4 to 2.15 at pH 8. For soils with pH of 4-8 and OC content of 1-6%, the ACLs for amended soils range from 11 mg/kg to 2080 mg/kg added Cu. For soils with pH of 4-8 and a CEC from 5-60, the ACLs for Zn ranged from 21 to 1470 mg/kg added Zn. A SAAF of one was used for Zn as it concentrations in plant tissue and soil to water partitioning showed no difference between biosolids and soluble Zn salt treatments, indicating that Zn from biosolids and Zn salts are equally bioavailable to plants.

  14. Guidelines for Controlling Indoor Air Quality Problems Associated with Kilns, Copiers, and Welding in Schools. Technical Bulletin.

    ERIC Educational Resources Information Center

    Turner, Ronald W.; And Others

    Guidelines for controlling indoor air quality problems associated with kilns, copiers, and welding in schools are provided in this document. Individual sections on kilns, duplicating equipment, and welding operations contain information on the following: sources of contaminants; health effects; methods of control; ventilation strategies; and…

  15. Getting (Along) With the Guidelines: Reconciling Patient Autonomy and Quality Improvement Through Shared Decision Making

    PubMed Central

    Xu, Yan

    2016-01-01

    In past decades, stark differences in practice pattern, cost, and outcomes of care across regions with similar health demographics have prompted calls for reform. As health systems answer the growing call for accountability in the form of quality indices, while responding to increased scrutiny on practice variation in the form of pay for performance (P4P), a rift is widening between the system and individual patients. Currently, three areas are inadequately considered by P4P structures based largely on physician adherence to guidelines: diversity of patient values and preferences; time and financial burden of therapy in the context of multimorbidity; and narrow focus on quantitative measures that distract clinicians from providing optimal care. As health care reform efforts place greater emphasis on value-for-money of care delivered, they provide an opportunity to consider the other “value”—the values of each patient and care delivery that aligns with them. The inherent balance of risks and benefits in every treatment, especially those involving chronic conditions, calls for engagement of patients in decision-making processes, recognizing the diversity of preferences at the individual level. Shared decision making (SDM) is an attractive option and should be an essential component of quality health care rather than its adjunct. Four interwoven steps toward the meaningful implementation of SDM in clinical practice—embedding SDM as a health care quality measure, “real-world” evaluation of SDM effectiveness, pursuit of an SDM-favorable health system, and patient-centered medical education—are proposed to bring focus back to the beneficiary of health care accountability, the patient. PMID:26839943

  16. Getting (Along) With the Guidelines: Reconciling Patient Autonomy and Quality Improvement Through Shared Decision Making.

    PubMed

    Xu, Yan; Wells, Philip S

    2016-07-01

    In past decades, stark differences in practice pattern, cost, and outcomes of care across regions with similar health demographics have prompted calls for reform. As health systems answer the growing call for accountability in the form of quality indices, while responding to increased scrutiny on practice variation in the form of pay for performance (P4P), a rift is widening between the system and individual patients. Currently, three areas are inadequately considered by P4P structures based largely on physician adherence to guidelines: diversity of patient values and preferences; time and financial burden of therapy in the context of multimorbidity; and narrow focus on quantitative measures that distract clinicians from providing optimal care. As health care reform efforts place greater emphasis on value-for-money of care delivered, they provide an opportunity to consider the other "value"-the values of each patient and care delivery that aligns with them.The inherent balance of risks and benefits in every treatment, especially those involving chronic conditions, calls for engagement of patients in decision-making processes, recognizing the diversity of preferences at the individual level. Shared decision making (SDM) is an attractive option and should be an essential component of quality health care rather than its adjunct. Four interwoven steps toward the meaningful implementation of SDM in clinical practice-embedding SDM as a health care quality measure, "real-world" evaluation of SDM effectiveness, pursuit of an SDM-favorable health system, and patient-centered medical education-are proposed to bring focus back to the beneficiary of health care accountability, the patient. PMID:26839943

  17. Access to orphan drugs despite poor quality of clinical evidence

    PubMed Central

    Dupont, Alain G; Van Wilder, Philippe B

    2011-01-01

    AIM We analysed the Belgian reimbursement decisions of orphan drugs as compared with those of innovative drugs for more common but equally severe diseases, with special emphasis on the quality of clinical evidence. METHODS Using the National Health Insurance Agency administrative database, we evaluated all submitted orphan drug files between 2002 and 2007. A quality analysis of the clinical evidence in the orphan reimbursement files was performed. The evaluation reports of the French ‘Haute Autorité de Santé’, including the five-point scale parameter ‘Service Médical Rendu (SMR), were examined to compare disease severity. Chi-squared tests (at P < 0.05 significance level) were used to compare the outcome of the reimbursement decisions between orphan and non-orphan innovative medicines. RESULTS Twenty-five files of orphan drugs and 117 files of non-orphan drugs were evaluated. Twenty-two of 25 (88%) submissions of orphan drugs were granted reimbursement as opposed to 74 of the 117 (63%) non-orphan innovative medicines (P = 0.02). Only 52% of the 25 orphan drug files included a randomized controlled trial as opposed to 84% in a random control sample of 25 non-orphan innovative submissions (P < 0.01). The duration of drug exposure was in most cases far too short in relation to the natural history of the disease. CONCLUSIONS Orphan drug designation predicts reimbursement despite poor quality of clinical evidence. The evidence gap at market authorization should be reduced by post-marketing programmes, in which the centralized regulatory and the local reimbursement authorities collaborate in an efficient way across the European Union member states. PMID:21395641

  18. Selecting pesticides for inclusion in drinking water quality guidelines on the basis of detection probability and ranking.

    PubMed

    Narita, Kentaro; Matsui, Yoshihiko; Iwao, Kensuke; Kamata, Motoyuki; Matsushita, Taku; Shirasaki, Nobutaka

    2014-02-01

    Pesticides released into the environment may pose both ecological and human health risks. Governments set the regulations and guidelines for the allowable levels of active components of pesticides in various exposure sources, including drinking water. Several pesticide risk indicators have been developed using various methodologies, but such indicators are seldom used for the selection of pesticides to be included in national regulations and guidelines. The aim of the current study was to use risk indicators for the selection of pesticides to be included in regulations and guidelines. Twenty-four risk indicators were created, and a detection rate was defined to judge which indicators were the best for selection. The combination of two indicators (local sales of a pesticide for the purposes of either rice farming or other farming, divided by the guideline value and annual precipitation, and amended with the scores from the physical and chemical properties of the pesticide) gave the highest detection rates. In this case study, this procedure was used to evaluate 134 pesticides that are currently unregulated in the Japanese Drinking Water Quality Guidelines, from which 44 were selected as pesticides to be added to the primary group in the guidelines. The detection probability of the 44 pesticides was more than 72%. Among the 102 pesticides currently in the primary group, 17 were selected for withdrawal from the group.

  19. Evaluation of a practice guideline for the management of respiratory distress syndrome in preterm infants: A quality improvement initiative

    PubMed Central

    Read, Brooke; Lee, David SC; Fraser, Debbie

    2016-01-01

    BACKGROUND: The use of mechanical ventilation to treat respiratory distress syndrome in preterm infants has been associated with the development of bronchopulmonary dysplasia. As part of a quality improvement initiative to reduce the incidence of bronchopulmonary dysplasia in preterm infants, a new practice guideline for the management of respiratory distress syndrome was developed and adopted into practice in a neonatal intensive care unit in February 2012. OBJECTIVE: To evaluate the effects of implementing the new guideline in regard to the use of mechanical ventilation and surfactant, and the incidence of bronchopulmonary dypslasia. METHODS: An historical cohort of very preterm infants (gestational age 260 to 326 weeks) born one year before guideline implementation was compared with a similar cohort of infants born one year following guideline implementation. Data were collected retrospectively from the local neonatal intensive care unit database. RESULTS: A total of 272 preterm infants were included in the study: 129 in the preguideline cohort and 143 in the postguideline cohort. Following the implementation of the guideline, the proportion of infants treated with ongoing mechanical ventilation was reduced from 49% to 26% (P<0.001) and there was a trend toward a reduction in bronchopulmonary dysplasia (27% versus 18%; P=0.07). There was no difference in the proportion of infants treated with surfactant (54% versus 50%). CONCLUSION: The implementation of the practice guideline helped to minimize the use of ongoing mechanical ventilation in preterm infants. PMID:26941562

  20. Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

    PubMed Central

    Uchôa, Severina Alice da Costa; Arcêncio, Ricardo Alexandre; Fronteira, Inês Santos Estevinho; Coêlho, Ardigleusa Alves; Martiniano, Claudia Santos; Brandão, Isabel Cristina Araújo; Yamamura, Mellina; Maroto, Renata Melo

    2016-01-01

    Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fisher's exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%). Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000), availability (p=0.0000), coordination of care (p=0.0000), integration (p=0.0000) and supply (p=0.0000), verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil. PMID:26959332

  1. State-of-the art guideline manual for design, quality control and construction of Sulfur-Extended-Asphalt (SEA) pavements

    NASA Astrophysics Data System (ADS)

    McBee, W. C.; Sullivan, T. A.; Izatt, J. O.

    1980-08-01

    Sulfur-Extended-Asphalt (SEA) binders save asphalt, a potential energy source, by replacing some asphalt in conventional flexible pavement mixes with sulfur. These new binders appear to possess properties comparable to asphalt. The guideline manual discussed provides the highway community in both public and private organizations with the most definitive state-of-the-art guidelines extant for using these binders. Information on design, construction, quality control, equipment, mixing plants, specifications, and safety is included. Administrators and professionals in pavement construction, design, maintenance, and materials testing will be the personnel who are most interested in the manual.

  2. Overview of quality in cardiovascular imaging and procedures for clinicians: focus on appropriate-use-criteria guidelines.

    PubMed

    Stainback, Raymond F

    2014-01-01

    Cardiovascular imaging and procedures have experienced exponential growth over the past 20 years in terms of new modalities, procedure volume, technological sophistication, and cost. As a result, related quality improvement tools have become multifaceted works in progress. This article briefly summarizes the evolution of the time-honored American College of Cardiology Foundation/American Heart Association clinical practice guidelines versus the newer American College of Cardiology Foundation appropriate-use-criteria guidelines and how these may interact with emerging performance measures, clinical data registries, and cardiovascular laboratory accreditation initiatives.

  3. Application of water quality guidelines and water quantity calculations to decisions for beneficial use of treated water

    NASA Astrophysics Data System (ADS)

    Pham, Minh Phung T.; Castle, James W.; Rodgers, John H.

    2011-12-01

    Water reuse guidelines were compiled as a decision-analysis screening tool for application to potential water reuse for irrigation, livestock watering, aquaculture, and drinking. Data compiled from the literature for water reuses yielded guideline values for over 50 water quality parameters, including concentrations of inorganic and organic constituents as well as general water chemistry parameters. These water quality guidelines can be used to identify constituents of concern in water, to determine the levels to which the constituents must be treated for water reuse applications, and assess the suitability of treated water for reuse. An example is provided to illustrate the application of water quality guidelines for decision analysis. Water quantity analysis was also investigated, and water volumes required for producing 16 different crops in 15 countries were estimated as an example of applying water quantity in the decision-making process regarding the potential of water reuse. For each of the countries investigated, the crop that produces the greatest yield in terms of weight per water volume is tomatoes in Australia, Brazil, Italy, Japan, Saudi Arabia, Turkey, USA; sugarcane in Chad, India, Indonesia, Sudan; watermelons in China; lettuce in Egypt, Mexico; and onions (dry) in Russia.

  4. Guidelines for timely initiation of chemotherapy: a proposed framework for access to medical oncology and haematology cancer clinics and chemotherapy services.

    PubMed

    Alexander, M; Beattie-Manning, R; Blum, R; Byrne, J; Hornby, C; Kearny, C; Love, N; McGlashan, J; McKiernan, S; Milar, J L; Murray, D; Opat, S; Parente, P; Thomas, J; Tweddle, N; Underhill, C; Whitfield, K; Kirsa, S; Rischin, D

    2016-08-01

    These guidelines, informed by the best available evidence and consensus expert opinion, provide a framework to guide the timely initiation of chemotherapy for treating cancer. They sit at the intersection of patient experience, state-of-the-art disease management and rational efficient service provision for these patients at a system level. Internationally, cancer waiting times are routinely measured and publicly reported. In Australia, there are existing policies and guidelines relating to the timeliness of cancer care for surgery and radiation therapy; however, until now, equivalent guidance for chemotherapy was lacking. Timeliness of care should be informed, where available, by evidence for improved patient outcomes. Independent of this, it should be recognised that shorter waiting periods are likely to reduce patient anxiety. While these guidelines were developed as part of a proposed framework for consideration by the Victorian Department of Health, they are clinically relevant to national and international cancer services. They are intended to be used by clinical and administrative staff within cancer services. Adoption of these guidelines, which are for the timely triage, review and treatment of cancer patients receiving systemic chemotherapy, aims to ensure that patients receive care within a timeframe that will maximise health outcomes, and that access to care is consistent and equitable across cancer services. Local monitoring of performance against this guideline will enable cancer service providers to manage proactively future service demand. PMID:27553996

  5. The role of yogurt in improving the quality of the American diet and meeting dietary guidelines.

    PubMed

    Webb, Densie; Donovan, Sharon M; Meydani, Simin Nikbin

    2014-03-01

    The Dietary Guidelines for Americans (DGA) recommend three daily servings of low- or nonfat dairy products, yet two-thirds of individuals in the United States do not meet that goal. Including low- or nonfat yogurt as part of an overall healthful diet can be a positive step toward meeting the DGA recommendations. Yogurt naturally contains calcium and potassium, and some products are fortified with vitamin D. All of these nutrients were identified in the DGA as "nutrients of concern," because typical intake falls far short of recommended intakes. Yogurt can also be an excellent source of high-quality protein, which promotes satiety, helps in maintaining a healthy body weight, and aids muscle and bone growth. In addition, yogurt is low in sodium and contributes 1.0% or less of added sugars to the diets of most individuals in the United States; however, 90% of children and adults consume less than 8 ounces (1 cup) of yogurt per week. Thus, consuming 1 serving of yogurt per day would help to meet the DGA-recommended dairy servings and would provide nutrients of concern.

  6. Mechanistic sediment quality guidelines based on contaminant bioavailability: equilibrium partitioning sediment benchmarks.

    PubMed

    Burgess, Robert M; Berry, Walter J; Mount, David R; Di Toro, Dominic M

    2013-01-01

    Globally, estimated costs to manage (i.e., remediate and monitor) contaminated sediments are in the billions of U.S. dollars. Biologically based approaches for assessing the contaminated sediments which pose the greatest ecological risk range from toxicity testing to benthic community analysis. In addition, chemically based sediment quality guidelines (SQGs) provide a relatively inexpensive line of evidence for supporting these assessments. The present study summarizes a mechanistic SQG based on equilibrium partitioning (EqP), which uses the dissolved concentrations of contaminants in sediment interstitial waters as a surrogate for bioavailable contaminant concentrations. The EqP-based mechanistic SQGs are called equilibrium partitioning sediment benchmarks (ESBs). Sediment concentrations less than or equal to the ESB values are not expected to result in adverse effects and benthic organisms should be protected, while sediment concentrations above the ESB values may result in adverse effects to benthic organisms. In the present study, ESB values are reported for 34 polycyclic aromatic hydrocarbon, 32 other organic contaminants, and seven metals (cadmium, chromium, copper, nickel, lead, silver, zinc). Also included is an overview of EqP theory, ESB derivation, examples of applying ESB values, and considerations when using ESBs. The ESBs are intended as a complement to existing sediment-assessment tools, to assist in determining the extent of sediment contamination, to help identify chemicals causing toxicity, and to serve as targets for pollutant loading control measures.

  7. The role of yogurt in improving the quality of the American diet and meeting dietary guidelines.

    PubMed

    Webb, Densie; Donovan, Sharon M; Meydani, Simin Nikbin

    2014-03-01

    The Dietary Guidelines for Americans (DGA) recommend three daily servings of low- or nonfat dairy products, yet two-thirds of individuals in the United States do not meet that goal. Including low- or nonfat yogurt as part of an overall healthful diet can be a positive step toward meeting the DGA recommendations. Yogurt naturally contains calcium and potassium, and some products are fortified with vitamin D. All of these nutrients were identified in the DGA as "nutrients of concern," because typical intake falls far short of recommended intakes. Yogurt can also be an excellent source of high-quality protein, which promotes satiety, helps in maintaining a healthy body weight, and aids muscle and bone growth. In addition, yogurt is low in sodium and contributes 1.0% or less of added sugars to the diets of most individuals in the United States; however, 90% of children and adults consume less than 8 ounces (1 cup) of yogurt per week. Thus, consuming 1 serving of yogurt per day would help to meet the DGA-recommended dairy servings and would provide nutrients of concern. PMID:24602122

  8. Why do we observe a limited impact of primary care access measures on clinical quality indicators?

    PubMed

    Chung, Sukyung; Panattoni, Laura; Hung, Dorothy; Johns, Nicole; Trujillo, Laurel; Tai-Seale, Ming

    2014-01-01

    The study assessed the effects of enhanced primary care access and continuity on clinical quality in a large, multipayer, multispecialty ambulatory care organization with fee-for-service provider incentives. The difference-in-differences estimates indicate that access to own primary care physician is a statistically significant predictor of improved clinical quality, although the effect size is small such that clinical significance may be negligible. Reduced time for own primary care physician appointment and increased enrollment in electronic personal health record are positive predictors of chronic disease management processes and preventive screening but are inconsistently associated with clinical outcomes. Challenges in identifying relationships between access and quality outcomes in a real-world setting are also discussed. PMID:24594563

  9. Recommendations for mass spectrometry data quality metrics for open access data (corollary to the Amsterdam Principles).

    PubMed

    Kinsinger, Christopher R; Apffel, James; Baker, Mark; Bian, Xiaopeng; Borchers, Christoph H; Bradshaw, Ralph; Brusniak, Mi-Youn; Chan, Daniel W; Deutsch, Eric W; Domon, Bruno; Gorman, Jeff; Grimm, Rudolf; Hancock, William; Hermjakob, Henning; Horn, David; Hunter, Christie; Kolar, Patrik; Kraus, Hans-Joachim; Langen, Hanno; Linding, Rune; Moritz, Robert L; Omenn, Gilbert S; Orlando, Ron; Pandey, Akhilesh; Ping, Peipei; Rahbar, Amir; Rivers, Robert; Seymour, Sean L; Simpson, Richard J; Slotta, Douglas; Smith, Richard D; Stein, Stephen E; Tabb, David L; Tagle, Danilo; Yates, John R; Rodriguez, Henry

    2011-12-01

    Policies supporting the rapid and open sharing of proteomic data are being implemented by the leading journals in the field. The proteomics community is taking steps to ensure that data are made publicly accessible and are of high quality, a challenging task that requires the development and deployment of methods for measuring and documenting data quality metrics. On September 18, 2010, the United States National Cancer Institute convened the "International Workshop on Proteomic Data Quality Metrics" in Sydney, Australia, to identify and address issues facing the development and use of such methods for open access proteomics data. The stakeholders at the workshop enumerated the key principles underlying a framework for data quality assessment in mass spectrometry data that will meet the needs of the research community, journals, funding agencies, and data repositories. Attendees discussed and agreed up on two primary needs for the wide use of quality metrics: 1) an evolving list of comprehensive quality metrics and 2) standards accompanied by software analytics. Attendees stressed the importance of increased education and training programs to promote reliable protocols in proteomics. This workshop report explores the historic precedents, key discussions, and necessary next steps to enhance the quality of open access data. By agreement, this article is published simultaneously in the Journal of Proteome Research, Molecular and Cellular Proteomics, Proteomics, and Proteomics Clinical Applications as a public service to the research community. The peer review process was a coordinated effort conducted by a panel of referees selected by the journals.

  10. Recommendations for mass spectrometry data quality metrics for open access data (corollary to the Amsterdam Principles).

    PubMed

    Kinsinger, Christopher R; Apffel, James; Baker, Mark; Bian, Xiaopeng; Borchers, Christoph H; Bradshaw, Ralph; Brusniak, Mi-Youn; Chan, Daniel W; Deutsch, Eric W; Domon, Bruno; Gorman, Jeff; Grimm, Rudolf; Hancock, William; Hermjakob, Henning; Horn, David; Hunter, Christie; Kolar, Patrik; Kraus, Hans-Joachim; Langen, Hanno; Linding, Rune; Moritz, Robert L; Omenn, Gilbert S; Orlando, Ron; Pandey, Akhilesh; Ping, Peipei; Rahbar, Amir; Rivers, Robert; Seymour, Sean L; Simpson, Richard J; Slotta, Douglas; Smith, Richard D; Stein, Stephen E; Tabb, David L; Tagle, Danilo; Yates, John R; Rodriguez, Henry

    2012-02-01

    Policies supporting the rapid and open sharing of proteomic data are being implemented by the leading journals in the field. The proteomics community is taking steps to ensure that data are made publicly accessible and are of high quality, a challenging task that requires the development and deployment of methods for measuring and documenting data quality metrics. On September 18, 2010, the U.S. National Cancer Institute (NCI) convened the "International Workshop on Proteomic Data Quality Metrics" in Sydney, Australia, to identify and address issues facing the development and use of such methods for open access proteomics data. The stakeholders at the workshop enumerated the key principles underlying a framework for data quality assessment in mass spectrometry data that will meet the needs of the research community, journals, funding agencies, and data repositories. Attendees discussed and agreed up on two primary needs for the wide use of quality metrics: (1) an evolving list of comprehensive quality metrics and (2) standards accompanied by software analytics. Attendees stressed the importance of increased education and training programs to promote reliable protocols in proteomics. This workshop report explores the historic precedents, key discussions, and necessary next steps to enhance the quality of open access data. By agreement, this article is published simultaneously in the Journal of Proteome Research, Molecular and Cellular Proteomics, Proteomics, and Proteomics Clinical Applications as a public service to the research community. The peer review process was a coordinated effort conducted by a panel of referees selected by the journals.

  11. Recommendations for mass spectrometry data quality metrics for open access data (corollary to the Amsterdam principles).

    PubMed

    Kinsinger, Christopher R; Apffel, James; Baker, Mark; Bian, Xiaopeng; Borchers, Christoph H; Bradshaw, Ralph; Brusniak, Mi-Youn; Chan, Daniel W; Deutsch, Eric W; Domon, Bruno; Gorman, Jeff; Grimm, Rudolf; Hancock, William; Hermjakob, Henning; Horn, David; Hunter, Christie; Kolar, Patrik; Kraus, Hans-Joachim; Langen, Hanno; Linding, Rune; Moritz, Robert L; Omenn, Gilbert S; Orlando, Ron; Pandey, Akhilesh; Ping, Peipei; Rahbar, Amir; Rivers, Robert; Seymour, Sean L; Simpson, Richard J; Slotta, Douglas; Smith, Richard D; Stein, Stephen E; Tabb, David L; Tagle, Danilo; Yates, John R; Rodriguez, Henry

    2011-12-01

    Policies supporting the rapid and open sharing of proteomic data are being implemented by the leading journals in the field. The proteomics community is taking steps to ensure that data are made publicly accessible and are of high quality, a challenging task that requires the development and deployment of methods for measuring and documenting data quality metrics. On September 18, 2010, the U.S. National Cancer Institute (NCI) convened the "International Workshop on Proteomic Data Quality Metrics" in Sydney, Australia, to identify and address issues facing the development and use of such methods for open access proteomics data. The stakeholders at the workshop enumerated the key principles underlying a framework for data quality assessment in mass spectrometry data that will meet the needs of the research community, journals, funding agencies, and data repositories. Attendees discussed and agreed up on two primary needs for the wide use of quality metrics: (i) an evolving list of comprehensive quality metrics and (ii) standards accompanied by software analytics. Attendees stressed the importance of increased education and training programs to promote reliable protocols in proteomics. This workshop report explores the historic precedents, key discussions, and necessary next steps to enhance the quality of open access data. By agreement, this article is published simultaneously in Proteomics, Proteomics Clinical Applications, Journal of Proteome Research, and Molecular and Cellular Proteomics, as a public service to the research community. The peer review process was a coordinated effort conducted by a panel of referees selected by the journals.

  12. Recommendations for mass spectrometry data quality metrics for open access data (corollary to the Amsterdam principles).

    PubMed

    Kinsinger, Christopher R; Apffel, James; Baker, Mark; Bian, Xiaopeng; Borchers, Christoph H; Bradshaw, Ralph; Brusniak, Mi-Youn; Chan, Daniel W; Deutsch, Eric W; Domon, Bruno; Gorman, Jeff; Grimm, Rudolf; Hancock, William; Hermjakob, Henning; Horn, David; Hunter, Christie; Kolar, Patrik; Kraus, Hans-Joachim; Langen, Hanno; Linding, Rune; Moritz, Robert L; Omenn, Gilbert S; Orlando, Ron; Pandey, Akhilesh; Ping, Peipei; Rahbar, Amir; Rivers, Robert; Seymour, Sean L; Simpson, Richard J; Slotta, Douglas; Smith, Richard D; Stein, Stephen E; Tabb, David L; Tagle, Danilo; Yates, John R; Rodriguez, Henry

    2012-01-01

    Policies supporting the rapid and open sharing of proteomic data are being implemented by the leading journals in the field. The proteomics community is taking steps to ensure that data are made publicly accessible and are of high quality, a challenging task that requires the development and deployment of methods for measuring and documenting data quality metrics. On September 18, 2010, the U.S. National Cancer Institute (NCI) convened the "International Workshop on Proteomic Data Quality Metrics" in Sydney, Australia, to identify and address issues facing the development and use of such methods for open access proteomics data. The stakeholders at the workshop enumerated the key principles underlying a framework for data quality assessment in mass spectrometry data that will meet the needs of the research community, journals, funding agencies, and data repositories. Attendees discussed and agreed upon two primary needs for the wide use of quality metrics: (i) an evolving list of comprehensive quality metrics and (ii) standards accompanied by software analytics. Attendees stressed the importance of increased education and training programs to promote reliable protocols in proteomics. This workshop report explores the historic precedents, key discussions, and necessary next steps to enhance the quality of open access data. By agreement, this article is published simultaneously in Proteomics, Proteomics Clinical Applications, Journal of Proteome Research, and Molecular and Cellular Proteomics, as a public service to the research community. The peer review process was a coordinated effort conducted by a panel of referees selected by the journals.

  13. Adherence to Guidelines for Cancer Survivors and Health-Related Quality of Life among Korean Breast Cancer Survivors.

    PubMed

    Song, Sihan; Hwang, Eunkyung; Moon, Hyeong-Gon; Noh, Dong-Young; Lee, Jung Eun

    2015-12-01

    There is limited evidence on the association between adherence to guidelines for cancer survivors and health-related quality of life (HRQoL). In a cross-sectional study of Korean breast cancer survivors, we examined whether adherence to the guidelines of the American Cancer Society (ACS) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) for cancer survivors was related to levels of HRQoL, assessed by the Korean version of Core 30 (C30) and Breast cancer module 23 (BR23) of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC-QLQ). We included a total of 160 women aged 21 to 79 years who had been diagnosed with breast cancer according to American Joint Committee on Cancer (AJCC) stages I to III and had breast cancer surgery at least six months before the interview. Increasing adherence to ACS guidelines was associated with higher scores of social functioning (p for trend = 0.05), whereas increasing adherence to WCRF/AICR recommendations was associated with higher scores of arm symptoms (p for trend = 0.01). These associations were limited to those with stage II or III cancer. Diet may be an important factor in relation to quality of life among Korean breast cancer survivors, however our findings warrant further prospective studies to evaluate whether healthy diet improves survivors' quality of life.

  14. Guidelines for quality assurance and quality control of fish taxonomic data collected as part of the National Water-Quality Assessment Program

    USGS Publications Warehouse

    Walsh, Stephen Joseph; Meador, Michael R.

    1998-01-01

    Fish community structure is characterized by the U.S. Geological Survey's National Water-Quality Assessment (NAWQA) Program as part of a perennial, multidisciplinary approach to evaluating the physical, chemical, and biological conditions of the Nation's water resources. The objective of quality assurance and quality control of fish taxonomic data that are collected as part of the NAWQA Program is to establish uniform guidelines and protocols for the identification, processing, and archiving of fish specimens to ensure that accurate and reliable data are collected. Study unit biologists, collaborating with regional biologists and fish taxonomic specialists, prepare a pre-sampling study plan that includes a preliminary faunal list and identification of an ichthyological curation center for receiving preserved fish specimens. Problematic taxonomic issues and protected taxa also are identified in the study plan, and collecting permits are obtained in advance of sampling activities. Taxonomic specialists are selected to identify fish specimens in the field and to assist in determining what fish specimens should be sacrificed, fixed, and preserved for laboratory identification, independent taxonomic verification, and long-term storage in reference or voucher collections. Quantitative and qualitative sampling of fishes follows standard methods previously established for the NAWQA Program. Common ichthyological techniques are used to process samples in the field and prepare fish specimens to be returned to the laboratory or sent to an institutional repository. Taxonomic identifications are reported by using a standardized list of scientific names that provides nomenclatural consistency and uniformity across study units.

  15. What is the quality of smoking cessation advice in guidelines of tobacco-related diseases?

    PubMed

    Bogdanovica, Ilze; Agrawal, Sanjay; Gregory, Benjamin; Britton, John; Leonardi-Bee, Jo

    2015-12-01

    Smoking is a major risk factor for a range of diseases, and quitting smoking provides considerable benefits to health. It therefore follows that clinical guidelines on disease management, particularly for diseases caused by smoking, should include smoking cessation. The aim of this study was to determine the extent to which this is the case. We conducted a systematic review investigating clinical guidelines and recommendations issued by UK national or European transnational medical speciality associations and societies issued between 2000 and 2012 on a range of diseases caused by smoking. We then investigated whether selected guidelines contained reference to smoking cessation and smoking cessation advice. Although the extent to which smoking and smoking cessation was mentioned in the guidelines varied between diseases, only 60% of guidelines identified recognised that smoking is a risk factor for the development of the disease and 40% recommended smoking cessation. Only 19% of guidelines provided detailed information on how to deliver smoking cessation support. Smoking cessation is not comprehensively addressed in current UK and transnational European clinical practice guidelines and recommendations.

  16. Guidelines and standard procedures for studies of ground-water quality; selection and installation of wells, and supporting documentation

    USGS Publications Warehouse

    Lapham, W.W.; Wilde, F.D.; Koterba, M.T.

    1997-01-01

    This is the first of a two-part report to document guidelines and standard procedures of the U.S. Geological Survey for the acquisition of data in ground-water-quality studies. This report provides guidelines and procedures for the selection and installation of wells for water-quality studies/*, and the required or recommended supporting documentation of these activities. Topics include (1) documentation needed for well files, field folders, and electronic files; (2) criteria and information needed for the selection of water-supply and observation wells, including site inventory and data collection during field reconnaissance; and (3) criteria and preparation for installation of monitoring wells, including the effects of equipment and materials on the chemistry of ground-water samples, a summary of drilling and coring methods, and information concerning well completion, development, and disposition.

  17. Educational Access Is Educational Quality: Indigenous Parents' Perceptions of Schooling in Rural Guatemala

    ERIC Educational Resources Information Center

    Ishihara-Brito, Reiko

    2013-01-01

    This paper presents the findings and implications of a qualitative study conducted in Guatemala, which focused on rural, indigenous parents' perceptions of their children's schooling and educational quality. For these parents, the simple fact that their children had improved access to school signifies a satisfactory educational…

  18. Information-Seeking in Family Day Care: Access, Quality and Personal Cost

    ERIC Educational Resources Information Center

    Corr, L.; Davis, E.; Cook, K.; Mackinnon, A.; Sims, M.; Herrman, H.

    2014-01-01

    Family day-care (FDC) educators work autonomously to provide care and education for children of mixed ages, backgrounds and abilities. To meet the demands and opportunities of their work and regulatory requirements, educators need access to context-relevant and high quality information. No previous research has examined how and where these workers…

  19. A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Khan, Arshia A.

    2012-01-01

    Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

  20. Improving Access to Needed Health Care Improves Low-Income Children's Quality of Life: Research Highlights

    ERIC Educational Resources Information Center

    Seid, Michael. Varni, James W.; Cummings, Leslie; Schonlau, Matthias

    2006-01-01

    This research brief describes an examination of the effect of the State Children's Health Insurance Program (SCHIP) on children's access to needed health services and on their quality of life. The analysis focused on a sample of California families who had recently enrolled in that state's SCHIP. The study found that, after enrollment, children…

  1. Ensuring Access with Quality to California's Community Colleges. National Center Report #04-3

    ERIC Educational Resources Information Center

    Hayward, Gerald C.; Jones, Dennis P.; McGuinness, Aims C., Jr.; Timar, Allene

    2004-01-01

    This report finds that enrollment growth pressures, fee increases, and recent budget cuts in the California Community Colleges are having significant detrimental effects on student access and program quality. The report also provides recommendations for creating improvements that build from the state policy context and from existing promising…

  2. The Role of Boards in College Access Programs: Creating and Maintaining Quality

    ERIC Educational Resources Information Center

    Center for Higher Education Policy Analysis, University of Southern California, 2006

    2006-01-01

    Access programs are facing increased scrutiny. Not all programs are equally effective. In an environment in which resources are short, funders increasingly require criteria that enable them to make informed decisions about program quality. As elaborated in this report , one role of a high performance board is to help develop benchmarks of…

  3. Access, Participation, and Supports: The Defining Features of High-Quality Inclusion

    ERIC Educational Resources Information Center

    Buysse, Virginia

    2011-01-01

    This article describes current knowledge about early childhood inclusion, summarizing research and the DEC/NAEYC joint position statement on inclusion. The article also describes effective or promising educational practices that promote access, participation, and supports--the defining features of high-quality inclusion. Future efforts to improve…

  4. DELIVERING TIMELY WATER QUALITY INFORMATION TO YOUR COMMUNITY. THE LAKE ACCESS-MINNEAPOLIS PROJECT

    EPA Science Inventory

    This report is a summary of the near-real-time water quality-monitoring project conducted by a consortium of interested parties in the greater Minneapolis area. It was funded by an EPA program known as EMPACT (Environmental Monitoring, Public Access, and Community Tracking). In 1...

  5. [Medical guidelines for diabetes mellitus in Saxony. An instrument for interdisciplinary quality management for optimizing patient care].

    PubMed

    Schulze, J; Kunath, H; Rothe, U; Müller, G

    1998-09-01

    Patients with diabetes still have a life expectancy of 5-10 years less and a markedly reduced quality of life than non-diabetic persons. Concepts, models, and contracts aiming at an efficient co-operative care for chronically ill patients have been developed in the new German states to overcome shortage of care. The dual care of motivated diabetic patients by family physicians and experts for metabolic diseases has proven to be efficient both in pilot studies as well as in country-wide investigations. A representative commission for diabetes has developed guidelines for such a structure of dual care. Design and content of these regional developed guidelines about an cooperative evidence based care for diabetic patients fulfills the criteria suggested by international bodies of experts and the medical society for quality assurance. The Saxonian guidelines for diabetes have been successfully implemented step by step in medical offices and hospitals. We are sure that the further implementation of the shared care system diabetes will further improve quality of care. PMID:9842697

  6. Quality Multiple-Choice Test Questions: Item-Writing Guidelines and an Analysis of Auditing Testbanks.

    ERIC Educational Resources Information Center

    Hansen, James D.; Dexter, Lee

    1997-01-01

    Analysis of test item banks in 10 auditing textbooks found that 75% of questions violated one or more guidelines for multiple-choice items. In comparison, 70% of a certified public accounting exam bank had no violations. (SK)

  7. Quality of Reporting and Adherence to ARRIVE Guidelines in Animal Studies for Chagas Disease Preclinical Drug Research: A Systematic Review.

    PubMed

    Gulin, Julián Ernesto Nicolás; Rocco, Daniela Marisa; García-Bournissen, Facundo

    2015-11-01

    Publication of accurate and detailed descriptions of methods in research articles involving animals is essential for health scientists to accurately interpret published data, evaluate results and replicate findings. Inadequate reporting of key aspects of experimental design may reduce the impact of studies and could act as a barrier to translation of research findings. Reporting of animal use must be as comprehensive as possible in order to take advantage of every study and every animal used. Animal models are essential to understanding and assessing new chemotherapy candidates for Chagas disease pathology, a widespread parasitic disease with few treatment options currently available. A systematic review was carried out to compare ARRIVE guidelines recommendations with information provided in publications of preclinical studies for new anti-Trypanosoma cruzi compounds. A total of 83 publications were reviewed. Before ARRIVE guidelines, 69% of publications failed to report any macroenvironment information, compared to 57% after ARRIVE publication. Similar proportions were observed when evaluating reporting of microenvironmental information (56% vs. 61%). Also, before ARRIVE guidelines publication, only 13% of papers described animal gender, only 18% specified microbiological status and 13% reported randomized treatment assignment, among other essential information missing or incomplete. Unfortunately, publication of ARRIVE guidelines did not seem to enhance reporting quality, compared to papers appeared before ARRIVE publication. Our results suggest that there is a strong need for the scientific community to improve animal use description, animal models employed, transparent reporting and experiment design to facilitate its transfer and application to the affected human population. Full compliance with ARRIVE guidelines, or similar animal research reporting guidelines, would be an excellent start in this direction.

  8. Quality of Reporting and Adherence to ARRIVE Guidelines in Animal Studies for Chagas Disease Preclinical Drug Research: A Systematic Review

    PubMed Central

    Gulin, Julián Ernesto Nicolás; Rocco, Daniela Marisa; García-Bournissen, Facundo

    2015-01-01

    Publication of accurate and detailed descriptions of methods in research articles involving animals is essential for health scientists to accurately interpret published data, evaluate results and replicate findings. Inadequate reporting of key aspects of experimental design may reduce the impact of studies and could act as a barrier to translation of research findings. Reporting of animal use must be as comprehensive as possible in order to take advantage of every study and every animal used. Animal models are essential to understanding and assessing new chemotherapy candidates for Chagas disease pathology, a widespread parasitic disease with few treatment options currently available. A systematic review was carried out to compare ARRIVE guidelines recommendations with information provided in publications of preclinical studies for new anti-Trypanosoma cruzi compounds. A total of 83 publications were reviewed. Before ARRIVE guidelines, 69% of publications failed to report any macroenvironment information, compared to 57% after ARRIVE publication. Similar proportions were observed when evaluating reporting of microenvironmental information (56% vs. 61%). Also, before ARRIVE guidelines publication, only 13% of papers described animal gender, only 18% specified microbiological status and 13% reported randomized treatment assignment, among other essential information missing or incomplete. Unfortunately, publication of ARRIVE guidelines did not seem to enhance reporting quality, compared to papers appeared before ARRIVE publication. Our results suggest that there is a strong need for the scientific community to improve animal use description, animal models employed, transparent reporting and experiment design to facilitate its transfer and application to the affected human population. Full compliance with ARRIVE guidelines, or similar animal research reporting guidelines, would be an excellent start in this direction. PMID:26587586

  9. Making GRADE accessible: a proposal for graphic display of evidence quality assessments.

    PubMed

    Khan, Khalid S; Borowiack, Ewa; Roos, Carolien; Kowalska, Monika; Zapalska, Anna; Mol, Ben W; Mignini, Luciano; Meads, Catherine; Walczak, Jacek

    2011-06-01

    When generating guidelines, quality of evidence is frequently reported in tabulated form capturing several domains, for example, study design, risk of bias and heterogeneity. Increasingly, this is done using the Grading of Recommendations Assessment, Development and Evaluation approach. As assimilating large amount of tabulated data across several comparisons and outcomes spread over many pages (sometimes hundreds) is not easy, there is a need to present evidence summaries in a more effective way. A graphic display plotting the several domains used in evidence grading on equiangular spokes starting from the same point, the data length of each spoke proportional to the magnitude of the quality, succinctly captures tabulated information. These plots allow easy identification of deficiencies, outliers and similarities in evidence quality for individual and multiple comparisons and outcomes, paving the way for their routine use alongside tabulated information.

  10. Improving the quality of health care: using international collaboration to inform guideline programmes by founding the Guidelines International Network (G-I-N)*

    PubMed Central

    Ollenschlager, G; Marshall, C; Qureshi, S; Rosenbrand, K; Burgers, J; Makela, M; Slutsky, J; t for

    2004-01-01

    

 Clinical practice guidelines are regarded as powerful tools to achieve effective health care. Although many countries have built up experience in the development, appraisal, and implementation of guidelines, until recently there has been no established forum for collaboration at an international level. As a result, in different countries seeking similar goals and using similar strategies, efforts have been unnecessarily duplicated and opportunities for harmonisation lost because of the lack of a supporting organisational framework. This triggered a proposal in 2001 for an international guidelines network built on existing partnerships. A baseline survey confirmed a strong demand for such an entity. A multinational group of guideline experts initiated the development of a non-profit organisation aimed at promotion of systematic guideline development and implementation. The Guidelines International Network (G-I-N) was founded in November 2002. One year later the Network released the International Guideline Library, a searchable database which now contains more than 2000 guideline resources including published guidelines, guidelines under development, "guidelines for guidelines", training materials, and patient information tools. By June 2004, 52 organisations from 27 countries had joined the network including institutions from Oceania, North America, and Europe, and WHO. This paper describes the process that led to the foundation of the G-I-N, its characteristics, prime activities, and ideas on future projects and collaboration. PMID:15576708

  11. Socioeconomic inequalities in the access to and quality of health care services

    PubMed Central

    Nunes, Bruno Pereira; Thumé, Elaine; Tomasi, Elaine; Duro, Suele Manjourany Silva; Facchini, Luiz Augusto

    2014-01-01

    OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days) for assistance, and waiting time (in hours) in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services. PMID:26039400

  12. 32 CFR Appendix H to Part 154 - Adjudicative Guidelines for Determining Eligibility for Access to Classified Information

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... ability to protect classified information. No coercive policing could replace the self-discipline and... interest. Adjudication under this Guideline can and should consider the identity of the foreign country in... criminal nature, whether or not the individual has been prosecuted; (b) A pattern of compulsive,...

  13. 32 CFR Appendix H to Part 154 - Adjudicative Guidelines for Determining Eligibility for Access to Classified Information

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... ability to protect classified information. No coercive policing could replace the self-discipline and... interest. Adjudication under this Guideline can and should consider the identity of the foreign country in... criminal nature, whether or not the individual has been prosecuted; (b) A pattern of compulsive,...

  14. Guidelines for the processing and quality assurance of benthic invertebrate samples collected as part of the National Water-Quality Assessment Program

    USGS Publications Warehouse

    Cuffney, T.F.; Gurtz, M.E.; Meador, M.R.

    1993-01-01

    Benthic invertebrate samples are collected as part of the U.S. Geological Survey's National Water-Quality Assessment Program. This is a perennial, multidisciplinary program that integrates biological, physical, and chemical indicators of water quality to evaluate status and trends and to develop an understanding of the factors controlling observed water quality. The Program examines water quality in 60 study units (coupled ground- and surface-water systems) that encompass most of the conterminous United States and parts of Alaska and Hawaii. Study-unit teams collect and process qualitative and semi-quantitative invertebrate samples according to standardized procedures. These samples are processed (elutriated and subsampled) in the field to produce as many as four sample components: large-rare, main-body, elutriate, and split. Each sample component is preserved in 10-percent formalin, and two components, large-rare and main-body, are sent to contract laboratories for further processing. The large-rare component is composed of large invertebrates that are removed from the sample matrix during field processing and placed in one or more containers. The main-body sample component consists of the remaining sample materials (sediment, detritus, and invertebrates) and is subsampled in the field to achieve a volume of 750 milliliters or less. The remaining two sample components, elutriate and split, are used for quality-assurance and quality-control purposes. Contract laboratories are used to identify and quantify invertebrates from the large-rare and main-body sample components according to the procedures and guidelines specified within this document. These guidelines allow the use of subsampling techniques to reduce the volume of sample material processed and to facilitate identifications. These processing procedures and techniques may be modified if the modifications provide equal or greater levels of accuracy and precision. The intent of sample processing is to

  15. Guidelines and standard procedures for continuous water-quality monitors: Station operation, record computation, and data reporting

    USGS Publications Warehouse

    Wagner, Richard J.; Boulger, Robert W.; Oblinger, Carolyn J.; Smith, Brett A.

    2006-01-01

    The U.S. Geological Survey uses continuous water-quality monitors to assess the quality of the Nation's surface water. A common monitoring-system configuration for water-quality data collection is the four-parameter monitoring system, which collects temperature, specific conductance, dissolved oxygen, and pH data. Such systems also can be configured to measure other properties, such as turbidity or fluorescence. Data from sensors can be used in conjunction with chemical analyses of samples to estimate chemical loads. The sensors that are used to measure water-quality field parameters require careful field observation, cleaning, and calibration procedures, as well as thorough procedures for the computation and publication of final records. This report provides guidelines for site- and monitor-selection considerations; sensor inspection and calibration methods; field procedures; data evaluation, correction, and computation; and record-review and data-reporting processes, which supersede the guidelines presented previously in U.S. Geological Survey Water-Resources Investigations Report WRIR 00-4252. These procedures have evolved over the past three decades, and the process continues to evolve with newer technologies.

  16. Strategic purchasing reform in Estonia: Reducing inequalities in access while improving care concentration and quality.

    PubMed

    Habicht, Triin; Habicht, Jarno; van Ginneken, Ewout

    2015-08-01

    As of 2014, the Estonian Health Insurance Fund has adopted new purchasing procedures and criteria, which it now has started to implement in specialist care. Main changes include (1) redefined access criteria based on population need rather than historical supply, which aim to achieve more equal access of providers and specialties; (2) stricter definition and use of optimal workload criteria to increase the concentration of specialist care (3) better consideration of patient movement; and (4) an increased emphasis on quality to foster quality improvement. The new criteria were first used in the contract cycle that started in 2014 and resulted in fewer contracted providers for a similar volume of care compared to the previous contract cycle. This implies that provision of specialized care has become concentrated at fewer providers. It is too early to draw firm conclusions on the impact on care quality or on actors, but the process has sparked debate on the role of selective contracting and the role of public and private providers in Estonian health care. Lastly, the Estonian experience may hold important lessons for other countries looking to overcome inequalities in access while concentrating care and improving care quality.

  17. Strategic purchasing reform in Estonia: Reducing inequalities in access while improving care concentration and quality.

    PubMed

    Habicht, Triin; Habicht, Jarno; van Ginneken, Ewout

    2015-08-01

    As of 2014, the Estonian Health Insurance Fund has adopted new purchasing procedures and criteria, which it now has started to implement in specialist care. Main changes include (1) redefined access criteria based on population need rather than historical supply, which aim to achieve more equal access of providers and specialties; (2) stricter definition and use of optimal workload criteria to increase the concentration of specialist care (3) better consideration of patient movement; and (4) an increased emphasis on quality to foster quality improvement. The new criteria were first used in the contract cycle that started in 2014 and resulted in fewer contracted providers for a similar volume of care compared to the previous contract cycle. This implies that provision of specialized care has become concentrated at fewer providers. It is too early to draw firm conclusions on the impact on care quality or on actors, but the process has sparked debate on the role of selective contracting and the role of public and private providers in Estonian health care. Lastly, the Estonian experience may hold important lessons for other countries looking to overcome inequalities in access while concentrating care and improving care quality. PMID:26149322

  18. From Access to Success: An Integrated Approach to Quality Higher Education Informed by Social Inclusion Theory and Practice

    ERIC Educational Resources Information Center

    Gidley, Jennifer M.; Hampson, Gary P.; Wheeler, Leone; Bereded-Samuel, Elleni

    2010-01-01

    Equitable access, success and quality in higher education are examined from a variety of ideological perspectives. "Quality" is positioned as a complex generic concept while "access" and "success" are identified as key concepts in the social inclusion domain, supplemented by the concept of "participation." The topic is approached through an…

  19. The Quality and Accessibility of Primary School Music Education: Provision, Perceptions and Hopes in Six Non-Metropolitan Schools

    ERIC Educational Resources Information Center

    Hardcastle, Adam

    2009-01-01

    The National Review of School Music Education has systematically documented the variations in quality and accessibility of school music education in Australia. Rural and remote schools were found to be particularly vulnerable to relatively poorer quality and accessibility. These findings were not new; they echoed similar observations made by…

  20. A soil radiological quality guideline value for wildlife-based protection in uranium mine rehabilitation.

    PubMed

    Doering, Che; Bollhöfer, Andreas

    2016-01-01

    A soil guideline value for radiological protection of the environment was determined for the impending rehabilitation of Ranger uranium mine in the wet-dry tropics of northern Australia. The guideline value was 1000 Bq kg(-1) of (226)Ra in the proposed waste rock substrate of the rehabilitated landform and corresponded to an above-baseline dose rate of 100 μGy h(-1) to the most highly exposed individuals of the limiting organism. The limiting organism was reptile based on an assessment using site-specific concentration ratio data. PMID:26350640

  1. A soil radiological quality guideline value for wildlife-based protection in uranium mine rehabilitation.

    PubMed

    Doering, Che; Bollhöfer, Andreas

    2016-01-01

    A soil guideline value for radiological protection of the environment was determined for the impending rehabilitation of Ranger uranium mine in the wet-dry tropics of northern Australia. The guideline value was 1000 Bq kg(-1) of (226)Ra in the proposed waste rock substrate of the rehabilitated landform and corresponded to an above-baseline dose rate of 100 μGy h(-1) to the most highly exposed individuals of the limiting organism. The limiting organism was reptile based on an assessment using site-specific concentration ratio data.

  2. Using field data to assess the effects of pesticides on crustacea in freshwater aquatic ecosystems and verifying the level of protection provided by water quality guidelines.

    PubMed

    Guy, Martha; Singh, Lucina; Mineau, Pierre

    2011-07-01

    The purpose of this study was to investigate how well single-species laboratory data predict real-world pesticide toxicity effects on Crustacea. Data from field pesticide exposures from experimental mesocosm and small pond studies were converted into toxicity units (TUs) by dividing measured pesticide concentrations by the L(E)C50 for Daphnia or acute 5% hazard concentration for Crustacea (HC5-C). The proportion of crustacean taxa significantly affected by the pesticide treatment, called the count ratio of effect, was used in logistic regression models. Of 200 possible logistic model combinations of the TUs, fate, physicochemical variables, and structural variables versus the count ratio of effect for the mesocosm data, the best model was found to incorporate log(TU HC5-C). This model was used to convert pesticide water quality guidelines from around the world into estimates of the proportion of crustacean taxa predicted to be impacted by exposure to a pesticide at the water quality guideline concentration. This analysis suggests 64% of long-term water quality guidelines and 88% of short-term pesticide water quality guidelines are not protective of the aquatic life they are designed to protect. We conclude that empirically derived data from mesocosm studies should be incorporated into water quality guideline derivation for pesticides where available. Also, interspecific differences in susceptibility should be accounted for more accurately to ensure water quality guidelines are adequately protective against the adverse effects of pesticide exposure.

  3. Guidelines and standard procedures for continuous water-quality monitors : site selection, field operation, calibration, record computation, and reporting

    USGS Publications Warehouse

    Wagner, Richard J.; Mattraw, H.C.; Ritz, G.F.; Smith, B.A.

    2000-01-01

    The U.S. Geological Survey uses continuous water-quality monitors to assess variations in the quality of the Nation's surface water. A common system configuration for data collection is the four-parameter water-quality monitoring system, which collects temperature, specific conductance, dissolved oxygen, and pH data, although systems can be configured to measure other properties such as turbidity or chlorophyll. The sensors that are used to measure these water properties require careful field observation, cleaning, and calibration procedures, as well as thorough procedures for the computation and publication of final records. Data from sensors can be used in conjunction with collected samples and chemical analyses to estimate chemical loads. This report provides guidelines for site-selection considerations, sensor test methods, field procedures, error correction, data computation, and review and publication processes. These procedures have evolved over the past three decades, and the process continues to evolve with newer technologies.

  4. Leading the Way to Environmental Literacy and Quality: National Guidelines for Environmental Education

    ERIC Educational Resources Information Center

    McCrea, Edward J.

    2006-01-01

    Ed McCrea, former executive director of North American Association for Environmental Education (NAEE), calls the development of the environmental education guidelines the single most important event that has occurred in the field of environmental education in the last decade. For the first time in its history, environmental education has a set of…

  5. The role of yogurt in improving the quality of the American diet and meeting dietary guidelines

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Dietary Guidelines for Americans (DGA) recommend 3 daily servings of lowfat or nonfat dairy products, however, two-thirds of Americans do not meet that goal. Including lowfat or nonfat yogurt as part of an overall healthful diet can be a positive step towards meeting the DGA. Yogurt contains cal...

  6. From Principle to Practice: Using the Global Guidelines to Assess Quality Education and Care

    ERIC Educational Resources Information Center

    Barbour, Ann; Boyer, Wanda; Hardin, Belinda; Wortham, Sue

    2004-01-01

    Antarctica gathered in Ruschlikon, Switzerland, at the International Symposium on Early Childhood Education and Care for the 21st Century. The symposium's mission was to craft guidelines for programs that serve children under the age of formal schooling in countries throughout the world. After extensive discussions about what constitutes universal…

  7. 76 FR 37376 - Guidelines for Ensuring and Maximizing the Quality, Objectivity, Utility, and Integrity of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-27

    ... Management and Budget (67 FR 8452-8460), pursuant to section 515 of the Treasury and General Government... FR 8452-8460) that direct each federal agency to (1) Issue its own guidelines ensuring and maximizing... corruption or falsification. 6. ``Objectivity'' is a measure of whether disseminated information is...

  8. Parents' experience of support in Sweden: its availability, accessibility, and quality.

    PubMed

    Nowak, Herawati I; Broberg, Malin; Starke, Mikaela

    2013-06-01

    Semi-structured interviews were conducted with six parents of children with intellectual disabilities, in the Western region of Sweden. The aim of the study was to explore and to gain a deeper understanding of parents' experiences of received support for them and their children with intellectual disabilities. We focused particularly on their experiences of the availability, accessibility, and the quality of services. Parents in this study were unsure about what the diagnosis meant specifically for their child as well as for their whole family. Moreover, the parents experienced great difficulty in obtaining information about available services, which resulted in feelings of helplessness to some. Parents also reported that although services are available, they were not easily accessible. Lastly, parents felt that the quality of care and support were to some extent inadequate, as no attention was paid by professionals to their actual needs or wishes. PMID:23644952

  9. Traditional and emerging forms of dental practice. Cost, accessibility, and quality factors.

    PubMed Central

    Rovin, S; Nash, J

    1982-01-01

    The traditional and predominant manner of delivering dental care is through a fee-for-service, private practice system. A number of alternative dental care delivery systems have emerged and are being tested, and others are just emerging. These systems include department store practices, hospital dental services, health maintenance organizations, the independent practice of dental hygiene, and denturism. Although it is too soon to draw final conclusions about the efficacy and effectiveness of these systems, we examine them for their potential to compete with and change the way dental care is currently delivered. Using the parameters of cost, accessibility, and quality, we compare these systems to traditional dental practice. Some of these emerging forms clearly have the potential to complete favorably with traditional practice. Other seem less likely to alter the existing system substantially. The system which can best control costs, increase accessibility, and enhance quality will gain the competitive edge. PMID:7091453

  10. The Chinese pharmaceutical market at the crossroads: pro-competition solutions to improve access, quality and affordability.

    PubMed

    Wang, Y Richard

    2005-01-01

    The Chinese pharmaceutical market is large in absolute size (the second largest in Asia), but it faces similar problems to those that plague other developing countries, such as a lack of adequate patent protection, low pharmaceutical spending per capita, but high pharmaceutical expenditure as a proportion of total medical spending, and a lack of health insurance coverage. In this article, the pros and cons of two pro-competition policy proposals for China are explored. The first proposal is to follow the E5 guideline of the International Conference on Harmonisation and waive unnecessary local clinical trials for global new drugs that have been approved by the US Food and Drug Administration or the European Medicines Agency (except for drugs for which there is a real possibility of there being ethnic differences in patient responses). The second proposal is to tighten the standards for generic drugs and approve only bioequivalent ones. While the first proposal encourages price competition between similar compounds in the same therapeutic class, the second proposal enhances generic competition for off-patent drugs. Working together, these two proposals would improve access to and the quality and affordability of pharmaceuticals in China.

  11. Effects of physician joint ventures on health care costs, access, and quality: exploring some issues.

    PubMed

    Ahern, M; Scott, E

    1992-01-01

    Increasingly, physicians are joint-venturing with health care businesses such as physical therapy centers, diagnostic imaging centers, ambulatory surgical centers, and other services. Simultaneously, outpatient costs have been rising. Theoretical and empirical evidence, including results of an exploratory survey of experts, indicate that these two events are linked. Specifically, joint ventures between referring physicians and health care businesses often appear to increase costs, increase utilization, reduce quality of care, and reduce access.

  12. Drinking Water Quality Guidelines across Canadian provinces and territories: jurisdictional variation in the context of decentralized water governance.

    PubMed

    Dunn, Gemma; Bakker, Karen; Harris, Leila

    2014-04-25

    This article presents the first comprehensive review and analysis of the uptake of the Canadian Drinking Water Quality Guidelines (CDWQG) across Canada's 13 provinces and territories. This review is significant given that Canada's approach to drinking water governance is: (i) highly decentralized and (ii) discretionary. Canada is (along with Australia) only one of two Organization for Economic Cooperation and Development (OECD) member states that does not comply with the World Health Organization's (WHO) recommendation that all countries have national, legally binding drinking water quality standards. Our review identifies key differences in the regulatory approaches to drinking water quality across Canada's 13 jurisdictions. Only 16 of the 94 CDWQG are consistently applied across all 13 jurisdictions; five jurisdictions use voluntary guidelines, whereas eight use mandatory standards. The analysis explores three questions of central importance for water managers and public health officials: (i) should standards be uniform or variable; (ii) should compliance be voluntary or legally binding; and (iii) should regulation and oversight be harmonized or delegated? We conclude with recommendations for further research, with particular reference to the relevance of our findings given the high degree of variability in drinking water management and oversight capacity between urban and rural areas in Canada.

  13. Drinking Water Quality Guidelines across Canadian Provinces and Territories: Jurisdictional Variation in the Context of Decentralized Water Governance

    PubMed Central

    Dunn, Gemma; Bakker, Karen; Harris, Leila

    2014-01-01

    This article presents the first comprehensive review and analysis of the uptake of the Canadian Drinking Water Quality Guidelines (CDWQG) across Canada’s 13 provinces and territories. This review is significant given that Canada’s approach to drinking water governance is: (i) highly decentralized and (ii) discretionary. Canada is (along with Australia) only one of two Organization for Economic Cooperation and Development (OECD) member states that does not comply with the World Health Organization’s (WHO) recommendation that all countries have national, legally binding drinking water quality standards. Our review identifies key differences in the regulatory approaches to drinking water quality across Canada’s 13 jurisdictions. Only 16 of the 94 CDWQG are consistently applied across all 13 jurisdictions; five jurisdictions use voluntary guidelines, whereas eight use mandatory standards. The analysis explores three questions of central importance for water managers and public health officials: (i) should standards be uniform or variable; (ii) should compliance be voluntary or legally binding; and (iii) should regulation and oversight be harmonized or delegated? We conclude with recommendations for further research, with particular reference to the relevance of our findings given the high degree of variability in drinking water management and oversight capacity between urban and rural areas in Canada. PMID:24776725

  14. The Genome Sequence DataBase (GSDB): improving data quality and data access.

    PubMed Central

    Harger, C; Skupski, M; Bingham, J; Farmer, A; Hoisie, S; Hraber, P; Kiphart, D; Krakowski, L; McLeod, M; Schwertfeger, J; Seluja, G; Siepel, A; Singh, G; Stamper, D; Steadman, P; Thayer, N; Thompson, R; Wargo, P; Waugh, M; Zhuang, J J; Schad, P A

    1998-01-01

    In 1997 the primary focus of the Genome Sequence DataBase (GSDB; www. ncgr.org/gsdb ) located at the National Center for Genome Resources was to improve data quality and accessibility. Efforts to increase the quality of data within the database included two major projects; one to identify and remove all vector contamination from sequences in the database and one to create premier sequence sets (including both alignments and discontiguous sequences). Data accessibility was improved during the course of the last year in several ways. First, a graphical database sequence viewer was made available to researchers. Second, an update process was implemented for the web-based query tool, Maestro. Third, a web-based tool, Excerpt, was developed to retrieve selected regions of any sequence in the database. And lastly, a GSDB flatfile that contains annotation unique to GSDB (e.g., sequence analysis and alignment data) was developed. Additionally, the GSDB web site provides a tool for the detection of matrix attachment regions (MARs), which can be used to identify regions of high coding potential. The ultimate goal of this work is to make GSDB a more useful resource for genomic comparison studies and gene level studies by improving data quality and by providing data access capabilities that are consistent with the needs of both types of studies. PMID:9399793

  15. Effect-based trigger values for in vitro bioassays: Reading across from existing water quality guideline values.

    PubMed

    Escher, Beate I; Neale, Peta A; Leusch, Frederic D L

    2015-09-15

    Cell-based bioassays are becoming increasingly popular in water quality assessment. The new generations of reporter-gene assays are very sensitive and effects are often detected in very clean water types such as drinking water and recycled water. For monitoring applications it is therefore imperative to derive trigger values that differentiate between acceptable and unacceptable effect levels. In this proof-of-concept paper, we propose a statistical method to read directly across from chemical guideline values to trigger values without the need to perform in vitro to in vivo extrapolations. The derivation is based on matching effect concentrations with existing chemical guideline values and filtering out appropriate chemicals that are responsive in the given bioassays at concentrations in the range of the guideline values. To account for the mixture effects of many chemicals acting together in a complex water sample, we propose bioanalytical equivalents that integrate the effects of groups of chemicals with the same mode of action that act in a concentration-additive manner. Statistical distribution methods are proposed to derive a specific effect-based trigger bioanalytical equivalent concentration (EBT-BEQ) for each bioassay of environmental interest that targets receptor-mediated toxicity. Even bioassays that are indicative of the same mode of action have slightly different numeric trigger values due to differences in their inherent sensitivity. The algorithm was applied to 18 cell-based bioassays and 11 provisional effect-based trigger bioanalytical equivalents were derived as an illustrative example using the 349 chemical guideline values protective for human health of the Australian Guidelines for Water Recycling. We illustrate the applicability using the example of a diverse set of water samples including recycled water. Most recycled water samples were compliant with the proposed triggers while wastewater effluent would not have been compliant with a few

  16. Effect-based trigger values for in vitro bioassays: Reading across from existing water quality guideline values.

    PubMed

    Escher, Beate I; Neale, Peta A; Leusch, Frederic D L

    2015-09-15

    Cell-based bioassays are becoming increasingly popular in water quality assessment. The new generations of reporter-gene assays are very sensitive and effects are often detected in very clean water types such as drinking water and recycled water. For monitoring applications it is therefore imperative to derive trigger values that differentiate between acceptable and unacceptable effect levels. In this proof-of-concept paper, we propose a statistical method to read directly across from chemical guideline values to trigger values without the need to perform in vitro to in vivo extrapolations. The derivation is based on matching effect concentrations with existing chemical guideline values and filtering out appropriate chemicals that are responsive in the given bioassays at concentrations in the range of the guideline values. To account for the mixture effects of many chemicals acting together in a complex water sample, we propose bioanalytical equivalents that integrate the effects of groups of chemicals with the same mode of action that act in a concentration-additive manner. Statistical distribution methods are proposed to derive a specific effect-based trigger bioanalytical equivalent concentration (EBT-BEQ) for each bioassay of environmental interest that targets receptor-mediated toxicity. Even bioassays that are indicative of the same mode of action have slightly different numeric trigger values due to differences in their inherent sensitivity. The algorithm was applied to 18 cell-based bioassays and 11 provisional effect-based trigger bioanalytical equivalents were derived as an illustrative example using the 349 chemical guideline values protective for human health of the Australian Guidelines for Water Recycling. We illustrate the applicability using the example of a diverse set of water samples including recycled water. Most recycled water samples were compliant with the proposed triggers while wastewater effluent would not have been compliant with a few

  17. Guidelines, training, audit, and quality standards in children's epilepsy services: closing the loop.

    PubMed

    Kirkpatrick, Martin; Dunkley, Colin; Ferrie, Colin; Flower, Diane; Waldron, Bernie; Whitehouse, William P; Helen Cross, J; Rodie, Philippa; Appleton, Richard

    2014-11-01

    There has been considerable evolution in epilepsy healthcare for children over the last decade in the United Kingdom. There has been no single explanation for this. The development of national clinical guidelines, locally delivered but nationally designed educational programmes, nation-wide clinical audit, clinical networks and development of designated services have all had complimentary roles in enabling the implementation of national recommendations for the development of epilepsy care. These models may be applicable to other healthcare settings outside the UK.

  18. Quality Improvement Guidelines for Imaging Detection and Treatment of Endoleaks following Endovascular Aneurysm Repair (EVAR)

    SciTech Connect

    Rand, T.; Uberoi, R.; Cil, B.; Munneke, G.; Tsetis, D.

    2013-02-15

    Major concerns after aortic aneurysm repair are caused by the presence of endoleaks, which are defined as persistent perigraft flow within the aortic aneurysm sac. Diagnosis of endoleaks can be performed with various imaging modalities, and indications for treatment are based on further subclassifications. Early detection and correct classification of endoleaks are crucial for planning patient management. The vast majority of endoleaks can be treated successfully by interventional means. Guidelines for Imaging Detection and Treatment of endoleaks are described in this article.

  19. Guidelines of the Council on Environmental Quality for the preparation of environmental impact statements.

    PubMed Central

    Willard, B E

    1975-01-01

    Definitions and the seven principles of ecology are listed. NEPA expresses or implies all seven. Section 101 is quoted in illustration. CEQ Guidelines implement Sec. 102(2)(C). The reasons for initial delays in implementation are reviewed; these are now largely resolved. The policy involves action through integrating engineering, economics and ecology. Alternative actions must be considered, and short-term effects weighed against the long-term goals. Twelve modes of approach are advocated. PMID:1157792

  20. Improving application of data quality information in accessing and using satellite data

    NASA Astrophysics Data System (ADS)

    Armstrong, E. M.; Huang, T.; Xing, Z.; Khalsa, S. J. S.; Chin, T. M.; Alarcon, C.

    2014-12-01

    A recurring demand in working with satellite-based earth science data records is the need to apply data quality information. Such quality information is often contained within the data files as an array of "flags", but can also be represented by more complex quality descriptions such as combinations of bit flags, or even other ancillary variables indicating thresholds to be applied to the geophysical variable of interest. For example, with Level 2 granules from the Group for High Resolution Sea Surface Temperature (GHRSST) project up to 6 independent variables can be used to screen the sea surface temperature measurements on a pixel-by-pixel basis. Quality screening of Level 3 data from the upcoming Soil Moisture Active Passive (SMAP) instrument can be become even more complex, involving 26 unique bit states or conditions a user can screen for. The application of quality information is often a laborious process until the user understands the implications of all the flags and bit conditions, and requires iterative approaches using custom software. In addition, most visualization packages do not understand how to apply quality information. The Virtual Quality Screening Service, a recently funded 2013 NASA ACCESS project, aims to address these issues and concerns. The project will develop an infrastructure to expose, apply, and extract quality screening information, building off known and proven NASA components for data extraction and subset-by-value, implementations of Map Reduce workflows, data discovery, ontologies and exposure to the user of granule-based quality information. Further sharing of results through well defined URLs and visualization capabilities will also be described. The presentation will focus on overall description of the technologies and informatics principals employed by the project, and recent results and infrastructure status. Examples of implementations of the end-to-end web service for quality screening with GHRSST and SMAP granules will be

  1. [Accession to the PIC/S and pharmaceutical quality system in Japan].

    PubMed

    Katori, Noriko

    2014-01-01

    In March, 2012, Japan made the application for membership of the Pharmaceutical Inspection convention and Pharmaceutical Inspection Co-operation scheme (PIC/S) which is an international body of a GMP inspection. The globalization of pharmaceutical manufacturing and sales has been a driving force behind the decision to become a PIC/S member. For the application for membership, Japan's GMP inspectorate needs to fulfill PIC/S requirements, for example, the inspection organization has to have a quality system as a global standard. One of the other requirements is that the GMP inspectorate can access Official Medicines Control Laboratories (OMCL) having high analytical skills and also have a quality system based on ISO 17025. I would like to describe the process to make up a quality system in the National Institute of Health Sciences and also the circumstances around the PIC/S application in Japan.

  2. [Accession to the PIC/S and pharmaceutical quality system in Japan].

    PubMed

    Katori, Noriko

    2014-01-01

    In March, 2012, Japan made the application for membership of the Pharmaceutical Inspection convention and Pharmaceutical Inspection Co-operation scheme (PIC/S) which is an international body of a GMP inspection. The globalization of pharmaceutical manufacturing and sales has been a driving force behind the decision to become a PIC/S member. For the application for membership, Japan's GMP inspectorate needs to fulfill PIC/S requirements, for example, the inspection organization has to have a quality system as a global standard. One of the other requirements is that the GMP inspectorate can access Official Medicines Control Laboratories (OMCL) having high analytical skills and also have a quality system based on ISO 17025. I would like to describe the process to make up a quality system in the National Institute of Health Sciences and also the circumstances around the PIC/S application in Japan. PMID:25707200

  3. A multicenter, prospective evaluation of quality of care and mortality in Japan based on the Surviving Sepsis Campaign guidelines.

    PubMed

    Fujishima, Seitaro; Gando, Satoshi; Saitoh, Daizoh; Mayumi, Toshihiko; Kushimoto, Shigeki; Shiraishi, Shin-Ichiro; Ogura, Hiroshi; Takuma, Kiyotsugu; Kotani, Joji; Ikeda, Hiroto; Yamashita, Norio; Suzuki, Koichiro; Tsuruta, Ryosuke; Takeyama, Naoshi; Araki, Tsunetoshi; Suzuki, Yasushi; Miki, Yasuo; Yamaguchi, Yoshihiro; Aikawa, Naoki

    2014-02-01

    To elucidate the standard Surviving Sepsis Campaign (SSC) guidelines-based quality of care and mortality related to severe sepsis in Japan, we conducted a multicenter, prospective, observational study using a new web-based database between June 1, 2010, and December 31, 2011. A total of 1104 patients with severe sepsis were enrolled from 39 Japanese emergency and critical care centers. All-cause hospital mortality was 29.3% in patients with severe sepsis and 40.7% in patients with septic shock. Pulmonary, renal, hepatic, and hematological dysfunctions were associated with significantly higher mortality, and hematological dysfunction, especially coagulopathy, was associated with the highest odds ratio for mortality. Compliance with severe sepsis bundles in our study was generally low compared with that in a previous international sepsis registry study, and glycemic control was associated with lowest odds ratio for mortality. Despite higher complication rates of multiple organ dysfunction syndrome and low compliance with severe sepsis bundles on the whole, mortality in our study was similar to that in the international sepsis registry study. From these results, we concluded that our prospective multicenter study was successful in evaluating SSC guidelines-based standard quality of care and mortality related to severe sepsis in Japan. Although mortality in Japan was equivalent to that reported worldwide in the above-mentioned international sepsis registry study, compliance with severe sepsis bundles was low. Thus, there is scope for improvement in the initial treatment of severe sepsis and septic shock in Japanese emergency and critical care centers.

  4. Quality of Recovery Evaluation of the Protection Schemes for Fiber-Wireless Access Networks

    NASA Astrophysics Data System (ADS)

    Fu, Minglei; Chai, Zhicheng; Le, Zichun

    2016-03-01

    With the rapid development of fiber-wireless (FiWi) access network, the protection schemes have got more and more attention due to the risk of huge data loss when failures occur. However, there are few studies on the performance evaluation of the FiWi protection schemes by the unified evaluation criterion. In this paper, quality of recovery (QoR) method was adopted to evaluate the performance of three typical protection schemes (MPMC scheme, OBOF scheme and RPMF scheme) against the segment-level failure in FiWi access network. The QoR models of the three schemes were derived in terms of availability, quality of backup path, recovery time and redundancy. To compare the performance of the three protection schemes comprehensively, five different classes of network services such as emergency service, prioritized elastic service, conversational service, etc. were utilized by means of assigning different QoR weights. Simulation results showed that, for the most service cases, RPMF scheme was proved to be the best solution to enhance the survivability when planning the FiWi access network.

  5. Are migrants health policies aimed at improving access to quality healthcare? An analysis of Spanish policies.

    PubMed

    Vázquez, María Luisa; Terraza-Núñez, Rebeca; S-Hernández, Silvia; Vargas, Ingrid; Bosch, Lola; González, Andrea; Pequeño, Sandra; Cantos, Raquel; Martínez, Juan Ignacio; López, Luís Andrés

    2013-12-01

    Although until April 2012, all Spanish citizens regardless of their origin, residence status and work situation were entitled to health care, available evidence suggested inadequate access for immigrants. Following the Aday and Andersen model, we conducted an analysis of policy elements that affect immigrants' access to health care in Spain, based on documentary analysis of national policies and selected regional policies related to migrant health care. Selected documents were (a) laws and plans in force at the time containing migrant health policies and (b) evaluations. The analysis included policy principles, objectives, strategies and evaluations. Results show that the national and regional policies analyzed are based on the principle that health care is a right granted to immigrants by law. These policies include strategies to facilitate access to health care, reducing barriers for entry to the system, for example simplifying requirements and raising awareness, but mostly they address the necessary qualities for services to be able to attend to a more diverse population, such as the adaptation of resources and programs, or improved communication and training. However, limited planning was identified in terms of their implementation, necessary resources and evaluation. In conclusion, the policies address relevant barriers of access for migrants and signal improvements in the health system's responsiveness, but reinforcement is required in order for them to be effectively implemented. PMID:23850165

  6. Home informatics in healthcare: assessment guidelines to keep up quality of care and avoid adverse effects.

    PubMed

    Roback, Kerstin; Herzog, Almut

    2003-01-01

    Due to an ageing population and improved treatment possibilities, a shortage in hospital beds is a fact in many countries. Home healthcare schemes using information technology (IT) are under development as a response to this and with the intention to produce a more cost-effective care. So far it has been shown that home healthcare is beneficial to certain patient groups. The trend is a widening of the criteria for admission to home healthcare, which means treatment in the home of more severe conditions that otherwise would require in-hospital care. Home informatics has the potential to become a means of providing good care at home. In this process, it is important to consider what new risks will be encountered when placing electronic equipment in the home care environment. Continuous assessment and guidance is important in order to achieve a safe and effective care. Based on a review of current knowledge this paper presents an inventory of risks and adverse events specific to this area. It was found that risks and adverse events could stem from technology in itself, from human-technology interaction conditions or from the environment in which the technology is placed. As a result from the risk inventory, this paper proposes guidelines for the planning and assessment of IT-based hospital-at-home schemes. These assessment guidelines are specifically aimed at performance improvement and thus to be considered a complement to the more general guidelines on telehomecare adopted by the American Telemedicine Association (ATA) in October 2002. PMID:12775936

  7. The Importance and Degree of Implementation of the European Standards and Guidelines for Internal Quality Assurance in Universities: The Views of Portuguese Academics

    ERIC Educational Resources Information Center

    Manatos, Maria J.; Rosa, Maria J.; Sarrico, Cláudia S.

    2015-01-01

    This research seeks to explore academics' perceptions of the importance and degree of implementation of the Standards and Guidelines for Quality Assurance in the European Higher Education Area (ESG) for internal quality assurance. It uses empirical evidence from Portugal, gathered via a questionnaire given to all university academics. Results show…

  8. CRIS Guidelines (Checklist for Reporting In-vitro Studies): A concept note on the need for standardized guidelines for improving quality and transparency in reporting in-vitro studies in experimental dental research

    PubMed Central

    Krithikadatta, Jogikalmat; Gopikrishna, Velayutham; Datta, Manjula

    2014-01-01

    In vitro studies form a pivotal role in dental research contribution to a substantial evidence base. The reporting standards of these studies are not uniform thus resulting in lacunae in evidence reported. The effort of this concept note is to propose a Checklist for Reporting in vitro Studies (CRIS guidelines) that would promote quality and transparency in reporting in vitro studies. PMID:25125839

  9. Achieving sustainability, quality and access: lessons from the world's largest revolving drug fund in Khartoum.

    PubMed

    Witter, S

    2007-01-01

    Ensuring a reliable and affordable supply of essential drugs to health facilities is one of the main challenges facing developing countries. This paper describes the revolving drug fund in Khartoum, which was set up in 1989 to improve access to high quality drugs across the State. An evaluation in 2004 showed that the fund has successfully managed a number of threats to its financial sustainability and has expanded its network of facilities, its range of products and its financial assets. It now supplies essential drugs to 3 million out of the 5 million population of Khartoum each year, at prices between 40% and 100% less than alternative sources. However, results illustrated the tension between achieving an efficient cost-recovery system and access for the poorest.

  10. The Role of Measurement Quality on Practical Guidelines for Assessing Measurement and Structural Invariance

    ERIC Educational Resources Information Center

    Kang, Yoonjeong; McNeish, Daniel M.; Hancock, Gregory R.

    2016-01-01

    Although differences in goodness-of-fit indices (?GOFs) have been advocated for assessing measurement invariance, studies that advanced recommended differential cutoffs for adjudicating invariance actually utilized a very limited range of values representing the quality of indicator variables (i.e., magnitude of loadings). Because quality of…

  11. 40 CFR Appendix W to Part 51 - Guideline on Air Quality Models

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... quality models in response to regulatory requirements and the expanded requirements for models to cover....0Bibliography 12.0References Appendix A to Appendix W of 40 CFR Part 51—Summaries of Preferred Air Quality... assessing source impact and in evaluating control strategies. i. Appendix W to 40 CFR Part 51...

  12. Clinical practice guidelines at an HMO: development and implementation in a quality improvement model.

    PubMed

    Gottlieb, L K; Margolis, C Z; Schoenbaum, S C

    1990-02-01

    Harvard Community Health Plan (HCHP) is adapting to clinical medicine the managerial principles and methods of quality improvement theory that were originally developed and successfully applied in industrial settings. An essential step in applying the quality improvement cycle to clinical medicine is the setting of standards or specifications for clinical care. HCHP has chosen to focus its standard-setting efforts on the development of clinical algorithms, which provide an excellent basis for specifying and communicating optimal care processes and for evaluating actual clinical care. When implemented effectively, clinical algorithms may improve quality and decrease costs by guiding clinicians toward more standardized, high-quality, cost-effective clinical strategies and by facilitating more valid measurement of clinical process and outcomes. This article describes the evolution, structure, methods, and future agenda of the Algorithm Based Clinical Quality Improvement Process (ABCQIP) at HCHP.

  13. Air Quality uFIND: User-oriented Tool Set for Air Quality Data Discovery and Access

    NASA Astrophysics Data System (ADS)

    Hoijarvi, K.; Robinson, E. M.; Husar, R. B.; Falke, S. R.; Schultz, M. G.; Keating, T. J.

    2012-12-01

    Historically, there have been major impediments to seamless and effective data usage encountered by both data providers and users. Over the last five years, the international Air Quality (AQ) Community has worked through forums such as the Group on Earth Observations AQ Community of Practice, the ESIP AQ Working Group, and the Task Force on Hemispheric Transport of Air Pollution to converge on data format standards (e.g., netCDF), data access standards (e.g., Open Geospatial Consortium Web Coverage Services), metadata standards (e.g., ISO 19115), as well as other conventions (e.g., CF Naming Convention) in order to build an Air Quality Data Network. The centerpiece of the AQ Data Network is the web service-based tool set: user-oriented Filtering and Identification of Networked Data. The purpose of uFIND is to provide rich and powerful facilities for the user to: a) discover and choose a desired dataset by navigation through the multi-dimensional metadata space using faceted search, b) seamlessly access and browse datasets, and c) use uFINDs facilities as a web service for mashups with other AQ applications and portals. In a user-centric information system such as uFIND, the user experience is improved by metadata that includes the general fields for discovery as well as community-specific metadata to narrow the search beyond space, time and generic keyword searches. However, even with the community-specific additions, the ISO 19115 records were formed in compliance with the standard, so that other standards-based search interface could leverage this additional information. To identify the fields necessary for metadata discovery we started with the ISO 19115 Core Metadata fields and fields that were needed for a Catalog Service for the Web (CSW) Record. This fulfilled two goals - one to create valid ISO 19115 records and the other to be able to retrieve the records through a Catalog Service for the Web query. Beyond the required set of fields, the AQ Community added

  14. Access to and quality of health and social care for rare diseases: patients' and caregivers' experiences.

    PubMed

    Kodra, Y; Morosini, P R; Petrigliano, R; Agazio, E; Salerno, P; Taruscio, D

    2007-01-01

    People suffering from rare diseases, independently of the condition, often experience the same problems in receiving adequate health and social care. It is not clear how these problems differ in severity among different diseases and in different countries and how they change in time. In the framework of the NEPHIRD (Network of Public Health Institutions on Rare Diseases), a European project, funded by DG-SANCO (EU Commission), an effort was made to develop a simple but comprehensive tool to show patients' and/or caregivers' opinions about the quality and accessibility of health and social services. The self-filled questionnaire asks how often patients or caregivers had both negative and positive experiences about the quality and accessibility of health and social services and their opinion on their improvement, on 5-level scales. A pilot survey was carried out in several European Countries among members of Myasthenia Gravis, Neurofibromatosis, Prader Willi and Rett Syndrome volunteers' associations. Descriptive and comparative analyses were performed using Stata and Epi Info 2000. In total, 302 questionnaires were completed in France, Italy, Romania, Spain, Turkey and United Kingdom during 2004-05. In general, respondents thought that health care accessibility was worse than quality, and that social care and legal provisions were worse than health care, with some differences among countries. For all diseases, and for both patients and caregivers, the most frequent reported positive experiences were health professionals' kindness and readiness to help (all medians ranged from 3 to 5). As for the efforts for improvement made by public services in the last three years, the opinions were generally favourable. This study has several limitations. However the assessment tool that has been developed has some innovative and interesting features and may be considered a useful attempt to compare patients' and caregivers' experiences for a range of different diseases

  15. Sediment quality assessment and dredged material management in Spain: Part I, application of sediment quality guidelines in the Bay of Santander.

    PubMed

    Alvarez-Guerra, Manuel; Viguri, Javier R; Casado-Martínez, M Carmen; DelValls, T Angel

    2007-10-01

    Sediments are an essential component of aquatic ecosystems that must be assessed and managed properly. The use of quantitative environmental quality standards derived from consideration of sediment quality guidelines (SQGs) can be effective as part of a tiered risk assessment approach. In Part I of this 2-part paper addressing sediment quality assessment and dredged material management in Spain, different SQG methods are used to evaluate sediment quality in the Bay of Santander, located in the Cantabric Sea along the northern coast of Spain, and to guide development of empirically derived SQGs for marine sediments. The results of the study indicate a great heterogeneity of SQGs, both with regard to the numeric values for a particular chemical and the number of substances for which SQGs have been derived. The analysis highlights the scarce development of empirical SQGs for priority substances identified in current European Union water policy. Nonetheless, the application of SQGs makes it possible to classify different zones of sediment quality in the Bay of Santander. Part II of this 2-part paper considers the environmental impacts of dredged material disposal. Legislation and criteria used to regulate dredged material disposal at sea in different European countries are reviewed, and action levels derived by different countries were used to evaluate management of dredged sediments from Cádiz Bay, located on the South Atlantic coast of Spain.

  16. 42 CFR 457.495 - State assurance of access to care and procedures to assure quality and appropriateness of care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... appropriateness of care provided under the plan, including how the State will assure: (a) Access to well-baby care... 42 Public Health 4 2012-10-01 2012-10-01 false State assurance of access to care and procedures to assure quality and appropriateness of care. 457.495 Section 457.495 Public Health CENTERS FOR...

  17. 42 CFR 457.495 - State assurance of access to care and procedures to assure quality and appropriateness of care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... appropriateness of care provided under the plan, including how the State will assure: (a) Access to well-baby care... 42 Public Health 4 2013-10-01 2013-10-01 false State assurance of access to care and procedures to assure quality and appropriateness of care. 457.495 Section 457.495 Public Health CENTERS FOR...

  18. 42 CFR 457.495 - State assurance of access to care and procedures to assure quality and appropriateness of care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... appropriateness of care provided under the plan, including how the State will assure: (a) Access to well-baby care... 42 Public Health 4 2014-10-01 2014-10-01 false State assurance of access to care and procedures to assure quality and appropriateness of care. 457.495 Section 457.495 Public Health CENTERS FOR...

  19. 42 CFR 457.495 - State assurance of access to care and procedures to assure quality and appropriateness of care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... appropriateness of care provided under the plan, including how the State will assure: (a) Access to well-baby care... 42 Public Health 4 2011-10-01 2011-10-01 false State assurance of access to care and procedures to assure quality and appropriateness of care. 457.495 Section 457.495 Public Health CENTERS FOR...

  20. 42 CFR 457.495 - State assurance of access to care and procedures to assure quality and appropriateness of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... appropriateness of care provided under the plan, including how the State will assure: (a) Access to well-baby care... 42 Public Health 4 2010-10-01 2010-10-01 false State assurance of access to care and procedures to assure quality and appropriateness of care. 457.495 Section 457.495 Public Health CENTERS FOR...

  1. Building America Top Innovations 2013 Profile – Quality Management System Guidelines

    SciTech Connect

    none,

    2013-09-01

    This Top Innovation profile describes quality management system tools that were customized for residential construction by BSC, IBACOS, and PHI, for use by builders, trades, and designers to help eliminate mistakes that would require high-cost rework.

  2. Guidelines for collection and field analysis of water-quality samples from streams in Texas

    USGS Publications Warehouse

    Wells, F.C.; Gibbons, W.J.; Dorsey, M.E.

    1990-01-01

    Analyses for unstable constituents or properties are by necessity performed in the field. This manual addresses analytical techniques and quality assurance for: (1) Water temperature; (2) specific conductance; (3) pH; (4) alkalinity; (5) dissolved oxygen; and (6) bacteria.

  3. Image size invariant visual cryptography for general access structures subject to display quality constraints.

    PubMed

    Lee, Kai-Hui; Chiu, Pei-Ling

    2013-10-01

    Conventional visual cryptography (VC) suffers from a pixel-expansion problem, or an uncontrollable display quality problem for recovered images, and lacks a general approach to construct visual secret sharing schemes for general access structures. We propose a general and systematic approach to address these issues without sophisticated codebook design. This approach can be used for binary secret images in non-computer-aided decryption environments. To avoid pixel expansion, we design a set of column vectors to encrypt secret pixels rather than using the conventional VC-based approach. We begin by formulating a mathematic model for the VC construction problem to find the column vectors for the optimal VC construction, after which we develop a simulated-annealing-based algorithm to solve the problem. The experimental results show that the display quality of the recovered image is superior to that of previous papers.

  4. Quality assurance grading guidelines for research and development at DOE facilities

    SciTech Connect

    Powell, T.B.; Morris, R.N.

    1993-01-01

    The quality assurance (QA) requirements for the US Department of Energy (DOE) are established in DOE Order 5700.6C. This order is applicable for all DOE departmental elements, management, and maintenance and operating contractors and requires that documented Quality Assurance Programs (QAPs) are prepared at all levels; it has one attachment. The DOE Office of Energy Research (DOE-ER) has issued a standard to ensure implementation of the full intent of this order in the ER community.

  5. Quality control guidelines for National Committee for Clinical Laboratory Standards recommended broth macrodilution testing of amphotericin B, fluconazole, and flucytosine.

    PubMed Central

    Pfaller, M A; Bale, M; Buschelman, B; Lancaster, M; Espinel-Ingroff, A; Rex, J H; Rinaldi, M G; Cooper, C R; McGinnis, M R

    1995-01-01

    Amphotericin B, fluconazole, and flucytosine (5FC) were tested in a multilaboratory study to establish quality control (QC) guidelines for yeast antifungal susceptibility testing. Ten candidate QC strains were tested in accordance with National Committee for Clinical Laboratory Standards M27-P guidelines against the three antifungal agents in each of six laboratories. Each laboratory was assigned a unique lot of RPMI 1640 broth medium as well as a lot of RPMI 1640 common to all of the laboratories. The candidate QC strains were tested 20 times each against the three antifungal agents in both unique and common lots of RPMI 1640. A minimum of 220 MICs per drug per organism were generated during the study. Overall, 95% of the MICs of amphotericin B, fluconazole, and 5FC fell within the desired 3 log2-dilution range (mode +/- 1 log2 dilution). Excellent performance with all three drugs was observed for Candida parapsilosis ATCC 22019 and C. krusei ATCC 6258. With these strains, on-scale 3 log2-dilution ranges encompassing 96 to 99% of the MICs of all three drugs were established. These two strains are recommended for QC testing of amphotericin B, fluconazole, and 5FC. Reference ranges were also established for an additional four strains for use in method development and for training. Four strains failed to perform adequately for recommendation as either QC or reference strains. PMID:7615713

  6. Use of clinical guidelines: perspectives from clinicians in paediatric and maternity hospitals in Kabul, Afghanistan.

    PubMed

    Graham, H; Tokhi, M; Edward, A; Salehi, A S; Turkmani, S; Duke, T; Bartlett, L

    2015-04-02

    This study explored the perceived value, role and reported use of clinical guidelines by clinicians in urban paediatric and maternity hospital settings, and the effect of current implementation strategies on clinician attitudes, knowledge and behaviour. A total of 63 clinicians from 7 paediatric and maternity hospitals in Kabul, Afghanistan participated in structured focus groups; content analysis methodology was used for identification and analysis of key themes. Seven sets of guidelines, protocols or standards were identified (including 5 WHO-endorsed guidelines). However, most are failing to achieve high levels of use. Factors associated with guideline use included: clinician involvement in guideline development; multidisciplinary training; demonstrable results; and positive clinician perceptions regarding guideline quality and contextual appropriateness. Implementation activities should fulfil 3 major objectives: promote guideline awareness and access; stimulate motivation among clinical guideline users; and actively facilitate adherence to guidelines.

  7. Access and Barriers to Immunization in West Bengal, India: Quality Matters

    PubMed Central

    Dutta, Arijita

    2013-01-01

    While many studies attempted to evaluate performance of immunization programmes in developing countries by full coverage, there is a growing awareness about the limitations of such evaluation, irrespective of the overall quality of performance. Availability of human resources, equipment, supporting drugs, and training of personnel are considered to be crucial indicators of the quality of immunization programme. Also, maintenance of time schedule has been considered crucial in the context of the quality of immunization. In addition to overall coverage of vaccination, the coverage of immunization given at right time (month-specific) is to be considered with utmost importance. In this paper, District Level Household and Facility Survey-3 (DLHS-3) 2007-2008 data have been used in exploring the quality of immunization in terms of month-specific vaccine coverage and barriers to access inWest Bengal, India. In West Bengal, the month-specific coverage stands badly below 20% but the simple non-month-specific coverage is as high as 75%. Among the demand-side factors, birthplace of the child and religion of the household heads came out as significant predictors while, from the supply-side, availability of male health workers and equipment at the subcentres, were the important determinants for month-specific vaccine coverage. Hence, there should be a vigorous attempt to make more focused planning, keeping in mind the nature of the barriers, for improvement of the month-specific coverage in West Bengal. PMID:24592593

  8. Technical requirements of spirometers in the strategy for guaranteeing the access to quality spirometry.

    PubMed

    Salas, Tomàs; Rubies, Carles; Gallego, Carlos; Muñoz, Pilar; Burgos, Felip; Escarrabill, Joan

    2011-09-01

    Access to quality spirometry is an essential objective in order to be able to minimize the underdiagnosis of respiratory diseases, especially in those that are most frequent, such as COPD and asthma. This objective can be reached in the short term, but it requires the simultaneous integration of different strategies: training of the health-care professionals who perform spirometry, definition of standards for the transmission of the information, technical requirements for acquiring apparatuses and the correct interpretation of the results. This present study shows the use of standards for the electronic exchange of clinical information. In order to normalize the treatment of the data related with spirometry and to enable the exchange of information, we have used the standard CDA R2 (Clinical Document Architecture, Release 2) of HL7 (Health Level Seven), version 3. HL7 is a product by HL7 International, a non-profit organization that deals in the production of standards in the health-care setting in order to facilitate interoperability. Furthermore, defining these standards is essential for ensuring that they are adopted by spirometer manufacturers. Be means of this process, the base is set for facilitating access to spirometry at the health-care level, while at the same time it is a fundamental technical element for designing quality control programs of the explorations.

  9. Technical requirements of spirometers in the strategy for guaranteeing the access to quality spirometry.

    PubMed

    Salas, Tomàs; Rubies, Carles; Gallego, Carlos; Muñoz, Pilar; Burgos, Felip; Escarrabill, Joan

    2011-09-01

    Access to quality spirometry is an essential objective in order to be able to minimize the underdiagnosis of respiratory diseases, especially in those that are most frequent, such as COPD and asthma. This objective can be reached in the short term, but it requires the simultaneous integration of different strategies: training of the health-care professionals who perform spirometry, definition of standards for the transmission of the information, technical requirements for acquiring apparatuses and the correct interpretation of the results. This present study shows the use of standards for the electronic exchange of clinical information. In order to normalize the treatment of the data related with spirometry and to enable the exchange of information, we have used the standard CDA R2 (Clinical Document Architecture, Release 2) of HL7 (Health Level Seven), version 3. HL7 is a product by HL7 International, a non-profit organization that deals in the production of standards in the health-care setting in order to facilitate interoperability. Furthermore, defining these standards is essential for ensuring that they are adopted by spirometer manufacturers. Be means of this process, the base is set for facilitating access to spirometry at the health-care level, while at the same time it is a fundamental technical element for designing quality control programs of the explorations. PMID:21821333

  10. George M. Low trophy NASA's quality and excellence award, 1992. Application guidelines: Large business

    NASA Technical Reports Server (NTRS)

    1992-01-01

    The George M. Low Trophy is awarded to current NASA contractors, subcontractors, and suppliers in the aerospace industry who have demonstrated sustained excellence and outstanding achievements in quality and productivity for three or more years. The objectives of the award are to increase public awareness of the importance of quality and productivity to the Nation's aerospace program and industry in general; encourage domestic business to continue efforts to enhance quality, increase productivity, and thereby strengthen competitiveness; and provide the means for sharing the successful methods and techniques used by the applicants with other American enterprises. Information is given on candidate eligibility for large businesses, the selection process, the nomination letter, and the application report.

  11. Quality control guidelines for disk diffusion and broth microdilution antimicrobial susceptibility tests with seven drugs for veterinary applications.

    PubMed

    Odland, B A; Erwin, M E; Jones, R N

    2000-01-01

    This multicenter study proposes antimicrobial susceptibility (MIC and disk diffusion methods) quality control (QC) parameters for seven compounds utilized in veterinary health. Alexomycin, apramycin, tiamulin, tilmicosin, and tylosin were tested by broth microdilution against various National Committee for Clinical Laboratory Standards (NCCLS)-recommended QC organisms (Staphylococcus aureus ATCC 29213, Enterococcus faecalis ATCC 29212, Streptococcus pneumoniae ATCC 49619, Escherichia coli ATCC 25922, and Pseudomonas aeruginosa ATCC 27853). In addition, disk diffusion zone diameter QC limits were determined for apramycin, enrofloxacin, and premafloxacin by using E. coli ATCC 25922, P. aeruginosa ATCC 27853, and S. aureus ATCC 25923. The results from five or six participating laboratories produced >/=99.0% of MICs and >/=95.0% of the zone diameters within suggested guidelines. The NCCLS Subcommittee for Veterinary Antimicrobial Susceptibility Testing has recently approved these ranges for publication in the next M31 document. PMID:10618141

  12. Strategy Guideline: Application of a Construction Quality Process to Existing Home Retrofits

    SciTech Connect

    Mallay, D.; Del Bianco, M.

    2013-08-01

    The Home Innovation Research Labs developed a construction quality process for new and existing high performance homes (HPH) in which high performance goals are established, specifications to meet those goals are defined, and construction monitoring points are added to the construction schedule so that critical energy efficiency details are systematically reviewed, documented, and tested in a timely manner. This report follows the evolution of the construction quality process from its development for new homes, to its application in the construction of a high performance home with enhanced specifications, and its application in a crawlspace renovation.

  13. Strategy Guideline. Application of a Construction Quality Process to Existing Home Retrofits

    SciTech Connect

    Mallay, D.; Del Bianco, M.

    2013-08-01

    The Partnership for Home Innovation developed a construction quality process for new and existing high performance homes (HPH) in which high performance goals are established, specifications to meet those goals are defined, and construction monitoring points are added to the construction schedule so that critical energy efficiency details are systematically reviewed, documented, and tested in a timely manner. This report follows the evolution of the construction quality process from its development for new homes, to its application in the construction of a high performance home with enhanced specifications, and its application in a crawlspace renovation.

  14. Impact of a Standardized Treatment Guideline for Pediatric Iatrogenic Opioid Dependence: A Quality Improvement Initiative

    PubMed Central

    Reyburn-Orne, Teri; Youssef, Tarek H.; Haddad, Imad Y.; Gerkin, Richard D.

    2016-01-01

    OBJECTIVES: To determine whether utilization of a hospital-based clinical practice guideline for the care of pediatric iatrogenic opioid dependence (IOD) would promote a decrease in opioid exposure and improve management of opioid abstinence syndrome (AS). METHODS: This study is a retrospective chart review of critically ill patients from a tertiary care children's hospital. Inclusion criteria included mechanically ventilated patients up to 18 years of age who received continuous opioid infusions for at least 7 days and any length of methadone administration. Data on IOD patients from January 2005 to June 2010 was divided into 3 periods: baseline, phase 1, and phase 2. Primary outcome was decrease in opioid exposure, measured by methadone duration of use and any additional opioid bolus doses used in AS management. Documentation of additional opioid bolus doses was regarded as a surrogate measure of AS. Secondary outcomes included total cumulative fentanyl dose, continuous fentanyl infusion duration of use, and hospital and pediatric intensive care unit length of stay. RESULTS: There was a significant decrease in methadone duration of use in IOD patients from 15.3 ± 8.7 days at baseline to 9.5 ± 3.7 days during phase 1 (p = 0.002), to 8.1 ± 3.7 days on phase 2 (reduction not significant, p = 0.106) of this evaluation. Additional opioid bolus doses were significantly lower from baseline to phase 1 (5.5 ± 5.1 vs. 1.8 ± 2.3, p = 0.001) and from phase 1 to phase 2 (1.8 ± 2.3 vs. 0.2 ± 1.5, p = 0.003). For the remaining outcomes, differences were not observed among the evaluation periods, except for the total cumulative fentanyl dose, which was reduced from 2.8 ± 3.7 mg/kg at baseline to 1 ± 1 mg/kg only during phase 1 (p = 0.017). CONCLUSIONS: Introduction of a standardized, hospital-based clinical practice guideline for children with IOD reduced the length of exposure to opioids and improved opioid AS management. PMID:26997929

  15. Association of Initial Hemodialysis Vascular Access with Patient-Reported Health Status and Quality of Life

    PubMed Central

    Wasse, Haimanot; Kutner, Nancy; Zhang, Rebecca; Huang, Yijian

    2009-01-01

    Background Although the arteriovenous fistula (AVF) is the recommended form of vascular access for patients with ESRD, its impact on patient perception of health status, quality of life (QOL), or satisfaction is unknown. Design, setting, participants, and measurements This study compared patient-reported health status and QOL scores and vascular access type among a national random sample of 1563 patients at dialysis initiation and day 60 of ESRD during 1996 to 1997. Patients were stratified into five categories: AVF at first dialysis and day 60 of ESRD, arteriovenous graft (AVG) at first dialysis and day 60, central venous catheter (CVC) at first dialysis and AVF at day 60, CVC at first dialysis and AVG at day 60, and CVC at first dialysis and day 60. Results Ten percent (n = 154) of patients had an AVF, 21% (n = 326) had an AVG, and 69% (n = 1083) had a CVC at dialysis initiation; those who were most likely to use an AVF were white and male. After statistical adjustment, patients with persistent AVF use reported greater physical activity and energy, better emotional and social well-being, fewer symptoms, less effect of dialysis and burden of kidney disease, and better sleep compared with patients with persistent CVC use, whereas measures such as cognitive and sexual function did not differ by access type. Conclusions Compared with persistent CVC use, early persistent AVF use is associated with the perception of improved health status and QOL among patients with ESRD. Future longitudinal studies may help to clarify further the association between QOL and vascular access. PMID:17699486

  16. 40 CFR Appendix W to Part 51 - Guideline on Air Quality Models

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ....0Bibliography 12.0References Appendix A to Appendix W of 40 CFR Part 51—Summaries of Preferred Air Quality... assessing source impact and in evaluating control strategies. i. Appendix W to 40 CFR Part 51 itself... to Appendix A to Appendix W to 40 CFR Part 51. Appendix A contains summaries of refined air...

  17. 40 CFR Appendix W to Part 51 - Guideline on Air Quality Models

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ....0Bibliography 12.0References Appendix A to Appendix W of 40 CFR Part 51—Summaries of Preferred Air Quality... assessing source impact and in evaluating control strategies. i. Appendix W to 40 CFR Part 51 itself... to Appendix A to Appendix W to 40 CFR Part 51. Appendix A contains summaries of refined air...

  18. 40 CFR Appendix W to Part 51 - Guideline on Air Quality Models

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ....0Bibliography 12.0References Appendix A to Appendix W of 40 CFR Part 51—Summaries of Preferred Air Quality... assessing source impact and in evaluating control strategies. i. Appendix W to 40 CFR Part 51 itself... to Appendix A to Appendix W to 40 CFR Part 51. Appendix A contains summaries of refined air...

  19. Quality in Individualized Family Service Plans: Guidelines for Practitioners, Programs, and Families

    ERIC Educational Resources Information Center

    Gatmaitan, Michelle; Brown, Teresa

    2016-01-01

    The IFSP is both a document and process for developing, implementing, and evaluating the supports and services delivered to infants and toddlers with disabilities and their families eligible under Part C of the Individuals With Disabilities Education Improvement Act (IDEA; 2004). Recently, researchers have defined IFSP quality based on five…

  20. Statistics, Measures, and Quality Standards for Assessing Digital Reference Library Services: Guidelines and Procedures.

    ERIC Educational Resources Information Center

    McClure, Charles R.; Lankes, R. David; Gross, Melissa; Choltco-Devlin, Beverly

    This manual is a first effort to begin to identify, describe, and develop procedures for assessing various aspects of digital reference service. Its overall purpose is to improve the quality of digital reference services and assist librarians to design and implement better digital reference services. More specifically, its aim is to: assist…

  1. Guidelines of the Office International des Epizooties for laboratory quality evaluation, for international reference standards for antibody assays and for laboratory proficiency testing.

    PubMed

    1998-08-01

    Three guidelines, adopted by the International Committee of the Office International des Epizooties (OIE), have been combined for publication in a single document. The Guidelines for evaluating laboratory quality (adopted in 1995) form part of the OIE Guidelines for evaluating Veterinary Services. General requirements for equipment, staffing and management of laboratories are outlined. The guidelines for international reference standards for antibody assays (adopted in 1998) provide general rules governing the preparation of immune sera by OIE Reference Laboratories. A data sheet should accompany each preparation dispatched from the laboratory, and details are given of the information to be contained in the data sheet. The guidelines are to be used in conjunction with the OIE Manual of standards for diagnostic tests and vaccines. Guidelines on the proficiency of laboratory testing (adopted in 1996) describe how the operation of a laboratory can be assessed by inter-laboratory testing, and by voluntary participation in an accreditation (quality assurance) audit, operated by an independent authority. Criteria for assessing serological testing are provided.

  2. United States Access Board

    MedlinePlus

    ... Communications & IT Access to information and communication technology (ICT) is addressed by Board standards and guidelines issued ... Engineer (November 3) Access Board Approves Rules on ICT Refresh and Medical Diagnostic Equipment (September 14) Access ...

  3. Hybrid specification, storage, retrieval and runtime application of clinical guidelines.

    PubMed

    Shahar, Y

    2006-06-01

    Clinical guidelines are a major tool in improving the quality of medical care. However, most guidelines are in free text, are not machine-comprehensible and are not easily accessible to clinicians at the point of care. We have designed and implemented a web-based, modular, distributed architecture, the Digital Electronic Guideline Library (DeGeL), which facilitates gradual conversion of clinical guidelines from text to a formal representation in the chosen target guideline ontology. The architecture supports guideline classification, semantic markup, context-sensitive search, browsing, run-time application and retrospective quality assessment. The DeGeL hybrid meta-ontology includes elements common to all guideline ontologies, such as semantic classification and domain knowledge; it also includes four content-representation formats: free text, semi-structured text, semi-formal representation and a formal representation. These formats support increasingly sophisticated computational tasks. Guidelines can thus be in a hybrid representation in which guidelines, and even parts of the same guideline, might exist at different formalisation levels. We have also developed and rigorously evaluated a methodology and an associated web-based tool, Uruz, for gradually structuring and semi-formalising free-text clinical guidelines. Finally, we have designed, implemented and evaluated a new approach, the hybrid runtime application model, for supporting runtime application of clinical guidelines that are not necessarily in a machine-comprehensible format; in particular, when the guideline is in a semi-formal representation and the patient's data are either in an electronic medical record or in a paper format. The tool implementing this new approach, the Spock module, is customised at this point to the Asbru guideline specification language and exploits the hybrid structure of guidelines in DeGeL. The Spock module also exploits our temporal-abstraction mediator to the patient

  4. Summary of national standards and guidelines for pesticides in water, bed sediment, and aquatic organisms and their application to water-quality assessments

    USGS Publications Warehouse

    Nowell, Lisa H.; Resek, Elizabeth A.

    1994-01-01

    Current (1993) national standards and guidelines pertaining to pesticide contaminants in water, bed sediment, and fish and shellfish tissues are summarized to provide a condensed reference source for definitions and current values applicable to pesticides in aquatic environmental media. This report facilitates comparison of measured concen- trations of pesticides in environmental samples with applicable standards and guidelines. For each standard or guideline, the following is provided: (1) Definition, including the underlying assumptions and mathematical derivation; (2) originating agency; (3) statutory authority; (4) regulatory status and, for standards, the agency responsible for enforcing the standard; (5) applicable sampling medium; (6) beneficial use and resource protected, and (7) full citations of published documentation. The report emphasizes the appropriate application on national standards and guidelines to water-quality data on pesticides to aid in assessing potential adverse effects on human health, aquatic organisms, and wildlife. (USGS)

  5. A systematic review and quality appraisal of international guidelines for early breast cancer systemic therapy: Are recommendations sensitive to different global resources?

    PubMed

    Gandhi, S; Verma, S; Ethier, J-L; Simmons, C; Burnett, H; Alibhai, S M H

    2015-08-01

    The breast cancer incidence in low and middle income countries (LMCs) is increasing globally, and patient outcomes are generally worse in these nations compared to high income countries (HICs). This is partly due to resource constraints associated with implementing recommended breast cancer therapies. Clinical practice guideline (CPG) adherence can improve breast cancer outcomes, however, many CPGs are created in HICs, and include costly recommendations that may not be feasible in LMCs. In addition, the quality of CPGs can be variable. The aim of this study was to perform a systematic review of CPGs on early breast cancer systemic therapy with potential international impact, to evaluate their content, quality, and resource sensitivity. A MEDLINE and gray literature search was completed for English language CPGs published between 2005 and 2010, and then updated to July 2014. Extracted guidelines were evaluated using the AGREE 2 instrument. Guidelines were specifically analyzed for resource sensitivity. Most of the extracted CPGs had similar recommendations with regards to systemic therapy. However, only one, the Breast Health Global Initiative, made recommendations with consideration of different global resources. Overall, the CPGs were of variable quality, and most scored poorly in the quality domain evaluating implementation barriers such as resources. Published CPGs for early breast cancer are created in HICs, have similar recommendations, and are generally resource-insensitive. Given the visibility and influence of these CPGs on LMCs, efforts to create higher quality, resource-sensitive guidelines with less redundancy are needed.

  6. A systematic review and quality appraisal of international guidelines for early breast cancer systemic therapy: Are recommendations sensitive to different global resources?

    PubMed

    Gandhi, S; Verma, S; Ethier, J-L; Simmons, C; Burnett, H; Alibhai, S M H

    2015-08-01

    The breast cancer incidence in low and middle income countries (LMCs) is increasing globally, and patient outcomes are generally worse in these nations compared to high income countries (HICs). This is partly due to resource constraints associated with implementing recommended breast cancer therapies. Clinical practice guideline (CPG) adherence can improve breast cancer outcomes, however, many CPGs are created in HICs, and include costly recommendations that may not be feasible in LMCs. In addition, the quality of CPGs can be variable. The aim of this study was to perform a systematic review of CPGs on early breast cancer systemic therapy with potential international impact, to evaluate their content, quality, and resource sensitivity. A MEDLINE and gray literature search was completed for English language CPGs published between 2005 and 2010, and then updated to July 2014. Extracted guidelines were evaluated using the AGREE 2 instrument. Guidelines were specifically analyzed for resource sensitivity. Most of the extracted CPGs had similar recommendations with regards to systemic therapy. However, only one, the Breast Health Global Initiative, made recommendations with consideration of different global resources. Overall, the CPGs were of variable quality, and most scored poorly in the quality domain evaluating implementation barriers such as resources. Published CPGs for early breast cancer are created in HICs, have similar recommendations, and are generally resource-insensitive. Given the visibility and influence of these CPGs on LMCs, efforts to create higher quality, resource-sensitive guidelines with less redundancy are needed. PMID:25900382

  7. Gene Wiki Reviews-Raising the quality and accessibility of information about the human genome.

    PubMed

    Tsueng, Ginger; Good, Benjamin M; Ping, Peipei; Golemis, Erica; Hanukoglu, Israel; van Wijnen, Andre J; Su, Andrew I

    2016-11-01

    Wikipedia and other openly available resources are increasingly becoming commonly used sources of information not just among the lay public but even in academic circles including undergraduate students and postgraduate trainees. To enhance the quality of the Wikipedia articles, in 2013, we initiated the Gene Wiki Reviews on genes and proteins as a series of invited reviews that stipulated editing the corresponding Wikipedia article(s) that would be also subject to peer-review. Thus, while the review article serves as an authoritative snapshot of the field, the "living article" can continue to evolve with the crowdsourcing model of Wikipedia. After publication of over 50 articles, we surveyed the authors to assess the impact of the project. The author survey results revealed that the Gene Wiki project is achieving its major objectives to increase the involvement of scientists in authoring Wikipedia articles and to enhance the quantity and quality of the information about genes and their protein products. Thus, the dual publication model introduced in the Gene Wiki Reviews series represents a valuable innovation in scientific publishing and biomedical knowledge management. We invite experts on specific genes to contact the editors to take part in this project to enhance the quality and accessibility of information about the human genome. PMID:27150585

  8. Gene Wiki Reviews-Raising the quality and accessibility of information about the human genome.

    PubMed

    Tsueng, Ginger; Good, Benjamin M; Ping, Peipei; Golemis, Erica; Hanukoglu, Israel; van Wijnen, Andre J; Su, Andrew I

    2016-11-01

    Wikipedia and other openly available resources are increasingly becoming commonly used sources of information not just among the lay public but even in academic circles including undergraduate students and postgraduate trainees. To enhance the quality of the Wikipedia articles, in 2013, we initiated the Gene Wiki Reviews on genes and proteins as a series of invited reviews that stipulated editing the corresponding Wikipedia article(s) that would be also subject to peer-review. Thus, while the review article serves as an authoritative snapshot of the field, the "living article" can continue to evolve with the crowdsourcing model of Wikipedia. After publication of over 50 articles, we surveyed the authors to assess the impact of the project. The author survey results revealed that the Gene Wiki project is achieving its major objectives to increase the involvement of scientists in authoring Wikipedia articles and to enhance the quantity and quality of the information about genes and their protein products. Thus, the dual publication model introduced in the Gene Wiki Reviews series represents a valuable innovation in scientific publishing and biomedical knowledge management. We invite experts on specific genes to contact the editors to take part in this project to enhance the quality and accessibility of information about the human genome.

  9. A statistical evaluation of the safety factor and species sensitivity distribution approaches to deriving environmental quality guidelines.

    PubMed

    Zajdlik, Barry Alan

    2016-04-01

    The species sensitivity distribution (SSD) distribution approach to estimating water quality guidelines (WQGs) is the preferred method in all jurisdictions reviewed (Australia, Canada, New Zealand, Organisation for Economic Co-operation and Development [OECD] members, South Africa, United States) and is one of the recommended methods for European Commission members for 33 priority and priority hazardous substances. In the event that jurisdiction-specific criteria for data quality, quantity, and taxonomic representation are not met, all of these jurisdictions endorse the use of additional safety factors (SFs) applied to either the SSD-based WQG or, the lowest suitable toxicity test endpoint. In Canada, the British Columbia Ministry of Environment endorses this latter approach as the preferred approach in the belief that so-derived WQGs are more protective than SSD-based WQGs. The level of protection afforded by the latter SF approach was evaluated by statistically sampling minima from random samples of the following distributions: normal, Gumbel, logistic, and Weibull, using a range of coefficients of variation (cVs) and applying the SFs of 2 or 10 used in British Columbia. The simulations indicate that the potentially affected fraction of species (PAF) can be as high as 20%, or, approach 0%. The PAF varies with sample size and CV. Because CVs can vary systematically with mode of toxic action, the PAF using SF-based WQGs can also vary systematically with analyte class. The varying levels of protection afforded by SF-based WQGs are generally inconsistent with the common water quality management goal that allows for a small degree of change under long-term exposure. The findings suggest that further efforts be made to develop high-quality WQGs that support informed decision making and are consistent with the environmental management goal instead of using SFs in the hope of achieving an acceptable but unknown, degree of environmental protection. PMID:26272692

  10. [Implementation of Study Results in Guidelines and Adherence to Guidelines in Clinical Practice].

    PubMed

    Waldfahrer, F

    2016-04-01

    Guidelines were introduced in hospital and practice-based otorhinolaryngology in the 1990s, and have been undergoing further development ever since. There are currently 20 guidelines on file at the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. The Society has cooperated in a further 34 guidelines. The quality of the guidelines has been continually improved by concrete specifications put forward by the Association of the Scientific Medical Societies in Germany [Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.]. Since increasing digitalisation has made access to scientific publications quicker and more simple, relevant study results can be incorporated in guidelines more easily today than in the analogue world. S2e and S3 guidelines must be based on a formal literature search with subsequent evaluation of the evidence. The consensus procedure for S2k guidelines is also regulated. However, the implementation of guidelines in routine medical practice must still be considered inadequate, and there is still a considerable need for improvement in adherence to these guidelines. PMID:27128403

  11. 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

  12. [Implications of publication bias on guideline development and appraisal].

    PubMed

    Kopp, Ina B

    2011-01-01

    The issue of selective publishing of research results is gaining more and more scientific, public and political awareness. For guideline authors, in particular, it leads to uncertainty about the interpretability of the methodological quality and clinical relevance of the available evidence and the risk of bias where their conclusions and thus guideline recommendations are concerned. The actual impact of publication bias on guideline contents appears to be low if a systematic and methodically sound approach is followed in the process of guideline development. However, the quality of the evidence on this topic is poor. Different strategies to deal with publication bias have been proposed for authors of systematic reviews but they are of limited use for guideline authors. The goal must therefore be to implement appropriate measures in order to avoid the problem ex ante. The first step would be the systematic registration of study results in publicly accessible registers.

  13. Dietary quality-adherence to the dietary guidelines in Tehranian adolescents: Tehran Lipid and Glucose Study.

    PubMed

    Mirmiran, Parvin; Azadbakht, Leila; Azizi, Fereidoun

    2005-05-01

    The aim of this study was to determine the Healthy Eating Index (HEI) score and its relation take of nutrients and the number of servings from each food group consumed by adolescents residing in district 13 of Tehran. This study, conducted within the framework of Tehran Lipid and Glucose Study (TLGS), was a part of a dietary intake assessment carried out in 443 families, including 465 adolescents, aged 10-18 years, according to the Food Guide Pyramid and dietary guidelines on individuals residing in district 13 of Tehran. In this study, dietary intake was assessed with two-day 24-hour recalls. HEI was calculated based on nine components. The score range of each component was 0 to 10, the sum score of this index therefore being 90. The HEI score was categorized into three groups: less than 45 (poor diet), between 45-72 (needs improvement) and more than 72 (good diet). The mean score of HEI was 64.9 +/- 9.6 in boys and 64.8 +/- 9.4 in girls. The results showed that the number of servings of food groups in those with good diet was significantly higher than the two other groups (p < 0.05). In contrast the percent of saturated fat intake and cholesterol consumption in those with HEI > or = 72 was lower than the other groups (p < 0.05). The approximate number of food items consumed and the total nutrient intake by adolescents with HEI score > or = 72 was significantly higher than the others (p < 0.05). There was a significant positive correlation between the number of servings of grains group (r = 0.1), vegetables (r = 0.4), fruits (r = 0.4), dairy (r = 0.3), meat (r = 0.1), and HEI (p < 0.001). There was a significant negative correlation between fat intake (r = -0.2, p < 0.001), percent of saturated fatty acids (r = -0.2, p < 0.05), cholesterol consumption (r = -0.4, p < 0.05), and the ratio of polyunsaturated fatty acids/saturated fatty acids (P/S) in diet (r = 0.2, p < 0.05), and HEI score. Seventy-four, 23, and 3% of diets were categorized into "needs improvement

  14. Squire 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process.

    PubMed

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2015-11-01

    Since the publication of Standards for Quality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of 3 key components of systematic efforts to improve the quality, value, and safety of health care: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org). PMID:26523003

  15. [SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process].

    PubMed

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2015-11-20

    Since the publication of Standards for Quality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semi-structured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of three key components of systematic efforts to improve the quality, value, and safety of healthcare: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognizing that they can be complex and multi-dimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).

  16. Squire 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process.

    PubMed

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2015-11-01

    Since the publication of Standards for Quality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of 3 key components of systematic efforts to improve the quality, value, and safety of health care: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).

  17. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines From a Detailed Consensus Process.

    PubMed

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2015-11-01

    Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semi-structured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of three key components of systematic efforts to improve the quality, value, and safety of healthcare: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (http://www.squire-statement.org).

  18. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process.

    PubMed

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2015-10-01

    Since the publication of Standards for Quality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using 1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group; 2) 2 face-to-face consensus meetings to develop interim drafts and 3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of 3 key components of systematic efforts to improve the quality, value and safety of healthcare: the use of formal and informal theory in planning, implementing and evaluating improvement work; the context in which the work is done and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).

  19. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines from a Detailed Consensus Process.

    PubMed

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2015-01-01

    Since the publication of Standards for Quality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015, using 1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group; 2) two face-to-face consensus meetings to develop interim drafts; and 3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of three key components of systematic efforts to improve the quality, value, and safety of health care: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).

  20. Standards for QUality Improvement Reporting Excellence 2.0: revised publication guidelines from a detailed consensus process.

    PubMed

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2016-02-01

    Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this article, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of three key components of systematic efforts to improve the quality, value, and safety of health care: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).

  1. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process.

    PubMed

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2015-10-01

    Since the publication of Standards for Quality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using 1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group; 2) 2 face-to-face consensus meetings to develop interim drafts and 3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of 3 key components of systematic efforts to improve the quality, value and safety of healthcare: the use of formal and informal theory in planning, implementing and evaluating improvement work; the context in which the work is done and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org). PMID:26443286

  2. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines from a Detailed Consensus Process

    PubMed Central

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2015-01-01

    Since the publication of Standards for Quality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015, using 1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group; 2) two face-to-face consensus meetings to develop interim drafts; and 3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of three key components of systematic efforts to improve the quality, value, and safety of health care: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org). PMID:26517437

  3. Standardized quality assurance forms for organ transplantations with multilingual support, open access and UMLS coding.

    PubMed

    Varghese, Julian; Sünninghausen, Sarah Schulze; Dugas, Martin

    2015-01-01

    Quality assurance (QA) is a key factor to evaluate success of organ transplantations. In Germany QA documentation is progressively developed and enforced by law. Our objective is to share QA models from Germany in a standardized format within a form repository for world-wide reuse and exchange. Original QA forms were converted into standardized study forms according to the Operational Data Model (ODM) and shared for open access in an international forms repository. Form elements were translated into English and semantically enriched with Concept Unique Identifiers from the Unified Medical Language System (UMLS) based on medical expert decision. All forms are available on the web as multilingual ODM documents. UMLS concept coverage analysis indicates 92% coverage with few but critically important definition gaps. New content and infrastructure for harmonized documentation forms is provided in the domain of organ transplantations enabling world-wide reuse and exchange. PMID:26063252

  4. Financing American Indian health care: impacts and options for improving access and quality.

    PubMed

    Langwell, Kathryn; Anagnopoulos, Cheryl; Ryan, Frank; Melson, Jacob; Iron Rope, Sandor

    2009-10-01

    (1) Indian Health Service (HIS) per patient funding is less than half of national per capita health spending, and declined further between 2003 and 2006. (2) Under-funding of the IHS system has led to explicit rationing of services to American Indian and Alaska Native patients, with many specialized services provided only for "life or limb threatening" conditions. (3) IHS patients report experiencing access barriers and rate the quality of care process substantially lower than do Medicaid beneficiaries, but most indicate they prefer to use IHS for their health care. (4) Options to increase the funding for American Indian and Alaska Native health care exist, but would impose higher costs on federal and state budgets and are unlikely to be feasible in the current economic environment. However, IHS might be able to make certain organizational changes that would increase efficiency and its ability to extend existing funding to cover more services. PMID:19847975

  5. Changes in perceptions of quality of, and access to, services among clients of a fractional franchise network in Nepal.

    PubMed

    Agha, Sohail; Gage, Anastasia; Balal, Asma

    2007-05-01

    With declining levels of international donor funding for financing reproductive health programmes, developing country governments and international donors are looking towards private sector strategies to expand the supply of quality reproductive health services. One of the challenges of a health franchise is to improve the quality of services provided by independent private practitioners. Private providers are more likely to abide by the quality standards set by a franchiser if they see a financial benefit resulting from franchise participation. This study was conducted to measure whether (a) there were improvements in perceived quality of care and perceived access to health facilities once these facilities became part of a franchise and (b) improvements in perceived quality and perceived access were associated with increased client loyalty to franchised clinics. Franchisees were given basic reproductive health training for seven days and services marketing training for two days. Exit interviews were conducted with male and female clients at health facilities. A pre-test measurement was taken in April 2001, prior to the start of project activities. A post-test measurement was taken in February/March 2002, about 9 months after the pre-test. Multilevel regression analysis, which takes the hierarchical structure of the data into account, was used for the analysis. After taking provider-level variation into account and controlling for client characteristics, the analyses showed significant improvements in perceived quality of care and perceived access to services. Private provider participation in a franchise network helps improve client perceptions of quality of, and access to, services. Improvements in client perceptions of quality and access contribute to increased client loyalty to franchised clinics. Once increased client loyalty translates into higher client volumes, providers are likely to see the benefits of franchise participation. In turn, this should lead to

  6. A framework for a distributed, hybrid, multiple-ontology clinical-guideline library, and automated guideline-support tools.

    PubMed

    Shahar, Yuval; Young, Ohad; Shalom, Erez; Galperin, Maya; Mayaffit, Alon; Moskovitch, Robert; Hessing, Alon

    2004-10-01

    Clinical guidelines are a major tool in improving the quality of medical care. However, most guidelines are in free text, not in a formal, executable format, and are not easily accessible to clinicians at the point of care. We introduce a Web-based, modular, distributed architecture, the Digital Electronic Guideline Library (DeGeL), which facilitates gradual conversion of clinical guidelines from text to a formal representation in chosen target guideline ontology. The architecture supports guideline classification, semantic markup, context-sensitive search, browsing, run-time application, and retrospective quality assessment. The DeGeL hybrid meta-ontology includes elements common to all guideline ontologies, such as semantic classification and domain knowledge; it also includes four content-representation formats: free text, semi-structured text, semi-formal representation, and a formal representation. These formats support increasingly sophisticated computational tasks. The DeGeL tools for support of guideline-based care operate, at some level, on all guideline ontologies. We have demonstrated the feasibility of the architecture and the tools for several guideline ontologies, including Asbru and GEM.

  7. Improving product quality and productivity using better guidelines for concept design

    SciTech Connect

    Hinckley, C.M.; Barkan, P.

    1995-08-01

    The remarkable effectiveness of Japanese practices has led to a growing interest in the US in the development and application of rules and methodologies which attempt to capture design experience. US companies have found unexpected benefits and pitfalls in the application of these rules and methods. In this article, the authors critically examine one of the most widely accepted rules of Design for Manufacturability (DFM): minimize the number of parts. An examination of 240 assemblies and subassemblies has shown that rigid adherence to this rule can lead to unnecessarily complex parts and assembly. Quantitative insights derived from this study have led to a better design goal: minimize and simplify assembly operations. This new rule, which should not be rigidly interpreted, tends to reduce part count, while having the benefit of assuring improved assembly. Another significant advantage of the new design rule is that it results in lower product defect rates as demonstrated by correlations observed for a wide range of products from two different manufacturers. This research links quality to the product concept, enabling a new approach to improving quality at the earliest stages of design.

  8. Water quality laboratories in Colombia: a GIS-based study of urban and rural accessibility.

    PubMed

    Wright, Jim; Liu, Jing; Bain, Robert; Perez, Andrea; Crocker, Jonny; Bartram, Jamie; Gundry, Stephen

    2014-07-01

    The objective of this study was to quantify sample transportation times associated with mandated microbiological monitoring of drinking-water in Colombia. World Health Organization Guidelines for Drinking-Water Quality recommend that samples spend no more than 6h between collection and analysis in a laboratory. Census data were used to estimate the minimum number of operational and surveillance samples required from piped water supplies under national regulations. Drive-times were then computed from each supply system to the nearest accredited laboratory and translated into sample holding times based on likely daily monitoring patterns. Of 62,502 surveillance samples required annually, 5694 (9.1%) were found to be more than 6 h from the nearest of 278 accredited laboratories. 612 samples (1.0%) were more than 24 hours' drive from the nearest accredited laboratory, the maximum sample holding time recommended by the World Health Organization. An estimated 30% of required rural samples would have to be stored for more than 6 h before reaching a laboratory. The analysis demonstrates the difficulty of undertaking microbiological monitoring in rural areas and small towns from a fixed laboratory network. Our GIS-based approach could be adapted to optimise monitoring strategies and support planning of testing and transportation infra-structure development. It could also be used to estimate sample transport and holding times in other countries.

  9. Water quality laboratories in Colombia: a GIS-based study of urban and rural accessibility.

    PubMed

    Wright, Jim; Liu, Jing; Bain, Robert; Perez, Andrea; Crocker, Jonny; Bartram, Jamie; Gundry, Stephen

    2014-07-01

    The objective of this study was to quantify sample transportation times associated with mandated microbiological monitoring of drinking-water in Colombia. World Health Organization Guidelines for Drinking-Water Quality recommend that samples spend no more than 6h between collection and analysis in a laboratory. Census data were used to estimate the minimum number of operational and surveillance samples required from piped water supplies under national regulations. Drive-times were then computed from each supply system to the nearest accredited laboratory and translated into sample holding times based on likely daily monitoring patterns. Of 62,502 surveillance samples required annually, 5694 (9.1%) were found to be more than 6 h from the nearest of 278 accredited laboratories. 612 samples (1.0%) were more than 24 hours' drive from the nearest accredited laboratory, the maximum sample holding time recommended by the World Health Organization. An estimated 30% of required rural samples would have to be stored for more than 6 h before reaching a laboratory. The analysis demonstrates the difficulty of undertaking microbiological monitoring in rural areas and small towns from a fixed laboratory network. Our GIS-based approach could be adapted to optimise monitoring strategies and support planning of testing and transportation infra-structure development. It could also be used to estimate sample transport and holding times in other countries. PMID:24747256

  10. Establishing ‘quality of life’ parameters using behavioural guidelines for humane euthanasia of captive non-human primates

    PubMed Central

    Lambeth, SP; Schapiro, SJ; Bernacky, BJ; Wilkerson, GK

    2014-01-01

    Chronic pain and distress are universally accepted conditions that may adversely affect an animal’s quality of life (QOL) and lead to the humane euthanasia of an animal. At most research institutions and zoological parks in the USA, a veterinarian, who has physically examined the animal and reviewed the clinical records, ultimately decides when an animal has reached a humane endpoint. To aid in the difficult process of interpreting pain and distress, we have developed specific behavioural guidelines, in addition to standard clinical information, to help define unique characteristics and traits of primates to assess and promote discussion of an individual primate’s QOL, and thereby, to assist in the decision-making process regarding euthanasia. These guidelines advocate the creation of a QOL team when the animal is diagnosed with a life-threatening or debilitating chronic condition, or at the time the animal is entered into a terminal study. The team compiles a list of characteristics unique to that individual animal by utilising a questionnaire and a behavioural ethogram. This list enables the team to quantitatively assess any deviations from the established normal behavioural repertoire of that individual. Concurrently, the QOL team determines the number of behavioural deviations that are needed to trigger an immediate discussion of the necessity for humane euthanasia of the animal. The team remains intact once created, and revisits the animal’s condition as frequently as deemed necessary. This process improves animal welfare by continuing the quest to optimally define QOL for captive primates, and potentially for all captive animals. PMID:25505822

  11. Translation of the UNESCO/OECD Guidelines for Quality Provision in Cross-Border Higher Education into Local Policy Contexts: A Comparative Study of Finland and Russia

    ERIC Educational Resources Information Center

    Kallo, Johanna; Semchenko, Anzhelika

    2016-01-01

    This article analyses the localisation of the United Nations Educational Scientific and Cultural Organisation (UNESCO)/Organisation for Economic Co-operation and Development (OECD) "Guidelines for Quality Provision in Cross-Border Higher Education" (2005) at the national and university levels in Finland and Russia. The article engages…

  12. Guidelines for compliance with the National Environmental Policy Act and the California Environmental Quality Act

    SciTech Connect

    Kielusiak, C.

    1993-02-01

    The National Environmental Policy Act of 1969 (NEPA) sets forth national policy for the protection of the environment. The NEPA process is intended to help officials of the federal government make decisions that are based on an understanding of environmental consequences, and take actions that protect, restore, and enhance the environment. The California Environmental Quality Act of 1970 (CEQA) is similar to NEPA. The California legislature established CEQA to inform both state and local governmental decision-makers and the public about potential significant environmental effects of proposed activities, to identify ways to avoid or reduce environmental impacts, and to disclose to the public the reasons why a project is approved if significant environmental effects are involved. Lawrence Berkeley Laboratory (LBL), complies with the provisions of both NEPA and CEQA. This document defines the responsibilities and authorities for NEPA/CEQA compliance at LBL.

  13. The IEO Data Center Management System: Tools for quality control, analysis and access marine data

    NASA Astrophysics Data System (ADS)

    Casas, Antonia; Garcia, Maria Jesus; Nikouline, Andrei

    2010-05-01

    Since 1994 the Data Centre of the Spanish Oceanographic Institute develops system for archiving and quality control of oceanographic data. The work started in the frame of the European Marine Science & Technology Programme (MAST) when a consortium of several Mediterranean Data Centres began to work on the MEDATLAS project. Along the years, old software modules for MS DOS were rewritten, improved and migrated to Windows environment. Oceanographic data quality control includes now not only vertical profiles (mainly CTD and bottles observations) but also time series of currents and sea level observations. New powerful routines for analysis and for graphic visualization were added. Data presented originally in ASCII format were organized recently in an open source MySQL database. Nowadays, the IEO, as part of SeaDataNet Infrastructure, has designed and developed a new information system, consistent with the ISO 19115 and SeaDataNet standards, in order to manage the large and diverse marine data and information originated in Spain by different sources, and to interoperate with SeaDataNet. The system works with data stored in ASCII files (MEDATLAS, ODV) as well as data stored within the relational database. The components of the system are: 1.MEDATLAS Format and Quality Control - QCDAMAR: Quality Control of Marine Data. Main set of tools for working with data presented as text files. Includes extended quality control (searching for duplicated cruises and profiles, checking date, position, ship velocity, constant profiles, spikes, density inversion, sounding, acceptable data, impossible regional values,...) and input/output filters. - QCMareas: A set of procedures for the quality control of tide gauge data according to standard international Sea Level Observing System. These procedures include checking for unexpected anomalies in the time series, interpolation, filtering, computation of basic statistics and residuals. 2. DAMAR: A relational data base (MySql) designed to

  14. Urban farmers' markets: accessibility, offerings, and produce variety, quality, and price compared to nearby stores.

    PubMed

    Lucan, Sean C; Maroko, Andrew R; Sanon, Omar; Frias, Rafael; Schechter, Clyde B

    2015-07-01

    Most food-environment research has focused narrowly on select stores and restaurants. There has been comparatively less attention to non-storefront food sources like farmers' markets (FMs), particularly in urban communities. The objective of the present study was to assess FMs' potential contribution to an urban food environment in terms of specific foods offered, and compare FM accessibility as well as produce variety, quality, and price to that of nearby stores. Investigators conducted a detailed cross-sectional assessment of all FMs in Bronx County, NY, and of the nearest store(s) selling produce within a half-mile walking distance (up to two stores per FM). The study included 26 FMs and 44 stores. Investigators assessed accessibility (locations of FMs and stores relative to each other, and hours of operation for each), variety (the number and type of all food items offered at FMs and all fresh produce items offered at stores), quality (where produce items were grown and if they were organic), and price (including any sales prices or promotional discounts). Analyses included frequencies, proportions, and variable distributions, as well as mixed-effect regressions, paired t-tests, and signed rank tests to compare FMs to stores. Geographic information systems (GIS) allowed for mapping of FM and store locations and determining street-network distances between them. The mean distance between FMs and the nearest store selling fresh produce was 0.15 miles (range 0.02-0.36 miles). FMs were open substantially fewer months, days, and hours than stores. FMs offered 26.4 fewer fresh produce items on average than stores (p values <0.02). FM produce items were more frequently local and organic, but often tended toward less-common/more-exotic and heirloom varieties. FMs were more expensive on average (p values <0.001 for pairwise comparisons to stores) - even for more-commonplace and "conventional" produce - especially when discounts or sales prices were considered. Fully, 32

  15. Urban Farmers' Markets: accessibility, offerings, and produce variety, quality, and price compared to nearby stores

    PubMed Central

    Maroko, Andrew; Sanon, Omar; Frias, Rafael; Schechter, Clyde B.

    2015-01-01

    Most food-environment research has focused narrowly on select stores and restaurants. There has been comparatively less attention to non-storefront food sources like farmers' markets (FMs), particularly in urban communities. The objective of the present study was to assess FMs' potential contribution to an urban food environment in terms of specific foods offered, and compare FM accessibility as well as produce variety, quality, and price to that of nearby stores. Investigators conducted a detailed cross-sectional assessment of all FMs in Bronx County, NY, and of the nearest store(s) selling produce within a half-mile walking distance (up to two stores per FM). The study included 26 FMs and 44 stores. Investigators assessed accessibility (locations of FMs and stores relative to each other, and hours of operation for each), variety (the number and type of all food items offered at FMs and all fresh produce items offered at stores), quality (where produce items were grown and if they were organic), and price (including any sales prices or promotional discounts). Analyses included frequencies, proportions, and variable distributions, as well as mixed-effect regressions, paired t-tests, and signed rank tests to compare FMs to stores. Geographic information systems (GIS) allowed for mapping of FM and store locations and determining street-network distances between them. The mean distance between FMs and the nearest store selling fresh produce was 0.15 miles (range 0.02-0.36 miles). FMs were open substantially fewer months, days, and hours than stores. FMs offered 26.4 fewer fresh produce items on average than stores (p values <0.02). FM produce items were more frequently local and organic, but often tended towards less-common/more-exotic and heirloom varieties. FMs were more expensive on average (p values <0.001 for pairwise comparisons to stores)—even for more-commonplace and “conventional” produce—especially when discounts or sales prices were considered

  16. Urban farmers' markets: accessibility, offerings, and produce variety, quality, and price compared to nearby stores.

    PubMed

    Lucan, Sean C; Maroko, Andrew R; Sanon, Omar; Frias, Rafael; Schechter, Clyde B

    2015-07-01

    Most food-environment research has focused narrowly on select stores and restaurants. There has been comparatively less attention to non-storefront food sources like farmers' markets (FMs), particularly in urban communities. The objective of the present study was to assess FMs' potential contribution to an urban food environment in terms of specific foods offered, and compare FM accessibility as well as produce variety, quality, and price to that of nearby stores. Investigators conducted a detailed cross-sectional assessment of all FMs in Bronx County, NY, and of the nearest store(s) selling produce within a half-mile walking distance (up to two stores per FM). The study included 26 FMs and 44 stores. Investigators assessed accessibility (locations of FMs and stores relative to each other, and hours of operation for each), variety (the number and type of all food items offered at FMs and all fresh produce items offered at stores), quality (where produce items were grown and if they were organic), and price (including any sales prices or promotional discounts). Analyses included frequencies, proportions, and variable distributions, as well as mixed-effect regressions, paired t-tests, and signed rank tests to compare FMs to stores. Geographic information systems (GIS) allowed for mapping of FM and store locations and determining street-network distances between them. The mean distance between FMs and the nearest store selling fresh produce was 0.15 miles (range 0.02-0.36 miles). FMs were open substantially fewer months, days, and hours than stores. FMs offered 26.4 fewer fresh produce items on average than stores (p values <0.02). FM produce items were more frequently local and organic, but often tended toward less-common/more-exotic and heirloom varieties. FMs were more expensive on average (p values <0.001 for pairwise comparisons to stores) - even for more-commonplace and "conventional" produce - especially when discounts or sales prices were considered. Fully, 32

  17. Cyberinfrastructure for Online Access to High-Quality Data: Advances and Opportunities (Invited)

    NASA Astrophysics Data System (ADS)

    Baru, C.

    2010-12-01

    Advanced cyberinfrastructure capabilities are enabling end-to-end management of data flows in observing system networks and online access to very large data archives. We provide an overview of several projects in earth and environmental sciences that have developed and deployed cyberinfrastructure for collecting and organizing field observations and remote sensing data, to make them available to a community of users. The data cyberinfrastructure framework should cover the range from data acquisition, quality control, data archiving, discovery, access, integration, and modeling. Using examples from different earth and environmental science cyberinfrastructure efforts, we will describe the state of the art in data cyberinfrastructure and future directions and challenges. The Tropical Ecology, Assessment and Monitoring (TEAM) Network (http://teamnetwork.org), which is a network of forested sites—currently consisting of 15 sites, and growing—distributed across Central America, South America, Africa, and Asia. Each site implements a standardized set of data collection protocols, all under the control of a common cyberinfrastructure. The data are available via a portal from a central site, but with appropriate access controls. The TEAM Network is run by Conservation International, in partnership with the Wildlife Conservation Society, Smithsonian Institute, and the Missouri Botanical Gardens, and is funded by the Moore Foundation. The EarthScope Data Portal (portal.earthscope.org) implements a virtual metadata catalog and a data cart to provides a means for simultaneously exploring EarthScope's various instrument networks, as well as seamlessly downloading data from multiple stations and instrument types. The prototype of the US Geoinformatics Information Network (US GIN) project is implementing a federated catalog, using the Catalog Services for Web (CSW) standard. The NSF-funded Opentopography.org—a spinoff of the GEON project, www.geongrid.org—provides online

  18. A Spectrum Access Based on Quality of Service (QoS) in Cognitive Radio Networks.

    PubMed

    Zhai, Linbo; Wang, Hua; Gao, Chuangen

    2016-01-01

    The quality of service (QoS) is important issue for cognitive radio networks. In the cognitive radio system, the licensed users, also called primary users (PUs), are authorized to utilize the wireless spectrum, while unlicensed users, also called secondary users (SUs), are not authorized to use the wireless spectrum. SUs access the wireless spectrum opportunistically when the spectrum is idle. While SUs use an idle channel, the instance that PUs come back makes SUs terminate their communications and leave the current channel. Therefore, quality of service (QoS) is difficult to be ensured for SUs. In this paper, we first propose an analysis model to obtain QoS for cognitive radio networks such as blocking probability, completed traffic and termination probability of SUs. When the primary users use the channels frequently, QoS of SUs is difficult to be ensured, especially the termination probability. Then, we propose a channel reservation scheme to improve QoS of SUs. The scheme makes the terminated SUs move to the reserved channels and keep on communications. Simulation results show that our scheme can improve QoS of SUs especially the termination probability with a little cost of blocking probability in dynamic environment. PMID:27171196

  19. A Spectrum Access Based on Quality of Service (QoS) in Cognitive Radio Networks

    PubMed Central

    Zhai, Linbo; Wang, Hua; Gao, Chuangen

    2016-01-01

    The quality of service (QoS) is important issue for cognitive radio networks. In the cognitive radio system, the licensed users, also called primary users (PUs), are authorized to utilize the wireless spectrum, while unlicensed users, also called secondary users (SUs), are not authorized to use the wireless spectrum. SUs access the wireless spectrum opportunistically when the spectrum is idle. While SUs use an idle channel, the instance that PUs come back makes SUs terminate their communications and leave the current channel. Therefore, quality of service (QoS) is difficult to be ensured for SUs. In this paper, we first propose an analysis model to obtain QoS for cognitive radio networks such as blocking probability, completed traffic and termination probability of SUs. When the primary users use the channels frequently, QoS of SUs is difficult to be ensured, especially the termination probability. Then, we propose a channel reservation scheme to improve QoS of SUs. The scheme makes the terminated SUs move to the reserved channels and keep on communications. Simulation results show that our scheme can improve QoS of SUs especially the termination probability with a little cost of blocking probability in dynamic environment. PMID:27171196

  20. Drinking water insecurity: water quality and access in coastal south-western Bangladesh.

    PubMed

    Benneyworth, Laura; Gilligan, Jonathan; Ayers, John C; Goodbred, Steven; George, Gregory; Carrico, Amanda; Karim, Md Rezaul; Akter, Farjana; Fry, David; Donato, Katherine; Piya, Bhumika

    2016-01-01

    National drinking water assessments for Bangladesh do not reflect local variability, or temporal differences. This paper reports on the findings of an interdisciplinary investigation of drinking water insecurity in a rural coastal south-western Bangladesh. Drinking water quality is assessed by comparison of locally measured concentrations to national levels and water quality criteria; resident's access to potable water and their perceptions are based on local social surveys. Residents in the study area use groundwater far less than the national average; salinity and local rainwater scarcity necessitates the use of multiple water sources throughout the year. Groundwater concentrations of arsenic and specific conductivity (SpC) were greater than surface water (pond) concentrations; there was no statistically significant seasonal difference in mean concentrations in groundwater, but there was for ponds, with arsenic higher in the dry season. Average arsenic concentrations in local water drinking were 2-4 times times the national average. All of the local groundwater samples exceeded the Bangladesh guidance for SpC, although the majority of residents surveyed did not perceive their water as having a 'bad' or 'salty' taste. PMID:27277537

  1. Public library computer training for older adults to access high-quality Internet health information.

    PubMed

    Xie, Bo; Bugg, Julie M

    2009-09-01

    An innovative experiment to develop and evaluate a public library computer training program to teach older adults to access and use high-quality Internet health information involved a productive collaboration among public libraries, the National Institute on Aging and the National Library of Medicine of the National Institutes of Health (NIH), and a Library and Information Science (LIS) academic program at a state university. One hundred and thirty-one older adults aged 54-89 participated in the study between September 2007 and July 2008. Key findings include: a) participants had overwhelmingly positive perceptions of the training program; b) after learning about two NIH websites (http://nihseniorhealth.gov and http://medlineplus.gov) from the training, many participants started using these online resources to find high quality health and medical information and, further, to guide their decision-making regarding a health- or medically-related matter; and c) computer anxiety significantly decreased (p < .001) while computer interest and efficacy significantly increased (p = .001 and p < .001, respectively) from pre- to post-training, suggesting statistically significant improvements in computer attitudes between pre- and post-training. The findings have implications for public libraries, LIS academic programs, and other organizations interested in providing similar programs in their communities.

  2. Drinking water insecurity: water quality and access in coastal south-western Bangladesh.

    PubMed

    Benneyworth, Laura; Gilligan, Jonathan; Ayers, John C; Goodbred, Steven; George, Gregory; Carrico, Amanda; Karim, Md Rezaul; Akter, Farjana; Fry, David; Donato, Katherine; Piya, Bhumika

    2016-01-01

    National drinking water assessments for Bangladesh do not reflect local variability, or temporal differences. This paper reports on the findings of an interdisciplinary investigation of drinking water insecurity in a rural coastal south-western Bangladesh. Drinking water quality is assessed by comparison of locally measured concentrations to national levels and water quality criteria; resident's access to potable water and their perceptions are based on local social surveys. Residents in the study area use groundwater far less than the national average; salinity and local rainwater scarcity necessitates the use of multiple water sources throughout the year. Groundwater concentrations of arsenic and specific conductivity (SpC) were greater than surface water (pond) concentrations; there was no statistically significant seasonal difference in mean concentrations in groundwater, but there was for ponds, with arsenic higher in the dry season. Average arsenic concentrations in local water drinking were 2-4 times times the national average. All of the local groundwater samples exceeded the Bangladesh guidance for SpC, although the majority of residents surveyed did not perceive their water as having a 'bad' or 'salty' taste.

  3. Site-specific water quality guidelines: 2. Development of a water quality regulation framework for pulse exposures of mine water discharges at a uranium mine in northern Australia.

    PubMed

    Sinclair, A; Tayler, K; van Dam, R; Hogan, A

    2014-01-01

    The Ranger Uranium Mine, in northern Australia, is monitored by the Supervising Scientist Division (SSD) of the Australian Government to ensure that it does not impact on the highly valued aquatic ecosystems of Kakadu National Park. In 2010, the SSD adopted the continuous monitoring of electrical conductivity (EC) and turbidity, in combination with event-triggered automated grab samples, as its primary water quality monitoring method. The continuous monitoring of EC has shown that mine discharges typically occur over short-term 'pulse' durations of minutes to hours. Given that magnesium (Mg) is the most likely mine-derived solute to approach or exceed the applicable water quality limit value, the focus has been on developing a pulse exposure assessment framework for Mg, as represented by its proxy EC, which is tracked by the continuous monitoring system. This study presents a possible ecotoxicologically derived Mg pulse exposure limit and trigger regulation framework for Magela and Gulungul Creeks and an assessment of historic continuous monitoring EC data from these creeks. This framework demonstrates potential to supersede the current EC guideline and associated trigger levels, which are statistically derived from historic grab sample data.

  4. Health care quality, access, cost, workforce, and surgical education: the ultimate perfect storm.

    PubMed

    Schwartz, Marshall Z

    2012-01-01

    The discussions on health care reform over the past two years have focused on cost containment while trying to maintain quality of care. Focusing on just cost and quality unfortunately does not address other very important factors that impact on our health care delivery system. Availability of a well-trained workforce, maintaining the sophisticated medical/surgical education system, and ultimately access to quality care by the public are critical to maintaining and enhancing our health care delivery system. Unfortunately, all five of these components are under at risk. Thus, we have evolving the ultimate perfect storm affecting our health care delivery system. Although not ideal and given the uniqueness of our population and their expectations, our current delivery system is excellent compared to other countries. However, the cost of our current system is rising at an alarming rate. Currently, health care consumes 17% of our gross domestic product. If our system is not revised this will continue to rise and by 2025 it will consume 48%. The dilemma, given the current state of our overall economy and rising debt, is how to address this major problem. Unfortunately, the Affordable Care Act, which is now law, does not address most of the issues and the cost was initially grossly under estimated. Furthermore, the law does not address the issues of workforce, maintaining our medical education system or ultimately, access. A major revision of our system will be necessary to truly create a system that protects and enhances all five of the components of our health care delivery system. To effectively accomplish this will require addressing those issues that lead to wasteful spending and diversion of our health care dollars to profit instead of care. Improved and efficient delivery systems that reduce complications, reduction of duplication of tertiary and quaternary programs or services within the same markets (i.e. regionalization of care), health insurance reform, and

  5. Evaluation of the cefonicid disk test criteria, including disk quality control guidelines.

    PubMed Central

    Barry, A L; Jones, R N; Thornsberry, C

    1983-01-01

    Cefonicid (SKF 75073) is a second-generation cephalosporin which has a spectrum of antimicrobial activity similar to that of cefamandole, but cefoxitin (a cephamycin) and cephalothin have uniquely different spectra of activity. The second-generation cephalosporins tested displayed comparable susceptibility to beta-lactamases and inhibited type I beta-lactamases. Although cefonicid has a longer serum half-life (3 to 4 h) compared with the currently used drugs, the same minimal inhibitory concentration breakpoints separating susceptible and resistant categories were applied to tests with cefonicid, cefamandole, and cephalothin. Regression analysis of the disk diffusion test results confirmed the use of identical zone size breakpoints for 30-micrograms cefonicid, cefamandole, and cephalothin disks: all three produced similar parabolic regression lines. Further analysis of disk test data confirmed the fact that cefonicid and cefamandole disks might be used interchangeably. But for routine tests, cefonicid disks might be preferred in order to minimize the number of very major (false-susceptible) interpretive errors. Suggested cefonicid 30-micrograms disk interpretive criteria are: susceptible, greater than or equal to 18 mm (less than or equal to 8.0 micrograms/ml), and resistant, less than or equal to 14 mm (greater than 16 micrograms/ml). Quality control zone diameter limits were calculated from data obtained in a multilaboratory collaborative study. PMID:6601113

  6. Recommendations for mass spectrometry data quality metrics for open access data(corollary to the Amsterdam principles)

    SciTech Connect

    Kingsinger, Christopher R.; Apffel, James; Baker, Mark S.; Bian, Xiaopeng; Borchers, Christoph H.; Bradshaw, Ralph A.; Brusniak, Mi-Youn; Chan, Daniel W.; Deutsch, Eric W.; Domon, Bruno; Gorman, Jeff; Grimm, Rudolf; Hancock, William S.; Hermjakob, Henning; Horn, David; Hunter, Christie; Kolar, Patrik; Kraus, Hans-Joachim; Langen, Hanno; Linding, Rune; Moritz, Robert L.; Omenn, Gilbert S.; Orlando, Ron; Pandey, Akhilesh; Ping, Peipei; Rahbar, Amir; Rivers, Robert; Seymour, Sean L.; Simpson, Richard J.; Slotta, Douglas; Smith, Richard D.; Stein, Stephen E.; Tabb, David L.; Tagle, Danilo; Yates, John R.; Rodriguez, Henry

    2011-12-01

    Policies supporting the rapid and open sharing of proteomic data are being implemented by the leading journals in the field. The proteomics community is taking steps to ensure that data are made publicly accessible and are of high quality, a challenging task that requires the development and deployment of methods for measuring and documenting data quality metrics. On September 18, 2010, the U.S. National Cancer Institute (NCI) convened the 'International Workshop on Proteomic Data Quality Metrics' in Sydney, Australia, to identify and address issues facing the development and use of such methods for open access proteomics data. The stakeholders at the workshop enumerated the key principles underlying a framework for data quality assessment in mass spectrometry data that will meet the needs of the search community, journals, funding agencies, and data repositories. Attendees discussed and agreed upon two primary needs for the wide use of quality metrics: (i)an evolving list of comprehensive quality metrics and (ii)standards accompanied by software analytics. Attendees stressed the importance of increased education and training programs to promote reliable protocols in proteomics. This workshop report explores the historic precedents, key discussions, and necessary next steps to enhance the quality of open access data. By agreement, this article is published simultaneously in Proteomics, Proteomics Clinical Applications, Journal of Proteome Research, and Molecular and Cellular Proteomics, as a public service to the research community.The peer review process was a coordinated effort conducted by a panel of referees selected by the journals.

  7. Quality assurance program guidelines for application to and use by manufacturers of rail/guideway vehicles, buses, automatic train control systems, and their major subsystems

    NASA Technical Reports Server (NTRS)

    Witkin, S. A.

    1976-01-01

    Guidelines are presented for a quality assurance system to be implemented by the manufacturer in support of designing, developing, fabricating, assembling, inspecting, testing, handling, and delivery of equipment being procured for use in public urban mass transit systems. The guidelines apply to this equipment when being procured for: (1) use in revenue service; (2) demonstration of systems that will be revenue producing or used by the public; (3) use as a prototype for follow-on operational/revenue producing equipment procurements; and (4) qualification tests.

  8. Applying a developmental approach to quality of life assessment in children and adolescents with psychological disorders: challenges and guidelines.

    PubMed

    Carona, Carlos; Silva, Neuza; Moreira, Helena

    2015-02-01

    Research on the quality of life (QL) of children/adolescents with psychological disorders has flourished over the last few decades. Given the developmental challenges of QL measurements in pediatric populations, the aim of this study was to ascertain the extent to which a developmental approach to QL assessment has been applied to pedopsychiatric QL research. A systematic literature search was conducted in three electronic databases (PubMed, PsycINFO, SocINDEX) from 1994 to May 2014. Quantitative studies were included if they assessed the self- or proxy-reported QL of children/adolescents with a psychological disorder. Data were extracted for study design, participants, QL instruments and informants, and statistical approach to age-related specificities. The systematic review revealed widespread utilization of developmentally appropriate QL instruments but less frequent use of both self and proxy reports and an inconsistent approach to age group specificities. Methodological guidelines are discussed to improve the developmental validity of QL research for children/adolescents with mental disorders.

  9. Multigeneration zinc acclimation and tolerance in Daphnia magna: implications for water-quality guidelines and ecological risk assessment.

    PubMed

    Muyssen, B T; Janssen, C R

    2001-09-01

    Development of zinc tolerance is described for the cladoceran Daphnia magna Straus. Zinc tolerance (i.e., toxicity and deficiency) was monitored during successive generations of D. magna acclimated to different zinc concentrations. Survival, reproduction, carapax length measurements, and cellular energy allocation assessments were used as test endpoints. Special attention was paid to the consequences of zinc deficiency. The zinc acclimation concentration clearly influenced the overall fitness of the organism. After several generations of acclimation, an optimal concentration curve was observed, with an optimum zinc concentration between 300 and 450 microg/L. Zinc deficiency resulted in a lower zinc tolerance, a higher coefficient of variation for brood size, and an increased pH sensitivity. These results clearly indicate that (background) zinc concentrations present in test and culture media have to be considered in the evaluation of toxicity test results, especially when the toxicity data are used for water-quality guideline derivation and/or ecological risk assessment. Culture and test media containing very little or no zinc do not provide a basis for useful ecotoxicological data. PMID:11521834

  10. Evidence-Based Practice Guidelines and School Nursing

    ERIC Educational Resources Information Center

    Adams, Susan; McCarthy, Ann Marie

    2007-01-01

    The use of evidence-based practice (EBP) has become the standard of health care practice. Nurses are expected to use best evidence on a wide range of topics, yet most nurses have limited time, resources, and/or skills to access and evaluate the quality of research and evidence needed to practice evidence-based nursing. EBP guidelines allow nurses…

  11. Evaluating the Good Ontology Design Guideline (GoodOD) with the Ontology Quality Requirements and Evaluation Method and Metrics (OQuaRE)

    PubMed Central

    Duque-Ramos, Astrid; Boeker, Martin; Jansen, Ludger; Schulz, Stefan; Iniesta, Miguela; Fernández-Breis, Jesualdo Tomás

    2014-01-01

    Objective To (1) evaluate the GoodOD guideline for ontology development by applying the OQuaRE evaluation method and metrics to the ontology artefacts that were produced by students in a randomized controlled trial, and (2) informally compare the OQuaRE evaluation method with gold standard and competency questions based evaluation methods, respectively. Background In the last decades many methods for ontology construction and ontology evaluation have been proposed. However, none of them has become a standard and there is no empirical evidence of comparative evaluation of such methods. This paper brings together GoodOD and OQuaRE. GoodOD is a guideline for developing robust ontologies. It was previously evaluated in a randomized controlled trial employing metrics based on gold standard ontologies and competency questions as outcome parameters. OQuaRE is a method for ontology quality evaluation which adapts the SQuaRE standard for software product quality to ontologies and has been successfully used for evaluating the quality of ontologies. Methods In this paper, we evaluate the effect of training in ontology construction based on the GoodOD guideline within the OQuaRE quality evaluation framework and compare the results with those obtained for the previous studies based on the same data. Results Our results show a significant effect of the GoodOD training over developed ontologies by topics: (a) a highly significant effect was detected in three topics from the analysis of the ontologies of untrained and trained students; (b) both positive and negative training effects with respect to the gold standard were found for five topics. Conclusion The GoodOD guideline had a significant effect over the quality of the ontologies developed. Our results show that GoodOD ontologies can be effectively evaluated using OQuaRE and that OQuaRE is able to provide additional useful information about the quality of the GoodOD ontologies. PMID:25148262

  12. Informal economic activities of public health workers in Uganda: implications for quality and accessibility of care.

    PubMed

    McPake, B; Asiimwe, D; Mwesigye, F; Ofumbi, M; Ortenblad, L; Streefland, P; Turinde, A

    1999-10-01

    This paper reports the results of a study in Uganda of the 'informal' economic activities of health workers, defined as those which earn incomes but fall outside official duties and earnings. The study was carried out in 10 sub-hospital health facilities of varying size and intended role and used a variety of quantitative and qualitative methods. The paper focuses on those activities which are carried out inside public health facilities and which directly affect quality and accessibility of care. The main strategies in this category were the leakage of drug supply, the informal charging of patients and the mismanagement of revenues raised from the formal charging of patients. Few of the drugs supplied to health units were prescribed and issued in those sites. Most health workers who have the opportunity to do so, levy informal charges. Where formal charges are collected, high levels of leakage occur both at the point of collection and at higher levels of the system. The implications of this situation for the quality and accessibility of services in public health facilities were assessed. Utilisation levels are less than those expected of the smallest rural units and this workload is managed by a handful of the expected staff complement who are available for a fraction of the working week. Even given these few patients, drugs available after leakage were sufficient to cover less than half of those attending in most facilities. Evidence on staff motivation was mixed and better motivation was associated with better performance only in a minority of units. Informal charging was associated with better performance regarding hours worked by health workers and utilisation rates. Drug leakage was associated with worse performance with respect to both of these and unsurprisingly, with drug availability. Short term strategies to effect marginal performance improvements may focus on the substitution of strategies based inside health units (such as informal charging) for those

  13. World Wide Access: Accessible Web Design.

    ERIC Educational Resources Information Center

    Washington Univ., Seattle.

    This brief paper considers the application of "universal design" principles to Web page design in order to increase accessibility for people with disabilities. Suggestions are based on the World Wide Web Consortium's accessibility initiative, which has proposed guidelines for all Web authors and federal government standards. Seven guidelines for…

  14. Quality, bias and service user experience in healthcare: 10 years of mental health guidelines at the UK National Collaborating Centre for Mental Health.

    PubMed

    Kendall, Tim; Glover, Naomi; Taylor, Clare; Pilling, Stephen

    2011-08-01

    The guideline programme developed by the National Collaborating Centre for Mental Health (NCCMH) for the National Institute for Health and Clinical Excellence (NICE) is probably the most comprehensive and methodologically advanced mental health guideline programme in the world, covering most adults and children with mental health problems and addressing a broad range of pharmacological and psychological/psychosocial interventions. As the success of the NICE programme gains momentum, its influence in the National Health Service (NHS) grows. If guidelines contain systematic bias the effects will be widespread. Over the last 10 years the NCCMH has recognized imperfections and patterns of bias in the way that evidence is generated and included in guidelines, including psychological/psychosocial interventions and drug treatments. The pharmaceutical industry remains a major source of bias through selective reporting and publishing, and represents a threat to ensuring the evidence underpinning guidelines and clinical decision-making is as complete and reliable as possible. The inclusion of service users into guideline development at the NCCMH has developed in parallel to the identification and understanding of evidential bias, and is now becoming an important focus for high-quality guidelines which are becoming increasingly person-centred. For mental health this is as radical as the integration of psychological/psychosocial treatments into what has, for many years, been a largely medical domain. The future role of service users in monitoring their own experience of care and ensuring that trusts are accountable to them is now a real possibility and is likely to have an impact upon the traditional power relations in mental health and the stigma usually associated with psychiatric problems.

  15. Defining the Utility of Clinically Acceptable Variations in Evidence-Based Practice Guidelines for Evaluation of Quality Improvement Activities.

    ERIC Educational Resources Information Center

    Lescoe-Long, Mary; Long, Michael J.

    1999-01-01

    Examined the usefulness of systematically accounting for acceptable physician variations in guideline application. Review of 141 cases of treatment of acute myocardial infarction in a Canadian hospital show that even seemingly noncontentious guideline protocols do not offer a threshold of variation similar to conventional Continuous Quality…

  16. Interprofessional collaborative model for medication therapy management (MTM) services to improve health care access and quality for underserved populations.

    PubMed

    Truong, Hoai-An; Groves, C Nicole; Congdon, Heather Brennan; Botchway, Rosemary; Dang, Diem-Thanh Tanya; Clark, Nancy Ripp; Zarfeshan, Faramarz

    2012-08-01

    As part of the Health Resources and Services Administration Patient Safety and Clinical Pharmacy Services Collaborative (PSPC), an interprofessional model with medication therapy management documentation and outcomes tracking tools (MTM-DOTT) is established to improve health care access and quality for underserved populations. Despite limitations, there have been positive outcomes and national recognitions.

  17. How Do Members of Different Stakeholder Groups Balance Concerns for Increasing Access with Improving Quality in the Tanzania Education System?

    ERIC Educational Resources Information Center

    Telli, Godfrey

    2012-01-01

    The purpose of this study was to explore how education stakeholders in Tanzania express and balance their priorities, perspectives, and concerns regarding the expansion of education access on the one hand, and improving quality of education on the other, as a means to enhance educational achievement. The study also explores how each group of…

  18. FACILITATING ADVANCED URBAN METEOROLOGY AND AIR QUALITY MODELING CAPABILITIES WITH HIGH RESOLUTION URBAN DATABASE AND ACCESS PORTAL TOOLS

    EPA Science Inventory

    Information of urban morphological features at high resolution is needed to properly model and characterize the meteorological and air quality fields in urban areas. We describe a new project called National Urban Database with Access Portal Tool, (NUDAPT) that addresses this nee...

  19. Designing to Promote Access, Quality, and Student Support in an Advanced Certificate Programme for Rural Teachers in South Africa

    ERIC Educational Resources Information Center

    Fresen, Jill W.; Hendrikz, Johan

    2009-01-01

    This paper reports on the re-design of the Advanced Certificate in Education (ACE) programme, which is offered by the University of Pretoria through distance education (DE) to teachers in rural South Africa. In 2007, a team re-designed the programme with the goal of promoting access, quality, and student support. The team included an independent…

  20. Guidelines for prevention in psychology.

    PubMed

    2014-04-01

    The effectiveness of prevention to enhance human functioning and reduce psychological distress has been demonstrated. From infancy through adulthood, access to preventive services and interventions is important to improve the quality of life and human functioning and reduce illness and premature death. The importance of prevention is consistent with the Patient Protection and Affordable Care Act of 2010. Even with the increased focus on prevention, psychology training programs rarely require specific courses on prevention. In particular, conceptualizations about best practices in prevention, particularly at the environmental level, are lacking. Therefore, psychologists engaged in prevention can benefit from a set of guidelines that address and inform prevention practices. Accordingly, the Guidelines for Prevention in Psychology are intended to "inform psychologists, the public, and other interested parties regarding desirable professional practices" in prevention. The Prevention Guidelines are recommended based on their potential benefits to the public and the professional practice of psychology. They support prevention as an important area of practice, research, and training for psychologists. The Guidelines give increased attention to prevention within APA, encouraging psychologists to become involved with preventive activities relevant to their area of practice. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  1. Linguistic acculturation and perceptions of quality, access, and discrimination in health care among Latinos in the United States.

    PubMed

    Becerra, David; Androff, David; Messing, Jill T; Castillo, Jason; Cimino, Andrea

    2015-01-01

    This study examined the relationship between acculturation and Latinos' perceptions of health care treatment quality, discrimination, and access to health information. The results of this study indicated that participants who had lower levels of acculturation perceived: 1) greater discrimination in health care treatment; 2) a lower quality of health care treatment; 3) less confidence filling out health related forms; and 4) greater challenges understanding written information about their medical conditions. Participants who identified as immigrants also perceived that their poor quality of medical care was due to their inability to pay and to their race/ethnicity.

  2. Guidelines for Home Energy Professionals

    SciTech Connect

    2011-12-16

    The U.S. Department of Energy's (DOE's) Guidelines for Home Energy Professionals project (hereafter the Guidelines) fosters the growth of a high quality residential energy upgrade industry and a skilled and credentialed workforce.

  3. Payment mechanisms and the composition of physician practices: balancing cost-containment, access, and quality of care.

    PubMed

    Barham, Victoria; Milliken, Olga

    2015-07-01

    We take explicit account of the way in which the supply of physicians and patients in the economy affects the design of physician remuneration schemes, highlighting the three-way trade-off between quality of care, access, and cost. Both physicians and patients are heterogeneous. Physicians choose both the number of patients and the quality of care to provide to their patients. When determining physician payment rates, the principal must ensure access to care for all patients. When physicians can adjust the number of patients seen, there is no incentive to over-treat. In contrast, altruistic physicians always quality stint: they prefer to add an additional patient, rather than to increase the quality of service provided. A mixed payment mechanism does not increase the quality of service provided with respect to capitation. Offering a menu of compensation schemes may constitute a cost-effective strategy for inducing physicians to choose a given overall caseload but may also generate difficulties with access to care for frail patients. PMID:24990110

  4. California hospital networks are narrower in Marketplace than in commercial plans, but access and quality are similar.

    PubMed

    Haeder, Simon F; Weimer, David L; Mukamel, Dana B

    2015-05-01

    Do insurance plans offered through the Marketplace implemented by the State of California under the Affordable Care Act restrict consumers' access to hospitals relative to plans offered on the commercial market? And are the hospitals included in Marketplace networks of lower quality compared to those included in the commercial plans? To answer these questions, we analyzed differences in hospital networks across similar plan types offered both in the Marketplace and commercially, by region and insurer. We found that the common belief that Marketplace plans have narrower networks than their commercial counterparts appears empirically valid. However, there does not appear to be a substantive difference in geographic access as measured by the percentage of people residing in at least one hospital market area. More surprisingly, depending on the measure of hospital quality employed, the Marketplace plans have networks with comparable or even higher average quality than the networks of their commercial counterparts.

  5. Macroscopic characterisations of Web accessibility

    NASA Astrophysics Data System (ADS)

    Lopes, Rui; Carriço, Luis

    2010-12-01

    The Web Science framework poses fundamental questions on the analysis of the Web, by focusing on how microscopic properties (e.g. at the level of a Web page or Web site) emerge into macroscopic properties and phenomena. One research topic on the analysis of the Web is Web accessibility evaluation, which centres on understanding how accessible a Web page is for people with disabilities. However, when framing Web accessibility evaluation on Web Science, we have found that existing research stays at the microscopic level. This article presents an experimental study on framing Web accessibility evaluation into Web Science's goals. This study resulted in novel accessibility properties of the Web not found at microscopic levels, as well as of Web accessibility evaluation processes themselves. We observed at large scale some of the empirical knowledge on how accessibility is perceived by designers and developers, such as the disparity of interpretations of accessibility evaluation tools warnings. We also found a direct relation between accessibility quality and Web page complexity. We provide a set of guidelines for designing Web pages, education on Web accessibility, as well as on the computational limits of large-scale Web accessibility evaluations.

  6. Nanometals induce stress and alter thyroid hormone action in amphibia at or below North American water quality guidelines.

    PubMed

    Hinther, Ashley; Vawda, Saadia; Skirrow, Rachel C; Veldhoen, Nik; Collins, Patricia; Cullen, Jay T; van Aggelen, Graham; Helbing, Caren C

    2010-11-01

    Nanometals are manufactured to particle sizes with diameters in the nanometer range and are included in a variety of consumer and health products. There is a lack of information regarding potential effects of these materials on aquatic organisms. Amphibians are regarded as environmental sentinels and demonstrate an exquisite sensitivity to thyroid hormone action, a hormone that is essential for human health. This present study assessed the effect of exposure to nanometals on stress and thyroid hormone signaling in frog tissue using a cultured tail fin biopsy (C-fin) assay derived from Rana catesbeiana tadpoles. The C-fin assay maintains tissue complexity and biological replication while multiple chemical responses can be assessed from the same individual. We tested the ability of nanosilver (0.06 μg/L-5.5 mg/L), quantum dots (0.25 μg/L-22 mg/L), and nanozinc oxide (0.19-10 mg/L) to alter gene expression in the presence or absence of 3,3',5'-triiodothyronine (T(3)) using quantitative real-time polymerase chain reaction. Results were compared to exposure to micrometer-silver, silver nitrate, and micrometer-cadmium telluride. Nanosilver (≥2.75 mg/L) and quantum dots (≥0.22 mg/L) altered the expression of transcripts linked to T(3)- and stress-mediated pathways, while nanozinc oxide had no effect. Lower concentrations of nanosilver (0.6 to 550 μg/L) perturbed T(3)-mediated signaling while not inducing cell stress. The observed effects were orders of magnitude below acute toxicity levels and occurred at or below the current North American water quality guidelines for metals, underscoring the need for evaluating nanoparticles separately from their constituent chemicals. PMID:20929207

  7. Implementation workshop of WHO guidelines on evaluation of malaria vaccines: Current regulatory concepts and issues related to vaccine quality, Pretoria, South Africa 07 Nov 2014.

    PubMed

    Ho, Mei Mei; Baca-Estrada, Maria; Conrad, Christoph; Karikari-Boateng, Eric; Kang, Hye-Na

    2015-08-26

    The current World Health Organization (WHO) guidelines on the quality, safety and efficacy of recombinant malaria vaccines targeting the pre-erythrocytic and blood stages of Plasmodium falciparum were adopted by the WHO Expert Committee on Biological Standardization in 2012 to provide guidance on the quality, nonclinical and clinical aspects of recombinant malaria vaccines. A WHO workshop was organised to facilitate implementation into African (national/regional) regulatory practices, of the regulatory evaluation principles outlined in the guidelines regarding quality aspects. The workshop was used also to share knowledge and experience on regulatory topics of chemistry, manufacturing and control with a focus on vaccines through presentations and an interactive discussion using a case study approach. The basic principles and concepts of vaccine quality including consistency of production, quality control and manufacturing process were presented and discussed in the meeting. By reviewing and practicing a case study, better understanding on the relationship between consistency of production and batch release tests of an adjuvanted pre-erythrocytic recombinant malaria vaccine was reached. The case study exercise was considered very useful to understand regulatory evaluation principles of vaccines and a suggestion was made to WHO to provide such practices also through its Global Learning Opportunities for Vaccine Quality programme.

  8. Access and Quality of HIV-Related Point-of-Care Diagnostic Testing in Global Health Programs.

    PubMed

    Fonjungo, Peter N; Boeras, Debrah I; Zeh, Clement; Alexander, Heather; Parekh, Bharat S; Nkengasong, John N

    2016-02-01

    Access to point-of-care testing (POCT) improves patient care, especially in resource-limited settings where laboratory infrastructure is poor and the bulk of the population lives in rural settings. However, because of challenges in rolling out the technology and weak quality assurance measures, the promise of human immunodeficiency virus (HIV)-related POCT in resource-limited settings has not been fully exploited to improve patient care and impact public health. Because of these challenges, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in partnership with other organizations, recently launched the Diagnostics Access Initiative. Expanding HIV programs, including the "test and treat" strategies and the newly established UNAIDS 90-90-90 targets, will require increased access to reliable and accurate POCT results. In this review, we examine various components that could improve access and uptake of quality-assured POC tests to ensure coverage and public health impact. These components include evaluation, policy, regulation, and innovative approaches to strengthen the quality of POCT. PMID:26423384

  9. Improving the Quality of and Access to HIV Rapid Testing in the Caribbean Region: Program Implementation, Outcomes, and Recommendations.

    PubMed

    Alemnji, George; Guevara, Giselle; Parris, Keith; Kalou, Mireille; Behel, Stephanie; Parekh, Bharat; Nkengasong, John; Albalak, Rachel

    2016-09-01

    In 2008, HIV rapid testing (HIV RT) was only minimally used in the Caribbean region. Collaboration with countries and international partners since then has resulted in greater availability and use of HIV RT services. Surveys were conducted in 2012 and 2014 among 11 selected Caribbean countries to inform stakeholders of progress made since 2008 and to identify strategies to further improve access and uptake of high-quality HIV RT in community- and facility-based settings in support of the UNAIDS 90-90-90 targets. Key accomplishments during this period include (1) presence of in-country national HIV RT algorithms, (2) use of the dried tube specimen (DTS) as an external quality assessment (EQA) program, (3) use of standardized logbooks for data collection and monitoring, and (4) use of oral fluid for HIV RT, particularly for key population surveys. Although progress has been made since 2008 to increase access and improve the quality of HIV RT among countries in the Caribbean, some work remains to be done. This includes the development of new policies and implementation of existing ones, task shifting, quality and access to testing, testing strategies, and integration of HIV RT into HIV Testing Services.

  10. Water Quality vs. Sanitation Accessibility: What is the most effective intervention point for preventing cholera in Dhaka, Bangladesh?

    NASA Astrophysics Data System (ADS)

    Majumder, M. S.; Gute, D.; Faruque, A. S.

    2011-12-01

    Every year, 3 to 5 million individuals contract cholera, an acute diarrheal infection that is caused by the ingestion of food or water containing the Vibrio cholerae bacterium. Because cholera is a waterborne disease, it can be transmitted quickly in environments with inadequate water and sanitation systems where infected waste can easily pollute drinking water. Today, Bangladesh continues to struggle with endemic cholera. Donor organizations address water and sanitation via localized initiatives, including the installation of community water collection sites (i.e. tubewells; water-boiling points; etc.). At this small-scale level, water quality and sanitation accessibility can be improved independently of one another, and when resources are limited, donors must invest in the most effective disease prevention options. This study used laboratory-confirmed cholera incidence data (2000-2009) collected by the International Centre of Diarrheal Disease Research, Bangladesh at their on-site hospital to compare the efficacy of interventions addressing water quality versus sanitation accessibility in Dhaka, Bangladesh. Data regarding use of sanitary latrines and boiling of drinking water were extracted from sequential patient interviews conducted at the Dhaka facility and used as surrogate variables for sanitation accessibility and water quality respectively. Our analysis indicates that boiling water is 10 times more effective at preventing cholera than the use of a sanitary latrine. This finding suggests that regulating water quality is perhaps more critical to cholera prevention than increasing sanitation accessibility in an urban environment like that of Dhaka. At present, WaterAid - one of Bangladesh's most significant water and sanitation donor organizations - invests the majority of its budget on improving sanitation accessibility. The World Health Organization and the United Nations Millennium Development Goals also prioritize sanitation accessibility. However, in

  11. Access, Cost and Quality: Tensions in the Development of Primary Education in Kenya

    ERIC Educational Resources Information Center

    Somerset, Anthony

    2011-01-01

    Throughout Kenya's history, tensions between two goals have characterised the educational policy debate: first, the expansion of access; second, the containment of costs. During the colonial period, cost-containment predominated, leading to severe restrictions on access and massive unmet social demand. Then, during post-Independence years,…

  12. Accessibility versus quality of care plus retention: the formula for service delivery in Australian opioid replacement therapy?

    PubMed

    Harlow, Warren; Roman, Marian W; Happell, Brenda; Browne, Graeme

    2013-09-01

    The aim of this paper is to investigate how Australian Opioid Replacement Therapy (ORT) policy influences access to ORT treatment, including the resources required for implementation. In doing so, we also compare the accessibility of ORT treatment in Australia (AU) with ORT in the United Kingdom (UK) and United States (US). A review of government data and policy that influence service delivery was undertaken. When comparing across AU, the UK, and the US, we found several differences. To improve access to treatment in Australia more general practitioners need to provide ORT. Additionally, criteria for quality care, a centralised intake system, a national ORT treatment outcome measure, and a shift towards a recovery focus are recommended.

  13. Interactive effects of carbon footprint information and its accessibility on value and subjective qualities of food products.

    PubMed

    Kimura, Atsushi; Wada, Yuji; Kamada, Akiko; Masuda, Tomohiro; Okamoto, Masako; Goto, Sho-ichi; Tsuzuki, Daisuke; Cai, Dongsheng; Oka, Takashi; Dan, Ippeita

    2010-10-01

    We aimed to explore the interactive effects of the accessibility of information and the degree of carbon footprint score on consumers' value judgments of food products. Participants (n=151, undergraduate students in Japan) rated their maximum willingness to pay (WTP) for four food products varying in information accessibility (active-search or read-only conditions) and in carbon footprint values (low, middle, high, or non-display) provided. We also assessed further effects of information accessibly and carbon footprint value on other product attributes utilizing the subjective estimation of taste, quality, healthiness, and environmental friendliness. Results of the experiment demonstrated an interactive effect of information accessibility and the degree of carbon emission on consumer valuation of carbon footprint-labeled food. The carbon footprint value had a stronger impact on participants' WTP in the active-search condition than in the read-only condition. Similar to WTP, the results of the subjective ratings for product qualities also exhibited an interactive effect of the two factors on the rating of environmental friendliness for products. These results imply that the perceived environmental friendliness inferable from a carbon footprint label contributes to creating value for a food product.

  14. An Assessment of Female Prisoners’ Perception of the Accessibility of Quality Healthcare: A Survey in the Kumasi Central Prisons, Ghana

    PubMed Central

    Sarpong, AA; Otupiri, E; Yeboah-Awudzi, K; Osei-Yeboah, J; Berchie, GO; Ephraim, RKD

    2015-01-01

    Background: Accessibility of quality healthcare across the globe has generated a lot of attention among public health practitioners. Aim: This study explored the background characteristics of female prisoners and how it influences their assessment of the quality of accessible healthcare in the Kumasi Female Prison. Subjects and Methods: This descriptive cross-sectional survey was conducted at the Female section of the Kumasi Central Prisons from June to December 2011. We used pretested questionnaires to obtain quantitative data from all 39 inmates of the female Prisons. An in-depth interview was used to obtain qualitative data from the prison healthcare giver. Data were analyzed with Epi Info Version 3.5.1, (Centers for Disease Control and Prevention), Excel, and Graph Pad Prism version 5.00 for Windows (Graph Pad software, San Diego California USA, www.graphpad.com). Results: Using a 12-point scale inventory questionnaire, inmates with no formal education gave the highest mean health provision assessment score (6.0) whereas those with tertiary education gave the lowest (4.5). Females serving prison sentences gave the highest mean health assessment score whereas remand prisoners gave the lowest. Single females’ mean health assessment score was 5.7 whereas that of married inmates was 4.9. Unemployed inmates scored 5.8, informal 5.4 while civil servants scored 5.0. Conclusion: Access to quality healthcare was poor and demographic characteristics, marital status, educational background, and occupation influenced inmates’ perceptions of accessibility to quality healthcare. Inmates should be encouraged to be proactive in seeking healthcare irrespective of their background characteristics. PMID:26097759

  15. Liposomal Nasal Spray versus Guideline-Recommended Steroid Nasal Spray in Patients with Chronic Rhinosinusitis: A Comparison of Tolerability and Quality of Life

    PubMed Central

    Eitenmüller, Anna; Böhm, Myriam; Glowania, Andreas; Pfaar, Oliver; Mösges, Ralph; Klimek, Ludger

    2014-01-01

    Objective. To investigate the tolerability and impact on quality of life of liposomal nasal spray compared to guideline-recommended steroid-based therapy in patients with chronic rhinosinusitis. Symptom reduction and use of antisymptomatic medication were also examined. Methods. In this monocenter, prospective, controlled, open, and noninterventional study, 60 patients with chronic rhinosinusitis were treated with liposomal nasal spray and 30 patients received steroid-based therapy. The study comprised five visits occurring at intervals of two to four weeks. Efficacy was determined according to the sinusitis symptom score documented daily. The polyp score was recorded at the initial and final visits. Tolerability was determined through the Nasal Spray Evaluation Questionnaire, and quality of life was ascertained with the SNOT-20 Score. Results. Both treatments achieved a significant reduction of sinusitis symptoms (P < 0.05) and also rhinoscopic improvement (P < 0.05). The majority of patients assessed the treatments as “good” or “very good,” and the quality of life improved significantly (P < 0.05). There was no significant difference in symptom reduction, QoL, and endoscopic exams between both treatments. Conclusion. The treatment of chronic rhinosinusitis with liposomal nasal spray results in a similar, significant reduction of symptoms and significant improvement in quality of life as guideline-recommended treatment and is therefore a comparable alternative. PMID:24963305

  16. A method to derive the relationship between the annual and short-term air quality limits--analysis using the WHO Air Quality Guidelines for health protection.

    PubMed

    Lai, Hak-Kan; Hedley, Anthony J; Thach, Thuan-Quoc; Wong, Chit-Ming

    2013-09-01

    The World Health Organization (WHO) Air Quality Guidelines (AQG) were launched in 2006, but gaps remain in evidence on health impacts and relationships between short-term and annual AQG needed for health protection. We tested whether relationships between WHO short-term and annual AQG for particulates (PM10 and PM2.5) and nitrogen dioxide (NO2) are concordant worldwide and derived the annual limits for sulfur dioxide (SO2) and ozone (O3) based on the short-term AQG. We obtained air pollutant data over seven years (2004-2010) in seven cities from Asia-Pacific, North America and Europe. Based on probability distribution concept using maximum as the short-term limit and arithmetic mean as the annual limit, we developed a new method to derive limit value one from another in each paired limits for each pollutant with capability to account for allowable exceedances. We averaged the limit derived each year for each city, then used meta-analysis to pool the limit values in all cities. Pooled mean short-term limit for NO2 (140.5μg/m(3) [130.6-150.4]) was significantly lower than the WHO AQG of 200μg/m(3) while for PM10 (46.4μg/m(3) [95CI:42.1-50.7]) and PM2.5 (28.6μg/m(3) [24.5-32.6]) were not significantly different from the WHO AQG of 50 and 25μg/m(3) respectively. Pooled mean annual limits for SO2 and O3 were 4.6μg/m(3) [3.7-5.5] and 27.0μg/m(3) [21.7-32.2] respectively. Results were robust in various sensitivity analyses. The distribution relationships between the current WHO short-term and annual AQG are supported by empirical data from seven cities for PM10 and PM2.5, but not for NO2. The short-term AQG for NO2 should be lowered for concordance with the selected annual AQG for health protection. PMID:23792417

  17. Critical appraisal of clinical guidelines.

    PubMed

    Netsch, Debra S; Kluesner, Jean A

    2010-01-01

    Utilization of clinical guidelines is gaining in popularity due to their significant impact on clinical practice. While a plethora of guidelines exist, many are lacking in quality, based on current critical appraisal standards. It then becomes necessary for the end users of the guidelines to adopt or develop those that are deemed adequate for implementation. This often requires that users possess critical appraisal skills as they become proficient in discerning between guidelines of varying quality. This article provides direction and tools to support the critical appraisal process in the adoption of clinical guidelines. PMID:20838314

  18. 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

  19. The impact of cattle access on ecological water quality in streams: Examples from agricultural catchments within Ireland.

    PubMed

    Conroy, E; Turner, J N; Rymszewicz, A; O'Sullivan, J J; Bruen, M; Lawler, D; Lally, H; Kelly-Quinn, M

    2016-03-15

    Unrestricted cattle access to rivers and streams represent a potentially significant localised pressure on freshwater systems. However there is no consensus in the literature on the occurrence and extent of impact and limited research has examined the effects on aquatic biota in the humid temperate environment examined in the present study. Furthermore, this is one of the first times that research consider the potential for cattle access impacts in streams of varying water quality in Northern Europe. We investigated the effects of cattle access on macroinvertebrate communities and deposited fine sediment levels, in four rivers of high/good and four rivers of moderate water quality status which drain, low gradient, calcareous grassland catchments in Ireland. We assessed the temporal variability in macroinvertebrates communities across two seasons, spring and autumn. Site specific impacts were evident which appeared to be influenced by water quality status and season. All four high/good water status rivers revealed significant downstream changes in community structure and at least two univariate metrics (total richness and EPT richness together with taxon, E and EPT abundance). Two of the four moderate water status rivers showed significant changes in community structure, abundance and richness metrics and functional feeding groups driven in the main by downstream increases in collectors/gatherers, shredders and burrowing taxa. These two moderate water status rivers had high or prolonged livestock activity. In view of these findings, the potential for some of these sites to achieve at least high/good water quality status, as set out in the EU Water Framework Directive, may be compromised. The results presented highlight the need for additional research to further define the site specific factors and livestock management practices, under different discharge conditions, that increase the risk of impact on aquatic ecology due to these cattle-river interactions.

  20. The impact of cattle access on ecological water quality in streams: Examples from agricultural catchments within Ireland.

    PubMed

    Conroy, E; Turner, J N; Rymszewicz, A; O'Sullivan, J J; Bruen, M; Lawler, D; Lally, H; Kelly-Quinn, M

    2016-03-15

    Unrestricted cattle access to rivers and streams represent a potentially significant localised pressure on freshwater systems. However there is no consensus in the literature on the occurrence and extent of impact and limited research has examined the effects on aquatic biota in the humid temperate environment examined in the present study. Furthermore, this is one of the first times that research consider the potential for cattle access impacts in streams of varying water quality in Northern Europe. We investigated the effects of cattle access on macroinvertebrate communities and deposited fine sediment levels, in four rivers of high/good and four rivers of moderate water quality status which drain, low gradient, calcareous grassland catchments in Ireland. We assessed the temporal variability in macroinvertebrates communities across two seasons, spring and autumn. Site specific impacts were evident which appeared to be influenced by water quality status and season. All four high/good water status rivers revealed significant downstream changes in community structure and at least two univariate metrics (total richness and EPT richness together with taxon, E and EPT abundance). Two of the four moderate water status rivers showed significant changes in community structure, abundance and richness metrics and functional feeding groups driven in the main by downstream increases in collectors/gatherers, shredders and burrowing taxa. These two moderate water status rivers had high or prolonged livestock activity. In view of these findings, the potential for some of these sites to achieve at least high/good water quality status, as set out in the EU Water Framework Directive, may be compromised. The results presented highlight the need for additional research to further define the site specific factors and livestock management practices, under different discharge conditions, that increase the risk of impact on aquatic ecology due to these cattle-river interactions. PMID

  1. Free open access medical education can help rural clinicians deliver 'quality care, out there'.

    PubMed

    Leeuwenburg, Tim J; Parker, Casey

    2015-01-01

    Rural clinicians require expertise across a broad range of specialties, presenting difficulty in maintaining currency of knowledge and application of best practice. Free open access medical education is a new paradigm in continuing professional education. Use of the internet and social media allows a globally accessible crowd-sourced adjunct, providing inline (contextual) and offline (asynchronous) content to augment traditional educational principles and the availability of relevant resources for life-long learning. This markedly reduces knowledge translation (the delay from inception of a new idea to bedside implementation) and allows rural clinicians to further expertise by engaging in discussion of cutting edge concepts with peers worldwide. PMID:26278340

  2. [Suicide prevention: guidelines for timely and well-organised help].

    PubMed

    Kerkhof, Ad J F M; van Hemert, Albert M

    2013-01-01

    In the Netherlands, guidelines for the diagnosis and treatment of suicidal behaviour and a quality paper on the continuity of care have recently been published. In the United Kingdom, adherence to a similar guideline was associated with a lower suicide rate. General practitioners and mental health workers need to be systematically educated and trained in the application of the guideline. Because the majority of victims who die by suicide are not under any type of medical supervision, close relatives and friends as well as 'gatekeepers' should become involved in its prevention. Relatives and friends need to have access to relevant information and receive support for their suspicions and questions. The general practitioner and the Internet play important roles in this regard. Budget cuts that affect access to acute mental health care have an adverse impact on suicide rates. PMID:23890165

  3. Housing Quality and Access to Material and Learning Resources within the Home Environment in Developing Countries

    ERIC Educational Resources Information Center

    Bradley, Robert H.; Putnick, Diane L.

    2012-01-01

    This study examined home environment conditions (housing quality, material resources, formal and informal learning materials) and their relations with the Human Development Index (HDI) in 28 developing countries. Home environment conditions in these countries varied widely. The quality of housing and availability of material resources at home were…

  4. Quality of qualitative research in the health sciences: Analysis of the common criteria present in 58 assessment guidelines by expert users.

    PubMed

    Santiago-Delefosse, M; Gavin, A; Bruchez, C; Roux, P; Stephen, S L

    2016-01-01

    The number of qualitative research methods has grown substantially over the last thirty years, both in social sciences and, more recently, in health sciences. This growth came with questions on the quality criteria needed to evaluate this work, and numerous guidelines were published. These guidelines, however, include many discrepancies, both in terms of vocabulary and structure. Many expert evaluators also decry the absence of consensual and reliable evaluation tools. To address this gap, we present the results of an evaluation of 58 existing guidelines in four major health science fields (medicine and epidemiology; nursing and health education; social sciences and public health; psychology/psychiatry, research methods and organization) by expert (n = 16) and peer (n = 40) users (e.g., article reviewers, experts allocating funds, editors). This research was conducted between 2011 and 2014 at the University of Lausanne in Switzerland. Experts met during three workshops spread over this period. A series of 12 consensual essential criteria, along with definitions, stemmed from a question in a semi-qualitative evaluation questionnaire that we developed. Although there is consensus on the name of the criteria, we highlight limitations on the ability to compare specific definitions of criteria across health science fields. We conclude that each criterion must be explained to come to broader consensus and identify definitions that are easily operational and consensual to all fields examined.

  5. Access, Quality, and Opportunity: A Case Study of Zambia Open Community Schools (ZOCS)

    ERIC Educational Resources Information Center

    Mwalimu, Michelle

    2011-01-01

    Community schools and other approaches to Alternative Primary Education or APE have increased access to primary education for underserved populations in Africa, Asia, and Latin America as a major goal of the Education for All (EFA) movement. In Zambia, a country where an estimated 20 percent of the basic education enrollment now attends community…

  6. Enhancing Access to and Quality of Basic Education through Head Teachers' Leadership Functions

    ERIC Educational Resources Information Center

    Oni, J. O.; Jegede, A. A.; Osisami, R. A.; Illo, C. O.; Lawal, R. O.; Fabinu, F. A.

    2016-01-01

    Basic education is the fundamental requirement for idiosyncratic and societal development. The individual child needs to have access to it and acquire it qualitatively. The sum total of all the knowledge attitude, skills and competences that the Nigerian child today acquires have been declared to be on the decline. Every stakeholder: teacher,…

  7. Child Care for Low-Income Children with Disabilities: Access, Quality, and Parental Satisfaction

    ERIC Educational Resources Information Center

    Wall, Shavaun; Kisker, Ellen E.; Peterson, Carla A.; Carta, Judith J.; Jeon, Hyun-Joo

    2006-01-01

    Using data from the Early Head Start Research and Evaluation Project, this study analyzed the similarities and differences of variables associated with child care services for low-income families with young children with disabilities and low-income families with typically developing children. Four major variables were analyzed: access to child…

  8. Improving Access To, Quality, and the Effectiveness of Digital Tutoring in K-12 Education

    ERIC Educational Resources Information Center

    Burch, Patricia; Good, Annalee; Heinrich, Carolyn

    2016-01-01

    There is considerable variation in how providers of digital education describe what they do, their services, how students access services, and what is delivered, complicating efforts to accurately assess its impact. We examine program characteristics of digital tutoring providers using rich, longitudinal observational and interview data and then…

  9. Structuring Opportunity after Entry: Who Has Access to High Quality Instruction during College?

    ERIC Educational Resources Information Center

    Roksa, Josipa

    2016-01-01

    Background/Context: When inequality of opportunity is discussed in higher education, it typically pertains to access to college. Ample research has examined sociodemographic inequalities in transition to higher education and enrollment in particular types of institutions. Although providing valuable insights, social stratification research does…

  10. The Quality of Urban Environments: Mapping Variation in Access to Community Resources.

    ERIC Educational Resources Information Center

    Witten, Karen; Exeter, Daniel; Field, Adrian

    2003-01-01

    Discusses the relationship between community infrastructure and health through the development of the Community Resource Accessibility Index (CRAI) research tool.This area-based index of community services, facilities, and amenities enables comparisons between opportunity structures in the local environment and residents' health and wellbeing. It…

  11. Guidelines International Network: toward international standards for clinical practice guidelines.

    PubMed

    Qaseem, Amir; Forland, Frode; Macbeth, Fergus; Ollenschläger, Günter; Phillips, Sue; van der Wees, Philip

    2012-04-01

    Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. Standards for guideline development can help organizations ensure that recommendations are evidence-based and can help users identify high-quality guidelines. Such organizations as the U.S. Institute of Medicine and the United Kingdom's National Institute for Health and Clinical Excellence have developed recommendations to define trustworthy guidelines within their locales. Many groups charged with guideline development find the lengthy list of standards developed by such organizations to be aspirational but infeasible to follow in entirety. Founded in 2002, the Guidelines International Network (G-I-N) is a network of guideline developers that includes 93 organizations and 89 individual members representing 46 countries. The G-I-N board of trustees recognized the importance of guideline development processes that are both rigorous and feasible even for modestly funded groups to implement and initiated an effort toward consensus about minimum standards for high-quality guidelines. In contrast to other existing standards for guideline development at national or local levels, the key components proposed by G-I-N will represent the consensus of an international, multidisciplinary group of active guideline developers. This article presents G-I-N's proposed set of key components for guideline development. These key components address panel composition, decision-making process, conflicts of interest, guideline objective, development methods, evidence review, basis of recommendations, ratings of evidence and recommendations, guideline review, updating processes, and funding. It is hoped that this article promotes discussion and eventual agreement on a set of international standards for guideline development.

  12. Using the ACEI Global Guidelines Assessment to Evaluate the Quality of Early Child Care in Greek Settings

    ERIC Educational Resources Information Center

    Rentzou, Konstantina

    2010-01-01

    In recent years, there has been a significant growth of interest in ensuring that child care provision for children is of a high quality. This interest has been stimulated by research evidence according to which good quality child care has a positive influence on children's overall development. The global quality in Greek preschool and…

  13. 42 CFR 417.106 - Quality assurance program; Availability, accessibility, and continuity of basic and supplemental...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualified Health Maintenance Organizations: Services § 417.106 Quality assurance program... the following conditions: (1) Stresses health outcomes to the extent consistent with the state of...

  14. 42 CFR 417.106 - Quality assurance program; Availability, accessibility, and continuity of basic and supplemental...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualified Health Maintenance Organizations: Services § 417.106 Quality assurance program... the following conditions: (1) Stresses health outcomes to the extent consistent with the state of...

  15. 42 CFR 417.106 - Quality assurance program; Availability, accessibility, and continuity of basic and supplemental...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualified Health Maintenance Organizations: Services § 417.106 Quality assurance program... the following conditions: (1) Stresses health outcomes to the extent consistent with the state of...

  16. Villagisation Guidelines, October 1985.

    PubMed

    1988-01-01

    The following major aims are set forth in these Guidelines issued by the Ministry of Agriculture of Ethiopia: 1) enhancing extension services aimed at increasing agricultural productivity; 2) promoting more rational land-use patterns and conserving natural resources; 3) facilitating access of rural people to schools, clinics, water supplies, and service co-operatives; and 4) strengthening security and self-defense.

  17. Efficient, quality-assured data capture in operational research through innovative use of open-access technology.

    PubMed

    Kumar, A M V; Naik, B; Guddemane, D K; Bhat, P; Wilson, N; Sreenivas, A N; Lauritsen, J M; Rieder, H L

    2013-03-21

    Ensuring quality of data during electronic data capture has been one of the most neglected components of operational research. Multicentre studies are also challenged with issues about logistics of travel, training, supervision, monitoring and troubleshooting support. Allocating resources to these issues can pose a significant bottleneck for operational research in resource-limited settings. In this article, we describe an innovative and efficient way of coordinating data capture in multicentre operational research using a combination of three open access technologies-EpiData for data capture, Dropbox for sharing files and TeamViewer for providing remote support.

  18. Consensus guidelines for implementation of quality processes to prevent invasive fungal disease and enhanced surveillance measures during hospital building works, 2014.

    PubMed

    Chang, C C; Ananda-Rajah, M; Belcastro, A; McMullan, B; Reid, A; Dempsey, K; Athan, E; Cheng, A C; Slavin, M A

    2014-12-01

    Healthcare-associated fungal outbreaks impose a substantial economic burden on the health system and typically result in high patient morbidity and mortality, particularly in the immunocompromised host. As the population at risk of invasive fungal infection continues to grow due to the increased burden of cancer and related factors, the need for hospitals to employ preventative measures has become increasingly important. These guidelines outline the standard quality processes hospitals need to accommodate into everyday practice and at times of healthcare-associated outbreak, including the role of antifungal stewardship programmes and best practice environmental sampling. Specific recommendations are also provided to help guide the planning and implementation of quality processes and enhanced surveillance before, during and after high-risk activities, such as hospital building works. Areas in which information is still lacking and further research is required are also highlighted. PMID:25482747

  19. Baseline ecological risk assessment of the Calcasieu Estuary, Louisiana: 2. An evaluation of the predictive ability of effects-based sediment quality guidelines

    USGS Publications Warehouse

    MacDonald, Donald D.; Ingersoll, Christopher G.; Smorong, Dawn E.; Sinclair, Jesse A.; Lindskoog, Rebekka; Wang, Ning; Severn, Corrine; Gouguet, Ron; Meyer, John; Field, Jay

    2011-01-01

    Three sets of effects-based sediment-quality guidelines (SQGs) were evaluated to support the selection of sediment-quality benchmarks for assessing risks to benthic invertebrates in the Calcasieu Estuary, Louisiana. These SQGs included probable effect concentrations (PECs), effects range median values (ERMs), and logistic regression model (LRMs)-based T50 values. The results of this investigation indicate that all three sets of SQGs tend to underestimate sediment toxicity in the Calcasieu Estuary (i.e., relative to the national data sets), as evaluated using the results of 10-day toxicity tests with the amphipod, Hyalella azteca, or Ampelisca abdita, and 28-day whole-sediment toxicity tests with the H. azteca. These results emphasize the importance of deriving site-specific toxicity thresholds for assessing risks to benthic invertebrates.

  20. [Evaluation of the quality of clinical practice guidelines published in the Annales de Biologie Clinique with the help of the EFLM checklist].

    PubMed

    Wils, Julien; Fonfrède, Michèle; Augereau, Christine; Watine, Joseph

    2014-01-01

    Several tools are available to help evaluate the quality of clinical practice guidelines (CPG). The AGREE instrument (Appraisal of guidelines for research & evaluation) is the most consensual tool but it has been designed to assess CPG methodology only. The European federation of laboratory medicine (EFLM) recently designed a check-list dedicated to laboratory medicine which is supposed to be comprehensive and which therefore makes it possible to evaluate more thoroughly the quality of CPG in laboratory medicine. In the present work we test the comprehensiveness of this check-list on a sample of CPG written in French and published in Annales de biologie clinique (ABC). Thus we show that some work remains to be achieved before a truly comprehensive check-list is designed. We also show that there is some room for improvement for the CPG published in ABC, for example regarding the fact that some of these CPG do not provide any information about allowed durations of transport and of storage of biological samples before analysis, or about standards of minimal analytical performance, or about the sensitivities or the specificities of the recommended tests.

  1. Evaluation of the quality of publications on randomized clinical trials using the Consolidated Standards of Reporting Trials (CONSORT) statement guidelines in a Spanish tertiary hospital.

    PubMed

    Dasí, Francisco; Navarro-García, María Mercedes; Jiménez-Heredia, Mercedes; Magraner, Jose; Viña, Juan R; Pallardó, Federico V; Cervantes, Andres; Morcillo, Esteban

    2012-07-01

    The main reason for conducting a clinical trial (CT) is to test the effect of a drug or medical procedure to improve treatment of a disease. CTs contribute most when they are rigorously conducted and the results are published adequately. The aim of this study is to assess, using the CONSORT statement guidelines, the quality of reporting of completed CTs conducted at a tertiary hospital to determine which sections of the articles should be improved. CTs published between 2002 and 2008 were identified by searching the MEDLINE and Cochrane Library. Forty of 127 completed CTs were published. There was a marked increase in the number of articles and the quality of the journals that published the CTs over time. Although the articles were published in high-impact index journals, the Consolidated Standards of Reporting Trials (CONSORT) score reporting quality of the articles varied substantially, which indicates that they should be improved. The title, abstract, introduction, and discussion sections received the highest CONSORT scores and need little improvement. Poor reporting of methodological details and discussion on limitations and strengths were observed. In conclusion, much improvement remains to be made in the quality of reporting of CTs to allow reliable quality assessment of published trials.

  2. Impact of adherence to GOLD guidelines on 6-minute walk distance, MRC dyspnea scale score, lung function decline, quality of life, and quality-adjusted life years in a Shanghai suburb.

    PubMed

    Jiang, Y Q; Zhu, Y X; Chen, X L; Xu, X; Li, F; Fu, H J; Shen, C Y; Lu, Y Y; Zhuang, Q J; Xu, G; Cai, Y Y; Zhang, Y; Liu, S S; Zhu, M Y; Li, S H

    2015-01-01

    We performed a 1-year cluster-randomized field trial to assess the effect of standardized management of chronic obstructive pulmonary disease (COPD) on lung function and quality of life (QOL) measures in patients in China. We used the Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines and assessed indexes including pulmonary function, QOL, quality-adjusted life years (QALY), Medical Research Council (MRC) dyspnea scale, 6-min walk distance (6-MWD), number of emergency visits, and frequency of hospitalization. Of a total of 711 patients with chronic cough and asthma, 132 were diagnosed as having COPD and 102 participated in this study [intervention group (N = 47); control group (N = 55)]. We found that adherence to GOLD guidelines had a perceivable impact on 6-MWD, MRC dyspnea scale score, and QOL. The average QALY increased by 1.42/person/year in the intervention group, but declined by 0.95/person/year in the control group. We conclude that standardized management improves disease severity, QOL, and QALY in COPD patients when treatment protocols adhere to GOLD guidelines.

  3. Contribution of Neighborhood Income and Access to Quality Physical Activity Resources to Physical Activity in Ethnic Minority Women Over Time

    PubMed Central

    Lee, Rebecca E.; Mama, Scherezade K.; Adamus-Leach, Heather J.; Soltero, Erica G.

    2015-01-01

    Purpose To create and test an index to indicate both availability and quality of physical activity (PA) resources (PARs), to examine associations between access to quality PARs and changes in PA, and to determine whether this association differed in lower- and higher-income neighborhoods. Design Longitudinal, 6-month intervention. Setting. Houston and Austin, Texas. Subjects African-American and Hispanic or Latina women. Measures Women (N = 410) completed a questionnaire and accelerometry to measure PA. Neighborhoods (N = 163) were classified as lower- or higher-income by median household income at the census-tract level. PARs were audited using the PARA (physical activity resource assessment). Access to quality PARs was determined by a composite index (QPAR) of features, amenities, and incivilities. Analysis Repeated measures analyses of variance were used to examine changes in PA by (1) neighborhood income (lower/higher) and QPAR (lower/higher) groups, and (2) neighborhood income (lower/higher) and number of PARs (lower/higher) groups, adjusting for ethnicity, household income, and body mass index. Results Women in neighborhoods with lower QPAR scores had small increases in self-reported vigorous PA (M Δ = 327.8 metabolic equivalent of task [MET]-min/wk) and decreases in accelerometer PA (M = −3.4 min/d), compared to those with higher QPAR scores who had larger increases in self-reported vigorous PA (M Δ = 709.8 MET-min/wk) and increased accelerometer PA (M = 3.9 min/d). There was a significant interaction between changes in leisure-time PA, QPAR score, and number of PARs (p =.049). Women with both more PARs and higher QPAR scores reported greater increases in leisure-time PA than women with fewer PARs and lower QPAR scores. Conclusion Access to higher-quality PARs can help increase or maintain PA over time regardless of neighborhood income. PAR quality is a separate and distinct, important determinant of PA in ethnic minority women. PMID:24524382

  4. Mobile Access to ClinicalConnect: A User Feedback Survey on Usability, Productivity, and Quality

    PubMed Central

    2015-01-01

    Background ClinicalConnect, a federated clinical viewer for South West Ontario, Canada, launched a mobile interface in June 2012. Objective The aim of the study was to assess usability of the mobile interface and the perceived impact on productivity of health care providers and quality of healthcare delivery. Methods A survey was conducted using the System Usability Scale (SUS) and questionnaires designed to measure productivity and quality based on Canada Health Infoway's Benefits Evaluation framework. Results The mean SUS score was 67 based on 77 responses. The mean scores for productivity and quality were 3.37 (N=74) and 3.62 (N=71), respectively, on a 5-point Likert scale where 3 was neutral. Conclusions Users perceived the mobile interface of ClinicalConnect as useful but were neutral about the ease of use. PMID:25877226

  5. Housing Quality and Access to Material and Learning Resources within the Home Environment in Developing Countries

    PubMed Central

    Bradley, Robert H.; Putnick, Diane L.

    2011-01-01

    This study examined home environment conditions (housing quality, material resources, formal and informal learning materials) and their relations with the Human Development Index (HDI) in 28 developing countries. Home environment conditions in these countries varied widely. The quality of housing and availability of material resources at home were consistently tied to HDI; the availability of formal and informal learning materials little less so. Gross domestic product (GDP) tended to show a stronger independent relation with housing quality and material resources than life expectancy and education. Formal learning resources were independently related to the GDP and education indices, and informal learning resources were not independently related to any constituent indices of the overall HDI. PMID:22277008

  6. Proper management of rheumatoid arthritis in Latin America. What the guidelines say?

    PubMed

    Brenol, Claiton V; Nava, Jorge Ivan Gamez; Soriano, Enrique R

    2015-03-01

    To analyze characteristics of clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) developed in Latin American (LA) countries and to describe the knowledge, use, and barriers for their implementation perceived among LA rheumatologists, a comprehensive literature search including Medline, PubMed, Cochrane Library, LILACS and Scielo was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was applied for evaluation. A survey was sent to PANLAR members containing questions related to knowledge about guidelines, application of the recommendations, and difficulties in implementing CPGs. Eight guidelines were identified. Most guidelines were evidence based (62 %), but in only 37 % a systematic literature search was done. None of the guidelines included patients' views and preferences, and only few of them stated an updating procedure. Funding body independence and disclosure of conflicts of interest were rarely reported. The survey was answered by 214 rheumatologists from all Latin American countries. Most rheumatologist reported knowledge and use of clinical guidelines, mainly international ones. In general, rheumatologist felt that guidelines apply to only a minority of patients seen in daily clinical practice. Limited access expensive drugs, suggested by the guidelines, was the most frequent barrier to guidelines implementation that was reported. A good number of guidelines on the treatment of rheumatoid arthritis have been developed in Latin America. Most of them are lacking some of the components recognized for high-quality clinical guidelines development. In spite that most rheumatologist know and apply guidelines, access to drugs is still a very important barrier to their implementation in Latin America.

  7. Using Early Learning Standards to Provide High-Quality Education for All Children: The Early Learning Guidelines Toolkit

    ERIC Educational Resources Information Center

    Flores, Roseanne L.; Curby, Timothy W.; Coleman, Hardin; Melo, Kristan

    2016-01-01

    Today with the rise in the number of 3- to 6-year-old children enrolled in center-based early childhood programs, and a focus on program quality, it becomes imperative for educators to have a better understanding of the role research plays in establishing high-quality programs as these programs provide much of the foundation that supports early…

  8. [How to write, how to implement and how to evaluate a practice guideline in order to improve quality of care?].

    PubMed

    Moret, L; Lefort, C; Terrien, N

    2012-11-01

    Initiatives of clinical practices improvement have been gradually developing in France for 20 years. Nevertheless, effective implementation of change is still difficult for numerous reasons. The use of clinical practices guidelines is one of the different ways of improvement. It is however necessary to adapt these national guidelines to the specificities of the hospital and the team, to ensure implementation and appropriation by the professionals. These recommendations are thus translated into applicable and concrete standard operating procedures. These documents have to be built by and for the concerned professionals. They are also communication and training tools, precise, directive, uniform in terms of presentation and attractive visually. Once drafted, they have to be distributed widely to the professionals to facilitate implementation. The simple distribution of the recommendations is insufficient to modify the clinical practices and require association of several methods of promotion for an optimal appropriation. How then to make sure of their effective use? Practices evaluation is one of the steps of continuous professional development, including continuous training and analysis of clinical practices by using methods promoted by the "Haute Autorité de santé". One of them is the clinical audit; use of method assessing non-pertinent treatment is interesting too. Analysis of the non-conformities and gaps between theory and practice allows identifying various possible causes (professional, institutional, organizational or personal) in order to implement corrective action plans, in a logic of continuous improvement. PMID:23039956

  9. Expanding Access and Quality in Uganda: The Challenges of Building a Plane while Flying It

    ERIC Educational Resources Information Center

    Cutright, Marc

    2010-01-01

    Uganda is among many nations in sub-Saharan Africa that are trying simultaneously to expand higher education opportunities and to enhance the quality of higher-education offerings. These are particularly challenging goals in resource-rich environments and are even more difficulty in environments of more limited resources to include funding,…

  10. Does Access to High Quality Early Education Vary by State Policy Context?

    ERIC Educational Resources Information Center

    Connors, Maia C.; Morris, Pamela A.; Friedman-Krauss, Allison H.

    2015-01-01

    Research suggests that attending high quality, formal early childhood education (ECE) is associated with stronger cognitive and social-emotional skills, especially for low-income children. Yet at current funding levels, federally-funded programs like Head Start cannot serve all eligible children. Thus, state-level policies governing the…

  11. Strategic Priorities for Improving Access to Quality Education in the Kurdistan Region--Iraq. Monograph

    ERIC Educational Resources Information Center

    Vernez, Georges; Culbertson, Shelly; Constant, Louay

    2014-01-01

    The Kurdistan Regional Government (KRG) began an ambitious reform of the Kurdistan Region of Iraq's (KRI's) kindergarten through grade 12 (K-12) education system beginning in 2007 in an effort to modernize the curriculum, upgrade school facilities, and raise the quality of instruction. In 2010, RAND was asked to conduct a one-year study to assess…

  12. 42 CFR 417.106 - Quality assurance program; Availability, accessibility, and continuity of basic and supplemental...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualified Health Maintenance Organizations: Services § 417.106 Quality assurance program; Availability... following conditions: (1) Stresses health outcomes to the extent consistent with the state of the art....

  13. Tackling Student Literacy and Numeracy Underpreparedness in Ontario Colleges: Access, Quality and Funding

    ERIC Educational Resources Information Center

    Dziwak, Kasia

    2014-01-01

    As more students enter postsecondary education without the numeracy and literacy skills necessary for success, Ontario colleges are facing a challenge. While enrolment-based funding drives the colleges to seek growth to ensure financial stability, the quality assurance mechanism leads them to divert millions of dollars from their operating budgets…

  14. Better access, quality, and cost for clinically complex veterans with home-based primary care.

    PubMed

    Edes, Thomas; Kinosian, Bruce; Vuckovic, Nancy H; Nichols, Linda Olivia; Becker, Margaret Mary; Hossain, Monir

    2014-10-01

    In successfully reducing healthcare expenditures, patient goals must be met and savings differentiated from cost shifting. Although the Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) program for chronically ill individuals has resulted in cost reduction for the VA, it is unknown whether cost reduction results from restricting services or shifting costs to Medicare and whether HBPC meets patient goals. Cost projection using a hierarchical condition category (HCC) model adapted to the VA was used to determine VA plus Medicare projected costs for 9,425 newly enrolled HBPC recipients. Projected annual costs were compared with observed annualized costs before and during HBPC. To assess patient perspectives of care, 31 veterans and caregivers were interviewed from three representative programs. During HBPC, Medicare costs were 10.8% lower than projected, VA plus Medicare costs were 11.7% lower than projected, and combined hospitalizations were 25.5% lower than during the period without HBPC. Patients reported high satisfaction with HBPC team access, education, and continuity of care, which they felt contributed to fewer exacerbations, emergency visits, and hospitalizations. HBPC improves access while reducing hospitalizations and total cost. Medicare is currently testing the HBPC approach through the Independence at Home demonstration. PMID:25333529

  15. Process quality of diabetes care under favorable access to healthcare: a 2-year longitudinal study using claims data in Japan

    PubMed Central

    Tanaka, Hirokazu; Tomio, Jun; Sugiyama, Takehiro; Kobayashi, Yasuki

    2016-01-01

    Objective To investigate the process quality of diabetes care provided to patients under universal health insurance coverage. Research design and methods Using claim data for 570 363 beneficiaries aged 20–69 years who were covered by Health Insurance Societies between April 2010 and March 2012, we identified patients with type 2 diabetes who made follow-up visits at least every 3 months in the first year (subject-identification year). We assessed patient adherence to follow-up visits in the second year (quality-reporting year), calculated the proportion of patients that completed routine examinations for glycemic control and complications, and evaluated associations between characteristics of patients and quality indicators using multivariable logistic regression models. Results We identified 12 909 patients with diabetes; in the subject-identification year, 1415 (11.0%) had prescriptions for insulin injections, 6049 (46.9%) had prescriptions for oral antihyperglycemic agents, and 5445 (42.2%) had no diabetes-related prescriptions. Among patients using medication, 474 (6.4%) dropped out in the quality-reporting year. The adjusted percentages of quality indicators among patients using oral antihyperglycemic agents were 95.8% for glycated hemoglobin, 35.6% for eye examinations, 15.4% for urine microalbumin excretion, and 90.6% for serum lipids; the percentages among patients taking insulin were the same or higher. Annual testing for glycated hemoglobin was less frequent in patients aged 40–49 years than in patients aged 60–69 years (OR 0.77; 95% CI 0.66 to 0.91). Fewer men than women (OR 0.59; 95% CI 0.54 to 0.64), and fewer patients aged 40–49 years than those aged 60–69 years (OR 0.56; 95% CI 0.50 to 0.63) tended to complete routine eye examinations. Conclusions Screening for retinopathy and nephropathy was less frequent than required despite favorable conditions for access to healthcare in Japan. Suboptimal quality of care appeared to

  16. Process quality of diabetes care under favorable access to healthcare: a 2-year longitudinal study using claims data in Japan

    PubMed Central

    Tanaka, Hirokazu; Tomio, Jun; Sugiyama, Takehiro; Kobayashi, Yasuki

    2016-01-01

    Objective To investigate the process quality of diabetes care provided to patients under universal health insurance coverage. Research design and methods Using claim data for 570 363 beneficiaries aged 20–69 years who were covered by Health Insurance Societies between April 2010 and March 2012, we identified patients with type 2 diabetes who made follow-up visits at least every 3 months in the first year (subject-identification year). We assessed patient adherence to follow-up visits in the second year (quality-reporting year), calculated the proportion of patients that completed routine examinations for glycemic control and complications, and evaluated associations between characteristics of patients and quality indicators using multivariable logistic regression models. Results We identified 12 909 patients with diabetes; in the subject-identification year, 1415 (11.0%) had prescriptions for insulin injections, 6049 (46.9%) had prescriptions for oral antihyperglycemic agents, and 5445 (42.2%) had no diabetes-related prescriptions. Among patients using medication, 474 (6.4%) dropped out in the quality-reporting year. The adjusted percentages of quality indicators among patients using oral antihyperglycemic agents were 95.8% for glycated hemoglobin, 35.6% for eye examinations, 15.4% for urine microalbumin excretion, and 90.6% for serum lipids; the percentages among patients taking insulin were the same or higher. Annual testing for glycated hemoglobin was less frequent in patients aged 40–49 years than in patients aged 60–69 years (OR 0.77; 95% CI 0.66 to 0.91). Fewer men than women (OR 0.59; 95% CI 0.54 to 0.64), and fewer patients aged 40–49 years than those aged 60–69 years (OR 0.56; 95% CI 0.50 to 0.63) tended to complete routine eye examinations. Conclusions Screening for retinopathy and nephropathy was less frequent than required despite favorable conditions for access to healthcare in Japan. Suboptimal quality of care appeared to

  17. Accessibility and Quality of Online Cancer-Related Clinical Trial Information for Naïve Searchers.

    PubMed

    Abel, Gregory A; Cronin, Angel M; Earles, Kristofer; Gray, Stacy W

    2015-10-01

    Although the Internet may help to increase cancer patients' awareness of clinical trials, little is known about the accessibility and quality of online clinical trial information. We simulated the experience of a naïve cancer patient without clinical trial knowledge by searching three popular search engines for treatment information for breast, lung, and prostate cancer, and myelodysplastic syndromes (MDS). Two coders independently evaluated website content for accessibility and quality. We screened 120 websites and identified 40 unique sites for analysis. Overall, 85% [95% confidence interval (CI), 70%-94%] of sites mentioned clinical trials on the landing page and 68% (51%-81%) included links to specific trials. Overall readability was poor. Approximately half of websites (36%-68%) included information on the potential benefits and risks of clinical trials and 40% provided information about when the site had been updated (25%-57%). Among sites with links to specific clinical trials, only 44% (25%-65%) provided an interactive interface that would allow patients to customize search results; breast (100%) and prostate (50%) sites were more interactive than lung (25%) and MDS (14%; P = 0.007). Although cancer clinical trial information is widely available on the Internet, its quality is highly variable. Given the fact that many emerging cancer therapeutics are personalized based on disease or genomic characteristics, interactive web-based interfaces could serve as powerful vehicles to help patients locate appropriate clinical trials. Without enhanced efforts to ensure greater interactivity of cancer treatment websites, patient awareness of relevant clinical trials may remain low. PMID:26265204

  18. Impact of genetic drift on developing access and benefit sharing guidelines under the Nagoya Protocol: The case of Meishan pigs imported into the US

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Convention on Biological Diversity developed the Nagoya Protocol (NP) on access and benefit sharing (ABS) for international exchange of genetic resources across life forms. Concerns are NP will be cumbersome, stifle research, and not accommodate diverse life forms, such as livestock. NP was deve...

  19. Retrieval practice enhances the accessibility but not the quality of memory.

    PubMed

    Sutterer, David W; Awh, Edward

    2016-06-01

    Numerous studies have demonstrated that retrieval from long-term memory (LTM) can enhance subsequent memory performance, a phenomenon labeled the retrieval practice effect. However, the almost exclusive reliance on categorical stimuli in this literature leaves open a basic question about the nature of this improvement in memory performance. It has not yet been determined whether retrieval practice improves the probability of successful memory retrieval or the quality of the retrieved representation. To answer this question, we conducted three experiments using a mixture modeling approach (Zhang & Luck, 2008) that provides a measure of both the probability of recall and the quality of the recalled memories. Subjects attempted to memorize the color of 400 unique shapes. After every 10 images were presented, subjects either recalled the last 10 colors (the retrieval practice condition) by clicking on a color wheel with each shape as a retrieval cue or they participated in a control condition that involved no further presentations (Experiment 1) or restudy of the 10 shape/color associations (Experiments 2 and 3). Performance in a subsequent delayed recall test revealed a robust retrieval practice effect. Subjects recalled a significantly higher proportion of items that they had previously retrieved relative to items that were untested or that they had restudied. Interestingly, retrieval practice did not elicit any improvement in the precision of the retrieved memories. The same empirical pattern also was observed following delays of greater than 24 hours. Thus, retrieval practice increases the probability of successful memory retrieval but does not improve memory quality.

  20. The Effect of Personalized Guideline-Concordant Treatment on Quality of Life and Functional Impairment in Bipolar Disorder

    PubMed Central

    Sylvia, Louisa G.; Rabideau, Dustin J.; Nierenberg, Andrew A.; Bowden, Charles L.; Friedman, Edward S.; Iosifescu, Dan V.; Thase, Michael E.; Ketter, Terence; Greiter, Elizabeth A.; Calabrese, Joseph R.; Leon, Andrew C.; Ostacher, Michael J.; Reilly-Harrington, Noreen

    2014-01-01

    Objectives The aims of this study were to evaluate correlates and predictors of life functioning and quality of life in bipolar disorder during a comparative effectiveness trial of moderate doses of lithium. Methods In the Lithium treatment moderate-dose use study (LiTMUS), 283 symptomatic outpatients with bipolar disorder type I or II were randomized to receive lithium plus ”optimal personalized treatment (OPT), or OPT alone. Participants were assessed using structured diagnostic interviews, clinician-rated blinded assessments, and questionnaires. We employ linear mixed effects models to test the effect of treatment overall and adjunct lithium specifically on quality of life or functioning. Similar models are used to examine the association of baseline demographics and clinical features with quality of life and life functioning. Results Quality of life and impaired functioning at baseline were associated with lower income, higher depressive severity, and more psychiatric comorbid conditions. Over six months, patients in both treatment groups improved in quality of life and life functioning (p-values < 0.0001); without a statistically significant difference between the two treatment groups (p-values > 0.05). Within the lithium group, improvement in quality of life and functioning were not associated with concurrent lithium levels at week 12 or week 24 (p-values > 0.05). Lower baseline depressive severity and younger age of onset predicted less improvement in functioning over six months. Conclusions Optimized care for bipolar disorder improves overall quality of life and life functioning, with no additional benefit from adjunct moderate doses of lithium. Illness burden and psychosocial stressors were associated with worse quality of life and lower functioning in individuals with bipolar disorder. PMID:25194782

  1. Toxicity of magnesium pulses to tropical freshwater species and the development of a duration-based water quality guideline.

    PubMed

    Hogan, Alicia C; Trenfield, Melanie A; Harford, Andrew J; van Dam, Rick A

    2013-09-01

    Six freshwater species (Chlorella sp., Lemna aequinoctialis, Amerianna cumingi, Hydra viridissima, Moinodaphnia macleayi, and Mogurnda mogurnda) were exposed to 4-h, 8-h, and 24-h Mg pulses in natural creek water. Magnesium toxicity to all species increased with exposure duration; however, the extent of increase and the nature of the relationship differed greatly between species. Based on median inhibitory concentrations (IC50s), and compared with continuous exposure data from a previous study, the increase in toxicity with increasing exposure duration from 4 h to continuous (72-144 h) ranged from approximately 2-fold for Chlorella sp. and H. viridissima to greater than 40-fold for A. cumingi. Moreover, the form of the relationship between Mg toxicity and duration ranged from linear or near-linear to exponential for different species. The life-stage at which M. macleayi was exposed was important, with cladocerans pulsed at the onset of reproductive maturity being approximately 4 times more sensitive (based on IC50s) than younger than 6-h-old neonates. Species sensitivity distributions were constructed for the 4-h, 8-h, and 24-h pulse durations, from which 99% species protection guideline values (95% confidence limits [CLs]) of 94 (6.4-1360) mg/L, 14 (0.5-384) mg/L, and 8.0 (0.5-144) mg/L Mg, respectively, were derived. These values were plotted against exposure duration (h) and polynomial interpolation used to derive a guideline value for any pulse duration within the range assessed. PMID:23613126

  2. Defining an exposure-response relationship for suspended kaolin clay particulates and aquatic organisms: work toward defining a water quality guideline for suspended solids.

    PubMed

    Gordon, Andrew K; Palmer, Carolyn G

    2015-04-01

    Water quality guidelines for suspended solids generally rely on the percentage departure from reference condition, an approach that has been criticized. Attempts to develop a biological effects-base guideline have, however, been confounded by low data availability. Furthermore, the high biological response variability to suspended solids exposure suggests that organisms are responding not only to exposure concentration and duration but also to other mechanisms of effect associated with suspended particles (e.g., size, shape, and geochemical composition). An alternative option is to develop more situation and site specific guidelines by generating biological effects data to suspended particles of a particular geochemistry and restricted size range. With this in mind, aquatic organism responses to kaolin clay particle exposure were collated from the literature and incorporated into 2 exposure-response relationship approaches. The species sensitivity distribution approach produced a hazardous concentration affecting 5% of species estimate of 58 mg/L for mortality responses, and 36 mg/L for sublethal data. The severity-of-ill-effect approach produced similar estimates for lethal and sublethal data. These results suggest that aquatic organisms are slightly more tolerant of kaolin clay particles than particles from barite or bentonite clays, based on results from previous studies on these clay types. This type of information can enable better estimates of the risk faced by aquatic organisms exposed to suspended solids. For example, when the sediments of a particular water body are dominated by a particular type of clay particle, then the most appropriate exposure-response relationship can be applied. PMID:25711545

  3. Defining an exposure-response relationship for suspended kaolin clay particulates and aquatic organisms: work toward defining a water quality guideline for suspended solids.

    PubMed

    Gordon, Andrew K; Palmer, Carolyn G

    2015-04-01

    Water quality guidelines for suspended solids generally rely on the percentage departure from reference condition, an approach that has been criticized. Attempts to develop a biological effects-base guideline have, however, been confounded by low data availability. Furthermore, the high biological response variability to suspended solids exposure suggests that organisms are responding not only to exposure concentration and duration but also to other mechanisms of effect associated with suspended particles (e.g., size, shape, and geochemical composition). An alternative option is to develop more situation and site specific guidelines by generating biological effects data to suspended particles of a particular geochemistry and restricted size range. With this in mind, aquatic organism responses to kaolin clay particle exposure were collated from the literature and incorporated into 2 exposure-response relationship approaches. The species sensitivity distribution approach produced a hazardous concentration affecting 5% of species estimate of 58 mg/L for mortality responses, and 36 mg/L for sublethal data. The severity-of-ill-effect approach produced similar estimates for lethal and sublethal data. These results suggest that aquatic organisms are slightly more tolerant of kaolin clay particles than particles from barite or bentonite clays, based on results from previous studies on these clay types. This type of information can enable better estimates of the risk faced by aquatic organisms exposed to suspended solids. For example, when the sediments of a particular water body are dominated by a particular type of clay particle, then the most appropriate exposure-response relationship can be applied.

  4. Can we predict temperature-dependent chemical toxicity to marine organisms and set appropriate water quality guidelines for protecting marine ecosystems under different thermal scenarios?

    PubMed

    Zhou, Guang-Jie; Wang, Zhen; Lau, Edward Tak Chuen; Xu, Xiang-Rong; Leung, Kenneth Mei Yee

    2014-10-15

    Temperature changes due to climate change and seasonal fluctuation can have profound implications on chemical toxicity to marine organisms. Through a comprehensive meta-analysis by comparing median lethal or effect concentration data of six chemicals for various saltwater species obtained at different temperatures, we reveal that the chemical toxicity generally follows two different models: (1) it increases with increasing temperature and (2) it is the lowest at an optimal temperature and increases with increasing or decreasing temperature from the optimal temperature. Such observations are further supported by temperature-dependent hazardous concentration 10% (HC10) values derived from species sensitivity distributions which are constructed using the acute toxicity data generated at different temperatures. Considering these two models and natural variations of seawater temperature, we can scientifically assess whether applying an assessment factor (e.g. 10) to modify water quality guidelines of the chemicals can adequately protect marine ecosystems in tropics, subtropics and temperate regions, respectively.

  5. Quality assurance grading guidelines for research and development at DOE facilities. DOE Order 5700.6C

    SciTech Connect

    Powell, T.B.; Morris, R.N.

    1992-10-01

    The quality assurance (QA) requirements for the US Department of Energy (DOE) are established in DOE Order 5700.6C. This order is applicable for all DOE departmental elements, management, and maintenance and operating contractors and requires that documented Quality Assurance Programs (QAPS) are prepared at all levels; it has one attachment. The DOE Office of Energy Research (DOE-ER) has issued a standard to ensure implementation of the full intent of this order in the ER community. This report discusses order 5700.6C in relation to research with DOE.

  6. Assessment of metal toxicity and development of sediment quality guidelines using the equilibrium partitioning model for the Three Gorges Reservoir, China.

    PubMed

    Gao, Li; Gao, Bo; Wei, Xin; Zhou, Huaidong; Xu, Dongyu; Wang, Yuchun

    2015-11-01

    The impoundment of the Three Gorges Reservoir (TGR) in China influences the quality of the water supply. Surface sediment samples from the TGR mainstream and three tributaries were collected. Acid volatile sulfide (AVS), simultaneously extractable metals (SEMs), and the fraction of organic carbon (f(oc)) were used to assess the toxicity of heavy metals. Sediment quality guidelines (SQGs) were established using the equilibrium partitioning approach. The results showed that the surface sediments were found to be oxic or suboxic. AVS concentrations in sediments were relatively low, below SEM concentrations. The [SEM] - [AVS] model indicated that all sediments possibly have adverse effects on aquatic life. However, ([SEM] - [AVS])/f(oc) predicted no adverse biological effects in some areas of the Meixi and Caotang Rivers, while adverse effects to aquatic life were uncertain for the other sediments. The partitioning coefficients, water quality criteria, and residual metals in the sediments were the main factors influencing the SQGs for the TGR, while the metals bound to AVS had a negligible effect. The normalized TGR SQGs were all much higher than the existing standards except for cadmium and copper. The differences might be attributed to the approaches used for derivation of SQGs and the physical and chemical characteristics of the sediments.

  7. Standardization of disk diffusion and agar dilution susceptibility tests for Neisseria gonorrhoeae: interpretive criteria and quality control guidelines for ceftriaxone, penicillin, spectinomycin, and tetracycline.

    PubMed Central

    Jones, R N; Gavan, T L; Thornsberry, C; Fuchs, P C; Gerlach, E H; Knapp, J S; Murray, P; Washington, J A

    1989-01-01

    A six-laboratory study developed a standardized method for determining the susceptibilities of Neisseria gonorrhoeae strains to penicillin, tetracycline, spectinomycin, and ceftriaxone. Three quality control organisms were also selected, and quality assurance guidelines were initially generated for the disk diffusion and agar dilution methods. The medium recommended for gonococcal susceptibility testing was GC agar with a defined "XV-like" supplement. The supplement should be free of cysteine, a component implicated in the inactivation of some newer beta-lactam compounds. Penicillin, tetracycline, spectinomycin, and ceftriaxone were stable in agar plates stored at 3 to 5 degrees C for at least 2 weeks. Numerous GC agar and drug disk lots were used during the trials without significant variation in test results. Several other gonococcal strains were recommended for additional medium quality assurance. The disk quality control zone limits were established for N. gonorrhoeae ATCC 49226 (formerly CDC F-18) and Staphylococcus aureus ATCC 25923. MIC quality control ranges were also developed for N. gonorrhoeae ATCC 49226 and S. aureus ATCC 29213. The interpretive criteria for penicillin were as follows: susceptibility, greater than or equal to 47 mm (diameter of inhibition zone) (less than or equal to 0.06 micrograms/ml [MIC]); resistance, less than or equal to 26 mm (greater than or equal to 2 micrograms/ml). For tetracycline they were as follows: susceptibility, greater than or equal to 38 mm (less than or equal to 0.25 microgram/ml); resistance, less than or equal to 30 mm (greater than or equal to 2 micrograms/ml). For spectinomycin they were as follows: susceptibility, >/= 18 mm (/= 128 micrograms/ml). For ceftriaxone susceptibility, the criterion was >/= 35 mm (

  8. Improving efficiency or impairing access? Health care consolidation and quality of care: Evidence from emergency hospital closures in Sweden.

    PubMed

    Avdic, Daniel

    2016-07-01

    Recent health care consolidation trends raise the important policy question whether improved emergency medical services and enhanced productivity can offset adverse quality effects from decreased access. This paper empirically analyzes how geographical distance from an emergency hospital affects the probability of surviving an acute myocardial infarction (AMI), accounting for health-based spatial sorting and data limitations on out-of-hospital mortality. Exploiting policy-induced variation in hospital distance derived from emergency hospital closures and detailed Swedish mortality data over two decades, results show a drastically decreasing probability of surviving an AMI as residential distance from a hospital increases one year after a closure occurred. The effect disappears in subsequent years, however, suggesting that involved agents quickly adapted to the new environment. PMID:27060525

  9. The effect of a Lean quality improvement implementation program on surgical pathology specimen accessioning and gross preparation error frequency.

    PubMed

    Smith, Maxwell L; Wilkerson, Trent; Grzybicki, Dana M; Raab, Stephen S

    2012-09-01

    Few reports have documented the effectiveness of Lean quality improvement in changing anatomic pathology patient safety. We used Lean methods of education; hoshin kanri goal setting and culture change; kaizen events; observation of work activities, hand-offs, and pathways; A3-problem solving, metric development, and measurement; and frontline work redesign in the accessioning and gross examination areas of an anatomic pathology laboratory. We compared the pre- and post-Lean implementation proportion of near-miss events and changes made in specific work processes. In the implementation phase, we documented 29 individual A3-root cause analyses. The pre- and postimplementation proportions of process- and operator-dependent near-miss events were 5.5 and 1.8 (P < .002) and 0.6 and 0.6, respectively. We conclude that through culture change and implementation of specific work process changes, Lean implementation may improve pathology patient safety.

  10. Global Access to Safe Water: Accounting for Water Quality and the Resulting Impact on MDG Progress

    PubMed Central

    Onda, Kyle; LoBuglio, Joe; Bartram, Jamie

    2012-01-01

    Monitoring of progress towards the Millennium Development Goal (MDG) drinking water target relies on classification of water sources as “improved” or “unimproved” as an indicator for water safety. We adjust the current Joint Monitoring Programme (JMP) estimate by accounting for microbial water quality and sanitary risk using the only-nationally representative water quality data currently available, that from the WHO and UNICEF “Rapid Assessment of Drinking Water Quality”. A principal components analysis (PCA) of national environmental and development indicators was used to create models that predicted, for most countries, the proportions of piped and of other-improved water supplies that are faecally contaminated; and of these sources, the proportions that lack basic sanitary protection against contamination. We estimate that 1.8 billion people (28% of the global population) used unsafe water in 2010. The 2010 JMP estimate is that 783 million people (11%) use unimproved sources. Our estimates revise the 1990 baseline from 23% to 37%, and the target from 12% to 18%, resulting in a shortfall of 10% of the global population towards the MDG target in 2010. In contrast, using the indicator “use of an improved source” suggests that the MDG target for drinking-water has already been achieved. We estimate that an additional 1.2 billion (18%) use water from sources or systems with significant sanitary risks. While our estimate is imprecise, the magnitude of the estimate and the health and development implications suggest that greater attention is needed to better understand and manage drinking water safety. PMID:22690170

  11. [Guidelines for clinical practice].

    PubMed

    Vleugels, A M

    1997-01-01

    Clinical practice guidelines are systematically developed statements that are intended to support medical decision making in well-defined clinical situations. Essentially, their object is to reduce the variability in medical practice, to improve quality, and to make appropriated control of the financial resources possible. Internationally, ever more organisations, associations, and institutions are concerned with the development of guidelines in many different areas of care. Making implicit knowledge explicit is one of the associated advantages of guidelines: they have a potential utility in training, in process evaluation, and in the reevaluation of outcome studies. In liability issues, their existence has a double effect: they can be used to justify medical behaviour, and they constitute a generally accepted reference point. A derivative problem is the legal liability of the compilers of the guidelines. The principle of the guideline approach can be challenged academically: science cannot give a definition of optimal care with absolute certainty. What is called objectivity often rests on methodologically disputable analyses; also the opinion of opinion leaders is not always a guarantee for scientific soundness. Moreover, patients are not all identical: biological variability, situational factors, patient expectations, and other elements play a role in this differentiation. Clinicians are often hesitant with respect to clinical guidelines: they are afraid of cookbook medicine and curtailment of their professional autonomy. Patients fear reduction of individualization of care and the use of guidelines as a rationing instrument. The effects of the introduction of clinical practice guidelines on medical practice, on the results and on the cost of care vary but are generally considered to be favourable. The choice of appropriate strategies in development, dissemination, and implementation turns out to be of critical importance. The article ends with concrete

  12. Private-Sector Social Franchising to Accelerate Family Planning Access, Choice, and Quality: Results From Marie Stopes International

    PubMed Central

    Munroe, Erik; Hayes, Brendan; Taft, Julia

    2015-01-01

    Background: To achieve the global Family Planning 2020 (FP2020) goal of reaching 120 million more women with voluntary family planning services, rapid scale-up of services is needed. Clinical social franchising, a service delivery approach used by Marie Stopes International (MSI) in which small, independent health care businesses are organized into quality-assured networks, provides an opportunity to engage the private sector in improving access to family planning and other health services. Methods: We analyzed MSI’s social franchising program against the 4 intended outputs of access, efficiency, quality, and equity. The analysis used routine service data from social franchising programs in 17 African and Asian countries (2008–2014) to estimate number of clients reached, couple-years of protection (CYPs) provided, and efficiency of services; clinical quality audits of 636 social franchisees from a subset of the 17 countries (2011–2014); and exit interviews with 4,844 clients in 14 countries (2013) to examine client satisfaction, demographics (age and poverty), and prior contraceptive use. The MSI “Impact 2” model was used to estimate population-level outcomes by converting service data into estimated health outcomes. Results: Between 2008 and 2014, an estimated 3,753,065 women cumulatively received voluntary family planning services via 17 national social franchise programs, with a sizable 68% choosing long-acting reversible contraceptives (LARCs). While the number of social franchisee outlets increased over time, efficiency also significantly improved over time, with each outlet delivering, on average, 178 CYPs in 2008 compared with 941 CYPs in 2014 (P = .02). Clinical quality audit scores also significantly improved; 39.8% of social franchisee outlets scored over 80% in 2011 compared with 84.1% in 2014. In 2013, 40.7% of the clients reported they had not been using a modern method during the 3 months prior to their visit (95% CI = 37.4, 44

  13. Linear Accelerator and Gamma Knife-Based Stereotactic Cranial Radiosurgery: Challenges and Successes of Existing Quality Assurance Guidelines and Paradigms

    SciTech Connect

    Goetsch, Steven J.

    2008-05-01

    Intracranial stereotactic radiosurgery has been practiced since 1951. The technique has expanded from a single dedicated unit in Stockholm in 1968 to hundreds of centers performing an estimated 100,000 Gamma Knife and linear accelerator cases in 2005. The radiation dosimetry of small photon fields used in this technique has been well explored in the past 15 years. Quality assurance recommendations have been promulgated in refereed reports and by several national and international professional societies since 1991. The field has survived several reported treatment errors and incidents, generally reacting by strengthening standards and precautions. An increasing number of computer-controlled and robotic-dedicated treatment units are expanding the field and putting patients at risk of unforeseen errors. Revisions and updates to previously published quality assurance documents, and especially to radiation dosimetry protocols, are now needed to ensure continued successful procedures that minimize the risk of serious errors.

  14. Nursing's response to the crisis of access, costs, and quality in health care.

    PubMed

    Schroeder, C

    1993-09-01

    Changes now taking place in the structure of health care delivery in the United States from regulatory models controlled by physicians to competitive models driven by traditional market forces of cost and quality are beginning to open opportunities for innovative nursing practice models. This article reports on the cost-effectiveness of a community nursing center for persons living with HIV/AIDS. The potential cost impact of the nursing center is significant because of the nurses' ability to forestall hospital admissions and readmissions, decrease prolonged lengths of stay, provide medically supportive outpatient treatments, care for clients at a low cost per client per year, attract professional and nonprofessional volunteer services and donations, and increase job satisfaction, thus reducing costly nurse turnover. The 1991 to 1992 costs of HIV/AIDS health care in the United States were used to estimate conservatively that the center has saved more than $700,000 in 1991 and over $1 million in 1992 in hospital charges for HIV/AIDS care. A rationale for the cost savings estimates is supplied by results of quantitative and qualitative evaluation research projects conducted at the center. Finally, implications of this analysis for future directions in nursing practice and education are discussed.

  15. German Guidelines.

    PubMed

    Kruis, Wolfgang; Nguyen, Gia P; Leifeld, Ludger

    2016-10-01

    Because of its frequency, diverticular disease is a burden on health care systems. Only few formal guidelines covering all aspects of the disease exist. Here, some selected statements from the German guidelines are given. The guidelines include significant recommendations for the diagnosis and management of diverticular disease. Both diagnosis and management depend definitely on clear definitions of the situation of an individual patient. Therefore, a new classification is proposed that is based on earlier suggestions. An internationally established classification would not only enable better patient care but could also lead to studies with comparable results.

  16. Evaluation of sediment quality guidelines derived using the screening-level concentration approach for application at uranium operations in Saskatchewan, Canada.

    PubMed

    Burnett-Seidel, Charlene; Liber, Karsten

    2012-03-01

    Sediment quality guidelines (SQGs) can be derived using different approaches and are commonly used in environmental management, reclamation, and risk assessment. The screening-level concentration (SLC) approach has been used in Ontario, Canada, to derive lowest effect levels (LELs) and severe effect levels for use as SQGs. This approach was adopted by the Canadian Nuclear Safety Commission (CNSC) to set guidelines for metals (As, Cr, Cu, Pb, Mo, Ni, Se, U, and V) and radionuclides (Ra-226, Pb-210, and Po-210) in sediment at northern Saskatchewan uranium mining and milling operations. The SLC approach is based on total metal and radionuclide concentrations in sediment, and corresponding benthic community composition data for a specific sampling site. In this study, sediment chemistry (total metals and radionuclides) and benthic community data from northern Saskatchewan uranium operations were compiled and examined. Results indicate that the CNSC-derived SQGs had limited relationships to observed effects, or lack thereof, on benthic invertebrate communities near uranium operations in Saskatchewan. The LELs were found to correctly align with effects at 95% of the sites that had effects, on a general basis, but on an element-specific basis many of the elements had concentrations at effect sites below their LELs. Furthermore, concentrations of the evaluated elements exceeded at least one LEL at 60% of the no-effect sites. The high number of exceedences of LELs at reference and no-effect sites (false-positives) calls to question the appropriateness of the CNSC-derived SQGs. It is suggested that alternatives to the SLC approach be explored.

  17. Latino Adults’ Access to Mental Health Care

    PubMed Central

    Cabassa, Leopoldo J.; Zayas, Luis H.; Hansen, Marissa C.

    2008-01-01

    Since the early 1980s, epidemiological studies using state-of-the-art methodologies have documented the unmet mental health needs of Latinos adults in the U.S. and Puerto Rico. This paper reviews 16 articles based on seven epidemiological studies, examines studies methodologies, and summarizes findings about how Latino adults access mental health services. Studies consistently report that, compared to non-Latino Whites, Latinos underutilize mental health services, are less likely to receive guideline congruent care, and rely more often on primary care for services. Structural, economic, psychiatric, and cultural factors influence Latinos’ service access. In spite of the valuable information these studies provide, methodological limitations (e.g., reliance on cross-sectional designs, scarcity of mixed Latino group samples) constrict knowledge about Latinos access to mental health services. Areas for future research and development needed to improve Latinos’ access and quality of mental health care are discussed. PMID:16598658

  18. Guideline-Directed Medication Use in Patients With Heart Failure With Reduced Ejection Fraction in India: American College of Cardiology's PINNACLE India Quality Improvement Program.

    PubMed

    Pokharel, Yashashwi; Wei, Jessica; Hira, Ravi S; Kalra, Ankur; Shore, Supriya; Kerkar, Prafulla G; Kumar, Ganesh; Risch, Samantha; Vicera, Veronique; Oetgen, William J; Deswal, Anita; Turakhia, Mintu P; Glusenkamp, Nathan; Virani, Salim S

    2016-03-01

    Little is known about the use of guideline-directed medical therapy (GDMT) in outpatients with heart failure with reduced left ventricular ejection fraction (HFrEF; ≤40%) in India. Our objective was to understand the use of GDMT in outpatients with HFrEF in India. The Practice Innovation And Clinical Excellence (PINNACLE) India Quality Improvement Program (PIQIP) is a registry for cardiovascular quality improvement in India supported by the American College of Cardiology Foundation. Between January 2008 and September 2014, we evaluated documentation of use of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and β-blockers, or both, among outpatients with HFrEF seeking care in 10 centers enrolled in the PIQIP registry. Among 75 639 patients in the PIQIP registry, 34 995 had EF reported, and 15 870 had an EF ≤40%. The mean age was 56 years; 23% were female. Hypertension, diabetes, coronary artery disease, and myocardial infarction were present in 37%, 23%, 27%, and 17%, respectively. Use of ACEIs/ARBs, β-blockers, and both were documented in 33.5%, 34.9%, and 29.6% of patients, respectively. The documentation of GDMT was higher in men, in patients age ≥65 years, and in those with presence of hypertension, diabetes, or coronary artery disease. Documentation of GDMT gradually increased over the study period. Among patients enrolled in the PIQIP registry, about two-thirds of patients with EF ≤40% did not have documented receipt of GDMT. This study is an initial step toward improving adherence to GDMT in India and highlights the feasibility of examining quality of care in HFrEF in a resource-limited setting.

  19. Implementation of quality control performance criteria and approved guidelines for upgrading of clinical chemistry laboratory procedures in Alexandria University hospitals.

    PubMed

    Rizk, Mohamed Moustafa M; el-Badawi, Nashwa A; Moez, Pacint E; Khattab, Azza A

    2009-03-01

    The aim of the present work was to assess the quality of work in Clinical Pathology Department, Alexandria Main University Hospital, Egypt; as regards the pre-analytical and analytical phases of testing; for later accreditation. This evaluation was performed using inspection sheets that were designed according to the CAP 2006 recommendations. All checklist questions that could not be answered "yes" were considered deficiencies and had to be corrected before being accredited. The questions were classified into ten groups; each group contained a number of questions concerning one of the pre-analytical and analytical assessment activities. We ranked our results into 4 categories according to the degree of fulfillment. The total number of questions that were answered "no" at the start and the end of the study accounted for 64/101 (63.4%) and 34/101 (33.7%) questions respectively. Most of the deficiencies were detected in the pre-analytical phase of the testing process; the first two checklists were used for the evaluation of this phase. At the start of the study, the degree of requirements fulfillment in checklist I and II were 0% and 21.1% respectively. By the end of the study the degree of fulfillment became, 85.7% and 63.2% respectively. Average number of sample rejection due to different causes was evaluated before and after implementing CAP recommendations; these causes include haemolysis, clotted serum, quantity not sufficient, and lost samples; the percentage of rejected samples before implementing CAP recommendations was 15.8%, 1.81%, 0.70%, and 0.51% respectively, while after implementing CAP recommendations it was 7%, 0.77%, 0.08%, and 0.05%, respectively. We concluded that the presence of standardized protocol for the pre-analytical activities had improved the quality of samples received by the lab, and we also concluded that accreditation allows laboratories to evaluate their performance, their compliance with the requirements of the accrediting association

  20. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process.

    PubMed

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2015-01-01

    In the past several years, the science of health care improvement has advanced considerably. In this article, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes 3 key components of systematic efforts to improve the quality, value, and safety of health care: formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).

  1. Low Quality of Free Coaching Apps With Respect to the American College of Sports Medicine Guidelines: A Review of Current Mobile Apps

    PubMed Central

    Bian, Jiang; Leavitt, Trevor; Bromwell, Jennifer; Harris III, Charles; Vincent, Heather

    2015-01-01

    Background Low physical activity level is a significant contributor to chronic disease, weight dysregulation, and mortality. Nearly 70% of the American population is overweight, and 35% is obese. Obesity costs an estimated US$ 147 billion annually in health care, and as many as 95 million years of life. Although poor nutritional habits remain the major culprit, lack of physical activity significantly contributes to the obesity epidemic and related lifestyle diseases. Objective Over the past 10 years, mobile devices have become ubiquitous, and there is an ever-increasing number of mobile apps that are being developed to facilitate physical activity, particularly for active people. However, no systematic assessment has been performed about their quality with respect to following the parameters of sound fitness principles and scientific evidence, or suitability for a variety of fitness levels. The aim of this paper is to fill this gap and assess the quality of mobile coaching apps on iOS mobile devices. Methods A set of 30 popular mobile apps pertaining to physical activity programming was identified and reviewed on an iPhone device. These apps met the inclusion criteria and provided specific prescriptive fitness and exercise programming content. The content of these apps was compared against the current guidelines and fitness principles established by the American College of Sports Medicine (ACSM). A weighted scoring method based on the recommendations of the ACSM was developed to generate subscores for quality of programming content for aerobic (0-6 scale), resistance (0-6 scale), and flexibility (0-2 scale) components using the frequency, intensity, time, and type (FITT) principle. An overall score (0-14 scale) was generated from the subscores to represent the overall quality of a fitness coaching app. Results Only 3 apps scored above 50% on the aerobic component (mean 0.7514, SD 1.2150, maximum 4.1636), 4 scored above 50% on the resistance/strength component (mean

  2. Access to Services, Quality of Care, and Family Impact for Children with Autism, Other Developmental Disabilities, and Other Mental Health Conditions

    ERIC Educational Resources Information Center

    Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha; St Peter, Claire

    2014-01-01

    This cross-sectional study examined perceived access to services, quality of care, and family impact reported by caregivers of children aged 3-17 years with autism spectrum disorders, as compared to caregivers of children with other developmental disabilities and other mental health conditions. The 2009-2010 National Survey of Children with…

  3. Things aren't getting better. Experts at federal hearing say healthcare costs, quality and access haven't improved much, if at all, since managed care.

    PubMed

    Fong, Tony

    2003-03-01

    Nearly a decade after managed care was supposed to revolutionize the healthcare industry, Americans have enjoyed little to no improvement in healthcare costs, quality or access, experts testified at a federal hearing last week. The hearing, arranged by the U.S. Justice Department and the Federal Trade Commission, was the first in a series of meetings.

  4. Access and Quality in Education in Resettlement Schools: The Case Study of Zvivingwi Secondary School in Gutu District, Masvingo Province in Zimbabwe

    ERIC Educational Resources Information Center

    Jenjekwa, Vincent

    2013-01-01

    In Zimbabwe, the discourse on access and quality in education has been a raging one since the colonial days of bottlenecks and outright discrimination against black Zimbabweans in education. The doors to education were declared open to all at independence in 1980 with the new Zimbabwe government's enunciated policy of education for all. It is an…

  5. South Africa: Distance Higher Education Policies for Access, Social Equity, Quality, and Social and Economic Responsiveness in a Context of the Diversity of Provision

    ERIC Educational Resources Information Center

    Badat, Saleem

    2005-01-01

    The principal concern of this paper is the implication of the increasing diversity of higher education provision in South Africa for equity of access and opportunity for historically disadvantaged social groups, high-quality provision, and social and economic responsiveness in distance higher education. This diversity is signalled by a variety of…

  6. 42 CFR 438.236 - Practice guidelines.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Measurement and Improvement Standards § 438.236 Practice guidelines. (a) Basic rule: The State must ensure, through...

  7. 7 CFR 622.5 - Guidelines.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... NEPA (40 CFR parts 1500-1508) issued by the Council on Environmental Quality, and in Economic and Environmental Principles and Guidelines for Water and Related Land Resources Implementation Studies issued by... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying...

  8. 7 CFR 622.5 - Guidelines.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying out... NEPA (40 CFR parts 1500-1508) issued by the Council on Environmental Quality, and in Economic and Environmental Principles and Guidelines for Water and Related Land Resources Implementation Studies issued...

  9. 7 CFR 622.5 - Guidelines.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying out... NEPA (40 CFR parts 1500-1508) issued by the Council on Environmental Quality, and in Economic and Environmental Principles and Guidelines for Water and Related Land Resources Implementation Studies issued...

  10. Food Web Bioaccumulation Model for Resident Killer Whales from the Northeastern Pacific Ocean as a Tool for the Derivation of PBDE-Sediment Quality Guidelines.

    PubMed

    Alava, Juan José; Ross, Peter S; Gobas, Frank A P C

    2016-01-01

    Resident killer whale populations in the NE Pacific Ocean are at risk due to the accumulation of pollutants, including polybrominated diphenyl ethers (PBDEs). To assess the impact of PBDEs in water and sediments in killer whale critical habitat, we developed a food web bioaccumulation model. The model was designed to estimate PBDE concentrations in killer whales based on PBDE concentrations in sediments and the water column throughout a lifetime of exposure. Calculated and observed PBDE concentrations exceeded the only toxicity reference value available for PBDEs in marine mammals (1500 μg/kg lipid) in southern resident killer whales but not in northern resident killer whales. Temporal trends (1993-2006) for PBDEs observed in southern resident killer whales showed a doubling time of ≈5 years. If current sediment quality guidelines available in Canada for polychlorinated biphenyls are applied to PBDEs, it can be expected that PBDE concentrations in killer whales will exceed available toxicity reference values by a large margin. Model calculations suggest that a PBDE concentration in sediments of approximately 1.0 μg/kg dw produces PBDE concentrations in resident killer whales that are below the current toxicity reference value for 95 % of the population, with this value serving as a precautionary benchmark for a management-based approach to reducing PBDE health risks to killer whales. The food web bioaccumulation model may be a useful risk management tool in support of regulatory protection for killer whales. PMID:26289814

  11. Food Web Bioaccumulation Model for Resident Killer Whales from the Northeastern Pacific Ocean as a Tool for the Derivation of PBDE-Sediment Quality Guidelines.

    PubMed

    Alava, Juan José; Ross, Peter S; Gobas, Frank A P C

    2016-01-01

    Resident killer whale populations in the NE Pacific Ocean are at risk due to the accumulation of pollutants, including polybrominated diphenyl ethers (PBDEs). To assess the impact of PBDEs in water and sediments in killer whale critical habitat, we developed a food web bioaccumulation model. The model was designed to estimate PBDE concentrations in killer whales based on PBDE concentrations in sediments and the water column throughout a lifetime of exposure. Calculated and observed PBDE concentrations exceeded the only toxicity reference value available for PBDEs in marine mammals (1500 μg/kg lipid) in southern resident killer whales but not in northern resident killer whales. Temporal trends (1993-2006) for PBDEs observed in southern resident killer whales showed a doubling time of ≈5 years. If current sediment quality guidelines available in Canada for polychlorinated biphenyls are applied to PBDEs, it can be expected that PBDE concentrations in killer whales will exceed available toxicity reference values by a large margin. Model calculations suggest that a PBDE concentration in sediments of approximately 1.0 μg/kg dw produces PBDE concentrations in resident killer whales that are below the current toxicity reference value for 95 % of the population, with this value serving as a precautionary benchmark for a management-based approach to reducing PBDE health risks to killer whales. The food web bioaccumulation model may be a useful risk management tool in support of regulatory protection for killer whales.

  12. Use of Sediment Quality Guidelines and pollution indicators for the assessment of heavy metal and PAH contamination in Greek surficial sea and lake sediments.

    PubMed

    Hahladakis, John; Smaragdaki, Eleftheria; Vasilaki, Georgia; Gidarakos, Evangelos

    2013-03-01

    Eight different surface sediment samples (K1-K8) were collected from two separate areas of Lake Koumoundourou and two samples (E1 and E2) from one area of Elefsis Bay, Athens, Greece. The level of pollution attributed to heavy metals was evaluated using several pollution indicators. Degree of Contamination, Modified Contamination Degree and Geoaccumulation Indexes were applied in order to determine and assess the anthropogenic contribution of the selected six elements (Cr, Ni, Cu, Zn, As and Pb). Moreover, the adverse effects of the sediments to aquatic organisms, from both heavy metals and polycyclic aromatic hydrocarbons (PAHs), were determined by using Sediment Quality Guidelines. The results indicated that Lake Koumoundourou is contaminated with heavy metals in a moderate degree and almost 50 % of the sediments are associated with frequent observation of adverse effects, when it comes to Ni and occasional observation of adverse effects, when it comes to Cu, Zn and Pb. As far as PAHs are concerned, around 60 % of the samples can be occasionally associated to toxic biological effects according to the effect-range classification for phenanthrene, benzo(a)anthracene, chrysene and pyrene. Finally, samples taken from the north side of the lake are more contaminated with PAHs than the ones taken from the east side probably due to the existence of the water barrier which acts as a reservoir of PAHs.

  13. Study of quality assurance regulations for linear accelerators in Korea: A comparison study between the current status in Korea and the international guidelines

    NASA Astrophysics Data System (ADS)

    Lee, Hyunho; Jeong, Seonghoon; Jo, Yunhui; Yoon, Myonggeun

    2015-07-01

    Quality assurance (QA) for medical linear accelerators is indispensable for appropriate cancer treatment. Some international organizations and advanced Western countries have provided QA guidelines for linear accelerators. Currently, QA regulations for linear accelerators in Korean hospitals specify a system in which each hospital stipulates its independent hospital-based protocols for QA procedures (HP_QAPs) and conducts QA based on those HP_QAPs while regulatory authorities verify whether items under those HP_QAPs have been performed. However, because this regulatory method cannot guarantee the quality of universal treatment and QA items with tolerance criteria are different in many hospitals, the presentation of standardized QA items and tolerance criteria is essential. In this study, QA items in HP_QAPs from various hospitals and those presented by international organizations, such as the International Atomic Energy Agency, the European Union, and the American Association of Physicist in Medicine, and by advanced Western countries, such as the USA, the UK, and Canada, were compared. Concordance rates between QA items for linear accelerators that were presented by the aforementioned organizations and those currently being implemented in Korean hospitals were shown to exhibit a daily QA of 50%, a weekly QA of 22%, a monthly QA of 43%, and an annual QA of 65%, and the overall concordance rates of all QA items were approximately 48%. In the comparison between QA items being implemented in Korean hospitals and those being implemented in advanced Western countries, concordance rates were shown to exhibit a daily QA of 50%, a weekly QA of 33%, a monthly QA of 60%, and an annual QA of 67%, and the overall concordance rates of all QA items were approximately 57%. The results of this study indicate that the HP_QAPs currently implemented by Korean hospitals as QA standards for linear accelerators used in radiation therapy do not meet international standards. If this

  14. 78 FR 18562 - Economic and Environmental Principles and Guidelines for Water and Related Land Resources...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-27

    ... QUALITY Economic and Environmental Principles and Guidelines for Water and Related Land Resources... Quality. ACTION: Draft guidelines with request for comments. SUMMARY: Section 2031 of the Water Resources... Environmental Principles and Guidelines for Water and Related Land Resources Implementation...

  15. Solvent and lipid accessibility prediction as a basis for model quality assessment in soluble and membrane proteins.

    PubMed

    Phatak, Mukta; Adamczak, Rafał; Cao, Baoqiang; Wagner, Michael; Meller, Jarosław

    2011-09-01

    On-going efforts to improve protein structure prediction stimulate the development of scoring functions and methods for model quality assessment (MQA) that can be used to rank and select the best protein models for further refinement. In this work, sequence-based prediction of relative solvent accessibility (RSA) is employed as a basis for a simple MQA method for soluble proteins, and subsequently extended to the much less explored case of (alpha-helical) membrane proteins. In analogy to soluble proteins, the level of exposure to the lipid of amino acid residues in transmembrane (TM) domains is captured in terms of the relative lipid accessibility (RLA), which is predicted from sequence using low-complexity Support Vector Regression models. On an independent set of 23 TM proteins, the new SVR-based predictor yields correlation coefficient (CC) of 0.56 between the predicted and observed RLA profiles, as opposed to CC of 0.13 for a baseline predictor that utilizes TMLIP2H empirical lipophilicity scale (with standard deviations of about 0.15). A simple MQA approach is then defined by ranking models of membrane proteins in terms of consistency between predicted and observed RLA profiles, as a measure of similarity to the native structure. The new method does not require a set of decoy models to optimize parameters, circumventing current limitations in this regard. Several different sets of models, including those generated by fragment based folding simulations, and decoys obtained by swapping TM helices to mimic errors in template based assignment, are used to assess the new approach. Predicted RLA profiles can be used to successfully discriminate near native models from non-native decoys in most cases, significantly improving the separation of correct and incorrectly folded models compared to a simple baseline approach that utilizes TMLIP2H. As suggested by the robust performance of a simple MQA method for soluble proteins that utilizes more accurate RSA predictions

  16. Non-vitamin K antagonist oral anticoagulants and atrial fibrillation guidelines in practice: barriers to and strategies for optimal implementation

    PubMed Central

    Camm, A. John; Pinto, Fausto J.; Hankey, Graeme J.; Andreotti, Felicita; Hobbs, F.D. Richard

    2015-01-01

    Stroke is a leading cause of morbidity and mortality worldwide. Atrial fibrillation (AF) is an independent risk factor for stroke, increasing the risk five-fold. Strokes in patients with AF are more likely than other embolic strokes to be fatal or cause severe disability and are associated with higher healthcare costs, but they are also preventable. Current guidelines recommend that all patients with AF who are at risk of stroke should receive anticoagulation. However, despite this guidance, registry data indicate that anticoagulation is still widely underused. With a focus on the 2012 update of the European Society of Cardiology (ESC) guidelines for the management of AF, the Action for Stroke Prevention alliance writing group have identified key reasons for the suboptimal implementation of the guidelines at a global, regional, and local level, with an emphasis on access restrictions to guideline-recommended therapies. Following identification of these barriers, the group has developed an expert consensus on strategies to augment the implementation of current guidelines, including practical, educational, and access-related measures. The potential impact of healthcare quality measures for stroke prevention on guideline implementation is also explored. By providing practical guidance on how to improve implementation of the ESC guidelines, or region-specific modifications of these guidelines, the aim is to reduce the potentially devastating impact that stroke can have on patients, their families and their carers. PMID:26116685

  17. WHO indoor air quality guidelines on household fuel combustion: Strategy implications of new evidence on interventions and exposure-risk functions

    NASA Astrophysics Data System (ADS)

    Bruce, Nigel; Pope, Dan; Rehfuess, Eva; Balakrishnan, Kalpana; Adair-Rohani, Heather; Dora, Carlos

    2015-04-01

    Background: 2.8 billion people use solid fuels as their primary cooking fuel; the resulting high levels of household air pollution (HAP) were estimated to cause more than 4 million premature deaths in 2012. The people most affected are among the world's poorest, and past experience has shown that securing adoption and sustained use of effective, low-emission stove technologies and fuels in such populations is not easy. Among the questions raised by these challenges are (i) to what levels does HAP exposure need to be reduced in order to ensure that substantial health benefits are achieved, and (ii) what intervention technologies and fuels can achieve the required levels of HAP in practice? New WHO air quality guidelines are being developed to address these issues. Aims: To address the above questions drawing on evidence from new evidence reviews conducted for the WHO guidelines. Methods: Discussion of key findings from reviews covering (i) systematic reviews of health risks from HAP exposure, (ii) newly developed exposure-response functions which combine combustion pollution risk evidence from ambient air pollution, second-hand smoke, HAP and active smoking, and (iii) a systematic review of the impacts of solid fuel and clean fuel interventions on kitchen levels of, and personal exposure to, PM2.5 and carbon monoxide (CO). Findings: Evidence on health risks from HAP suggest that controlling this exposure could reduce the risk of multiple child and adult health outcomes by 20-50%. The new integrated exposure-response functions (IERs) indicate that in order to secure these benefits, HAP levels require to be reduced to the WHO IT-1 annual average level (35 μg/m3 PM2.5), or below. The second review found that, in practice, solid fuel 'improved stoves' led to large percentage and absolute reductions, but post-intervention kitchen levels were still very high, at several hundreds of μg/m3 of PM2.5, although most solid fuel stove types met the WHO 24-hr average guideline

  18. Access to Coronary Artery Bypass Graft Surgery under Pay for Performance: Evidence from the Premier Hospital Quality Incentive Demonstration

    PubMed Central

    Epstein, Arnold M.; Joynt, Karen E.; Jha, Ashish K.; Orav, E. John

    2014-01-01

    Background Although Pay for Performance (P4P) has become common, many worry that P4P will lead providers to avoid offering surgical procedures to the sickest patients out of concern that poor outcomes will lead to financial penalties. Methods and Results We used Medicare data to compare change in rates of coronary artery bypass graft surgery (CABG) between 2002–03 and 2008–09 among patients with acute myocardial infarction (AMI) admitted to 126 hospitals participating in Medicare’s Premier Hospital Quality Incentive Demonstration P4P program (HQID) with patients in 848 control hospitals participating in public reporting alone. We examined rates for all AMI patients and those in the top decile of predicted mortality based on demographics, medical comorbidities and AMI characteristics. We identified 91,393 patients admitted for AMI in Premier hospitals and 502,536 Medicare patients admitted for AMI in control hospitals. CABG rates for AMI patients in Premier decreased from 13.6% in 2002–03 to 10.4% in 2008–09; there was a comparable decrease in non-Premier hospitals (13.6% to 10.6%, p-value for comparison of changes between Premier and non-Premier of 0.67). CABG rates for high-risk patients in Premier decreased from 8.4% in FY 2002–3 to 8.2% in 2008–9. Patterns were similar in non-Premier hospitals (8.4% to 8.3%, p-value for comparison of changes between Premier and non-Premier, 0.82). Conclusions Our results show no evidence of a deleterious impact of P4P on access to CABG for high-risk patients with AMI. These results should be reassuring to those concerned about the potential negative impact of P4P on high-risk patients. PMID:25160840

  19. Current topics on vascular access for hemodialysis.

    PubMed

    Tordoir, J H M; Van Der Sande, F M; De Haan, M W

    2004-09-01

    Vascular access remains the lifeline for end-stage renal failure patients, which have been treated by chronic intermittent hemodialysis. Due to the steady increase in the number of patients with difficulties to create access, in particular in elderly with various comorbidities, the need for more insight and regulations have evolved into the publications of the American and European guidelines. From the latter it may be obvious that an adequate preoperative assessment followed by the creation of autogenous arteriovenous fistulas (AVFs) is far better and preferred to the implantation of grafts. Vascular access maintenance by monitoring and elective percutanuous or surgical revision is of utmost importance to keep the access site functional. Despite up-to-date measures for vascular access maintenance, various complications may treaten not only the access site but also quality and expectance of life. Thrombotic occlusion remains a major event, leading to permanent failure in 10% of AVFs and 20% of grafts each year. Interventional (percutaneous transluminal angioplasty and/or stent implantation) or surgical revision of thrombosed accesses have similar outcomes with a high rate of reinterventions. The elderly diabetic population with peripheral arteriosclerotic obstructive disease is in particular prone to angio-access induced handischemia. When not timely and properly treated this may lead to minor or major amputation, further hampering quality of life. Also, the enormous application in the past 2 decades of acute central venous lines has lead to a significant increase of central venous obstruction with concomittent morbidity and problems creating vascular access in the upper extremities. Radiological intervention in these cases is a primary option, leaving surgical reconstruction as a second best method. It may be obvious that creation and maintenance of hemodialysis vascular access has become an important and time-consuming speciality. Only an up

  20. Hemodialysis vascular access survival: upper-arm native arteriovenous fistula.

    PubMed

    Dixon, Bradley S; Novak, Lisa; Fangman, Jerry

    2002-01-01

    Achieving Dialysis Outcomes Quality Initiative guidelines for native arteriovenous fistulae using the radiocephalic forearm fistula (lower-arm fistula [LAF]) is difficult. This study reports results using the upper-arm native arteriovenous fistula (UAF). From a prospective access database (1992 to 1998), this study was based on 204 patients (322 accesses). Average patient age was 56 +/- 1 years, 63% were men, and 47% had diabetes. A native fistula was the first access in 73% of patients (36%, LAFs; 37%, UAFs) and accounted for 48% of subsequent accesses (13%, LAFs; 35%, UAFs). Younger men were more likely to receive an LAF, but there was no demographic difference between patients receiving a UAF or arteriovenous graft (AVG). Both primary unassisted and cumulative access patencies were significantly better for UAFs than either LAFs or AVGs. For first accesses, cumulative access patency rates at 1, 3, and 5 years were 71%, 57%, and 57% for UAFs; 54%, 46%, and 36% for LAFs; and 54%, 28%, and 0% for AVGs (P < 0.01). Despite shorter access survival, AVGs required more total access procedures than either UAFs or LAFs (procedures per access: 2.5, 1.0, and 0.6 for AVGs, UAFs, and LAFs, respectively). When used, catheters were required for dialysis for a longer time for UAFs (median catheter days, 36, 53, and 56 for AVGs, LAFs, and UAFs, respectively; P < 0.05). Access flow rates were greater in UAFs (1,247 mL/min; n = 48; P < 0.01) than AVGs (851 mL/min; n = 30) or LAFs (938 mL/min; n = 31). There was no evidence that UAFs were banded or ligated for steal syndromes or heart failure more often than AVGs or LAFs. These results show that the UAF is a good alternative to an AVG for achieving Dialysis Outcomes Quality Initiative guidelines.

  1. Roadmap for Teacher Access to Student-Level Longitudinal Data: Key Focus Areas to Ensure Quality Implementation. Data for Action

    ERIC Educational Resources Information Center

    Data Quality Campaign, 2014

    2014-01-01

    Teachers have access to information about the students in their classrooms each year, but schools and districts often cannot provide teachers with longitudinal data (or data linked over time). Given resource constraints in schools and districts, states are best positioned to ensure that teachers have secure access to their students' longitudinal…

  2. Testing the Digital Divide: Does Access to High-Quality Use of Technology in Schools Affect Student Achievement?

    ERIC Educational Resources Information Center

    Talley, Gregory Keith

    2012-01-01

    This study investigates the relationship between access, use of technology and student achievement in public middle schools in Maryland. The objective of this study was to determine whether a digital divide (differences in access and utilization of technology based on student characteristics of race, socioeconomic status, and gender) exists among…

  3. Canadian hereditary angioedema guideline.

    PubMed

    Betschel, Stephen; Badiou, Jacquie; Binkley, Karen; Hébert, Jacques; Kanani, Amin; Keith, Paul; Lacuesta, Gina; Yang, Bill; Aygören-Pürsün, Emel; Bernstein, Jonathan; Bork, Konrad; Caballero, Teresa; Cicardi, Marco; Craig, Timothy; Farkas, Henriette; Longhurst, Hilary; Zuraw, Bruce; Boysen, Henrik; Borici-Mazi, Rozita; Bowen, Tom; Dallas, Karen; Dean, John; Lang-Robertson, Kelly; Laramée, Benoît; Leith, Eric; Mace, Sean; McCusker, Christine; Moote, Bill; Poon, Man-Chiu; Ritchie, Bruce; Stark, Donald; Sussman, Gordon; Waserman, Susan

    2014-01-01

    Hereditary angioedema (HAE) is a disease which is associated with random and often unpredictable attacks of painful swelling typically affecting the extremities, bowel mucosa, genitals, face and upper airway. Attacks are associated with significant functional impairment, decreased Health Related Quality of Life, and mortality in the case of laryngeal attacks. Caring for patients with HAE can be challenging due to the complexity of this disease. The care of patients with HAE in Canada is neither optimal nor uniform across the country. It lags behind other countries where there are more organized models for HAE management, and where additional therapeutic options are licensed and available for use. The objective of this guideline is to provide graded recommendations for the management of patients in Canada with HAE. This includes the treatment of attacks, short-term prophylaxis, long-term prophylaxis, and recommendations for self-administration, individualized therapy, quality of life, and comprehensive care. It is anticipated that by providing this guideline to caregivers, policy makers, patients and their advocates, that there will be an improved understanding of the current recommendations regarding management of HAE and the factors that need to be considered when choosing therapies and treatment plans for individual patients. The primary target users of this guideline are healthcare providers who are managing patients with HAE. Other healthcare providers who may use this guideline are emergency physicians, gastroenterologists, dentists and otolaryngologists, who will encounter patients with HAE and need to be aware of this condition. Hospital administrators, insurers and policy makers may also find this guideline helpful.

  4. Jogging Guidelines.

    ERIC Educational Resources Information Center

    President's Council on Physical Fitness and Sports, Washington, DC.

    Jogging guidelines are set forth under the following headings: a) What Is Jogging; c) Why One Should Jog; c) How To Begin; d) What To Wear (with the emphasis on proper shoes); e) When and Where To Jog; and f) How To Jog. A 16-week basic program, outlined for inactive adults, recommends for each week the number of days to exercise, the distance,…

  5. Italian Guidelines.

    PubMed

    Annibale, Bruno; Carabotti, Marilia; Cuomo, Rosario

    2016-10-01

    Diverticular disease (DD) is a widespread condition, however limited evidences are available about its management and complications. In the last years, an Italian Consensus Conference promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) and a Guideline, by Italian Society of Colorectal Surgery (SICCR) were published. The aim of the Consensus was to provide clinical recommendation for appropriate definition, diagnosis, and management of DD, in particular 4 areas of interest were identified, namely: (i) definition and epidemiology, (ii) pathophysiology, (iii) diagnosis, and (iv) medical and surgical treatment. A total of 55 statements graded according to different level of evidence and strength of recommendation were approved. However, if we consider the grade of recommendation, their strength remains suboptimal, with only 3 statements with grade of evidence A in the area of diagnosis. The Clinical guidelines by SICCR focus mainly on acute diverticulitis, and surgical treatment of complicated DD. One of the main topic analyzed, is represented by the management of the acute uncomplicated diverticulitis, in particular about the use of antibiotics and need of hospitalization. Despite the presence of many recent European and western country guidelines, there is a lack of robust data on epidemiology, risk factors, and medical and surgical management of DD, calling the need of further studies aimed to obtain an evidence-based approach in this condition. PMID:27622363

  6. 36 CFR 1191.1 - Accessibility guidelines.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... facilities subject to its regulations under the Architectural Barriers Act. 41 CFR 102-76.65, as added at 70... its postal facilities subject to the Architectural Barriers Act, effective October 1, 2005. 39 CFR 254..., effective November 29, 2006. 49 CFR 37.9 and Appendix A to 49 CFR part 37, as amended at 71 FR...

  7. 36 CFR 1191.1 - Accessibility guidelines.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Americans with Disabilities Act (ADA), effective March 15, 2012. 28 CFR 35.151(c)(3), as amended at 75 FR 56163, September 15, 2010; and 28 CFR 36.406(a)(3), as amended at 75 FR 56236, September 15, 2010. For state and local governments, the 2010 Standards consist of the regulations at 28 CFR 35.151 and...

  8. Absence of socioeconomic inequalities in access to good-quality breast cancer treatment within a population-wide screening programme in Turin (Italy).

    PubMed

    Zengarini, Nicolás; Ponti, Antonio; Tomatis, Mariano; Casella, Denise; Giordano, Livia; Mano, Maria P; Segnan, Nereo; Whitehead, Margaret; Costa, Giuseppe; Spadea, Teresa

    2016-11-01

    Several studies suggest that population-based breast cancer screening programmes might help reduce social inequalities in breast cancer survival both by increasing early diagnosis and by improving access to effective treatments. To start disentangling the two effects, we evaluated social inequalities in quality of treatment of screen-detected breast cancer in the city of Turin (Italy). Combining data from the Audit System on Quality of Breast Cancer Treatment and the Turin Longitudinal Study, we analysed 2700 cases in the screening target age class 50-69 diagnosed in the period 1995-2008. We selected 10 indicators of the pathway of care, relative to timeliness and appropriateness of diagnosis and treatment, and three indicators of socioeconomic position: education, occupational status and housing characteristics. For each indicator of care, relative risks of failure were estimated by robust Poisson regression models, controlling for calendar period of diagnosis, size of tumour and activity volume of the surgery units. The principal predictor of failure of the good care indicators was the calendar period of diagnosis, with a general improvement with time in the quality of diagnosis and treatment, followed by size of the tumour and volume of activity. Socioeconomic indicators show only a marginal independent effect on timeliness indicators. The observed associations of quality indicators with socioeconomic characteristics are lower than expected, suggesting a possible role of the screening programme in reducing disparities in the access to good-quality treatments thanks to its capability to enter screen-detected women into a protected pathway of care.

  9. An open-access database of grape harvest dates for climate research: data description and quality assessment

    NASA Astrophysics Data System (ADS)

    Daux, V.; Garcia de Cortazar-Atauri, I.; Yiou, P.; Chuine, I.; Garnier, E.; Ladurie, E. Le Roy; Mestre, O.; Tardaguila, J.

    2012-09-01

    We present an open-access dataset of grape harvest dates (GHD) series that has been compiled from international, French and Spanish literature and from unpublished documentary sources from public organizations and from wine-growers. As of June 2011, this GHD dataset comprises 380 series mainly from France (93% of the data) as well as series from Switzerland, Italy, Spain and Luxemburg. The series have variable length (from 1 to 479 data, mean length of 45 data) and contain gaps of variable sizes (mean ratio of observations/series length of 0.74). The longest and most complete ones are from Burgundy, Switzerland, Southern Rhône valley, Jura and Ile-de-France. The most ancient harvest date of the dataset is in 1354 in Burgundy. The GHD series were grouped into 27 regions according to their location, to geomorphological and geological criteria, and to past and present grape varieties. The GHD regional composite series (GHD-RCS) were calculated and compared pairwise to assess their reliability assuming that series close to one another are highly correlated. Most of the pairwise correlations are significant (p-value < 0.001) and strong (mean pairwise correlation coefficient of 0.58). As expected, the correlations tend to be higher when the vineyards are closer. The highest correlation (R = 0.91) is obtained between the High Loire Valley and the Ile-de-France GHD-RCS. The strong dependence of the vine cycle on temperature and, therefore, the strong link between the harvest dates and the temperature of the growing season was also used to test the quality of the GHD series. The strongest correlations are obtained between the GHD-RCS and the temperature series of the nearest weather stations. Moreover, the GHD-RCS/temperature correlation maps show spatial patterns similar to temperature correlation maps. The stability of the correlations over time is explored. The most striking feature is their generalised deterioration at the late 19th-early 20th century. The possible

  10. A review of clinical practice guidelines for lung cancer

    PubMed Central

    Ball, David; Silvestri, Gerard A.

    2013-01-01

    Clinical practice guidelines are important evidence-based resources to guide complex clinical decision making. However, it is challenging for health professionals to keep abreast available guidelines and to know how and where to access relevant guidelines. This review examines currently available guidelines for lung cancer published in the English language. Important key features are listed for each identified guideline. The methodology, approaches to dissemination and implementation, and associated resources are summarised. General challenges in the area of guideline development are highlighted. The potential to collaborate more widely across lung cancer guideline developers by sharing literature searches and assessments is discussed. PMID:24163752

  11. Vascular access creation and care should be provided by nephrologists.

    PubMed

    Malovrh, Marko

    2015-01-01

    The long-term survival and quality of life of patients on hemodialysis is dependent on the adequacy of dialysis via an appropriately placed vascular access. Recent clinical practice guidelines recommend the creation of native arteriovenous fistula or synthetic graft before start of chronic hemodialysis therapy to prevent the need for complication-prone dialysis catheters. The direct involvement of nephrologists in the management of referral patterns, predialysis follow-up, policy of venous preservation, preoperative evaluation, vascular access surgery and vascular access care seems to be important and productive targets for the quality of care delivered to the patients with end-stage renal disease. Early referral to nephrologists is important for delay progression of both kidney disease and its complications by specific and adequate treatment, for education program which should include modification of lifestyle, medication management, selection of treatment modality and instruction for vein preservation and vascular access. Nephrologists are responsible for on-time placement and adequate maturation of vascular access. The number of nephrologists around the world who create their own fistulas and grafts is growing, driven by a need for better patient outcomes on hemodialysis. Nephrologists have also a key role for care of vascular access during hemodialysis treatment by following vascular access function using clinical data, physical examination and additional ultrasound evaluation. Timely detection of malfunctioning vascular access means timely surgical or radiological intervention and increases the survival of vascular access. PMID:25751545

  12. Clinical practice guidelines in hypertension: a review.

    PubMed

    Álvarez-Vargas, Mayita Lizbeth; Galvez-Olortegui, José Kelvin; Galvez-Olortegui, Tomas Vladimir; Sosa-Rosado, José Manuel; Camacho-Saavedra, Luis Arturo

    2015-10-23

    The aim of this study is the methodological evaluation of Clinical Practice Guidelines (CPG) in hypertension. This is the first in a series of review articles, analysis, assessment in methodology and content of clinical practice guidelines in Cardiology. Of all clinical practice guidelines, three were selected and the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was used to assess each guide. The guidelines obtained the lowest score in the domain of applicability (mean 43.8%); while the highest score was for clarity of presentation (mean 81.5%). The lowest percentage was found in the applicability domain (European guideline) and the highest of all scores was found in two domains: scope and purpose, and clarity of presentation (Canadian guideline). Assessing the quality of the clinical practice guidelines analyzed, the Canadian is one with the best scores obtained by applying the AGREE II instrument, and it is advised to be used without modifications.

  13. Education For All, The Quality Imperative and the Problem of Pedagogy. CREATE Pathways to Access. Research Monograph No. 20

    ERIC Educational Resources Information Center

    Alexander, Robin

    2008-01-01

    This monograph critically examines the emerging discourse on quality associated with Education for All (EFA). It contends that EFA discourse has moved from a welcome and vital commitment to quality to its measurement without adequate consideration of what "quality" entails, particularly in the vital domain of pedagogy. Meanwhile, the demand for…

  14. VINSIA: visual navigator for surgical information access.

    PubMed

    Luo, Lingyun; Rowbottom, James; Craker, John; Xu, Rong; Zhang, Guo-Qiang

    2013-07-01

    Information access at the point of care presents a different set of requirements than those for traditional search engines. Critical care in remote (e.g., battle field) and rural settings not only requires access to clinical guidelines and medical libraries with surgical precision but also with minimal user effort and time. Our development of a graphical, anatomy-driven navigator called Visual Navigator for Surgical Information Access (VINSIA) fulfills the goal for providing evidence-based clinical decision support, specifically in perioperative and critical care settings, to allow rapid and precise information access through a portable stand-alone system. It comes with a set of unique characteristics: (a) a high precision, interactive visual interface driven by human anatomy; (b) direct linkage of anatomical structures to associated content such as clinical guidelines, literature, and medical libraries; and (c) an administrative content management interface allowing only an accredited, expert-level curator to edit and update the clinical content to ensure accuracy and currency. We believe that the deployment of VINSIA will improve quality, safety, and evidence-based standardization of patient care.

  15. Inventory of Cancer Guidelines: a tool to advance the guideline enterprise and improve the uptake of evidence.

    PubMed

    Brouwers, Melissa C; Rawski, Ellen; Spithoff, Karen; Oliver, Thomas K

    2011-04-01

    The Inventory of Cancer Guidelines (ICG) was designed to mitigate challenges associated with inconsistencies in the quality of cancer guidelines, keeping guidelines current and the duplication of effort in guideline development. The ICG is a searchable database of quality-appraised guidelines in cancer control that also includes designations of guidelines in progress, those in need of an update and those currently being updated. From a clinical perspective, the majority of the completed guidelines target breast, lung, colorectal and prostate cancers, and focus on the treatment stage of the cancer continuum. There is considerable variability in guideline quality both within and across guideline developers, as measured by the Appraisal of Guidelines for Research and Evaluation II. Quality domains of applicability and editorial independence are the guideline quality domains that score the poorest. While the ability to inform on the status of cancer control guidelines is important, the real potential of the ICG is in its ability to leverage positive change in the guideline enterprise. Pilot projects are underway to use data from the ICG to tailor audit and feedback interventions for guideline developers and to pursue collaborative updating and guideline adaptation initiatives, using the ICG as the platform from which these partnerships can evolve. PMID:21476817

  16. Americans with Disabilities Act (ADA) Accessibility Guidelines for Buildings and Facilities; Play Areas; Final Rule. Federal Register, Part IV: Architectural and Transportation Barriers Compliance Board, 36 CFR Part 1191.

    ERIC Educational Resources Information Center

    Federal Register, 2000

    2000-01-01

    The Architectural and Transportation Barriers Compliance Board has issued guidelines to serve as the basis for enforceable standards to be adopted by the Department of Justice for new construction and alterations of play areas covered by the Americans with Disabilities Act. The guidelines include scoping and technical provisions for ground level…

  17. The Challenge of Increasing Access and Improving Quality: An Analysis of Universal Primary Education Interventions in Kenya and Tanzania since the 1970s

    NASA Astrophysics Data System (ADS)

    Sifuna, Daniel N.

    2007-11-01

    This article shows how interventions to provide Universal Primary Education (UPE) from the 1970s into the twenty-first century affected efforts to improve the quality of primary education in Kenya and Tanzania. While the interventions have made significant differences in the lives of many communities by increasing access to education of children who would have been denied schooling, quality indicators (including attrition and completion rates and examination scores) have stagnated at best or declined. Efforts to ensure and maintain quality in primary education in the two countries are reported to face serious challenges, including mainly inadequate funding to ensure the provision of essential teaching and learning materials, appropriate infrastructure as well as a sufficient number of competent teachers.

  18. An Evaluation of Web-Based Clinical Practice Guidelines for Managing Problems Associated with Cannabis Use

    PubMed Central

    Turner, Michael W; Rooke, Sally E; Langton, Julia M; Gates, Peter J

    2012-01-01

    Background Cannabis is the most widely used illicit substance, and multiple treatment options and avenues exist for managing its use. There has been an increase in the development of clinical practice guidelines (CPGs) to improve standards of care in this area, many of which are disseminated online. However, little is known about the quality and accessibility of these online CPGs. Objective The purpose of study 1 was to determine the extent to which cannabis-related CPGs disseminated online adhere to established methodological standards. The purpose of study 2 was to determine if treatment providers are familiar with these guidelines and to assess their perceived quality of these guidelines. Methods Study 1 involved a systematic search using the Google Scholar search engine and the National Drugs Sector Information Service (NDSIS) website of the Alcohol and Other Drugs Council of Australia (ADCA) to identify CPGs disseminated online. To be included in the current study, CPGs needed to be free of charge and provide guidance on psychological interventions for reducing cannabis use. Four trained reviewers independently assessed the quality of the 7 identified guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Study 2 assessed 166 Australian cannabis-use treatment providers’ (mean age = 45.47 years, SD 12.14) familiarity with and opinions of these 7 guidelines using an online survey. Treatment providers were recruited using online advertisements that directed volunteers to a link to complete the survey, which was posted online for 6 months (January to June 2012). Primary study outcomes included quality scores and rates of guideline familiarity, guideline use, and discovery methods. Results Based on the AGREE II, the quality of CPGs varied considerably. Across different reporting domains, adherence to methodological standards ranged from 0% to 92%. Quality was lowest in the domains of rigor of development (50%), applicability (46

  19. Telemedicine for access to quality care on medical practice and continuing medical education in a global arena.

    PubMed

    Rafiq, Azhar; Merrell, Ronald C

    2005-01-01

    Health care practices continue to evolve with technological advances integrating computer applications and patient information management into telemedicine systems. Telemedicine can be broadly defined as the use of information technology to provide patient care and share clinical information from one geographic location to another. Telemedicine can lower costs and increase access to health care, especially for those who live in remote or underserved areas. The mechanism of telemedicine raises some difficult legal and regulatory issues as well since technology provides remote diagnosis and treatment across state lines resulting in unclear definitions for liability coverage. Physician licensing becomes an issue because telemedicine facilitates consultations without respect to state or national borders. With the increased access to current information and resources, continuing medical education becomes more feasible with synchronous or asynchronous access to educational content. The challenge in implementation of these unique educational tools is the inclusion for standards of practice and appropriate regulatory mechanisms to cover the audiences.

  20. The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

    PubMed Central

    Howlett, Jonathan G; McKelvie, Robert S; Costigan, Jeannine; Ducharme, Anique; Estrella-Holder, Estrellita; Ezekowitz, Justin A; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Herd, Anthony M; Isaac, Debra; Kouz, Simon; Leblanc, Kori; Liu, Peter; Mann, Elizabeth; Moe, Gordon W; O’Meara, Eileen; Rajda, Miroslav; Siu, Samuel; Stolee, Paul; Swiggum, Elizabeth; Zeiroth, Shelley

    2010-01-01

    Since 2006, the Canadian Cardiovascular Society heart failure (HF) guidelines have published annual focused updates for cardiovascular care providers. The 2010 Canadian Cardiovascular Society HF guidelines update focuses on an increasing issue in the western world – HF in ethnic minorities – and in an uncommon but important setting – the pregnant patient. Additionally, due to increasing attention recently given to the assessment of how care is delivered and measured, two critically important topics – disease management programs in HF and quality assurance – have been included. Both of these topics were written from a clinical perspective. It is hoped that the present update will become a useful tool for health care providers and planners in the ongoing evolution of care for HF patients in Canada. PMID:20386768

  1. Equitable Access to Educational Resources: An Investigation of the Distribution of Teacher Quality across Secondary Schools in South Florida

    ERIC Educational Resources Information Center

    Richards, Sabrina

    2014-01-01

    This quantitative study examined secondary schools across a south Florida school district to determine the relationship between school characteristics and measures of teacher quality with the aim of ascertaining the equitable distribution of the educational resource, teacher quality. Data regarding student population, staff climate survey…

  2. Access to What? Creating a Composite Measure of Educational Quantity and Educational Quality for 11 African Countries

    ERIC Educational Resources Information Center

    Spaull, Nicholas; Taylor, Stephen

    2015-01-01

    The aim of the current study is to create a composite statistic of educational quantity and educational quality by combining household data (Demographic and Health Survey) on grade completion and survey data (Southern and Eastern African Consortium for Monitoring Educational Quality) on cognitive outcomes for 11 African countries: Kenya, Lesotho,…

  3. Low-Skill Workers' Access to Quality Green Jobs. Perspectives on Low-Income Working Families. Brief 13

    ERIC Educational Resources Information Center

    Martinson, Karin; Stanczyk, Alexandra; Eyster; Lauren

    2010-01-01

    This brief discusses strategies for improving access to green jobs among those with low skill levels, particularly jobs that can help improve workers' economic standing and better support their families. In order to understand where green jobs for low-skill individuals can be found, the first section provides an overview of green industries and…

  4. Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment.

    PubMed

    Rosenow, Felix; Bast, Thomas; Czech, Thomas; Feucht, Martha; Hans, Volkmar H; Helmstaedter, Christoph; Huppertz, Hans-Jürgen; Noachtar, Soheyl; Oltmanns, Frank; Polster, Tilman; Seeck, Margitta; Trinka, Eugen; Wagner, Kathrin; Strzelczyk, Adam

    2016-08-01

    The definition of minimal standards remains pivotal as a basis for a high standard of care and as a basis for staff allocation or reimbursement. Only limited publications are available regarding the required staffing or methodologic expertise in epilepsy centers. The executive board of the working group (WG) on presurgical epilepsy diagnosis and operative epilepsy treatment published the first guidelines in 2000 for Austria, Germany, and Switzerland. In 2014, revised guidelines were published and the WG decided to publish an unaltered English translation in this report. Because epilepsy surgery is an elective procedure, quality standards are particularly high. As detailed in the first edition of these guidelines, quality control relates to seven different domains: (1) establishing centers with a sufficient number of sufficiently and specifically trained personnel, (2) minimum technical standards and equipment, (3) continuous medical education of employees, (4) surveillance by trained personnel during video electroencephalography (EEG) monitoring (VEM), (5) systematic acquisition of clinical and outcome data, (6) the minimum number of preoperative evaluations and epilepsy surgery procedures, and (7) the cooperation of epilepsy centers. These standards required the certification of the different professions involved and minimum numbers of procedures. In the subsequent decade, quite a number of colleagues were certified by the trinational WG; therefore, the executive board of the WG decided in 2013 to make these standards obligatory. This revised version is particularly relevant given that the German procedure classification explicitly refers to the guidelines of the WG with regard to noninvasive/invasive preoperative video-EEG monitoring and invasive intraoperative diagnostics in epilepsy. PMID:27354263

  5. From guidelines to practice: How reporting templates promote the use of radiology practice guidelines

    PubMed Central

    Kahn, Charles E.; Heilbrun, Marta E.; Applegate, Kimberly E.

    2013-01-01

    Radiology practice guidelines have been developed to help radiologists achieve quality and safety in their clinical practice. One means to promote the use of practice guidelines in radiology is through wider use of reporting templates, also known as “structured reporting.” This article presents specific examples in which radiology reporting templates can promote adherence to guidelines, gather data for quality improvement efforts, and facilitate compliance with performance incentive programs. PMID:23332496

  6. Legislation should support optimal breastfeeding practices and access to low-cost, high-quality complementary foods: Indonesia provides a case study.

    PubMed

    Soekarjo, Damayanti; Zehner, Elizabeth

    2011-10-01

    It is important to support women to exclusively breastfeed for 6 months and continue breastfeeding for 24 months and beyond. It is also necessary to provide the poor with access to affordable ways to improve the quality of complementary foods. Currently, many countries do not have the legal and policy environment necessary to support exclusive and continued breastfeeding. Legislative and policy changes are also necessary for introducing complementary food supplements, allowing them to be marketed to those who need them, and ensuring that marketing remains appropriate and in full compliance with the International Code of Marketing of Breastmilk Substitutes. This paper aims to illustrate the above with examples from Indonesia and to identify legislative requirements for supporting breastfeeding and enabling appropriate access to high-quality complementary food supplements for children 6-24 months of age. Requirements include improved information, training, monitoring and enforcement systems for the International Code of Marketing of Breastmilk Substitutes; implementation and monitoring of the Baby-Friendly Hospital Initiative; establishment of a registration category for complementary food supplements to enhance availability of high-quality, low-cost fortified products to help improve young child feeding; clear identification and marketing of these products as complementary food supplements for 6-24-month-olds so as to promote proper use and not interfere with breastfeeding. PMID:21929639

  7. Adherence to guidelines in gynecologic cancer surgery.

    PubMed

    Ferron, Gwenael; Martinez, Alejandra; Gladieff, Laurence; Mery, Eliane; David, Isabelle; Delannes, Martine; Montastruc, Marion; Balagué, Gisèle; Picaud, Laetitia; Querleu, Denis

    2014-11-01

    The purpose of this study is to review the available evidence documenting the prognostic role of adherence to guidelines in gynecologic cancers. A systematic review of the PubMed database using "guideline," "adherence," and "cancer" was carried out on February 25, 2014. Two thousand one hundred twenty-three publications were identified. Only publications addressing the question of adherence to recommendations regarding surgical care and multidisciplinary management of gynecologic cancers were selected. Six studies were identified in endometrial cancer, 4 in ovarian cancer, and none in cervical cancer. Adoption of guidelines is an effective tool for disease control and must consequently be considered as a process measure of quality cancer care. It is urgent to develop reliable and reproducible tools to assess adherence to guidelines based on level 1 evidence in gynecologic cancer then to carry out investigations to document the prognostic impact of compliance with guidelines. The time has come to include adherence to guidelines in quality assurance programs. PMID:25340292

  8. Absence of socioeconomic inequalities in access to good-quality breast cancer treatment within a population-wide screening programme in Turin (Italy).

    PubMed

    Zengarini, Nicolás; Ponti, Antonio; Tomatis, Mariano; Casella, Denise; Giordano, Livia; Mano, Maria P; Segnan, Nereo; Whitehead, Margaret; Costa, Giuseppe; Spadea, Teresa

    2016-11-01

    Several studies suggest that population-based breast cancer screening programmes might help reduce social inequalities in breast cancer survival both by increasing early diagnosis and by improving access to effective treatments. To start disentangling the two effects, we evaluated social inequalities in quality of treatment of screen-detected breast cancer in the city of Turin (Italy). Combining data from the Audit System on Quality of Breast Cancer Treatment and the Turin Longitudinal Study, we analysed 2700 cases in the screening target age class 50-69 diagnosed in the period 1995-2008. We selected 10 indicators of the pathway of care, relative to timeliness and appropriateness of diagnosis and treatment, and three indicators of socioeconomic position: education, occupational status and housing characteristics. For each indicator of care, relative risks of failure were estimated by robust Poisson regression models, controlling for calendar period of diagnosis, size of tumour and activity volume of the surgery units. The principal predictor of failure of the good care indicators was the calendar period of diagnosis, with a general improvement with time in the quality of diagnosis and treatment, followed by size of the tumour and volume of activity. Socioeconomic indicators show only a marginal independent effect on timeliness indicators. The observed associations of quality indicators with socioeconomic characteristics are lower than expected, suggesting a possible role of the screening programme in reducing disparities in the access to good-quality treatments thanks to its capability to enter screen-detected women into a protected pathway of care. PMID:26999379

  9. American Cancer Society lung cancer screening guidelines.

    PubMed

    Wender, Richard; Fontham, Elizabeth T H; Barrera, Ermilo; Colditz, Graham A; Church, Timothy R; Ettinger, David S; Etzioni, Ruth; Flowers, Christopher R; Gazelle, G Scott; Kelsey, Douglas K; LaMonte, Samuel J; Michaelson, James S; Oeffinger, Kevin C; Shih, Ya-Chen Tina; Sullivan, Daniel C; Travis, William; Walter, Louise; Wolf, Andrew M D; Brawley, Otis W; Smith, Robert A

    2013-01-01

    Findings from the National Cancer Institute's National Lung Screening Trial established that lung cancer mortality in specific high-risk groups can be reduced by annual screening with low-dose computed tomography. These findings indicate that the adoption of lung cancer screening could save many lives. Based on the results of the National Lung Screening Trial, the American Cancer Society is issuing an initial guideline for lung cancer screening. This guideline recommends that clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about screening with apparently healthy patients aged 55 years to 74 years who have at least a 30-pack-year smoking history and who currently smoke or have quit within the past 15 years. A process of informed and shared decision-making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with low-dose computed tomography should occur before any decision is made to initiate lung cancer screening. Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation.

  10. Are guidelines ethical? Some considerations for general practice.

    PubMed Central

    Rogers, Wendy A

    2002-01-01

    Guidelines have been promoted in various roles in general practice, e.g. to improve quality of care, to assist patient decision making, and to improve resource allocation. This paper examines these claims using ethical analysis. Guidelines may help general practitioners to act for thegood of their patients and avoid harm; but, on their own, guidelines cannot ensure quality of care or the protection of patients' interests. Patient choice may be limited rather than enhanced by following guideline recommendations. Guidelines contribute to rationing of resources but do not use explicit citeria for this. The ethical implications for guideline use are complex and far-reaching PMID:12171228

  11. Developing nursing computer interpretable guidelines: a feasibility study of heart failure guidelines in homecare.

    PubMed

    Topaz, Maxim; Shalom, Erez; Masterson-Creber, Ruth; Rhadakrishnan, Kavita; Monsen, Karen A; Bowles, Kathryn H

    2013-01-01

    Homecare is the fastest growing healthcare sector and evidence based information systems are critically needed. Nurses provide most of the care in homecare setting, yet there is a lack of knowledge on the feasibility of applying existing methodologies to generate computer interpretable nursing guidelines for home care. This study examined the feasibility of encoding homecare nursing heart failure guideline into a computer interpretable format. First, we achieved experts' consensus on the relevant guideline. Then, after training on the graphical tool for gradual knowledge specification (Gesher), we generated a comprehensive, hierarchical and time-oriented computer interpretable guideline using one of the guideline modeling languages (Asbru). The final guideline included 167 recommendations and experts' evaluation confirmed the adequacy of guideline knowledge representation. Future work should expand the applicability of our methodology and tools to nursing specialties other than heart failure and develop methods for comprehensive quality evaluation of the resulting guidelines.

  12. Developing nursing computer interpretable guidelines: a feasibility study of heart failure guidelines in homecare.

    PubMed

    Topaz, Maxim; Shalom, Erez; Masterson-Creber, Ruth; Rhadakrishnan, Kavita; Monsen, Karen A; Bowles, Kathryn H

    2013-01-01

    Homecare is the fastest growing healthcare sector and evidence based information systems are critically needed. Nurses provide most of the care in homecare setting, yet there is a lack of knowledge on the feasibility of applying existing methodologies to generate computer interpretable nursing guidelines for home care. This study examined the feasibility of encoding homecare nursing heart failure guideline into a computer interpretable format. First, we achieved experts' consensus on the relevant guideline. Then, after training on the graphical tool for gradual knowledge specification (Gesher), we generated a comprehensive, hierarchical and time-oriented computer interpretable guideline using one of the guideline modeling languages (Asbru). The final guideline included 167 recommendations and experts' evaluation confirmed the adequacy of guideline knowledge representation. Future work should expand the applicability of our methodology and tools to nursing specialties other than heart failure and develop methods for comprehensive quality evaluation of the resulting guidelines. PMID:24551412

  13. Expanding Access to Care and Improving Quality in the Mid-Atlantic States Safety-Net Clinics: Kaiser Permanente’s Community Ambassador Program

    PubMed Central

    Maeda, Jared Lane K; Bradley, Jacqueline J; Eissler, Sarah R; LoBrano, Marcia; Rubin, Mindy R; Gay, Maritha; Horberg, Michael A; Loftus, Bernadette C

    2015-01-01

    Context: As part of its longstanding commitment to improve the health of the communities it serves, Kaiser Permanente (KP) established the Community Ambassador Program (CAP) in the Mid-Atlantic States Region. The CAP places KP-employed nurse practitioners, midwives, and physician assistants to work in the safety-net clinics and to share best practices through a long-term community collaboration. Objective: To share the early experiences of the CAP and describe the initial results of the program’s impact on the safety-net clinics. Methods: We conducted an evaluation of 18 safety-net clinics that participated in the CAP in 2012 to determine the program’s early impact in expanding access to care, increasing the capacity of safety-net providers, and improving the quality of care on evidence-based measures in the year following program implementation. The safety-net clinics are comprised of federally qualified health centers, free clinics, and other community-based organizations. The clinics were asked to respond to questions regarding their evidence-based practices promoted by KP and on primary care-related utilization. Results: The Community Ambassadors provided an estimated 32,249 encounters to 11,988 patients. Performance by the Community Ambassadors was at or near 90% for 2 adult quality measures (weight screening and tobacco use assessment). For breast cancer screenings, however, performance among the Community Ambassadors was much lower (48%). Conclusion: The CAP demonstrated some early success in expanding access and improving quality of care on several key measures for certain subpopulations. Despite these achievements, opportunities remain for quality improvement, expanded capacity, and enhanced data reporting infrastructure. PMID:25785638

  14. 7 CFR 622.5 - Guidelines.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... NEPA (40 CFR parts 1500-1508) issued by the Council on Environmental Quality, and in Economic and... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying out... the Water Resources Council. Watershed projects are to be planned and carried out in a way that...

  15. 7 CFR 622.5 - Guidelines.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... NEPA (40 CFR parts 1500-1508) issued by the Council on Environmental Quality, and in Economic and... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying out... the Water Resources Council. Watershed projects are to be planned and carried out in a way that...

  16. [Accessibility and quality of Italian health and social services: the experiences of patients with neurofibromatosis type 1 and of their relatives].

    PubMed

    Kodra, Y; Salerno, P; Agazio, E; Mirabella, F; Taruscio, D

    2007-01-01

    Opinions of patients and relatives about their experiences with health and social services were assessed in a pilot study. The study was carried out in collaboration with two patients' Associations of Neurofibromatosis, "Neurofibromatosi--Onlus" and "LINFA--Onlus". An ad-hoc questionnaire was developed by the Italian National Centre of Rare Diseases and was sent to the Responsibles of the two aforementioned patients' Associations. The Responsibles distributed the questionnaire to their members by mail. The questionnaire investigated, using 5-level Likert scales, the following topics: quality and accessibility of health services (diagnostic exams, pharmacological therapies, rehabilitation, psychological support), quality and accessibility of social services (school, vocational training, health information, information on legal matters and rights). Finally, the questionnaire investigated also opinions about improvements of public health and social services in the last three years. Overall, 79 out 144 questionnaires were filled by patients or their relatives. The most frequent negative experiences concerned vocational training and both health and legal information. The most frequent positive opinions were reported for the human relationships with health professionals. This pilot study seems to point out a promising way to investigate systematically opinions of patients suffering from rare diseases and their relatives.

  17. Access to services, quality of care, and family impact for children with autism, other developmental disabilities, and other mental health conditions.

    PubMed

    Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha; St Peter, Claire

    2014-10-01

    This cross-sectional study examined perceived access to services, quality of care, and family impact reported by caregivers of children aged 3-17 years with autism spectrum disorders, as compared to caregivers of children with other developmental disabilities and other mental health conditions. The 2009-2010 National Survey of Children with Special Health Care Needs was utilized to examine the association between child's special needs condition and three outcomes (N = 18,136): access to services (difficulty using services, difficulty getting referrals, lack of source of care, and inadequate insurance coverage), quality of care (lack of care coordination, lack of shared decision making, and no routine screening), and family impact (financial, employment, and time-related burden). Multivariate logistic regressions were performed to compare caregivers of children with autism spectrum disorders to caregivers of children with developmental disabilities (cerebral palsy, Down syndrome, developmental delay, or intellectual disability), mental health conditions (attention deficit hyperactivity disorder, anxiety, behavioral/conduct problems, or depression), or both developmental disabilities and mental health conditions. Caregivers of children with autism spectrum disorders were significantly more likely to report difficulty using services, lack of source of care, inadequate insurance coverage, lack of shared decision making and care coordination, and adverse family impact as compared to caregivers of children with developmental disabilities, mental health conditions, or both.

  18. Access and utilisation of healthcare services in rural Tanzania: A comparison of public and non-public facilities using quality, equity, and trust dimensions.

    PubMed

    Shayo, Elizabeth H; Senkoro, Kesheni P; Momburi, Romanus; Olsen, Øystein E; Byskov, Jens; Makundi, Emmanuel A; Kamuzora, Peter; Mboera, Leonard E G

    2016-01-01

    This study compared the access and utilisation of health services in public and non-public health facilities in terms of quality, equity and trust in the Mbarali district, Tanzania. Interviews, focus group discussions, and informal discussions were used to generate data. Of the 1836 respondents, 1157 and 679 respondents sought healthcare services on their last visit at public or non-public health facilities, respectively. While 45.5% rated the quality of services to be good in both types of facilities, reported medicine shortages were more pronounced among those who visited public rather than non-public health facilities (OR = 1.7, 95% CI 1.4, 2.1). Respondents who visited public facilities were 4.9 times less likely than those who visited non-public facilities to emphasise the influence of cost in accessing and utilising health care (OR = 4.9, CI 3.9-6.1). A significant difference was also found in the provider-client relationship satisfaction level between non-public (89.1%) and public facilities (74.7%) (OR = 2.8, CI: 1.5-5.0), indicating a level of lower trust in the later. Revised strategies are needed to ensure availability of medicines in public facilities, which are used by the majority of the population, while strengthening private-public partnerships to harmonise healthcare costs.

  19. Guideline for primary care management of headache in adults

    PubMed Central

    Becker, Werner J.; Findlay, Ted; Moga, Carmen; Scott, N. Ann; Harstall, Christa; Taenzer, Paul

    2015-01-01

    Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. PMID:26273080

  20. Analyzing Accessibility Dimension of Urban Quality of Life: Where Urban Designers Face Duality between Subjective and Objective Reading of Place

    ERIC Educational Resources Information Center

    Lotfi, Sedigheh; Koohsari, M. J.

    2009-01-01

    The subject of urban quality of life and the promotion of its concept in particular, has always been the central focus of urban designers. This term is a multi-conceptual and dimensions. However most of the scholars have agreed that the concept consisted from two main dimensions; objective and subjective which these two approaches are used for its…