Too Much Emphasis on Research? An Empirical Examination of the Relationship between Research and Teaching in Multitasking Environments

ERIC Educational Resources Information Center

Bak, Hee-Je; Kim, Do Han

2015-01-01

While the public is concerned that emphasizing research performance among university faculty results in inadequate attention to undergraduate teaching, research on the relationship between research and teaching in higher education has failed to confirm or deny the validity of this concern. To empirically test this popular concern, we examined how…

Feminist psychodynamic psychotherapy of eating disorders. Theoretic integration informing clinical practice.

PubMed

Zerbe, K J

1996-12-01

Ideas derived from feminism and psychoanalytic theory can be combined for the integrated treatment of eating disorder patients. For a large subgroup of patients who continue to have a poor quality of life or inadequate symptom control (despite customary psychopharmacologic and cognitive behavioral interventions), feminist psychodynamic psychotherapy may prove lifesaving. This article explores how the patient may come to grasp more deeply the multiple roles her symptom has played in her psychological survival. Practical suggestions to enrich the psychotherapy as the patient traverses the natural struggles of adult life are emphasized. The importance of understanding and working with transference and countertransference issues while helping the patient accept life's paradoxes, ambiguities, and potential avenues for growth are underscored. The author reviews eight specific areas that warrant attention in psychotherapeutic exploration from a feminist psychoanalytic perspective (Culture as Bedrock Issue; Gender as Organizer of Behavior, Ownership of Body; Moral Development; Development of Personal Voice; Emphasis on Adult Development; Sexual Concerns; and Aggressive Conflicts).

Food Insecurity and Chronic Diseases Among American Indians in Rural Oklahoma: The THRIVE Study

PubMed Central

Wetherill, Marianna S.; Hearod, Jordan; Jacob, Tvli; Salvatore, Alicia L.; Cannady, Tamela; Grammar, Mandy; Standridge, Joy; Fox, Jill; Spiegel, Jennifer; Wiley, AnDina; Noonan, Carolyn; Buchwald, Dedra

2017-01-01

Objectives. To examine food insecurity and cardiovascular disease–related health outcomes among American Indians (AIs) in rural Oklahoma. Methods. We surveyed a cross-sectional sample of 513 AI adults to assess food insecurity domains (i.e., food quality and quantity) and obesity, diabetes, and hypertension. Results. Among AIs surveyed, 56% reported inadequate food quantity and 62% reported inadequate food quality. The unadjusted prevalence of diabetes (28.4% vs 18.4%), obesity (60.0% vs 48.3%), and hypertension (54.1% vs 41.6%) was higher among participants with inadequate food quantity than among those with adequate food quantity. These associations did not reach statistical significance after adjustment for age, gender, study site, education, and income. The unadjusted prevalence of obesity (60.7% vs 45.8%), diabetes (27.3% vs 18.8%), and hypertension (52.5% vs 42.5%) was higher among those with inadequate food quality than among those with adequate food quality, even after adjustment for age, gender, study site, education, and income. Conclusions. Tribal, federal, and state policymakers, as well as businesses and nonprofit organizations, must collaboratively take aggressive action to address food insecurity and its underlying causes, including improving tribal food environments, reducing barriers to healthy foods, and increasing living wages. PMID:28103070

Ethically problematic treatment decisions: a physician survey.

PubMed

Saarni, Samuli I; Parmanne, Piitu; Halila, Ritva

2008-02-01

Experiencing ethical problems requires both ethically problematic situations and ethical sensitivity. Ethically problematic treatment decisions are distressing and might reflect health care quality problems. Whether all physicians actually experience ethical problems, what these problems are and how they vary according to physician age, gender and work sector are largely unknown. A mail survey of all non-retired physicians licensed in Finland (n = 17,172, response rate 75.6%). The proportion of physicians reporting having made ethically problematic treatment decisions decreased in linear fashion from 60% at ages below 30 years to 21% at ages over 63 years. The only problem that did not decrease in frequency with age was having withdrawn necessary treatments. Women and primary care physicians reported problematic decisions most often, although gender differences were small. Primary care physicians most often reported having performed too many investigations or having pressured patients, whereas hospital physicians emphasized having withdrawn necessary treatments. Performing unnecessary treatments or investigations was explained by pressure from patients or relatives, and performing too few treatments or investigations was explained by inadequate resources. In general, young physicians felt pressured to do too much, whereas older physicians felt they could not do enough due to inadequate resources. Older physicians might be less exposed to ethically problematic situations, be more able to handle them or have lower ethical sensitivity. Young physicians could benefit from support in resisting pressure to perform unnecessary treatments, whereas older physicians might benefit from training in recognizing ethical issues.

Randomized clinical trials in dentistry: Risks of bias, risks of random errors, reporting quality, and methodologic quality over the years 1955–2013

PubMed Central

Armijo-Olivo, Susan; Cummings, Greta G.; Amin, Maryam; Flores-Mir, Carlos

2017-01-01

Objectives To examine the risks of bias, risks of random errors, reporting quality, and methodological quality of randomized clinical trials of oral health interventions and the development of these aspects over time. Methods We included 540 randomized clinical trials from 64 selected systematic reviews. We extracted, in duplicate, details from each of the selected randomized clinical trials with respect to publication and trial characteristics, reporting and methodologic characteristics, and Cochrane risk of bias domains. We analyzed data using logistic regression and Chi-square statistics. Results Sequence generation was assessed to be inadequate (at unclear or high risk of bias) in 68% (n = 367) of the trials, while allocation concealment was inadequate in the majority of trials (n = 464; 85.9%). Blinding of participants and blinding of the outcome assessment were judged to be inadequate in 28.5% (n = 154) and 40.5% (n = 219) of the trials, respectively. A sample size calculation before the initiation of the study was not performed/reported in 79.1% (n = 427) of the trials, while the sample size was assessed as adequate in only 17.6% (n = 95) of the trials. Two thirds of the trials were not described as double blinded (n = 358; 66.3%), while the method of blinding was appropriate in 53% (n = 286) of the trials. We identified a significant decrease over time (1955–2013) in the proportion of trials assessed as having inadequately addressed methodological quality items (P < 0.05) in 30 out of the 40 quality criteria, or as being inadequate (at high or unclear risk of bias) in five domains of the Cochrane risk of bias tool: sequence generation, allocation concealment, incomplete outcome data, other sources of bias, and overall risk of bias. Conclusions The risks of bias, risks of random errors, reporting quality, and methodological quality of randomized clinical trials of oral health interventions have improved over time; however, further efforts that contribute to the development of more stringent methodology and detailed reporting of trials are still needed. PMID:29272315

Randomized clinical trials in dentistry: Risks of bias, risks of random errors, reporting quality, and methodologic quality over the years 1955-2013.

PubMed

Saltaji, Humam; Armijo-Olivo, Susan; Cummings, Greta G; Amin, Maryam; Flores-Mir, Carlos

2017-01-01

To examine the risks of bias, risks of random errors, reporting quality, and methodological quality of randomized clinical trials of oral health interventions and the development of these aspects over time. We included 540 randomized clinical trials from 64 selected systematic reviews. We extracted, in duplicate, details from each of the selected randomized clinical trials with respect to publication and trial characteristics, reporting and methodologic characteristics, and Cochrane risk of bias domains. We analyzed data using logistic regression and Chi-square statistics. Sequence generation was assessed to be inadequate (at unclear or high risk of bias) in 68% (n = 367) of the trials, while allocation concealment was inadequate in the majority of trials (n = 464; 85.9%). Blinding of participants and blinding of the outcome assessment were judged to be inadequate in 28.5% (n = 154) and 40.5% (n = 219) of the trials, respectively. A sample size calculation before the initiation of the study was not performed/reported in 79.1% (n = 427) of the trials, while the sample size was assessed as adequate in only 17.6% (n = 95) of the trials. Two thirds of the trials were not described as double blinded (n = 358; 66.3%), while the method of blinding was appropriate in 53% (n = 286) of the trials. We identified a significant decrease over time (1955-2013) in the proportion of trials assessed as having inadequately addressed methodological quality items (P < 0.05) in 30 out of the 40 quality criteria, or as being inadequate (at high or unclear risk of bias) in five domains of the Cochrane risk of bias tool: sequence generation, allocation concealment, incomplete outcome data, other sources of bias, and overall risk of bias. The risks of bias, risks of random errors, reporting quality, and methodological quality of randomized clinical trials of oral health interventions have improved over time; however, further efforts that contribute to the development of more stringent methodology and detailed reporting of trials are still needed.

State Implementation Plans (SIP): Submissions that EPA has Found Adequate or Inadequate

EPA Pesticide Factsheets

EPA/OTAQ’s State and Local Transportation Resources are for air quality and transportation government and community leaders. Information on state implementation plans (SIPs) that EPA has found either adequate or inadequate is provided here.

The search for life's origins: Progress and future directions in planetary biology and chemical evolution

NASA Technical Reports Server (NTRS)

1990-01-01

The current state is reviewed of the study of chemical evolution and planetary biology and the probable future is discussed of the field, at least for the near term. To this end, the report lists the goals and objectives of future research and makes detailed, comprehensive recommendations for accomplishing them, emphasizing those issues that were inadequately discussed in earlier Space Studies Board reports.

The role of higher education in transforming the quality of dementia care: dementia studies at the University of Bradford.

PubMed

Downs, M; Capstick, A; Baldwin, P C; Surr, C; Bruce, E

2009-04-01

There is now widespread concern about the inadequate care and support provided to people with dementia from diagnosis to death. It is acknowledged that while there is a range of effective ways to care for and support people with dementia and their families from diagnosis to death, these have yet to become integral to practice. In England, for example, the National Dementia Strategy seeks to transform the quality of dementia care. One of the key components to transforming the quality of care is to ensure we have an informed and effective workforce. We argue here that in order to transform the quality of care we need to distinguish between the aims of training and education. Whilst there is a place for skills-based workplace training, Higher Education in dementia studies has a key role to play in the provision of specialist knowledge and skills in dementia care emphasizing as it does the development of critical thinking, reflection and action. In this paper we describe dementia studies at Bradford University available at both undergraduate and postgraduate levels. We outline their aims and learning outcomes, curricula, approach to teaching, learning and assessment. We describe the nature of students who study with us, noting their fit with the Higher Education Funding Council in England's agenda for widening participation in higher education. Higher Education in dementia studies has a unique role to play in equipping practitioners and professionals with the information, skills and attitudes to realize the potential for quality of life for people with dementia and their families.

Application of a karst disturbance index in Hillsborough County, Florida.

PubMed

van Beynen, Philip; Feliciano, Nilda; North, Leslie; Townsend, Kaya

2007-02-01

Hillsborough County, Florida, is a karst region that is heavily urbanized, yet no study has been undertaken measuring the degree of human disturbance. Van Beynen and Townsend (2005) created a hierarchical and standardized disturbance index specifically designed for karst environments. To address the problem of determining human disturbance in the county, the above index was successfully applied and it was found that Hillsborough was highly disturbed (disturbance score of 0.69 of 1.0) because of its predominant urban and rural land use. Furthermore, the application of the index allowed for its refinement and the highlighting of environmental aspects in need of remediation such as soil compaction, deforestation, disturbance of archaeological sites, and the expanding urban footprint. Several minor issues arose during the application: the need for broader indicator descriptions that encompass a variety of scenarios, the need for a revised water quality indicator, inadequate data on sinkholes, and a lack of data for species richness and species population density. The utility of the index to resource managers arises from emphasizing certain areas of the environment that require immediate attention and determining temporal changes in environmental quality. Future application of the index requires potential retooling of the biota indicators, tightening of scoring descriptions for certain indicators, and further examination of the scale at which the index can be applied.

Testing optimal foraging theory in a penguin-krill system.

PubMed

Watanabe, Yuuki Y; Ito, Motohiro; Takahashi, Akinori

2014-03-22

Food is heterogeneously distributed in nature, and understanding how animals search for and exploit food patches is a fundamental challenge in ecology. The classic marginal value theorem (MVT) formulates optimal patch residence time in response to patch quality. The MVT was generally proved in controlled animal experiments; however, owing to the technical difficulties in recording foraging behaviour in the wild, it has been inadequately examined in natural predator-prey systems, especially those in the three-dimensional marine environment. Using animal-borne accelerometers and video cameras, we collected a rare dataset in which the behaviour of a marine predator (penguin) was recorded simultaneously with the capture timings of mobile, patchily distributed prey (krill). We provide qualitative support for the MVT by showing that (i) krill capture rate diminished with time in each dive, as assumed in the MVT, and (ii) dive duration (or patch residence time, controlled for dive depth) increased with short-term, dive-scale krill capture rate, but decreased with long-term, bout-scale krill capture rate, as predicted from the MVT. Our results demonstrate that a single environmental factor (i.e. patch quality) can have opposite effects on animal behaviour depending on the time scale, emphasizing the importance of multi-scale approaches in understanding complex foraging strategies.

[Extensive injuries due to high-tension electrical current].

PubMed

Tomásek, D; Königová, R; Snupárek, Z

1989-03-01

The authors submit a case of severe injury with high tension electric current. They emphasize the necessity of prevention of this injury which occurs most frequently when transformer stations are not adequately safeguarded, in case of inadequate protection when approaching trolley wires on the railway track, and when safety principles are not respected during work on the railway. The authors draw attention to the importance of immediate resuscitation and multidisciplinary comprehensive care.

Health-related quality of life among breast cancer patients in Lebanon.

PubMed

Abu-Saad Huijer, Huda; Abboud, Sarah

2012-12-01

High incidence rates of breast cancer (BC) emphasize the need to address health-related quality of life (QoL) in this population. The aim of this study was to evaluate the QoL, symptom prevalence and management, functional ability, and quality of care in Lebanese women with BC at a tertiary health care facility. Cross-sectional descriptive survey targeting Lebanese adults with cancer and using a combination of four instruments: European Organization for Research and treatment of Cancer-Quality of Life Questionnaire, Memorial Symptom Assessment Scale; Barthel Index; Needs at End of life Screening Tool, and a demographic/clinical characteristics section. 89 breast cancer patients participated in the study; data was collected from 2009 to 2010. Descriptive analysis in addition to independent sample t-test, ANOVA, and Pearson r correlation were used for data analysis. The most prevalent symptoms were feeling nervous, feeling sad, lack of energy, and pain; symptom management was inadequate; high scores were reported on functional ability, medical care, spirituality, and relationships. Younger, single, and better educated participants who were diagnosed for less than 30 months, had no metastasis, and paid less than $450 dollars per month on medical expenses showed better global health status/QoL. Payments per month for medical expenses, presence of metastasis, time since diagnosis, and type of treatment received were significantly associated with QoL, the different functioning dimensions, and symptoms. Strategies addressing symptom management in particular psychological symptoms need to be developed and implemented in addition to a holistic multidisciplinary palliative care approach. Copyright © 2011 Elsevier Ltd. All rights reserved.

Patients with History of Colonoscopy Are Less Likely to Achieve High Quality Preparation After Implementing Split-Dose Bowel Preparation.

PubMed

Madhoun, M F; Bitar, H; Parava, P; Bashir, M H; Zia, H

2017-01-01

Anecdotally, we observed that patients who had previous colonoscopies were less likely to follow newly implemented split-dose bowel preparation (SDBP) instructions. We investigated whether the indication for colonoscopy is an independent factor for achieving high quality bowel preparation among patients asked to follow SDBP. We performed a retrospective study of data from 1478 patients who received outpatient colonoscopies in 2014 (the year of SDBP implementation) at our Veterans Affairs Medical Center. We collected information related to demographics and factors known to affect bowel preparations. Reasons for colonoscopy were dichotomized into surveillance (previous colonoscopy) vs. non-surveillance (positive occult blood test or screening). Bowel preparation quality was scored using the Boston Bowel Preparation Scale (BBPS), and was categorized as either excellent vs. not excellent (BBPS≥7 vs. BBPS<7), or adequate vs. inadequate (BBPS≥6 vs. BBPS<6). Bowel preparation quality was excellent in 60% of colonoscopies and adequate in 84% of colonoscopies. Thirty-six percent (535) were surveillance colonoscopies. In multivariate logistic regression analysis, more patients in the non-surveillance group achieved excellent (OR 0.8 ; 95% CI [0.7-0.8], P <0.0001) and adequate (OR 0.8 ; 95% CI [0.7-0.9], P <0.006) bowel preparation than did patients in the surveillance group. Patients with a prior colonoscopy might not follow the split-dose bowel preparation instructions. Educational interventions emphasizing the benefits of SDBP in this group of patients may help ensure compliance and prevent the habitual use of day-before preparations. © Acta Gastro-Enterologica Belgica.

A meta-analysis of the effect of media devices on sleep outcomes

PubMed Central

Carter, Ben; Rees, Philippa; Hale, Lauren; Bhattacharjee, Darsharna; Paradkar, Mandar

2017-01-01

Importance Sleep is vital to children’s bio-psycho-social development. Inadequate sleep quantity and quality is a public health concern with an array of detrimental health outcomes. Portable mobile and media device have become a ubiquitous part of children’s lives and may impact children’s sleep duration and quality. Objective This systematic review was conducted to examine the effect of portable media devices (e.g. mobile phones, and tablet devices) on sleep outcomes Data Sources A search strategy was developed and searches of the published and grey literature were conducted across 12 databases from January 1st 2011 to June 15th, 2015. No language restriction was applied. Study Selection We included randomized controlled trials; cohort; and cross sectional study designs. Of 467 studies identified, 20 cross-sectional studies were assessed for quality Data Extraction and Synthesis Data extraction and quality assessment was independently carried out by two reviewers and disagreements resolved by a third. Data was pooled in a random-effects meta-analysis, and an individual participant meta-analysis was carried out where possible. Main Outcomes and Measures The primary outcomes were: inadequate sleep quantity; poor sleep quality; and excessive daytime sleepiness, carried out following an a priori protocol. Results Twenty studies were included and quality assessed, involving 125,198 children, 50.1% were male. There was a strong and consistent association between bedtime media device use and: inadequate sleep quantity (OR =2.17; 95%CI 1.42-3.32); poor sleep quality (OR=1.46; 95%CI 1.14-1.88); and excessive daytime sleepiness (OR=2.72; 95%CI 1.32-5.61). Additionally, children who had access to (but did not use) media devices at night were more likely to have inadequate: sleep quantity (OR=1.79; 95%CI 1.39-2.31); sleep quality (OR=1.53; 95%CI 1.11-2.10); and daytime sleepiness (OR=2.27; 95%CI 1.54-3.35). Conclusions and relevance This was the first meta-analysis of the effect of access and use of media device on sleep outcomes. Bedtime access and use of media devices was significantly associated with inadequate sleep quantity; poor sleep quality; and excessive daytime sleepiness. An integrated approach between teachers, healthcare providers and parents is needed to minimize device access at bedtime, and future research is needed to evaluate the impact on sleep hygiene and outcomes. PMID:27802500

The medical and scientific responsibility of pollen information services.

PubMed

Bastl, Katharina; Berger, Markus; Bergmann, Karl-Christian; Kmenta, Maximilian; Berger, Uwe

2017-01-01

Pollen information as such is highly valuable and was considered so far as a self-evident good free for the public. The foundation for reliable and serious pollen information is the careful, scientific evaluation of pollen content in the air. However, it is essential to state and define now the requirements for pollen data and qualifications needed for institutions working with pollen data in the light of technical developments such as automated pollen counting and various political interests in aerobiology including attempts to finally acknowledge pollen and spores as relevant biological particles in the air worth being considered for pollution and health directives. It has to be emphasized that inadequate pollen forecasts are a considerable health risk for pollen allergy sufferers. Therefore, the responsibility of institutions involved in pollen monitoring and forecasting is high and should be substantiated with respective qualifications and know-how. We suggest here for the first time a portfolio of quality criteria and demand rigorous scientific monitoring and certification of such institutions in the interest and for the protection of persons affected by a pollen allergy.

Dietary Protein Intake in Young Children in Selected Low-Income Countries Is Generally Adequate in Relation to Estimated Requirements for Healthy Children, Except When Complementary Food Intake Is Low.

PubMed

Arsenault, Joanne E; Brown, Kenneth H

2017-05-01

Background: Previous research indicates that young children in low-income countries (LICs) generally consume greater amounts of protein than published estimates of protein requirements, but this research did not account for protein quality based on the mix of amino acids and the digestibility of ingested protein. Objective: Our objective was to estimate the prevalence of inadequate protein and amino acid intake by young children in LICs, accounting for protein quality. Methods: Seven data sets with information on dietary intake for children (6-35 mo of age) from 6 LICs (Peru, Guatemala, Ecuador, Bangladesh, Uganda, and Zambia) were reanalyzed to estimate protein and amino acid intake and assess adequacy. The protein digestibility-corrected amino acid score of each child's diet was calculated and multiplied by the original (crude) protein intake to obtain an estimate of available protein intake. Distributions of usual intake were obtained to estimate the prevalence of inadequate protein and amino acid intake for each cohort according to Estimated Average Requirements. Results: The prevalence of inadequate protein intake was highest in breastfeeding children aged 6-8 mo: 24% of Bangladeshi and 16% of Peruvian children. With the exception of Bangladesh, the prevalence of inadequate available protein intake decreased by age 9-12 mo and was very low in all sites (0-2%) after 12 mo of age. Inadequate protein intake in children <12 mo of age was due primarily to low energy intake from complementary foods, not inadequate protein density. Conclusions: Overall, most children consumed protein amounts greater than requirements, except for the younger breastfeeding children, who were consuming low amounts of complementary foods. These findings reinforce previous evidence that dietary protein is not generally limiting for children in LICs compared with estimated requirements for healthy children, even after accounting for protein quality. However, unmeasured effects of infection and intestinal dysfunction on the children's protein requirements could modify this conclusion.

Patients with Gout Treated with Conventional Urate-lowering Therapy: Association with Disease Control, Health-related Quality of Life, and Work Productivity.

PubMed

Wood, Robert; Fermer, Steve; Ramachandran, Sulabha; Baumgartner, Scott; Morlock, Robert

2016-10-01

Implications of inadequate gout control were assessed through health-related quality of life (HRQOL) and work productivity of patients with gout adequately controlled while taking conventional urate-lowering therapy (ULT) for ≥ 3 months vs those whose gout was inadequately controlled. Retrospective data were drawn from the Adelphi Disease Specific Programme (DSP), a cross-sectional survey of patients with gout in France, Germany, the United Kingdom, and the United States. Patients completed these questionnaires: EQ-5D (3L), Patient Reported Outcomes Measurement Information System (PROMIS) Health Assessment Questionnaire (HAQ), and Work Productivity and Activity Impairment. Inadequate control was defined as the most recent serum uric acid (SUA) level > 6 mg/dl (> 360 µmol/l) or ≥ 2 flares in the last 12 months; adequate control as SUA level ≤ 6 mg/dl (≤ 360 µmol/l) and 0 flares. Appropriate statistical tests were used to assess differences between groups. There were 836 (69%) inadequately and 368 (31%) adequately controlled gout cases. Mean age was 61 and 63 years and duration of current ULT was 32 and 57 months, respectively. Patients experiencing inadequate control reported significantly worse functioning and HRQOL, as measured by the EQ-5D (0.790 vs 0.877; difference: -0.087; p < 0.001) and PROMIS HAQ (13.21 vs 6.91; difference: 6.30; p < 0.001) scales. Productivity was also more impaired (work time missed: 4.5% vs 1.3%; impairment while working: 19.1% vs 5.2%; overall work impairment: 20.4% vs 5.6%; activity impairment: 20.3% vs 5.3%; all p < 0.001). Less than one-third of patients had gout that was adequately controlled. Those experiencing inadequately controlled gout reported significantly worse functioning, quality of life, and work productivity. Gout treatment strategies to improve disease control may lead to improvements in HRQOL and productivity.

Global trends in dietary micronutrient supplies and estimated prevalence of inadequate intakes

PubMed Central

Arsenault, Joanne E.; Smith, Matthew R.

2017-01-01

Understanding dietary patterns is vital to reducing the number of people experiencing hunger (about 795 million), micronutrient deficiencies (2 billion), and overweight or obesity (2.1 billion). We characterize global trends in dietary quality by estimating micronutrient density of the food supply, prevalence of inadequate intake of 14 micronutrients, and average prevalence of inadequate intake of these micronutrients for all countries between 1961 and 2011. Over this 50-year period, the estimated prevalence of inadequate intakes of micronutrients has declined in all regions due to increased total production of food and/or micronutrient density. This decline has been particularly strong in East and Southeast Asia and weaker in South Asia and sub-Saharan Africa. Sub-Saharan Africa is the only region where dietary micronutrient density has declined over this 50-year period. At the global level, micronutrients with the lowest levels of adequate estimated intake are calcium, iron, vitamin A, and zinc, but there are strong differences between countries and regions. Fortification has reduced the estimated prevalence of inadequate micronutrient intakes in all low-income regions, except South Asia. The food supply in many countries is still far below energy requirements, which suggests a need to increase the availability and accessibility of nutritious foods. Countries where the food energy supply is adequate show a very large variation in dietary quality, and in many of these countries people would benefit from more diverse diets with a greater proportion of micronutrient-dense foods. Dietary quality can be improved through fortification, biofortification, and agricultural diversification, as well as efforts to improve access to and use of micronutrient-dense foods and nutritional knowledge. Reducing poverty and increasing education, especially of women, are integral to sustainably addressing malnutrition. PMID:28399168

Performance of the Lot Quality Assurance Sampling Method Compared to Surveillance for Identifying Inadequately-performing Areas in Matlab, Bangladesh

PubMed Central

Hanifi, S.M.A.; Roy, Nikhil; Streatfield, P. Kim

2007-01-01

This paper compared the performance of the lot quality assurance sampling (LQAS) method in identifying inadequately-performing health work-areas with that of using health and demographic surveillance system (HDSS) data and examined the feasibility of applying the method by field-level programme supervisors. The study was carried out in Matlab, the field site of ICDDR,B, where a HDSS has been in place for over 30 years. The LQAS method was applied in 57 work-areas of community health workers in ICDDR,B-served areas in Matlab during July-September 2002. The performance of the LQAS method in identifying work-areas with adequate and inadequate coverage of various health services was compared with those of the HDSS. The health service-coverage indicators included coverage of DPT, measles, BCG vaccination, and contraceptive use. It was observed that the difference in the proportion of work-areas identified to be inadequately performing using the LQAS method with less than 30 respondents, and the HDSS was not statistically significant. The consistency between the LQAS method and the HDSS in identifying work-areas was greater for adequately-performing areas than inadequately-performing areas. It was also observed that the field managers could be trained to apply the LQAS method in monitoring their performance in reaching the target population. PMID:17615902

Performance of the lot quality assurance sampling method compared to surveillance for identifying inadequately-performing areas in Matlab, Bangladesh.

PubMed

Bhuiya, Abbas; Hanifi, S M A; Roy, Nikhil; Streatfield, P Kim

2007-03-01

This paper compared the performance of the lot quality assurance sampling (LQAS) method in identifying inadequately-performing health work-areas with that of using health and demographic surveillance system (HDSS) data and examined the feasibility of applying the method by field-level programme supervisors. The study was carried out in Matlab, the field site of ICDDR,B, where a HDSS has been in place for over 30 years. The LQAS method was applied in 57 work-areas of community health workers in ICDDR,B-served areas in Matlab during July-September 2002. The performance of the LQAS method in identifying work-areas with adequate and inadequate coverage of various health services was compared with those of the HDSS. The health service-coverage indicators included coverage of DPT, measles, BCG vaccination, and contraceptive use. It was observed that the difference in the proportion of work-areas identified to be inadequately performing using the LQAS method with less than 30 respondents, and the HDSS was not statistically significant. The consistency between the LQAS method and the HDSS in identifying work-areas was greater for adequately-performing areas than inadequately-performing areas. It was also observed that the field managers could be trained to apply the LQAS method in monitoring their performance in reaching the target population.

Vitamins for chronic disease prevention in adults: scientific review.

PubMed

Fairfield, Kathleen M; Fletcher, Robert H

2002-06-19

Although vitamin deficiency is encountered infrequently in developed countries, inadequate intake of several vitamins is associated with chronic disease. To review the clinically important vitamins with regard to their biological effects, food sources, deficiency syndromes, potential for toxicity, and relationship to chronic disease. We searched MEDLINE for English-language articles about vitamins in relation to chronic diseases and their references published from 1966 through January 11, 2002. We reviewed articles jointly for the most clinically important information, emphasizing randomized trials where available. Our review of 9 vitamins showed that elderly people, vegans, alcohol-dependent individuals, and patients with malabsorption are at higher risk of inadequate intake or absorption of several vitamins. Excessive doses of vitamin A during early pregnancy and fat-soluble vitamins taken anytime may result in adverse outcomes. Inadequate folate status is associated with neural tube defect and some cancers. Folate and vitamins B(6) and B(12) are required for homocysteine metabolism and are associated with coronary heart disease risk. Vitamin E and lycopene may decrease the risk of prostate cancer. Vitamin D is associated with decreased occurrence of fractures when taken with calcium. Some groups of patients are at higher risk for vitamin deficiency and suboptimal vitamin status. Many physicians may be unaware of common food sources of vitamins or unsure which vitamins they should recommend for their patients. Vitamin excess is possible with supplementation, particularly for fat-soluble vitamins. Inadequate intake of several vitamins has been linked to chronic diseases, including coronary heart disease, cancer, and osteoporosis

Academic Achievement Standards and Quality Assurance

ERIC Educational Resources Information Center

Sadler, D. Royce

2017-01-01

Quality assurance processes have been applied to many aspects of higher education, including teaching, learning and assessment. At least in the latter domain, quality assurance needs its fundamental tenets critically scrutinised. A common but inadequate approach has been to identify and promote learning environment changes "likely to…

[Evaluations by hospital-ward physicians of patient care management quality for patients hospitalized after an emergency department admission].

PubMed

Bartiaux, M; Mols, P

2017-01-01

patient management in the acute and sub-acute setting of an Emergency Department is challenging. An assessment of the quality of provided care enables an evaluation of failings. It contributes to the identification of areas for improvement. to obtain an analysis, by hospital-ward physicians, of adult patient care management quality, as well as of the correctness of diagnosis made during emergency admissions. To evaluate the consequences of inadequate patient care management on morbidity, mortality and cost and duration of hospitalization. prospective data analysis obtained between the 1/12/2009 and the 21/12/2009 from physicians using a questionnaire on adult-patient emergency admissions and subsequent hospitalization. questionnaires were completed for 332 patients. Inadequate management of patient care were reported for 73/332 (22 %) cases. Incorrect diagnoses were reported for 20/332 (6 %) cases. 35 cases of inadequate care management (10.5 % overall) were associated with morbidity (34 cases) or mortality (1 case), including 4 cases (1.2 % ) that required emergency intensive-care or surgical interventions. this quality study analyzed the percentage of patient management cases and incorrect diagnoses in the emergency department. The data for serious outcome and wrong diagnosis are comparable with current literature. To improve performance, we consider the process for establishing a diagnosis and therapeutic care.

Field evaluation of a portable gyratory compactor : final report.

DOT National Transportation Integrated Search

2002-06-01

Application of quality management concepts to asphalt paving evolved because recipe specifications frequently proved inadequate for ensuring pavement performance. Quality management of asphalt concrete is founded on the premise that the producer cont...

Engineering Quality Software: 10 Recommendations for Improved Software Quality Management

DTIC Science & Technology

2010-04-27

lack of user involvement • Inadequate Software Process Management & Control By Contractors • No “Team” of Vendors and users; little SME participation...1990 Quality Perspectives • Process Quality ( CMMI ) • Product Quality (ISO/IEC 2500x) – Internal Quality Attributes – External Quality Attributes... CMMI /ISO 9000 Assessments – Capture organizational knowledge • Identify best practices, lessons learned Know where you are, and where you need to be

Importance of methodology on (99m)technetium dimercapto-succinic acid scintigraphic image quality: imaging pilot study for RIVUR (Randomized Intervention for Children With Vesicoureteral Reflux) multicenter investigation.

PubMed

Ziessman, Harvey A; Majd, Massoud

2009-07-01

We reviewed our experience with (99m)technetium dimercapto-succinic acid scintigraphy obtained during an imaging pilot study for a multicenter investigation (Randomized Intervention for Children With Vesicoureteral Reflux) of the effectiveness of daily antimicrobial prophylaxis for preventing recurrent urinary tract infection and renal scarring. We analyzed imaging methodology and its relation to diagnostic image quality. (99m)Technetium dimercapto-succinic acid imaging guidelines were provided to participating sites. High-resolution planar imaging with parallel hole or pinhole collimation was required. Two core reviewers evaluated all submitted images. Analysis included appropriate views, presence or lack of patient motion, adequate magnification, sufficient counts and diagnostic image quality. Inter-reader agreement was evaluated. We evaluated 70, (99m)technetium dimercapto-succinic acid studies from 14 institutions. Variability was noted in methodology and image quality. Correlation (r value) between dose administered and patient age was 0.780. For parallel hole collimator imaging good correlation was noted between activity administered and counts (r = 0.800). For pinhole imaging the correlation was poor (r = 0.110). A total of 10 studies (17%) were rejected for quality issues of motion, kidney overlap, inadequate magnification, inadequate counts and poor quality images. The submitting institution was informed and provided with recommendations for improving quality, and resubmission of another study was required. Only 4 studies (6%) were judged differently by the 2 reviewers, and the differences were minor. Methodology and image quality for (99m)technetium dimercapto-succinic acid scintigraphy varied more than expected between institutions. The most common reason for poor image quality was inadequate count acquisition with insufficient attention to the tradeoff between administered dose, length of image acquisition, start time of imaging and resulting image quality. Inter-observer core reader agreement was high. The pilot study ensured good diagnostic quality standardized images for the Randomized Intervention for Children With Vesicoureteral Reflux investigation.

Dietary Protein Intake in Young Children in Selected Low-Income Countries Is Generally Adequate in Relation to Estimated Requirements for Healthy Children, Except When Complementary Food Intake Is Low123

PubMed Central

Arsenault, Joanne E; Brown, Kenneth H

2017-01-01

Background: Previous research indicates that young children in low-income countries (LICs) generally consume greater amounts of protein than published estimates of protein requirements, but this research did not account for protein quality based on the mix of amino acids and the digestibility of ingested protein. Objective: Our objective was to estimate the prevalence of inadequate protein and amino acid intake by young children in LICs, accounting for protein quality. Methods: Seven data sets with information on dietary intake for children (6–35 mo of age) from 6 LICs (Peru, Guatemala, Ecuador, Bangladesh, Uganda, and Zambia) were reanalyzed to estimate protein and amino acid intake and assess adequacy. The protein digestibility–corrected amino acid score of each child’s diet was calculated and multiplied by the original (crude) protein intake to obtain an estimate of available protein intake. Distributions of usual intake were obtained to estimate the prevalence of inadequate protein and amino acid intake for each cohort according to Estimated Average Requirements. Results: The prevalence of inadequate protein intake was highest in breastfeeding children aged 6–8 mo: 24% of Bangladeshi and 16% of Peruvian children. With the exception of Bangladesh, the prevalence of inadequate available protein intake decreased by age 9–12 mo and was very low in all sites (0–2%) after 12 mo of age. Inadequate protein intake in children <12 mo of age was due primarily to low energy intake from complementary foods, not inadequate protein density. Conclusions: Overall, most children consumed protein amounts greater than requirements, except for the younger breastfeeding children, who were consuming low amounts of complementary foods. These findings reinforce previous evidence that dietary protein is not generally limiting for children in LICs compared with estimated requirements for healthy children, even after accounting for protein quality. However, unmeasured effects of infection and intestinal dysfunction on the children’s protein requirements could modify this conclusion. PMID:28202639

The right to a decent minimum of health care.

PubMed

Buchanan, Allen E

1984-01-01

Buchanan examines, and finds inadequate, several philosophical approaches to justifying and specifying the content of a universal right to a decent minimum of health care: utilitarian arguments, Rawlsian ideal contract arguments, and Norman Daniels' equality of opportunity argument. Also rejecting the libertarian hypothesis that there is no right to a decent minimum of care, he contends that the claim that society should guarantee certain health care services can be supported by a pluralistic approach encompassing special right-claims, harm prevention, prudential arguments emphasizing public health benefits, and beneficence.

The influence of handling qualities on safety and survivability

NASA Technical Reports Server (NTRS)

Anderson, S. B.

1977-01-01

The relationship of handling qualities to safety and survivability of military aircraft is examined which includes the following: (1) a brief discussion of the philosophy used in the military specifications for treatment of degraded handling qualities, (2) an examination of several example handling qualities problem areas which influence safety and survivability; and (3) a movie illustrating the potential dangers of inadequate handling qualities features.

Advanced high school biology in an era of rapid change: a summary of the biology panel report from the NRC Committee on Programs for Advanced Study of Mathematics and Science in American High Schools.

PubMed

Wood, William B

2002-01-01

A recently released National Research Council (NRC) report, Learning and Understanding: Improving Advanced Study of Mathematics and Science in U.S. High Schools, evaluated and recommended changes in the Advanced Placement (AP), International Baccalaureate (IB), and other advanced secondary school science programs. As part of this study, discipline-specific panels were formed to evaluate advanced programs in biology, chemistry, physics, and mathematics. Among the conclusions of the Content Panel for Biology were that AP courses in particular suffer from inadequate quality control as well as excessive pressure to fulfill their advanced placement function, which encourages teachers to attempt coverage of all areas of biology and emphasize memorization of facts rather than in-depth understanding. In this essay, the Panel's principal findings are discussed, with an emphasis on its recommendation that colleges and universities should be strongly discouraged from using performance on either the AP examination or the IB examination as the sole basis for automatic placement out of required introductory courses for biology majors and distribution requirements for nonmajors.

Advanced High School Biology in an Era of Rapid Change: A Summary of the Biology Panel Report from the NRC Committee on Programs for Advanced Study of Mathematics and Science in American High Schools

PubMed Central

2002-01-01

A recently released National Research Council (NRC) report, Learning and Understanding: Improving Advanced Study of Mathematics and Science in U.S. High Schools, evaluated and recommended changes in the Advanced Placement (AP), International Baccalaureate (IB), and other advanced secondary school science programs. As part of this study, discipline-specific panels were formed to evaluate advanced programs in biology, chemistry, physics, and mathematics. Among the conclusions of the Content Panel for Biology were that AP courses in particular suffer from inadequate quality control as well as excessive pressure to fulfill their advanced placement function, which encourages teachers to attempt coverage of all areas of biology and emphasize memorization of facts rather than in-depth understanding. In this essay, the Panel's principal findings are discussed, with an emphasis on its recommendation that colleges and universities should be strongly discouraged from using performance on either the AP examination or the IB examination as the sole basis for automatic placement out of required introductory courses for biology majors and distribution requirements for nonmajors. PMID:12669097

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... diagnostic system must monitor reductant quality and tank levels and alert operators to the need to refill... specified in § 1033.110 and an audible alarm. You do not need to separately monitor reductant quality if you include an exhaust NOX sensor (or other sensor) that allows you to determine inadequate reductant quality...

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... diagnostic system must monitor reductant quality and tank levels and alert operators to the need to refill... specified in § 1033.110 and an audible alarm. You do not need to separately monitor reductant quality if you include an exhaust NOX sensor (or other sensor) that allows you to determine inadequate reductant quality...

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... diagnostic system must monitor reductant quality and tank levels and alert operators to the need to refill... specified in § 1033.110 and an audible alarm. You do not need to separately monitor reductant quality if you include an exhaust NOX sensor (or other sensor) that allows you to determine inadequate reductant quality...

Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis.

PubMed

Carter, Ben; Rees, Philippa; Hale, Lauren; Bhattacharjee, Darsharna; Paradkar, Mandar S

2016-12-01

Sleep is vital to children's biopsychosocial development. Inadequate sleep quantity and quality is a public health concern with an array of detrimental health outcomes. Portable mobile and media devices have become a ubiquitous part of children's lives and may affect their sleep duration and quality. To conduct a systematic review and meta-analysis to examine whether there is an association between portable screen-based media device (eg, cell phones and tablet devices) access or use in the sleep environment and sleep outcomes. A search strategy consisting of gray literature and 24 Medical Subject Headings was developed in Ovid MEDLINE and adapted for other databases between January 1, 2011, and June 15, 2015. Searches of the published literature were conducted across 12 databases. No language restriction was applied. The analysis included randomized clinical trials, cohort studies, and cross-sectional study designs. Inclusion criteria were studies of school-age children between 6 and 19 years. Exclusion criteria were studies of stationary exposures, such as televisions or desktop or personal computers, or studies investigating electromagnetic radiation. Of 467 studies identified, 20 cross-sectional studies were assessed for methodological quality. Two reviewers independently extracted data. The primary outcomes were inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness, studied according to an a priori protocol. Twenty studies were included, and their quality was assessed. The studies involved 125 198 children (mean [SD] age, 14.5 [2.2] years; 50.1% male). There was a strong and consistent association between bedtime media device use and inadequate sleep quantity (odds ratio [OR], 2.17; 95% CI, 1.42-3.32) (P < .001, I2 = 90%), poor sleep quality (OR, 1.46; 95% CI, 1.14-1.88) (P = .003, I2 = 76%), and excessive daytime sleepiness (OR, 2.72; 95% CI, 1.32-5.61) (P = .007, I2 = 50%). In addition, children who had access to (but did not use) media devices at night were more likely to have inadequate sleep quantity (OR, 1.79; 95% CI, 1.39-2.31) (P < .001, I2 = 64%), poor sleep quality (OR, 1.53; 95% CI, 1.11-2.10) (P = .009, I2 = 74%), and excessive daytime sleepiness (OR, 2.27; 95% CI, 1.54-3.35) (P < .001, I2 = 24%). To date, this study is the first systematic review and meta-analysis of the association of access to and the use of media devices with sleep outcomes. Bedtime access to and use of a media device were significantly associated with the following: inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness. An integrated approach among teachers, health care professionals, and parents is required to minimize device access at bedtime, and future research is needed to evaluate the influence of the devices on sleep hygiene and outcomes.

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway.

PubMed

Wischmeyer, Paul E; Carli, Franco; Evans, David C; Guilbert, Sarah; Kozar, Rosemary; Pryor, Aurora; Thiele, Robert H; Everett, Sotiria; Grocott, Mike; Gan, Tong J; Shaw, Andrew D; Thacker, Julie K M; Miller, Timothy E; Hedrick, Traci L; McEvoy, Matthew D; Mythen, Michael G; Bergamaschi, Roberto; Gupta, Ruchir; Holubar, Stefan D; Senagore, Anthony J; Abola, Ramon E; Bennett-Guerrero, Elliott; Kent, Michael L; Feldman, Liane S; Fiore, Julio F

2018-06-01

Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.

Endoscopic training in gastroenterology fellowship: adherence to core curriculum guidelines.

PubMed

Jirapinyo, Pichamol; Imaeda, Avlin B; Thompson, Christopher C

2015-12-01

The Gastroenterology Core Curriculum and American Society of Gastrointestinal Endoscopy provide guidelines for endoscopic training. Program adherence to these recommendations is unclear. This study aims to assess endoscopic training experience during fellowship. Questionnaire study. The questionnaire was circulated to US fellowship programs, with the assistance of the American Gastroenterological Association. Graduating third-year fellows. Seventy-three fellows returned the questionnaire. Nearly all fellows met the required numbers for esophagoduodenoscopy (98%) and colonoscopy (100%), with fewer meeting requirements for PEG (73%) and non-variceal hemorrhage (75%). The majority of fellows did not meet minimum numbers for variceal banding (40%), esophageal dilation (43%), capsule endoscopy (42%). Fellows rated training in cognitive aspects of endoscopy as 3.86 [1 (inadequate), 5 (excellent)] and reported greatest emphasis on interpreting endoscopic findings and least on virtual colonography. Quality indicators of endoscopy received little emphasis (rating of 3.04; p = 0.00001), with adenoma detection rate being least emphasized. Fifty-six percent of fellows reported having routine endoscopy conferences. Half of the programs have endoscopic simulators, with 15% of fellows being required to use simulation. Following direct hands-on experience, fellows rated external endoscopy courses (64%) as the next most useful experience. Many fellows do not meet required numbers for several endoscopic procedures, and quality indicators receive little emphasis during training. Most programs do not provide simulation training or hold regular endoscopy conferences. Fellowship programs should perform internal audits and make feasible adjustments. Furthermore, it may be time for professional societies to revisit training guidelines.

Demand-driven care and hospital choice. Dutch health policy toward demand-driven care: results from a survey into hospital choice.

PubMed

Lako, Christiaan J; Rosenau, Pauline

2009-03-01

In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician's opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician's advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient's confidence in physician referral and advice.

Education Quality and Teacher Salary.

ERIC Educational Resources Information Center

Land, Arthur J.

In view of the emphasis on money as a motivator mentioned in reports examining theoretical notions about teacher motivation, this paper focuses on the efficacy of using salary to attract quality teacher candidates. Although standarized testing and internship programs often supplement inadequate certification requirements, critics question the…

An analysis of the warning letters issued by the FDA to pharmaceutical manufacturers regarding misleading health outcomes claims

PubMed Central

Chatterjee, Satabdi; Patel, Harshali K.; Sansgiry, Sujit S.

Objective To evaluate the number and type of warning letters issued by the US Food and Drug Administration (FDA) to pharmaceutical manufacturers for promotional violations. Methods Two reviewers downloaded, printed and independently evaluated warning letters issued by the FDA to pharmaceutical manufacturers from years 2003-2008. Misleading claims were broadly classified as clinical, Quality-of-Life (QoL), and economic claims. Clinical claims included claims regarding unsubstantiated efficacy, safety and tolerability, superiority, broadening of indication and/or omission of risk information. QoL claims included unsubstantiated quality of life and/or health-related quality of life claims. Economic claims included any form of claim made on behalf of the pharmaceutical companies related to cost superiority of or cost savings from the drug compared to other drugs in the market. Results In the 6-year study period, 65 warning letters were issued by FDA, which contained 144 clinical, three QoL, and one economic claim. On an average, 11 warning letters were issued per year. Omission of risk information was the most frequently violated claim (30.6%) followed by unsubstantiated efficacy claims (18.6%). Warning letters were primarily directed to manufacturers of cardiovascular (14.6%), anti-microbial (14.6%), and CNS (12.5%) drugs. Majority of the claims referenced in warning letters contained promotional materials directed to physicians (57%). Conclusions The study found that misleading clinical outcome claims formed the majority of the promotional violations, and majority of the claims were directed to physicians. Since inadequate promotion of medications may lead to irrational prescribing, the study emphasizes the importance of disseminating reliable, credible, and scientific information to patients, and more importantly, physicians to protect public health. PMID:24155837

Knowledge translation on dementia: a cluster randomized trial to compare a blended learning approach with a "classical" advanced training in GP quality circles.

PubMed

Vollmar, Horst C; Butzlaff, Martin E; Lefering, Rolf; Rieger, Monika A

2007-06-22

Thus far important findings regarding the dementia syndrome have been implemented into patients' medical care only inadequately. A professional training accounting for both, general practitioners' (GP) needs and learning preferences as well as care-relevant aspects could be a major step towards improving medical care. In the WIDA-study, entitled "Knowledge translation on dementia in general practice" two different training concepts are developed, implemented and evaluated. Both concepts are building on an evidence-based, GP-related dementia guideline and communicate the guideline's essential insights. Both development and implementation emphasize a procedure that is well-accepted in practice and, thus, can achieve a high degree of external validity. This is particularly guaranteed through the preparation of training material and the fact that general practitioners' quality circles (QC) are addressed. The evaluation of the two training concepts is carried out by comparing two groups of GPs to which several quality circles have been randomly assigned. The primary outcome is the GPs' knowledge gain. Secondary outcomes are designed to indicate the training's potential effects on the GPs' practical actions. In the first training concept (study arm A) GPs participate in a structured case discussion prepared for by internet-based learning material ("blended-learning" approach). The second training concept (study arm B) relies on frontal medical training in the form of a slide presentation and follow-up discussion ("classical" approach). This paper presents the outline of a cluster-randomized trial which has been peer reviewed and support by a national funding organization--Federal Ministry of Education and Research (BMBF)--and is approved by an ethics commission. The data collection has started in August 2006 and the results will be published independently of the study's outcome. Current Controlled Trials [ISRCTN36550981].

[Analysis of productivity, quality and cost of first grade laboratories: blood biometry].

PubMed

Avila, L; Hernández, P; Cruz, A; Zurita, B; Terres, A M; Cruz, C

1999-04-01

Assessment of productivity, quality and production costs and determination of the efficiency of top grade clinical laboratories in Mexico. Ten laboratories were selected from among the total number (52) existing in Mexico City, and the Donabedian model of structure, process and results were applied. Blood count was selected as a tracer. The principal problems found were: inadequate distribution of trained human resources, poor glass material, inadequate analytic process and low productivity. These factors are reflected in the unit costs, which exceed reference laboratory costs by 200%. Only 50% of the laboratories analyzed generate reliable results. Only 20% of the laboratories studied operate efficiently. To solve the problems identified requires integral strategies at different levels. A specific recomendation for the improvement of quality and productivity is an assessment of the cost/benefit of creating a central laboratory and using the remaining sites exclusively for the collection of samples.

Impact of the quality of coronal restoration and root canal filling on the periapical health in adult syrian subpopulation

PubMed Central

Alafif, Hisham

2014-01-01

Background: The purpose of this study was to determine the status of periapical tissues of endodontically treated teeth according to coronal restorations and root canal fillings separately and in concomitant in adult Syrian subpopulation. Methods: 784 endodontically treated teeth from two hundred randomly selected Syrian adult patients were radiographically evaluated. According to predetermined criteria, the quality of coronal restorations and root canal filling of each tooth was scored as adequate or inadequate. The status of periapical tissues was also classified as healthy or diseased. Results were analyzed using Chi-squared test. Results: Adequate coronal restorations were determined in 58.54% of cases which was accompanied with less periapical pathosis than that in teeth with inadequate restorations (P < 0.01). 14% of teeth were restored by posts which showed no significant impact on the periapical tissues health. 18.5% of endodontic treatments were evaluated as adequate with less number of periapical radiolucencies than that of inadequate root canal fillings (P < 0.01). Absence of periapical pathosis was 96.6% in cases with both adequate coronal restorations and root canals fillings. The rate was 88.5% in cases with only adequate root canals fillings, and about 70% in cases with only adequate coronal restorations. When the treatment was inadequate in both coronal and root canals fillings, success rate was only observed in 48.8%. Conclusion: The most important factor with regard to the periradicular tissue health is the quality of root canal filling without neglecting the influence of coronal restoration (regardless of its type). There is a high prevalence rate of periapical pathosis in Syrian subpopulation due to poor dental practice. PMID:25565729

Association Between Functional Health Literacy and Postoperative Recovery, Health Care Contacts, and Health-Related Quality of Life Among Patients Undergoing Day Surgery: Secondary Analysis of a Randomized Clinical Trial.

PubMed

Hälleberg Nyman, Maria; Nilsson, Ulrica; Dahlberg, Karuna; Jaensson, Maria

2018-04-25

Day surgery puts demands on the patients to manage their own recovery at home according to given instructions. Low health literacy levels are shown to be associated with poorer health outcomes. To describe functional health literacy levels among patients in Sweden undergoing day surgery and to describe the association between functional health literacy (FHL) and health care contacts, quality of recovery (SwQoR), and health-related quality of life. This observational study was part of a secondary analysis of a randomized clinical trial of patients undergoing day surgery and was performed in multiple centers from October 2015 to July 2016 and included 704 patients. The primary end point was SwQoR in the FHL groups 14 days after surgery. Secondary end points were health care contacts, EuroQol-visual analog scales, and the Short Form (36) Health Survey in the FHL groups. Of 704 patients (418 [59.4%] women; mean [SD] age with inadequate or problematic FHL levels, 47 [16] years and 49 [15.1], respectively), 427 (60.7%) reported sufficient FHL, 223 (31.7%) problematic FHL, and 54 (7.7%) inadequate FHL. The global score of SwQoR indicated poor recovery in both inadequate (37.4) and problematic (22.9) FHL. There was a statistically significant difference in the global score of SwQoR (SD) between inadequate (37.4 [34.7]) and sufficient FHL (17.7 [21.0]) (P < .001). The patients with inadequate or problematic FHL had a lower health-related quality of life than the patients with sufficient FHL in terms of EuroQol-visual analog scale scores (mean [SD], 73 [19.1], 73 [19.1], and 78 [17.4], respectively; P = .008), physical function (mean [SD], 72 [22.7], 75 [23.8], and 81 [21.9], respectively; P < .001), bodily pain (mean [SD], 51 [28.7], 53 [27.4], and 61 [27.0], respectively; P = .001), vitality (mean [SD], 50 [26.7], 56 [23.5], and 62 [25.4], respectively; P < .001), social functioning (mean [SD], 73 [28.2], 81 [21.8], and 84 [23.3], respectively; P = .004), mental health (mean [SD], 65 [25.4], 73 [21.2], and 77 [21.2], respectively; P < .001), and physical component summary (mean [SD], 41 [11.2], 42 [11.3], and 45 [10.1], respectively; P = .004). There were no differences between the FHL groups regarding health care contacts. Inadequate FHL in patients undergoing day surgery was associated with poorer postoperative recovery and a lower health-related quality of life. Health literacy is a relevant factor to consider for optimizing the postoperative recovery in patients undergoing day surgery. clinicaltrials.gov Identifier: NCT02492191.

Promoting Physical Education: The Link to Academic Achievement

ERIC Educational Resources Information Center

Smith, Nicole J.; Lounsbery, Monica

2009-01-01

Quality physical education is recognized for its health-related benefits and should be supported as an integral component of every school's curriculum. Unfortunately, quality physical education is not easily established or maintained. Many physical education programs face challenges such as reduced staff, large class sizes, inadequate facilities…

Indoor Air Quality in Schools (IAQ): The Importance of Monitoring Carbon Dioxide Levels.

ERIC Educational Resources Information Center

Sundersingh, David; Bearg, David W.

This article highlights indoor air quality and exposure to pollutants at school. Typical air pollutants within schools include environmental tobacco smoke, formaldehyde, volatile organic compounds, nitrogen oxides, carbon monoxide, carbon dioxide, allergens, pathogens, radon, pesticides, lead, and dust. Inadequate ventilation, inefficient…

Quality control/quality assurance testing for joint density and segregation of asphalt mixtures : tech transfer summary.

DOT National Transportation Integrated Search

2013-04-01

A longitudinal joint is the interface between two adjacent and parallel hot-mix asphalt (HMA) mats. Inadequate joint construction can lead to a location where water can penetrate the pavement layers and reduce the structural support of the underlying...

Just-In-Time Inventory Management; Application and Recommendations for Naval Hospital, Oakland.

DTIC Science & Technology

1992-12-01

108 c. Break Bulk on Stored Material .................. 110 d. Emphasize Continuous Quality Improvement ...... 111 4. Streamline Order Processing for...manpower. 4. Use of existing industry automation to expedite order processing to the prime vendor. The intent of this research is to present the JIT...34* Collection of baseline data. "* Break bulk on stored material. 85 • Emphasize continuous quality improvement. 4. Streamline order processing for PV

Associations of diet quality with dairy group membership, membership duration and non-membership for Kenyan farm women and children: a comparative study.

PubMed

Walton, Colleen; Taylor, Jennifer; VanLeeuwen, John; Yeudall, Fiona; Mbugua, Samwel

2014-02-01

To examine associations among diet quality and dairy group membership, membership duration and non-member status for women and school-aged children in rural Kenya. A cross-sectional survey, using chain referral sampling, was conducted and diet quality indices and prevalence of inadequate intake (PII) were estimated using the 'estimated average requirement' cut-off point method from single 24 h recalls, using a Kenyan nutrient database. PII was compared among members and non-members and among membership-duration groups. Women and children of dairy group members (n 88), across membership-duration groups (1-3, 4-6, 7-9 and 10+ years), and non-members (n 23) living among members. Small farms in central Kenya. Members had higher energy, percentage of energy from animal-source foods and dietary diversity. Member women and children had lower PII for respectively seven and three of eleven micronutrients. Reduced PII for milk-source micronutrients was associated with membership duration for women. Many member women (38%) had inadequate vitamin A intake and 39% of member children had inadequate Zn intake. Members' PII was also high (>45%) for Fe, Ca and vitamin B12. A higher prevalence of being overweight among member women compared with non-member women suggested nutrition transition effects of higher farm productivity. Dairy group membership was positively associated with adequate quantity and quality of diets for women and children. Long-term membership was insufficient to address micronutrient deficiencies. Understanding and addressing barriers to better diet quality and strategies to mitigate negative nutrition transition effects are needed to optimize nutritional outcomes of dairy group membership.

Teachers' Voices: Work Environment Conditions That Impact Teacher Practice and Program Quality

ERIC Educational Resources Information Center

Whitebook, Marcy; King, Elizabeth; Philipp, George; Sakai, Laura

2016-01-01

Early childhood teachers routinely face insufficient teaching supports and inadequate rewards for their education and commitment (e.g., low pay, lack of professional supports, and lack of benefits). These shortcomings contribute to poor program quality and fuel high levels of teacher turnover, preventing program improvement and making it…

Non-Tenure Track Faculty and Learning Communities: Bridging the Divide to Enhance Teaching Quality

ERIC Educational Resources Information Center

Banasik, MaryJo D.; Dean, Jennifer L.

2016-01-01

Institutions of higher education are increasingly hiring non-tenure track faculty members (NTTF) to help meet the demands of the institutional teaching mission. Research suggests NTTF experience inadequate working conditions that hinder performance and negatively impact the quality of undergraduate education. Given the growing number of NTTF…

Global Health: Epilepsy.

PubMed

Ali, Amza

2018-04-01

Epilepsy is a frequently misunderstood and highly stigmatized condition. Major treatment gaps exist across the world, most so in areas of financial constraint. Classification permits the best approaches to treatment and to ascertaining prognosis. The International League Against Epilepsy's new classification system emphasizes clinical aspects and utilizes all available resources to determine whether it is a focal or generalized epilepsy. The most important tools are a careful history, clinical examination, electroencephalography, and appropriate neuroimaging. Inadequate, delayed, and incomplete evaluation may lead to misdiagnosis and costly mismanagement. Treatment is generally pharmacological, with approximately 20 to 30% of patients eventually proving refractory to medications and thus becoming potential surgical candidates. The type of epilepsy, age, gender, comorbidities, drug interactions, and drug cost are important factors in choosing an antiepileptic drug (AED). The teratogenic potential of some AEDs, weight gain, and menstrual hormone-related issues are important considerations in women. The impact of AEDs on bone health is critical in all age groups, particularly in the elderly. Psychiatric problems, mostly depression and anxiety, can have a great impact on seizure control and overall quality of life. Finally, effective partnerships and collaborations can bring resources, both human and financial, to regions that would otherwise find it impossible to effect change on their own. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A continuous quality improvement project to improve the quality of cervical Papanicolaou smears.

PubMed

Burkman, R T; Ward, R; Balchandani, K; Kini, S

1994-09-01

To improve the quality of cervical Papanicolaou smears by continuous quality improvement techniques. The study used a Papanicolaou smear data base of over 200,000 specimens collected between June 1988 and December 1992. A team approach employing techniques such as process flow-charting, cause and effect diagrams, run charts, and a randomized trial of collection methods was used to evaluate potential causes of Papanicolaou smear reports with the notation "inadequate" or "less than optimal" due to too few or absent endocervical cells. Once a key process variable (method of collection) was identified, the proportion of Papanicolaou smears with inadequate or absent endocervical cells was determined before and after employment of a collection technique using a spatula and Cytobrush. We measured the rate of less than optimal Papanicolaou smears due to too few or absent endocervical cells. Before implementing the new collection technique fully by June 1990, the overall rate of less than optimal cervical Papanicolaou smears ranged from 20-25%; by December 1993, it had stabilized at about 10%. Continuous quality improvement can be used successfully to study a clinical process and implement change that will lead to improvement.

Prospective analysis of factors associated with inadequate bowel preparation for colonoscopy in actual clinical practice

PubMed Central

Woo, Dae Hyung; Jeong, Da Eun; Nam, Yoon Jeong; Lee, Si Hyung; Jang, Byung Ik; Kim, Tae Nyeun

2018-01-01

Background/Aims Inadequate bowel preparation can result in prolonged procedure time and increased missed lesion and complication rates. This prospective study aimed to evaluate bowel preparation quality and identify the predictive factors for inadequate bowel preparation in actual clinical practice. Methods We included 399 patients who underwent colonoscopy between June 2015 and July 2016. Using the Aronchick bowel preparation scale, we defined a score ≤2 as adequate preparation and a score >2 as inadequate preparation. Results Mean patient age was 58.38±12.97 years; 60.6% were male. Indications for colonoscopy included screening (69.7%) and surveillance after polyp removal (21.3%). A split-dose regimen was prescribed to 55.4% of patients. The inadequate bowel preparation rate was 28.1%. Overall, the median time between the last bowel preparation agent dose and start of colonoscopy was 5.0 hours (range, 1.5–16.0 hours); that of the adequate group was 5.0 hours (range, 1.5–16.0 hours); and that of the inadequate group was 5 hours (range, 2–23 hours). The mean bowel preparation scale score of the ascending colon (1.94±0.25) was significantly higher than that of other colon segments. On multivariate analysis, elderly age, history of cerebrovascular disease, history of gastrectomy or appendectomy, and total preparation solution uptake <2 L were the independent predictors of inadequate bowel preparation. Conclusions The inadequate bowel preparation rate was 28.1%. Risk factors included elderly age and history of cerebrovascular disease or abdominal surgery. Patients with these risk factors require special care and education. PMID:29743843

Health literacy, computer skills and quality of patient-physician communication in Chinese patients with cataract.

PubMed

Lin, Xianchai; Wang, Mei; Zuo, Yajing; Li, Mingge; Lin, Xiaofeng; Zhu, Siping; Zheng, Yongxin; Yu, Minbin; Lamoureux, Ecosse L

2014-01-01

The aim of the study was to assess levels of health literacy and computer skills in Chinese patients with cataract, and their impact on the doctor-patient relationship. We undertook a cross-sectional study of cataract patients scheduled for cataract extraction procedures in Guangdong Province, China. Generic health literacy was assessed using 3 established screening questions. Adequate computer skills was determined if patients had used a computer and routinely used search engines on the Internet. Socio-demographic measures (e.g., age, sex, education) were obtained from a standardized interview. Participants who indicated that they could not understand what their doctors mean were considered to have had poor patient-physician communications. Of the 211 participants, 92 (43.6%) had inadequate health literacy and 204 (96.7%) inadequate computer skills. In multivariate analysis, females were more likely to have inadequate health literacy (odds ratio = 2.5, 95% confidence intervals [CI]: 1.3 to 4.7). People with inadequately health literacy were more likely to have a poor patient-physician communication (odds ratio = 3.5, 95% CIs: 1.3 to 9.0). Similar associations were found for inadequate computer skills. Chinese elderly patients with cataract have inadequate health literacy and very limited computer skills, which place them at high risk of misunderstanding and mismanaging their ocular conditions. Patient education information other than online materials may improve the eye care and outcomes of these patients.

APPETITE PREDICTS INTAKE AND NUTRITIONAL STATUS IN PATIENTS RECEIVING PERITONEAL DIALYSIS.

PubMed

Young, Valerie; Balaam, Sarah; Orazio, Linda; Bates, Annerley; Badve, Sunil V; Johnson, David W; Campbell, Katrina L

2016-06-01

Sub-optimal nutrition status is common amongst patients receiving peritoneal dialysis (PD) and leads to poor clinical outcome. This population experiences multi-factorial challenges to achieving optimal nutritional status, particularly driven by inadequate intake. The aim of this investigation was to identify factors associated with inadequate protein intake and sub-optimal nutritional status in patients undergoing PD. This was a cross-sectional study of 67 adult patients receiving PD (mean age 59 ± 14 years; 57% male) within a single centre. Participants were consecutively recruited and interviewed by renal dietitians, collecting: Subjective Global Assessment (SGA); quality of life (using EQ-5D); dietary intake (via dietary interview); and appetite (using Appetite and Diet Assessment Tool). Participant demographics were obtained via survey or medical charts. Main outcome measures were inadequate dietary protein intake (<1.1 g/kg adjusted body weight/day) and malnutrition (as defined by SGA rating B or C). Overall, 15 (22%) patients were malnourished and 29 (43%) had inadequate protein intake. Poor appetite (anorexia) was reported in 62% (18/29) of participants with inadequate protein malnourished patients reported anorexia versus 12 (23%) of the well-nourished patients (p = 0.0001). Anorexia was a key risk factor for inadequate protein intake and malnutrition in patients undergoing PD. These findings highlight a need to closely monitor patients with appetite disturbances. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

An overview of indoor air quality and its impact on respiratory health among Malaysian school-aged children.

PubMed

Choo, Chua Poh; Jalaludin, Juliana

2015-01-01

The indoor environment is a major source of human exposure to pollutants. Some pollutants can have concentrations that are several times higher indoors than outdoors. Prolonged exposure may lead to adverse biologic effects, even at low concentrations. Several studies done in Malaysia had underlined the role of indoor air pollution in affecting respiratory health, especially for school-aged children. A critical review was conducted on the quantitative literature linking indoor air pollution with respiratory illnesses among school-aged children. This paper reviews evidence of the association between indoor air quality (IAQ) and its implications on respiratory health among Malaysian school-aged children. This review summarizes six relevant studies conducted in Malaysia for the past 10 years. Previous epidemiologic studies relevant to indoor air pollutants and their implications on school-aged children's respiratory health were obtained from electronic database and included as a reference in this review. The existing reviewed data emphasize the impact of IAQ parameters, namely, indoor temperature, ventilation rates, indoor concentration of carbon dioxide (CO2), carbon monoxide (CO), particulate matters (PM), volatile organic compounds (VOCs), nitrogen dioxide (NO2) and airborne microbes, on children's respiratory health. The study found that most of the Malaysian school-aged children are exposed to the inadequate environment during their times spent either in their houses or in their classrooms, which is not in compliance with the established standards. Children living in households or studying in schools in urban areas are more likely to suffer from respiratory illnesses compared with children living in homes or studying in schools in rural areas.

Periapical Status and Quality of Root Canal Fillings in a Moroccan Subpopulation

PubMed Central

El Merini, Hafsa; Lamzawaq, Amine; Hamza, Mouna

2017-01-01

Aim The aim of the study was to assess the prevalence of apical periodontitis (AP) and quality of root canal fillings in an adult Moroccan subpopulation. Methods In the study 508 patients were included, attending the Conservative Dentistry Clinic at the Faculty of Dentistry of Casablanca. 508 panoramic and 709 periapical radiographs were observed. The periapical status of all teeth (with the exception of third molars) was examined according to Ørstavik's periapical index. The statistical analysis was performed with the software Epi Info Version 6.04dfr, April 2001. Results A total of 12719 teeth were examined. 45.3% of patients had apical periodontitis. 4.2% of teeth were treated endodontically and 70.4% of these treatments were inadequate. 91,5% with inadequate endodontic treatment presented apical periodontitis, while only 8,2% with adequate endodontic treatment had apical periodontitis. The lower molars and the upper premolars were the most affected teeth. The presence of apical periodontitis was correlated significantly with insufficient root canal fillings (p < 0.05). Conclusions The present study found a high prevalence of apical periodontitis in this Moroccan population. Inadequate root canal fillings were associated with an increased prevalence of apical periodontitis. PMID:28713425

The impact of an inadequate municipal water system on the residents of Chinhoyi town, Zimbabwe.

PubMed

Schwartz, U; Siziya, S; Tshimanga, M; Barduagni, P; Chauke, T L

1999-06-01

To assess the use and impact of the water reticulation system in Chinhoyi on its residents. Cross sectional and case series studies. Chinhoyi town. 600 Chinhoyi residents. Practices and perceptions of Chinhoyi residents on the water system, and distribution of water-related diseases per area of residence. Out of 600 respondents, 565 (99.3%) had access to piped water and 558 (98.0%) to flush toilets. Breakdowns of water supply and functioning of toilet facility were reported by 308 (77.0%) and 110 (28.0%) respondents in the previous six months, respectively. Main complaints of Chinhoyi residents were about low water quality (36.2%), inadequate sewage system (31.3%) and environmental pollution (26.5%). Cases of water-related diseases were not associated with natural water bodies. Chinhoyi residents have good access to the municipal water and an adequate sanitation system. However, low quality of the water, frequent system breakdowns and the degradation and loss of amenity of the environment impair their quality of life.

Factoring quality laboratory diagnosis into the malaria control agenda for sub-Saharan Africa.

PubMed

Aidoo, Michael

2013-09-01

Recent progress in malaria control in sub-Saharan Africa has been achieved primarily through provision of insecticide-treated nets, indoor residual spraying, and antimalarial drugs. Although these interventions are important, proper case identification and accurate measurement of their impact depend on quality diagnostic testing. Current availability of diagnostic testing for malaria in sub-Saharan Africa is inadequate to support disease management, prevention programs, and surveillance needs. Challenges faced include a dearth of skilled workforce, inadequate health systems infrastructure, and lack of political will. A coordinated approach to providing pre-service clinical and laboratory training together with systems that support a scale-up of laboratory services could provide means not only for effective malaria case management but also, management of non-malaria febrile illnesses, disease surveillance, and accurate control program evaluation. A synthesis of the challenges faced in ensuring quality malaria testing and how to include this information in the malaria control and elimination agenda are presented.

The potential of crowdsourcing to improve patient-centered care.

PubMed

Weiner, Michael

2014-01-01

Crowdsourcing (CS) is the outsourcing of a problem or task to a crowd. Although patient-centered care (PCC) may aim to be tailored to an individual's needs, the uses of CS for generating ideas, identifying values, solving problems, facilitating research, and educating an audience represent powerful roles that can shape both allocation of shared resources and delivery of personalized care and treatment. CS can often be conducted quickly and at relatively low cost. Pitfalls include bias, risks of research ethics, inadequate quality of data, inadequate metrics, and observer-expectancy effect. Health professionals and consumers in the US should increase their attention to CS for the benefit of PCC. Patients' participation in CS to shape health policy and decisions is one way to pursue PCC itself and may help to improve clinical outcomes through a better understanding of patients' perspectives. CS should especially be used to traverse the quality-cost curve, or decrease costs while preserving or improving quality of care.

Dynamics of pleural fluid effusion and chylothorax in the fetus and newborn: role of the lymphatic system.

PubMed

Bellini, C; Ergaz, Z; Boccardo, F; Bellini, T; Campisi, C C; Bonioli, E; Ramenghi, L A

2013-06-01

Pleural fluid effusion particularly chylothorax is a relatively rare occurrence in the newborn, but when it occurs it is often life-threatening. In this article, we describe and illustrate the morphologic features of the visceral and parietal pleura including pleural lymphatics and the physiology and pathophysiology of pleural fluid balance. The role and function of the lymphatic system in controlling the volume and composition of pleural liquid are detailed and a conceptual scheme presented. Finally, the crucial role of inadequate lymphatic drainage (either functional overload from an imbalance in Starling forces or mechanical insufficiency from lymphatic dysplasia) is emphasized.

[Circadian rhythm disruption and human development].

PubMed

Kohyama, Jun

2013-12-01

Ontogenetic developments of rest-activity, sleep-wakefulness, temperature and several hormone rhythms in humans were reviewed. The reported effects of environment on these alterations were also summarized. Then, disorders or conditions which often encounter during early stage of life and reveal circadian rhythm disruptions were described. These disorders or conditions included severe brain damage, visual disturbance, developmental disorders(autistic spectrum disorder and attention deficit/hyperactivity disorder), Rett syndrome, Angelman syndrome, Smith-Magenis syndrome, epilepsy, Yonaki, and inadequate sleep hygiene. Finally, it was emphasized that we should pay special attention on the development of youngsters who showed sleep disturbance during early stage of life with special reference to the later occurrence of developmental disorders.

Solar heating and the electric utilities

NASA Astrophysics Data System (ADS)

Maidique, M. A.; Woo, B.

1980-05-01

The article considers the effect of widespread use of solar thermal systems on the role of electric utilities, emphasizing the foreseen short term economic problems. While the average electricity demand will be reduced, infrequent high demand peaks could occur when on nights and certain days, solar users with inadequate storage capacity are forced to depend upon conventional energy sources. Since utility costs are closely related to changes in peak demands, the modification of electricity rate structures as a load management technique is discussed. Some advantages of wide solar energy application for electric utilities are cited including the possibility of their key role in the development of solar heating.

[Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study].

PubMed

Mahner, Maria; Raus, Christina; Ludwig, Fabian; Weckmann, Gesine; Stracke, Sylvia; Chenot, Jean-François

2018-06-01

Many drugs require dose adjustment or are contraindicated in patients with chronic kidney disease (CKD) to avoid adverse events. The aims of this study were to assess if medication was appropriately dose adjusted in patients with CKD in primary care, to identify medications that were frequently prescribed inappropriately and to identify factors predicting mal-prescription. We conducted a cross-sectional observational study in 34 general practioners' offices, assessing the medication of patients with CKD stage ≥ 3 according to the corresponding pharmaceutical product information. Additional information was extracted from recommendations of scientific societies and regulatory authorities. Contraindicated and overdosed medications were identified. Predictive factors for inadequate prescribing were analyzed with multiple logistic regression. 589 patients (Ø 78 years, 63 % female) with CKD stage ≥ 3 were included. A total of 5102 medications were extracted from the medication sheets (94,6 % regular, 5,4 % "as needed"). 4,2 % were judged as being inadequate according to pharmaceutical information (2,1 % contraindicated, 2,1 % overdosed). 173 patients (29 %) had ≥ 1 inadequate prescription. The proportion of inadequate prescriptions fell to 3,5 % after adjustment for the most recent recommendations of scientific societies and regulatory authorities. Most frequent inappropriate prescriptions were ACE-inhibitors, diuretics, oral antidiabetic drugs, methotrexate and potassium supplements. Most important predictors for inadequate prescriptions were CKD stage ≥ 3b and number of medications. A quarter of all patients had a least one inadequate prescription. The overall proportion of inadequately prescribed drugs was low. Adjustment for recommendations by scientific societies and regulatory authorities further reduced the number of inadequate prescriptions. Valid data on the clinical relevance of inadequate prescriptions is scarce and further research is required. Because of the time and effort needed to assess all medications, future quality improvement projects should focus on CKD stage ≥ 3b, patients with polypharmacy and crucial medication. © Georg Thieme Verlag KG Stuttgart · New York.

Can Internet information on vertebroplasty be a reliable means of patient self-education?

PubMed

Sullivan, T Barrett; Anderson, Joshua T; Ahn, Uri M; Ahn, Nicholas U

2014-05-01

Studies of the quality and accuracy of health and medical information available on the Internet have shown that many sources provide inadequate information. However, to our knowledge, there are no published studies analyzing the quality of information available online regarding vertebroplasty. Because this has been a high-volume procedure with highly debated efficacy, it is critical that patients receive complete, accurate, and well-balanced information before deciding a treatment course. Additionally, few studies have evaluated the merit of academic site authorship or site certification on information quality, but some studies have used measurements of quality that are based primarily on subjective criteria or information accuracy rather than information completeness. The purposes of our study were (1) to evaluate and analyze the information on vertebroplasty available to the general public through the Internet; (2) to see if sites sponsored by academic institutions offered a higher quality of information; and (3) to determine whether quality of information varied according to site approval by a certification body. Three search engines were used to identify 105 web sites (35 per engine) offering information regarding vertebroplasty. Sites were evaluated for authorship/sponsorship, content, and references cited. Information quality was rated as "excellent," "high," "moderate," "low," or "unacceptable." Sites also were evaluated for contact information to set up an appointment. Data were analyzed as a complete set, then compared between authorship types, and finally evaluated by certification status. Academic sites were compared with other authorship groups and certified sites were compared with noncertified sites using Student's t-test. Appropriate indications were referenced in 74% of sites, whereas only 45% discussed a contraindication to the procedure. Benefits were expressed by 100% of sites, but risks were outlined in only 53% (p < 0.001). Ninety-nine percent of sites provided step-by-step descriptions of the procedure, and 44% of sites also included images. Alternative treatments were mentioned by 51% of sites. Twenty-seven percent of sites referenced peer-reviewed literature, 41% offered experiential or noncited data based on American populations, and 7% offered analogous data from international populations. Thirty percent of sites provided contact information for patient appointment scheduling. Seven percent of sites were classified as excellent quality, 6% as high quality, 11% as moderate quality, 19% as poor quality, and 57% as unacceptable. Sixteen percent of sites were sponsored by academic institutions, 62% by private groups, 8% by biomedical device companies, and 14% were sponsored otherwise. Academic sites reported fewer risks of the procedure than private sites or other sites (p = 0.05 and p = 0.04), but reported more risks than industry sites (p = 0.007). Academic sites were more likely than sites classified as other to offer contact information for patient appointment scheduling (p = 0.004). Nine percent of sites evaluated were Health on the Net Foundation (HONCode) certified. No association with improved information quality was observed in these sites relative to noncertified sites (all p > 0.05). Internet information regarding vertebroplasty is not only inadequate for proper patient education, but also potentially misleading as sites are more likely to present benefits of the procedure than risks. Although academic sites might be expected to offer higher-quality information than private, industry, or other sites, our data would suggest that they do not. HONCode certification cannot be used reliably as a means of qualifying website information quality. Academic sites should be expected to set a high standard and alter their Internet presence with adequate information distribution. Certification bodies also should alter their standards to necessitate provision of complete information in addition to emphasizing accurate information. Treating physicians may want to counsel their patients regarding the limitations of information present on the Internet and the pitfalls of current certification systems. Level IV, economic and decision analyses. See the Instructions for Authors for a complete description of levels of evidence.

Sleep Deprivation.

PubMed

Abrams, Robert M

2015-09-01

Sleep deprivation occurs when inadequate sleep leads to decreased performance, inadequate alertness, and deterioration in health. It is incompletely understood why humans need sleep, although some theories include energy conservation, restoration, and information processing. Sleep deprivation has many deleterious health effects. Residency programs have enacted strict work restrictions because of medically related errors due to sleep deprivation. Because obstetrics is an unpredictable specialty with long irregular hours, enacting a hospitalist program enhances patient safety, decreases malpractice risk, and improves the physician's quality of life by allowing obstetricians to get sufficient rest. Copyright © 2015 Elsevier Inc. All rights reserved.

Advances in traffic data collection and management : white paper.

DOT National Transportation Integrated Search

2003-01-31

This white paper identifies innovative approaches for improving data quality through Quality Control. Quality Control emphasizes good data by ensuring selection of the most accurate detector then optimizing detector system performance. This is contra...

Dahuk Rehabilitation Center. Dahuk, Iraq

DTIC Science & Technology

2007-01-08

this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services , Directorate for Information...construction services . As a result, it was very likely that the project would be successfully completed without major issues related to inadequate design...visit. Specifically, Quality Control and Quality Assurance personnel were well informed about the history and progression of the project and its

A Construal of the Understanding Level of Quality Assurance by Internal Stakeholders in Two Malaysian Universities

ERIC Educational Resources Information Center

Njie, Baboucarr; Asimiran, Soaib

2016-01-01

The "understanding" in terms of interpretation of quality assurance is essential for the acceptance, theorizing and the practical application of the methods proposed by it. A great deal of research papers have often pointed to the lack of understanding, among others, as the reason behind the inadequate nature of implementing quality…

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... This section does not apply for SCR systems using the engine's fuel as the reductant. (a) The... computer memory all incidents of engine operation with inadequate reductant injection or reductant quality...

Multidisciplinary approach to improve the quality of below-knee plaster casting.

PubMed

Williams, John Teudar; Kedrzycki, Marta; Shenava, Yathish

2018-01-01

In our trauma unit, we noted a high rate of incorrectly applied below-knee casts for ankle fractures, in some cases requiring reapplication. This caused significant discomfort and inconvenience for patients and additional burden on plaster-room services. Our aim was to improve the quality of plaster casts and reduce the proportion that needed to be reapplied. Our criteria for plaster cast quality were based on the British Orthopaedic Association Casting Standards (2015) and included neutral (plantargrade) ankle position, adequacy of fracture reduction and rate of cast reapplication. Baseline data collection was performed over a 2-month period by two independent reviewers. After distributing findings and presenting to relevant departments, practical casting sessions with orthopaedic technicians were arranged for the multidisciplinary team responsible for casting. This was later supplemented by new casting guidelines in clinical areas and available online. Postintervention data collection was performed over two separate cycles to assess the effect and permanence of intervention. Data from the preintervention period (n=29) showed median ankle position was 32° plantarflexion (PF), with nine (31%) inadequate reductions and six (20%) backslabs reapplied. Following Plan-Do-Study-Act (PDSA) 1, ankle position was significantly improved (median 25° PF), there were fewer inadequate reductions (12%; 2/17) and a lower rate of reapplication (0%; 0/17). After PDSA 2 (n=16), median ankle position was 21° PF, there was one (6%) inadequate reduction and two (12%) reapplications of casts. Following implementation of plaster training sessions for accident and emergency and junior orthopaedic staff, in addition to publishing guidance and new protocol, there has been a sustained improvement in the quality of below-knee backslabs and fewer cast reapplications. These findings justify continuation and expansion of the current programme to include other commonly applied plaster casts.

Availability and Quality of Size Estimations of Female Sex Workers, Men Who Have Sex with Men, People Who Inject Drugs and Transgender Women in Low- and Middle-Income Countries

PubMed Central

Sabin, Keith; Zhao, Jinkou; Garcia Calleja, Jesus Maria; Sheng, Yaou; Arias Garcia, Sonia; Reinisch, Annette; Komatsu, Ryuichi

2016-01-01

Objective To assess the availability and quality of population size estimations of female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women. Methods Size estimation data since 2010 were retrieved from global reporting databases, Global Fund grant application documents, and the peer-reviewed and grey literature. Overall quality and availability were assessed against a defined set of criteria, including estimation methods, geographic coverage, and extrapolation approaches. Estimates were compositely categorized into ‘nationally adequate’, ‘nationally inadequate but locally adequate’, ‘documented but inadequate methods’, ‘undocumented or untimely’ and ‘no data.’ Findings Of 140 countries assessed, 41 did not report any estimates since 2010. Among 99 countries with at least one estimate, 38 were categorized as having nationally adequate estimates and 30 as having nationally inadequate but locally adequate estimates. Multiplier, capture-recapture, census and enumeration, and programmatic mapping were the most commonly used methods. Most countries relied on only one estimate for a given population while about half of all reports included national estimates. A variety of approaches were applied to extrapolate from sites-level numbers to national estimates in two-thirds of countries. Conclusions Size estimates for FSW, MSM, PWID and transgender women are increasingly available but quality varies widely. The different approaches present challenges for data use in design, implementation and evaluation of programs for these populations in half of the countries assessed. Guidance should be further developed to recommend: a) applying multiple estimation methods; b) estimating size for a minimum number of sites; and, c) documenting extrapolation approaches. PMID:27163256

Intelligent Monitoring? Assessing the ability of the Care Quality Commission's statistical surveillance tool to predict quality and prioritise NHS hospital inspections.

PubMed

Griffiths, Alex; Beaussier, Anne-Laure; Demeritt, David; Rothstein, Henry

2017-02-01

The Care Quality Commission (CQC) is responsible for ensuring the quality of the health and social care delivered by more than 30 000 registered providers in England. With only limited resources for conducting on-site inspections, the CQC has used statistical surveillance tools to help it identify which providers it should prioritise for inspection. In the face of planned funding cuts, the CQC plans to put more reliance on statistical surveillance tools to assess risks to quality and prioritise inspections accordingly. To evaluate the ability of the CQC's latest surveillance tool, Intelligent Monitoring (IM), to predict the quality of care provided by National Health Service (NHS) hospital trusts so that those at greatest risk of providing poor-quality care can be identified and targeted for inspection. The predictive ability of the IM tool is evaluated through regression analyses and χ 2 testing of the relationship between the quantitative risk score generated by the IM tool and the subsequent quality rating awarded following detailed on-site inspection by large expert teams of inspectors. First, the continuous risk scores generated by the CQC's IM statistical surveillance tool cannot predict inspection-based quality ratings of NHS hospital trusts (OR 0.38 (0.14 to 1.05) for Outstanding/Good, OR 0.94 (0.80 to -1.10) for Good/Requires improvement, and OR 0.90 (0.76 to 1.07) for Requires improvement/Inadequate). Second, the risk scores cannot be used more simply to distinguish the trusts performing poorly-those subsequently rated either 'Requires improvement' or 'Inadequate'-from the trusts performing well-those subsequently rated either 'Good' or 'Outstanding' (OR 1.07 (0.91 to 1.26)). Classifying CQC's risk bandings 1-3 as high risk and 4-6 as low risk, 11 of the high risk trusts were performing well and 43 of the low risk trusts were performing poorly, resulting in an overall accuracy rate of 47.6%. Third, the risk scores cannot be used even more simply to distinguish the worst performing trusts-those subsequently rated 'Inadequate'-from the remaining, better performing trusts (OR 1.11 (0.94 to 1.32)). Classifying CQC's risk banding 1 as high risk and 2-6 as low risk, the highest overall accuracy rate of 72.8% was achieved, but still only 6 of the 13 Inadequate trusts were correctly classified as being high risk. Since the IM statistical surveillance tool cannot predict the outcome of NHS hospital trust inspections, it cannot be used for prioritisation. A new approach to inspection planning is therefore required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Effects of Tier 3 Intervention for Students With Persistent Reading Difficulties and Characteristics of Inadequate Responders.

PubMed

Denton, Carolyn A; Tolar, Tammy D; Fletcher, Jack M; Barth, Amy E; Vaughn, Sharon; Francis, David J

2013-08-01

This article describes a randomized controlled trial conducted to evaluate the effects of an intensive, individualized, Tier 3 reading intervention for second grade students who had previously experienced inadequate response to quality first grade classroom reading instruction (Tier 1) and supplemental small-group intervention (Tier 2). Also evaluated were cognitive characteristics of students with inadequate response to intensive Tier 3 intervention. Students were randomized to receive the research intervention ( N = 47) or the instruction and intervention typically provided in their schools ( N = 25). Results indicated that students who received the research intervention made significantly better growth than those who received typical school instruction on measures of word identification, phonemic decoding, and word reading fluency and on a measure of sentence- and paragraph-level reading comprehension. Treatment effects were smaller and not statistically significant on phonemic decoding efficiency, text reading fluency, and reading comprehension in extended text. Effect sizes for all outcomes except oral reading fluency met criteria for substantive importance; however, many of the students in the intervention continued to struggle. An evaluation of cognitive profiles of adequate and inadequate responders was consistent with a continuum of severity (as opposed to qualitative differences), showing greater language and reading impairment prior to the intervention in students who were inadequate responders.

Effects of Tier 3 Intervention for Students With Persistent Reading Difficulties and Characteristics of Inadequate Responders

PubMed Central

Denton, Carolyn A.; Tolar, Tammy D.; Fletcher, Jack M.; Barth, Amy E.; Vaughn, Sharon; Francis, David J.

2013-01-01

This article describes a randomized controlled trial conducted to evaluate the effects of an intensive, individualized, Tier 3 reading intervention for second grade students who had previously experienced inadequate response to quality first grade classroom reading instruction (Tier 1) and supplemental small-group intervention (Tier 2). Also evaluated were cognitive characteristics of students with inadequate response to intensive Tier 3 intervention. Students were randomized to receive the research intervention (N = 47) or the instruction and intervention typically provided in their schools (N = 25). Results indicated that students who received the research intervention made significantly better growth than those who received typical school instruction on measures of word identification, phonemic decoding, and word reading fluency and on a measure of sentence- and paragraph-level reading comprehension. Treatment effects were smaller and not statistically significant on phonemic decoding efficiency, text reading fluency, and reading comprehension in extended text. Effect sizes for all outcomes except oral reading fluency met criteria for substantive importance; however, many of the students in the intervention continued to struggle. An evaluation of cognitive profiles of adequate and inadequate responders was consistent with a continuum of severity (as opposed to qualitative differences), showing greater language and reading impairment prior to the intervention in students who were inadequate responders. PMID:25308995

Challenges impacting on the quality of care to persons living with HIV/AIDS and other terminal illnesses with reference to Kanye community home-based care programme.

PubMed

Kang'ethe, S M

2009-03-01

HIV/AIDS has been found to be a challenging disease to humanity, its challenge spin-offs falling especially on to the caregivers of those infected and affected by the virus. This paper aims to discuss the challenges influencing the state of caregiving in the Kanye community home-based care (CHBC) programme in Botswana. The study was qualitative in design and explorative in nature, involving 82 primary caregivers in focus group discussions, and 5 CHBC nurses in individual interviews. Caregivers were found challenged by lack of community networks support, inadequate sanitary and care packages, poor shelter compromising privacy, inadequate income and food for their clients, inadequate care motivation as their volunteerism does not attract any payment, inadequate health personnel to offer psychosocial support like counselling, and an unconducive caring environment generally. Putting in place policies to redress caregivers' poverty, helping caregivers start income-generating projects, increasing community assistance and caregiving facilities are recommended as factors to address caregiver challenges.

Inadequate pelvic radiographs: implications of not getting it right the first time.

PubMed

Parker, S; Nagra, N S; Kulkarni, K; Pegrum, J; Barry, S; Hughes, R; Ghani, Y

2017-09-01

Introduction Pelvic radiography is a frequent investigation. European guidelines aim to ensure appropriate use and adequate quality. When initial images are inadequate, repeat radiographs are often required, which may have significant patient safety and economic implications. Objectives The study aimed to assess the adequacy of pelvic imaging across three orthopaedic centres, to identify causes for inadequate imaging and to establish the cost of inadequate imaging from financial and patient safety perspectives. Methods Pelvic radiographs were identified on Picture Archiving and Communication System software at three UK hospitals. Radiographs were assessed against European guidelines and indications for repeat imaging were analysed. Results A total of 1,531 sequential pelvic radiographs were reviewed. The mean age of patients was 60 years (range 5 months to 101 years). Of this total, 51.9% of images were suboptimal, with no significant difference across the three hospitals (P > 0.05). Hospital 3 repeated radiographs in 6.3% of cases, compare with 18.1% and 19.7% at hospitals 1 and 2, respectively (P > 0.05). Hospital 3 identified pathology missed on the initial radiograph in 1% of cases, compared with 5.4% and 5.5% at hospitals 1 and 2, respectively (P > 0.05). Out-of-hours imaging is associated with a higher rate of suboptimal quality (69.1%) compared with normal working hours (51.3%; P = 0.006). Adequacy rates vary with age (χ 2 = 43.62, P < 0.001). Risk of having a suboptimal radiograph increases above the age of 60-years (χ 2 = 4.45, P < 0.05). The annual cost of repeat radiographs was £56,200 per hospital. Discussion and conclusion High rates of pelvic radiograph inadequacy can lead to missed pathology and the requirement for repeat imaging, which has significant patient safety and financial implications. Risk factors for inadequate radiographs include older patients and those having out-of-hours imaging.

Research Pearls: The Significance of Statistics and Perils of Pooling. Part 3: Pearls and Pitfalls of Meta-analyses and Systematic Reviews.

PubMed

Harris, Joshua D; Brand, Jefferson C; Cote, Mark P; Dhawan, Aman

2017-08-01

Within the health care environment, there has been a recent and appropriate trend towards emphasizing the value of care provision. Reduced cost and higher quality improve the value of care. Quality is a challenging, heterogeneous, variably defined concept. At the core of quality is the patient's outcome, quantified by a vast assortment of subjective and objective outcome measures. There has been a recent evolution towards evidence-based medicine in health care, clearly elucidating the role of high-quality evidence across groups of patients and studies. Synthetic studies, such as systematic reviews and meta-analyses, are at the top of the evidence-based medicine hierarchy. Thus, these investigations may be the best potential source of guiding diagnostic, therapeutic, prognostic, and economic medical decision making. Systematic reviews critically appraise and synthesize the best available evidence to provide a conclusion statement (a "take-home point") in response to a specific answerable clinical question. A meta-analysis uses statistical methods to quantitatively combine data from single studies. Meta-analyses should be performed with high methodological quality homogenous studies (Level I or II) or evidence randomized studies, to minimize confounding variable bias. When it is known that the literature is inadequate or a recent systematic review has already been performed with a demonstration of insufficient data, then a new systematic review does not add anything meaningful to the literature. PROSPERO registration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines assist authors in the design and conduct of systematic reviews and should always be used. Complete transparency of the conduct of the review permits reproducibility and improves fidelity of the conclusions. Pooling of data from overly dissimilar investigations should be avoided. This particularly applies to Level IV evidence, that is, noncomparative investigations. With proper technique, systematic reviews and meta-analyses have the potential to be powerful investigations that efficiently assist clinicians in decision making. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Poor sleep quality and insufficient sleep of a collegiate student-athlete population.

PubMed

Mah, Cheri D; Kezirian, Eric J; Marcello, Brandon M; Dement, William C

2018-06-01

Poor and inadequate sleep negatively impact cognitive and physical functioning and may also affect sports performance. The study aim is to examine sleep quality, sleep duration, and daytime sleepiness in collegiate student-athletes across a wide range of sports. Questionnaire. University setting. 628 athletes across 29 varsity teams at Stanford University. Athletes completed a questionnaire inquiring about sleep quality via a modified Pittsburgh Sleep Quality Index (PSQI), sleep duration, and daytime sleepiness via Epworth Sleepiness Scale. Sleep quality on campus and while traveling for competition was rated on a 10-point scale. Collegiate athletes were classified as poor sleepers (PSQI 5.38 ± 2.45), and 42.4% of athletes experience poor sleep quality (reporting PSQI global scores >5). Athletes reported lower sleep quality on campus than when traveling for competition (7.1 vs 7.6, P< .001). Inadequate sleep was demonstrated by 39.1% of athletes that regularly obtain <7 hours of sleep on weekdays. Fifty-one percent of athletes reported high levels of daytime sleepiness with Epworth scores ≥10. Teen student-athletes in the first and second year of college reported the highest mean levels of daytime sleepiness. Greater total sleep time was associated with daytime functioning including lower frequency of difficulty waking up for practice or class (P< .001) and lower frequency of trouble staying awake during daily activities (P< .001). Collegiate athletes frequently experience poor sleep quality, regularly obtain insufficient sleep, and commonly exhibit daytime sleepiness. Copyright © 2018 National Sleep Foundation. All rights reserved.

Characterizing Virus Decay in Environmental Freshwater Habitats

EPA Science Inventory

Recreational water quality is typically assessed using fecal indicator bacteria (FIB), however, FIB are inadequate surrogates for the viral pathogens. Bacteriophage share similar morphologies to viral pathogens allowing closer representation of viral behavior, making their inclu...

Region 9: Nevada Inadequate Letter (2/17/2000)

EPA Pesticide Factsheets

This January 12, 2000, letter from EPA transmits the inadequacy finding for transportation conformity purposes the motor vehicle emission budgets in the Carbon Monoxide Air Quality Implementation Plan for the Clark County Nonattainment Area.

Maternal diet quality and nutrient intake in the gestational period: results from the Delta Healthy Sprouts comparative impact trial

USDA-ARS?s Scientific Manuscript database

A woman’s diet while pregnant can play an important role in her reproductive health as well as the health of her unborn child. Diet quality and nutrient intake amongst pregnant women residing in the rural Lower Mississippi Delta (LMD) region of the United States is strikingly inadequate. The Delta H...

Shaky Methods, Shaky Motives: A Critique of the National Council of Teacher Quality's Review of Teacher Preparation Programs

ERIC Educational Resources Information Center

Fuller, Edward J.

2014-01-01

The National Council on Teacher Quality's (NCTQ) recent review of university-based teacher preparation programs concluded the vast majority of such programs were inadequately preparing the nation's teachers. The study, however, has a number of serious flaws that include narrow focus on inputs, lack of a strong research base, missing standards,…

Causes of Indoor Air Quality Problems in Schools: Summary of Scientific Research.

ERIC Educational Resources Information Center

Bayer, Charlene W.; Crow, Sidney A.; Fischer, John

Research show that one in five U.S. schools has indoor air quality (IAQ) problems; 36 percent have inadequate heating, ventilation, and air conditioning (HVAC) systems; and there appears to be a correlation between IAQs and the proportion of a school's students coming from low-income households. This report examines the IAQ issue in U.S. public…

[Feasibility and results of the short Diet Quality Screener in Primary Care: EMAP study].

PubMed

Ríos-Rodríguez, María de Los Ángeles; García-Cerdán, María Rosa; Calonge-Vallejo, Ana Rosa; Tobella-Andreu, Laia; Baena-Díez, José Miguel; Schröder, Helmut

To study the feasibility and results of the self-reported short diet quality screener (sDQS) in Primary Care. The variables associated with difficulty and inadequate diet are also determined. Cross-sectional descriptive study conducted with 196 participants aged >18 years with diabetes mellitus, hypertension, or hypercholesterolaemia, consecutively included from 4 Primary Health Care Centres in Barcelona. The main variables collected were, age, sex, educational level, cardiovascular risk factors, body mass index, time to complete the sDQS, degree of difficulty, and diet score: inadequate diet ≤18, adequate in some aspects 19-27, adequate >27. The mean age was 48.8 years (52% males). The analysis of the variables showed that the prevalence of having higher than a primary education level, hypertension, diabetes, hypercholesterolemia, and obesity was 50%, 54.6%, 23.5%, 56.6%, and 27.5%, respectively. The mean time to complete the questionnaire was 2.3min. More than 80% considered it easy or very easy. An inadequate diet was reported by 21.4%, adequate in some aspects by 76.5%, and an adequate diet only by 2%. To be older than 49 years and a low diet quality increased the risk of needing ≥2min to complete the sDQS (OR 2.0, 95% CI; 1.0-4.3, and OR 2.3, 95% CI; 1.1-5.1, respectively). Not following a low cholesterol diet and age less than 49 years increased the risk of a low diet quality (OR 2.2; 95% CI: 1.1-4.5, and OR 2.9; 95% CI: 1.2-6.8, respectively). The completion of the sDQS is easy and was not a significant time-burden in Primary Care. A significant proportion of participants with cardiovascular risk reported a low diet quality. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

2004 Japanese Society for Dialysis Therapy guidelines for renal anemia in chronic hemodialysis patients.

PubMed

Gejyo, Fumitake; Saito, Akira; Akizawa, Tadao; Akiba, Takashi; Sakai, Tatsuya; Suzuki, Masashi; Nishi, Shinichi; Tsubakihara, Yoshiharu; Hirakata, Hideki; Bessho, Masami

2004-12-01

The guideline committee of Japanese Society for Dialysis Therapy (JSDT), chaired by Professor F. Gejyo of Niigata University, now publishes an original Japanese guideline entitled 'Guidelines for Renal Anemia in Chronic Hemodialysis Patients'. It includes the re-evaluation of the usage of recombinant human erythropoietin (rHuEPO) with the medical and economical arguments regarding the prognosis and the quality of life of Japanese hemodialysis patients. This guideline consists of 7 sections. The first section comprises the general definition and the differential diagnosis of anemia. The hemoglobin (Hb) level of the Japanese population seemed to be low when compared with that of the European and American populations. The second section describes the target Hb level in hemodialysis patients. Multivariate analysis of the data that were collected from dialysis institutions throughout the country showed that an Hb level of 10-11 g/dL (Ht level 30-33%) at the first dialysis session in a week is the ideal range for chronic hemodialysis patients in terms of the 3-5 year survival rate. The supine position at blood sampling and the sampling timing at the first dialysis session in a week might affect the lower setting of target Hb hematocrit (Ht), compared to that of European and American guidelines. However, we particularly recommended that an Hb level of 11-12 g/dL (Ht level from 33 to 36%) at the first dialysis session in a week is desirable in relatively young patients. In the third section, the markers of iron deficiency are discussed. The Transferin saturation test (TSAT) and serum ferritin were emphasized as the standard markers. The routes of administration of rHuEPO and its dosages are written in the fourth section. The subcutaneous route was associated with the occurrence of secondary red cell aplasia due to anti-rHuEPO antibodies; however, secondary red cell aplasia was seldom observed in the venous injection. From this fact we recommend venous injection for chronic hemodialysis patients. We advocate an initial dosage of 1500 U three times per week. The fifth section deals with the factors refractory to treatment with rHuEPO. If the patient shows an inadequate response to the usage of 9000 U per week, this condition defines the inadequate response to rHuEPO in Japan. Blood transfusion must be avoided where possible. The reasons for this and the adverse effects are interpreted in section six. In the final section, the adverse effects of rHuEPO are listed. Among them, hypertension, thrombotic events and secondary red cell aplasia were emphasized as the major complications.

Ethnic differences in the nutrient intake adequacy of premenopausal US women: results from the Third National Health Examination Survey.

PubMed

Arab, Lenore; Carriquiry, Alicia; Steck-Scott, Susan; Gaudet, Mia M

2003-08-01

To examine the adequacy of dietary intake of calcium; folate; and vitamins C, D, E, B-6, and B-12 in premenopausal US women of differing ethnicity. Analyses of single and duplicate 24-hour recalls were conducted to determine dietary intake during the Third National Health and Nutrition Examination Survey. Three thousand five hundred eighty-five randomly selected women aged 20 to 50 years from across the United States who were not pregnant or lactating were examined between 1988 and 1994. Usual nutrient intake distributions were estimated using the Iowa State University method for adjustment of the distribution. The Estimated Average Requirement cut-point method was used to determine the proportion of women with inadequate intake for each nutrient in each ethnic group. More than 75% of women irrespective of ethnic group had usual intakes of calcium lower than the new Adequate Intake. More than 90% of the women had inadequate intakes of folate and vitamin E from food sources alone. More than half of smokers had inadequate intakes of vitamin C. Intakes of vitamins B-6 and B-12 were low in less than 10% of these women. This article provides evidence that a high proportion of premenopausal US women are underconsuming a variety of nutrients. Dietary intakes alone are not currently adequate to meet the new recommended intakes. Nutritional supplement use is widespread and effective, but does not eliminate the concerns for at-risk populations. Awareness of the general inadequacies in intakes of vitamin E and folic acid at large, and in many women vitamin C as well, can help direct individual dietary recommendations and place the emphasis in group counseling on nutrients that are of widespread concern. In addition, foods rich in vitamins B-6 and of general nutritional benefit should be emphasized among African American women in the United States as a substantial proportion of this group is still showing inadequate intakes from foods.

Fluoroscopy

MedlinePlus

... through a clinical facility’s quality assurance program, are fundamental to radiation protection. More information about the principles ... as part of quality assurance program emphasizing radiation management. Health care providers who use fluoroscopy should be ...

Inverted base pavements : new field test and design catalogue.

DOT National Transportation Integrated Search

2014-01-01

The current economic situation has severely affected the US road infrastructure and funding has become : inadequate for either maintenance or future growth. : The inverted base pavement structure is a promising alternative to achieve high quality roa...

Birch nutrition

Treesearch

Merrill C. Hoyle; John C. Bjorkbom

1969-01-01

Much of the slow growth and low quality of our birches and other northern hardwoods in New England can be traced to inadequate soil fertility. This problem can be overcome by remedial fertilization, which will enhance the production of healthy, vigorous birch trees.

QUALITY ASSURANCE FOR METHODS TO DETECT HUMAN ENTERIC VIRUSES IN DRINKING WATER

EPA Science Inventory

Surface or groundwaters impacted by untreated or inadequately treated domestic wastes may contain human pathogenic viruses that cause hepatitis, gastroenteritis, meningitis, encephalitis, myocarditis, diabetes, conjunctivitis and temporary or permanent paralysis. These viruses c...

Quality of Life. NARF Monograph Series.

ERIC Educational Resources Information Center

National Association of Rehabilitation Facilities, Washington, DC.

Oriented to rehabilitation facilities that are interested in maintaining and expanding their markets, this pamphlet presents publication excerpts that provide an understanding of the impact of organizational quality. The excerpts emphasize development of quality products and services through motivation of staff, effective communication, use of…

In Defense of Educators: The Problem of Idea Quality, Not "Teacher Quality"

ERIC Educational Resources Information Center

Hirsch, E. D., Jr.

2017-01-01

People who emphasize teaching quality and the central importance of teachers are right to do so. Where some go wrong is in thinking that teacher quality is an innate characteristic. The effectiveness of a teacher is not some inherent competence, as the phrase "teacher quality" suggests. Teacher effectiveness is contextual. Why has the…

Impact of Major Depression and Subsyndromal Symptoms on Quality of Life and Attitudes toward Aging in an International Sample of Older Adults

ERIC Educational Resources Information Center

Chachamovich, Eduardo; Fleck, Marcelo; Laidlaw, Ken; Power, Mick

2008-01-01

Purpose: The impact of major depression on quality of life (QOL) and aging experiences in older adults has been reported. Studies have demonstrated that the clinical diagnosis of major depression is the strongest predictor for QOL. We postulate that some findings are biased because of the use of inadequate instruments. Although subsyndromal…

Early Childhood Reform in Seven Communities: Front-Line Practice, Agency Management, and Public Policy. [Volume I: Final Technical Report.] Studies of Education Reform.

ERIC Educational Resources Information Center

Schultz, Tom; And Others

An era of substantial growth in investment of resources, program development, and research has led to tangible gains in the scope and quality of early childhood education programs. However, the system of early childhood education programs is plagued by unequal access and inconsistent, inadequate levels of quality. Additionally, the focus of…

Knowledge translation on dementia: a cluster randomized trial to compare a blended learning approach with a "classical" advanced training in GP quality circles

PubMed Central

Vollmar, Horst C; Butzlaff, Martin E; Lefering, Rolf; Rieger, Monika A

2007-01-01

Background Thus far important findings regarding the dementia syndrome have been implemented into patients' medical care only inadequately. A professional training accounting for both, general practitioners' (GP) needs and learning preferences as well as care-relevant aspects could be a major step towards improving medical care. In the WIDA-study, entitled "Knowledge translation on dementia in general practice" two different training concepts are developed, implemented and evaluated. Both concepts are building on an evidence-based, GP-related dementia guideline and communicate the guideline's essential insights. Methods/Design Both development and implementation emphasize a procedure that is well-accepted in practice and, thus, can achieve a high degree of external validity. This is particularly guaranteed through the preparation of training material and the fact that general practitioners' quality circles (QC) are addressed. The evaluation of the two training concepts is carried out by comparing two groups of GPs to which several quality circles have been randomly assigned. The primary outcome is the GPs' knowledge gain. Secondary outcomes are designed to indicate the training's potential effects on the GPs' practical actions. In the first training concept (study arm A) GPs participate in a structured case discussion prepared for by internet-based learning material ("blended-learning" approach). The second training concept (study arm B) relies on frontal medical training in the form of a slide presentation and follow-up discussion ("classical" approach). Discussion This paper presents the outline of a cluster-randomized trial which has been peer reviewed and support by a national funding organization – Federal Ministry of Education and Research (BMBF) – and is approved by an ethics commission. The data collection has started in August 2006 and the results will be published independently of the study's outcome. Trial Registration Current Controlled Trials [ISRCTN36550981] PMID:17587452

Stakeholder Perspectives on the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) Project.

PubMed

Ersek, Mary; Hickman, Susan E; Thomas, Anne C; Bernard, Brittany; Unroe, Kathleen T

2017-10-17

The need to reduce burdensome and costly hospitalizations of frail nursing home residents is well documented. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project achieved this reduction through a multicomponent collaborative care model. We conducted an implementation-focused project evaluation to describe stakeholders' perspectives on (a) the most and least effective components of the intervention; (b) barriers to implementation; and (c) program features that promoted its adoption. Nineteen nursing homes participated in OPTIMISTIC. We conducted semistructured, qualitative interviews with 63 stakeholders: 23 nursing home staff and leaders, 4 primary care providers, 10 family members, and 26 OPTIMISTIC clinical staff. We used directed content analysis to analyze the data. We found universal endorsement of the value of in-depth advance care planning (ACP) discussions in reducing hospitalizations and improving care. Similarly, all stakeholder groups emphasized that nursing home access to specially trained, project registered nurses (RNs) and nurse practitioners (NPs) with time to focus on ACP, comprehensive resident assessment, and staff education was particularly valuable in identifying residents' goals for care. Challenges to implementation included inadequately trained facility staff and resistance to changing practice. In addition, the program sometimes failed to communicate its goals and activities clearly, leaving facilities uncertain about the OPTIMISTIC clinical staff's roles in the facilities. These findings are important for dissemination efforts related to the OPTIMISTIC care model and may be applicable to other innovations in nursing homes. Published by Oxford University Press on behalf of The Gerontological Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Landsat change detection can aid in water quality monitoring

NASA Technical Reports Server (NTRS)

Macdonald, H. C.; Steele, K. F.; Waite, W. P.; Shinn, M. R.

1977-01-01

Comparison between Landsat-1 and -2 imagery of Arkansas provided evidence of significant land use changes during the 1972-75 time period. Analysis of Arkansas historical water quality information has shown conclusively that whereas point source pollution generally can be detected by use of water quality data collected by state and federal agencies, sampling methodologies for nonpoint source contamination attributable to surface runoff are totally inadequate. The expensive undertaking of monitoring all nonpoint sources for numerous watersheds can be lessened by implementing Landsat change detection analyses.

Making the Right Choice.

ERIC Educational Resources Information Center

Cox, Edward P.; Malone, Bobby G.

2001-01-01

When 34 Indiana school-board presidents were surveyed regarding their districts' superintendent hiring processes, most were not impressed with candidate quality. Applicants' top weaknesses included insufficient administrative experience, limited communication skills, and inadequate knowledge of school finance. Internal candidates are scarce, and…

Epidemiology of dietary nutrient intake in ESRD.

PubMed

Kovesdy, Csaba P; Shinaberger, Christian S; Kalantar-Zadeh, Kamyar

2010-01-01

Protein-energy wasting (PEW) is one of the strongest risk factors of adverse outcomes in patients with chronic kidney disease including those with end-stage renal disease (ESRD) who undergo maintenance dialysis treatment. One important determinant of PEW in this patient population is an inadequate amount of protein and energy intake. Compounding the problem are the many qualitative nutritional deficiencies that arise because of the altered dietary habits of dialysis patients. Many of these alterations are iatrogenically induced, and albeit well intentioned, they could induce unintended harmful effects. In order to determine the best possible diet in ESRD patients, one must first understand the complex interplay between the quantity and quality of nutrient intake in these patients, and their impact on relevant clinical outcomes. We review available studies examining the association of nutritional intake with clinical outcomes in ESRD, stressing the complicated and often difficult-to-study inter-relationship between quantitative and qualitative aspects of nutrient intake in nutritional epidemiology. The currently recommended higher protein intake of 1.2 g/kg/day may be associated with a higher phosphorus and potassium burden and with worsening hyperphosphatemia and hyperkalemia, whereas dietary control of phosphorus and potassium by restricting protein intake may increase the risk of PEW. We assess the relevance of associative studies by examining the biologic plausibility of underlying mechanisms of action and emphasize areas in need of further research.

Improvement of ablative margins by the intraoperative use of CEUS-CT/MR image fusion in hepatocellular carcinoma.

PubMed

Li, Kai; Su, Zhong-Zhen; Xu, Er-Jiao; Ju, Jin-Xiu; Meng, Xiao-Chun; Zheng, Rong-Qin

2016-04-18

To assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after hepatocellular carcinoma (HCC) ablation. Ninety-eight patients with 126 HCCs designated to undergo thermal ablation treatment were enrolled in this prospective study. CEUS-CT/MR image fusion was performed intraoperatively to evaluate whether 5-mm AM was covered by the ablative area. If possible, supplementary ablation was applied at the site of inadequate AM. The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded. Local tumor progression (LTP) was observed during follow-up. Clinical factors including AM were examined to identify risk factors for LTP. The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min. The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases. By supplementary ablation, 21.8% (12/55) of lesions with inadequate AMs became adequate AMs. During follow-up, there were 5 LTPs in lesions with inadequate AMs and 1 LTP in lesions with adequate AMs. Multivariate analysis showed that AM was the only independent risk factor for LTP (hazard ratio, 9.167; 95% confidence interval, 1.070-78.571; p = 0.043). CEUS-CT/MR image fusion is feasible for intraoperative use and can serve as an accurate method to evaluate AMs and guide supplementary ablation to lower inadequate AMs.

DISC (Defense Industrial Supply Center) TQM (Total Quality Management) Operations Plan

DTIC Science & Technology

1989-07-01

This document represents the continuance of the Defense Industrial Supply Center implementation of Total Quality Management which began in 1986. It...outlines how DISC intends to emphasize process improvement through the integration of all TQM initiates. Quality management at DISC prescribes defining

(AWMA) IMPROVING EMISSION INVENTORIES FOR EFFECTIVE AIR-QUALITY MANAGEMENT ACROSS NORTH AMERICA - A NARSTO ASSESSMENT

EPA Science Inventory

The NARSTO Ozone and Particulate Matter Assessments emphasized that emission inventories are critical to the success of air quality management programs and that emissions inventories in Canada, Mexico, and the United States need improvement to meet expectations for quality, timel...

IMPROVING EMISSION INVENTORIES FOR EFFECTIVE AIR-QUALITY MANAGMENT ACROSS NORTH AMERICA - A NARSTO ASSESSMENT

EPA Science Inventory

The NARSTO Ozone and Particulate Matter Assessments emphasized that emission inventories are critical to the success of air quality management programs and that emissions inventories in Canada, Mexico, and the United States need improvement to meet expectations for quality, timel...

IMPROVING EMISSION INVENTORIES FOR EFFECTIVE AIR-QUALITY MANAGEMENT ACROSS NORTH AMERICA - A NARSTO ASSESSMENT

EPA Science Inventory

The NARSTO Ozone and Particulate Matter Assessments emphasized that emission inventories are critical to the success of air quality management programs and that emissions inventories in Canada, Mexico, and the United States need improvement to meet expectations for quality, timel...

History and background of quality measurement.

PubMed

Chun, Jonathan; Bafford, Andrea Chao

2014-03-01

Health care quality measurement has become increasingly emphasized, as providers and administrators respond to public and government demands for improved patient care. This article will review the evolution of surgical quality measurement and improvement from its infancy in the 1850s to the vast efforts being undertaken today.

Guide for Indoor Air Quality Surveys

DTIC Science & Technology

1992-05-01

investigations, but is most useful as a tool for the Heating, Ventilating, and Air-Conditioning ( HVAC ) experts. The standard describes two procedures for...providing acceptable air quality and includes design criteria for HVAC systems. Perhaps the most important contribution from ASHRAE 62-1989 is its...Selected Selected Cause Subcauses Subrates(%) Overall Rate(%) A. Inadequate Design or Maintenance of HVAC 70 (32/46) Al. Mold 47 (15/32) 33 (15/46) A2

Statistical process control methods allow the analysis and improvement of anesthesia care.

PubMed

Fasting, Sigurd; Gisvold, Sven E

2003-10-01

Quality aspects of the anesthetic process are reflected in the rate of intraoperative adverse events. The purpose of this report is to illustrate how the quality of the anesthesia process can be analyzed using statistical process control methods, and exemplify how this analysis can be used for quality improvement. We prospectively recorded anesthesia-related data from all anesthetics for five years. The data included intraoperative adverse events, which were graded into four levels, according to severity. We selected four adverse events, representing important quality and safety aspects, for statistical process control analysis. These were: inadequate regional anesthesia, difficult emergence from general anesthesia, intubation difficulties and drug errors. We analyzed the underlying process using 'p-charts' for statistical process control. In 65,170 anesthetics we recorded adverse events in 18.3%; mostly of lesser severity. Control charts were used to define statistically the predictable normal variation in problem rate, and then used as a basis for analysis of the selected problems with the following results: Inadequate plexus anesthesia: stable process, but unacceptably high failure rate; Difficult emergence: unstable process, because of quality improvement efforts; Intubation difficulties: stable process, rate acceptable; Medication errors: methodology not suited because of low rate of errors. By applying statistical process control methods to the analysis of adverse events, we have exemplified how this allows us to determine if a process is stable, whether an intervention is required, and if quality improvement efforts have the desired effect.

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors.

PubMed

Mahmood, Mohammad Afzal; Mufidah, Ismi; Scroggs, Steven; Siddiqui, Amna Rehana; Raheel, Hafsa; Wibdarminto, Koentijo; Dirgantoro, Bernardus; Vercruyssen, Jorien; Wahabi, Hayfaa A

2018-01-01

Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped.

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors

PubMed Central

Mufidah, Ismi; Scroggs, Steven; Siddiqui, Amna Rehana; Raheel, Hafsa; Wibdarminto, Koentijo; Dirgantoro, Bernardus; Vercruyssen, Jorien

2018-01-01

Background Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Method Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. Findings The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. Conclusion There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped. PMID:29682538

Monitoring the quality of total hip replacement in a tertiary care department using a cumulative summation statistical method (CUSUM).

PubMed

Biau, D J; Meziane, M; Bhumbra, R S; Dumaine, V; Babinet, A; Anract, P

2011-09-01

The purpose of this study was to define immediate post-operative 'quality' in total hip replacements and to study prospectively the occurrence of failure based on these definitions of quality. The evaluation and assessment of failure were based on ten radiological and clinical criteria. The cumulative summation (CUSUM) test was used to study 200 procedures over a one-year period. Technical criteria defined failure in 17 cases (8.5%), those related to the femoral component in nine (4.5%), the acetabular component in 32 (16%) and those relating to discharge from hospital in five (2.5%). Overall, the procedure was considered to have failed in 57 of the 200 total hip replacements (28.5%). The use of a new design of acetabular component was associated with more failures. For the CUSUM test, the level of adequate performance was set at a rate of failure of 20% and the level of inadequate performance set at a failure rate of 40%; no alarm was raised by the test, indicating that there was no evidence of inadequate performance. The use of a continuous monitoring statistical method is useful to ensure that the quality of total hip replacement is maintained, especially as newer implants are introduced.

Adverse nurse outcomes: correlation to nurses' workload, staffing, and shift rotation in Kuwaiti hospitals.

PubMed

Al-Kandari, Fatimah; Thomas, Deepa

2008-08-01

This study was conducted to identify adverse outcomes to nurses in relation to their daily patient load, nursing care activities, staffing, and shift rotation. A structured questionnaire was used to collect data from medical and surgical nurses (N = 784). Skipping tea/coffee breaks (95%), feeling responsible for more patients than they could safely care for (87%), inadequate help available (86%), inadequate time to document care (80%), verbal abuse by a patient or a visitor (77%), and concern about quality of care (71%) were the major reported adverse outcomes related to short staffing, increased patient load, and increased nursing care activities.

Model Curriculum Emphasizing Transition: A Curriculum Planning Guide for Students with Mild Disabilities.

ERIC Educational Resources Information Center

Andersen, Lee; And Others

This curriculum emphasizes successful transition from school to work and to a quality adult life for students with mild disabilities. The curriculum includes a scope and sequence outlining 11 subject matter content areas, covering tasks appropriate for learners from a developmental age of 1 month to 21 years. The 11 content areas include…

Implementation of Programmatic Quality and the Impact on Safety

NASA Astrophysics Data System (ADS)

Huls, Dale T.; Meehan, Kevin M.

2005-12-01

The implementation of an inadequate programmatic quality assurance discipline has the potential to adversely affect safety and mission success. This is best demonstrated in the lessons provided by the Apollo 1 Apollo 13 Challenger, and Columbia accidents; NASA Safety and Mission Assurance (S&MA) benchmarking exchanges; and conclusions reached by the Shuttle Return-to-Flight Task Group established following the Columbia Shuttle accident. Examples from the ISS Program demonstrate continuing issues with programmatic quality. Failure to adequately address programmatic quality assurance issues has a real potential to lead to continued inefficiency, increases in program costs, and additional catastrophic accidents.

( RTP, NC ) IMPROVING EMISSION INVENTORIES FOR EFFECTIVE AIR-QUALITY MANAGEMENT ACROSS NORTH AMERICA - A NARSTO ASSESSMENT

EPA Science Inventory

The NARSTO Ozone and Particulate Matter Assessments emphasized that emission inventories are critical to the success of air quality management programs and that emissions inventories in Canada, Mexico, and the United States need improvement to meet expectations for quality, timel...

(NEW YORK) IMPROVING EMISSION INVENTORIES FOR EFFECTIVE AIR-QUALITY MANAGEMENT ACROSS NORTH AMERICA - A NARSTO ASSESSMENT

EPA Science Inventory

The NARSTO Ozone and Particulate Matter Assessments emphasized that emission inventories are critical to the success of air quality management programs and that emissions inventories in Canada, Mexico, and the United States need improvement to meet expectations for quality, timel...

Environmental Involvement. . . A Teacher's Guide (2nd Edition).

ERIC Educational Resources Information Center

1971

Presented in this teacher's guide are ideas and projects to help students develop an awareness and appreciation of their environment. Sharpening the senses is emphasized through activities dealing with water quality, sound qualities, and noise, air quality, solid waste control, and soil management. The text is divided into four levels roughly…

Dietary supplements and disease prevention — a global overview

USDA-ARS?s Scientific Manuscript database

Dietary supplements are widely used and offer the potential to improve health if appropriately targeted to those in need. Inadequate nutrition and micronutrient deficiencies are prevalent conditions that adversely affect global health. Although improvements in diet quality are essential to address t...

Inland marine fish culture in low-salinity recirculating aquaculture systems

USDA-ARS?s Scientific Manuscript database

Expansion of marine aquaculture is challenged by the high cost and limited availability of coastal land and water resources, effluent concerns, high production costs, restricted growing seasons, lack of quality seedstock, and inadequate regulatory and permitting processes. Many of these constraints...

PROVIDING SAFE WATER TO RURAL NEPAL: A NOVEL WATER FILTRATION SYSTEM

EPA Science Inventory

The quality of Nepalese water sources is often compromised by pathogen contamination resulting from inadequate wastewater management, and arsenic contamination from natural and anthropogenic sources. The primary source of Nepal’s arsenic problem is suspected to arise fro...

LETHAL LEVELS OF HYPOXIA FOR GULF COAST ESTUARINE ANIMALS

EPA Science Inventory

There is increasing concern about eutrophication and subsequent hypoxia problems in estuaries. The U.S. Environmental Protection Agency has developed Water Quality Criteria (WQC) for dissolved oxygen (DO) in saltwater for Cape Cod, MA to Cape Hatteras, NC but inadequate data exis...

NARSTO EMISSION INVENTORY ASSESSMENT

EPA Science Inventory

The NARSTO Ozone and Particulate Matter Assessments emphasized that emission inventories are critical to the success of air quality management programs and that emissions inventories in Canada, Mexico, and the United States need improvement to meet expectations for quality, timel...

Geophysical variables and behavior: XXVI. A response to Rutkowski's critique of the tectonic strain hypothesis for UFO phenomena.

PubMed

Persinger, M A

1985-04-01

The tectonic strain hypothesis for many reports of UFOs (UFORs), primarily odd luminosities and metallic-looking phenomena, has been criticized on the basis of inadequate data. This reply begins with the distinction between the empirical basis for the association between UFORs and seismic activity, the hypothesis, and laboratory experiments. It is emphasized that criticisms of data should be based upon empirical criteria rather than value judgments about scientific credibility. Multivariate and bivariate analyses have indicated systematic relationships between UFORs and earthquake measures within several different areas and for different historical periods. However, the physical mechanisms for the generation of individual UFO events and their relationship to UFORs require closer examination.

[Trends in the utilization of food additives].

PubMed

Szűcs, Viktória; Bánáti, Diána

2013-11-17

The frequent media reports on food additives weakened consumers' trust in food producers and food control authorities as well. Furthermore, consumers' uncertainty is also raised by the fact that they obtain their information from inadequate, mistrustful sources and, therefore, consumers might avoid the consumption of certain foodstuffs. While food producers may react by replacing artificial components by natural ones, they try to emphasize the favourable characteristics of their products. The authors describe the main trends and efforts related to food additives. On the basis of the overview it can be concluded that - besides taking into consideration consumers' needs - product development and research directions are promising. Food producers' efforts may help to restore consumer confidence and trust and they may help them to have informed choice.

Technology assessment or technology harassment: The attacks on science and technology

NASA Technical Reports Server (NTRS)

Green, L., Jr.

1972-01-01

The manner in which technology is being assessed by various groups and individuals is discussed. Attacks on science and technology (specifically military uses and funding), and the disillusionment of the public with the lack of relevance of science to the public interest and with the infallible wisdom of scientists are described. The effects of the fear of environmental pollution are emphasized. It is concluded that the important issues of science, technology, and public policy will require a pluralistic definition of the public interest by open adversary proceedings. It is also felt that the danger is not that new technology will receive inadequate assessment for possible deleterious secondary effects, but that harassment by an overemotional political process may prevent its coming to fruition.

Handling qualities criteria for the space shuttle orbiter during the terminal phase of flight

NASA Technical Reports Server (NTRS)

Stapleford, R. L.; Klein, R. H.; Hob, R. H.

1972-01-01

It was found that large portions of the military handling qualities specification are directly applicable. However a number of additional and substitute criteria are recommended for areas not covered or inadequately covered in the military specification. Supporting pilot/vehicle analyses and simulation experiments were conducted and are described. Results are also presented of analytical and simulator evaluations of three specific interim Orbiter designs which provided a test of the proposed handling qualities criteria. The correlations between the analytical and experimental evaluations were generally excellent.

Audits of radiopharmaceutical formulations

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

Castronovo, F.P. Jr.

A procedure for auditing radiopharmaceutical formulations is described. To meet FDA guidelines regarding the quality of radiopharmaceuticals, institutional radioactive drug research committees perform audits when such drugs are formulated away from an institutional pharmacy. All principal investigators who formulate drugs outside institutional pharmacies must pass these audits before they can obtain a radiopharmaceutical investigation permit. The audit team meets with the individual who performs the formulation at the site of drug preparation to verify that drug formulations meet identity, strength, quality, and purity standards; are uniform and reproducible; and are sterile and pyrogen free. This team must contain an expertmore » knowledgeable in the preparation of radioactive drugs; a radiopharmacist is the most qualified person for this role. Problems that have been identified by audits include lack of sterility and apyrogenicity testing, formulations that are open to the laboratory environment, failure to use pharmaceutical-grade chemicals, inadequate quality control methods or records, inadequate training of the person preparing the drug, and improper unit dose preparation. Investigational radiopharmaceutical formulations, including nonradiolabeled drugs, must be audited before they are administered to humans. A properly trained pharmacist should be a member of the audit team.« less

RESPONDING TO WATER CONTAMINATION THREATS

EPA Science Inventory

Drinking water safety has traditionally been linked to water quality. The possibility of terrorism directed against the drinking water supply has emphasized the link between water safety and water security. The traditional paradigm in solving water quality problems is to develop ...

[Quality management: its use in nursing].

PubMed

Antunes, A V; Trevizan, M A

2000-01-01

The Quality Management has been used and it is a reality in the hospitals. Thus the authors comment about its importance for Nursing and analyse its utilization in a Nursing Service of a private hospital, with purpose to evaluate the implementation form, nurses' involvement and the Deming' Principles application. Data show that the implementation has brought good results, nurses are engaged in the process and the Deming's Principles have been utilized, adequate or inadequately.

Quality - Inexpensive if a way of life.

NASA Technical Reports Server (NTRS)

Grau, D.

1972-01-01

NASA major projects require phased planning. The participation of persons charged with maintaining the proper quality during the last two of four phases has become accepted practice. Current objectives are concerned with the application of quality assurance techniques during the second phase. It is pointed out that quality must be emphasized during the entire engineering process, starting with the selection of the components.

Why Are Some Texts Good and Others Not? Relationship between Text Quality and Management of the Writing Processes

ERIC Educational Resources Information Center

Beauvais, Caroline; Olive, Thierry; Passerault, Jean-Michel

2011-01-01

Two experiments examined whether text quality is related to online management of the writing processes. Experiment 1 focused on the relationship between online management and text quality in narrative and argumentative texts. Experiment 2 investigated how this relationship might be affected by a goal emphasizing text quality. In both experiments,…

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Emission diagnostics for SCR systems. 1033.112 Section 1033.112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... computer memory all incidents of engine operation with inadequate reductant injection or reductant quality...

30 CFR 582.28 - Environmental protection measures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 582.28 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE... evaluation of the approved Delineation, Testing, or Mining Plan. The Director's review of the air quality... to be inadequate to support an environmental evaluation of a proposed Delineation, Testing, or Mining...

30 CFR 582.28 - Environmental protection measures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Section 582.28 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE... evaluation of the approved Delineation, Testing, or Mining Plan. The Director's review of the air quality... to be inadequate to support an environmental evaluation of a proposed Delineation, Testing, or Mining...

30 CFR 582.28 - Environmental protection measures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Section 582.28 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE... evaluation of the approved Delineation, Testing, or Mining Plan. The Director's review of the air quality... to be inadequate to support an environmental evaluation of a proposed Delineation, Testing, or Mining...

Utility of alfalfa stemlage for feeding dairy heifers

USDA-ARS?s Scientific Manuscript database

Dairy heifers are typically offered high-forage diets to control weight gains; however, these forage-based diets often contain significant portions of corn silage or other high-quality forages with low fiber concentrations. Inadequate concentrations of dietary fiber can lead to greater feed and ener...

Skill Set

ERIC Educational Resources Information Center

Holdsworth, Tom

2007-01-01

With competition to attract quality students into career and technical education programs and many entrants to the workforce inadequately prepared with employability skills, some community colleges have found a way to answer industry's call--they are launching SkillsUSA chapters on campus. In this article, the author features SkillsUSA, a…

The demise of plastic encapsulated microcircuit myths

NASA Astrophysics Data System (ADS)

Hakim, E. B.; Agarwal, R. K.; Pecht, M.

1994-10-01

Production of microelectronic devices encapsulated in solid, molded plastic packages has rapidly increased since the early 1980's. Today, millions of plastic-encapsulated devices are produced daily. On the other hand, only a few million hermetic (cavity) packages are produced per year. Reasons for the increased use of plastic-encapsulated packages include cost, availability, size, weight, quality, and reliability. Markets taking advantage of this technology range from computers and telecommunications to automotive uses. Yet, several industries, the military in particular, will not accept such devices. One reason for this reluctance to use the best available commercial parts is a perceived risk of poor reliability, derived from antiquated military specifications, standards, and handbooks; other common justifications cite differing environments; inadequate screens; inadequate test data, and required government audits of suppliers' processes. This paper describes failure mechanisms associated with plastic encapsulation and their elimination. It provides data indicating the relative reliability of cavity and solid-encapsulated packaging, and presents possible approaches to assuring quality and reliability in the procuring and applying this successful commercial technology.

Narrative Review of Statistical Reporting Checklists, Mandatory Statistical Editing, and Rectifying Common Problems in the Reporting of Scientific Articles.

PubMed

Dexter, Franklin; Shafer, Steven L

2017-03-01

Considerable attention has been drawn to poor reproducibility in the biomedical literature. One explanation is inadequate reporting of statistical methods by authors and inadequate assessment of statistical reporting and methods during peer review. In this narrative review, we examine scientific studies of several well-publicized efforts to improve statistical reporting. We also review several retrospective assessments of the impact of these efforts. These studies show that instructions to authors and statistical checklists are not sufficient; no findings suggested that either improves the quality of statistical methods and reporting. Second, even basic statistics, such as power analyses, are frequently missing or incorrectly performed. Third, statistical review is needed for all papers that involve data analysis. A consistent finding in the studies was that nonstatistical reviewers (eg, "scientific reviewers") and journal editors generally poorly assess statistical quality. We finish by discussing our experience with statistical review at Anesthesia & Analgesia from 2006 to 2016.

Associations among Teacher-Child Interactions, Teacher Curriculum Emphases, and Reading Skills in Grade 1

ERIC Educational Resources Information Center

Pakarinen, Eija; Lerkkanen, Marja-Kristiina; Poikkeus, Anna-Maija; Rasku-Puttonen, Helena; Eskelä-Haapanen, Sirpa; Siekkinen, Martti; Nurmi, Jari-Erik

2017-01-01

Research Findings: The purpose of the present study was to examine the extent to which the quality of teacher-child interactions and teachers' self-reported curriculum emphases are related to children's reading skill development during their 1st school year. To accomplish this, we assessed the reading skills of 1,029 Finnish children (M…

DIET MICRONUTRIENT ADEQUACY OF WOMEN AFTER 1 YEAR OF GASTRIC BYPASS

PubMed Central

LEIRO, Larissa Silveira; Melendez-ARAÚJO, Mariana Silva

2014-01-01

Background The more effective treatment for severe obesity is bariatric surgery. Gastric bypass is a surgical technique used worldwide; however, as well as other techniques; it has postoperative risks, including nutrient deficiency. Aim To determine the amounts of dietary iron, calcium, vitamin D and vitamin B12 ingested by patients of a public hospital one year after gastric bypass, and compare with the recommendations of the Recommended Dietary Allowances. Methods This was a transverse descriptive study and the sample consisted of 36 women, with at least one year of gastric bypass. Data collected included sociodemographic, anthropometric and diet variables. Dietetic information was collected through a validated food frequency questionnaire. Ingestion of iron, calcium, vitamin D and vitamina B12 was evaluated in comparison with the Recommended Dietary Allowances, as well as correlation of micronutrient ingestion with time of surgery. Results There was inadequate consumption of iron, calcium and vitamin D. The vitamin B12 intake was considered adequate. There was statistically significant positive correlation between the time of surgery and the ingestion of iron, vitamin B12 and vitamin D. Conclusion The intake of iron, calcium and vitamin D of women one year after gastric bypass was inadequate, emphasizing the importance of multiprofessional monitoring postoperatively to prevent nutrient deficiencies. PMID:25409960

Commitments to Improve the Quality of Learning.

ERIC Educational Resources Information Center

Cross, K. Patricia

For the nation as a whole, there is a moving bandwagon of educational change, clearly hitched to attempts to personalize and individualize instruction. The new emphases on the quality of learning appears to offer some potential solutions to two current problems: the twin problems of quality and equality in education. Traditional group-oriented…

Adolescent Depression and Time Spent with Parents and Siblings

ERIC Educational Resources Information Center

Desha, Laura N.; Nicholson, Jan M.; Ziviani, Jenny M.

2011-01-01

This study examines adolescent depressive symptoms and the quantity and quality of time spent by adolescents with their parents and siblings. We use measures of the quality of relationships with parents and siblings as proxy indicators for the quality of time spent with these social partners. The study emphasizes the salience of parent…

What must I do to succeed?: Narratives from the US Premedical Experience

PubMed Central

Lin, Katherine Y.; Anspach, Renee R.; Crawford, Brett; Parnami, Sonali; Fuhrel-Forbis, Andrea; De Vries, Raymond G.

2014-01-01

Medical sociologists have long been fascinated with the process through which laypersons are transformed into physicians, uncovering the ways in which one learns, not just the facts of medical science, but also how to be a physician. Despite this abiding focus on socialization, nearly all of the literature on this process in the US is informed by studies of the medical school and residency years, with almost no empirical attention paid to the premedical years. Our study addresses this gap in knowledge. To better understand the premedical years we conducted 49 in-depth interviews with premedical students at a selective, public Midwestern university. We found that students understand and explain decisions made during the premedical years with narratives that emphasize the qualities of achievement-orientation, perseverance, and individualism. We also find that these qualities are also emphasized in narratives employed to account for the choice to collaborate with, or compete against, premedical peers. Examination of premedical narratives, and the qualities they emphasize, enriches our understanding of how premedical education shapes a physician's moral development, and underscores the need to include the premedical years in our accounts of “becoming a doctor.” PMID:25163642

Vision for Future North American Emission Inventory Programs

EPA Science Inventory

The NARSTO Ozone and Particulate Matter Assessments emphasized that emission inventories are critical to the success of air quality management programs and that emissions inventories in Canada, Mexico, and the United States need improvement to meet expectations for quality, timel...

Sexual Functioning, Beliefs About Sexual Functioning and Quality of Life of Women with Infertility Problems.

PubMed

Agustus, Prathibha; Munivenkatappa, Manjula; Prasad, Padmini

2017-01-01

The study was conducted in the background of paucity of studies examining the sexual and psychosocial functioning of women with infertility. The study explored sexual functioning in women with infertility problems, their beliefs about sexuality and their quality of life. A single group exploratory design with non-probability purposive sampling was used. A total of 30 participants diagnosed with primary infertility were included in the study. The data were obtained by individual administration of the following tools: Semi-structured interview schedule, Female Sexual Functioning Inventory, Sexual Dysfunctional Beliefs Questionnaire, World Health Organization Quality of Life Scale - BREF Version and General Health Questionnaire-12. The data obtained were analyzed using descriptive statistics and non-parametric tests. About half of the participants had sexual dysfunction. Pain-related problems were most commonly reported (50%). Factors contributing to dysfunction included inadequate knowledge about sex, sexual stimulation and sexual communication. Along with inadequate self-image, negative childhood experiences, financial difficulties and marital discord in parents influenced the perception of self. Majority of the women had dysfunctional beliefs about sexuality (56%), and greater beliefs were found to be in the domain of sexual conservatism. The overall quality of life was poor, and 56% of women experienced psychological distress. There was significant positive correlation between sexual conservatism and experience of pain and overall sexual functioning. Women with infertility bear dysfunctional beliefs and suffer from problems in sexual functioning, have low quality of life and high psychological distress.

Study Blasts Leadership Preparation

ERIC Educational Resources Information Center

Archer, Jeff

2005-01-01

A far-reaching study offers a damning assessment of the programs that prepare most of the nation's principals and superintendents. Led by Arthur E. Levine, the president of Teachers College, Columbia University, the report says most university-based preparation programs for administrators range in quality from "inadequate to appalling." The…

Influence of processing factors over concrete strength.

NASA Astrophysics Data System (ADS)

Kara, K. A.; Dolzhenko, A. V.; Zharikov, I. S.

2018-03-01

Construction of facilities of cast in-situ reinforced concrete poses additional requirements to quality of material, peculiarities of the construction process may sometimes lead to appearance of lamination planes and inhomogeneity of concrete, which reduce strength of the material and structure as a whole. Technology compliance while working with cast in-situ concrete has a significant impact onto the concrete strength. Such process factors as concrete curing, vibration and compaction of the concrete mixture, temperature treatment, etc., when they are countered or inadequately followed lead to a significant reduction in concrete strength. Here, the authors experimentally quantitatively determine the loss of strength in in-situ cast concrete structures due to inadequate following of process requirements, in comparison with full compliance.

Nutritional adequacy according to carbohydrates and fat quality.

PubMed

Sánchez-Tainta, Ana; Zazpe, Itziar; Bes-Rastrollo, Maira; Salas-Salvadó, Jordi; Bullo, Mónica; Sorlí, José Vicente; Corella, Dolores; Covas, M Isabel; Arós, Fernando; Gutierrez-Bedmar, Mario; Fiol, Miquel; de la Corte, F García; Serra-Majem, Lluis; Pinto, Xavier; Schröeder, Helmut; Ros, Emilio; López-Sabater, M Carmen; Estruch, Ramón; Martínez-González, Miguel Angel

2016-02-01

To investigate the association between carbohydrate quality, fat quality or adherence to the Mediterranean diet and intake adequacy of 19 micronutrients in the PREDIMED (PREvención con DIeta MEDiterránea) trial, a multicenter, randomized, controlled, parallel group and primary prevention trial conducted in Spain. We assessed baseline dietary intake of 6,542 elderly subjects at high cardiovascular risk through a validated food frequency questionnaire (FFQ) and a validated 14-item Mediterranean diet (Med-diet) score. We used a multidimensional carbohydrate quality index (CQI) using four criteria and a fat quality index (FQI) according to the ratio (MUFA + PUFA)/(SFA + TFA). The probability of intake adequacy was calculated comparing the intakes to DRI, and also using the probabilistic approach. Absolute and adjusted probability of having inadequate intake for either ≥6 DRI or ≥8 DRI were estimated to assess nutritional adequacy according to quintiles of each index. The lowest prevalence of inadequate micronutrient intake (≥8 DRI) was found in the highest quintile of CQI or Med-diet score, and in the lowest quintile of FQI (adjusted fold risk: 1.4, 3.4 and 10.2 respectively in comparison with the lowest quintile). P for trend <0.001 in three multivariable models. A higher CQI or Med-Diet score and a lower FQI were significantly associated with a lower fold risk of unmet EAR values. A multidimensional assessment of CQI can be a useful tool to evaluate the quality of carbohydrates. This score and a 14-item Med-diet score were positively related to overall micronutrient adequacy in elderly participants.

Health insurance and quality of care: Comparing perceptions of quality between insured and uninsured patients in Ghana's hospitals.

PubMed

Abuosi, Aaron A; Domfeh, Kwame Ameyaw; Abor, Joshua Yindenaba; Nketiah-Amponsah, Edward

2016-05-12

The introduction of health insurance in Ghana in 2003 has resulted in a tremendous increase in utilization of health services. However, concerns are being raised about the quality of patient care. Some of the concerns include long waiting times, verbal abuse of patients by health care providers, inadequate physical examination by doctors and discrimination of insured patients. The study compares perceptions of quality of care between insured and uninsured out-patients in selected hospitals in Ghana to determine whether there is any unequal treatment between insured and uninsured patients in terms of quality of care, as empirical and anecdotal evidence seem to suggest. A cross-sectional survey of 818 out-patients was conducted in 17 general hospitals from three regions of Ghana. These are the Upper East, Brong Ahafo and Central Regions. Convenience sampling was employed to select the patients in exit interviews. Descriptive statistics, including frequency distributions, means and standard deviations, were used to describe socio-economic and demographic characteristics of respondents. Factor analysis was used to determine distinct quality of care constructs; t-test statistic was used to test for differences in quality perceptions between the insured and uninsured patients; and regression analysis was used to test the association between health insurance and quality of care. Overall, there was no significant difference in perceptions of quality between insured and uninsured patients. However, there was a significant difference between insured and uninsured patients in respect of financial access to care. The major quality of care concern affecting all patients was the problem of inadequate resources, especially lack of doctors, lack of drugs and other basic supplies and equipment to work with. It was concluded that generally, insured and uninsured patients are not treated unequally, contrary to prevailing anecdotal and empirical evidence. On the contrary, quality of care is a concern of both insured and uninsured patients.

Total Quality Management: Getting Started

DTIC Science & Technology

1990-08-01

Quality Management (TQM) program using Organizational Development (OD) intervention techniques to gain acceptance of the program. It emphasizes human behavior and the need for collaborative management and consensus in organizational change. Lessons learned stress the importance of choosing a skilled TQM facilitator, training process action teams, and fostering open communication and teamwork to minimize resistance to change. Keywords: Management planning and control, Quality control, Quality , Management , Organization change, Organization development,

Soil agroecosystem health: current challenges and future opportunities

USDA-ARS?s Scientific Manuscript database

Soil health is a broad concept that emphasizes the ecological importance of soils, including sustained plant and animal productivity, human health, and environmental quality. In the United States, soil degradation and associated water quality problems have been widely documented. Improvement and mai...

Quality Circles: A Corporate Strategy Applied in a Student Services Setting.

ERIC Educational Resources Information Center

Steele, Brenton H.; And Others

1987-01-01

Discusses the historical and conceptual framework of quality circles, presents a brief case history of circles initiated by the University of Maryland Office of Admissions, and provides a summary of implications. Emphasizes implications for student affairs administrators. (Author/ABB)

Quality of Education, Comparability, and Assessment Choice in Developing Countries

ERIC Educational Resources Information Center

Wagner, Daniel A.

2010-01-01

Over the past decade, international development agencies have begun to emphasize the improvement of the quality (rather than simply quantity) of education in developing countries. This new focus has been paralleled by a significant increase in the use of educational assessments as a way to measure gains and losses in quality. As this interest in…

Conceptual Principles of Quality of Life: An Empirical Exploration

ERIC Educational Resources Information Center

Bramston, P.; Chipuer, H.; Pretty, G.

2005-01-01

Background: Quality of life is a popular measure of outcomes and its widespread use has led to recent calls for a better understanding of the construct, emphasizing the need to build a substantial body of knowledge around what determines perceptions of life quality. Three widely reported and used conceptual principles are examined in this study.…

An Empirical Analysis of the Service Quality Gap in Business Education: Evidence from Higher Education in Pakistan

ERIC Educational Resources Information Center

Sardar, Amber; Amjad, Shehla; Ali, Ubaid

2016-01-01

This survey investigated the relationship and gap between students' expectations and perceptions of perceived service quality of education, emphasizing the least effective service quality dimension. The study was based on primary data, which turned out to be most significant. Data were collected from 349 of 405 students through a questionnaire…

Private Schools and the Willingness to Pay for Public Schooling

ERIC Educational Resources Information Center

Brasington, David M.

2007-01-01

Households pay a premium to live in houses assigned to high quality public schools, and the housing market yields information about the demand for public school quality. The current study estimates a two-stage house price hedonic emphasizing the role that private schools play in the willingness to pay for public school quality. The elasticity of…

Indigenous Rights in Aotearoa/New Zealand--Inakitia Rawatia Hei Kakano Mo aPopo: Students' Encounters with Bicultural Commitment

ERIC Educational Resources Information Center

Gordon-Burns, Diane; Campbell, Leeanne

2014-01-01

Teacher quality and the preparation of quality teachers have been at the center of debates and discussions related to improving educational outcomes among diverse student populations across the world. In New Zealand, the education system emphasizes high-quality, bicultural practice among teachers through regulations and curriculum that call for…

Towards an Understanding of Mobile Website Contextual Usability and Its Impact on Mobile Commerce

ERIC Educational Resources Information Center

Hyman, Jack Alan

2012-01-01

An increasing number of technologies and applications have begun to focus on mobile computing and the wireless Web as a way to conduct commerce-oriented transactions. M-commerce Websites that are usability friendly must emphasize information quality, system quality, and service quality, as these are proxy measures to mobile commerce user…

[Sibling relations between individuation and attachment: attempt at a conceptualization].

PubMed

Seiffge-Krenke, I

2001-01-01

Although sibling relationships can be considered as one of the most durable and intensive relationships, not much research in developmental psychology and family research has been done on this issue. The strong focus on parents, more specifically on mothers, stood in the way of adequate conceptualization and understanding of the function and contribution of siblings to individual development and family interaction. In this contribution a conceptualization of sibling relationships is presented. Siblings as objects of aggressive and sexual feelings as well as the function of siblings in the family system, for example, as parentification and negative identity is emphasized. In addition, the different qualities of sibling relationships, for example, envy, rivalry, similarity, and difference, are emphasized. The function of siblings as love objects is stressed, and the role of siblings as support as well as teaching object is illustrated. Finally, it is emphasized that, similar to relationships between parents and child, the quality of sibling relationships changed over time and leads, for example, to a detachment between sibling relationships during adolescence.

NEVER AUDIT ALONE--THE CASE FOR AUDIT TEAMS

EPA Science Inventory

On-site audits conducted by technical and quality assurance (QA) experts at the data-gathering location are the core of an effective QA program. However, inadequate resources for such audits are the bane of a QA program, and the proposed solution frequently is to send only one au...

Optimizing the Usability of Mobile Phones for Individuals Who Are Deaf

ERIC Educational Resources Information Center

Liu, Chien-Hsiou; Chiu, Hsiao-Ping; Hsieh, Ching-Lin; Li, Rong-Kwer

2010-01-01

Mobile phones are employed as an assistive platform to improve the living quality of individuals who are deaf. However, deaf individuals experience difficulties using existing functions on mobile phones. This study identifies the functions that are inadequate and insufficient for deaf individuals using existing mobile phones. Analytical results…

Toward a Quality-of-Life Paradigm for Sustainable Communities.

ERIC Educational Resources Information Center

Hyman, Drew

This paper suggests that current paradigms and world views guiding research for social action are inadequate for directing rural community change in a high-tech, global community. For several generations, the agrarian and industrial paradigms have been accepted as appropriate for guiding social change and development. However, there are problems…

Chapel Hill Campus Grapples with Problems of Governance.

ERIC Educational Resources Information Center

Jaschik, Scott

1989-01-01

Despite positive outward signs, the University of North Carolina at Chapel Hill is seen by some as resting on its reputation. Faculty and alumni complain that intrusive regulation by the state, lack of respect by the university system administration, and inadequate financial support are endangering its quality. (MSE)

Accountability and Control in American Schools

ERIC Educational Resources Information Center

Ingersoll, Richard M.; Collins, Gregory J.

2017-01-01

One of the most controversial and significant of contemporary education reforms has been the teacher accountability movement. From this perspective, low-quality teachers and teaching are a major factor behind inadequate school performance, and a lack of accountability and control in schools is a major factor behind the problem of low-quality…

Fibromyalgia at an Educational Facility--Is There a Link to Indoor Air Quality?

ERIC Educational Resources Information Center

Wilson, Emily J.

1999-01-01

Discusses whether it is biologically plausible for an environmental laboratory contaminant to cause fibromyalgia. Presents a study of two populations which indicated that fibromyalgia was occurring at an elevated rate in a building where ventilation was deemed inadequate for laboratory activities. (Author/WRM)

Production and supply of high-quality food protein for human consumption: Sustainability, challenges, and innovations

USDA-ARS?s Scientific Manuscript database

The Food and Agriculture Organization of the United Nations estimates that 843 million people worldwide are hungry and a greater number suffer from nutrient deficiencies. Approximately one billion people have inadequate protein intake. The challenge of preventing hunger and malnutrition will become ...

Vietnam and American Government Textbooks.

ERIC Educational Resources Information Center

Cline, Paul C.; Eksterowicz, Anthony J.

1998-01-01

Discusses the importance of studying the Vietnam War. Attempts to illustrate the amount and quality of coverage of the Vietnam War in U.S. government textbooks. Explains that the amount of space devoted to the war in most of these texts remains inadequate for student understanding of the Vietnam War. (CMK)

Proposal for Implementation of Office of Educational Radio Services.

ERIC Educational Resources Information Center

Petrizzi, David M.; Wright, A. J.

Auburn University's radio station is being faced with providing quality public radio programing with inadequate resources, including money, personnel, and university support. This proposal is directed to the university community and discusses the university radio station's problems at three levels. At the federal level, concerns relate to…

Evaluating the quality of Internet information for femoroacetabular impingement.

PubMed

Lee, Simon; Shin, Jason J; Haro, Marc S; Song, Sang H; Nho, Shane J

2014-10-01

The Internet has become a ubiquitous source of medical information for both the patient and the physician. However, the quality of this information is highly variable. We evaluated the quality of Internet information available for femoroacetabular impingement (FAI). Four popular search engines were used to collect 100 Web sites containing information on FAI. Web sites were evaluated based on authorship, various content criteria, and the presence of Health On the Net Code of Conduct (HONcode) certification. By use of a novel evaluation system for quality, Web sites were also classified as excellent, high, moderate, poor, or inadequate and were subsequently analyzed. Web sites were evaluated as a group, followed by authorship type, by HONcode certification, and by quality level. Of the Web sites, 73 offered the ability to contact the author, 91 offered a considerable explanation of FAI, 54 provided surgical treatment options, 58 offered nonsurgical treatment options, 27 discussed possible complications, 11 discussed eligibility criteria, 31 discussed rehabilitation, 67 discussed a differential diagnosis, and 48 included peer-reviewed citations. We categorized 40 Web sites as academic, 33 as private, 9 as industry, 9 as public education, and 9 as blogs. Our novel quality evaluation system classified 16 Web sites as excellent, 18 as high, 17 as moderate, 18 as poor, and 31 as inadequate. Only 8% of all evaluated Web sites contained HONcode certification. We found that the quality of information available on the Internet about FAI was dramatically variable. A significantly large proportion of Web sites were from academic sources, but this did not necessarily indicate higher quality. Sites with HONcode certification showed as much variability in quality as noncertified sites. This study increases clinician competence in the available Internet information about FAI and helps them to confidently guide patients to formulate appropriate medical decisions based on high-quality information. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

[Method of correcting sensitivity nonuniformity using gaussian distribution on 3.0 Tesla abdominal MRI].

PubMed

Hayashi, Norio; Miyati, Tosiaki; Takanaga, Masako; Ohno, Naoki; Hamaguchi, Takashi; Kozaka, Kazuto; Sanada, Shigeru; Yamamoto, Tomoyuki; Matsui, Osamu

2011-01-01

In the direction where the phased array coil used in parallel magnetic resonance imaging (MRI) is perpendicular to the arrangement, sensitivity falls significantly. Moreover, in a 3.0 tesla (3T) abdominal MRI, the quality of the image is reduced by changes in the relaxation time, reinforcement of the magnetic susceptibility effect, etc. In a 3T MRI, which has a high resonant frequency, the signal of the depths (central part) is reduced in the trunk part. SCIC, which is sensitivity correction processing, has inadequate correction processing, such as that edges are emphasized and the central part is corrected. Therefore, we used 3T with a Gaussian distribution. The uneven compensation processing for sensitivity of an abdomen MR image was considered. The correction processing consisted of the following methods. 1) The center of gravity of the domain of the human body in an abdomen MR image was calculated. 2) The correction coefficient map was created from the center of gravity using the Gaussian distribution. 3) The sensitivity correction image was created from the correction coefficient map and the original picture image. Using the Gaussian correction to process the image, the uniformity calculated using the NEMA method was improved significantly compared to the original image of a phantom. In a visual evaluation by radiologists, the uniformity was improved significantly using the Gaussian correction processing. Because of the homogeneous improvement of the abdomen image taken using 3T MRI, the Gaussian correction processing is considered to be a very useful technique.

Social support and relationship satisfaction in bipolar disorder.

PubMed

Boyers, Grace B; Simpson Rowe, Lorelei

2018-06-01

Social support is positively associated with individual well-being, particularly if an intimate partner provides that support. However, despite evidence that individuals with bipolar disorder (BPD) are at high risk for relationship discord and are especially vulnerable to low or inadequate social support, little research has explored the relationship between social support and relationship quality among couples in which a partner has BPD. The current study addresses this gap in the literature by examining the association between social support and relationship satisfaction in a weekly diary study. Thirty-eight opposite-sex couples who were married or living together for at least one year and in which one partner met diagnostic criteria for BPD completed up to 26 weekly diaries measuring social support and relationship satisfaction, as well as psychiatric symptoms. Results revealed that greater social support on average was associated with higher average relationship satisfaction for individuals with BPD and their partners, and that more support than usual in any given week was associated with higher relationship satisfaction that week. The converse was also true, with greater-than-average relationship satisfaction and more satisfaction than usual associated with greater social support. The results emphasize the week-to-week variability of social support and relationship satisfaction and the probable reciprocal relationship between support and satisfaction among couples in which a partner has BPD. Thus, social support may be important for maintaining relationship satisfaction and vice versa, even after controlling for concurrent mood symptoms. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

[Mobbing--special reference to the nursing profession].

PubMed

Milutinović, Dragana; Prokes, Bela; Gavrilov-Jerkovié, Vesna; Filipović, Danka

2009-01-01

Heinz Leymann defined this phenomenon as a hostile and unethical communication. In his definition Leymann points out that the distinction between "conflict" and "mobbing" does not focus on what is done or how it is done, but rather on the frequency and duration of whatever is done. The exposure to the strain of mobbing begins to result in psychiatrically or psychosomatically pathological conditions due to the accumulation of negative emotions. Leyman emphasizes four main factors which cause harrasment in the workplace: lack of clarity of goals in work, inadequate management, victim's social status and low moral standards in the work environment. The epidemiological data in the European Union, indicate great national differences relative to the percentage of those subjected to mobbing, with increasing exposure rates in all professions, the highest being found in education (14%) and health services. Nurses are considered a professional group at a rather high risk for trauma caused by harrasment in the workplace. "Horizontal violence" is a widely used term regarding mobbing aclions in nursing profession even though vertical violence is present both in this profession and all other health services. Horizontal violence is implied due to the traditional assumption that nurses have a subordinate role compared to doctors, which often brings them into conflict with their peers. Mobbing may be prevented by systematic primary prevention, information, education, and training in communication skills. As a result, we could expect to get a higher quality of nursing care and healthier nurses.

Irrigation efficiency and quality of irrigation return flows in the Ebro River Basin: an overview.

PubMed

Causapé, J; Quílez, D; Aragüés, R

2006-06-01

The review analysis of twenty two irrigation efficiency (IE) studies carried out in the Ebro River Basin shows that IE is low (average IE)(avg)(= 53%) in surface-irrigated areas with high-permeable and shallow soils inadequate for this irrigation system, high (IE)(avg)(= 79%) in surface-irrigated areas with appropriate soils for this system, and very high (IE)(avg)(= 94%) in modern, automated and well managed sprinkler-irrigated areas. The unitary salt (total dissolved solids) and nitrate loads exported in the irrigation return flows (IRF) of seven districts vary, depending on soil salinity and on irrigation and N fertilization management, between 3-16 Mg salt/ha x year and 23-195 kg NO)(3) (-)-N/ha x year, respectively. The lower nitrate loads exported from high IE districts show that a proper irrigation design and management is a key factor to reduce off-site nitrogen pollution. Although high IE's also reduce off-site salt pollution, the presence of salts in the soil or subsoil may induce relatively high salt loads (>or=14 Mg/ha x year) even in high IE districts. Two important constrains identified in our revision were the short duration of most surveys and the lack of standards for conducting irrigation efficiency and mass balance studies at the irrigation district level. These limitations {emphasize the need for the establishment of a permanent and standardized network of drainage monitoring stations for the appropriate off-site pollution diagnosis and control of irrigated agriculture.

Land use change detection with LANDSAT-2 data for monitoring and predicting regional water quality degradation. [Arkansas

NASA Technical Reports Server (NTRS)

Macdonald, H.; Steele, K. (Principal Investigator); Waite, W.; Rice, R.; Shinn, M.; Dillard, T.; Petersen, C.

1977-01-01

The author has identified the following significant results. Comparison between LANDSAT 1 and 2 imagery of Arkansas provided evidence of significant land use changes during the 1972-75 time period. Analysis of Arkansas historical water quality information has shown conclusively that whereas point source pollution generally can be detected by use of water quality data collected by state and federal agencies, sampling methodologies for nonpoint source contamination attributable to surface runoff are totally inadequate. The expensive undertaking of monitoring all nonpoint sources for numerous watersheds can be lessened by implementing LANDSAT change detection analyses.

Human-Centered Aviation Automation: Principles and Guidelines

NASA Technical Reports Server (NTRS)

Billings, Charles E.

1996-01-01

This document presents principles and guidelines for human-centered automation in aircraft and in the aviation system. Drawing upon operational experience with highly automated aircraft, it describes classes of problems that have occurred in these vehicles, the effects of advanced automation on the human operators of the aviation system, and ways in which these problems may be avoided in the design of future aircraft and air traffic management automation. Many incidents and a few serious accidents suggest that these problems are related to automation complexity, autonomy, coupling, and opacity, or inadequate feedback to operators. An automation philosophy that emphasizes improved communication, coordination and cooperation between the human and machine elements of this complex, distributed system is required to improve the safety and efficiency of aviation operations in the future.

A Framework for Enhancing the Value of Research for Dissemination and Implementation

PubMed Central

Glasgow, Russell E.; Carpenter, Christopher R.; Grimshaw, Jeremy M.; Rabin, Borsika A.; Fernandez, Maria E.; Brownson, Ross C.

2015-01-01

A comprehensive guide that identifies critical evaluation and reporting elements necessary to move research into practice is needed. We propose a framework that highlights the domains required to enhance the value of dissemination and implementation research for end users. We emphasize the importance of transparent reporting on the planning phase of research in addition to delivery, evaluation, and long-term outcomes. We highlight key topics for which well-established reporting and assessment tools are underused (e.g., cost of intervention, implementation strategy, adoption) and where such tools are inadequate or lacking (e.g., context, sustainability, evolution) within the context of existing reporting guidelines. Consistent evaluation of and reporting on these issues with standardized approaches would enhance the value of research for practitioners and decision-makers. PMID:25393182

Imported Malaria in Turkey: The Importance of Diagnosis and Treatment of Plasmodium falciparum/Plasmodium vivax Mixed Infection.

PubMed

Tünger, Özlem; Çakmak, Akide; Özbilgin, Ahmet; Tunalı, Varol; Çetin, Çiğdem Banu

2018-05-21

The most common types of malaria in the world are Plasmodium vivax and P. falciparum. In countries where both species are endemic, P. vivax and P. falciparum coinfection also occurs. Thus, the possibility of mixed malaria in Turkey should always be considered in cases with a traveling history to these countries. Here, we report a case of P. vivax/P. falciparum mixed infection that was diagnosed as P. falciparum malaria in Ethiopia. However, the administered treatment was inadequate, and infection recurred because of the miss in the diagnosis of P. vivax malaria, for which an effective drug for hypnozoites was not administered. This case report emphasizes the importance of diagnosis, correct and adequate treatment of infections, and a close follow-up of diseases.

Quality Health Care for People with Developmental Disabilities: A Guide for Parents and Other Caregivers.

ERIC Educational Resources Information Center

Pfaffinger, Kathleen M.; Nelson, Richard P.

Starting with the premise that all people have a right to quality health care, this guide emphasizes that assisting people with developmental disabilities to obtain health care and maintain healthy life styles will enhance the quality of their lives at home and in the community. The guide consists of four sections. A section on obtaining care…

Establishing Quality Assurance in Nigerian Education System: Implication for Educational Managers

ERIC Educational Resources Information Center

Adegbesan, Sunday O.

2010-01-01

The importance of quality education in nation building cannot be over emphasized. There have been several calls on the educational managers on how to make the educational system to be more vibrant in the quality of its products after several quantity of mass failure and half baked products from our various educational institutions in the country.…

Establishing Quality Assurance in Nigerian Education System: Implication for Educational Managers

ERIC Educational Resources Information Center

Adegbesan, Sunday O.

2011-01-01

The importance of quality education in nation building cannot be over emphasized. There have been several calls on the educational managers on how to make the educational system to be more vibrant in the quality of its products after several quantity of mass failure and half baked products from our various educational institutions in the country.…

Saving Educational Dollars through Quality Objectives.

ERIC Educational Resources Information Center

Alvir, Howard P.

This document is a collection of working papers written to meet the specific needs of teachers who are starting to think about and write performance objectives. It emphasizes qualitative objectives as opposed to quantitative classroom goals. The author describes quality objectives as marked by their clarity, accessibility, accountability, and…

John Stuart Mill's Concepts of Quality and Pedagogical Norms.

ERIC Educational Resources Information Center

Kim, Ki Su

1986-01-01

Considers the paradoxical relationship between two pervasive educational goals--quality and equality. Sees this paradox embedded in John Stuart Mill's writings on education, which attempted to reconcile the utilitarian pleasure principle (which emphasizes quantitative measures), with a traditional differentiation among levels and kinds of desires…

[Errors in medical care rendered by military treatment and prevention institutions (according to the data of forensic medical expertise].

PubMed

Kolkutin, V V; Fetisov, V A

2003-12-01

The authors discuss one of the important aspects of military medicolegal laboratory activities connected with the quality control of medical care rendered in the military treatment-and-prophylactic institutions in the nineties of the XX century. The example of medical care defects (MCD) permitted to reveal their nature, causes and sites of origin at pre-hospital (PHS) and hospital (HS) stages. Despite some decrease in the total number of MCD revealed HS defects prevail (more than 75%); the organizational defects at PHS and diagnostic defects at HS are predominant. The main MCD causes are inadequate qualification of medical workers, defects in organization of treatment-and-diagnostic process and inadequate examination of patients.

Assuring quality in narrative analysis.

PubMed

Bailey, P H

1996-04-01

Many nurse-researchers using qualitative strategies have been concerned with assuring quality in their work. The early literature reveals that the concepts of validity and reliability, as understood from the positivist perspective, are somehow inappropriate and inadequate when applied to interpretive research. More recent literature suggests that because of the positivist and interpretive paradigms are epistemologically divergent, the transfer of quality criteria from one perspective to the other is not automatic or even reasonable. The purpose of this article, therefore, is to clarify what the terms quality, trustworthiness, credibility, authenticity, and goodness mean in qualitative research findings. The process of assuring quality, validation, in qualitative research will be discussed within the context of the interpretive method, narrative analysis. A brief review of quality in narrative analysis nursing research will also be presented.

Footwear used by older people and a history of hyperkeratotic lesions on the foot

PubMed Central

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

2017-01-01

Abstract Inadequate footwear, painful and hyperkeratotic lesions (HL) are an extremely common problems amongst older people. Such problems increase the risk of falls, hamper mobility, reduction of quality of life, dignity, and ability to remain independent. The etiology of painful and feet conditions is poorly understood. To discover footwear preferences of older people, pain tolerance may favor presence of HL for the use of inadequate footwear in old age. A sample of 100 participants with a mean age of 74.90 ± 7.01 years attended an outpatient clinic where self-reported demographic data, frequency with which they checked their feet were recorded and measurements were taken of foot sensitivity. Additionally, all participants’ shoes were allocated into optimal, adequate, and dangerous categories based on design, structural and safety features, and materials. Only 12% of the sample population checked their feet every day, 37% revealed symptoms of neuropathy, 14% used optimal shoes, and 61% presented HL. In a bivariate analysis, no significant differences were observed. HL are associated with inadequate footwear, loss of sensitivity, and low frequency of foot health checks. PMID:28403112

Bereaved family member perceptions of quality of end-of-life care in U.S. regions with high and low usage of intensive care unit care.

PubMed

Teno, Joan M; Mor, Vincent; Ward, Nicholas; Roy, Jason; Clarridge, Brian; Wennberg, John E; Fisher, Elliott S

2005-11-01

To compare the quality of end-of-life care of persons dying in regions of differing practice intensity. Mortality follow-back survey. Geographic regions in the highest and lowest deciles of intensive care unit (ICU) use. Bereaved family member or other knowledgeable informants. Unmet needs, concerns, and rating of quality of end-of-life care in five domains (physical comfort and emotional support of the decedent, shared decision-making, treatment of the dying person with respect, providing information and emotional support to family members). Decedents in high- (n=365) and low-intensity (n=413) hospital service areas (HSAs) did not differ in age, sex, education, marital status, leading causes of death, or the degree to which death was expected, but those in the high-intensity ICU HSAs were more likely to be black and to live in nonrural areas. Respondents in high-intensity HSAs were more likely to report that care was of lower quality in each domain, and these differences were statistically significant in three of five domains. Respondents from high-intensity HSAs were more likely to report inadequate emotional support for the decedent (relative risk (RR)=1.2, 95% confidence interval (CI)=1.0-1.4), concerns with shared decision-making (RR=1.8, 95% CI=1.0-2.9), inadequate information about what to expect (RR=1.5, 95% CI=1.3-1.8), and failure to treat the decedent with respect (RR=1.4, 95% CI=1.0-1.9). Overall ratings of the quality of end-of-life care were also significantly lower in high-intensity HSAs. Dying in regions with a higher use of ICU care is not associated with improved perceptions of quality of end-of-life care.

Sexual Functioning, Beliefs About Sexual Functioning and Quality of Life of Women with Infertility Problems

PubMed Central

Agustus, Prathibha; Munivenkatappa, Manjula; Prasad, Padmini

2017-01-01

Background: The study was conducted in the background of paucity of studies examining the sexual and psychosocial functioning of women with infertility. Aims: The study explored sexual functioning in women with infertility problems, their beliefs about sexuality and their quality of life. Settings and Design: A single group exploratory design with non-probability purposive sampling was used. A total of 30 participants diagnosed with primary infertility were included in the study. Materials and Methods: The data were obtained by individual administration of the following tools: Semi-structured interview schedule, Female Sexual Functioning Inventory, Sexual Dysfunctional Beliefs Questionnaire, World Health Organization Quality of Life Scale − BREF Version and General Health Questionnaire-12. The data obtained were analyzed using descriptive statistics and non-parametric tests. Results: About half of the participants had sexual dysfunction. Pain-related problems were most commonly reported (50%). Factors contributing to dysfunction included inadequate knowledge about sex, sexual stimulation and sexual communication. Along with inadequate self-image, negative childhood experiences, financial difficulties and marital discord in parents influenced the perception of self. Majority of the women had dysfunctional beliefs about sexuality (56%), and greater beliefs were found to be in the domain of sexual conservatism. The overall quality of life was poor, and 56% of women experienced psychological distress. There was significant positive correlation between sexual conservatism and experience of pain and overall sexual functioning. Conclusion: Women with infertility bear dysfunctional beliefs and suffer from problems in sexual functioning, have low quality of life and high psychological distress. PMID:29142451

Defective support network: a major obstacle to coping for patients with heart failure: a qualitative study

PubMed Central

Shahrbabaki, Parvin Mangolian; Nouhi, Esmat; Kazemi, Majid; Ahmadi, Fazlollah

2016-01-01

Background Heart failure as a chronic disease poses many challenges for a patient in his or her everyday life. Support in various aspects of life positively affects coping strategies and influences the well-being and health outcomes of heart failure patients. Inadequate support may lead to a worsening of symptoms, increased hospital readmissions, psychological disorders, and a reduced quality of life. Objective This study explored obstacles to coping related to support for heart failure patients as viewed by the patients themselves and their family members and caregivers. Design This qualitative study was conducted using content analysis. The 20 Iranian participants included 11 patients with heart failure, three cardiologists, three nurses, and three family members of heart failure patients selected through purposive sampling. Data were collected through semi-structured interviews and analyzed using the Lundman and Graneheim qualitative content analysis method. Results During data analysis, ‘defective support network’ developed as the main theme along with four other categories of ‘inadequate family performance’, ‘inadequate support by the healthcare team’, ‘distorted societal social support’, and ‘inadequate welfare support’. Conclusion The findings of the current study can assist health authorities and planners in identifying the needs of patients with heart failure so as to focus and plan on facilitating their coping as much as possible by obviating the existing obstacles. PMID:27041539

General practitioners’ and primary care nurses’ care for people with disabilities: quality of communication and awareness of supportive services

PubMed Central

Storms, Hannelore; Marquet, Kristel; Claes, Neree

2017-01-01

Background General practitioners (GPs) and primary-care nurses (PCNs) often feel inexperienced or inadequately educated to address unmet needs of people with disabilities (PDs). In this research, GPs’ and PCNs’ communication with PDs and health care professionals, as well as their awareness of supportive measures relevant to PDs (sensory disabilities excluded), was examined. Materials and methods An electronic questionnaire was sent out to 545 GPs and 1,547 PCNs employed in Limburg (Belgium). GPs and PCNs self-reported about both communication with parties involved in care for PDs (scale very good, good, bad, very bad) and their level of awareness of supportive measures relevant for PDs (scale unaware, inadequately aware, adequately aware). Results Of the questionnaire recipients, 6.6% (36 of 545) of GPs and 37.6% (588 of 1,547) of PCNs participated: 68.8% of 32 GPs and 45.8% of 443 PCNs categorized themselves as communicating well with PDs, and attributed miscommunication to limited intellectual capacities of PDs. GPs and PCNs reported communicating well with other health care professionals. Inadequate awareness was reported for tools to communicate (88.3% of GPs, 89% of PCNs) and benefits for PDs (44.1% of GPs, 66.9% of PCNs). Conclusion GPs’ and PCNs’ lacking awareness of communication aids is problematic. Involvement in a multidisciplinary, expert network might bypass inadequate awareness of practical and social support measures. PMID:29033579

General practitioners' and primary care nurses' care for people with disabilities: quality of communication and awareness of supportive services.

PubMed

Storms, Hannelore; Marquet, Kristel; Claes, Neree

2017-01-01

General practitioners (GPs) and primary-care nurses (PCNs) often feel inexperienced or inadequately educated to address unmet needs of people with disabilities (PDs). In this research, GPs' and PCNs' communication with PDs and health care professionals, as well as their awareness of supportive measures relevant to PDs (sensory disabilities excluded), was examined. An electronic questionnaire was sent out to 545 GPs and 1,547 PCNs employed in Limburg (Belgium). GPs and PCNs self-reported about both communication with parties involved in care for PDs (scale very good, good, bad, very bad) and their level of awareness of supportive measures relevant for PDs (scale unaware, inadequately aware, adequately aware). Of the questionnaire recipients, 6.6% (36 of 545) of GPs and 37.6% (588 of 1,547) of PCNs participated: 68.8% of 32 GPs and 45.8% of 443 PCNs categorized themselves as communicating well with PDs, and attributed miscommunication to limited intellectual capacities of PDs. GPs and PCNs reported communicating well with other health care professionals. Inadequate awareness was reported for tools to communicate (88.3% of GPs, 89% of PCNs) and benefits for PDs (44.1% of GPs, 66.9% of PCNs). GPs' and PCNs' lacking awareness of communication aids is problematic. Involvement in a multidisciplinary, expert network might bypass inadequate awareness of practical and social support measures.

The Need for Foreign Language Competence in the United States. ERIC Digest.

ERIC Educational Resources Information Center

Hamayan, Else

Americans generally lack foreign language competence, and their exposure to foreign languages in the United States is inadequate. Foreign language instruction is deficient in both quality and quantity, and although there are indications of improvement in both areas, it will be many years before the effects of improvements are clear. The…

Geologic influences on Apache trout habitat in the White Mountains of Arizona

Treesearch

Jonathan W. Long; Alvin L. Medina

2006-01-01

Geologic variation has important influences on habitat quality for species of concern, but it can be difficult to evaluate due to subtle variations, complex terminology, and inadequate maps. To better understand habitat of the Apache trout (Onchorhynchus apache or O. gilae apache Miller), a threatened endemic species of the White...

Higher Education Financing in Nigeria: Issues and Trends

ERIC Educational Resources Information Center

Adewuyi, Jacob Olusayo; Okemakinde, Timothy

2013-01-01

The potential of the higher education system to act as an agent of growth and development in Nigeria is being challenged by the long-standing problems of limited access, inadequate financing, poor governance, declining quality and relevance. Thus, this paper provides an overview of the trends and nature of public funding of higher education in…

Who Cares for the Children? Denmark's Unique Public Child-Care Model.

ERIC Educational Resources Information Center

Polakow, Valerie

1997-01-01

U.S. working mothers wrestle daily with a child-care crisis characterized by unavailable infant care, high costs, and inadequate access and regulation. In Denmark, high-quality child care is a guaranteed entitlement for every child. Other benefits include paid parental leaves, single-parent allowances, housing subsidies, and universal health care.…

How Are Kentucky's Children Stacking Up? A County by County Analysis.

ERIC Educational Resources Information Center

Chandler, Betsy

In a county by county analysis, this report assesses the quality of life for Kentucky's children. Researchers developed a child quotient (CQ) based on 18 indicators: per capita income, children in poverty, women receiving inadequate prenatal care, infant deaths, teens giving birth, substandard dwellings, children in foster care, per-pupil…

Challenges and Opportunities in Adult Education.

ERIC Educational Resources Information Center

Brand, Betsy

Literacy and work force preparedness are two of the most important issues facing education today. Findings of nationwide studies show that reading and writing performance of students is inadequate. One of every eight current workers reads at the fourth-grade level or lower. The nation's economic future will be determined by the quality and…

Hypnotic Relaxation and Yoga to Improve Sleep and School Functioning

ERIC Educational Resources Information Center

Perfect, Michelle M.; Smith, Bradley

2016-01-01

Sleep insufficiency, defined as inadequate sleep duration, poor sleep quality, and daytime sleepiness, has been linked with students' learning and behavioral outcomes at school. However, there is limited research on interventions designed to improve the sleep of school-age children. In order to promote more interest on this critical topic, we…

State Strategies for Fixing Failing Schools and Districts. Issue Brief

ERIC Educational Resources Information Center

Wakelyn, David

2011-01-01

At least 5,000 public schools have failed to meet their academic achievement targets for at least five consecutive years. The underlying causes of such failure are usually a combination of weak leadership, inadequate skill levels among teachers, and insufficient high-quality teaching materials. In 2009, the National Governors Association Center…

Weighing the Options for Improving the National Postsecondary Data Infrastructure

ERIC Educational Resources Information Center

Rorison, Jamey; Voight, Mamie

2015-01-01

Students, policymakers and institutions all need to have high quality data about how today's students access and pay for higher education--and what contributes to their success. But the data that are available now are woefully inadequate. We need to improve the national postsecondary data infrastructure The report thoroughly explores seven options…

Education in Healthy Lifestyles: Curriculum Implications. Fastback 216.

ERIC Educational Resources Information Center

Seffrin, John R.; Torabi, Mohammad R.

The nature of a healthy lifestyle and its significance to quality of life is examined. Following a discussion on what is involved in a healthy lifestyle, major health problems are described: (1) smoking; (2) alcohol and drug abuse; (3) sexually transmitted diseases; (4) diet and obesity; (5) stress; and (6) inadequate sleep. Recommendations are…

A Case Study of Student Achievement in a Secondary Charter School

ERIC Educational Resources Information Center

Hung, Li-Ching; Badejo, Folashade; Bennett, Jo

2014-01-01

The quality of student learning and achievement in public schools has become a matter of public discourse and policy, thus led to the establishment of charter school concept. However, there are controversial reports on the academic performances of charter schools, inadequate information on their instructional practices, and the learning…

An Intervention to Assist Students with Writing Their Dissertations and Theses

ERIC Educational Resources Information Center

Singh, S.

2011-01-01

An inadequate number of suitably qualified and experienced supervisors, an increase in the number of students, uncertainty regarding the suitability of supervision and academic rigour in dissertations and theses make it difficult to produce quality graduates within the prescribed time-frame as stipulated by the Department of Education. By…

Teacher Effects on Student Achievement and Height: A Cautionary Tale

ERIC Educational Resources Information Center

Bitler, Marianne P.; Corcoran, Sean P.; Domina, Thurston; Penner, Emily K.

2014-01-01

The growing availability of data linking students to classroom teachers has made it possible to estimate the contribution teachers make to student achievement. While there is a growing consensus that teacher quality is important and current evaluation systems are inadequate, many have expressed concerns over the use of value-added measures (VAMs)…

Developing a Quality Curriculum.

ERIC Educational Resources Information Center

Glatthorn, Allan A.

In the face of increasing demands for school reform, educational leaders are looking anew at the core elements of the instructional program, including the curriculum. This book serves as a guide to both understanding and practicing sound curriculum development. It lays out the steps of a quality curriculum-development process and emphasizes that…

Researcher-Portraitists: An Exploration of Aesthetics and Research Quality

ERIC Educational Resources Information Center

Muccio, Leah Schoenberg; Reybold, L. Earle; Kidd, Julie

2015-01-01

In this article, we critique the use of portraiture as a qualitative research method, emphasizing the relationship between the fundamental aspects of portraiture and the recurring themes of research quality associated with alternative qualitative inquiry. To accomplish this goal, we conducted a study of culturally responsive practices of three…

On Quality Education Reform in International Trade Major

ERIC Educational Resources Information Center

Ma, Jing; Xiao, Jing

2011-01-01

The purpose of this paper is to analyze the existing problems of quality education of specialization of international trade in current colleges and universities of China, and then propose several pieces of corresponding suggestion on educational reform. According to the characteristics of college and university education, we shall emphasize on the…

Mind the Gap: An Analysis of How Quality Assurance Processes Influence Programme Assessment Patterns

ERIC Educational Resources Information Center

Jessop, Tansy; McNab, Nicole; Gubby, Laura

2012-01-01

This article explores the relationship between the lack of visible attention to formative assessment in degree specifications and its marginalization in practice. Degree specification documents form part of the quality apparatus emphasizing the accountability and certification duties of assessment. Ironically, a framework designed to assure…

Influence of pollen feeding and physiological condition on pesticide sensitivity of the honey bee Apis mellifera carnica.

PubMed

Wahl, O; Ulm, K

1983-08-01

In two consecutive years heavy bee mortality at end April/early May followed the use of pesticides classed as harmless for bees along road verges. It was thought that old weak winter bees had succumbed to a preparation otherwise innocuous. Extensive tests to reveal any links between the bees' physiological condition and pesticide sensitivity involved 6 hormone herbicides, 11 fungicides and 2 insecticides, all approved harmless for bees and functioning on them wholly or mainly as stomach poisons. As a rule bee sensitivity was measured as LD 50 per os, in smaller tests as percentage mortality. Amount and quality of pollen ingested in the first days of life affected the pesticide sensitivity of young and older bees. Bees fed adequate high quality pollen are less sensitive than counterparts fed inadequate or inferior pollen or pollen substitute; such differences persisted if the LD 50 was calculated for the same body weight. Pesticides containing manganese are an exception. To these, bees fed inadequate pollen are no more or even less sensitive than comparable well-fed bees. Pesticide sensitivity decreases generally from early to late summer. Quality of pollen available for larvae has no effect on poison sensitivity of imagines. Food supply conditions however exert a clear influence: tested with the same pesticides, hive bees from colonies having had a rich early food supply, and young bees bred then, are less sensitive than their counterparts having had moderate or no early food supply. Poison sensitivity of summer bees increases with age; most sensitive are old winter bees which had practiced broodcare in early spring.Inadequate pollen intake can be regarded as causing protein deficiency. Investigation of this in mammals and man indicate that the higher poison sensitivity in bees results from inhibition of the enzymatic decomposition of pesticides. For practical bee protection it is important that all organic fungicides tested are effectively harmless. Hormone hebicides can be ranked as practically harmless even for bees inadequately protein-fed, as long as the approved concentrations are observed. Our tests raised doubts however about the registration as harmless for bees of insecticides based on Endosulfan and Phosalon. Of interest in practice and for the official testing of pesticides are also the high pesticide sensitivity of old winter bees, the decrease in sensitivity of bees on a stable feed from early to late summer, and the sensitivity-reducing influence of pollen-rich food supply promoting development.It is important ecologically that pollens of different plant species vary in nutrient quality for the honey bee: there are perfectly worthless (conifers), poor-to-medium, and highly effective pollen types. As shown in this paper, these differences are relevant not only for the development of the physiological condition and breeding potential of the bee, but also for pesticide sensitivity. That bees gather worthless and poor-quality, sometimes even poisonous, pollen (some Ranunculus sp.) is evidently due to the phagostimulant present in all pollen types.

Strategic Planning, Assessment and Accountability: Their Impact on the Establishment of Centers of Excellence in Academic Departments. AIR 1998 Annual Forum Paper.

ERIC Educational Resources Information Center

Pollicino, Elizabeth B.; Hall, Clover W.

This paper reviews the literature on academic quality programs and examines issues faced at one institution in which two initiatives emphasizing student outcomes and faculty performance as indicators of quality are underway. In its review of the literature the paper focuses on concepts such as total quality management, peer or student evaluation…

[The hospital perspective: disease management and integrated health care].

PubMed

Schrappe, Matthias

2003-06-01

Disease Management is a transsectoral, population-based form of health care, which addresses groups of patients with particular clinical entities and risk factors. It refers both to an evidence-based knowledge base and corresponding guidelines, evaluates outcome as a continuous quality improvement process and usually includes active participation of patients. In Germany, the implementation of disease management is associated with financial transactions for risk adjustment between health care assurances [para. 137 f, Book V of Social Code (SGB V)] and represents the second kind of transsectoral care, besides a program designed as integrated health care according to para. 140 a ff f of Book V of Social Code. While in the USA and other countries disease management programs are made available by several institutions involved in health care, in Germany these programs are offered by health care insurers. Assessment of disease management from the hospital perspective will have to consider three questions: How large is the risk to compensate inadequate quality in outpatient care? Are there synergies in internal organisational development? Can the risk of inadequate funding of the global "integrated" budget be tolerated? Transsectoral quality assurance by valid performance indicators and implementation of a quality improvement process are essential. Internal organisational changes can be supported, particularly in the case of DRG introduction. The economic risk and financial output depends on the kind of disease being focussed by the disease management program. In assessing the underlying scientific evidence of their cost effectiveness, societal costs will have to be precisely differentiated from hospital-associated costs.

Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality: analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program

PubMed Central

Chiu, Sherry Yueh-Hsia; Chuang, Shu-Ling; Chen, Sam Li-Sheng; Yen, Amy Ming-Fang; Fann, Jean Ching-Yuan; Chang, Dun-Cheng; Lee, Yi-Chia; Wu, Ming-Shiang; Chou, Chu-Kuang; Hsu, Wen-Feng; Chiou, Shu-Ti; Chiu, Han-Mo

2017-01-01

Objectives Interval colorectal cancer (CRC) after colonoscopy may affect effectiveness and cost-effectiveness of screening programmes. We aimed to investigate whether and how faecal haemoglobin concentration (FHbC) of faecal immunochemical testing (FIT) affected the risk prediction of interval cancer (IC) caused by inadequate colonoscopy quality in a FIT-based population screening programme. Design From 2004 to 2009, 29 969 subjects underwent complete colonoscopy after positive FIT in the Taiwanese Nationwide CRC Screening Program. The IC rate was traced until the end of 2012. The incidence of IC was calculated in relation to patient characteristics, endoscopy-related factors (such adenoma detection rate (ADR)) and FHbC. Poisson regression analysis was performed to assess the potential risk factors for colonoscopy IC. Results One hundred and sixty-two ICs developed after an index colonoscopy and the estimated incidence was 1.14 per 1000 person-years of observation for the entire cohort. Increased risk of IC was most remarkable in the uptake of colonoscopy in settings with ADR lower than 15% (adjusted relative risk (aRR)=3.09, 95% CI 1.55 to 6.18) and then higher FHbC (μg Hb/g faeces) (100–149: aRR=2.55, 95% CI 1.52 to 4.29, ≥150: aRR=2.74, 95% CI 1.84 to 4.09) with adjustment for older age and colorectal neoplasm detected at baseline colonoscopy. Similar findings were observed for subjects with negative index colonoscopy. Conclusions Colonoscopy ICs arising from FIT-based population screening programmes were mainly influenced by inadequate colonoscopy quality and independently predicted by FHbC that is associated with a priori chance of advanced neoplasm. This finding is helpful for future modification of screening logistics based on FHbC. PMID:26515543

How Much Does Malaria Vector Control Quality Matter: The Epidemiological Impact of Holed Nets and Inadequate Indoor Residual Spraying

PubMed Central

Rehman, Andrea M.; Coleman, Mike; Schwabe, Christopher; Baltazar, Giovanna; Matias, Abrahan; Roncon Gomes, Irina; Yellott, Lee; Aragon, Cynthia; Nseng Nchama, Gloria; Mzilahowa, Themba; Rowland, Mark; Kleinschmidt, Immo

2011-01-01

Background Insecticide treated nets (ITN) and indoor residual spraying (IRS) are the two pillars of malaria vector control in Africa, but both interventions are beset by quality and coverage concerns. Data from three control programs were used to investigate the impact of: 1) the physical deterioration of ITNs, and 2) inadequate IRS spray coverage, on their respective protective effectiveness. Methods Malaria indicator surveys were carried out in 2009 and 2010 in Bioko Island, mainland Equatorial Guinea and Malawi to monitor infection with P.falciparum in children, mosquito net use, net condition and spray status of houses. Nets were classified by their condition. The association between infection and quality and coverage of interventions was investigated. Results There was reduced odds of infection with P.falciparum in children sleeping under ITNs that were intact (Odds ratio (OR): 0.65, 95% CI: 0.55–0.77 and OR: 0.81, 95% CI: 0.56–1.18 in Equatorial Guinea and in Malawi respectively), but the protective effect became less with increasingly worse condition of the net. There was evidence for a linear trend in infection per category increase in deterioration of nets. In Equatorial Guinea IRS offered protection to those in sprayed and unsprayed houses alike when neighbourhood spray coverage was high (≥80%) compared to those living in areas of low IRS coverage (<20%), regardless of whether the house they lived in was sprayed or not (adjusted OR = 0.54, 95% CI 0.33–0.89). ITNs provided only personal protection, offering no protection to non users. Although similar effects were seen in Malawi, the evidence was much weaker than in Equatorial Guinea. Conclusions Universal coverage strategies should consider policies for repair and replacement of holed nets and promote the care of nets by their owners. IRS programs should ensure high spray coverage since inadequate coverage gives little or no protection at all. PMID:21559436

Mentoring Faculty: A US National Survey of Its Adequacy and Linkage to Culture in Academic Health Centers.

PubMed

Pololi, Linda H; Evans, Arthur T; Civian, Janet T; Vasiliou, Vasilia; Coplit, Lisa D; Gillum, Linda H; Gibbs, Brian K; Brennan, Robert T

2015-01-01

The aims of this study were to (1) describe the quantity and quality of mentoring faculty in US academic health centers (AHCs), (2) measure associations between mentoring and 12 dimensions that reflect the culture of AHCs, and (3) assess whether mentoring predicts seriously contemplating leaving one's institution. During 2007-2009, our National Initiative on Gender, Culture and Leadership in Medicine (C - Change) conducted a cross-sectional study of faculty from 26 representative AHCs in the United States using the 74-item C - Change Faculty Survey to assess relationships of faculty characteristics and various aspects of the institutional culture (52% response rate). Among the 2178 eligible respondents (assistant, associate, and full professors), we classified their mentoring experience as either inadequate, neutral, or positive. In this national sample, 43% of the 2178 respondents had inadequate mentoring; only 30% had a positive assessment of mentoring. There was no statistical difference by sex, minority status, or rank. Inadequate mentoring was most strongly associated with less institutional support, lower self-efficacy in career advancement, and lower scores on the trust/relationship/inclusion scale. The percent of faculty who had seriously considered leaving their institution was highest among those who had inadequate mentoring (58%), compared to those who were neutral (28%) or had positive mentoring (14%) (all paired comparisons, p < .001). In a national survey of faculty of US AHCs, mentoring was frequently inadequate and this was associated with faculty contemplating leaving their institutions. Positive mentoring, although less prevalent, was associated with many other positive dimensions of AHCs. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

Impact of Inadequate Empirical Therapy on the Mortality of Patients with Bloodstream Infections: a Propensity Score-Based Analysis

PubMed Central

Retamar, Pilar; Portillo, María M.; López-Prieto, María Dolores; Rodríguez-López, Fernando; de Cueto, Marina; García, María V.; Gómez, María J.; del Arco, Alfonso; Muñoz, Angel; Sánchez-Porto, Antonio; Torres-Tortosa, Manuel; Martín-Aspas, Andrés; Arroyo, Ascensión; García-Figueras, Carolina; Acosta, Federico; Corzo, Juan E.; León-Ruiz, Laura; Escobar-Lara, Trinidad

2012-01-01

The impact of the adequacy of empirical therapy on outcome for patients with bloodstream infections (BSI) is key for determining whether adequate empirical coverage should be prioritized over other, more conservative approaches. Recent systematic reviews outlined the need for new studies in the field, using improved methodologies. We assessed the impact of inadequate empirical treatment on the mortality of patients with BSI in the present-day context, incorporating recent methodological recommendations. A prospective multicenter cohort including all BSI episodes in adult patients was performed in 15 hospitals in Andalucía, Spain, over a 2-month period in 2006 to 2007. The main outcome variables were 14- and 30-day mortality. Adjusted analyses were performed by multivariate analysis and propensity score-based matching. Eight hundred one episodes were included. Inadequate empirical therapy was administered in 199 (24.8%) episodes; mortality at days 14 and 30 was 18.55% and 22.6%, respectively. After controlling for age, Charlson index, Pitt score, neutropenia, source, etiology, and presentation with severe sepsis or shock, inadequate empirical treatment was associated with increased mortality at days 14 and 30 (odds ratios [ORs], 2.12 and 1.56; 95% confidence intervals [95% CI], 1.34 to 3.34 and 1.01 to 2.40, respectively). The adjusted ORs after a propensity score-based matched analysis were 3.03 and 1.70 (95% CI, 1.60 to 5.74 and 0.98 to 2.98, respectively). In conclusion, inadequate empirical therapy is independently associated with increased mortality in patients with BSI. Programs to improve the quality of empirical therapy in patients with suspicion of BSI and optimization of definitive therapy should be implemented. PMID:22005999

Transboundary movement of hazardous wastes into Lebanon: Part 2. Environmental impacts and the need for remedial actions.

PubMed

Jurdi, Mey

2002-01-01

This paper discusses the transboundary movement of hazardous wastes (the "silent trade") into Lebanon in terms of environmental impacts and remedial actions. It highlights the projected impacts on potable-water quality, the exposure of the groundwater aquifer, and the status of quality control programs. The public responses to these problems are presented and characterized in terms of mistrust and rejection. The constraints developing countries face in handling environmental impacts and undertaking remedial actions are emphasized. The vision derived from the decade covered (1990-2000) emphasizes the need for international collaboration, through Basel Convention efforts, to control the transboundary movement of hazardous wastes and the disposal of such wastes. The need for "global harmonization" should be given serious consideration.

Bangladesh arsenic mitigation programs: lessons from the past

PubMed Central

Milton, Abul Hasnat; Hore, Samar Kumar; Hossain, Mohammad Zahid; Rahman, Mahfuzar

2012-01-01

Ensuring access to safe drinking water by 2015 is a global commitment by the Millennium Development Goals (MDGs). In Bangladesh, significant achievements in providing safe water were made earlier by nationwide tubewell-installation programme. This achievement was overshadowed in 1993 by the presence of arsenic in underground water. A total of 6 million tubewells have been tested for arsenic since then, the results of which warranted immediate mitigation. Mitigation measures included tubewell testing and replacing; usage of deeper wells; surface water preservation and treatment; use of sanitary dug wells, river sand and pond sand filters; rainwater collection and storage; household-scale and large-scale arsenic filtrations; and rural pipeline water supply installation. Shallow tubewell installation was discouraged. Efforts have been made to increase people's awareness. This paper describes the lessons learned about mitigation efforts by the authors from experience of arsenic-related work. In spite of national mitigation plans and efforts, a few challenges still persist: inadequate coordination between stakeholders, differences in inter-sectoral attitudes, inadequate research to identify region-specific, suitable safe water options, poor quality of works by various implementing agencies, and inadequate dissemination of the knowledge and experiences to the people by those organizations. Issues such as long-time adaptation using ground water, poor surface water quality including bad smell and turbidity, and refusal to using neighbor's water have delayed mitigation measures so far. Region-specific mitigation water supply policy led by the health sector could be adopted with multisectoral involvement and responsibility. Large-scale piped water supply could be arranged through Public Private Partnerships (PPP) in new national approach. PMID:22558005

Bangladesh arsenic mitigation programs: lessons from the past.

PubMed

Milton, Abul Hasnat; Hore, Samar Kumar; Hossain, Mohammad Zahid; Rahman, Mahfuzar

2012-01-01

Ensuring access to safe drinking water by 2015 is a global commitment by the Millennium Development Goals (MDGs). In Bangladesh, significant achievements in providing safe water were made earlier by nationwide tubewell-installation programme. This achievement was overshadowed in 1993 by the presence of arsenic in underground water. A total of 6 million tubewells have been tested for arsenic since then, the results of which warranted immediate mitigation. Mitigation measures included tubewell testing and replacing; usage of deeper wells; surface water preservation and treatment; use of sanitary dug wells, river sand and pond sand filters; rainwater collection and storage; household-scale and large-scale arsenic filtrations; and rural pipeline water supply installation. Shallow tubewell installation was discouraged. Efforts have been made to increase people's awareness. This paper describes the lessons learned about mitigation efforts by the authors from experience of arsenic-related work. In spite of national mitigation plans and efforts, a few challenges still persist: inadequate coordination between stakeholders, differences in inter-sectoral attitudes, inadequate research to identify region-specific, suitable safe water options, poor quality of works by various implementing agencies, and inadequate dissemination of the knowledge and experiences to the people by those organizations. Issues such as long-time adaptation using ground water, poor surface water quality including bad smell and turbidity, and refusal to using neighbor's water have delayed mitigation measures so far. Region-specific mitigation water supply policy led by the health sector could be adopted with multisectoral involvement and responsibility. Large-scale piped water supply could be arranged through Public Private Partnerships (PPP) in new national approach.

Increasing access to healthful foods: a qualitative study with residents of low-income communities

PubMed Central

2015-01-01

Background Inadequate access to healthful foods has been identified as a significant barrier to healthful dietary behaviors among individuals who live in low-income communities. The purpose of this study was to gather low-income community members’ opinions about their food purchasing choices and their perceptions of the most effective ways to increase access to healthful foods in their communities. Methods Spanish and English focus groups were conducted in low-income, ethnically-diverse communities. Participants were asked about their knowledge, factors influencing their food purchasing decisions, and their perceptions regarding solutions to increase access to healthful foods. Results A total of 148 people participated in 13 focus groups. The majority of participants were female and ethnically diverse (63% Hispanic, 17% African American, 16% Caucasian, and 4% “other”). More than 75% of the participants reported making less than $1999 USD per month. Participants reported high levels of knowledge and preference for healthful foods. The most important barriers influencing healthful shopping behaviors included high price of healthful food, inadequate geographical access to healthful food, poor quality of available healthful food, and lack of overall quality of the proximate retail stores. Suggested solutions to inadequate access included placement of new chain supermarkets in their communities. Strategies implemented in convenience stores were not seen as effective. Farmers’ markets, with specific stipulations, and community gardens were regarded as beneficial supplementary solutions. Conclusion The results from the focus groups provide important input from a needs assessment perspective from the community, identify gaps in access, and offer potential effective solutions to provide direction for the future. PMID:26222910

Experts stress both wellness and amenity aspects of food and nutrition services in assisted living facilities for older adults.

PubMed

Chao, Shirley Y; Dwyer, Johanna T; Houser, Robert F; Jacques, Paul; Tennstedt, Sharon

2008-10-01

There has been no consensus on best practices in food and nutrition services in assisted living facilities for older adults. We documented experts' views on optimal food and nutrition services emphases in assisted living facilities, and factors affecting their views. One hundred thirty-five national experts specializing in health, aging, nutrition and assisted living facilities completed a survey consisting four scenarios (ie, home-style, restaurant/hotel, and health/medical, and a combination of these three) in six food and nutrition services areas: dining room environment, meal services, meal quality, nutrition services, employees' qualifications, and therapeutic nutrition services. Sixty-three percent of experts favored the combination scenario. Dietetics education and experts' beliefs that assisted living facilities should be health promotion and maintenance facilities were significant predictors of emphases, including wellness considerations. Experts' personal views exerted a powerful influence. Experts chose food and nutrition service quality indicators that emphasized a focus on both wellness and amenities as their ideal scenarios for optimal food and nutrition services in assisted living facilities.

Locating Continuing Education Programs.

ERIC Educational Resources Information Center

Mason, Robert C.

1986-01-01

Emphasizes program location as an important component of the marketing plan for continuing education. Also discusses relations among program location and quality, costs, supportive services, and economies of scale. (CH)

Food Production, Population Growth, and Environmental Quality. Caltech Population Program Occasional Papers, Series 1, Number 7.

ERIC Educational Resources Information Center

Groth, Edward, III

This paper, one in a series of occasional publications, discusses trends in food production and population growth, emphasizing how environmental quality will be affected. The series is intended to increase understanding of the interrelationships between population growth and socioeconomic and cultural patterns throughout the world, and to…

The Debate on Learning Assessments in Developing Countries

ERIC Educational Resources Information Center

Wagner, Daniel A.; Lockheed, Marlaine; Mullis, Ina; Martin, Michael O.; Kanjee, Anil; Gove, Amber; Dowd, Amy Jo

2012-01-01

Over the past decade, international and national education agencies have begun to emphasize the improvement of the quality (rather than quantity) of education in developing countries. This trend has been paralleled by a significant increase in the use of educational assessments as a way to measure gains and losses in quality of learning. As…

Quality and Equality in Internet-Based Higher Education: Benchmarks for Success.

ERIC Educational Resources Information Center

Merisotis, Jamie P.

The Institute for Higher Education Policy reviewed the research on quality and equality in Internet-based higher education and found a relative paucity of original research dedicated to explaining or predicting phenomena related to distance learning. The research that does exist has tended to emphasize student outcomes for individual courses,…

Deconstructing Teacher Quality in Urban Early Childhood Education

ERIC Educational Resources Information Center

Young, Jemimah L.; Butler, Bettie Ray; Dolzhenko, Inna N.; Ardrey, Tameka N.

2018-01-01

Purpose: The purpose of this paper is to deconstruct the extant scholarship on quality in early childhood education and to emphasize the importance of extending the literature to explore the potential influence that a teachers' educational background may have on kindergarten readiness for African American children in urban early learning settings.…

A Model of Homeschooling Based on Technology in Malaysia

ERIC Educational Resources Information Center

Alias, Norlidah; Rahman, Mohd. Nazri Abdul; Siraj, Saedah; Ibrahim, Ruslina

2013-01-01

Homeschooling in Malaysia is a form of alternative education that emphasizes quality education based on moral values and belief in strengthening family ties. The purpose of this study is to produce a model of homeschooling technology-based learning activities in Malaysia as a guideline to improve the quality of education, curriculum and organize…

Relationships between Observations of Elementary Mathematics Instruction and Student Achievement: Exploring Variability across Districts

ERIC Educational Resources Information Center

Lynch, Kathleen; Chin, Mark; Blazar, David

2017-01-01

Much debate surrounding teacher quality has focused on students' standardized test scores, but recent federal and state initiatives have emphasized the use of multiple measures to evaluate teacher quality, including classroom observations. In this study, we explore differences across school districts in the relationship between student achievement…

Career Education and the Quality of Working Life. Monographs on Career Education.

ERIC Educational Resources Information Center

Bernstein, Paul

A career continuum has evolved with career education being the preparatory phase in the schools and the quality of working life or career development in the profit and nonprofit sectors representing the participatory aspect. Historically, career education has emphasized preparatory processes providing learners with attitudes, knowledge, and skills…

Quality as Critique: Promoting Critical Reflection among Youth in Structured Encounter Programs

ERIC Educational Resources Information Center

Ross, Karen

2015-01-01

In this manuscript, I interrogate the concept of "quality" encounter programs for youth in conflict zones. I focus on two Israeli organizations implementing encounters for Jewish and Palestinian citizens, and draw upon narratives of former participants as articulated during life history narratives to illustrate divergent emphases in each…

Family Functioning and Adolescent Psychological Maladjustment: The Mediating Role of Coping Strategies.

PubMed

Francisco, Rita; Loios, Sara; Pedro, Marta

2016-10-01

This study aims to analyze the mediating role of coping strategies in the relationship between family functioning and youth maladjustment. A community sample of 341 adolescents (M = 15.11 years old; SD = 1.71) completed self-report measures about such variables. Results showed that a perception of an inadequate family functioning was associated with the use of maladaptive coping strategies, as well as with youth psychological maladjustment. The results also revealed that rumination and support-seeking mediated the relationship between family functioning and internalizing behavior, and hostile expression of feelings played a mediating role between family functioning and externalizing behavior. No gender differences were found in the relationship between variables. This study emphasizes the importance of coping strategies used by adolescents to understand the relationship between family functioning and youth psychological maladjustment.

Reliability of Fault Tolerant Control Systems. Part 1

NASA Technical Reports Server (NTRS)

Wu, N. Eva

2001-01-01

This paper reports Part I of a two part effort, that is intended to delineate the relationship between reliability and fault tolerant control in a quantitative manner. Reliability analysis of fault-tolerant control systems is performed using Markov models. Reliability properties, peculiar to fault-tolerant control systems are emphasized. As a consequence, coverage of failures through redundancy management can be severely limited. It is shown that in the early life of a syi1ein composed of highly reliable subsystems, the reliability of the overall system is affine with respect to coverage, and inadequate coverage induces dominant single point failures. The utility of some existing software tools for assessing the reliability of fault tolerant control systems is also discussed. Coverage modeling is attempted in Part II in a way that captures its dependence on the control performance and on the diagnostic resolution.

Problems in merging Earth sensing satellite data sets

NASA Technical Reports Server (NTRS)

Smith, Paul H.; Goldberg, Michael J.

1987-01-01

Satellite remote sensing systems provide a tremendous source of data flow to the Earth science community. These systems provide scientists with data of types and on a scale previously unattainable. Looking forward to the capabilities of Space Station and the Earth Observing System (EOS), the full realization of the potential of satellite remote sensing will be handicapped by inadequate information systems. There is a growing emphasis in Earth science research to ask questions which are multidisciplinary in nature and global in scale. Many of these research projects emphasize the interactions of the land surface, the atmosphere, and the oceans through various physical mechanisms. Conducting this research requires large and complex data sets and teams of multidisciplinary scientists, often working at remote locations. A review of the problems of merging these large volumes of data into spatially referenced and manageable data sets is presented.

Telemedicine and the National Information Infrastructure

PubMed Central

Jones, Mary Gardiner

1997-01-01

Abstract Health care is shifting from a focus on hospital-based acute care toward prevention, promotion of wellness, and maintenance of function in community and home-based facilities. Telemedicine can facilitate this shifted focus, but the bulk of the current projects emphasize academic medical center consultations to rural hospitals. Home-based projects encounter barriers of cost and inadequate infrastructure. The 1996 Telecommunications Act as implemented by the Federal Communications commission holds out significant promise to overcome these barriers, although it has serious limitations in its application to health care providers. Health care advocates must work actively on the federal, state, and local public and private sector levels to address these shortcomings and develop cost effective partnerships with other community-based organizations to build network links to facilitate telemedicine-generated services to the home, where the majority of health care decisions are made. PMID:9391928

The System of Russian Education as Assessed by the Population: The Problem of Level and Quality

ERIC Educational Resources Information Center

Dubin, Boris; Zorkaia, Nataliia

2010-01-01

Russians are less concerned about the poor material conditions of institutions or inadequate textbooks than about the commercialization of education and high tuition. Also of great concern is the gap between educational achievement and employment opportunities, especially for the more highly educated. The perception that a higher education is a…

Strengthening Institutional Research Administration in Uganda: A Case Study on Developing Collaborations among Academic and Research Institutions

ERIC Educational Resources Information Center

Kakande, Nelson; Namirembe, Regina; Kaye, Dan K.; Mugyenyi, Peter N.

2012-01-01

Despite the presence of several funded research projects at academic and research institutions in sub-Saharan Africa, the quality of the pre/post grant award process in these institutions is inadequate. There is a need to strengthen research administration through infrastructural, organizational, and human resource development to match the dynamic…

Lingual Pressure as a Clinical Indicator of Swallowing Function in Parkinson's Disease

ERIC Educational Resources Information Center

Pitts, Laura L.; Morales, Sarah; Stierwalt, Julie A. G.

2018-01-01

Purpose: Swallowing impairment, or dysphagia, is a known contributor to reduced quality of life, pneumonia, and mortality in Parkinson's disease (PD). However, the contribution of tongue dysfunction, specifically inadequate pressure generation, to dysphagia in PD remains unclear. Our purpose was to determine whether lingual pressures in PD are (a)…

Nature's Pharmacy: Do You Have a Green Tongue?

ERIC Educational Resources Information Center

Vamos, Sandra

2005-01-01

The use of plants for healing purposes has been prevalent in all cultures throughout history and continues to play a role in medicine today. While herbal medicine has much to offer, adverse effects can result from lack of quality control and standardization, consuming an inadequate dose, using the wrong herb, and reactions with modern drugs. To…

Elementary Classroom Teachers and Physical Education: Change in Teacher-Related Factors during Pre-Service Teacher Education

ERIC Educational Resources Information Center

Fletcher, Tim; Mandigo, James; Kosnik, Clare

2013-01-01

Background: In many contexts, elementary physical education (PE) classes are taught by the classroom teacher rather than by a PE specialist. Elementary classroom teachers often cite negative attitudes resulting from experiences as school pupils and inadequate pre-service PE teacher education as barriers to teaching a quality PE programme. Purpose:…

An Evaluation of Web Based Instruction in View of the Tutors' and Students' Perspectives

ERIC Educational Resources Information Center

Erdogan, Yavuz

2008-01-01

In today's world, it is acknowledged by almost all folks of life that the traditional educational institutions are inadequate in educating the growing population. This situation has triggered research into finding ways to provide economical and of high quality education to wider masses of people. Currently, web based instruction seems to be the…

An Inquiry into the Impact of Admissions Policy that Diversifies the Selection of Pre-Service Teacher Education Candidates

ERIC Educational Resources Information Center

Stead, Virginia

2006-01-01

The world of educational quality in 2006 is infused with conflicting ecopolitical agendas that constitute evidence of social strain and what Cherry Banks (2006) calls the tension between unity and diversity. That tension is increasingly prevalent among growing multicultural communities where centuries of inadequate educational funding have created…

The State of the Science of Health and Wellness for Adults with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Anderson, Lynda Lahti; Humphries, Kathy; McDermott, Suzanne; Marks, Beth; Sisirak, Jasmina; Larson, Sheryl

2013-01-01

Historically, people with intellectual and developmental disabilities (IDD) have experienced health disparities related to several factors including: a lack of access to high quality medical care, inadequate preparation of health care providers to meet their needs, the social determinants of health (e.g., poverty, race and gender), and the failure…

Dropping Out of High School: The Effects of Family, Ability, School Quality and Local Employment Conditions.

ERIC Educational Resources Information Center

Hill, C. Russell

The author, after reviewing briefly the research literature on dropouts, mentions the following shortcomings of such studies: (1) lack of ability to control for differences in the students' abilities; (2) incomplete and inadequate measures of socioeconomic background; (3) inability to control for qualitative differences in the schools attended;…

Evaluating the Use of Reflective Practice in a Nonprofessional, Undergraduate Clinical Communication Skills Course

ERIC Educational Resources Information Center

Beveridge, Tyler S.; Fruchter, Lauren L.; Sanmartin, Cleo V.; deLottinville, Carl B.

2014-01-01

Recent studies suggest that the quality of reflective practice being achieved in educational settings is inadequate. Our study aims to determine the level of reflection present in written student reflections in a nonprofessional undergraduate course. We also seek to explore student and instructor perspectives on the value of reflective practices.…

40 CFR Appendix C to Part 132 - Great Lakes Water Quality Initiative Methodologies for Development of Human Health Criteria and...

Code of Federal Regulations, 2013 CFR

2013-07-01

... organisms where higher doses or concentrations resulted in an adverse effect. Quantitative structure... probable or possible human carcinogen, when, because of major qualitative or quantitative limitations, the... quantitative risk assessment, but for which data are inadequate for Tier I criterion development due to a tumor...

40 CFR Appendix C to Part 132 - Great Lakes Water Quality Initiative Methodologies for Development of Human Health Criteria and...

Code of Federal Regulations, 2014 CFR

2014-07-01

... organisms where higher doses or concentrations resulted in an adverse effect. Quantitative structure... probable or possible human carcinogen, when, because of major qualitative or quantitative limitations, the... quantitative risk assessment, but for which data are inadequate for Tier I criterion development due to a tumor...

40 CFR Appendix C to Part 132 - Great Lakes Water Quality Initiative Methodologies for Development of Human Health Criteria and...

Code of Federal Regulations, 2012 CFR

2012-07-01

... organisms where higher doses or concentrations resulted in an adverse effect. Quantitative structure... probable or possible human carcinogen, when, because of major qualitative or quantitative limitations, the... quantitative risk assessment, but for which data are inadequate for Tier I criterion development due to a tumor...

Ambulatory Care Sensitive Conditions in Persons with an Intellectual Disability--Development of a Consensus

ERIC Educational Resources Information Center

Balogh, Robert S.; Ouellette-Kuntz, Helene; Brownell, Marni; Colantonio, Angela

2011-01-01

Background: There is evidence that the primary care provided for persons with an intellectual disability living in the community has been inadequate. Hospitalization rates for ambulatory care sensitive (ACS) conditions are considered an indicator for access to, and quality of, primary care. The objective of this research was to identify ACS…

Education Services in Juvenile Corrections: 40 Years of Litigation and Reform

ERIC Educational Resources Information Center

Leone, Peter E.; Wruble, Pamela Cichon

2015-01-01

Children and youth in juvenile corrections have statutory rights to education services of comparable quality to those found in the public schools. However, during the past 40 years in many states, access to education services that meet state and federal requirements under IDEA and state regulations has been inconsistent and inadequate for youth in…

Three Experts on Quality Management: Philip B. Crosby, W. Edwards Deming, Joseph M. Juran

DTIC Science & Technology

1992-07-01

Department of the Navy Office of the Under Secretary of the Navy Total Quality Leadership Omce THREE EXPERTS ON QUALITY MANAGEMENT : PHILIP B. CROSBY W...research, as the "price of nonconformance." To aid managers in statistical theory , statistical thinking, and the application tracking the cost of doing...Quality Management emphasizes that the process must become a way of life in Theory of Systems. "A system is a series of the organization. Continuance is

A blinded assessment of video quality in wearable technology for telementoring in open surgery: the Google Glass experience.

PubMed

Hashimoto, Daniel A; Phitayakorn, Roy; Fernandez-del Castillo, Carlos; Meireles, Ozanan

2016-01-01

The goal of telementoring is to recreate face-to-face encounters with a digital presence. Open-surgery telementoring is limited by lack of surgeon's point-of-view cameras. Google Glass is a wearable computer that looks like a pair of glasses but is equipped with wireless connectivity, a camera, and viewing screen for video conferencing. This study aimed to assess the safety of using Google Glass by assessing the video quality of a telementoring session. Thirty-four (n = 34) surgeons at a single institution were surveyed and blindly compared via video captured with Google Glass versus an Apple iPhone 5 during the open cholecystectomy portion of a Whipple. Surgeons were asked to evaluate the quality of the video and its adequacy for safe use in telementoring. Thirty-four of 107 invited surgical attendings (32%) responded to the anonymous survey. A total of 50% rated the Google Glass video as fair with the other 50% rating it as bad to poor. A total of 52.9% of respondents rated the Apple iPhone video as good. A significantly greater proportion of respondents felt Google Glass video quality was inadequate for telementoring versus the Apple iPhone's (82.4 vs 26.5%, p < 0.0001). Intraclass correlation coefficient was 0.924 (95% CI 0.660-0.999, p < 0.001). While Google Glass provides a great breadth of functionality as a wearable device with two-way communication capabilities, current hardware limitations prevent its use as a telementoring device in surgery as the video quality is inadequate for safe telementoring. As the device is still in initial phases of development, future iterations or competitor devices may provide a better telementoring application for wearable devices.

Impact of reinforced education by telephone and short message service on the quality of bowel preparation: a randomized controlled study.

PubMed

Lee, Yoo Jin; Kim, Eun Soo; Choi, Jae Hyuk; Lee, Kyung In; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok

2015-11-01

High quality bowel preparation is essential for successful colonoscopy. This study aimed to assess the impact of reinforced education by telephone or short message service (SMS) on the quality of bowel preparation. A prospective, endoscopist-blinded, randomized, controlled study was conducted. Reinforced education groups received additional education via reminders by telephone or SMS 2 days before colonoscopy. The primary outcome was the quality of the bowel preparation according to the Boston Bowel Preparation Scale (BBPS). The secondary outcomes included polyp detection rate (PDR), adenoma detection rate (ADR), tolerance, and subjective feelings of patients. A total of 390 patients were included. Total BBPS score was significantly higher in the reinforced education groups than in the control group (mean [SD] telephone vs. 7.1 [1.2] vs. 6.3 [1.4], P < 0.001; SMS vs. 6.8 [1.3] vs. 6.3 [1.4], P = 0.027). Between the two interventions, there was no significant difference in total BBPS score. PDR and ADR were not different among groups. Reinforced education groups showed lower anxiety and better tolerance compared with controls. A preparation-to-colonoscopy time of > 6 hours and < 80 % of the purgative ingested were independent factors associated with inadequate bowel preparation (BBPS < 5), whereas re-education by telephone was inversely related to inadequate bowel preparation. SMS was the optimal education modality, and was as effective as telephone reminders for the quality of bowel preparation. A reinforced educational approach via telephone or SMS should be individualized, depending on the resource availability of each clinical practice. ClinicalTrials.gov (NCT01911052). © Georg Thieme Verlag KG Stuttgart · New York.

Good clinical practice regulatory inspections: Lessons for Indian investigator sites

PubMed Central

Marwah, R.; Van de Voorde, K.; Parchman, J.

2010-01-01

Regulatory inspections are important to evaluate the integrity of the data submitted to health authorities (HAs), protect patient safety, and assess adequacy of site/sponsor quality systems to achieve the same. Inspections generally occur after submission of data for marketing approval of an investigational drug. In recent years, there has been a significant increase in number of inspections by different HAs, including in India. The assessors/inspectors generally do a thorough review of site data before inspections. All aspects of ICH-GCP, site infrastructure, and quality control systems are assessed during the inspection. Findings are discussed during the close out meeting and a detailed inspection report issued afterward, which has to be responded to within 15–30 days with effective Corrective and Preventive Action Plan (CAPA). Protocol noncompliance, inadequate/inaccurate records, inadequate drug accountability, informed consent issues, and adverse event reporting were some of the most common findings observed during recent Food and Drug Administration (FDA) inspections. Drug development is being increasingly globalized and an increased number of patients enrolled in studies submitted as part of applications come from all over the world including India. Because of the steep increase in research activity in the country, inexperienced sites, and more stakeholders, increased efforts will be required to ensure continuous quality and compliance. HAs have also made clear that enforcement will be increased and be swift, aggressive, and effective. PMID:21350732

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. © The Author(s) 2013.

The consistency approach for quality control of vaccines - a strategy to improve quality control and implement 3Rs.

PubMed

De Mattia, Fabrizio; Chapsal, Jean-Michel; Descamps, Johan; Halder, Marlies; Jarrett, Nicholas; Kross, Imke; Mortiaux, Frederic; Ponsar, Cecile; Redhead, Keith; McKelvie, Jo; Hendriksen, Coenraad

2011-01-01

Current batch release testing of established vaccines emphasizes quality control of the final product and is often characterized by extensive use of animals. This report summarises the discussions of a joint ECVAM/EPAA workshop on the applicability of the consistency approach for routine release of human and veterinary vaccines and its potential to reduce animal use. The consistency approach is based upon thorough characterization of the vaccine during development and the principle that the quality of subsequent batches is the consequence of the strict application of a quality system and of a consistent production of batches. The concept of consistency of production is state-of-the-art for new-generation vaccines, where batch release is mainly based on non-animal methods. There is now the opportunity to introduce the approach into established vaccine production, where it has the potential to replace in vivo tests with non-animal tests designed to demonstrate batch quality while maintaining the highest quality standards. The report indicates how this approach may be further developed for application to established human and veterinary vaccines and emphasizes the continuing need for co-ordination and harmonization. It also gives recommendations for work to be undertaken in order to encourage acceptance and implementation of the consistency approach. Copyright © 2011. Published by Elsevier Ltd.. All rights reserved.

Cognitive, Behavioral, and Functional Consequences of Inadequate Sleep in Children and Adolescents

PubMed Central

Beebe, Dean W.

2011-01-01

Synopsis During the past few decades, studies using multiple research designs have examined whether sleep during childhood and adolescence is related to cognition, behavior, and other aspects of daytime functioning. This paper summarizes recent correlational, case-control, quasi-experimental, and experimental studies, highlighting how the strengths and limitations of each research design are complementary, thereby allowing one to more confidently draw conclusions when viewing the research literature as a whole. Viewed in this manner, published findings suggest that inadequate sleep quality and/or quantity can cause sleepiness, inattention and, very likely, other cognitive and behavioral deficits that significantly impact children and adolescents in important functional settings (e.g., school). This paper then integrates findings from longitudinal studies within a developmental psychopathology model. In this model, inadequate sleep is viewed as a noxious exposure that can, over time, fundamentally alter a child or adolescent's development, resulting in poorer long-term outcomes. Important research questions remain, but the available evidence supports the integration of sleep screening and interventions into routine clinical care and also supports advocacy for public policy changes to improve the sleep of children and adolescents. PMID:21600347

The Impact of Identifying a Specific Purpose and External Audience for Writing on Second Graders' Writing Quality

ERIC Educational Resources Information Center

Block, Meghan K.

2013-01-01

The Common Core State Standards for English Language Arts and Literacy in History/Social Studies, Science, and Technical Subjects (CCSS) emphasize the importance of writing and specify that students should write for external, and, at times, unfamiliar audiences. Given the relationship between audience specification and quality writing in older…

Student Writing Accepted as High-Quality Responses to Analytic Text-Based Writing Tasks

ERIC Educational Resources Information Center

Wang, Elaine; Matsumura, Lindsay Clare; Correnti, Richard

2018-01-01

Literacy standards increasingly emphasize the importance of analytic text-based writing. Little consensus exists, however, around what high-quality student responses should look like in this genre. In this study, we investigated fifth-grade students' writing in response to analytic text-based writing tasks (15 teachers, 44 writing tasks, 88 pieces…

Developing Professional Early Childhood Educators in England and Hungary: Where Has All the Love Gone?

ERIC Educational Resources Information Center

Campbell-Barr, Verity; Georgeson, Janet; Varga, Anikó Nagy

2015-01-01

European education agendas have emphasized the importance of early childhood education in providing the foundations for lifelong learning. Central to the success of early childhood education is the quality of provision, with the workforce being key. While qualifications levels are frequently cited as important for the quality of provision here we…

Influence of a Physical Education Methods Course on Elementary Education Majors' Knowledge of Fundamental Movement Skills

ERIC Educational Resources Information Center

Hart, Melanie A.

2005-01-01

With an increase concern for childhood obesity, many individuals and organizations are emphasizing the importance of quality physical education. The need for quality physical education at the elementary level is extremely important as research has shown a relationship between the performance of fundamental movement skills and children's body…

Efficiency vs. Effectiveness: Can W. Edwards Deming's Principles of Quality Management Be Applied Successfully to American Education.

ERIC Educational Resources Information Center

Petry, John R.

The field of education has been slow to recognize the Total Quality Management (TQM) concept. This resistance may result from entrenched management styles characterized by hierarchical decision-making structures. TQM emphasizes management based on leadership instead of management by objective, command, and coercion. The TQM concept consists of…

Exploring the Link between Intrinsic Motivation and Quality

DTIC Science & Technology

1992-12-01

to and motivation for quality. " Effective human relations is basic to quality control," Fiegenbaum (1991) says. A major effect of this activity is... overjustification (explained later in this chapter). Deming "fervently believes in the intrinsic motivation of mankind," wrote Gabor (1990, p. 13). "All...see the congruence between Deming’s philosophy and overjustification theory (Deci, 1975). This is the idea that extrinsic motivators can be emphasized

La investigacion sobre la calidad de los programas para ninos de hasta dos anos de edad (Research on Quality in Infant-Toddler Programs). ERIC Digest.

ERIC Educational Resources Information Center

Honig, Alice Sterling

Concern about the quality of infant-toddler care programs has grown recently in response to two factors. The first is the need of employed parents for such care, and the second is research emphasizing the importance of brain development in the early years. This Spanish-language Digest introduces some of the many issues related to the quality of…

Prevalence of apical periodontitis and quality of root canal treatment in an adult Palestinian sub-population

PubMed Central

Mukhaimer, Raed; Hussein, Emad; Orafi, Ibtesam

2012-01-01

Purpose The aim of this study was to determine the prevalence of apical periodontitis and the technical quality of root canal fillings in a Palestinian sub-population. Methods The panoramic radiographs of 258 patients (142 females, 116 males) attending dental clinics in 2010 were examined to identify the presence of apical lesions associated with any remaining teeth, excluding third molars. The technical quality of root canal fillings was also evaluated by assessing apical extension from the radiographic apex. The panoramic radiographs were taken by a well-trained radiology assistant and evaluated by a radiologist and an endodontist. Statistical analysis was performed with the chi-square test with a significant level set at P < 0.05%. Results Of 6482 teeth examined radiographically, 978 (15.1%) had radiographic signs of apical periodontitis (AP). The prevalence of AP was 8.3% in teeth without filled roots and 59.5% (509/855) in root canal-treated teeth. The prevalence of AP and endodontic treatment increased with age and differed significantly (p < 0.05) between males and females. The majority (74.5%) of root canal fillings was performed inadequately, and most (77.2%) inadequate fillings were >2 mm short of the radiographic apex. The presence of AP was correlated significantly with poorly executed root canal fillings (p < 0.05). Conclusions The present study found a high prevalence and incidence of AP in association with root-filled teeth. The technical quality of many root canal treatments was unacceptable. PMID:23960544

[Continuous quality improvement in anesthesia].

PubMed

Gaitini, L; Vaida, S; Madgar, S

1998-01-01

Slow continuous quality improvement (SCQI) in anesthesia is a process that allows identification of problems and their causes. Implementing measures to correct them and continuous monitoring to ensure that the problems have been eliminated are necessary. The basic assumption of CQI is that the employees of an organization are competent and working to the best of their abilities. If problems occur they are the consequences of inadequacies in the process rather that in the individual. The CQI program is a dynamic but gradual system that invokes a slower rate of response in comparison with other quality methods, like quality assurance. Spectacular results following a system change are not to be expected an the ideal is slow and continuous improvement. A SCQI program was adapted by our department in May 1994, according to the recommendations of the American Society of Anesthesiologists. Problem identification was based on 65 clinical indicators, reflecting negative events related to anesthesia. Data were collected using a specially designed computer database. 4 events were identified as crossing previously established thresholds (hypertension, hypotension, hypoxia and inadequate nerve block). Statistical process control was used to establish stability of the system and whether negative events were influenced only by the common causes. The causes responsible for these negative events were identified using specific SCQI tools, such as control-charts, cause-effect diagrams and Pareto diagrams. Hypertension and inadequate nerve block were successfully managed. The implementation of corrective measures for the other events that cross the threshold is still in evolution. This program requires considerable dedication on the part of the staff, and it is hoped that it will improve our clinical performance.

Quality Early Education and Child Care From Birth to Kindergarten.

PubMed

Donoghue, Elaine A

2017-08-01

High-quality early education and child care for young children improves physical and cognitive outcomes for the children and can result in enhanced school readiness. Preschool education can be viewed as an investment (especially for at-risk children), and studies show a positive return on that investment. Barriers to high-quality early childhood education include inadequate funding and staff education as well as variable regulation and enforcement. Steps that have been taken to improve the quality of early education and child care include creating multidisciplinary, evidence-based child care practice standards; establishing state quality rating and improvement systems; improving federal and state regulations; providing child care health consultation; as well as initiating other innovative partnerships. Pediatricians have a role in promoting quality early education and child care for all children not only in the medical home but also at the community, state, and national levels. Copyright © 2017 by the American Academy of Pediatrics.

[Indicators of water microbial pollution: problems and perspectives].

PubMed

Nusca, A; D'Alessandro, D; Funari, E

2008-01-01

Conventional indicators of fecal contamination provide a precious contribution in evaluating water microbiological quality. In recent years some important issues have sprung up which have risen doubts about their reliability and have suggested a revision of their function. In developed countries, where the law regarding water quality is very strict, there have been several outbreaks, even though conventional indicators of fecal pollution pointed an appropriate microbiological quality. These outbreaks have been imputed to new pathogenic microorganisms which are often characterized by a great resistance to disinfection treatments than conventional indicators. In order to obtain an appropriate microbiological quality of waters, various approaches have been started such as the Water Safety Plans by World Health Organization the revision of the functions of suitable indicators (of the water quality), the setting up of specific methods either for pathogen microorganisms and for a quick surveying of an inadequate microbiological water quality.

A systematic evaluation of websites offering information on chronic kidney disease.

PubMed

Lutz, Erin R; Costello, Kaitlin L; Jo, Minjeong; Gilet, Constance A; Hawley, Jennifer M; Bridgman, Jessica C; Song, Mi-Kyung

2014-01-01

In this study, we described the content and characteristics of 40 non-proprietary websites offering information about chronic kidney disease (CKD) and evaluated their information quality using the DISCERN scale and readability using Flesch Reading Ease and Flesch-Kincaid grade level. The areas in which the websites scored the lowest on the DISCERN scale were whether the website discussed knowledge gaps, presented balanced information, and was clear about the information source. Websites that rated higher quality on the DISCERN scale were more difficult to read. The quality and readability of many websites about CKD to be used as meaningful educational resources for patients who desire to learn more about CKD and treatment options remain inadequate.

New Perspectives on Compensation Strategies for the Out-of-School Time Workforce. Working Paper Series. Report.

ERIC Educational Resources Information Center

Morgan, Gwen; Harvey, Brooke

Noting that the quality, continuity, and stability of out-of-school time programs depend, in part, on the presence of a well-trained and fairly compensated staff, this paper examines the unique characteristics of the out-of-school time workforce that contribute to inadequate compensation and explores workforce compensation from an economic…

Students' Perceptions and Readiness towards Mobile Learning in Colleges of Education: A Nigerian Perspective

ERIC Educational Resources Information Center

Chaka, John Gyang; Govender, Irene

2017-01-01

Access to quality education is becoming a huge challenge in Nigeria, in view of the exponential growth in its population, coupled with ethno-religious crises and other acts of terrorism. A large chunk of the country's population--about 26% have no access to education, as existing teaching and learning facilities have become inadequate. Some…

The Impact of Primary Education on School-to-Work Transitions for Young People in Rural Bolivia

ERIC Educational Resources Information Center

Punch, Samantha

2004-01-01

As in many parts of the majority world, primary education in rural Bolivia is constrained by a range of factors: poor teaching quality, lack of resources, limited infrastructure, inadequate teaching materials, and low wages for teachers. Furthermore, high rates of absenteeism, drop-out, repetition, and failure can be exacerbated by children's work…

What Students Need to Know and Be Able to Do On Leaving School for College.

ERIC Educational Resources Information Center

Hanford, George H.; Taylor, Daniel B.

One of our nation's educational triumphs is that admission to college has been brought within the reach of a majority of our high school graduates. Yet inadequate preparation often deprives students of this opportunity. Their stunted hopes are a major reason for growing naitonal concern about the quality of education in our schools. The College…

Special Education: Examining the Impact of Poverty on the Quality of Life of Families of Children with Disabilities

ERIC Educational Resources Information Center

Enwefa, Regina L.; Enwefa, Stephen C.; Jennings, Robert

2006-01-01

Today, school personnel are facing many challenges in their efforts to serve diverse families and children with disabilities. Inadequate human and fiscal capacity, attitudinal and cultural barriers are among the many hurdles that must be surmounted for successful provision of related services. Decisions about who is educated versus who is…

Private Relations' Last Stand: U.S. Steel vs. the U.S.A..

ERIC Educational Resources Information Center

Olasky, Marvin N.

1987-01-01

Discusses how (1) the "private relations" that existed between U.S. Steel and the government between 1930 and 1960 ended in steel crisis of 1962 and (2) this policy was viewed as inadequate by both an angry public and the Kennedy Administration when the steel industry tried to match foreign competition on quality and prices by raising…

Under-treatment of cancer pain.

PubMed

Fairchild, Alysa

2010-03-01

Cancer pain remains inadequately treated, despite internationally accepted management guidelines and a myriad of treatment options. Risk factors for undertreatment are reviewed, along with possible explanations. Recent studies documenting the scope of the problem as well as investigating solutions are discussed with clinical-practice recommendations outlined. Women over 65 years of age representative of a cultural minority, with earlier stage disease, cared for at home, and with high-school education or less are at highest risk of having uncontrolled cancer pain. Optimal treatment is impeded by patients' maladaptive beliefs, nonadherence, underreporting or miscommunication with caregivers; from a healthcare provider perspective, it may be due to inadequate assessment, documentation, knowledge, and communication. Emerging data support the vital influence of lay caregivers on appropriate pain management. Although home-education programs may decrease pain and improve quality of life, there are also less intensive approaches deliverable by individuals to holistically address pain. Prospective study of barriers to both delivery and receipt of adequate pain management is needed, as the majority of published literature is based on survey studies. Treatment must be individualized based on clinical circumstances and patient wishes, with the goal of maximizing function and quality of life.

Distress Tolerance Links Sleep Problems with Stress and Health in Homeless.

PubMed

Reitzel, Lorraine R; Short, Nicole A; Schmidt, Norman B; Garey, Lorra; Zvolensky, Michael J; Moisiuc, Alexis; Reddick, Carrie; Kendzor, Darla E; Businelle, Michael S

2017-11-01

We examined associations between sleep problems, distress intolerance, and perceived stress and health in a convenience sample of homeless adults. Participants (N = 513, 36% women, Mage = 44.5 ±11.9) self-reported sleep adequacy, sleep duration, unintentional sleep during the daytime, distress tolerance, urban stress, and days of poor mental health and days of poor physical health over the last month. The indirect effects of sleep problems on stress and health through distress tolerance were examined using a non-parametric, bias-corrected bootstrapping procedure. Sleep problems were prevalent (eg, 13.0 ±11.4 days of inadequate sleep and 4.7 ±7.9 days of unintentionally falling asleep during the preceding month). Distress intolerance partially accounted for the associations of inadequate sleep and unintentionally falling asleep, but not sleep duration, with urban stress and more days of poor mental and physical health. Many homeless individuals endure sleep problems. Given the connections between sleep and morbidity and mortality, results further support the need for more attention directed toward facilitating improvements in sleep quality to improve the quality of life of homeless adults, potentially including attention to improving distress tolerance skills.

Postmortem Biochemistry of Meat and Fish.

ERIC Educational Resources Information Center

Hultin, Herbert O.

1984-01-01

Discusses structural and chemical features of muscle tissue. Emphasizes chemical and physical changes which occur during processing and storage and how these changes affect the eating quality of meat and fish. (JN)

A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

PubMed

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

2016-01-01

The introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana. Electronic search was done for literature published between 2003-2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context. Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients' trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper. The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors.

A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

PubMed Central

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

2016-01-01

Background The introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana. Methods Electronic search was done for literature published between 2003–2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context. Results Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients’ trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper. Conclusions The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors. PMID:27832082

Semmelweis revisited: hand hygiene and nosocomial disease transmission in the anesthesia workstation.

PubMed

Biddle, Chuck

2009-06-01

Hospital-acquired infections occur at an alarmingly high frequency, possibly affecting as many as 1 in 10 patients, resulting in a staggering morbidity and an annual mortality of many tens of thousands of patients. Appropriate hand hygiene is highly effective and represents the simplest approach that we have to preventing nosocomial infections. The Agency for Healthcare Research and Quality has targeted hand-washing compliance as a top research agenda item for patient safety. Recent research has identified inadequate hand washing and contaminated anesthesia workstation issues as likely contributors to nosocomial infections, finding aseptic practices highly variable among providers. It is vital that all healthcare providers, including anesthesia providers, appreciate the role of inadequate hand hygiene in nosocomial infection and meticulously follow the mandates of the American Association of Nurse Anesthetists and other professional healthcare organizations.

Growing Problem of Multidrug-Resistant Enteric Pathogens in Africa

PubMed Central

Aboderin, Oladiipo A.; Byarugaba, Denis K.; Ojo, Kayode K.; Opintan, Japheth A.

2007-01-01

Control of fecal–orally transmitted pathogens is inadequate in many developing countries, in particular, in sub-Saharan Africa. Acquired resistance to antimicrobial drugs is becoming more prevalent among Vibrio cholerae, Salmonella enteritidis, diarrheagenic Escherichia coli, and other pathogens in this region. The poor, who experience most of the infections caused by these organisms, bear the brunt of extended illness and exacerbated proportion of deaths brought about by resistance. Improved antimicrobial drug stewardship is an often cited, but inadequately implemented, intervention for resistance control. Resistance containment also requires improvements in infectious disease control, access to and quality assurance of antimicrobial agents, as well as diagnostic facilities. Structural improvements along these lines will also enhance disease prevention and control as well as rational antimicrobial drug use. Additionally, more research is needed to identify low-cost, high-impact interventions for resistance control. PMID:18217545

Risk of Performance Decrement and Crew Illness Due to an Inadequate Food System

NASA Technical Reports Server (NTRS)

Douglas, Grace L.; Cooper, Maya; Bermudez-Aguirre, Daniela; Sirmons, Takiyah

2016-01-01

NASA is preparing for long duration manned missions beyond low-Earth orbit that will be challenged in several ways, including long-term exposure to the space environment, impacts to crew physiological and psychological health, limited resources, and no resupply. The food system is one of the most significant daily factors that can be altered to improve human health, and performance during space exploration. Therefore, the paramount importance of determining the methods, technologies, and requirements to provide a safe, nutritious, and acceptable food system that promotes crew health and performance cannot be underestimated. The processed and prepackaged food system is the main source of nutrition to the crew, therefore significant losses in nutrition, either through degradation of nutrients during processing and storage or inadequate food intake due to low acceptability, variety, or usability, may significantly compromise the crew's health and performance. Shelf life studies indicate that key nutrients and quality factors in many space foods degrade to concerning levels within three years, suggesting that food system will not meet the nutrition and acceptability requirements of a long duration mission beyond low-Earth orbit. Likewise, mass and volume evaluations indicate that the current food system is a significant resource burden. Alternative provisioning strategies, such as inclusion of bioregenerative foods, are challenged with resource requirements, and food safety and scarcity concerns. Ensuring provisioning of an adequate food system relies not only upon determining technologies, and requirements for nutrition, quality, and safety, but upon establishing a food system that will support nutritional adequacy, even with individual crew preference and self-selection. In short, the space food system is challenged to maintain safety, nutrition, and acceptability for all phases of an exploration mission within resource constraints. This document presents the evidence for the Risk of Performance Decrement and Crew Illness Due to an Inadequate Food System and the gaps in relation to exploration, as identified by the NASA Human Research Program (HRP). The research reviewed here indicates strategies to establish methods, technologies, and requirements that increase food stability, support adequate nutrition, quality, and variety, enable supplementation with grow-pick-and-eat salad crops, ensure safety, and reduce resource use. Obtaining the evidence to establish an adequate food system is essential, as the resources allocated to the food system may be defined based on the data relating nutritional stability and food quality requirements to crew performance and health.

U.S. dental students' attitudes toward research and science: impact of research experience.

PubMed

Holman, Shaina Devi; Wietecha, Mateusz S; Gullard, Angela; Peterson, Jon M B

2014-03-01

This study aimed to provide a first nationwide assessment of dental students' attitudes toward the importance of research and its integration into the dental curriculum. For this purpose, the American Association for Dental Research National Student Research Group developed an online survey that was distributed to 89 percent of U.S. dental students in May 2012. The survey consisted of twenty-one Likert-type items divided into three groups: importance of research in dentistry, barriers to research involvement, and exposure to research in the dental curriculum. There were 733 responses (3.9 percent response rate), including students in all stages of education representing fifty-eight out of sixty-one dental schools. Age and race/ethnic distributions corresponded with U.S. dental school enrollees. Results showed that 63 percent of respondents had conducted research before matriculation, and of the 34 percent that participated in research during dental school, only 27 percent were newcomers. Respondents strongly agreed that scientific research enabled their progress in dentistry. Inadequate time in the curriculum was an obstacle they perceived to research involvement during dental school. Respondents agreed that dental curricula emphasize evidence-based practices but may be inadequately teaching biostatistics and research methodologies. Students with research experience tended to have stronger positive opinions about the importance of research in dental education. Efforts to foster research in schools have been well received by students, but several issues remain for enriching dental education through greater involvement of students in research.

The interactive effects of housing and neighbourhood quality on psychological well-being.

PubMed

Jones-Rounds, McKenzie L; Evans, Gary W; Braubach, Matthias

2014-02-01

Many individuals are subject to the physically and mentally detrimental effects of living in substandard housing and inadequate neighbourhoods. We propose that better physical neighbourhood quality can partially offset some of the negative effects of poor housing quality on psychological well-being. Interviews and questionnaires were used to collect data in a cross-sectional study of housing quality, the state of the surrounding environment, and individual health and well-being for 5605 European adults from the Large Analysis and Review of European housing and health Status conducted by WHO in eight European cities. Multilevel random coefficient modelling was used to statistically analyse the main and interactive effects of housing quality and neighbourhood quality on psychological well-being. Socioeconomic status, employment status, gender and marital status were included as statistical controls. Substandard housing quality and poor neighbourhood quality each contribute to lower psychological well-being. Furthermore better neighbourhood quality buffers against the negative effects of poor housing quality on psychological well-being. These results fill a gap in research concerning the ability of neighbourhood quality to amplify or attenuate housing quality impacts on well-being.

Image Quality Assessment Using the Joint Spatial/Spatial-Frequency Representation

NASA Astrophysics Data System (ADS)

Beghdadi, Azeddine; Iordache, Răzvan

2006-12-01

This paper demonstrates the usefulness of spatial/spatial-frequency representations in image quality assessment by introducing a new image dissimilarity measure based on 2D Wigner-Ville distribution (WVD). The properties of 2D WVD are shortly reviewed, and the important issue of choosing the analytic image is emphasized. The WVD-based measure is shown to be correlated with subjective human evaluation, which is the premise towards an image quality assessor developed on this principle.

[THE VIRTUAL CYTOLOGIC SLIDES FOR EXTERNAL EVALUATION OF QUALITY OF IMPLEMENTATION OF CYTOLOGIC ANALYSES IN CLINICAL DIAGNOSTIC LABORATORIES: POSSIBILITIES AND PERSPECTIVES].

PubMed

Djangirova, T V; Shabalova, I P; Pronichev, A N; Polyakov, E V

2015-08-01

The article considers application of technology of analysis of cytological slides in external quality control of clinical diagnostic laboratories. The advantages of virtual slides are demonstrated against other applied technologies of external evaluation of quality i.e. slide plate and digital micro-photography. The conditions of formation of virtual slides for external evaluation of quality of clinical diagnostic laboratories. The technology of their application is described. The success of practical application of considered technology in the Federal system of external evaluation of quality is emphasized.

Polyvagal Theory and Developmental Psychopathology: Emotion Dysregulation and Conduct Problems from Preschool to Adolescence

PubMed Central

Beauchaine, Theodore P.; Gatzke-Kopp, Lisa; Mead, Hilary K.

2007-01-01

In science, theories lend coherence to vast amounts of descriptive information. However, current diagnostic approaches in psychopathology are primarily atheoretical, emphasizing description over etiological mechanisms. We describe the importance of Polyvagal Theory toward understanding the etiology of emotion dysregulation, a hallmark of psychopathology. When combined with theories of social reinforcement and motivation, Polyvagal Theory specifies etiological mechanisms through which distinct patterns of psychopathology emerge. In this paper, we summarize three studies evaluating autonomic nervous system functioning in children with conduct problems, ages 4-18. At all age ranges, these children exhibit attenuated sympathetic nervous system responses to reward, suggesting deficiencies in approach motivation. By middle school, this reward insensitivity is met with inadequate vagal modulation of cardiac output, suggesting additional deficiencies in emotion regulation. We propose a biosocial developmental model of conduct problems in which inherited impulsivity is amplified through social reinforcement of emotional lability. Implications for early intervention are discussed. PMID:17045726

The immune response to Nipah virus infection.

PubMed

Prescott, Joseph; de Wit, Emmie; Feldmann, Heinz; Munster, Vincent J

2012-09-01

Nipah virus has recently emerged as a zoonotic agent that is highly pathogenic in humans. Outbreaks have occurred regularly over the last two decades in South and Southeast Asia, where mortality rates reach as high as 100 %. The natural reservoir of Nipah virus has been identified as bats from the Pteropus family, where infection is largely asymptomatic. Human disease is characterized by both respiratory and encephalitic components, and thus far, no effective vaccine or intervention strategies are available. Little is know about how the immune response of either the reservoir host or incidental hosts responds to infection, and how this immune response is either inadequate or might contribute to disease in the dead-end host. Experimental vaccines strategies have given us some insight into the immunological requirements for protection. This review summarizes our current understanding of the immune response to Nipah virus infection and emphasizes the need for further research.

Constraints and spandrels of interareal connectomes

PubMed Central

Rubinov, Mikail

2016-01-01

Interareal connectomes are whole-brain wiring diagrams of white-matter pathways. Recent studies have identified modules, hubs, module hierarchies and rich clubs as structural hallmarks of these wiring diagrams. An influential current theory postulates that connectome modules are adequately explained by evolutionary pressures for wiring economy, but that the other hallmarks are not explained by such pressures and are therefore less trivial. Here, we use constraint network models to test these postulates in current gold-standard vertebrate and invertebrate interareal-connectome reconstructions. We show that empirical wiring-cost constraints inadequately explain connectome module organization, and that simultaneous module and hub constraints induce the structural byproducts of hierarchies and rich clubs. These byproducts, known as spandrels in evolutionary biology, include the structural substrate of the default-mode network. Our results imply that currently standard connectome characterizations are based on circular analyses or double dipping, and we emphasize an integrative approach to future connectome analyses for avoiding such pitfalls. PMID:27924867

Constraints and spandrels of interareal connectomes.

PubMed

Rubinov, Mikail

2016-12-07

Interareal connectomes are whole-brain wiring diagrams of white-matter pathways. Recent studies have identified modules, hubs, module hierarchies and rich clubs as structural hallmarks of these wiring diagrams. An influential current theory postulates that connectome modules are adequately explained by evolutionary pressures for wiring economy, but that the other hallmarks are not explained by such pressures and are therefore less trivial. Here, we use constraint network models to test these postulates in current gold-standard vertebrate and invertebrate interareal-connectome reconstructions. We show that empirical wiring-cost constraints inadequately explain connectome module organization, and that simultaneous module and hub constraints induce the structural byproducts of hierarchies and rich clubs. These byproducts, known as spandrels in evolutionary biology, include the structural substrate of the default-mode network. Our results imply that currently standard connectome characterizations are based on circular analyses or double dipping, and we emphasize an integrative approach to future connectome analyses for avoiding such pitfalls.

Climate services: Lessons learned and future prospects

NASA Astrophysics Data System (ADS)

Brasseur, Guy P.; Gallardo, Laura

2016-03-01

This perspective paper reviews progress made in the last decades to enhance the communication and use of climate information relevant to the political and economic decision process. It focuses, specifically, on the creation and development of climate services, and highlights a number of difficulties that have limited the success of these services. Among them are the insufficient awareness by societal actors of their vulnerability to climate change, the lack of relevant products and services offered by the scientific community, the inappropriate format in which the information is provided, and the inadequate business model adopted by climate services. The authors suggest that, to be effective, centers should host within the same center a diversity of staff including experts in climate science, specialists in impact, adaptation, and vulnerability, representatives of the corporate world, agents of the public service as well as social managers and communication specialists. The role and importance of environmental engineering is emphasized.

Polyvagal Theory and developmental psychopathology: emotion dysregulation and conduct problems from preschool to adolescence.

PubMed

Beauchaine, Theodore P; Gatzke-Kopp, Lisa; Mead, Hilary K

2007-02-01

In science, theories lend coherence to vast amounts of descriptive information. However, current diagnostic approaches in psychopathology are primarily atheoretical, emphasizing description over etiological mechanisms. We describe the importance of Polyvagal Theory toward understanding the etiology of emotion dysregulation, a hallmark of psychopathology. When combined with theories of social reinforcement and motivation, Polyvagal Theory specifies etiological mechanisms through which distinct patterns of psychopathology emerge. In this paper, we summarize three studies evaluating autonomic nervous system functioning in children with conduct problems, ages 4-18. At all age ranges, these children exhibit attenuated sympathetic nervous system responses to reward, suggesting deficiencies in approach motivation. By middle school, this reward insensitivity is met with inadequate vagal modulation of cardiac output, suggesting additional deficiencies in emotion regulation. We propose a biosocial developmental model of conduct problems in which inherited impulsivity is amplified through social reinforcement of emotional lability. Implications for early intervention are discussed.

The immune response to Nipah virus infection

PubMed Central

Prescott, Joseph; de Wit, Emmie; Feldmann, Heinz; Munster, Vincent J.

2012-01-01

Nipah virus has recently emerged as a zoonotic agent that is highly pathogenic in humans. Outbreaks have occurred regularly over the last two decades in South and Southeast Asia, where mortality rates reach as high as 100%. The natural reservoir of Nipah virus has been identified as bats from the Pteropus family, where infection is largely asymptomatic. Human disease is characterized by both respiratory and encephalitic components, and thus far, no effective vaccine or intervention strategies are available. Little is know about how the immune response of either the reservoir host or incidental hosts responds to infection, and how this immune response is either inadequate or might contribute to disease in the dead-end host. Experimental vaccines strategies have given us some insight into the immunological requirements for protection. This review summarizes our current understanding of the immune response to Nipah virus infection and emphasizes the need for further research. PMID:22669317

Implications of a Culturally Evolved Self for Notions of Free Will

PubMed Central

Robertson, Lloyd Hawkeye

2017-01-01

Most schools in psychology have emphasized individual choice despite evidence of genetic and cultural determinism. It is suggested in this paper that the rejection of classical behaviorism by psychology and other humanities flowed from deeply held cultural assumptions about volition and free will. While compatibilists have suggested that notions of free will and determinism are not mutually exclusive, the psychological mechanisms by which such an accommodation could be explained have been inadequately explored. Drawing on research into classical cultures, this paper builds an argument that the notion of free will was adaptive flowing from culturally evolved changes to the self, and that this “evolved self,” containing assumptions of personal volition, continuity, and reason, became benchmarks of what it means to be human. The paper proposes a model of a culturally evolved self that is compatible with understandings of free will and determinism. Implications for therapeutic practice and future research are discussed. PMID:29163273

Pediatric pleural empyema: one of the management challenges in children of Democratic Republic of Congo.

PubMed

Simbi, Kibwe Alphonse; Kazadi, Valentin; Aissi, Louis-Marie; Katsuva, François Mbahewaka; Luboya, Numbi Oscar; Tshilolo, Léon; Zanardo, Vincenzo

2017-06-23

Empyema is a serious complication characterized by purulent exudate and bacteria in the pleural space, which may progress to necrosis, cavitations or fistulas in the thoracic cavity. It remains a major challenge throughout low-income countries. Objectives were to emphasize the role of basic medical and radiologic approach and to resolve a severe lung complication when facilities are inadequate. A five-year-old female was referred with distress respiratory to the Emergency Unit of Monkole, a large public-private missionary hospital in Kinshasa, Congo. Chest X-ray showed a massive empyema that was resolved by immediate drainage and antibiotiocs. Results were rapid improvement and discharge after 3 weeks. A classic medical and imaging approach is a winning return in low-income countries. According to the British Thoracic Society guidelines, pleural effusion with compromising respiratory function can be managed by drainage and antibiotics.

Quality of Life in Caregivers of ADHD Children and Diabetes Patients.

PubMed

Andrade, Elisa Meirelles; Geha, Laysa Minella; Duran, Paula; Suwwan, Raphael; Machado, Felipe; do Rosário, Maria Conceição

2016-01-01

Studies have shown that the presence of attention-deficit hyperactivity disorder (ADHD) causes great impairment in academic, social, and professional activities as well as in the quality of life (QoL) of its patients. Similarly, the impact caused by other chronic disorders, such as diabetes, in the patient's QoL has been emphasized in many studies. Despite its relevance, no study has yet investigated whether ADHD caregivers and diabetic patients would have similar QoL impairment. This study was conducted in order to compare the QoL scores among ADHD caregivers and diabetic patients. We evaluated 63 caregivers of ADHD children treated at the Child and Adolescent Psychiatric Unit at the Federal University of São Paulo (UPIA-UNIFESP) and 52 adult diabetic patients. Subjects were assessed with the World Health Organization quality of Life-Bref Version (WHOQOL-BREF), the Beck and Hamilton depression scales, and the Adult Self-Report Scale. When compared to the Brazilian normative data, ADHD caregivers had significantly lower scores in the social relations and environment WHOQOL domains. ADHD caregivers and diabetic patients had similar impairment in all WHOQOL domains except for the physical domain. ADHD affects the QoL of the patient's caregiver, with similar impairment, when compared to the QoL of diabetic patients. These results emphasize the need for assessing QoL of the caregivers as part of the treatment strategies. They also emphasize the need for future studies with larger sample sizes comparing how the QOL is impacted in different chronic disorders.

A M-Health Platform for Supporting Clinical Data Integration and Service Delivery: An Example from Augmentative and Alternative Communication Intervention

ERIC Educational Resources Information Center

Wang, Erh-Hsuan

2016-01-01

Improving the quality of healthcare while simultaneously reducing its overall costs remains a challenge. One of the recommended approaches for achieving this goal is to build high quality data collection and reporting systems to facilitate evidence-based practice (EBP), which emphasizes the importance of using the solid evidence available to make…

Improving decision making in multidisciplinary tumor boards: prospective longitudinal evaluation of a multicomponent intervention for 1,421 patients.

PubMed

Lamb, Benjamin W; Green, James S A; Benn, Jonathan; Brown, Katrina F; Vincent, Charles A; Sevdalis, Nick

2013-09-01

Due to its complexity, cancer care is increasingly being delivered by multidisciplinary tumor boards (MTBs). Few studies have investigated how best to organize and run MTBs to optimize clinical decision making. We developed and evaluated a multicomponent intervention designed to improve the MTB's ability to reach treatment decisions. We conducted a prospective longitudinal study during 16 months that evaluated MTB decision making for urological cancer patients at a university hospital in London, UK. After a baseline period, MTB improvement interventions (eg, MTBs checklist, MTB team training, and written guidance) were delivered sequentially. Outcomes measures were the MTB's ability to reach a decision, the quality of information presentation, and the quality of teamwork (as assessed by trained assessors using a previously validated observational assessment tool). The efficacy of the intervention was evaluated using multivariate analyses. There were 1,421 patients studied between December 2009 and April 2, 2011. All outcomes improved considerably between baseline and intervention implementation: the MTB's ability to reach a decision rose from 82.2% to 92.7%, quality of information presentation rose from 29.6% to 38.3%, and quality of teamwork rose from 37.8% to 43.0%. The MTB's ability to reach a treatment decision was related to the quality of available information (r = 0.298; p < 0.05) and quality of teamwork within the MTB (r = 0.348; p < 0.05). The most common barriers to reaching clinical decisions were inadequate radiologic information (n = 77), inadequate pathologic information (n = 51), and inappropriate patient referrals (n = 21). Multidisciplinary tumor board-delivered treatment is becoming the standard for cancer care worldwide. Our intervention is efficacious and applicable to MTBs and can improve decision making and expedite cancer care. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Nuclear safety: is NRC enforcement working. Hearing before a Subcommittee of the Committee on Government Operations, House of Representatives, Ninety-Seventh Congress, First Session, December 14, 1981

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

Not Available

Nunzio Palladino, the new Chairman of the Nuclear Regulatory Commission, and associates testified at this hearing on the effectiveness of NRC's enforcement program and responded to allegations that quality assurance is inadequate. At issue were the value of NRC fines as a deterrent to utility misconduct and the NRC's reluctance to pursue new provisions for criminal penalties. Mr. Palladino was welcomed and applauded for his strong statements on the nuclear industry's need for strict quality control. (DCK)

On evaluating compliance with air pollution levels 'not to be exceeded more than once per year'

NASA Technical Reports Server (NTRS)

Neustadter, H. E.; Sidik, S. M.

1974-01-01

The point of view taken is that the Environmental Protection Agency (EPA) Air Quality Standards (AQS) represent conditions which must be made to exist in the ambient environment. The statistical techniques developed should serve as tools for measuring the closeness to achieving the desired quality of air. It is shown that the sampling frequency recommended by EPA is inadequate to meet these objectives when the standard is expressed as a level not to be exceeded more than once per year and sampling frequency is once every three days or less frequent.

Public accountability for health: new standards for health system performance.

PubMed

Lansky, D; Purdy, S

1995-01-01

This article reviews the failure of contemporary quality oversight organizations to respond to the changing health care environment and suggests an overhaul of quality measurement and assurance functions. The authors examine the factors that have limited public accountability for health care, emphasizing the limited agreement that exists on the purpose of American health care, standards for evaluating care, or the appropriate locus of responsibility for quality of care. A five-part quality oversight system is proposed including development of quality measures, promulgation of national standards, validation and accreditation, use of data for purchasing and provider selection, and use of data for quality improvement.

Methods for assessing the quality of data in public health information systems: a critical review.

PubMed

Chen, Hong; Yu, Ping; Hailey, David; Wang, Ning

2014-01-01

The quality of data in public health information systems can be ensured by effective data quality assessment. In order to conduct effective data quality assessment, measurable data attributes have to be precisely defined. Then reliable and valid measurement methods for data attributes have to be used to measure each attribute. We conducted a systematic review of data quality assessment methods for public health using major databases and well-known institutional websites. 35 studies were eligible for inclusion in the study. A total of 49 attributes of data quality were identified from the literature. Completeness, accuracy and timeliness were the three most frequently assessed attributes of data quality. Most studies directly examined data values. This is complemented by exploring either data users' perception or documentation quality. However, there are limitations of current data quality assessment methods: a lack of consensus on attributes measured; inconsistent definition of the data quality attributes; a lack of mixed methods for assessing data quality; and inadequate attention to reliability and validity. Removal of these limitations is an opportunity for further improvement.

Critical maternal health knowledge gaps in low- and middle-income countries for the post-2015 era.

PubMed

Kendall, Tamil; Langer, Ana

2015-06-05

Effective interventions to promote maternal health and address obstetric complications exist, however 800 women die every day during pregnancy and childbirth from largely preventable causes and more than 90% of these deaths occur in low and middle income countries (LMIC). In 2014, the Maternal Health Task Force consulted 26 global maternal health researchers to identify persistent and critical knowledge gaps to be filled to reduce maternal morbidity and mortality and improve maternal health. The vision of maternal health articulated was comprehensive and priorities for knowledge generation encompassed improving the availability, accessibility, acceptability, and quality of institutional labor and delivery services and other effective interventions, such as contraception and safe abortion services. Respondents emphasized the need for health systems research to identify models that can deliver what is known to be effective to prevent and treat the main causes of maternal death at scale in different contexts and to sustain coverage and quality over time. Researchers also emphasized the development of tools to measure quality of care and promote ongoing quality improvement at the facility, district, and national level. Knowledge generation to improve distribution and retention of healthcare workers, facilitate task shifting, develop and evaluate training models to improve "hands-on" skills and promote evidence-based practice, and increase managerial capacity at different levels of the health system were also prioritized. Interviewees noted that attitudes, behavior, and power relationships between health professionals and within institutions must be transformed to achieve coverage of high-quality maternal health services in LMIC. The increasing burden of non-communicable diseases, urbanization, and the persistence of social and economic inequality were identified as emerging challenges that require knowledge generation to improve health system responses and evaluate progress. Respondents emphasized evaluating effectiveness, feasibility, and equity impacts of health system interventions. A prominent role for implementation science, evidence for policy advocacy, and interdisciplinary collaboration were identified as critical areas for knowledge generation to improve maternal health in the post-2015 era.

Factors Associated With Inadequate Effectiveness of a Multidisciplinary Disease Management Program in Heart Failure Patients Stratified by Galectin 3 Level.

PubMed

Liu, Min-Hui; Wang, Chao-Hung; Chiou, Ai-Fu; Yang, Ning-I; Kuo, Li-Tang

2016-07-21

This study investigated whether multidisciplinary disease management programs (MDPs) exert the same effects in heart failure (HF) patients across risk levels stratified by galectin-3 (Gal-3) level and what factors are associated with inadequate effectiveness of MDP. We used a longitudinal follow-up design based on a previous randomized trial. A total of 355 stabilized hospitalized HF patients were enrolled. The effects of MDP on death and HF-related rehospitalization were analyzed according to Gal-3 levels. During the 4-year follow-up, Gal-3 levels predicted mortality and composite events (p < .001). Multivariable analysis demonstrated the event-lowering effect of MDP (hazard ratio [HR] = 0.49, p = .001 for death and HR = 0.50, p < .001 for composite events). However, the effect of MDP was inadequate for those with high Gal-3 levels (≥17.9 ng/ml), whose 4-year composite event rate was 43% in the MDP arm. Further analysis showed that, in patients with Gal-3 ≥ 17.9 ng/ml, the independent factors associated with a high composite event rate were no MDP, older age, worse New York Heart Association functional class, no angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use, higher predischarge natriuretic peptide levels, and wider QRS complexes. The effectiveness of MDP for HF patients at high risk was inadequate. Our findings identified the characteristics of these MDP nonresponders. Better integration of advanced care plans based on strategies guided by Gal-3 level is needed to improve care quality. © The Author(s) 2016.

Racial and ethnic differences in lymph node examination after colon cancer resection do not completely explain disparities in mortality.

PubMed

Rhoads, Kim F; Cullen, Jennifer; Ngo, Justine V; Wren, Sherry M

2012-01-15

In 1999, a multidisciplinary panel of experts in colorectal cancer reviewed the relevant medical literature and issued a consensus recommendation for a 12-lymph node (LN) minimum examination after resection for colon cancer. Some authors have shown racial/ethnic differences in receipt of this evidence-based care. To date, however, none has investigated the correlation between disparities in LN examination and disparities in outcomes after colon cancer treatment. This retrospective analysis used California Cancer Registry linked to California Office of Statewide Health Planning and Development discharge data (1996-2006). Chi-square analysis, logistic regression, and Cox proportional hazard models predicted disparities in receipt of an adequate examination and the effect of an inadequate exam on mortality and disparities. Patients with stage I and II colon cancers undergoing surgery in California were included; patients with stage III and IV disease were excluded. A total of 37,911 records were analyzed. Adequate staging occurred in fewer than half of cases. An inadequate examination (<12 LNs) was associated with higher mortality rates. Hispanics had the lowest odds of receiving an adequate exam; however, blacks, not Hispanics, had the highest risk of mortality compared with whites. This disparity was not completely explained by inadequate LN examination. Inadequate LN exam occurs often and is associated with increased mortality. There are disparities in receipt of the minimum exam, but this only explains a small part of the observed disparity in mortality. Improving the quality of LN examination alone is unlikely to correct colon cancer disparities. Copyright © 2011 American Cancer Society.

Are we doing enough to prevent poor-quality antimalarial medicines in the developing world?

PubMed

Walker, Erin J; Peterson, Gregory M; Grech, James; Paragalli, Evie; Thomas, Jackson

2018-05-15

Malaria is a deadly parasitic disease that affects more than 3 billion people worldwide, in predominantly resource-poor countries. Despite malaria being preventable and treatable, a large number of adults and children, mostly in Africa, die from this disease each year. One contributor to needless morbidity and mortality is the production and distribution of poor-quality antimalarial medicines; indeed, it is estimated that over 122,000 deaths of children under 5 years of age in sub-Saharan countries were caused by poor-quality antimalarial medicines, in 2013 alone. Poor-quality medicines include those that are deliberately falsified for monetary gain and may contain incorrect amounts or even no active ingredients at all, as well as products that are inadequate due to poor compliance to conventional quality standards and medicines that have degraded over time. Across a number of studies it has been reported that 4-92% of antimalarials tested are poor quality. This represents a massive risk to the population subjected to the use of these medicines, in the form of more severe and prolonged illness, additional costs to individuals who already have very little money, and lack of confidence in treatments. The continuing circulation of poor-quality medicines results from a number of factors, including insufficient regulatory capacity in susceptible countries, inadequate funding to perform regulatory functions, poor coordination between regulatory authorities, and inefficient import/export control systems. To combat the distribution of poor-quality medicines a number of organisations have developed guidelines for the procurement of antimalarials, and programs to educate consumers about the risks of poor-quality medicines and incentivise retailers to identify and report falsified medicines. The development of new technologies to quickly identify poor-quality medicines in the field is also essential, and some significant advances have been made. There has been considerable improvement in the delivery of high-quality antimalarials to those who need them; however, there is still an urgent need for a collective response by the international community, political leaders, regulatory bodies, and pharmaceutical companies. This should include political commitment for enhanced research and development funding, such as for new innovative track-and-trace field devices, and international efforts to strengthen and harmonise drug regulation practices.

Adapting Japanese Lesson Study to Enhance the Teaching and Learning of Geometry and Spatial Reasoning in Early Years Classrooms: A Case Study

ERIC Educational Resources Information Center

Moss, Joan; Hawes, Zachary; Naqvi, Sarah; Caswell, Beverly

2015-01-01

Increased efforts are needed to meet the demand for high quality mathematics in early years classrooms. Despite the foundational role of geometry and spatial reasoning for later mathematics success, the strand receives inadequate instructional time and is limited to concepts of static geometry. Moreover, early years teachers typically lack both…

Establishment and Growth of Cherrybark Oak Seedlings Underplanted Beneath a Partial Overstory in a Minor Bottom of Southwestern Arkansas: First Year Results

Treesearch

Emile S. Gardiner; Jimmie L. Yeiser

1999-01-01

Advance regeneration is frequently inadequate to sufficiently restock the oak component of many bottomland stands, especially on productive sites with high levels of competition. We initiated a study near Beime, AR to examine the effects of pre-plant control of Japanese honeysuckle (Lonicera japonica Thunberg) and seedling quality on establishment...

Character Development: Encouraging Self-Esteem & Self-Discipline in Infants, Toddlers, and Two-Year-Olds.

ERIC Educational Resources Information Center

Greenberg, Polly

With the goal of maintaining settings most conducive to helping each child develop optimally, the essays in this book delve into realistic ways in which child care providers can move from providing inadequate or merely adequate day care to providing high quality center-based or family child care. Most of the 12 essays begin with a question or…

If GDP Is Not the Answer, What Is the Question? The Juncture of Capabilities, Institutions and Measurement in the Stiglitz-Sen-Fitoussi Report

ERIC Educational Resources Information Center

Tsai, Ming-Chang

2011-01-01

This review essay offers an institutional critique of the Stiglitz-Sen-Fitoussi Report. The notion of human capabilities and functionings advocated by the Report demonstrates an inspirational perspective to monitor human progress in quality of life (QoL). Several measurements the Report suggested remain inadequate. The personal diary techniques…

Housing Satisfaction Related to Health and Importance of Services in Urban Slums: Evidence from Dhaka, Bangladesh

ERIC Educational Resources Information Center

Zanuzdana, Arina; Khan, Mobarak; Kraemer, Alexander

2013-01-01

Quality of housing plays one of the key roles in a public health research, since inadequate housing may have direct or indirect negative impact on health. Higher satisfaction with housing was shown to be associated with higher income, higher age, a smaller family, higher education, being female and being an owner of a dwelling. The aim of our…

Circadian Biology and Sleep: Missing Links in Obesity and Metabolism

DTIC Science & Technology

2009-05-01

Department of Defense, Washington Headquarters Services , Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite...Army and academic laboratories, both national and international . Much of the information related at the symposium will be made available to the...deprivation to increase appetite by decreasing leptin and increasing ghrelin levels. Inadequate sleep and poor- quality sleep are associated with obesity in

No Preschooler Left Behind: The Need for High Quality Early Intervention for Children Born into Poverty

ERIC Educational Resources Information Center

Schippers, Vicky

2014-01-01

It is a sad fact that children born into poverty are far less likely to perform well in school and to finish school. Their inadequate schooling then negatively affects their degree of economic success at a large cost to society. The author--a professional tutor for underachieving students at PS 8 and Brooklyn High School for Leadership and…

Health services reform in Bangladesh: hearing the views of health workers and their professional bodies.

PubMed

Cockcroft, Anne; Milne, Deborah; Oelofsen, Marietjie; Karim, Enamul; Andersson, Neil

2011-12-21

In Bangladesh, widespread dissatisfaction with government health services did not improve during the Health and Population Sector Programme (HPSP) reforms from 1998-2003. A 2003 national household survey documented public and health service users' views and experience. Attitudes and behaviour of health workers are central to quality of health services. To investigate whether the views of health workers influenced the reforms, we surveyed local health workers and held evidence-based discussions with local service managers and professional bodies. Some 1866 government health workers in facilities serving the household survey clusters completed a questionnaire about their views, experience, and problems as workers. Field teams discussed the findings from the household and health workers' surveys with local health service managers in five upazilas (administrative sub-districts) and with the Bangladesh Medical Association (BMA) and Bangladesh Nurses Association (BNA). Nearly one half of the health workers (45%) reported difficulties fulfilling their duties, especially doctors, women, and younger workers. They cited inadequate supplies and infrastructure, bad behaviour of patients, and administrative problems. Many, especially doctors (74%), considered they were badly treated as employees. Nearly all said lack of medicines in government facilities was due to inadequate supply, not improved during the HPSP. Two thirds of doctors and nurses complained of bad behaviour of patients. A quarter of respondents thought quality of service had improved as a result of the HPSP.Local service managers and the BMA and BNA accepted patients had negative views and experiences, blaming inadequate resources, high patient loads, and patients' unrealistic expectations. They said doctors and nurses were demotivated by poor working conditions, unfair treatment, and lack of career progression; private and unqualified practitioners sought to please patients instead of giving medically appropriate care. The BMA considered it would be dangerous to attempt to train and register unqualified practitioners. The continuing dissatisfaction of health workers may have undermined the effectiveness of the HPSP. Presenting the views of the public and service users to health managers helped to focus discussions about quality of services. It is important to involve health workers in health services reforms.

Health services reform in Bangladesh: hearing the views of health workers and their professional bodies

PubMed Central

2011-01-01

Background In Bangladesh, widespread dissatisfaction with government health services did not improve during the Health and Population Sector Programme (HPSP) reforms from 1998-2003. A 2003 national household survey documented public and health service users' views and experience. Attitudes and behaviour of health workers are central to quality of health services. To investigate whether the views of health workers influenced the reforms, we surveyed local health workers and held evidence-based discussions with local service managers and professional bodies. Methods Some 1866 government health workers in facilities serving the household survey clusters completed a questionnaire about their views, experience, and problems as workers. Field teams discussed the findings from the household and health workers' surveys with local health service managers in five upazilas (administrative sub-districts) and with the Bangladesh Medical Association (BMA) and Bangladesh Nurses Association (BNA). Results Nearly one half of the health workers (45%) reported difficulties fulfilling their duties, especially doctors, women, and younger workers. They cited inadequate supplies and infrastructure, bad behaviour of patients, and administrative problems. Many, especially doctors (74%), considered they were badly treated as employees. Nearly all said lack of medicines in government facilities was due to inadequate supply, not improved during the HPSP. Two thirds of doctors and nurses complained of bad behaviour of patients. A quarter of respondents thought quality of service had improved as a result of the HPSP. Local service managers and the BMA and BNA accepted patients had negative views and experiences, blaming inadequate resources, high patient loads, and patients' unrealistic expectations. They said doctors and nurses were demotivated by poor working conditions, unfair treatment, and lack of career progression; private and unqualified practitioners sought to please patients instead of giving medically appropriate care. The BMA considered it would be dangerous to attempt to train and register unqualified practitioners. Conclusions The continuing dissatisfaction of health workers may have undermined the effectiveness of the HPSP. Presenting the views of the public and service users to health managers helped to focus discussions about quality of services. It is important to involve health workers in health services reforms. PMID:22375856

Quality assurance and gastrointestinal endoscopy: an audit of 500 colonoscopic procedures.

PubMed

Denis, Bernard; Weiss, Anne-Marie; Peter, André; Bottlaender, Jacques; Chiappa, Pascale

2004-12-01

The aim of this study was to assess the quality of colonoscopic procedures in our endoscopy unit with the goal of improving performance. We prospectively audited 500 consecutive colonoscopic procedures and assessed sixty-two process or outcome indicators for each procedure. Most of the measured indicators were within standard limits: cecal intubation rate (92%), inadequate bowel preparations (24%), inappropriate procedures (9.7%), normal procedures (54%), yield for neoplasia (32%), morbidity (0.4%), and overall patient satisfaction (95.8%). Some indicators were outside standard limits suggesting our practices should be modified: endoscopy withdrawal time less than 6 minutes (78%), forceps removal of polyps (31%), resected polyps not recovered for pathological examination (12%), adenomas with villous elements (22%), patients unsatisfied because of time spent waiting for the procedure (19%), patients unsatisfied because of inadequate explanations (10%). There was no standard for a few indicators: patient discomfort (6.9%), diagnostic success (89%), therapeutic success (92%). Three new indicators were proposed: proportion of patients aged<50 years, number of normal colonoscopic procedures to perform to detect one advanced adenoma or cancer, and proportion of colonoscopic procedures causing discomfort. The diagnostic yield of colonoscopy was dependent on age, gender, indication and appropriateness of indication but not on the prescriber. This audit allowed us to evaluate our endoscopic practices and to detect certain shortcomings and deviations from standards. It enabled us to change some of our practices with the goal of improving the quality of our colonoscopic procedures.

A framework for evaluating student perceptions of health policy training in medical school.

PubMed

Patel, Mitesh S; Lypson, Monica L; Miller, D Douglas; Davis, Matthew M

2014-10-01

Nearly half of graduating medical students in the United States report that medical school provides inadequate instruction in topics related to health policy. Although most medical schools report some form of policy education, there lacks a standard for teaching core concepts and evaluating student satisfaction. Responses to the Association of American Medical College's Medical School Graduation Questionnaire were obtained for the years 2007-2008 and 2011-2012 and mapped to domains of training in health policy curricula for four domains: systems and principles; value and equity; quality and safety; and politics and law. Chi-square tests were used to test differences among unadjusted temporal trends. Multiple logistic regression models were fit to the outcome variables and adjusted for student characteristics, student preferences, and medical school characteristics. Compared with 2007-2008, students' perceptions of training in 2011-2012 increased on a relative basis by 11.7% for components within systems and principles, 2.8% for quality and safety, and 6.8% for value and equity. Components within politics and law had a composite decline of 4.8%. Multiple logistic regression models found higher odds of reporting satisfaction with training over time for all components within the domains of systems and principles, quality and safety, and value and equity (P < .01), with the exception of medical economics. Medical student perceptions of training in health policy improved over time. Causal factors for these trends require further study. Despite improvement, nearly 40% of graduating medical students still report inadequate instruction in health policy.

Problems with provision: barriers to drinking water quality and public health in rural Tasmania, Australia.

PubMed

Whelan, Jessica J; Willis, Karen

2007-01-01

Access to safe drinking water is essential to human life and wellbeing, and is a key public health issue. However, many communities in rural and regional parts of Australia are unable to access drinking water that meets national standards for protecting human health. The aim of this research was to identify the key issues in and barriers to the provision and management of safe drinking water in rural Tasmania, Australia. Semi-structured interviews were conducted with key local government employees and public health officials responsible for management of drinking water in rural Tasmania. Participants were asked about their core public health duties, regulatory responsibilities, perceptions and management of risk, as well as the key barriers that may be affecting the provision of safe drinking water. This research highlights the effect of rural locality on management and safety of fresh water in protecting public health. The key issues contributing to problems with drinking water provision and quality identified by participants included: poor and inadequate water supply infrastructure; lack of resources and staffing; inadequate catchment monitoring; and the effect of competing land uses, such as forestry, on water supply quality. This research raises issues of inequity in the provision of safe drinking water in rural communities. It highlights not only the increasing need for greater funding by state and commonwealth government for basic services such as drinking water, but also the importance of an holistic and integrated approach to managing drinking water resources in rural Tasmania.

Improvement of quality of life and survival using self-expandable metal stent placement for severe malignant stenosis of the gastric body: a case report.

PubMed

Kumagai, Hozumi; Nio, Kenta; Shirakawa, Tsuyoshi; Uchino, Keita; Kusaba, Hitoshi; Isobe, Taichi; Komoda, Masato; Tamura, Shingo; Maeyama, Ryo; Nagai, Eishi; Akashi, Koichi; Baba, Eishi

2012-09-19

Advanced gastric carcinoma often decreases quality of life because of upper gastrointestinal tract stenosis. Self-expandable metal stents have been thought to be an effective, minimally invasive treatment for stenosis. However, the effectiveness of self-expandable metal stent placement for carcinomatous stenosis of the gastric body and antrum has not been clarified, and there have been few reports of such cases. A 74-year-old Japanese woman developed stenosis of the gastric body and antrum caused by advanced gastric cancer during first-line chemotherapy. She developed weight loss and poor nutrition due to inadequate intake. Self-expandable metal stent placement for stenosis of the gastric body and antrum ameliorated her symptoms rapidly and improved her general condition and quality of life. Eight days after self-expandable metal stent placement, second-line chemotherapy could be administered safely. Oral intake and nutritional status were maintained for 117 days after self-expandable metal stent placement, and she died of gastric cancer 176 days after self-expandable metal stent placement and initiation of second-line chemotherapy. Self-expandable metal stent placement for carcinomatous stenosis in the gastric body and antrum could be an effective therapeutic strategy for patients with inadequate oral uptake. It may provide rapid improvement of the patient's general condition and oral intake with minimal complications, comparatively long-term symptom relief, and a survival benefit by allowing second-line chemotherapy.

Chronic sleep reduction is associated with academic achievement and study concentration in higher education students.

PubMed

van der Heijden, Kristiaan B; Vermeulen, Marije C M; Donjacour, Claire E H M; Gordijn, Marijke C M; Hamburger, Hans L; Meijer, Anne M; van Rijn, Karin J; Vlak, Monique; Weysen, Tim

2018-04-01

Inadequate sleep impairs cognitive function and has been associated with worse academic achievement in higher education students; however, studies that control for relevant background factors and include knowledge on sleep hygiene are scarce. This study examined the association of chronic sleep reduction (i.e. symptoms of chronic sleep reduction such as shortness of sleep, sleepiness and irritation), subjective sleep quality and sleep hygiene knowledge with academic achievement (grades and study credits) and study concentration among 1378 higher education students (71% female, mean age 21.73 years, SD = 3.22) in the Netherlands. Demographic, health, lifestyle and study behaviour characteristics were included as covariates in hierarchical regression analyses. After controlling for significant covariates, only chronic sleep reduction remained a significant predictor of lower grades (last exam, average in current academic year). Better sleep quality and sleep hygiene knowledge were associated with better academic achievement, but significance was lost after controlling for covariates, except for a remaining positive association between sleep hygiene beliefs and grades in the current academic year. Moreover, better sleep quality and lower scores on chronic sleep reduction were associated with better study concentration after controlling for significant covariates. To conclude, chronic sleep reduction is associated with academic achievement and study concentration in higher education students. Inadequate sleep hygiene knowledge is moderately associated with worse academic achievement. Future research should investigate whether sleep hygiene interventions improve academic achievement in students of higher education. © 2017 European Sleep Research Society.

A Systematic Evaluation of Websites Offering Information on Chronic Kidney Disease

PubMed Central

Lutz, Erin R.; Costello, Kaitlin L.; Jo, Minjeong; Gilet, Constance A.; Hawley, Jennifer M.; Bridgman, Jessica C.; Song, Mi-Kyung

2014-01-01

In this study, we described the content and characteristics of 40 non-proprietary websites offering information about chronic kidney disease (CKD) and evaluated their information quality using the DISCERN scale and readability using Flesch Reading Ease and Flesch-Kincaid grade level. The areas in which the websites scored the lowest on the DISCERN scale were whether the website discussed knowledge gaps, presented balanced information, and was clear about the information source. Websites that rated higher quality on the DISCERN scale were more difficult to read. The quality and readability of many websites about CKD to be used as meaningful educational resources for patients who desire to learn more about CKD and treatment options remain inadequate. PMID:25244890

Priority for a Quality Basic Education. A First Report to Governor Joe Frank Harris and the Georgia General Assembly.

ERIC Educational Resources Information Center

Georgia Governor's Education Review Commission, Atlanta.

This report defines what is meant by quality basic education in Georgia and makes numerous recommendations for achieving it for all Georgians. The recommendations are that: (1) basic skills and general job skills be emphasized in vocational education; (2) the salary base for teachers be increased; (3) a five plateau teacher career ladder be…

Factors Contributed by Community Organizations to the Motivation of Teachers in Rural Punjab, Pakistan, and Implications for the Quality of Teaching

ERIC Educational Resources Information Center

Barrs, J.

2005-01-01

The double-edged sword of Jomtien (1990), which emphasized access to education, and of Dakar (2000), which placed additional emphasis on the quality of education, the Holy Grail, provides the context for the expansion of education in developing countries. One of the most frequently espoused ingredients for success is good governance. The…

Vouchers for primary healthcare services in an ageing world? The perspectives of elderly voucher recipients in Hong Kong.

PubMed

Lai, Angel Hor-Yan; Kuang, Zoey; Yam, Carrie Ho-Kwan; Ayub, Shereen; Yeoh, Eng-Kiong

2018-05-01

Considering the ageing population in economically advanced regions across the world, measures are necessary to enhance the health of the older population as well as contain public healthcare spending. Hong Kong implements the Elderly Health Care Voucher Scheme (EHCVS), providing older people aged 65 or above an annual subsidy of visiting private healthcare service providers for chronic disease prevention and management. The services also aim at reallocating demand from the public to private sector as well as improve quality of services. This qualitative study explored the experiences of EHCVS recipients (n = 55, aged 61-94) with eight focus group interviews in Hong Kong in the year 2016. Convenience sampling was used. Research questions were: (1) Why do older people choose not to use EHCVS for preventive as well as disease management services among older people in Hong Kong? (2) What are the barriers to reallocating demand from the public to private sector? (3) In what ways did EHCVS improve the quality of primary care services for older people? Using a deductive and inductive approach, eight qualitative themes were identified. Findings suggested that the non-targeted services and inadequate knowledge on EHCVS deterred older people from using the vouchers for disease management and prevention. The relatively expensive private services, lack of trust in the private sector, low public clinic fees and good services quality of the public sector, together with inadequate private practitioners in the healthcare market were barriers that hinder demand reallocation. Nevertheless, the quality of primary care services had been improved after the implementation of EHCVS with shortened wait times and opportunities to discuss health-related issues with private practitioners. Findings were discussed with practice, policy and research implications. © 2017 John Wiley & Sons Ltd.

Nutrition quality control in the prescription and administration of parenteral nutrition therapy for hospitalized patients.

PubMed

Shiroma, Glaucia Midori; Horie, Lilian Mika; Castro, Melina Gouveia; Martins, Juliana R; Bittencourt, Amanda F; Logullo, Luciana; Teixeira da Silva, Maria de Lourdes; Waitzberg, Dan L

2015-06-01

Nutrition quality control in parenteral nutrition therapy (PNT) allows the identification of inadequate processes in parenteral nutrition (PN). The objective of this study was to assess the quality of PNT at a hospital with an established nutrition support team (NST). This observational, longitudinal, analytical, and prospective study examined 100 hospitalized PNT adult patients under the care of an NST for 21 days or until death/hospital discharge. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) 2007 guidelines for PNT prescription were followed. PNT indications were not in accordance with the A.S.P.E.N. 2007 guidelines in 15 patients. Among the remaining 85 patients, 48 (56.5%) did not receive adequate PNT (≥80% of the total volume prescribed). Non-NST medical orders, progression to and from enteral nutrition, changes in the central venous catheter, unknown causes, and operational errors (eg, medical prescription loss, PN nondelivery, pharmacy delays, inadequate PN bag temperature) were associated with PNT inadequacy (P < .005). Compared with patients who died, the discharged patients received PN volumes ≥80% on most days (P = .047). The quality indicators for nutrition therapy related to estimated energy expenditure and protein requirements and glycemia levels reached the expected targets; however, the central venous catheter infection rate was higher than 6 per 1000 catheters/d and did not meet the expected targets. Despite an established NST, there was a moderate level of PNT inadequacy in indications, administration, and monitoring. It is important to establish periodic meetings among different health professionals who prescribe and deliver PNT to define responsibilities and protocols. © 2015 American Society for Parenteral and Enteral Nutrition.

Keratoprosthesis: preliminary results of an artificial corneal button as a full-thickness implant in the rabbit model.

PubMed

Hicks, C R; Chirila, T V; Dalton, P D; Clayton, A B; Vijayasekaran, S; Crawford, G J; Constable, I J

1996-08-01

To develop a prototype artificial cornea and evaluate it in the rabbit model. Hydrogel core-and-skirt keratoprostheses were made and were inserted as full-thickness implants covered with conjunctival flaps in the right eyes of eight rabbits. Peroperative complications related to inadequate mechanical strength led to failure in the early postoperative period in three animals, one was euthanased for an unrelated reason and the remaining four have been successful for up to 16 weeks' follow-up. Full-thickness implantation of an artificial cornea, analogous to penetrating keratoplasty, has been achieved in the rabbit model. Histological findings confirm that integration of the prosthesis with host tissue occurs. The main complications encountered in this preliminary series were related to inadequate strength of the sponge skirt of this prototype device. Work in our laboratories is now concentrated upon improving the mechanical qualities of the hydrogel skirt and on the enhancement of biointegration.

Monitoring patients with continuous-flow ventricular assist devices outside of the intensive care unit: novel challenges to bedside nursing.

PubMed

O'Shea, Genevieve; Teuteberg, Jeffrey J; Severyn, Donald A

2013-03-01

Ventricular assist devices provide therapeutic options for patients with severe heart failure who have exhausted available medical therapies. With restoration of organ perfusion with ventricular assist devices, the heart failure resolves and quality of life and functional status improve. The current generation of continuous-flow devices present novel challenges to the clinical assessment of patients by substantially reducing or nearly eliminating any palpable pulse. Patients therefore generally have inadequate arterial pulsatility for most noninvasive monitoring devices such as pulse oximeters or automated blood pressure cuffs to work accurately. This article describes the function of continuous-flow devices and how this function affects common monitoring options, as well as how to clinically assess recipients of continuous-flow devices to promptly identify those whose condition may be deteriorating or who may be receiving inadequate perfusion.

Prevalence of health literacy and its correlates among patients with type II diabetes in Kuwait: A population based study.

PubMed

Hussein, Shaimaa H; Almajran, Abdullah; Albatineh, Ahmed N

2018-05-03

The purpose of this study is to estimate the prevalence of health literacy among patients with type II diabetes and investigate its association with several covariates. No studies were conducted in the Arabian Gulf region characterizing such factors for this population. A cross sectional study was implemented in which 359 type II diabetes patients were recruited from diabetes centers across Kuwait. Health literacy was measured by STOFHLA. Multivariate linear regression was applied to investigate the relationship between health literacy and several covariates. About 44.5% had inadequate, 19.5% marginal, and 35.5% adequate health literacy. Patients with inadequate health literacy were more likely to be older, females, widowed, low education, with income less than 500 KD/month. Multivariate linear regression indicated residence, nationality, education level, and age were significantly associated with health literacy. Adding marital status and gender, hierarchical linear regression revealed that 43.4% of the variability was accounted for. Inadequate health literacy is high in Kuwait. Interventions should be implemented to improve health literacy. This will reduce the prevalence of diabetes-related complications, produce better diabetes outcomes, and improve patients' quality-of-life. Health literacy should be an integral part to health promotion and chronic diseases' management programs in Kuwait. Copyright © 2018 Elsevier B.V. All rights reserved.

Mechanisms Involved in Injury and Repair of the Murine Lacrimal Gland: Role of Programmed Cell Death and Mesenchymal Stem Cells

PubMed Central

Zoukhri, Driss

2011-01-01

The non-keratinized epithelia of the ocular surface are constantly challenged by environmental insults, such as smoke, dust, and airborne pathogens. Tears are the sole physical protective barrier for the ocular surface. Production of tears in inadequate quantity or of inadequate quality results in constant irritation of the ocular surface, leading to dry eye disease, also referred to as keratoconjunctivitis sicca (KCS). Inflammation of the lacrimal gland, such as occurs in Sjögren’s syndrome, sarcoidosis, chronic graft versus-host disease, and other pathological conditions, results in inadequate secretion of the aqueous layer of the tear film, and is a leading cause of dry eye disease. The hallmarks of lacrimal gland inflammation are the presence of immune cell infiltrates, loss of acinar epithelial cells (the secreting cells), and increased production of proinflammatory cytokines. To date, the mechanisms leading to acinar cell loss and the associated decline in lacrimal gland secretion are still poorly understood. It is also not understood why the remaining lacrimal gland cells are unable to proliferate in order to regenerate a functioning lacrimal gland. This article reviews recent advances in exocrine tissue injury and repair, with emphasis on the roles of programmed cell death and stem/progenitor cells. PMID:20427009

Balancing a Baptist Tradition and the Liberal Arts.

ERIC Educational Resources Information Center

Ingalls, Zoe

1987-01-01

Although Wake Forest University recently dissolved its ties with the Baptist church, it is committed to maintaining its Baptist tradition while emphasizing high-quality teaching and academic freedom and increasing diversity in its student population. (MSE)

Early-starting conduct problems: intersection of conduct problems and poverty.

PubMed

Shaw, Daniel S; Shelleby, Elizabeth C

2014-01-01

The current article reviews extant literature on the intersection between poverty and the development of conduct problems (CP) in early childhood. Associations between exposure to poverty and disruptive behavior are reviewed through the framework of models emphasizing how the stressors associated with poverty indirectly influence child CP by compromising parent psychological resources, investments in children's welfare, and/or caregiving quality. We expand on the best-studied model, the family stress model, by emphasizing the mediating contribution of parent psychological resources on children's risk for early CP, in addition to the mediating effects of parenting. Specifically, we focus on the contribution of maternal depression, in terms of both compromising parenting quality and exposing children to higher levels of stressful events and contexts. Implications of the adapted family stress model are then discussed in terms of its implications for the prevention and treatment of young children's emerging CP.

Early-Onset Conduct Problems: Intersection of Conduct Problems and Poverty

PubMed Central

Shaw, Daniel S.; Shelleby, Elizabeth C.

2014-01-01

The current paper reviewed extant literature on the intersection between poverty and the development of conduct problems (CP) in early childhood. Associations between exposure to poverty and disruptive behavior were reviewed through the framework of models emphasizing how the stressors associated with poverty indirectly influence child CP by compromising parent psychological resources, investments in children’s welfare, and/or caregiving quality. We expanded upon the most well studied of these models, the family stress model, by emphasizing the mediating contribution of parent psychological resources on children’s risk for early CP, in addition to the mediating effects of parenting. Specifically, in we focused on the contribution of maternal depression, both in terms of compromising parenting quality and exposing children to even higher levels of stressful events and contexts. Implications of the adapted family stress model were then discussed in terms of its implications for the prevention and treatment of young children’s emerging CP. PMID:24471370

How to Measure Quality-of-Life Concerns in Patients with Neurogenic Lower Urinary Tract Dysfunction.

PubMed

Patel, Darshan P; Myers, Jeremy B; Lenherr, Sara M

2017-08-01

There is an evolving role for quality-of-life measures and patient-reported outcomes in the evaluation of neurogenic lower urinary tract dysfunction. We review available health-related quality-of-life instruments and patient-reported outcomes measures used in the assessment of patients with neurogenic bladder. We also discuss considerations for incorporation of these measures into clinical and patient-reported research. Emphasizing patient-reported outcomes in neurogenic bladder research will guide clinicians and other stakeholders to improve quality of life in this patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

Considering quality of care for young adults with diabetes in Ireland

PubMed Central

2013-01-01

Background Research on the quality of diabetes care provided to young adults with Type 1 diabetes is lacking. This study investigates perceptions of quality of care for young adults with Type 1 diabetes (23–30 years old) living in the Republic of Ireland. Methods Thirty-five young adults with Type 1 diabetes (twenty-nine women, six men) and thirteen healthcare professionals (ten diabetes nurse specialists, three consultant Endocrinologists) were recruited. All study participants completed semi-structured interviews that explored their perspectives on the quality of diabetes services in Ireland. Interviews were analyzed using standard qualitative thematic analysis techniques. Results Most interviewees identified problems with Irish diabetes services for young adults. Healthcare services were often characterised by long waiting times, inadequate continuity of care, overreliance on junior doctors and inadequate professional-patient interaction times. Many rural and non-specialist services lacked funding for diabetes education programmes, diabetes nurse specialists, insulin pumps or for psychological support, though these services are important components of quality Type 1 diabetes healthcare. Allied health services such as psychology, podiatry and dietician services appeared to be underfunded in many parts of the country. While Irish diabetes services lacked funding prior to the recession, the economic decline in Ireland, and the subsequent austerity imposed on the Irish health service as a result of that decline, appears to have additional negative consequences. Despite these difficulties, a number of specialist healthcare services for young adults with diabetes seemed to be providing excellent quality of care. Although young adults and professionals identified many of the same problems with Irish diabetes services, professionals appeared to be more critical of diabetes services than young adults. Young adults generally expressed high levels of satisfaction with services, even where they noted that aspects of those services were sub-optimal. Conclusion Good quality care appears to be unequally distributed throughout Ireland. National austerity measures appear to be negatively impacting health services for young adults with diabetes. There is a need for more Endocrinologist and diabetes nurse specialist posts to be funded in Ireland, as well as allied health professional posts. PMID:24168159

A study of the factors that influence consumer attitudes toward beef products using the conjoint market analysis tool.

PubMed

Mennecke, B E; Townsend, A M; Hayes, D J; Lonergan, S M

2007-10-01

This study utilizes an analysis technique commonly used in marketing, the conjoint analysis method, to examine the relative utilities of a set of beef steak characteristics considered by a national sample of 1,432 US consumers, as well as additional localized samples representing undergraduate students at a business college and in an animal science department. The analyses indicate that among all respondents, region of origin is by far the most important characteristic; this is followed by animal breed, traceability, animal feed, and beef quality. Alternatively, the cost of cut, farm ownership, the use (or nonuse) of growth promoters, and whether the product is guaranteed tender were the least important factors. Results for animal science undergraduates are similar to the aggregate results, except that these students emphasized beef quality at the expense of traceability and the nonuse of growth promoters. Business students also emphasized region of origin but then emphasized traceability and cost. The ideal steak for the national sample is from a locally produced, choice Angus fed a mixture of grain and grass that is traceable to the farm of origin. If the product was not produced locally, respondents indicated that their preferred production states are, in order from most to least preferred, Iowa, Texas, Nebraska, and Kansas.

A focus on the asthma HEDIS measure and its implications for clinical practice.

PubMed

Davies, Thomas J; Bunn, William B; Fromer, Leonard; Gelfand, Erwin W; Colice, Gene L

2006-02-01

With more than $16.1 billion in annual costs, the asthma management system is inadequate and needs revision to improve health and financial outcomes. Solutions may be found in the National Committee for Quality Assurance's guidelines and in such programs as Pay for Performance that financially reward providers for adherence to standards of practice based on Health Plan Employer Data and Information Set measures.

Massachusetts wants a tougher federal oil spill control plan

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

Not Available

Massachusetts wants a tougher federal oil spill control plan and has petitioned the U.S. Council on Environmental Quality (CEQ). The present oil spill contingency plan is inadequate, according to M. Dukakis (Gov. Mass.). The Massachusetts plan, which CEQ officials view favorably, would extend responsibility to the 200 mi fishing limit, provide for protection of birds, and set up an oil strike force on 24 hr alert.

Science and Engineering Library and Information Service Development in Support of Research and Development in Indonesia; Report to the Chairman of the Indonesian Institute of Sciences (LIPI).

ERIC Educational Resources Information Center

Shank, Russell

Access to scientific and technical information is essential to the conduct of high quality research and development work. Indonesia's scientists and engineers in Government research institutes are generally not being well-served by their own libraries. The most serious deficiencies are: (1) inadequately trained library staffs, (2) lack of…

Growth and bole quality responses to thinning in a red oak-sweetgum stand in southeastern Arkansas: nine-year results

Treesearch

James S. Meadows

2012-01-01

Science-based guidelines for thinning in southern bottomland hardwood stands are inadequate. To address this need, we established a series of thinning studies based on stand density management in hardwood stands on minor streambottom sites across the South. In the third study in this series, four thinning treatments were applied to a poletimber-sized, red oak-sweetgum...

Educational Resources "Over the Head" of Neurosurgical Patients: The Economic Impact of Inadequate Health Literacy.

PubMed

Agarwal, Nitin; Shah, Kush; Stone, Jeremy G; Ricks, Christian B; Friedlander, Robert M

2015-11-01

Health literacy is the ability with which individuals can obtain, understand, and apply basic health information. Approximately 36% of Americans have basic or below basic health literacy skills. This low health literacy is particularly prevalent in neurosurgery, a growing field of medicine with considerable complexity and a patient population commonly affected with disease-related cognitive impairment. Consequences of poor patient understanding range from increased emergency department admissions rates to reduced adherence to preoperative medication instructions. Economic implications include increasing health care expenditures, decreasing access to health care, and decreasing quality of care. Health literacy costs the United States $106-236 billion per year. Consequences of inadequate patient understanding vary widely. This article reviews and addresses the economic impact of the failure to address low health literacy in neurosurgery. Various groups have proposed techniques and devised outlines to improve health literacy, such as detailing principles targeting the underlying issues of health care illiteracy. The government, through legislation including the Affordable Care Act and the National Action Plan to Improve Health Literacy, has also shown its desire to remedy the effects of insufficient health literacy. Despite current efforts, further action is still needed. Health literacy is a key determinant in ensuring longevity and quality of life. Copyright © 2015 Elsevier Inc. All rights reserved.

Infant feeding counselling of HIV-infected women in two areas in Kenya in 2008.

PubMed

Israel-Ballard, Kiersten; Waithaka, Margaret; Greiner, Ted

2014-11-01

While WHO no longer recommends individual infant feeding counselling to HIV-positive women, it may still be practised in some settings and for specific cases. In any case, lessons can be learned by examining how well front line health workers are able to take on counselling tasks. This qualitative study was designed to assess how counsellors deal with challenges they face in two Kenyan provinces. It consisted of brief post-counselling exit interviews with 80 mothers, observations of 21 counselling sessions and 11 key informant interviews. Much infant feeding counselling was of reasonable quality, better than often reported elsewhere. However, nutrition and infant feeding were given low priority, counsellors' training was inadequate, individual postnatal counselling as well as growth monitoring and promotion were rarely done and complementary feeding was inadequately covered. Acceptable, feasible, affordable, sustainable and safe (AFASS) assessments were not of satisfactory quality. Breast milk expression was mentioned only to a minority and the possibility of heat treatment during the transition to cessation was not mentioned. Counsellors were often biased in discussing risks of breastfeeding and replacement feeding. Implementing the new WHO guidance will reduce the need for AFASS assessments, greatly simplifying both the government's and counsellors' tasks. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Audit of sweat testing: a first report from Italian Cystic Fibrosis Centres.

PubMed

Cirilli, Natalia; Padoan, Rita; Raia, Valeria

2008-09-01

Cystic Fibrosis diagnosis is confirmed using sweat test. The aim of our study was to evaluate current techniques and methodologies in use at Italian CF Care Centres. A series of questions related to the performance of the sweat test was collected by all CF Care Centres in Italy. Answers were compared with UK and NCCLS guidelines. 39/41 Centres replied to the questionnaire. A good adherence to guidelines was registered for storing samples before analysis in 90.9%, while performing CF diagnosis by at least two sweat tests, and chloride analysis were reported respectively in 100% and 75.7% of Centres. Some inconsistencies were registered for minimum acceptable sweat quantity and time to collect sweat inadequate in respectively 42.5% and 24.2% of Centres, while performing quality control procedures and referring to an external quality assessment scheme were found inadequate in respectively 54.6% and 100%. 57.6% didn't provide any appropriate analytical ranges and only 15.1% of Centres offered proper information to patients/parents. A report form, including sweat quantity, reference ranges and interpretation, was adequate only for 9.4 up to 41.4% of CF Centres. Our study showed areas of inconsistencies in sweat testing current practices in Italy and highlights the need for evidence based national guidelines to improve practice and management strategies.

Knowledge, Attitude and Practices (KAP) Survey on Water, Sanitation and Hygiene in Selected Schools in Vhembe District, Limpopo, South Africa

PubMed Central

Sibiya, Jerry E.; Gumbo, Jabulani Ray

2013-01-01

This study assessed the knowledge, attitude and practices (KAP) of learners on issues related to water, sanitation and hygiene in selected schools in Vhembe District, South Africa. The methodology relied on a questionnaire, an inspection of sanitary facilities and discussion with the school authorities. The data was analyzed using the Statistical Package for Social Science. The study revealed that the level of knowledge about waterborne diseases was relatively high (76.7 ± 1.75%), but knowledge on transmission routes was inadequate. The majority of the respondents had no knowledge when it comes to water-based diseases and their prevention (78.4 ± 1.71%).The attitude and practice on hygiene was also found to be high (91.40 ± 1.16%). Some schools from the urban area had proper handwashing facilities, but there was no soap available. The borehole water quality for rural schools appeared clear, but the microbial quality was unknown. The water supply and sanitation facilities were inadequate in rural schools, with no handwashing areas and no sanitary bins for girls. Some schools had toilets with broken doors which did not offer privacy. The only water tap, located at the centre of the school premises, was not enough for the whole school community. PMID:23736657

Bayesian Revision of Residual Detection Power

NASA Technical Reports Server (NTRS)

DeLoach, Richard

2013-01-01

This paper addresses some issues with quality assessment and quality assurance in response surface modeling experiments executed in wind tunnels. The role of data volume on quality assurance for response surface models is reviewed. Specific wind tunnel response surface modeling experiments are considered for which apparent discrepancies exist between fit quality expectations based on implemented quality assurance tactics, and the actual fit quality achieved in those experiments. These discrepancies are resolved by using Bayesian inference to account for certain imperfections in the assessment methodology. Estimates of the fraction of out-of-tolerance model predictions based on traditional frequentist methods are revised to account for uncertainty in the residual assessment process. The number of sites in the design space for which residuals are out of tolerance is seen to exceed the number of sites where the model actually fails to fit the data. A method is presented to estimate how much of the design space in inadequately modeled by low-order polynomial approximations to the true but unknown underlying response function.

Linking nurses' perceptions of patient care quality to job satisfaction: the role of authentic leadership and empowering professional practice environments.

PubMed

Spence Laschinger, Heather K; Fida, Roberta

2015-05-01

A model linking authentic leadership, structural empowerment, and supportive professional practice environments to nurses' perceptions of patient care quality and job satisfaction was tested. Positive work environment characteristics are important for nurses' perceptions of patient care quality and job satisfaction (significant factors for retention). Few studies have examined the mechanism by which these characteristics operate to influence perceptions of patient care quality or job satisfaction. A cross-sectional provincial survey of 723 Canadian nurses was used to test the hypothesized models using structural equation modeling. The model was an acceptable fit and all paths were significant. Authentic leadership had a positive effect on structural empowerment, which had a positive effect on perceived support for professional practice and a negative effect on nurses' perceptions that inadequate unit staffing prevented them from providing high-quality patient care. These workplace conditions predicted job satisfaction. Authentic leaders play an important role in creating empowering professional practice environments that foster high-quality care and job satisfaction.

The role of imperfect surrogate endpoint information in drug approval and reimbursement decisions.

PubMed

Bognar, Katalin; Romley, John A; Bae, Jay P; Murray, James; Chou, Jacquelyn W; Lakdawalla, Darius N

2017-01-01

Approval of new drugs is increasingly reliant on "surrogate endpoints," which correlate with but imperfectly predict clinical benefits. Proponents argue surrogate endpoints allow for faster approval, but critics charge they provide inadequate evidence. We develop an economic framework that addresses the value of improvement in the predictive power, or "quality," of surrogate endpoints, and clarifies how quality can influence decisions by regulators, payers, and manufacturers. For example, the framework shows how lower-quality surrogates lead to greater misalignment of incentives between payers and regulators, resulting in more drugs that are approved for use but not covered by payers. Efficient price-negotiation in the marketplace can help align payer incentives for granting access based on surrogates. Higher-quality surrogates increase manufacturer profits and social surplus from early access to new drugs. Since the return on better quality is shared between manufacturers and payers, private incentives to invest in higher-quality surrogates are inefficiently low. Copyright © 2016 The Author(s). Published by Elsevier B.V. All rights reserved.

Training Heads of Department in Effective Leadership.

ERIC Educational Resources Information Center

Meijer, Folke

1989-01-01

Sweden's Karolinska Institute has developed a course in leadership that emphasizes these leader qualities: enthusiasm and support for the program's aims and operations; goal-setting for the department; insight into people's motivation; and an ability to deal with conflict. (MSE)

Handicapped Infants and Euthanasia: A Challenge to Our Advocacy.

ERIC Educational Resources Information Center

Smith, J. David

1985-01-01

The issue of pediatric euthanasia for handicapped newborns is examined and contrasting viewpoints emphasizing the quality and the sanctity of life are considered. The author asserts that advocacy for handicapped children involves decisions regarding the euthanasia question. (CL)

Proceedings of the Symposium on Welding, Bonding, and Fastening. [production engineering for aircraft and spacecraft structures

NASA Technical Reports Server (NTRS)

Stein, B. A. (Compiler); Buckley, J. D. (Compiler)

1972-01-01

Various technological processes to achieve lightweight reliable joining systems for structural elements of aircraft and spacecraft are considered. Joining methods, combinations of them, and nondestructive evaluation and quality assurance are emphasized.

Profile of the oral healthcare team in countries with emerging economies.

PubMed

Nash, D; Ruotoistenmäki, J; Argentieri, A; Barna, S; Behbehani, J; Berthold, P; Catalanotto, F; Chidzonga, M; Goldblatt, L; Jaafar, N; Kikwilu, E; Konoo, T; Kouzmina, E; Lindh, C; Mathu-Muju, K; Mumghamba, E; Nik Hussein, N; Phantumvanit, P; Runnel, R; Shaw, H; Forna, N; Orliaguet, T; Honkala, E

2008-02-01

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

Blood transfusion services in Delhi.

PubMed

Makroo, R N; Kumar, N D

1993-04-01

In 1991, approximately 40% of total blood requirement in Delhi was collected from commercial blood donors. The rest was supplied by voluntary and replacement donations in hospital-based blood banks and by voluntary blood recruiting agency (Indian Red Cross Society). This study analyses the standards of working and quality assurance in 26 blood transfusion centers in Delhi. The majority of these centers are ill-equipped and lack trained manpower. Most of these do not have adequate testing facilities and any standardized procedure for blood collection. Quality assurance scheme is not being followed and documentation and record maintenance is grossly inadequate. This reports also gives the recommendations for improvements of blood transfusion services in Delhi.

[Introduction of Functional Foods--Types, Manufacturing Methods and Quality Assurance].

PubMed

Budai, Kinga Anna; Hankó, Balázs; AntalL, István; Zelkó, Romána

2015-01-01

Because of the beneficial effects to health functional foods are important elements of health promotion. The positive effect of the functional components should be based on scientific evidence-based. In addition to the traditional food processing technology new technologies have appeared, e.g. microencapsulation, edible coatings and orodispersible films, nano-technology, vacuum impregnation. In the present study, probiotics and the structure, the production and the impact of prebiotic functional cereals are discussed in more detail. In addition to their numerous advantages in connection with the safe application, several questions arise because of inadequate quality control measures prior to coming onto the market.

ACO model should encourage efficient care delivery.

PubMed

Toussaint, John; Krueger, David; Shortell, Stephen M; Milstein, Arnold; Cutler, David M

2015-09-01

The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance. Copyright © 2015 Elsevier Inc. All rights reserved.

Improvement of the quality of work in a biochemistry laboratory via measurement system analysis.

PubMed

Chen, Ming-Shu; Liao, Chen-Mao; Wu, Ming-Hsun; Lin, Chih-Ming

2016-10-31

An adequate and continuous monitoring of operational variations can effectively reduce the uncertainty and enhance the quality of laboratory reports. This study applied the evaluation rule of the measurement system analysis (MSA) method to estimate the quality of work conducted in a biochemistry laboratory. Using the gauge repeatability & reproducibility (GR&R) approach, variations in quality control (QC) data among medical technicians in conducting measurements of five biochemical items, namely, serum glucose (GLU), aspartate aminotransferase (AST), uric acid (UA), sodium (Na) and chloride (Cl), were evaluated. The measurements of the five biochemical items showed different levels of variance among the different technicians, with the variances in GLU measurements being higher than those for the other four items. The ratios of precision-to-tolerance (P/T) for Na, Cl and GLU were all above 0.5, implying inadequate gauge capability. The product variation contribution of Na was large (75.45% and 31.24% in normal and abnormal QC levels, respectively), which showed that the impact of insufficient usage of reagents could not be excluded. With regard to reproducibility, high contributions (of more than 30%) of variation for the selected items were found. These high operator variation levels implied that the possibility of inadequate gauge capacity could not be excluded. The analysis of variance (ANOVA) of GR&R showed that the operator variations in GLU measurements were significant (F=5.296, P=0.001 in the normal level and F=3.399, P=0.015 in the abnormal level, respectively). In addition to operator variations, product variations of Na were also significant for both QC levels. The heterogeneity of variance for the five technicians showed significant differences for the Na and Cl measurements in the normal QC level. The accuracy of QC for five technicians was identified for further operational improvement. This study revealed that MSA can be used to evaluate product and personnel errors and to improve the quality of work in a biochemical laboratory through proper corrective actions.

Interrelationships between romance, life quality, and medical training of female residents.

PubMed

Wang, Yu-Jung; Hsu, Kan-Lin; Chang, Chin-Sung; Wu, Chih-Hsing

2012-08-01

For the past 30 years, there has been a steady increase in the number of female physicians, but the relationship between their romantic lives and their pattern of training has been inadequately reported. This study was designed to investigate the interrelationships between medical training, quality of life, and the attitudes that female residents have toward romance. Of the 106 female medical residents at our medical center in 2009, a total of 78 residents (73.6%) were enrolled for the study. Structured questionnaires (Cronbach α = 0.878), which included questions about female resident quality of life, attitude toward spousal choice, and the impact of programmed professional medical training, were self-administered through an anonymous process. Female residents, especially ward-care specialists, were determined to have excessively long working hours (84.6% > 88 work hours/week), insufficient and irregular sleep (44.9%), and inadequate personal time (73.1% < 24 hours/week) on average. Of the 48 residents with ongoing romances, 87.5% (n = 40) of romantic partners were physicians and 58.3% (n = 28) initiated their relationships when they were medical students, but exhibited no preferential dating of senior medical students or physicians. Factors affecting the choice of spouses included time limitations, a limited circle of friends, differences in values, and work-related stress. Those presumptive factors influencing romance between the assumed partner being a doctor or a "nondoctor" were significantly different with regard to lack of time (p = 0.002), values (p < 0.001), work-related stress (p < 0.001), and family background (p = 0.004). Romance and quality of life were significantly influenced by the pattern of medical training in female residents. Setting duty-hour limits and initiating a new hobby were determined to be potentially beneficial to their quality of life and attitudes toward romance. Copyright © 2012. Published by Elsevier B.V.

Quality Information--Informed Choices: Advancing the Workforce Information System. Secretary of Labor's Workforce Information System Plan for Federal Fiscal Years 2001-2005.

ERIC Educational Resources Information Center

Workforce Information Council (DOL), Washington, DC.

The Workforce Investment Act of 1998 emphasizes the importance of high quality, accessible, and relevant information about the labor market for making sound decisions. In order to help both workers and employers, as well as the government agencies that serve them, the Workforce Information System was created and is being improved. The action plan…

Estimated medical expenditure and risk of job loss among rheumatoid arthritis patients undergoing tofacitinib treatment: post hoc analyses of two randomized clinical trials

PubMed Central

Rendas-Baum, Regina; Kosinski, Mark; Singh, Amitabh; Mebus, Charles A.; Wilkinson, Bethany E.; Wallenstein, Gene V.

2017-01-01

Abstract Objectives. RA causes high disability levels and reduces health-related quality of life, triggering increased costs and risk of unemployment. Tofacitinib is an oral Janus kinase inhibitor for the treatment of RA. These post hoc analyses of phase 3 data aimed to assess monthly medical expenditure (MME) and risk of job loss for tofacitinib treatment vs placebo. Methods. Data analysed were from two randomized phase 3 studies of RA patients (n = 1115) with inadequate response to MTX or TNF inhibitors (TNFi) receiving tofacitinib 5 or 10 mg twice daily, adalimumab (one study only) or placebo, in combination with MTX. Short Form 36 version 2 Health Survey physical and mental component summary scores were translated into predicted MME via an algorithm and concurrent inability to work and job loss risks at 6, 12 and 24 months, using Medical Outcomes Study data. Results. MME reduction by month 3 was $100 greater for tofacitinib- than placebo-treated TNFi inadequate responders (P < 0.001); >20 and 6% reductions from baseline, respectively. By month 3 of tofacitinib treatment, the odds of inability to work decreased ⩾16%, and risk of future job loss decreased ∼20% (P < 0.001 vs placebo). MME reduction by month 3 was $70 greater for tofacitinib- than placebo-treated MTX inadequate responders (P < 0.001); ⩾23 and 13% reductions from baseline, respectively. By month 3 of tofacitinib treatment, the odds of inability to work decreased ⩾31% and risk of future job loss decreased ⩾25% (P < 0.001 vs placebo). Conclusion. Tofacitinib treatment had a positive impact on estimated medical expenditure and risk of job loss for RA patients with inadequate response to MTX or TNFi. PMID:28460083

A Cost-Utility Analysis of Lisdexamfetamine Versus Atomoxetine in the Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Inadequate Response to Methylphenidate.

PubMed

Zimovetz, Evelina A; Beard, Stephen M; Hodgkins, Paul; Bischof, Matthias; Mauskopf, Josephine A; Setyawan, Juliana

2016-10-01

An economic analysis from the perspective of the UK National Health Service (NHS) evaluated the cost effectiveness of lisdexamfetamine dimesylate (LDX) compared with atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder who have had an inadequate response to methylphenidate. A 1-year decision-analytic model was constructed, with the health outcomes "response", "nonresponse", and "unable to tolerate". Clinical data were taken from a head-to-head, randomized controlled trial in inadequate responders to methylphenidate. Response to treatment was defined as a score of 1 (very much improved) or 2 (much improved) on the Clinical Global Impression-Improvement subscale. Tolerability was assessed by discontinuation rates owing to adverse events. Utility weights were identified via a systematic literature review. Healthcare resource use estimates were obtained via a survey of clinicians. Daily drug costs were derived from British National Formulary 2012 costs and mean doses reported in the trial. One-way and probabilistic sensitivity analyses (PSAs) were performed. The comparison of LDX with atomoxetine resulted in an estimate of an incremental cost-effectiveness ratio of £1802 per quality-adjusted life-year (QALY). The result was robust in a wide range of sensitivity analyses; results were most sensitive to changes in drug costs and efficacy. In the PSA, assuming a maximum willingness to pay of £20,000 per QALY, LDX versus atomoxetine had an 86 % probability of being cost effective. In 38 % of PSA runs, LDX was more effective and less costly than atomoxetine. From the perspective of the UK NHS, LDX provides a cost-effective treatment option for children and adolescents who are inadequate responders to methylphenidate.

Sleeping beauty: awakening urothelium from its slumber.

PubMed

Balsara, Zarine R; Li, Xue

2017-04-01

The bladder urothelium is essentially quiescent but regenerates readily upon injury. The process of urothelial regeneration harkens back to the process of urothelial development whereby urothelial stem/progenitor cells must proliferate and terminally differentiate to establish all three urothelial layers. How the urothelium regulates the level of proliferation and the timing of differentiation to ensure the precise degree of regeneration is of significant interest in the field. Without a carefully-orchestrated process, urothelial regeneration may be inadequate, thereby exposing the host to toxins or pathogens. Alternatively, regeneration may be excessive, thereby setting the stage for tumor development. This review describes our current understanding of urothelial regeneration. The current controversies surrounding the identity and location of urothelial progenitor cells that mediate urothelial regeneration are discussed and evidence for each model is provided. We emphasize the factors that have been shown to be crucial for urothelial regeneration, including local growth factors that stimulate repair, and epithelial-mesenchymal cross talk, which ensures feedback regulation. Also highlighted is the emerging concept of epigenetic regulation of urothelial regeneration, which additionally fine tunes the process through transcriptional regulation of cell cycle genes and growth and differentiation factors. Finally, we emphasize how several of these pathways and/or programs are often dysregulated during malignant transformation, further corroborating their importance in directing normal urothelial regeneration. Together, evidence in the field suggests that any attempt to exploit regenerative programs for the purposes of enhanced urothelial repair or replacement must take into account this delicate balance. Copyright © 2017 the American Physiological Society.

Sleeping beauty: awakening urothelium from its slumber

PubMed Central

Balsara, Zarine R.

2017-01-01

The bladder urothelium is essentially quiescent but regenerates readily upon injury. The process of urothelial regeneration harkens back to the process of urothelial development whereby urothelial stem/progenitor cells must proliferate and terminally differentiate to establish all three urothelial layers. How the urothelium regulates the level of proliferation and the timing of differentiation to ensure the precise degree of regeneration is of significant interest in the field. Without a carefully-orchestrated process, urothelial regeneration may be inadequate, thereby exposing the host to toxins or pathogens. Alternatively, regeneration may be excessive, thereby setting the stage for tumor development. This review describes our current understanding of urothelial regeneration. The current controversies surrounding the identity and location of urothelial progenitor cells that mediate urothelial regeneration are discussed and evidence for each model is provided. We emphasize the factors that have been shown to be crucial for urothelial regeneration, including local growth factors that stimulate repair, and epithelial-mesenchymal cross talk, which ensures feedback regulation. Also highlighted is the emerging concept of epigenetic regulation of urothelial regeneration, which additionally fine tunes the process through transcriptional regulation of cell cycle genes and growth and differentiation factors. Finally, we emphasize how several of these pathways and/or programs are often dysregulated during malignant transformation, further corroborating their importance in directing normal urothelial regeneration. Together, evidence in the field suggests that any attempt to exploit regenerative programs for the purposes of enhanced urothelial repair or replacement must take into account this delicate balance. PMID:28122714

Stifled Stakeholders and Subdued Participation: Interpreting Local Responses Toward Shimentai Nature Reserve in South China

NASA Astrophysics Data System (ADS)

Jim, C. Y.; Xu, Steve S. W.

2002-09-01

In recent decades, protected-area management in many developing countries has been molded to win the support and participation of local people. Increasingly, research initiatives are undertaken to enhance understanding of the perceptions and attitudes of rural stakeholders. The effectiveness of the expanding protected-area system in China is critically constrained by similar considerations of community mentality. This paper provides an empirical assessment of local responses towards conservation efforts based on a case study of the recently established Shimentai Nature Reserve (SNR) situated in Yingde, Guangdong Province, China. Questionnaire surveys, face-to-face interviews, and group discussions were employed to gauge local residents' knowledge, perceptions, and expectations towards the SNR. The study covered seven villages situated in and around the reserve, grouped into far-zone (floodplain) and near-zone (upland) categories, accommodating Hakka (Han) and minority Yao peoples. Many respondents had inadequate knowledge, understanding, and perceptions of the reserve. Although most respondents welcomed the expected park-related dividends, the most affected near-zone villagers anticipated losses due to restriction on traditional resource-extraction activities in the forest. The local expectations were influenced by place of residence, emigration of rural young, and household affluence. The lack of local participation in management and inadequate dissemination of information posed obstacles to effective conservation. The high expectation of accruing benefits from development projects, including tourism, might be misplaced and might not be realized. The present honeymoon period of positive attitudes could end soon if the hopes remain unfulfilled for too long. The need to win sustained local support and provide alternative means of livelihood is emphasized.

Reforming medical education in ethics and humanities by finding common ground with Abraham Flexner.

PubMed

Doukas, David J; McCullough, Laurence B; Wear, Stephen

2010-02-01

Abraham Flexner was commissioned by the Carnegie Foundation for the Advancement of Teaching to conduct the 1910 survey of all U.S. and Canadian medical schools because medical education was perceived to lack rigor and strong learning environments. Existing proprietary schools were shown to have inadequate student scholarship and substandard faculty and teaching venues. Flexner's efforts and those of the American Medical Association resulted in scores of inadequate medical schools being closed and the curricula of the survivors being radically changed. Flexner presumed that medical students would already be schooled in the humanities in college. He viewed the humanities as essential to physician development but did not explicitly incorporate this position into his 1910 report, although he emphasized this point in later writings. Medical ethics and humanities education since 1970 has sought integration with the sciences in medical school. Most programs, however, are not well integrated with the scientific/clinical curriculum, comprehensive across four years of training, or cohesive with nationally formulated goals and objectives. The authors propose a reformation of medical humanities teaching in medical schools inspired by Flexner's writings on premedical education in the context of contemporary educational requirements. College and university education in the humanities is committed to a broad education, consistent with long-standing tenets of liberal arts education. As a consequence, premedical students do not study clinically oriented science or humanities. The medical school curriculum already provides teaching of clinically relevant sciences. The proposed four-year curriculum should likewise provide clinically relevant humanities teaching to train medical students and residents comprehensively in humane, professional patient care.

Sleep Disorders as a Cause of Motor Vehicle Collisions

PubMed Central

de Mello, Marco Túlio; Narciso, Fernanda Veruska; Tufik, Sergio; Paiva, Teresa; Spence, David Warren; BaHammam, Ahmed S.; Verster, Joris C.; Pandi-Perumal, Seithikurippu R.

2013-01-01

Studies have shown that a large proportion of traffic accidents around the world are related to inadequate or disordered sleep. Recent surveys have linked driver fatigue to 16% to 20% of serious highway accidents in the UK, Australia, and Brazil. Fatigue as a result of sleep disorders (especially obstructive sleep apnea), excessive workload and lack of physical and mental rest, have been shown to be major contributing factors in motor vehicle accidents. A number of behavioral, physiological, and psychometric tests are being used increasingly to evaluate the impact of fatigue on driver performance. These include the oculography, polysomnography, actigraphy, the maintenance of wakefulness test, and others. Various strategies have been proposed for preventing or reducing the impact of fatigue on motor vehicle accidents. These have included: Educational programs emphasizing the importance of restorative sleep and the need for drivers to recognize the presence of fatigue symptoms, and to determine when to stop to sleep; The use of exercise to increase alertness and to promote restorative sleep; The use of substances or drugs to promote sleep or alertness (i.e. caffeine, modafinil, melatonin and others), as well as specific sleep disorders treatment; The use of CPAP therapy for reducing excessive sleepiness among drivers who have been diagnosed with obstructive sleep apnea. The evidence cited in this review justifies the call for all efforts to be undertaken that may increase awareness of inadequate sleep as a cause of traffic accidents. It is strongly recommended that, for the purpose of promoting highway safety and saving lives, all disorders that cause excessive sleepiness should be investigated and monitored. PMID:23626880

Performance of biometric quality measures.

PubMed

Grother, Patrick; Tabassi, Elham

2007-04-01

We document methods for the quantitative evaluation of systems that produce a scalar summary of a biometric sample's quality. We are motivated by a need to test claims that quality measures are predictive of matching performance. We regard a quality measurement algorithm as a black box that converts an input sample to an output scalar. We evaluate it by quantifying the association between those values and observed matching results. We advance detection error trade-off and error versus reject characteristics as metrics for the comparative evaluation of sample quality measurement algorithms. We proceed this with a definition of sample quality, a description of the operational use of quality measures. We emphasize the performance goal by including a procedure for annotating the samples of a reference corpus with quality values derived from empirical recognition scores.

Colour Measurements and Modeling

NASA Astrophysics Data System (ADS)

Jha, Shyam N.

The most common property to measure quality of any material is its appearance. Appearance includes colour, shape, size and surface conditions. The analysis of colour is especially an important consideration when determining the efficacy of variety of postharvest treatments. Consumers can easily be influenced by preconceived ideas of how a particular fruit or vegetable or a processed food should appear, and marketers often attempt to improve upon what nature has painted. Recently colour measurements have also been used as quality parameters and indicator of some inner constituents of the material. In spite of the significance of colour in food industries, many continue to analyze it inadequately. This chapter deals with theory of colour, colour scales and its measurement, sampling techniques, and modeling of colour values for correlating them with some internal quality parameters of selected fruits.

Indoor Environmental Quality in Mechanically Ventilated, Energy-Efficient Buildings vs. Conventional Buildings.

PubMed

Wallner, Peter; Munoz, Ute; Tappler, Peter; Wanka, Anna; Kundi, Michael; Shelton, Janie F; Hutter, Hans-Peter

2015-11-06

Energy-efficient buildings need mechanical ventilation. However, there are concerns that inadequate mechanical ventilation may lead to impaired indoor air quality. Using a semi-experimental field study, we investigated if exposure of occupants of two types of buildings (mechanical vs. natural ventilation) differs with regard to indoor air pollutants and climate factors. We investigated living and bedrooms in 123 buildings (62 highly energy-efficient and 61 conventional buildings) built in the years 2010 to 2012 in Austria (mainly Vienna and Lower Austria). Measurements of indoor parameters (climate, chemical pollutants and biological contaminants) were conducted twice. In total, more than 3000 measurements were performed. Almost all indoor air quality and room climate parameters showed significantly better results in mechanically ventilated homes compared to those relying on ventilation from open windows and/or doors. This study does not support the hypothesis that occupants in mechanically ventilated low energy houses are exposed to lower indoor air quality.

Telecommuting: Implications for Business Education.

ERIC Educational Resources Information Center

Holmquist, Donna; Risk, Shirley

1991-01-01

Advantages to telecommuting are flexibility, control, productivity, morale, quality of life, and, for employers, access to a wider skill pool. Disadvantages are frustration, isolation, sweatshop potential, and resentment of co-workers. Business education should emphasize keyboarding, telecommunications, time management, and communication skills in…

Limnology. Student Fieldbook.

ERIC Educational Resources Information Center

Jones, Michael

This student fieldbook provides exercises for a three-week course in limnology. Exercises emphasize applications of knowledge in chemistry, physics, and biology to understand the natural operation of freshwater systems. Fourteen field exercises include: (1) testing for water quality; (2) determination of water temperature, turbidity, dissolved…

[Classification and monitoring of the appropriateness of emergency admissions in a tertiary hospital].

PubMed

López-Picazo Ferrer, J J; Tomás García, N; Cubillana Herrero, J D; Gómez Company, J A; de Dios Cánovas García, J

2014-01-01

To measure the appropriateness of hospital admissions, to classify its Clinical Services (CS) according to the level of inappropriateness, and to determine the usefulness of applying rapid assessment techniques (lot quality assurance sampling) in these types of measurements. A descriptive, retrospective study was conducted in a tertiary hospital to assess the clinical records of emergency admissions to the 12 CS with a higher volume of admissions, using the Appropriateness Evaluation Protocol (AEP). A four-level («A» to «D») increasingly inadequate admissions scale was constructed setting both standard and threshold values in every stratum. Every CS was classified in one of them using lot quality assurance sampling (LQAS). A total of 156 cases (13 cases from every CS) were assessed. The assessment effort (devoted time) was also estimated. There were 22.4±6.3% of inadequate admissions. In the CS classification, 9 (75%) got a good or acceptable appropriateness level, and only 1 (8%) got an inacceptable level. The time devoted was estimated at 17 hours. AEP is useful to assess the admission appropriateness and may be included in the «Emergencies» process management, although its variability prevents the use for external comparisons. If both LQAS and the appropriateness classification level and the global estimation (by unifying lot samples) are combined, the monitoring is affordable without a great effort. To extend these tools to other quality indicators requiring direct observation or clinical records, manual assessment could improve the monitoring efficiency. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Family Health Services project: the way forward.

PubMed

Dabiri, O M

1993-01-01

Nigerians did not readily accept family planning when Family Health Services (FHS) began in 1988. FHS has made much headway in training, IEC (information, education, and communication), and constituency building and advocacy. Its staff have identified obstacles to implementation, especially program sustainability and management structure. Key limits to sustainability of IEC efforts were inadequately trained personnel and inability of trained personnel to apply what they learned at work stations. The Federal Ministry and Social Services' role in the FHS project was not clearly defined. Some private sector factors contributing to a confused management structure were inadequate method mix, high contraceptive cost, poor monitoring of quality of care, and no coordination of family planning training with the public factor. FHS has since decided to focus its efforts on increasing the demand for and availability of modern contraceptives and improving the quality of family planning services of both the public and private sectors. FHS hopes that accomplishing these activities will reduce fertility, morbidity, and mortality. Strategic plans include a regional focus, quality of care, a variety of methods offered, intensification, hospital and clinics, a management information system, contraceptive logistics, distribution regulations, and addressing social, cultural, and behavioral factors. To effectively implement the strategy, USAID and the Federal Ministry held a workshop in 1993 to effect full integration of Nigerian experience in the 2nd phase of the project (FHS II). Participants reviewed the strengths and weaknesses of the first phase and agreed on implementation. For example, nongovernmental organizations should implement FHS II. FHS II includes training, IEC, and commodities/logistics.

Typology of eaters based on conventional and organic food consumption: results from the NutriNet-Santé cohort study.

PubMed

Baudry, Julia; Touvier, Mathilde; Allès, Benjamin; Péneau, Sandrine; Méjean, Caroline; Galan, Pilar; Hercberg, Serge; Lairon, Denis; Kesse-Guyot, Emmanuelle

2016-08-01

Limited information is available on large-scale populations regarding the socio-demographic and nutrient profiles and eating behaviour of consumers, taking into account both organic and conventional foods. The aims of this study were to draw up a typology of consumers according to their eating habits, based both on their dietary patterns and the mode of food production, and to outline their socio-demographic, behavioural and nutritional characteristics. Data were collected from 28 245 participants of the NutriNet-Santé study. Dietary information was obtained using a 264-item, semi-quantitative, organic FFQ. To identify clusters of consumers, principal component analysis was applied on sixteen conventional and sixteen organic food groups followed by a clustering procedure. The following five clusters of consumers were identified: (1) a cluster characterised by low energy intake, low consumption of organic food and high prevalence of inadequate nutrient intakes; (2) a cluster of big eaters of conventional foods with high intakes of SFA and cholesterol; (3) a cluster with high consumption of organic food and relatively adequate nutritional diet quality; (4) a group with a high percentage of organic food consumers, 14 % of which were either vegetarians or vegans, who exhibited a high nutritional diet quality and a low prevalence of inadequate intakes of most vitamins except B12; and (5) a group of moderate organic food consumers with a particularly high intake of proteins and alcohol and a poor nutritional diet quality. These findings may have implications for future aetiological studies investigating the potential impact of organic food consumption.

Improving the diagnostic quality and adequacy of shoulder radiographs in a District General Hospital

PubMed Central

Richards, Bethany; Riley, James; Saithna, Adnan

2016-01-01

A high rate of suboptimal shoulder radiographs was identified during a service evaluation exercise in our orthopaedic outpatient clinics. Inadequate radiographs require a return to the radiology department for further imaging, a resultant increased workload, delays in the clinic, increased radiation for patients, and inconvenience and decreased patient satisfaction. Furthermore, if a sub-optimal radiograph is accepted there is concern that diagnoses may be missed. The aim of this project was to decrease the rate of suboptimal radiographs by delivering a teaching package directed towards quality improvement. Evaluation criteria were set for standard orthopaedic shoulder radiographs (Anterior-posterior, axillary, and Velpeau views). Baseline data collection was performed over three, two-week periods and included all patients attending the shoulder clinic. The percentage of x-rays which were deemed adequate was only 19.4% for anterior-posterior views and 57.9% for axillary views. A comprehensive educational package was delivered to radiographers. This included a formal PowerPoint based teaching session, hands on training with practice using a skeleton, posters with step-by step instructions on how to obtain an adequate image, and PDF aide memoires suitable for viewing on a smartphone. Two subsequent two-week periods of data collection were performed to evaluate the benefit of this intervention. Delivery of focussed training and provision of easily accessible aide memoires to facilitate improved quality of radiographs resulted in a significant (p<0.05) reduction in the rate of inadequate images. There was also a significant decreases in the rate of return to the radiology department for repeat imaging. PMID:27559473

Burnout, Moral Distress, Work-Life Balance, and Career Satisfaction among Hematopoietic Cell Transplantation Professionals.

PubMed

Neumann, Joyce L; Mau, Lih-Wen; Virani, Sanya; Denzen, Ellen M; Boyle, Deborah A; Boyle, Nancy J; Dabney, Jane; De KeselLofthus, Alexandra; Kalbacker, Marion; Khan, Tippu; Majhail, Navneet S; Murphy, Elizabeth A; Paplham, Pamela; Parran, Leslie; Perales, Miguel-Angel; Rockwood, Todd H; Schmit-Pokorny, Kim; Shanafelt, Tait D; Stenstrup, Elaine; Wood, William A; Burns, Linda J

2018-04-01

A projected shortage of hematopoietic cell transplantation (HCT) health professionals was identified as a major issue during the National Marrow Donor Program/Be The Match System Capacity Initiative. Work-related distress and work-life balance were noted to be potential barriers to recruitment/retention. This study examined these barriers and their association with career satisfaction across HCT disciplines. A cross-sectional, 90-item, web-based survey was administered to advanced practice providers, nurses, physicians, pharmacists, and social workers in 2015. Participants were recruited from membership lists of 6 professional groups. Burnout (measured with the Maslach Burnout Inventory subscales of emotional exhaustion and depersonalization) and moral distress (measured by Moral Distress Scale-Revised) were examined to identify work-related distress. Additional questions addressed demographics, work-life balance, and career satisfaction. Of 5759 HCT providers who received an individualized invitation to participate, 914 (16%) responded; 627 additional participants responded to an open link survey. Significant differences in demographic and practice characteristics existed across disciplines (P < .05). The prevalence of burnout differed across disciplines (P < .05) with an overall prevalence of 40%. Over one-half of pharmacists had burnout, whereas social workers had the lowest prevalence at less than one-third. Moral distress scores ranged from 0 to 336 and varied by discipline (P < .05); pharmacists had the highest mean score (62.9 ± 34.8) and social workers the lowest (42.7 ± 24.4). In multivariate and univariate analyses, variables contributing to burnout varied by discipline; however, moral distress was a significant contributing factor for all providers. Those with burnout were more likely to report inadequate work-life balance and a low level of career satisfaction; however, overall there was a high level of career satisfaction across disciplines. Burnout, moral distress, and inadequate work-life balance existed at a variable rate in all HCT disciplines, yet career satisfaction was high. These results suggest specific areas to address in the work environment for HCT health professionals, especially the need for relief of moral distress and a greater degree of personal time. As the creation of healthy work environments is increasingly emphasized to improve quality care and decrease costs, these findings should be used by HCT leadership to develop interventions that mitigate work-related distress and in turn foster recruitment and retention of HCT providers. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Mortality patterns in the accident and emergency department of an urban hospital in Nigeria.

PubMed

Ekere, A U; Yellowe, B E; Umune, S

2005-06-01

The accident and emergency (A & E) department of any hospital provides an insight to the quality of care available in the institution. The University of Port Harcourt Teaching Hospital (UPTH) is a foremost institution in the South-South geopolitical region of Nigeria, servicing a core population of about 5 million people. The aim of this review was to highlight the demographic patterns of mortality, time spent before death in the emergency room. A 3 year retrospective review, covering April 2000 - March 2003, of patients attended to in the Accident & Emergency department of University of Port Harcourt Teaching Hospital was carried out. Casualty records including attendance registers, Nurses' report books and death certificates were used to extract demographic indices, causes of death and time from arrival to death in the Accident and Emergency Unit. Multiway frequency tables were used for analysis. Of the 22,791 patients seen during the study period, 446 died, giving a crude mortality rate of 2 percent. The male to female ratio was 1.5:1; the trauma subset and the non-traumatic subset being 4.6:1 and 1.2:1 respectively. Most of the cases were of non-traumatic origin (79.8%), with the 20-49 age group being the most affected when all the cases were taken into consideration. However, the overall mean age was 33+/-9.4 years. The peak age in trauma deaths was 20-29 year, while that in non-traumatic deaths was 40-49 years. Some of the deaths (3.4%) could not be traced to any cause. Probably due to incomplete records or ignorance to the cause of death. Road traffic accidents and assaults were the commonest causes of traumatic death, accounting for 57.8% and 11.1% respectively. Bulk of the non traumatic deaths (25.2%) was from cardiovascular diseases. Most of the patients (70.9%) died within six hours of arrival in the accident and emergency, while 3.6% (16) were dead on arrival. The average time in the casualty before death was about 22.0 hours. Contributing factors to theses deaths might include poor infrastructures on ground, inadequate transportation to hospital, delay in presentation and inadequate clinical exposure by the first line physicians in the accident and emergency department. Improvement in management techniques might unravel the mysteries of death of unknown origin. Management of medical emergencies should be emphasized in the training of accident and emergency workers.

Development of a health education intervention strategy using an implementation research method to control taeniasis and cysticercosis in Burkina Faso.

PubMed

Ngowi, Helena; Ozbolt, Ivan; Millogo, Athanase; Dermauw, Veronique; Somé, Télesphore; Spicer, Paul; Jervis, Lori L; Ganaba, Rasmané; Gabriel, Sarah; Dorny, Pierre; Carabin, Hélène

2017-06-01

Taeniasis and cysticercosis are two diseases caused by Taenia solium, a parasite transmitted between humans and pigs, leading to considerable economic loss and disabilities. Transmission of the parasite is linked to environmental and behavioural factors such as inadequate sanitation and hygiene, poor pig management, and consumption of infected pork. This study used implementation research method to design a health education intervention strategy for reducing T. solium infections in Burkina Faso, a country endemic for the parasite. Eighteen group discussions were conducted with 8-18 participants each in three villages. In addition, structured interviews were conducted among 4 777 participants and 2 244 pig owners, who were selected through cluster random sampling in 60 villages of three provinces of Burkina Faso. Both approaches assessed knowledge and practices related to T. solium. The information obtained was used to develop a community-adapted health education intervention strategy to control taeniasis and cysticercosis in Burkina Faso. The group discussions revealed that participants had a poor quality of life due to the diseases as well as inadequate access to latrines, safe water, and healthcare services. In addition, it was found that pig production was an important economic activity, especially for women. Furthermore, financial and knowledge constraints were important limitations to improved pig management and latrine construction. The survey data also showed that open defecation and drinking unboiled water were common behaviours, enhanced by a lack of knowledge regarding the transmission of the parasite, perceived financial barriers to the implementation of control measures, lack of public sensitization, as well as a lack of self-efficacy towards control of the parasite. Nevertheless, the perceived financial benefits of controlling porcine cysticercosis could be emphasized by an education program that discourages open defecation and encourages drinking safe water. The final intervention strategy included a Participatory Hygiene and Sanitation Transformation (PHAST) approach, as well as a 52-min film and an accompanying comic booklet. The main problem in the study communities regarding the transmission of T. solium cysticercosis is the random disposal of human faeces, which can be contaminated with parasite eggs. Prevention of open defecation requires the building of latrines, which can be quite problematic in economically challenged settings. Providing the community with the skills to construct durable latrines using low-cost locally available materials would likely help to resolve this problem. Further studies are required to implement and evaluate the T. solium control strategy developed in this study.

Development, evaluation, and utility of a peer evaluation form for online teaching.

PubMed

Gaskamp, Carol D; Kintner, Eileen

2014-01-01

Formative assessment of teaching by peers is an important component of quality improvement for educators. Teaching portfolios submitted for promotion and tenure are expected to include peer evaluations. Faculty resources designed for peer evaluation of classroom teaching are often inadequate for evaluating online teaching. The authors describe development, evaluation, and utility of a new peer evaluation form for formative assessment of online teaching deemed relevant, sound, feasible, and beneficial.

Socioeconomic and Behavioral Factors Leading to Acquired Bacterial Resistance to Antibiotics in Developing Countries

PubMed Central

Okeke, Iruka N.; Lamikanra, Adebayo

1999-01-01

In developing countries, acquired bacterial resistance to antimicrobial agents is common in isolates from healthy persons and from persons with community-acquired infections. Complex socioeconomic and behavioral factors associated with antibiotic resistance, particularly regarding diarrheal and respiratory pathogens, in developing tropical countries, include misuse of antibiotics by health professionals, unskilled practitioners, and laypersons; poor drug quality; unhygienic conditions accounting for spread of resistant bacteria; and inadequate surveillance. PMID:10081668

Information systems for mental health in six low and middle income countries: cross country situation analysis.

PubMed

Upadhaya, Nawaraj; Jordans, Mark J D; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Hanlon, Charlotte; Kigozi, Fred; Kizza, Dorothy; Lund, Crick; Semrau, Maya; Shidhaye, Rahul; Thornicroft, Graham; Komproe, Ivan H; Gureje, Oye

2016-01-01

Research on information systems for mental health in low and middle income countries (LMICs) is scarce. As a result, there is a lack of reliable information on mental health service needs, treatment coverage and the quality of services provided. With the aim of informing the development and implementation of a mental health information sub-system that includes reliable and measurable indicators on mental health within the Health Management Information Systems (HMIS), a cross-country situation analysis of HMIS was conducted in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda), participating in the 'Emerging mental health systems in low and middle income countries' (Emerald) research programme. A situation analysis tool was developed to obtain and chart information from documents in the public domain. In circumstances when information was inadequate, key government officials were contacted to verify the data collected. In this paper we compare the baseline policy context, human resources situation as well as the processes and mechanisms of collecting, verifying, reporting and disseminating mental health related HMIS data. The findings suggest that countries face substantial policy, human resource and health governance challenges for mental health HMIS, many of which are common across sites. In particular, the specific policies and plans for the governance and implementation of mental health data collection, reporting and dissemination are absent. Across sites there is inadequate infrastructure, few HMIS experts, and inadequate technical support and supervision to junior staff, particularly in the area of mental health. Nonetheless there are also strengths in existing HMIS where a few mental health morbidity, mortality, and system level indicators are collected and reported. Our study indicates the need for greater technical and resources input to strengthen routine HMIS and develop standardized HMIS indicators for mental health, focusing in particular on indicators of coverage and quality to facilitate the implementation of the WHO mental health action plan 2013-2020.

Potential of integrated continuous surveys and quality management to support monitoring, evaluation, and the scale-up of health interventions in developing countries.

PubMed

Rowe, Alexander K

2009-06-01

Well-funded initiatives are challenging developing countries to increase health intervention coverage and show impact. Despite substantial resources, however, major obstacles include weak health systems, a lack of reasonably accurate monitoring data, and inadequate use of data for managing programs. This report discusses how integrated continuous surveys and quality management (I-Q), which are well-recognized approaches in wealthy countries, could support intervention scale-up, monitoring and evaluation, quality control for commodities, capacity building, and implementation research in low-resource settings. Integrated continuous surveys are similar to existing national cross-sectional surveys of households and health facilities, except data are collected over several years by permanent teams, and most results are reported monthly at the national, province, and district levels. Quality management involves conceptualizing work as processes, involving all workers in quality improvement, monitoring quality, and teams that improve quality with "plan-do-study-act" cycles. Implementing and evaluating I-Q in a low-income country would provide critical information on the value of this approach.

Evidence synthesis for medical decision making and the appropriate use of quality scores.

PubMed

Doi, Suhail A R

2014-09-01

Meta-analyses today continue to be run using conventional random-effects models that ignore tangible information from studies such as the quality of the studies involved, despite the expectation that results of better quality studies reflect more valid results. Previous research has suggested that quality scores derived from such quality appraisals are unlikely to be useful in meta-analysis, because they would produce biased estimates of effects that are unlikely to be offset by a variance reduction within the studied models. However, previous discussions took place in the context of such scores viewed in terms of their ability to maximize their association with both the magnitude and direction of bias. In this review, another look is taken at this concept, this time asserting that probabilistic bias quantification is not possible or even required of quality scores when used in meta-analysis for redistribution of weights. The use of such a model is contrasted with the conventional random effects model of meta-analysis to demonstrate why the latter is inadequate in the face of a properly specified quality score weighting method. © 2014 Marshfield Clinic.

Posteroanterior versus anteroposterior lumbar spine radiology

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

Tsuno, M.M.; Shu, G.J.

The posteroanterior view of the lumbar spine has important features including radiation protection and image quality; these have been studied by various investigators. Investigators have shown that sensitive tissues receive less radiation dosage in the posteroanterior view of the spine for scoliosis screening and intracranial tomography without altering the image quality. This paper emphasizes the importance of the radiation safety aspect of the posteroanterior view and shows the improvement in shape distortion in the lumbar vertebrae.

Targeted Alteration of Dietary Omega-3 and Omega-6 Fatty Acids for the Treatment of Post-Traumatic Headaches

DTIC Science & Technology

2016-10-01

reduced psychological distress and improved quality-of- life in a chronic headache population. We propose to carry out a 2-arm, parallel group...emphasize the role of inflammation, cytokine modulation, microglial activation, and abnormalities in neurotransmitter activity in mediating PTH. These...anti- and pro-nociceptive lipid mediators and their precursor fatty acids, reduced psychological distress and improved quality-of-life in a chronic

Composicion de aves del Pacifico Sur de Nicaragua enfatizando las especies indicadoras dependientes de bosque [Community composition of Nicaragua's Pacific Slope forest birds, emphasizing forest quality-dependent species

Treesearch

M. Torrez; W.J. Arendt; M. Sotelo

2013-01-01

Given the importance of biological corridors, it is necessary to evaluate their fauna especially those species are bioindicators of habitat quality, to determine patterns and extent of community diversity and how such factors reflect the level of conservation within and among green corridors in general. We investigated how selected landscape features within the Paso...

High Performing Colleges. The Malcolm Baldrige National Quality Award as a Framework for Improving Higher Education. Volume I: Theory and Concepts [and] Volume II: Case and Practice.

ERIC Educational Resources Information Center

Seymour, Daniel, Ed.; And Others

This publication provides research-based discussion in 20 chapters of possible extension of the Malcolm Baldrige National Quality Award to honor high performing colleges. Chapters are organized into two volumes, the first exploring a broad range of issues from a scholarly point of view and the second emphasizing the practical application of a…

Developments in veterinary herd health programmes on dairy farms: a review.

PubMed

Noordhuizen, J P; Wentink, G H

2001-11-01

This review article addresses some major developments in herd health programmes for dairy farms over the last decades. It focuses particularly on herd health and production management programmes that use protocols and monitoring activities. The article further emphasizes the need for merging herd health programmes with quantitative epidemiological principles and methods. Subsequently, this article points to the latest developments regarding quality assurance in the dairy sector and some quality management methods. Quality should be regarded in its broadest sense. The importance of integrating veterinary herd health programmes and quality (risk) management support at a dairy farm level is stressed. Examples are provided.

Assessing competition in hospital care markets: the importance of accounting for quality differentiation.

PubMed

Tay, Abigail

2003-01-01

Quality differentiation is especially important in the hospital industry, where the choices of Medicare patients are unaffected by prices. Unlike previous studies that use geographic market concentration to estimate hospital competitiveness, this article emphasizes the importance of quality differentiation in this spatially differentiated market. I estimate a random-coefficients discrete-choice model that predicts patient flow to different hospitals and find that demand responses to both distance and quality are substantial. The estimates suggest that patients do not substitute toward alternative hospitals in proportion to current market shares, implying that geographic market concentration is an inappropriate measure of hospital competitiveness.

Methodological quality and reporting of systematic reviews in hand and wrist pathology.

PubMed

Wasiak, J; Shen, A Y; Ware, R; O'Donohoe, T J; Faggion, C M

2017-10-01

The objective of this study was to assess methodological and reporting quality of systematic reviews in hand and wrist pathology. MEDLINE, EMBASE and Cochrane Library were searched from inception to November 2016 for relevant studies. Reporting quality was evaluated using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and methodological quality using a measurement tool to assess systematic reviews, the Assessment of Multiple Systematic Reviews (AMSTAR). Descriptive statistics and linear regression were used to identify features associated with improved methodological quality. A total of 91 studies were included in the analysis. Most reviews inadequately reported PRISMA items regarding study protocol, search strategy and bias and AMSTAR items regarding protocol, publication bias and funding. Systematic reviews published in a plastics journal, or which included more authors, were associated with higher AMSTAR scores. A large proportion of systematic reviews within hand and wrist pathology literature score poorly with validated methodological assessment tools, which may affect the reliability of their conclusions. I.

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

PubMed

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

2012-08-09

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

Southern Fruit Producing Woody Plants Used by Wildlife

Treesearch

Lowell K. Halls; [Editor

1977-01-01

Describes and provides illustrations of 106 woody plant species that produce fruit useful to wildlife in southern forests. It also includes information about plant growth requirements, management, and nutritional quality. Trees, shrubs, and vines that produce fleshy fruits or nuts are emphasized.

48 CFR 2901.603-72 - Administrative procurement management reviews.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Authority, and Responsibilities 2901.603-72 Administrative procurement management reviews. (a) The Senior..., policies, procedures and applicable directives. The reviews are to emphasize the development and... quality reviews and assessment techniques. This system is required to: (1) Evaluate the effectiveness and...

Maximizing Value for Training with ISO 9000.

ERIC Educational Resources Information Center

Russo, C. W. Russ; Russo, Tracy Callaway

1996-01-01

The International Organization for Standardization (ISO) has created quality assurance guidelines that help technology trainers and educators manage and organize training programs. This article briefly outlines program design principles, emphasizing needs analysis and outcome evaluation, performance documentation, and process management. ISO 9000…

Our Student-Teacher Program Lets Us Spot Hot Faculty Prospects Early.

ERIC Educational Resources Information Center

Kolze, Richard C.

1988-01-01

A high school district in suburban Chicago recruits top quality teachers by emphasizing the importance of its student teaching program, committing extra time and resources to the program, and recruiting new staff members from the student teacher ranks. (MLF)

Quest for Quality.

ERIC Educational Resources Information Center

Wilson, Richard B.; Schmoker, Mike

1992-01-01

Unlike traditional school management, Toyota of America recognizes thinking employees and emphasizes problems and measurable approaches to improvement. Instead of meeting to discuss short-term goals, specific problems, and concrete successes, school leaders often alienate staff by leading year-end discussions of standardized test score data.…

Accounting Systems for School Districts.

ERIC Educational Resources Information Center

Atwood, E. Barrett, Jr.

1983-01-01

Advises careful analysis and improvement of existing school district accounting systems prior to investment in new ones. Emphasizes the importance of attracting and maintaining quality financial staffs, developing an accounting policies and procedures manual, and designing a good core accounting system before purchasing computer hardware and…

Managing Uncertainty: Thinking and Planning Strategically.

ERIC Educational Resources Information Center

Lorenzo, Albert L.

1993-01-01

Argues that rapid change and tight resources demand reality-based planning, rather than planning models that ignore internal and external customers or emphasize process over product. Describes the Strategic Guidance Model (SGM) which provides colleges with strategic visioning, organizational assessment, environmental scanning, quality improvement,…

Environmental Education Center.

ERIC Educational Resources Information Center

Holmes (Warren) Co. and Black (Kenneth) Associate, Architects, Lansing, MI.

Public awareness and concern for our natural environment have rapidly increased. With new demands for knowledge and action concerning all aspects of environmental quality, schools have begun to incorporate into their curriculums new programs emphasizing environmental awareness and appreciation at all age levels. To bring students into further…

Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence.

PubMed

Madzimbamuto, Farai D; Ray, Sunanda; Mogobe, Keitshokile D

2013-06-10

The failure to reduce preventable maternal deaths represents a violation of women's right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks. Confidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman's death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women's lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients' rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques. In countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes of hemorrhage, hypertension and sepsis. Advocacy for all pregnant HIV-positive women to be on anti-retroviral therapy must extend to improvements in the quality of service offered, better organised obstetric services and integration of clinical HIV care into maternity services. Improved communication and specialist support to peripheral facilities can be facilitated through advances in technology such as mobile phones.

Usual Vitamin Intakes by Mexican Populations.

PubMed

Pedroza-Tobías, Andrea; Hernández-Barrera, Lucía; López-Olmedo, Nancy; García-Guerra, Armando; Rodríguez-Ramírez, Sonia; Ramírez-Silva, Ivonne; Villalpando, Salvador; Carriquiry, Alicia; Rivera, Juan A

2016-09-01

In the past several years, the consumption of high-energy, nutrient-poor foods has increased globally. Dietary intake data collected by the National Health and Nutrition Survey (ENSANUT) 2012 provide information to assess the quality of the Mexican diet and to guide food and nutrition policy. The aim was to describe the usual intake and the prevalence of inadequate intakes of vitamins for the overall Mexican population and by subgroups defined by sex, age, region, urban or rural areas, and socioeconomic status (SES). ENSANUT 2012 is a cross-sectional probabilistic survey representative of the Mexican population. Dietary information was collected by using the 24-h recall automated multiple-pass method (n = 10,096) with a repeated measurement on a subsample (n = 889) to permit adjustment for intraindividual variability with the use of the Iowa State University method. Mean usual intakes and the prevalence of inadequate intakes of thiamin, riboflavin, niacin, folate, and vitamins A, D, E, C, B-6, and B-12 were calculated for children aged 1-4 y (CH1-4y), children aged 5-11 y (CH5-11y), adolescents aged 12-19 y, and adults aged ≥20 y. In all of the age groups, prevalences of inadequate intakes of vitamins D and E were the highest (77-99% of adults and adolescents and 53-95% of CH5-11y and CH1-4y) and those of folate and vitamin A were intermediate (47-70% of adults and adolescents, 15-23% of CH5-11y and 8-13% of CH1-4y), whereas those of thiamin, riboflavin, niacin, and vitamins B-6, B-12, and C were the lowest (0-37% of adults, 1-27% of adolescents, and 0-2.4% of CH5-11y and CH1-4y). With few exceptions, the highest prevalences of inadequate intakes for vitamins were observed in the poorest populations (rural South region and the lowest tertile of SES). The intake of vitamins among Mexicans is inadequate overall. Information collected by ENSANUT can help target food assistance programs and develop strategies to prevent vitamin deficiencies. © 2016 American Society for Nutrition.

The Mediating Effect of Kaizen between Total Quality Management (TQM) and Business Performance

NASA Astrophysics Data System (ADS)

Shan, Ang Wei; Fauzi Ahmad, Mohd; Hisyamudin Muhd Nor, Nik

2016-11-01

Every customer preference is different but yet important. The global market is shifting rapidly, organizations are needed to continuously identify new opportunity to obtain competitive advantages. Literature suggested that manufacturing companies are needed to differentiate themselves through emphasize on quality and continuous improvement in product and services as a crucial part to secure and success in the future. The Total Quality Management (TQM) practices has developed a strong bearing on growth and competitiveness in market. Therefore, a proper continuous improvement (Kaizen) practice is needed to eliminate waste and value added in production to remain competitiveness and retained the potential customer. However, based on the previous study it had indicated an inconsistent result between TQM and BP. Besides that, researcher also less emphasized on mediator in previous work. Therefore, the purpose of this paper is to recommend the relationship between TQM and business performance with a mediator's effect of Kaizen. This proposed model attempt to create knowledge to both academician and company players to acquire a better understanding among the TQM and Kaizen practices. Consequently, the Structural Equation Modelling (SEM) techniques is applying to identify and evaluate the relationship among TQM, Kaizen, and business performance in developing a new TQM model.

Primary Care Practice Transformation Is Hard Work

PubMed Central

Crabtree, Benjamin F.; Nutting, Paul A.; Miller, William L.; McDaniel, Reuben R.; Stange, Kurt C.; Jaén, Carlos Roberto; Stewart, Elizabeth

2010-01-01

Background Serious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a patient-centered medical home present even greater challenges and require more effective approaches. Methods Our research team conducted a series of National Institutes of Health funded descriptive and intervention projects to understand organizational change in primary care practice settings, emphasizing a complexity science perspective. The result was a developmental research effort that enabled the identification of critical lessons relevant to enabling practice change. Results A summary of findings from a 15-year program of research highlights the limitations of viewing primary care practices in the mechanistic terms that underlie current or traditional approaches to quality improvement. A theoretical perspective that views primary care practices as dynamic complex adaptive systems with “agents” who have the capacity to learn, and the freedom to act in unpredictable ways provides a better framework for grounding quality improvement strategies. This framework strongly emphasizes that quality improvement interventions should not only use a complexity systems perspective, but also there is a need for continual reflection, careful tailoring of interventions, and ongoing attention to the quality of interactions among agents in the practice. Conclusions It is unlikely that current strategies for quality improvement will be successful in transforming current primary care practice to a patient-centered medical home without a stronger guiding theoretical foundation. Our work suggests that a theoretical framework guided by complexity science can help in the development of quality improvement strategies that will more effectively facilitate practice change. PMID:20856145

PERSPECTIVE: Is acuity enough? Other considerations in clinical investigations of visual prostheses

NASA Astrophysics Data System (ADS)

Lepri, Bernard P.

2009-06-01

Visual impairing eye diseases are the major frontier facing ophthalmic research today in light of our rapidly aging population. The visual skills necessary for improving the quality of daily function and life are inextricably linked to these impairing diseases. Both research and reimbursement programs are emphasizing outcome-based results. Is improvement in visual acuity alone enough to improve the function and quality of life of visually impaired persons? This perspective summarizes the types of effectiveness endpoints for clinical investigations of visual prostheses that go beyond visual acuity. The clinical investigation of visual prostheses should include visual function, functional vision and quality of life measures. Specifically, they encompass contrast sensitivity, orientation and mobility, activities of daily living and quality of life assessments. The perspective focuses on the design of clinical trials for visual prostheses and the methods of determining effectiveness above and beyond visual acuity that will yield outcomes that are measured by improved function in the visual world and quality of life. The visually impaired population is the primary consideration in this presentation with particular emphases on retinitis pigmentosa and age-related macular degeneration. Clinical trials for visual prostheses cannot be isolated from the need for medical rehabilitation in order to obtain measurements of effectiveness that produce outcomes/evidence-based success. This approach will facilitate improvement in daily function and quality of life of patients with diseases that cause chronic vision impairment. The views and opinions are those of the author and do not necessarily reflect those of the US Food and Drug Administration, the US Department of Health and Human Services or the Public Health Service.

Limited Health Literacy is a Barrier to Medication Reconciliation in Ambulatory Care

PubMed Central

Persell, Stephen D.; Osborn, Chandra Y.; Richard, Robert; Skripkauskas, Silvia

2007-01-01

Background Limited health literacy may influence patients’ ability to identify medications taken; a serious concern for ambulatory safety and quality. Objective To assess the relationship between health literacy, patient recall of antihypertensive medications, and reconciliation between patient self-report and the medical record. Design In-person interviews, literacy assessment, medical records abstraction. Participants Adults with hypertension at three community health centers. Measurement We measured health literacy using the short-form Test of Functional Health Literacy in Adults. Patients were asked about the medications they took for blood pressure. Their responses were compared with the medical record. Results Of 119 participants, 37 (31%) had inadequate health literacy. Patients with inadequate health literacy were less able to name any of their antihypertensive medications compared to those with adequate health literacy (40.5% vs 68.3%, p = 0.005). After adjusting for age and income, this difference remained (adjusted odds ratio [OR] = 2.9, 95% confidence interval [95%CI] = 1.3–6.7). Agreement between patient reported medications and the medical record was low: 64.9% of patients with inadequate and 37.8% with adequate literacy had no medications common to both lists. Conclusions Limited health literacy was associated with a greater number of unreconciled medications. Future studies should investigate how this may impact safety and hypertension control. PMID:17786521

The Dual Burden of Malnutrition and Associated Dietary and Lifestyle Habits among Lebanese School Age Children Living in Orphanages in North Lebanon.

PubMed

El-Kassas, Germine; Ziade, Fouad

2017-01-01

Childhood is a crucial period affecting physical and intellectual development. Although children living in orphanages are among the most vulnerable groups at risk of malnutrition, there is scarcity of data concerning their nutritional status in Lebanon. To investigate these data, a cross-sectional survey was conducted including a sample of 153 institutionalized children aged 5-14 years from all orphanages in Tripoli. Nutritional status was assessed using anthropometric, clinical, and dietary tools. Interpretation of anthropometric data showed that 13.8% were stunted while the prevalence of overweight/obesity was 9.2% according to the World Health Organization (WHO) reference criteria. Physical signs suggesting nutritional deficiencies were detected in about 25% of the sample. Dietary intake evaluation showed that about half of the participants had inadequate dietary intakes of proteins, fruits, and vegetables and 92% had inadequate milk and dairy intakes recommended for their age specific needs. Multivariate regression analysis revealed statistically significant positive association of age, skipping breakfast, and increased screen time with stunting while it showed statistically significant negative association of inadequate protein intake with overweight/obesity. The coexistence of under- and overnutrition among institutionalized children calls for implementation of comprehensive intervention strategies committed to reducing undernutrition while simultaneously preventing overnutrition through improving diet quality and physical activity of these children.

Prevalence and types of preanalytical error in hematology laboratory of a tertiary care hospital in South India.

PubMed

Arul, Pitchaikaran; Pushparaj, Magesh; Pandian, Kanmani; Chennimalai, Lingasamy; Rajendran, Karthika; Selvaraj, Eniya; Masilamani, Suresh

2018-01-01

An important component of laboratory medicine is preanalytical phase. Since laboratory report plays a major role in patient management, more importance should be given to the quality of laboratory tests. The present study was undertaken to find the prevalence and types of preanalytical errors at a tertiary care hospital in South India. In this cross-sectional study, a total of 118,732 samples ([62,474 outpatient department [OPD] and 56,258 inpatient department [IPD]) were received in hematology laboratory. These samples were analyzed for preanalytical errors such as misidentification, incorrect vials, inadequate samples, clotted samples, diluted samples, and hemolyzed samples. The overall prevalence of preanalytical errors found was 513 samples, which is 0.43% of the total number of samples received. The most common preanalytical error observed was inadequate samples followed by clotted samples. Overall frequencies (both OPD and IPD) of preanalytical errors such as misidentification, incorrect vials, inadequate samples, clotted samples, diluted samples, and hemolyzed samples were 0.02%, 0.05%, 0.2%, 0.12%, 0.02%, and 0.03%, respectively. The present study concluded that incorrect phlebotomy techniques due to lack of awareness is the main reason for preanalytical errors. This can be avoided by proper communication and coordination between laboratory and wards, proper training and continuing medical education programs for laboratory and paramedical staffs, and knowledge of the intervening factors that can influence laboratory results.

Implementing effective and sustainable multidisciplinary clinical thoracic oncology programs

PubMed Central

Freeman, Richard K.; Krasna, Mark J.

2015-01-01

Three models of care are described, including two models of multidisciplinary care for thoracic malignancies. The pros and cons of each model are discussed, the evidence supporting each is reviewed, and the need for more (and better) research into care delivery models is highlighted. Key stakeholders in thoracic oncology care delivery outcomes are identified, and the need to consider stakeholder perspectives in designing, validating and implementing multidisciplinary programs as a vehicle for quality improvement in thoracic oncology is emphasized. The importance of reconciling stakeholder perspectives, and identify meaningful stakeholder-relevant benchmarks is also emphasized. Metrics for measuring program implementation and overall success are proposed. PMID:26380186

Implementing effective and sustainable multidisciplinary clinical thoracic oncology programs.

PubMed

Osarogiagbon, Raymond U; Freeman, Richard K; Krasna, Mark J

2015-08-01

Three models of care are described, including two models of multidisciplinary care for thoracic malignancies. The pros and cons of each model are discussed, the evidence supporting each is reviewed, and the need for more (and better) research into care delivery models is highlighted. Key stakeholders in thoracic oncology care delivery outcomes are identified, and the need to consider stakeholder perspectives in designing, validating and implementing multidisciplinary programs as a vehicle for quality improvement in thoracic oncology is emphasized. The importance of reconciling stakeholder perspectives, and identify meaningful stakeholder-relevant benchmarks is also emphasized. Metrics for measuring program implementation and overall success are proposed.

The situation of sanitary systems in rural areas in the Miyun catchment, China.

PubMed

Kröger, C; Xu, A; Duan, S; Zhang, B; Eckstädt, H; Meissner, R

2012-01-01

The Miyun Reservoir provides most of Beijing's drinking water. Despite its importance, the Miyun reservoir suffers from decreasing water quality caused by uncontrolled wastewater discharges, inadequate land use and over fertilization, which increase the pressure on soil and water resources. The major pollutants are nitrogen and phosphorus which emanate to some extent from untreated sewage. So far there is little data about the existing wastewater quantity and quality in rural settlements in northern China. This study was conducted in typical villages situated along upstream rivers in the catchment of the Miyun Reservoir. The main objective was to determine the current situation and efficiency of the wastewater treatment system in rural settlements.

[The conceptual bases for an entrepreneurial management of local health systems].

PubMed

Yepes, F J; Durán-Arenas, L

1994-01-01

Health management has become a fashion and it is now common to talk about strategic or service management, or of total quality management applied to health systems. However, all these elements of business management are being translated to health systems without a previous analysis on the implicit health model and the rationality of the prevalent production functions, which can lead to a higher level of efficiency but with an inadequate use of resources. This paper suggests the importance of integrating the advances in management and health sciences and proposes what are considered to be the conceptual basis for the design of a management tool geared to conduct local health systems with effectiveness, efficiency, quality and equity.

Dot-gov: market failure and the creation of a national health information technology system.

PubMed

Kleinke, J D

2005-01-01

The U.S. health care marketplace's continuing failure to adopt information technology (IT) is the result of economic problems unique to health care, business strategy problems typical of fragmented industries, and technology standardization problems common to infrastructure development in free-market economies. Given the information intensity of medicine, the quality problems associated with inadequate IT, the magnitude of U.S. health spending, and the large federal share of that spending, this market failure requires aggressive governmental intervention. Federal policies to compel the creation of a national health IT system would reduce aggregate health care costs and improve quality, goals that cannot be attained in the health care marketplace.

A Review on the Respiratory System Toxicity of Carbon Nanoparticles.

PubMed

Pacurari, Maricica; Lowe, Kristine; Tchounwou, Paul B; Kafoury, Ramzi

2016-03-15

The respiratory system represents the main gateway for nanoparticles' entry into the human body. Although there is a myriad of engineered nanoparticles, carbon nanoparticles/nanotubes (CNPs/CNTs) have received much attention mainly due to their light weight, very high surface area, durability, and their diverse applications. Since their discovery and manufacture over two decades ago, much has been learned about nanoparticles' interactions with diverse biological system models. In particular, the respiratory system has been of great interest because various natural and man-made fibrous particles are known to be responsible for chronic and debilitating lung diseases. In this review, we present up-to-date the literature regarding the effects of CNTs or carbon nanofibers (CNFs) on the human respiratory system with respect to respiratory toxicity pathways and associated pathologies. This article is intended to emphasize the potentially dangerous effects to the human respiratory system if inadequate measures are used in the manufacture, handling, and preparation and applications of CNP or CNP-based products.

Ten Demands of Improved Usability in eHealth and Some Progress - Co-Creation by Health and Social Care Professionals.

PubMed

Scandurra, Isabella; Liljequist, David

2016-01-01

Current healthcare organizations often do not accomplish the intended effects of their eHealth systems due to inadequate usability. Commissioned by the Swedish Ministry of Health and Social Affairs, the usability of current eHealth systems in Swedish health and social care has been analysed from the perspective of their professionals. The objective of the study was to report on current problems, potential solutions as well as to relate these to research in relevant areas. Using a participatory approach, nine workshops were held where health informatics researchers guided staff from different care organizations, representatives of the national associations of health and social care professionals and the national eHealth system vendor organization. This paper presents ten demands that Swedish health and social care professionals find imperative to prioritize. The study emphasizes that development of eHealth systems must be integrated into the care practice improvement process and iteratively evaluated regarding usability.

A study of the limitations of linear theory methods as applied to sonic boom calculations

NASA Technical Reports Server (NTRS)

Darden, Christine M.

1990-01-01

Current sonic boom minimization theories have been reviewed to emphasize the capabilities and flexibilities of the methods. Flexibility is important because it is necessary for the designer to meet optimized area constraints while reducing the impact on vehicle aerodynamic performance. Preliminary comparisons of sonic booms predicted for two Mach 3 concepts illustrate the benefits of shaping. Finally, for very simple bodies of revolution, sonic boom predictions were made using two methods - a modified linear theory method and a nonlinear method - for signature shapes which were both farfield N-waves and midfield waves. Preliminary analysis on these simple bodies verified that current modified linear theory prediction methods become inadequate for predicting midfield signatures for Mach numbers above 3. The importance of impulse is sonic boom disturbance and the importance of three-dimensional effects which could not be simulated with the bodies of revolution will determine the validity of current modified linear theory methods in predicting midfield signatures at lower Mach numbers.

Neuromarkers for Mental Disorders: Harnessing Population Neuroscience.

PubMed

Jollans, Lee; Whelan, Robert

2018-01-01

Despite abundant research into the neurobiology of mental disorders, to date neurobiological insights have had very little impact on psychiatric diagnosis or treatment. In this review, we contend that the search for neuroimaging biomarkers-neuromarkers-of mental disorders is a highly promising avenue toward improved psychiatric healthcare. However, many of the traditional tools used for psychiatric neuroimaging are inadequate for the identification of neuromarkers. Specifically, we highlight the need for larger samples and for multivariate analysis. Approaches such as machine learning are likely to be beneficial for interrogating high-dimensional neuroimaging data. We suggest that broad, population-based study designs will be important for developing neuromarkers of mental disorders, and will facilitate a move away from a phenomenological definition of mental disorder categories and toward psychiatric nosology based on biological evidence. We provide an outline of how the development of neuromarkers should occur, emphasizing the need for tests of external and construct validity, and for collaborative research efforts. Finally, we highlight some concerns regarding the development, and use of, neuromarkers in psychiatric healthcare.

Plastic surgery residency graduate outcomes: a 43-year experience at a single institution and the first "integrated" training program in the United States.

PubMed

Noland, Shelley S; Lee, Gordon K

2012-04-01

The Accreditation Council for Graduate Medical Education emphasizes outcome-based residency education. This project is an outcomes study on graduates of the Stanford University Integrated Plastic Surgery Residency. A survey assessing various outcomes, including practice profile, financial, personal, and educational issues, was electronically distributed to all 130 graduates between 1966 and 2009. There was a 65% response rate. Nearly all respondents are currently in practice. Popular fellowships included hand and microsurgery. Most respondents participated in research and held leadership roles. Adequate residency education was noted in areas of patient care, board preparation, and ethical and legal issues. Inadequate residency education was noted in areas of managing a practice, coding, and cost-effective medicine. This is the first long-term outcomes study of plastic surgery graduates. Most are in active, successful practice. We have incorporated educational content related to running a small business, contract negotiating, and marketing to better prepare our residents for future practice.

Community food environments and healthy food access among older adults: A review of the evidence for the Senior Farmers' Market Nutrition Program (SFMNP).

PubMed

O'Dare Wilson, Kellie

2017-04-01

Although an array of federal, state, and local programs exist that target food insecurity and the specific nutritional needs of seniors, food insecurity among older adults in the United States remains a persistent problem, particularly in minority and rural populations. Food insecurity is highly predictive of inadequate fresh fruit and vegetable (FFV) consumption in particular. The Senior Farmers' Market Nutrition Program (SFMNP) is a community-based program to help seniors purchase FFVs at farmer's markets in their neighborhoods. The SFMNP continues to grow; however, little is known about the effectiveness of the program. The purposes of this article are to (1) highlight the importance of community and neighborhood based food insecurity programs, specifically emphasizing the importance of FFV access for seniors, (2) review the current state of the evidence on the SFMNP, and (3) provide recommendations for researchers and policy-makers wishing to continue to advance the knowledge base in neighborhood-based food security among older adults.

Cemento-ossyfying fibroma juvenile of the oral cavity.

PubMed

Cecchetti, F; Luciani, F; Bramanti, E; Bartuli, F N; Ottria, L; Arcuri, C

2010-01-01

Fibro-osseous neoplasm remains somewhat controversial, and differing concept have been advanced regarding their nature and the proper terminology for them. Cemento-ossyfying fibroma juvenile (JOF) is a rare type of fibro-osseous tumor as also been included under the "umbrella" of cemento-ossyfying fibroma. The JOF is most often seen in patients who are between 5 and 15 years of age. With this work we emphasize the importance of a correct diagnostic approach. MATERIAL AND METHODS.: The case describes a form of cemento-ossyfying fibroma hight active and aggressive like JOF. The patient thirteen older showed from 2004 to 2008 three times the palatal lesion, it was performed with a incisional biopsy and excisional biopsy. The tumor were fixed in 10% buffered formalin embedded in paraffin cut into thick sections and stained with ematoxylineosin. The incisional biopsy was inadequate to formulate a correct diagnosis. The histological exams have showed for three times different aspects. Some authors in the past have suggested different classification. The COFs show different clinical, histological and radiographical patterns.

A Review on the Respiratory System Toxicity of Carbon Nanoparticles

PubMed Central

Pacurari, Maricica; Lowe, Kristine; Tchounwou, Paul B.; Kafoury, Ramzi

2016-01-01

The respiratory system represents the main gateway for nanoparticles’ entry into the human body. Although there is a myriad of engineered nanoparticles, carbon nanoparticles/nanotubes (CNPs/CNTs) have received much attention mainly due to their light weight, very high surface area, durability, and their diverse applications. Since their discovery and manufacture over two decades ago, much has been learned about nanoparticles’ interactions with diverse biological system models. In particular, the respiratory system has been of great interest because various natural and man-made fibrous particles are known to be responsible for chronic and debilitating lung diseases. In this review, we present up-to-date the literature regarding the effects of CNTs or carbon nanofibers (CNFs) on the human respiratory system with respect to respiratory toxicity pathways and associated pathologies. This article is intended to emphasize the potentially dangerous effects to the human respiratory system if inadequate measures are used in the manufacture, handling, and preparation and applications of CNP or CNP-based products. PMID:26999172

40 CFR 1500.5 - Reducing delay.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 33 2011-07-01 2011-07-01 false Reducing delay. 1500.5 Section 1500.5 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY PURPOSE, POLICY, AND MANDATE § 1500.5 Reducing...). (b) Emphasizing interagency cooperation before the environmental impact statement is prepared, rather...

40 CFR 1500.5 - Reducing delay.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Reducing delay. 1500.5 Section 1500.5 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY PURPOSE, POLICY, AND MANDATE § 1500.5 Reducing...). (b) Emphasizing interagency cooperation before the environmental impact statement is prepared, rather...

An Introduction to Value Analysis.

ERIC Educational Resources Information Center

Takacs, Kalman

1983-01-01

Emphasizes consciousness as a quality which differentiates a human being from other living organisms. Excerpts various perspectives that are value-analyzed to illustrate two assumptions: (1) thinking leads to valuing and values and (2) all psychological perspectives are based upon some value system which can be identified. (JAC)

Motivation, Management, and Performance.

ERIC Educational Resources Information Center

Olmstead, Joseph A.

There is an increasing interest today in the ways in which human motivation contributes to the productivity and performance of personnel. This early study of motivation management emphasizes that the organizational environment is a principal determinant of the quality of employee motivation. Concrete considerations in the management of motivation…

Experiences from CSCW in Virtual Classrooms.

ERIC Educational Resources Information Center

Multisilta, Jari

The rapid development of modern information and communications technologies has opened new possibilities for establishing and delivering distance learning. In addition, the new learning paradigm based on cognitive learning theories can emphasize the quality of the learning process. The open learning environment that utilizes modern communications…

Graying America Presents Golden Opportunities for Camp Directors.

ERIC Educational Resources Information Center

Cosky, Alicia C.

1989-01-01

Discusses quality-of-life issues for ever-increasing population of American elderly, emphasizing value of recreation. Offers organized camping as way of exposing older adults to enjoyable physical activities. Cites evidence supporting beneficial effects of regular exercise for elderly, beginning at any age. (TES)

Hyporheic flow patterns in relation to large river floodplain attributes

EPA Science Inventory

Field-calibrated models of hyporheic flow have emphasized low-order headwater systems. In many cases, however, hyporheic flow in large lowland river floodplains may be an important contributor to ecosystem services such as maintenance of water quality and habitat. In this study, ...

The Social Effects of Cable Television.

ERIC Educational Resources Information Center

Johnson, Leland L.

Cable television illustrates the problems that can arise in exploiting a promising new technology to meet social needs. Cable operators' marketing procedures have emphasized improvement of the quality of reception from local broadcasting stations, increased programming choice by introduction of distant signals, and introduction of special pay…

Portfolios for Majors in Professional Communication.

ERIC Educational Resources Information Center

Killingsworth, M. Jimmie; Sanders, Scott P.

1987-01-01

Suggests general principles for developing assignments where students prepare portfolios that reveal their overall communication skills in addition to the usual job search tools. Emphasizes that students should concentrate on including works in the portfolio with the criteria of quality, variety, professionalism, and maturity in mind. (SKC)

Exploring Pedagogical Relationships in the Context of Free Play

ERIC Educational Resources Information Center

Hall-Kenyon, Kendra M.; Rosborough, Alessandro A.

2017-01-01

Early childhood advocates agree that positive teacher-child relationships are critical to classroom quality. Much research has emphasized quantifiable teacher characteristics and child outcomes without fully capturing the complexity of these relationships. Drawing on extensive classroom observations, two video-recorded free play sessions and…

Teaching Teaching.

ERIC Educational Resources Information Center

Watts, Heidi

1982-01-01

A staff development specialist describes personal qualities demanded by that field: (1) a "watchbird" mentality, emphasizing self-awareness; (2) a clear sense of personal goals; (3) a sense of the mutuality of teaching and learning; and (4) willingness to take risks. Staff developers benefit from frequent returns to classroom teaching.…

Hyporheic flow patterns in relation to large river floodplain attributes Journal

EPA Science Inventory

Field-calibrated models of hyporheic flow have emphasized low-order headwater systems. In many cases, however, hyporheic flow in large lowland river floodplains may be an important contributor to ecosystem services such as maintenance of water quality and habitat. In this study, ...

Cultivating Practical Wisdom as Education

ERIC Educational Resources Information Center

Marshall, Aaron; Thorburn, Malcolm

2014-01-01

This article argues, from a critical realist perspective, that it would be beneficial to extend thinking on how personal and social education could become more central to students' learning. We explore how constructive-informed arrangements which emphasize cognitive skills and affective qualities could be realized through experiential…

Older and wiser? An affective science perspective on age-related challenges in financial decision making

PubMed Central

Kensinger, Elizabeth A.; Munnell, Alicia H.; Sass, Steven A.; Dickerson, Brad C.; Wright, Christopher I.; Barrett, Lisa Feldman

2011-01-01

Financial planning decisionss are fundamentally affective in nature; they are decisions related to money, longevity and quality of life. Over the next several decades people will be increasingly responsible for managing their own assets and investments, and they will be subject to the affective influences on active, personal decision-making. Many of these crucial decisions are made and revised across the lifespan, including when to buy or sell a home, how to save for childrens’ education, how to manage healthcare costs, when to retire, how much to save for retirement and how to allocate retirement funds. As average life expectancy increases, many retirees will be faced with inadequate savings to live comfortably until the end of their lives. In the current article, we examine the problems of and potential solutions to inadequate financial planning through the lens of affective science, with an emphasis on how brain-based changes in affective processing with age might contribute to the challenge of financial planning. PMID:20587596

Vitamin D and Depression: Where is all the Sunshine?

PubMed Central

Penckofer, Sue; Kouba, Joanne; Byrn, Mary; Ferrans, Carol Estwing

2010-01-01

Depression in its own right is a disabling condition impairing all aspects of human function. In persons with a chronic medical disease, depression often makes the management of chronic illness more difficult. Recently, vitamin D has been reported in the scientific and lay press as an important factor that may have significant health benefits in the prevention and the treatment of many chronic illnesses. Most individuals in this country have insufficient levels of vitamin D. This is also true for persons with depression as well as other mental disorders. Whether this is due to insufficient dietary intake, lifestyle (e.g., little outdoor exposure to sunshine), or other factors is addressed in this paper. In addition, groups at risk and suggested treatment for inadequate vitamin D levels are addressed. Effective detection and treatment of inadequate vitamin D levels in persons with depression and other mental disorders may be an easy and cost-effective therapy which could improve patients’ long-term health outcomes as well as their quality of life. PMID:20450340

Hair transplantation in patients with inadequate head donor supply using nonhead hair: report of 3 cases.

PubMed

Umar, Sanusi

2011-10-01

Follicular unit extraction is becoming an increasingly popular technique for hair transplantation, as it obviates the linear scarring associated with strip harvesting, and can provide highly presentable results. Using this technique, a few reports have described the small scale use of nonhead hair for head hair transplantation in men with inadequate head hair donor supply. In this report, 3 patients who were severely bald had hair transplanted from the chest, abdomen, legs, shoulders, or beard, as well as the head to achieve full coverage and excellent hairlines. Of the 3 cases, 2 had undergone previously unsuccessful hair transplant surgeries. Approximately 80% to 85% of the transplanted grafts survived. Although hair length and quality, surgery time, and the requirement for improved surgical skills remain challenges when using this technique, the sufficiently good outcomes from these selected candidates suggest that this technique may offer the possibility of restoring even severely bald states to normality in patients who would otherwise not be candidates for traditional hair transplantation surgery.

Older and wiser? An affective science perspective on age-related challenges in financial decision making.

PubMed

Weierich, Mariann R; Kensinger, Elizabeth A; Munnell, Alicia H; Sass, Steven A; Dickerson, Brad C; Wright, Christopher I; Barrett, Lisa Feldman

2011-04-01

Financial planning decisionss are fundamentally affective in nature; they are decisions related to money, longevity and quality of life. Over the next several decades people will be increasingly responsible for managing their own assets and investments, and they will be subject to the affective influences on active, personal decision-making. Many of these crucial decisions are made and revised across the lifespan, including when to buy or sell a home, how to save for childrens' education, how to manage healthcare costs, when to retire, how much to save for retirement and how to allocate retirement funds. As average life expectancy increases, many retirees will be faced with inadequate savings to live comfortably until the end of their lives. In the current article, we examine the problems of and potential solutions to inadequate financial planning through the lens of affective science, with an emphasis on how brain-based changes in affective processing with age might contribute to the challenge of financial planning.

The influence of sleep on human hypothalamic-pituitary-adrenal (HPA) axis reactivity: A systematic review.

PubMed

van Dalfsen, Jens H; Markus, C Rob

2018-06-01

Inadequate sleep is highly prevalent and known to decline both physical- and mental health. Literature suggests that altered functioning of the hypothalamic-pituitary-adrenal (HPA) axis might underlie this association. This assumption is mainly based on changes in basal neuroendocrine activity and it is of equal importance to elucidate whether sleep may also influence HPA stress responsiveness. The present review provides a complete outline of recent human studies that have investigated how different aspects of sleep influence cortisol reactivity to laboratory stress. From the available data it can be concluded that both objective and subjective decrements in sleep quality potentiate the stress reactivity of the HPA axis. On the contrary, normal variations in sleep duration do not seem to influence cortisol stress responsiveness whereas excessive daytime sleepiness is associated with a blunting of the cortisol response. Given its well-established health consequences, sensitization of the HPA axis might well be a crucial component linking inadequate sleep to stress-related pathology. Copyright © 2017 Elsevier Ltd. All rights reserved.

High Sensitivity and Specificity of Clinical Microscopy in Rural Health Facilities in Western Kenya Under an External Quality Assurance Program

PubMed Central

Wafula, Rebeccah; Sang, Edna; Cheruiyot, Olympia; Aboto, Angeline; Menya, Diana; O'Meara, Wendy Prudhomme

2014-01-01

Microscopic diagnosis of malaria is a well-established and inexpensive technique that has the potential to provide accurate diagnosis of malaria infection. However, it requires both training and experience. Although it is considered the gold standard in research settings, the sensitivity and specificity of routine microscopy for clinical care in the primary care setting has been reported to be unacceptably low. We established a monthly external quality assurance program to monitor the performance of clinical microscopy in 17 rural health centers in western Kenya. The average sensitivity over the 12-month period was 96% and the average specificity was 88%. We identified specific contextual factors that contributed to inadequate performance. Maintaining high-quality malaria diagnosis in high-volume, resource-constrained health facilities is possible. PMID:24935953

[Stimulation of labour with oxytocin and ventouse deliveries are inadequately documented].

PubMed

Lindved, Birgitte Freilev; Kierkegaard, Ole; Anhøj, Jacob

2014-09-15

A retrospective sample of 180 records from four regional hospitals and five university hospitals in Denmark was collected and the documentation for use of oxytocin in augmentation of labour and ventouse deliveries according to the national guidelines was registered. Only approximately half of the elements in the national guidelines were documented. This shows that there is a potential for improvement in the ongoing Danish national quality improvement project Safe Deliveries (Sikre Fødsler).

Fertility preservation in young cancer patients--too little, too late?

PubMed

Robbins, Helen Louise; Zahoor, Arooba; Jones, Kevin

2015-12-01

Fertility is an important concern for many younger women with cancer; however, evidence suggests that these matters are often inadequately addressed, potentially with long-term implications for quality of life. Increased confidence in discussing fertility-related matters and an emphasis on early discussion and referral are needed to improve current practice. Further work is needed to better assess current practice and to explore how barriers to discussion about fertility preservation may be best overcome.

Sleep patterns and sleep disturbances across pregnancy.

PubMed

Mindell, Jodi A; Cook, Rae Ann; Nikolovski, Janeta

2015-04-01

This study sought to characterize sleep patterns and sleep problems in a large sample of women across all months of pregnancy. A total of 2427 women completed an Internet-based survey that included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, vitality scale of the Short Form 36 Health Survey (SF-36), Insomnia Severity Index (ISI), Berlin questionnaire, International Restless Legs Syndrome (IRLS) question set, and a short version of the Pregnancy Symptoms Inventory (PSI). Across all months of pregnancy, women experienced poor sleep quality (76%), insufficient nighttime sleep (38%), and significant daytime sleepiness (49%). All women reported frequent nighttime awakenings (100%), and most women took daytime naps (78%). Symptoms of insomnia (57%), sleep-disordered breathing (19%), and restless legs syndrome (24%) were commonly endorsed, with no difference across the month of pregnancy for insomnia, sleep-disorder breathing, daytime sleepiness, or fatigue. In addition, high rates of pregnancy-related symptoms were found to disturb sleep, especially frequent urination (83%) and difficulty finding a comfortable sleep position (79%). Women experience significant sleep disruption, inadequate sleep, and high rates of symptoms of sleep disorder throughout pregnancy. These results suggest that all women should be screened and treated for sleep disturbances throughout pregnancy, especially given the impact of inadequate sleep and sleep disorders on fetal, pregnancy, and postpartum outcomes. Copyright © 2014 Elsevier B.V. All rights reserved.

The impact of the night float system on internal medicine residency programs.

PubMed

Trontell, M C; Carson, J L; Taragin, M I; Duff, A

1991-01-01

To study the design, method of implementation, perceived benefits, and problems associated with a night float system. Self-administered questionnaire completed by program directors, which included both structured and open-ended questions. The answers reflect resident and student opinions as well as those of the program directors, since program directors regularly obtain feedback from these groups. The 442 accredited internal medicine residency programs listed in the 1988-89 Directory of Graduate Medical Education Programs. Of the 442 programs, 79% responded, and 30% had experience with a night float system. The most frequent methods for initiating a night float system included: decreasing elective time (42.3%), hiring more residents (26.9%), creating a non-teaching service (12.5%), and reallocating housestaff time (9.6%). Positive effects cited include decreased fatigue, improved housestaff morale, improved recruiting, and better attitude toward internal medicine training. The quality of medical care was considered the same or better by most programs using it. The most commonly cited problems were decreased continuity of care, inadequate teaching of the night float team, and miscommunication. Residency programs using a night float system usually observe a positive effect on housestaff morale, recruitment, and working hours and no detrimental effect on the quality of patient care. Miscommunication and inadequate learning experience for the night float team are important potential problems. This survey suggests that the night float represents one solution to reducing resident working hours.

Invertebrate communities of small streams in northeastern Wyoming

USGS Publications Warehouse

Peterson, D.A.

1990-01-01

Invertebrate communities of small streams in an energy-mineral- development area in the Powder River structural basin of northeastern Wyoming were studied during 1980-81. The largest average density of benthic invertebrates among 11 sites was 983 invertebrates/sq ft at a site on a perennial stream, the Little Powder River at State Highway 59. The smallest average densities were 3.4 invertebrates/sq ft in Salt Creek and 16.6 invertebrates/sq ft in the Cheyenne River, two streams where the invertebrates were stressed by degraded water quality or inadequate substrate or both. The rates of invertebrate drift were fastest in three perennial streams, compared to the rates in intermittent and ephemeral streams. Analysis of the invertebrate communities using the Jaccard coefficient of community similarity and a cluster diagram showed communities inhabiting perennial streams were similar to each other, because of the taxa adapted to flowing water in riffles and runs. Communities from sites on ephemeral streams were similar to each other, because of the taxa adapted to standing water and vegetation in pools. Communities of intermittent streams did not form a group; either they were relatively similar to those of perennial or ephemeral streams or they were relatively dissimilar to other communities. The communities of the two streams stressed by degraded water quality or inadequate substrate or both, Salt Creek and the Cheyenne River, were relatively dissimilar to communities of the other streams in the study. (USGS)

Effect of Chinese Herbal Medicine on Male Infertility.

PubMed

Jiang, Dan; Coscione, Alberto; Li, Lily; Zeng, Bai-Yun

2017-01-01

Male infertility normally refers a male's inability to cause pregnancy in a fertile female partner after 1 year of unprotected intercourse. Male infertility in recent years has been attracting increasing interest from public due to the evidence in decline in semen quality. There are many factors contributing to the male infertility including abnormal spermatogenesis; reproductive tract anomalies or obstruction; inadequate sexual and ejaculatory functions; and impaired sperm motility, imbalance in hormone levels, and immune system dysfunction. Although conventional treatments such as medication, surgical operation, and advanced techniques have helped many male with infertility cause pregnancy in their female partners, effectiveness is not satisfactory and associated with adverse effects. Chinese herbal medicine (CHM) has been used to improve male infertility in China for a very long time and has now been increasingly popular in Western countries for treating infertility. In this chapter we summarized recent development in basic research and clinical studies of CHM in treating male infertility. It has showed that CHM improved sperm motility and quality, increased sperm count and rebalanced inadequate hormone levels, and adjusted immune functions leading to the increased number of fertility. Further, CHM in combination with conventional therapies improved efficacy of conventional treatments. More studies are needed to indentify the new drugs from CHM and ensure safety, efficacy, and consistency of CHM. © 2017 Elsevier Inc. All rights reserved.

Development of Family Medicine training in Botswana: Views of key stakeholders in Ngamiland.

PubMed

Ogundipe, Radiance M; Mash, Robert

2018-08-31

Family Medicine training commenced in Botswana in 2011, and Maun was one of the two sites chosen as a training complex. If it is to be successful there has to be investment in the training programme by all stakeholders in healthcare delivery in the district. The aim of the study was to explore the attitudes of stakeholders to initiation of Family Medicine training and their perspectives on the future roles of family physicians in Ngami district, Botswana. Maun and the surrounding Ngami subdistrict of Botswana. Thirteen in-depth interviews were conducted with purposively selected key stakeholders in the district health services. Data were recorded, transcribed and analysed using the framework method. Participants welcomed the development of Family Medicine training in Maun and expect that this will result in improved quality of primary care. Participants expect the registrars and family physicians to provide holistic health care that is of higher quality and expertise than currently experienced, relevant research into the health needs of the community, and reduced need for referrals. Inadequate personal welfare facilities, erratic ancillary support services and an inadequate complement of mentors and supervisors for the programme were some of the gaps and challenges highlighted by participants. Family Medicine training is welcomed by stakeholders in Ngamiland. With proper planning introduction of the family physician in the district is expected to result in improvement of primary care.

Weaknesses in the reporting of cross-sectional studies according to the STROBE statement

PubMed Central

Malaga, German; Miranda, Jaime

2015-01-01

Introduction: The inadequate reporting of cross-sectional studies, as in the case of the prevalence of metabolic syndrome, could cause problems in the synthesis of new evidence and lead to errors in the formulation of public policies. Objective: To evaluate the reporting quality of the articles regarding metabolic syndrome prevalence in Peruvian adults using the STROBE recommendations. Methods: We conducted a thorough literature search with the terms "Metabolic Syndrome", "Sindrome Metabolico" and "Peru" in MEDLINE/PubMed, LILACS, SciELO, LIPECS and BVS-Peru until December 2014. We selected those who were population-based observational studies with randomized sampling that reported prevalence of metabolic syndrome in adults aged 18 or more of both sexes. Information was analysed through the STROBE score per item and recommendation. Results: Seventeen articles were included in this study. All articles met the recommendations related to the report of the study's rationale, design, and provision of summary measures. The recommendations with the lowest scores were those related to the sensitivity analysis (8%, n= 1/17), participant flowchart (18%, n= 3/17), missing data analysis (24%, n= 4/17), and number of participants in each study phase (24%, n= 4/17). Conclusion: Cross-sectional studies regarding the prevalence of metabolic syndrome in peruvian adults have an inadequate reporting on the methods and results sections. We identified a clear need to improve the quality of such studies. PMID:26848197

Weaknesses in the reporting of cross-sectional studies according to the STROBE statement: the case of metabolic syndrome in adults from Peru.

PubMed

Tapia, Jose Carlos; Ruiz, Eloy F; Ponce, Oscar J; Malaga, German; Miranda, Jaime

2015-12-30

The inadequate reporting of cross-sectional studies, as in the case of the prevalence of metabolic syndrome, could cause problems in the synthesis of new evidence and lead to errors in the formulation of public policies. To evaluate the reporting quality of the articles regarding metabolic syndrome prevalence in Peruvian adults using the STROBE recommendations. We conducted a thorough literature search with the terms "Metabolic Syndrome", "Sindrome Metabolico" and "Peru" in MEDLINE/PubMed, LILACS, SciELO, LIPECS and BVS-Peru until December 2014. We selected those who were population-based observational studies with randomized sampling that reported prevalence of metabolic syndrome in adults aged 18 or more of both sexes. Information was analysed through the STROBE score per item and recommendation. Seventeen articles were included in this study. All articles met the recommendations related to the report of the study's rationale, design, and provision of summary measures. The recommendations with the lowest scores were those related to the sensitivity analysis (8%, n= 1/17), participant flowchart (18%, n= 3/17), missing data analysis (24%, n= 4/17), and number of participants in each study phase (24%, n= 4/17). Cross-sectional studies regarding the prevalence of metabolic syndrome in peruvian adults have an inadequate reporting on the methods and results sections. We identified a clear need to improve the quality of such studies.

What Comes after Ursodeoxycholic Acid in Primary Biliary Cholangitis?

PubMed

Wong, Lin Lee; Hegade, Vinod S; Jones, David E J

2017-01-01

Primary biliary cholangitis (PBC) is a rare autoimmune liver disease characterized by chronic cholestasis. Treatment with the accepted primary therapy ursodeoxycholic acid (UDCA) has been shown to be associated with delayed disease progression probably through reduced impact of cholestatic injury on the target biliary epithelial cells. Patients with inadequate response to UDCA (which can be identified through validated biochemical criteria) are at increased risk of disease progression, need for liver transplantation, and death. Obeticholic acid (OCA) is a farnesoid X receptor (FXR) agonist which has been evaluated as a second-line therapy in PBC and has been recently licensed by the Food and Drug Administration and European Medicines Agency for use in patients showing an inadequate response to UDCA or who are unable to tolerate it. Although evidence for biochemical improvement by OCA is compelling, there is, as yet, no evidence that OCA improves hard clinical outcomes or quality of life. In addition, OCA may not be suitable for PBC patients with pruritus as it can worsen the symptom. Other novel agents currently in clinical development may have better side-effect profile. Fibrates have the potential but currently lack high quality evidence to support their routine clinical use in PBC. Symptom management of PBC is challenging and ASBT inhibitors and rituximab are being evaluated for pruritus and fatigue, respectively. © 2017 S. Karger AG, Basel.

Intermittent Water Supply: Prevalence, Practice, and Microbial Water Quality.

PubMed

Kumpel, Emily; Nelson, Kara L

2016-01-19

Intermittent water supplies (IWS), in which water is provided through pipes for only limited durations, serve at least 300 million people around the world. However, providing water intermittently can compromise water quality in the distribution system. In IWS systems, the pipes do not supply water for periods of time, supply periods are shortened, and pipes experience regular flow restarting and draining. These unique behaviors affect distribution system water quality in ways that are different than during normal operations in continuous water supplies (CWS). A better understanding of the influence of IWS on mechanisms causing contamination can help lead to incremental steps that protect water quality and minimize health risks. This review examines the status and nature of IWS practices throughout the world, the evidence of the effect of IWS on water quality, and how the typical contexts in which IWS systems often exist-low-income countries with under-resourced utilities and inadequate sanitation infrastructure-can exacerbate mechanisms causing contamination. We then highlight knowledge gaps for further research to improve our understanding of water quality in IWS.

Developing students' worksheets applying soft skill-based scientific approach for improving building engineering students' competencies in vocational high schools

NASA Astrophysics Data System (ADS)

Suparno, Sudomo, Rahardjo, Boedi

2017-09-01

Experts and practitioners agree that the quality of vocational high schools needs to be greatly improved. Many construction services have voiced their dissatisfaction with today's low-quality vocational high school graduates. The low quality of graduates is closely related to the quality of the teaching and learning process, particularly teaching materials. In their efforts to improve the quality of vocational high school education, the government have implemented Curriculum 2013 (K13) and supplied teaching materials. However, the results of monitoring and evaluation done by the Directorate of Vocational High School, Directorate General of Secondary Education (2014), the provision of tasks for students in the teaching materials was totally inadequate. Therefore, to enhance the quality and the result of the instructional process, there should be provided students' worksheets that can stimulate and improve students' problem-solving skills and soft skills. In order to develop worksheets that can meet the academic requirements, the development needs to be in accordance with an innovative learning approach, which is the soft skill-based scientific approach.

Applications of flight control system methods to an advanced combat rotorcraft

NASA Technical Reports Server (NTRS)

Tischler, Mark B.; Fletcher, Jay W.; Morris, Patrick M.; Tucker, George T.

1989-01-01

Advanced flight control system design, analysis, and testing methodologies developed at the Ames Research Center are applied in an analytical and flight test evaluation of the Advanced Digital Optical Control System (ADOCS) demonstrator. The primary objectives are to describe the knowledge gained about the implications of digital flight control system design for rotorcraft, and to illustrate the analysis of the resulting handling-qualities in the context of the proposed new handling-qualities specification for rotorcraft. Topics covered in-depth are digital flight control design and analysis methods, flight testing techniques, ADOCS handling-qualities evaluation results, and correlation of flight test results with analytical models and the proposed handling-qualities specification. The evaluation of the ADOCS demonstrator indicates desirable response characteristics based on equivalent damping and frequency, but undersirably large effective time-delays (exceeding 240 m sec in all axes). Piloted handling-qualities are found to be desirable or adequate for all low, medium, and high pilot gain tasks; but handling-qualities are inadequate for ultra-high gain tasks such as slope and running landings.

A new independent authority is needed to issue National Health Care guidelines.

PubMed

Keyhani, Salomeh; Kim, Azalea; Mann, Micah; Korenstein, Deborah

2011-02-01

Health experts emphasize that getting doctors to follow clinical guidelines can save both lives and money. Less attention has been paid to how the guidelines are developed and the variability in the recommendations they include. We examined the quality and content of screening guidelines as a proxy for guidelines in general and found that the source of the guidelines affects their quality. Guidelines with inconsistent recommendations are unlikely to serve patients or physicians well. The creation of an independent organization that would work with multiple stakeholders to develop guidelines holds the potential to improve their quality.

Poor tap water quality experiences and poor sleep quality during the Flint, Michigan Municipal Water Crisis.

PubMed

Kruger, Daniel J; Kodjebacheva, Gergana D; Cupal, Suzanne

2017-08-01

After inadequate official response to community concerns over water quality following changes in Flint's municipal water supply, this study sought evidence for a relationship between water quality and community mental health. The Speak to Your Health Community Survey is a community-based participatory component of the health surveillance system in Genesee County, Michigan. This cross-sectional survey recruits participants from every residential Census Tract of the county and strives for demographic representativeness. Respondents (n=834) rated their tap water quality (taste, smell, appearance) as poor (36%), fair (18%), good (20%), very good (17%), and excellent (10%). They rated their sleep quality as poor (12%), fair (28%), good (39%), very good (18%), and excellent (4%), and had an average (SD) sleep length of 408(90) minutes. Controlling for age, sex, years of education, and whether respondents were African American and Hispanic/Latino/a, lower perceived tap water quality was associated with lower sleep quality and shorter sleep length. Results indicate that adverse health conditions related to the water crisis extend beyond lead poisoning in children and include deterioration of sleep conditions among adult residents. Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

The relationship between health related quality of life and sensory deficits among patients with diabetes mellitus.

PubMed

Engel-Yeger, Batya; Darawsha Najjar, Sanaa; Darawsha, Mahmud

2017-08-13

(1) To profile sensory deficits examined in the ability to process sensory information from daily environment and discriminate between tactile stimuli among patients with controlled and un-controlled diabetes mellitus. (2) Examine the relationship between the sensory deficits and patients' health-related quality of life. This study included 115 participants aged 33-55 with uncontrolled (n = 22) or controlled (n = 24) glycemic levels together with healthy subjects (n = 69). All participants completed the brief World Health Organization Quality of Life Questionnaire, the Adolescent/Adult Sensory Profile and performed the tactile discrimination test. Sensory deficits were more emphasized among patients with uncontrolled glycemic levels as expressed in difficulties to register sensory input, lower sensation seeking in daily environments and difficulties to discriminate between tactile stimuli. They also reported the lowest physical and social quality of life as compared to the other two groups. Better sensory seeking and registration predicted better quality of life. Disease control and duration contributed to these predictions. Difficulties in processing sensory information from their daily environments are particularly prevalent among patients with uncontrolled glycemic levels, and significantly impacted their quality of life. Clinicians should screen for sensory processing difficulties among patients with diabetes mellitus and understand their impacts on patients' quality of life. Implications for Rehabilitation Patients with diabetes mellitus, and particularly those with uncontrolled glycemic levels, may have difficulties in processing sensory information from daily environment. A multidisciplinary intervention approach is recommended: clinicians should screen for sensory processing deficits among patients with diabetes mellitus and understand their impacts on patients' daily life. By providing the patients with environmental adaptations and coping strategies, clinicians may assist in optimizing sensory experiences in real life context and elevate patients' quality of life. Relating to quality of life and emphasizing a multidisciplinary approach is of major importance in broadening our understanding of health conditions and providing holistic treatment for patients.

Creating and Using Culturally Sustaining Informational Texts

ERIC Educational Resources Information Center

Watanabe Kganetso, Lynne M.

2017-01-01

Current standards and assessments emphasize the importance of a variety of genres in students' literacy diets, which has placed increased attention on informational texts. Unfortunately, young students' current exposure to and experiences with informational texts are often limited by the texts' availability, quality, and relevance to children's…

Transforming Schools through Total Quality Education.

ERIC Educational Resources Information Center

Schmoker, Mike; Wilson, Richard B.

1993-01-01

Deming's work emphasizes advantages of teamwork, investment in ongoing training for all employees to increase their value to the company, and insistence that research and employee-gathered data guide and inform every decision and improvement effort. The parallel between psychologist Mihaly Csikszenmihalyi's work and Deming's shows that Total…

Total Quality Management Implementation at the Defense Technical Information Center

DTIC Science & Technology

1989-09-01

industry user groups, as well as the contracting process to emphasize the benefits of TQM to the private sector . 5. Demonstrate an Uncompromising... worklife enhancements are important elements in creating the environment in which DTIC personnel will grow, gain new experiences and capabilities, and

Environmental applications activity at Marshall Space Flight Center

NASA Technical Reports Server (NTRS)

Paludan, C. T. N.

1972-01-01

MSFC environmental applications demonstration projects have emphasized application of aerospace technology to community needs of southeastern U.S. Some of the typical projects underway are: hydrological parameter determination; land use surveys; agricultural stress detection; new community site surveys; pollution monitoring; urban transportation studies; and urban environmental quality.

Unpacking Community Participation: A Gendered Perspective

ERIC Educational Resources Information Center

Rouhani, Leva

2017-01-01

In recent years heightened attention has been directed towards the connections between schooling and local communities in sub-Saharan Africa. While community participation in school management has been emphasized as a strategy to promote sustainable development and improve quality education in sub-Saharan Africa, in practice this strategy has…

Adapting Entry-Level Engineering Courses to Emphasize Critical Thinking

ERIC Educational Resources Information Center

Hagerty, D. Joseph; Rockaway, Thomas D.

2012-01-01

The University of Louisville recently developed a Quality Enhancement Plan (QEP) to improve undergraduate instruction across all disciplines as part of its ongoing accreditation requirements. Central elements of the plan are emphasis on critical thinking; integration of critical thinking throughout the curriculum; service learning for…

Music Education for All?

ERIC Educational Resources Information Center

Bledsoe, Ryan N.

2015-01-01

School music programs are changing. For years the music education profession has emphasized large ensemble experiences for reasons that include quality of music making, sense of community, and individual and collective pride for many of the students involved. As a high school saxophonist, I valued that experience, but other high school…

Marking Closely or on the Bench?: An Australian's Benchmark Statement.

ERIC Educational Resources Information Center

Jones, Roy

2000-01-01

Reviews the benchmark statements of the Quality Assurance Agency for Higher Education in the United Kingdom. Examines the various sections within the benchmark. States that in terms of emphasizing the positive attributes of the geography discipline the statements have wide utility and applicability. (CMK)

Constructivism in the Art Classroom: Praxis and Policy

ERIC Educational Resources Information Center

Thompson, Christine Marmé

2015-01-01

Constructivist thought and practice connect easily with forms of art education that emphasize choice and student agency. This article traces the contemporary forms of constructivism that vie with more structured pedagogical approaches in American schools and recommends policies and procedures that may preserve the qualities of constructivist…

Man and Environment, Study Guide, Volume One.

ERIC Educational Resources Information Center

Miami-Dade Junior Coll., FL.

Subject information, course instructions, and resource materials for a television course, "Man and Environment," are compiled in this student study guide. The interdisciplinary, modular course emphasizes the importance of such concerns as destruction of the environment and the declining quality of life while educating the public about…

Statistical virtual eye model based on wavefront aberration

PubMed Central

Wang, Jie-Mei; Liu, Chun-Ling; Luo, Yi-Ning; Liu, Yi-Guang; Hu, Bing-Jie

2012-01-01

Wavefront aberration affects the quality of retinal image directly. This paper reviews the representation and reconstruction of wavefront aberration, as well as the construction of virtual eye model based on Zernike polynomial coefficients. In addition, the promising prospect of virtual eye model is emphasized. PMID:23173112

Green Dot Public Schools. What Works Clearinghouse Intervention Report

ERIC Educational Resources Information Center

What Works Clearinghouse, 2018

2018-01-01

"Green Dot Public Schools" is a nonprofit organization that operates more than 20 public charter middle and high schools in California, Tennessee, and Washington. The "Green Dot Public Schools" model emphasizes high quality teaching, strong school leadership, a curriculum that prepares students for college, and partnerships…

A randomised control trial of prompt and feedback devices and their impact on quality of chest compressions--a simulation study.

PubMed

Yeung, Joyce; Davies, Robin; Gao, Fang; Perkins, Gavin D

2014-04-01

This study aims to compare the effect of three CPR prompt and feedback devices on quality of chest compressions amongst healthcare providers. A single blinded, randomised controlled trial compared a pressure sensor/metronome device (CPREzy), an accelerometer device (Phillips Q-CPR) and simple metronome on the quality of chest compressions on a manikin by trained rescuers. The primary outcome was compression depth. Secondary outcomes were compression rate, proportion of chest compressions with inadequate depth, incomplete release and user satisfaction. The pressure sensor device improved compression depth (37.24-43.64 mm, p=0.02), the accelerometer device decreased chest compression depth (37.38-33.19 mm, p=0.04) whilst the metronome had no effect (39.88 mm vs. 40.64 mm, p=0.802). Compression rate fell with all devices (pressure sensor device 114.68-98.84 min(-1), p=0.001, accelerometer 112.04-102.92 min(-1), p=0.072 and metronome 108.24 min(-1) vs. 99.36 min(-1), p=0.009). The pressure sensor feedback device reduced the proportion of compressions with inadequate depth (0.52 vs. 0.24, p=0.013) whilst the accelerometer device and metronome did not have a statistically significant effect. Incomplete release of compressions was common, but unaffected by the CPR feedback devices. Users preferred the accelerometer and metronome devices over the pressure sensor device. A post hoc study showed that de-activating the voice prompt on the accelerometer device prevented the deterioration in compression quality seen in the main study. CPR feedback devices vary in their ability to improve performance. In this study the pressure sensor device improved compression depth, whilst the accelerometer device reduced it and metronome had no effect. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Multidimensional Measurement of Household Water Poverty in a Mumbai Slum: Looking Beyond Water Quality.

PubMed

Subbaraman, Ramnath; Nolan, Laura; Sawant, Kiran; Shitole, Shrutika; Shitole, Tejal; Nanarkar, Mahesh; Patil-Deshmukh, Anita; Bloom, David E

2015-01-01

A focus on bacterial contamination has limited many studies of water service delivery in slums, with diarrheal illness being the presumed outcome of interest. We conducted a mixed methods study in a slum of 12,000 people in Mumbai, India to measure deficiencies in a broader array of water service delivery indicators and their adverse life impacts on the slum's residents. Six focus group discussions and 40 individual qualitative interviews were conducted using purposeful sampling. Quantitative data on water indicators-quantity, access, price, reliability, and equity-were collected via a structured survey of 521 households selected using population-based random sampling. In addition to negatively affecting health, the qualitative findings reveal that water service delivery failures have a constellation of other adverse life impacts-on household economy, employment, education, quality of life, social cohesion, and people's sense of political inclusion. In a multivariate logistic regression analysis, price of water is the factor most strongly associated with use of inadequate water quantity (≤20 liters per capita per day). Water service delivery failures and their adverse impacts vary based on whether households fetch water or have informal water vendors deliver it to their homes. Deficiencies in water service delivery are associated with many non-health-related adverse impacts on slum households. Failure to evaluate non-health outcomes may underestimate the deprivation resulting from inadequate water service delivery. Based on these findings, we outline a multidimensional definition of household "water poverty" that encourages policymakers and researchers to look beyond evaluation of water quality and health. Use of multidimensional water metrics by governments, slum communities, and researchers may help to ensure that water supplies are designed to advance a broad array of health, economic, and social outcomes for the urban poor.

Multidimensional Measurement of Household Water Poverty in a Mumbai Slum: Looking Beyond Water Quality

PubMed Central

Subbaraman, Ramnath; Nolan, Laura; Sawant, Kiran; Shitole, Shrutika; Shitole, Tejal; Nanarkar, Mahesh; Patil-Deshmukh, Anita; Bloom, David E.

2015-01-01

Objective A focus on bacterial contamination has limited many studies of water service delivery in slums, with diarrheal illness being the presumed outcome of interest. We conducted a mixed methods study in a slum of 12,000 people in Mumbai, India to measure deficiencies in a broader array of water service delivery indicators and their adverse life impacts on the slum’s residents. Methods Six focus group discussions and 40 individual qualitative interviews were conducted using purposeful sampling. Quantitative data on water indicators—quantity, access, price, reliability, and equity—were collected via a structured survey of 521 households selected using population-based random sampling. Results In addition to negatively affecting health, the qualitative findings reveal that water service delivery failures have a constellation of other adverse life impacts—on household economy, employment, education, quality of life, social cohesion, and people’s sense of political inclusion. In a multivariate logistic regression analysis, price of water is the factor most strongly associated with use of inadequate water quantity (≤20 liters per capita per day). Water service delivery failures and their adverse impacts vary based on whether households fetch water or have informal water vendors deliver it to their homes. Conclusions Deficiencies in water service delivery are associated with many non-health-related adverse impacts on slum households. Failure to evaluate non-health outcomes may underestimate the deprivation resulting from inadequate water service delivery. Based on these findings, we outline a multidimensional definition of household “water poverty” that encourages policymakers and researchers to look beyond evaluation of water quality and health. Use of multidimensional water metrics by governments, slum communities, and researchers may help to ensure that water supplies are designed to advance a broad array of health, economic, and social outcomes for the urban poor. PMID:26196295

Patient complaints about hospital services: applying a complaint taxonomy to analyse and respond to complaints.

PubMed

Harrison, Reema; Walton, Merrilyn; Healy, Judith; Smith-Merry, Jennifer; Hobbs, Coletta

2016-04-01

To explore the applicability of a patient complaint taxonomy to data on serious complaint cases. Qualitative descriptive study. Complaints made to the New South Wales (NSW) Health Care Complaints Commission, Australia between 2005 and 2010. All 138 cases of serious complaints by patients about public hospitals and other health facilities investigated in the 5-year period. A thematic analysis of the complaints was conducted to identify particular complaint issues and the Reader et al. (Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf 2014;23:678-89.) patient complaint taxonomy was then used to classify these issues into categories and sub-categories. The 138 investigated cases revealed 223 complaint issues. Complaint issues were distributed into the three domains of the patient complaint taxonomy: clinical, management and relationships. Complaint issue most commonly related to delayed diagnosis, misdiagnosis, medication errors, inadequate examinations, inadequate/nil treatment and quality of care including nursing care. The types of complaints from patients about their healthcare investigated by the NSW Commission were similar to those received by other patient complaint entities in Australia and worldwide. The application of a standard taxonomy to large numbers of complaints cases from different sources would enable the creation of aggregated data. Such data would have better statistical capacity to identify common safety and quality healthcare problems and so point to important areas for improvement. Some conceptual challenges in devising and using a taxonomy must be addressed, such as inherent problems in ensuring coding consistency, and giving greater weight to patient concerns about their treatment. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Nocturnal temperature controlled laminar airflow for treating atopic asthma: a randomised controlled trial

PubMed Central

Boyle, Robert J; Pedroletti, Christophe; Wickman, Magnus; Bjermer, Leif; Valovirta, Erkka; Dahl, Ronald; Von Berg, Andrea; Zetterström, Olof

2011-01-01

Objective To determine whether environmental control using nocturnal temperature controlled laminar airflow (TLA) treatment could improve the quality of life of patients with persistent atopic asthma. Design Randomised, double-blind, placebo-controlled, parallel-group trial. Setting Nineteen European asthma clinics. Participants 312 patients aged 7–70 with inadequately controlled persistent atopic asthma. Main outcome measure Proportion of patients with an increase of ≥0.5 points in asthma quality of life score after 1 year of treatment. Results TLA devices were successfully installed in the bedrooms of 282 (90%) patients included in the primary efficacy analysis. There was a difference in treatment response rate between active (143 of 189, 76%) and placebo (56 of 92, 61%) groups, difference 14.8% (95% CI 3.1 to 26.5, p=0.02).3 In patients aged ≥12, on whom the study was powered, the difference in response rate was similar-active 106 of 143 (74%), placebo 42 of 70 (60%), difference 14.1% (0.6 to 27.7, p=0.059). There was a difference between groups in fractional exhaled nitric oxide change of −7.1 ppb (−13.6 to −0.7, p=0.03). Active treatment was associated with less increase in cat-specific IgE than placebo. There was no difference in adverse event rates between treatment groups. Conclusion Inhalant exposure reduction with TLA improves quality of life, airway inflammation and systemic allergy in patients with persistent atopic asthma. TLA may be a treatment option for patients with inadequately controlled persistent atopic asthma. Trial registration number Clinical Trials NCT00986323. PMID:22131290

[Quality assurance and total quality management in residential home care].

PubMed

Nübling, R; Schrempp, C; Kress, G; Löschmann, C; Neubart, R; Kuhlmey, A

2004-02-01

Quality, quality assurance, and quality management have been important topics in residential care homes for several years. However, only as a result of reform processes in the German legislation (long-term care insurance, care quality assurance) is a systematic discussion taking place. Furthermore, initiatives and holistic model projects, which deal with the assessment and improvement of service quality, were developed in the field of care for the elderly. The present article gives a critical overview of essential developments. Different comprehensive approaches such as the implementation of quality management systems, nationwide expert-based initiatives, and developments towards professionalizing care are discussed. Empirically based approaches, especially those emphasizing the assessment of outcome quality, are focused on in this work. Overall, the authors conclude that in the past few years comprehensive efforts have been made to improve the quality of care. However, the current situation still requires much work to establish a nationwide launch and implementation of evidence-based quality assurance and quality management.

Beverage Consumption Habits and Association with Total Water and Energy Intakes in the Spanish Population: Findings of the ANIBES Study

PubMed Central

Nissensohn, Mariela; Sánchez-Villegas, Almudena; Ortega, Rosa M.; Aranceta-Bartrina, Javier; Gil, Ángel; González-Gross, Marcela; Varela-Moreiras, Gregorio; Serra-Majem, Lluis

2016-01-01

Background: Inadequate hydration is a public health issue that imposes a significant economic burden. In Spain, data of total water intake (TWI) are scarce. There is a clear need for a national study that quantifies water and beverage intakes and explores associations between the types of beverages and energy intakes. Methods: The Anthropometry, Intake and Energy Balance Study ANIBES is a national survey of diet and nutrition conducted among a representative sample of 2285 healthy participants aged 9–75 years in Spain. Food and beverage intakes were assessed in a food diary over three days. Day and time of beverage consumption were also recorded. Results: On average, TWI was 1.7 L (SE 21.2) for men and 1.6 L (SE 18.9) for women. More than 75% of participants had inadequate TWI, according to European Food Safety Authority (EFSA) recommendations. Mean total energy intake (EI) was 1810 kcal/day (SE 11.1), of which 12% was provided by beverages. Water was the most consumed beverage, followed by milk. The contribution of alcoholic drinks to the EI was near 3%. For caloric soft drinks, a relatively low contribution to the EI was obtained, only 2%. Of eight different types of beverages, the variety score was positively correlated with TWI (r = 0.39) and EI (r = 0.23), suggesting that beverage variety is an indicator of higher consumption of food and drinks. Conclusions: The present study demonstrates that well-conducted surveys such as the ANIBES study have the potential to yield rich contextual value data that can emphasize the need to undertake appropriate health and nutrition policies to increase the total water intake at the population level promoting a healthy Mediterranean hydration pattern. PMID:27104564

Is it more dangerous to perform inadequate packing?

PubMed Central

Aydin, Unal; Yazici, Pinar; Zeytunlu, Murat; Coker, Ahmet

2008-01-01

Peri-hepatic packing procedure, which is the basic damage control technique for the treatment of hepatic hemorrhage, is one of the cornerstones of the surgical strategy for abdominal trauma. The purpose of this study was to evaluate the efficacy of the perihepatic packing procedure by comparing the outcomes of appropriately and inappropriately performed interventions. Trauma patients with liver injury were retrospectively evaluated. The patients who had undergone adequate packing were classified as Group A, and the patients who had undergone inappropriate packing, as Group B. Over a five-year period, nineteen patients underwent perihepatic packing. Thirteen of these patients were referred by other hospitals. Of 13 patients, 9 with inappropriate packing procedure due to insertion of intraabdominal drainage catheter (n=4) and underpacking (n=5) were evaluated in Group B, and the others (n=10) with adequate packing were assessed in Group A. Mean 3 units of blood were transfused in Group A and unpacking procedure was performed in the 24th hour. Only 3 (30%) patients required segment resection with homeostasis, and the mortality rate was 20% (2/10 patients). In Group B, 4 patients required repacking in the first 6 hrs. Mean 8 units of blood were transfused until unpacking procedure. The mortality rate was 44% (4/9 patients). The length of intensive care unit stay and requirement of blood transfusion were statistically significantly lower in Group A (p < 0.05). The mortality rate of this group was also lower. However, the difference between the groups for mortality rates was not statistically significant. This study emphasizes that efficacy of the procedure is one of the determinants that affects the results, and inadequate or inappropriate packing may easily result in poor outcome. PMID:18194549

John F. Kennedy Space Center, Safety, Reliability, Maintainability and Quality Assurance, Survey and Audit Program

NASA Technical Reports Server (NTRS)

1994-01-01

This document is the product of the KSC Survey and Audit Working Group composed of civil service and contractor Safety, Reliability, and Quality Assurance (SR&QA) personnel. The program described herein provides standardized terminology, uniformity of survey and audit operations, and emphasizes process assessments rather than a program based solely on compliance. The program establishes minimum training requirements, adopts an auditor certification methodology, and includes survey and audit metrics for the audited organizations as well as the auditing organization.

Historical overview of V/STOL aircraft technology

NASA Technical Reports Server (NTRS)

Anderson, S. B.

1981-01-01

The requirements for satisfactory characteristics in several key technology areas are discussed and a review is made of various V/STOL aircraft for the purpose of assessing the success or failure of each design in meeting design requirements. Special operating techniques were developed to help circumvent deficiencies. For the most part performance and handling qualities limitations restricted operational evaluations. Flight operations emphasized the need for good STOL performance, good handling qualities, and stability and control augmentation. The majority of aircraft suffered adverse ground effects.

Training to reduce behavioral health disparities: How do we optimally prepare family medicine residents for practice in rural communities?

PubMed

Robohm, Jennifer S

2017-05-01

Family physicians are a critical part of the healthcare system in rural areas, but little is known about the training they need to more effectively address behavioral health disparities. Practicing family physicians in Montana were surveyed about the behavioral health needs of their patients, the behavioral resources at their disposal, their prioritization of a number of behavioral skills and interventions in the training of family physicians, factors that limit their own use of behavioral skills, and the extent of their behavioral science training. Respondents across the state reported high rates of mental/emotional health issues and high need for health behavior change in their patients. Surprisingly, although rural family physicians reported access to significantly fewer behavioral health resources, they did not rate any of the behavioral skills as higher training priorities than their urban counterparts and they were more likely to identify limitations (lack of patient interest, lack of confidence or competence, and inadequate knowledge or training) on their own use of such skills in practice. Family physicians, both rural and urban, whose residency programs had a higher emphasis on behavioral science felt better prepared to use behavioral skills in practice. Consequently, rural training programs are encouraged to emphasize behavioral science training for their family medicine residents, particularly training that focuses on mental health stigma reduction, emphasizes time savings and practicality, covers more severe psychiatric presentations, promotes cultural sensitivity to rural values of autonomy and self-sufficiency, and teaches skills to advocate for individual and community health with regard to behavioral health disparities.

Interactive Multimedia Learning: Innovating Classroom Education in a Malaysian University

ERIC Educational Resources Information Center

Leow, Fui-Theng; Neo, Mai

2014-01-01

This research study was conducted at INTI International University, and aimed at enhancing the quality of classroom learning for University students with three important emphases: Gagne's instructional model, multimedia, and student-centred learning. An Interactive Learning Module (ILM) was developed as the core component in forming the…

School Public Relations: Personnel Roles and Responsibilities

ERIC Educational Resources Information Center

Norton, M. Scott

2008-01-01

This article emphasizes the paramount importance of the human resources function in the school system--specifically, in the implementation of an effective school public relations program and in the quality of leadership given by the administrators and the professional and classified staffs. The article submits that school administrators at every…

Story Games: Marrying Silicon, Celluloid, and CD-ROM.

ERIC Educational Resources Information Center

Gussin, Lawrence

1994-01-01

Reports on themes emphasized at the April 1994 Computer Game Developers Conference held in Santa Clara (California), including the exploding CD-ROM marketplace and the potential and challenge of using CD-ROM's multimedia capacity to build cinema-quality stories and characters into computer games. Strategies for introducing more complex plots are…

Effective Schools: Teacher Hiring, Assignment, Development, and Retention

ERIC Educational Resources Information Center

Loeb, Susanna; Kalogrides, Demetra; Beteille, Tara

2012-01-01

The literature on effective schools emphasizes the importance of a quality teaching force in improving educational outcomes for students. In this article we use value-added methods to examine the relationship between a school's effectiveness and the recruitment, assignment, development, and retention of its teachers. Our results reveal four key…