Policy Reforms, Trojan Horses, and Imaginary Friends: The Role of External Stakeholders in Internal Quality Assurance Systems

ERIC Educational Resources Information Center

Rosa, Maria João; Teixeira, Pedro

2014-01-01

The governance of higher education has been changing across Europe, most notably in response to the reform agenda that has been pervading many higher education systems. This wave of reforms has given enhanced visibility to external stakeholders, which has been often received with contrasting views. Some regarded it as a factor that would undermine…

Differential Susceptibility to Long-Term Effects of Quality of Child Care on Externalizing Behavior in Adolescence?

ERIC Educational Resources Information Center

Belsky, Jay; Pluess, Michael

2012-01-01

Much research on the quality of child care reveals it--in the case of low-quality child care--to be related to poorer child functioning, net of confounding factors, perhaps especially in the case of cognitive-linguistic performance. Recent work using data from the National Institute of Child Health and Human Development (NICHD) Study of Early…

Assessing Learning in News, Public Relations Curricula.

ERIC Educational Resources Information Center

Caudill, Edward; And Others

1990-01-01

Discusses the University of Tennessee's externally mandated undergraduate exams in public relations and news-editorial skills. Analyzes (1) whether the exams are valid measures of qualities in students that faculty believe are important; (2) what factors are related to scores; and (3) whether these factors are related to specific courses in the…

The mechanical properties of high speed GTAW weld and factors of nonlinear multiple regression model under external transverse magnetic field

NASA Astrophysics Data System (ADS)

Lu, Lin; Chang, Yunlong; Li, Yingmin; He, Youyou

2013-05-01

A transverse magnetic field was introduced to the arc plasma in the process of welding stainless steel tubes by high-speed Tungsten Inert Gas Arc Welding (TIG for short) without filler wire. The influence of external magnetic field on welding quality was investigated. 9 sets of parameters were designed by the means of orthogonal experiment. The welding joint tensile strength and form factor of weld were regarded as the main standards of welding quality. A binary quadratic nonlinear regression equation was established with the conditions of magnetic induction and flow rate of Ar gas. The residual standard deviation was calculated to adjust the accuracy of regression model. The results showed that, the regression model was correct and effective in calculating the tensile strength and aspect ratio of weld. Two 3D regression models were designed respectively, and then the impact law of magnetic induction on welding quality was researched.

Improving health care quality and safety: the role of collective learning.

PubMed

Singer, Sara J; Benzer, Justin K; Hamdan, Sami U

2015-01-01

Despite decades of effort to improve quality and safety in health care, this goal feels increasingly elusive. Successful examples of improvement are infrequently replicated. This scoping review synthesizes 76 empirical or conceptual studies (out of 1208 originally screened) addressing learning in quality or safety improvement, that were published in selected health care and management journals between January 2000 and December 2014 to deepen understanding of the role that collective learning plays in quality and safety improvement. We categorize learning activities using a theoretical model that shows how leadership and environmental factors support collective learning processes and practices, and in turn team and organizational improvement outcomes. By focusing on quality and safety improvement, our review elaborates the premise of learning theory that leadership, environment, and processes combine to create conditions that promote learning. Specifically, we found that learning for quality and safety improvement includes experimentation (including deliberate experimentation, improvisation, learning from failures, exploration, and exploitation), internal and external knowledge acquisition, performance monitoring and comparison, and training. Supportive learning environments are characterized by team characteristics like psychological safety, appreciation of differences, openness to new ideas social motivation, and team autonomy; team contextual factors including learning resources like time for reflection, access to knowledge, organizational capabilities; incentives; and organizational culture, strategy, and structure; and external environmental factors including institutional pressures, environmental dynamism and competitiveness and learning collaboratives. Lastly learning in the context of quality and safety improvement requires leadership that reinforces learning through actions and behaviors that affect people, such as coaching and trust building, and through influencing contextual factors, including providing resources, developing culture, and taking strategic actions that support improvement. Our review highlights the importance of leadership in both promoting a supportive learning environment and implementing learning processes.

Improving health care quality and safety: the role of collective learning

PubMed Central

Singer, Sara J; Benzer, Justin K; Hamdan, Sami U

2015-01-01

Despite decades of effort to improve quality and safety in health care, this goal feels increasingly elusive. Successful examples of improvement are infrequently replicated. This scoping review synthesizes 76 empirical or conceptual studies (out of 1208 originally screened) addressing learning in quality or safety improvement, that were published in selected health care and management journals between January 2000 and December 2014 to deepen understanding of the role that collective learning plays in quality and safety improvement. We categorize learning activities using a theoretical model that shows how leadership and environmental factors support collective learning processes and practices, and in turn team and organizational improvement outcomes. By focusing on quality and safety improvement, our review elaborates the premise of learning theory that leadership, environment, and processes combine to create conditions that promote learning. Specifically, we found that learning for quality and safety improvement includes experimentation (including deliberate experimentation, improvisation, learning from failures, exploration, and exploitation), internal and external knowledge acquisition, performance monitoring and comparison, and training. Supportive learning environments are characterized by team characteristics like psychological safety, appreciation of differences, openness to new ideas social motivation, and team autonomy; team contextual factors including learning resources like time for reflection, access to knowledge, organizational capabilities; incentives; and organizational culture, strategy, and structure; and external environmental factors including institutional pressures, environmental dynamism and competitiveness and learning collaboratives. Lastly learning in the context of quality and safety improvement requires leadership that reinforces learning through actions and behaviors that affect people, such as coaching and trust building, and through influencing contextual factors, including providing resources, developing culture, and taking strategic actions that support improvement. Our review highlights the importance of leadership in both promoting a supportive learning environment and implementing learning processes. PMID:29355197

Linking quality and performance. Quality orientation can be a competitive strategy for health care providers.

PubMed

Rapert, M I; Babakus, E

1996-01-01

Many organizations are not convinced a quality orientation pays off and are looking for ways to link quality with performance. The authors' exploratory study found that a quality orientation is a differentiating factor between low-performing and high-performing general service hospitals. They also developed a quality scale to assess the performance implications of quality-based strategies in the health care industry. Successful health care organizations (1) develop a strategic quality orientation at the management level, (2) support the pursuit of quality at the contact level, and (3) monitor external customers' perceptions of quality.

[Satisfaction of Users with Spinal Cord Injury in relation to the Service of Promotion of Personal Autonomy of the Balearic Islands, Spain].

PubMed

Capó-Juan, Miguel Ángel; Fiol-Delgado, Rosa Mª; Alzamora-Perelló, Mª Magdalena; Bosch-Gutiérrez, Marta; Serna-López, Lucía; Bennasar-Veny, Miguel; Aguiló-Pons, Antonio; De Pedro-Gómez, Joan E

2016-11-10

Public Service Promotion of Personal Autonomy aims to provide care to users with severe physical and/or physical-mental disabilities, including people with spinal cord injury. These users are in a chronic phase and thus they require educational-therapeutic measures of physiotherapy. This study is meant to determine the satisfaction of people with spinal cord injury who attend this service. A descriptive, cross-sectional, quantitative study in the Public Service Promotion of Personal Autonomy after a sixteen-month therapeutic monitoring process was carried out, which began in March 2015. The final study sample was 25 people with spinal cord injury (17 men and 8 women). At the end of therapeutic intervention, users responded to the SERVQHOS questionnaire, which consists in nineteen questions that aim to measure the quality of the care services provided. A statistical analysis was conducted, calculating averages and standard deviations or frecuencies and percentages. The best valued external factor was the staff appearance with 4,5 on average and the worst scored external factor was the ease of access and / or signposting of the center with 2,6 on average. On the other hand, the best valued internal factor was the kindness of the staff with 4,8 on average and the worst scored factor was the speed in which the users receive what they requested with 4,2 on average. We concluded that the quality offered is determined by internal factors (kindness, trust, willingness to help) and weaknesses are related to structural factors of the center (external factors).

Epilepsy and secondary perceived stigma in a social setting: A night at the theater.

PubMed

Kaufman, Kenneth R

2016-08-01

Stigma impacts >50% of persons with epilepsy (PWE) and is a key factory in quality of life. Stigma can be both enacted (external factors) and felt (internal factors). In this article, felt/perceived stigma is more broadly defined as a combination of internal factors and perceptions of external factors. Secondary perceived stigma is felt/perceived stigma by a third party. A key, but often underappreciated, consideration in felt/perceived stigma may occur when a seemingly innocuous statement by a speaker is perceived as stigmatizing by the PWE and/or even by an unintended third party. This autobiographic short report addresses secondary perceived stigma in a social setting, the theater. Copyright © 2016 Elsevier Inc. All rights reserved.

42 CFR 438.320 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.320 Definitions. As used in this subpart— EQR stands for external quality review. EQRO stands for external quality review organization. External quality review means the analysis and evaluation by an EQRO, of aggregated information on quality...

42 CFR 438.320 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.320 Definitions. As used in this subpart— EQR stands for external quality review. EQRO stands for external quality review organization. External quality review means the analysis and evaluation by an EQRO, of aggregated information on quality...

42 CFR 438.320 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.320 Definitions. As used in this subpart— EQR stands for external quality review. EQRO stands for external quality review organization. External quality review means the analysis and evaluation by an EQRO, of aggregated information on quality...

42 CFR 438.320 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.320 Definitions. As used in this subpart— EQR stands for external quality review. EQRO stands for external quality review organization. External quality review means the analysis and evaluation by an EQRO, of aggregated information on quality...

Self-evaluations of factors promoting and disturbing sleep: an epidemiological survey in Finland.

PubMed

Urponen, H; Vuori, I; Hasan, J; Partinen, M

1988-01-01

The purpose of this epidemiological survey (N = 1600) was to describe the factors which middle-aged urban people in Finland perceived as promoting or disturbing sleep. The response rate was 75%. The results suggested that quality of sleep is determined by numerous factors; social and psychological factors, health status, external sleeping conditions, life style and living habits. Every third respondent felt that exercise had a positive impact on sleep. Second in importance were reading and listening to music. Furthermore, sauna, shower and bath, stability in life, psychological factors, positive experience in work, satisfactory sexual life and good and quiet sleeping environment were reported to have positive effects on sleep. Men considered work-related pressure and fatigue (20%) as the most important factor disturbing falling asleep or quality of sleep. In women's ranking work problems appeared no sooner than in the third place. Women reported worries, interpersonal problems, and marital and family discord as the most disturbing factors to sleep (37%). Coffee in the evening had a negative effect on falling asleep. Although a 'nightcap' was considered to improve relaxation on falling sleep, men ranked alcohol as the fourth disturbing factor. Other disturbing factors were stress, irregularities in everyday life because of social events, travelling or atypical catnaps. Eating and exercising too heavily or too late in the evening were found to disturb sleep. On the other hand, temporary lack of exercise seemed to impair the quality of sleep. As external factors disturbing sleep the subjects considered noise light, too high room temperature, tight clothing, unfamiliar sleeping environment and restless children.(ABSTRACT TRUNCATED AT 250 WORDS)

The Role of Peer Influence and Perceived Quality of Teaching in Faculty Acceptance of Web-Based Learning Management Systems

ERIC Educational Resources Information Center

Salajan, Florin D.; Welch, Anita G.; Ray, Chris M.; Peterson, Claudette

2015-01-01

This study's primary investigation is the impact of "peer influence" and "perceived quality of teaching" on faculty members' usage of web-based learning management systems within the Technology Acceptance Model (TAM) framework. These factors are entered into an extended TAM as external variables impacting on the core constructs…

Photonic Crystal Microchip Laser.

PubMed

Gailevicius, Darius; Koliadenko, Volodymyr; Purlys, Vytautas; Peckus, Martynas; Taranenko, Victor; Staliunas, Kestutis

2016-09-29

The microchip lasers, being very compact and efficient sources of coherent light, suffer from one serious drawback: low spatial quality of the beam strongly reducing the brightness of emitted radiation. Attempts to improve the beam quality, such as pump-beam guiding, external feedback, either strongly reduce the emission power, or drastically increase the size and complexity of the lasers. Here it is proposed that specially designed photonic crystal in the cavity of a microchip laser, can significantly improve the beam quality. Experiments show that a microchip laser, due to spatial filtering functionality of intracavity photonic crystal, improves the beam quality factor M 2 reducing it by a factor of 2, and increase the brightness of radiation by a factor of 3. This comprises a new kind of laser, the "photonic crystal microchip laser", a very compact and efficient light source emitting high spatial quality high brightness radiation.

What is needed to implement a web-based audit and feedback intervention with outreach visits to improve care quality: A concept mapping study among cardiac rehabilitation teams.

PubMed

van Engen-Verheul, Mariëtte M; Peek, Niels; Haafkens, Joke A; Joukes, Erik; Vromen, Tom; Jaspers, Monique W M; de Keizer, Nicolette F

2017-01-01

Evidence on successful quality improvement (QI) in health care requires quantitative information from randomized clinical trials (RCTs) on the effectiveness of QI interventions, but also qualitative information from professionals to understand factors influencing QI implementation. Using a structured qualitative approach, concept mapping, this study determines factors identified by cardiac rehabilitation (CR) teams on what is needed to successfully implement a web-based audit and feedback (A&F) intervention with outreach visits to improve the quality of CR care. Participants included 49 CR professionals from 18 Dutch CR centres who had worked with the A&F system during a RCT. In three focus group sessions participants formulated statements on factors needed to implement QI successfully. Subsequently, participants rated all statements for importance and feasibility and grouped them thematically. Multi dimensional scaling was used to produce a final concept map. Forty-two unique statements were formulated and grouped into five thematic clusters in the concept map. The cluster with the highest importance was QI team commitment, followed by organisational readiness, presence of an adequate A&F system, access to an external quality assessor, and future use and functionalities of the A&F system. Concept mapping appeared efficient and useful to understand contextual factors influencing QI implementation as perceived by healthcare teams. While presence of a web-based A&F system and external quality assessor were seen as instrumental for gaining insight into performance and formulating QI actions, QI team commitment and organisational readiness were perceived as essential to actually implement and carry out these actions. These two sociotechnical factors should be taken into account when implementing and evaluating the success of QI implementations in future research. Copyright © 2016. Published by Elsevier Ireland Ltd.

Selected Aspects Of The Risk In The Supply Chain In Context Of The Supplier Quality Management

NASA Astrophysics Data System (ADS)

Koblen, Ivan; Lestyánszka Škůrková, Katarína

2015-06-01

The introductory part of the paper underlines the importance of "Risk-based thinking" in the Quality Management System (QMS) and risk in the supply chain, as a principle part of the QMS. After introducing the key terms, the authors focused on the principle part of the article - explanation of the external and internal supply chain risks and the main factors concerning the supply risks, demand risks and environmental risks (as cardinal types of external supply chain risks) as well as the manufacturing and process risks, network/planning and control risks (as most important types of internal supply chain risks). The authors inform on the selected supply chain risk management tools, especially on those which are linked to the appropriate utilization of quality management tools.

Development and Evaluation of a Computer-Based Program for Assessing Quality of Family Medicine Teams Based on Accreditation Standards

PubMed Central

Valjevac, Salih; Ridjanovic, Zoran; Masic, Izet

2009-01-01

CONFLICT OF INTEREST: NONE DECLARED SUMMARY Introduction Agency for healthcare quality and accreditation in Federation of Bosnia and Herzegovina (AKAZ) is authorized body in the field of healthcare quality and safety improvement and accreditation of healthcare institutions. Beside accreditation standards for hospitals and primary health care centers, AKAZ has also developed accreditation standards for family medicine teams. Methods Software development was primarily based on Accreditation Standards for Family Medicine Teams. Seven chapters / topics: (1. Physical factors; 2. Equipment; 3. Organization and Management; 4. Health promotion and illness prevention; 5. Clinical services; 6. Patient survey; and 7. Patient’s rights and obligations) contain 35 standards describing expected level of family medicine team’s quality. Based on accreditation standards structure and needs of different potential users, it was concluded that software backbone should be a database containing all accreditation standards, self assessment and external assessment details. In this article we will present the development of standardized software for self and external evaluation of quality of service in family medicine, as well as plans for the future development of this software package. Conclusion Electronic data gathering and storing enhances the management, access and overall use of information. During this project we came to conclusion that software for self assessment and external assessment is ideal for accreditation standards distribution, their overview by the family medicine team members, their self assessment and external assessment. PMID:24109157

Photonic Crystal Microchip Laser

NASA Astrophysics Data System (ADS)

Gailevicius, Darius; Koliadenko, Volodymyr; Purlys, Vytautas; Peckus, Martynas; Taranenko, Victor; Staliunas, Kestutis

2016-09-01

The microchip lasers, being very compact and efficient sources of coherent light, suffer from one serious drawback: low spatial quality of the beam strongly reducing the brightness of emitted radiation. Attempts to improve the beam quality, such as pump-beam guiding, external feedback, either strongly reduce the emission power, or drastically increase the size and complexity of the lasers. Here it is proposed that specially designed photonic crystal in the cavity of a microchip laser, can significantly improve the beam quality. Experiments show that a microchip laser, due to spatial filtering functionality of intracavity photonic crystal, improves the beam quality factor M2 reducing it by a factor of 2, and increase the brightness of radiation by a factor of 3. This comprises a new kind of laser, the “photonic crystal microchip laser”, a very compact and efficient light source emitting high spatial quality high brightness radiation.

Photonic Crystal Microchip Laser

PubMed Central

Gailevicius, Darius; Koliadenko, Volodymyr; Purlys, Vytautas; Peckus, Martynas; Taranenko, Victor; Staliunas, Kestutis

2016-01-01

The microchip lasers, being very compact and efficient sources of coherent light, suffer from one serious drawback: low spatial quality of the beam strongly reducing the brightness of emitted radiation. Attempts to improve the beam quality, such as pump-beam guiding, external feedback, either strongly reduce the emission power, or drastically increase the size and complexity of the lasers. Here it is proposed that specially designed photonic crystal in the cavity of a microchip laser, can significantly improve the beam quality. Experiments show that a microchip laser, due to spatial filtering functionality of intracavity photonic crystal, improves the beam quality factor M2 reducing it by a factor of 2, and increase the brightness of radiation by a factor of 3. This comprises a new kind of laser, the “photonic crystal microchip laser”, a very compact and efficient light source emitting high spatial quality high brightness radiation. PMID:27683066

42 CFR 438.354 - Qualifications of external quality review organizations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Qualifications of external quality review... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.354 Qualifications of external quality review organizations. (a) General rule. The State must...

Factor information retrieval system version 2. 0 (fire) (for microcomputers). Software

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

Not Available

FIRE Version 2.0 contains EPA's unique recommended criteria and toxic air emission estimation factors. FIRE consists of: (1) an EPA internal repository system that contains emission factor data identified and collected, and (2) an external distribution system that contains only EPA's recommended factors. The emission factors, compiled from a review of the literature, are identified by pollutant name, CAS number, process and emission source descriptions, SIC code, SCC, and control status. The factors are rated for quality using AP-42 rating criteria.

42 CFR 438.352 - External quality review protocols.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false External quality review protocols. 438.352 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.352 External quality review protocols. Each protocol must specify— (a) The data to be gathered; (b) The sources of the...

Photonic crystal microchip laser

NASA Astrophysics Data System (ADS)

Gailevicius, D.; Koliadenko, V.; Purlys, V.; Peckus, M.; Taranenko, V.; Staliunas, K.

2017-02-01

The microchip lasers, being sources of coherent light, suffer from one serious drawback: low spatial quality of the beam, strongly reducing the brightness of emitted radiation. Attempts to improve the beam quality, such as pump-beam guiding, external feedback, either strongly reduce the emission power, or drastically increase the size and complexity of the lasers. Here we propose that specially designed photonic crystal in the cavity of a microchip laser, can significantly improve the beam quality. We experimentally show that a microchip laser, due to spatial filtering functionality of intracavity photonic crystal, improves the beam quality factor M2 reducing it by factor of 2, and thus increase the brightness of radiation by a factor of 4. This comprises a new kind of laser, the "photonic crystal microchip laser", a very compact and efficient light source emitting high spatial high brightness radiation.

Personal and macro-systemic factors as predictors of quality of life in chronic schizophrenia.

PubMed

Fontanil-Gómez, Yolanda; Alcedo Rodríguez, María A; Gutiérrez López, María I

2017-05-01

The goal of this research was to establish possible predictive factors for both subjective and externally assessed quality of life in people with chronic schizophrenia. Sixty-eight people with schizophrenia took part in the study and were assessed using the World Health Organisation Quality of Life Assessment - Brief Version (WHOQOL-BREF), the Quality of Life Scale (QLS), the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Global Assessment of Functioning (GAF), the Social Functioning Scale (SFS) tests. Correlations and multiple regression analysis were conducted to determine possible predictors of quality of life. The residential environment (rural/urban), diagnosis, age at onset of disorder, global functioning and social functioning explained 68% of the total variance based on proxies’ assessment quality of life. Living arrangements and social functioning emerged as predictor variables for subjective quality of life, explaining a 47.3% of the total variance. Socio-cultural factors, such as social integration or the quality of interpersonal relationships, have more influence on these peoples’ physical and psychological health than certain personal factors, such as psychopathology. It is therefore advisable to pay attention to the environment and macro-systemic variables when developing intervention plans to improve their quality of life.

Understanding the impact of accreditation on quality in healthcare: A grounded theory approach.

PubMed

Desveaux, L; Mitchell, J I; Shaw, J; Ivers, N M

2017-11-01

To explore how organizations respond to and interact with the accreditation process and the actual and potential mechanisms through which accreditation may influence quality. Qualitative grounded theory study. Organizations who had participated in Accreditation Canada's Qmentum program during January 2014-June 2016. Individuals who had coordinated the accreditation process or were involved in managing or promoting quality. The accreditation process is largely viewed as a quality assurance process, which often feeds in to quality improvement activities if the feedback aligns with organizational priorities. Three key stages are required for accreditation to impact quality: coherence, organizational buy-in and organizational action. These stages map to constructs outlined in Normalization Process Theory. Coherence is established when an organization and its staff perceive that accreditation aligns with the organization's beliefs, context and model of service delivery. Organizational buy-in is established when there is both a conceptual champion and an operational champion, and is influenced by both internal and external contextual factors. Quality improvement action occurs when organizations take purposeful action in response to observations, feedback or self-reflection resulting from the accreditation process. The accreditation process has the potential to influence quality through a series of three mechanisms: coherence, organizational buy-in and collective quality improvement action. Internal and external contextual factors, including individual characteristics, influence an organization's experience of accreditation. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

An In-Depth Study on the Impact of External Quality Assurance

ERIC Educational Resources Information Center

Stensaker, Bjorn; Langfeldt, Liv; Harvey, Lee; Huisman, Jeroen; Westerheijden, Don

2011-01-01

After more than two decades of external quality assurance, there is an increasing interest in questions concerning the impact and effects of this activity. Following an external evaluation of NOKUT--the Norwegian quality assurance agency, this article studies the impact of external quality assurance in detail by analysing quantitative and…

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

Accurate Determination of the Q Quality Factor in Magnetoelastic Resonant Platforms for Advanced Biological Detection.

PubMed

Lopes, Ana Catarina; Sagasti, Ariane; Lasheras, Andoni; Muto, Virginia; Gutiérrez, Jon; Kouzoudis, Dimitris; Barandiarán, José Manuel

2018-03-16

The main parameters of magnetoelastic resonators in the detection of chemical (i.e., salts, gases, etc.) or biological (i.e., bacteria, phages, etc.) agents are the sensitivity S (or external agent change magnitude per Hz change in the resonance frequency) and the quality factor Q of the resonance. We present an extensive study on the experimental determination of the Q factor in such magnetoelastic resonant platforms, using three different strategies: (a) analyzing the real and imaginary components of the susceptibility at resonance; (b) numerical fitting of the modulus of the susceptibility; (c) using an exact mathematical expression for the real part of the susceptibility. Q values obtained by the three methods are analyzed and discussed, aiming to establish the most adequate one to accurately determine the quality factor of the magnetoelastic resonance.

Accurate Determination of the Q Quality Factor in Magnetoelastic Resonant Platforms for Advanced Biological Detection

PubMed Central

Lopes, Ana Catarina; Sagasti, Ariane; Lasheras, Andoni; Muto, Virginia; Gutiérrez, Jon; Kouzoudis, Dimitris; Barandiarán, José Manuel

2018-01-01

The main parameters of magnetoelastic resonators in the detection of chemical (i.e., salts, gases, etc.) or biological (i.e., bacteria, phages, etc.) agents are the sensitivity S (or external agent change magnitude per Hz change in the resonance frequency) and the quality factor Q of the resonance. We present an extensive study on the experimental determination of the Q factor in such magnetoelastic resonant platforms, using three different strategies: (a) analyzing the real and imaginary components of the susceptibility at resonance; (b) numerical fitting of the modulus of the susceptibility; (c) using an exact mathematical expression for the real part of the susceptibility. Q values obtained by the three methods are analyzed and discussed, aiming to establish the most adequate one to accurately determine the quality factor of the magnetoelastic resonance. PMID:29547578

[Phosphatidylserine externalization and functional-morphological impairment of sperm in men with long barren marriage].

PubMed

Ploskonos, M V

2016-08-01

To identify the relationship between phosphatidylserine externalization, as an early marker of apoptosis, and functional and morphological sperm impairment in infertile men to subsequently evaluate the effect of apoptosis on sperm fertility. Ejaculates of 18 fertile and 78 subfertile men were examined. Phosphatidylserine externalization was detected by staining the sperm with fluorochrome conjugated Annexin V (AnV-FITC) and propidium iodide using fluorescence microscopy. and conclusions: Ejaculates of fertile and subfertile men differed in the percentage of annexin-V-positive sperm. The correlation of (AnV+/PI+) - sperm of subfertile men with sperm concentration, motility and defects of sperm morphology shows the adverse effects of apoptosis on sperm quality and suggests that phosphatidylserine externalization is a factor for reducing sperm fertility.

77 FR 21086 - Patents External Quality Survey (formerly Customer Panel Quality Survey)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-09

... DEPARTMENT OF COMMERCE United States Patent and Trademark Office Patents External Quality Survey (formerly Customer Panel Quality Survey) ACTION: Proposed collection; comment request. SUMMARY: The United...: [email protected] . Include ``0651- 0057 Patents External Quality Survey comment'' in the...

[Incidence and influencing factors of distal external iliac lymph node metastasis in early cervical cancer].

PubMed

Yin, Yueju; Sheng, Xiugui; Li, Xinglan; Li, Dapeng; Han, Xiaoyun; Zhang, Xiaoling; Zhang, Tingting

2014-06-01

The distal external iliac lymph nodes are located along the external iliac artery between the deep circumflex iliac vein and the inguinal canal. Our study aimed to investigate the incidence of metastasis in distal external iliac lymph nodes and its association with clinicopathological factors in patients with early stage cervical cancer, and to determine the role of distal external iliac lymph nodes dissection in the surgery. Five hundred and twenty-four patients with early stage cervical cancer underwent radical hysterectomy and bilateral pelvic lymphadenectomy in the Shandong Province Cancer Hospital between June 1995 and December 2011, and their clinicopathological features were analyzed retrospectively. Of the 524 patients, 124 (23.7%) had pelvic lymph node metastasis. The metastasis rates were 16.2% (85 of 524 patients) in the obturator lymph nodes, 12.2% (64 of 524 patients) in the internal and external iliac lymph nodes, 2.9% (15 of 524 patients) in the common iliac lymph nodes, 2.1% (11 of 524 patients) in the distal external iliac lymph nodes, and 1.7% (9 of 524 patients) in the para-aortic nodes. The incidence of isolated positive distal external iliac lymph nodes was 0.2%. Univariate analysis showed that lymphovascular space invasion, pelvic lymph node metastases (excluding distal external iliac lymph nodes) were significantly associated with distal external iliac lymph node metastasis (P < 0.05). Logistic regression analysis showed that pelvic lymph node metastasis (excluding distal external iliac lymph nodes) was the independent risk factor for metastasis to distal external iliac lymph nodes. In early stage cervical cancer, distal external iliac lymph node metastasis is rare, especially in cases with stage IA or without pelvic lymph node metastasis. Less extensive pelvic lymphadenectomy may be considered in these patients in order to reduce operative complications and improve patients' quality of life. The deep circumflex iliac vein may be an appropriate landmark for the caudal limit of external iliac lymphadenectomy. However, if pelvic lymph node metastasis (excluding distal external iliac lymph nodes) is found by intraoperative rapid pathological diagnosis, systematic pelvic lymphadenectomy including removal of the distal external iliac lymph nodes should be performed in order to reduce the risk of distant metastasis.

Development of a quality assessment tool for systematic reviews of observational studies (QATSO) of HIV prevalence in men having sex with men and associated risk behaviours

PubMed Central

Wong, William CW; Cheung, Catherine SK; Hart, Graham J

2008-01-01

Background Systematic reviews based on the critical appraisal of observational and analytic studies on HIV prevalence and risk factors for HIV transmission among men having sex with men are very useful for health care decisions and planning. Such appraisal is particularly difficult, however, as the quality assessment tools available for use with observational and analytic studies are poorly established. Methods We reviewed the existing quality assessment tools for systematic reviews of observational studies and developed a concise quality assessment checklist to help standardise decisions regarding the quality of studies, with careful consideration of issues such as external and internal validity. Results A pilot version of the checklist was developed based on epidemiological principles, reviews of study designs, and existing checklists for the assessment of observational studies. The Quality Assessment Tool for Systematic Reviews of Observational Studies (QATSO) Score consists of five items: External validity (1 item), reporting (2 items), bias (1 item) and confounding factors (1 item). Expert opinions were sought and it was tested on manuscripts that fulfil the inclusion criteria of a systematic review. Like all assessment scales, QATSO may oversimplify and generalise information yet it is inclusive, simple and practical to use, and allows comparability between papers. Conclusion A specific tool that allows researchers to appraise and guide study quality of observational studies is developed and can be modified for similar studies in the future. PMID:19014686

High-Q microwave photonic filter with a tuned modulator.

PubMed

Capmany, J; Mora, J; Ortega, B; Pastor, D

2005-09-01

We propose the use of tuned electro-optic or electroabsorption external modulators to implement high-quality (high-Q) factor, single-bandpass photonic filters for microwave signals. Using this approach, we experimentally demonstrate a transversal finite impulse response with a Q factor of 237. This is to our knowledge the highest value ever reported for a passive finite impulse-response microwave photonic filter.

The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews.

PubMed

Kringos, Dionne S; Sunol, Rosa; Wagner, Cordula; Mannion, Russell; Michel, Philippe; Klazinga, Niek S; Groene, Oliver

2015-07-22

It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual factors in the literature on the effectiveness of quality improvement strategies, (ii) assess the relationship between effectiveness and contextual factors, and (iii) analyse the importance of contextual factors. We conducted an umbrella review of systematic reviews searching the following databases: PubMed, Cochrane Database of Systematic Reviews, Embase and CINAHL. The search focused on quality improvement strategies included in the Cochrane Effective Practice and Organisation of Care Group taxonomy. We extracted data on quality improvement effectiveness and context factors. The latter were categorized according to the Model for Understanding Success in Quality tool. We included 56 systematic reviews in this study of which only 35 described contextual factors related with the effectiveness of quality improvement interventions. The most frequently reported contextual factors were: quality improvement team (n = 12), quality improvement support and capacity (n = 11), organization (n = 9), micro-system (n = 8), and external environment (n = 4). Overall, context factors were poorly reported. Where they were reported, they seem to explain differences in quality improvement effectiveness; however, publication bias may contribute to the observed differences. Contextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system. Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance.

On charged particle equilibrium violation in external photon fields.

PubMed

Bouchard, Hugo; Seuntjens, Jan; Palmans, Hugo

2012-03-01

In a recent paper by Bouchard et al. [Med. Phys. 36(10), 4654-4663 (2009)], a theoretical model of quality correction factors for idealistic so-called plan-class specific reference (PCSR) fields was proposed. The reasoning was founded on the definition of PCSR fields made earlier by Alfonso et al. [Med. Phys. 35(11), 5179-5186 (2008)], requiring the beam to achieve charged particle equilibrium (CPE), in a time-averaged sense, in the reference medium. The relation obtained by Bouchard et al. was derived using Fano's theorem (1954) which states that if CPE is established in a given medium, the dose is independent of point-to-point density variations. A potential misconception on the achievability of the condition required by Fano (1954) might be responsible for false practical conclusions, both in the definition of PCSR fields as well as the theoretical model of quality correction factor. In this paper, the practical achievability of CPE in external beams is treated in detail. The fact that this condition is not achievable in single or composite deliveries is illustrated by an intuitive method and is also formally demonstrated. Fano's theorem is not applicable in external beam radiation dosimetry without (virtually) removing attenuation effects, and therefore, the relation conditionally defined by Bouchard et al. (2009) cannot be valid in practice. A definition of PCSR fields in the recent formalism for nonstandard beams proposed by Alfonso et al. (2008) should be modified, revising the criterion of CPE condition. The authors propose reconsidering the terminology used to describe standard and nonstandard beams. The authors argue that quality correction factors of intensity modulated radiation therapy PCSR fields (i.e., k(Q(pcsr),Q) (f(pcsr),f(ref) )) could be unity under ideal conditions, but it is concluded that further investigation is necessary to confirm that hypothesis.

[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.

A potential non-invasive approach to evaluating blastocyst quality using biodynamic imaging

NASA Astrophysics Data System (ADS)

Li, Zhe; Ehmke, Natalie; Machaty, Zoltan; Nolte, David

2018-02-01

Biodynamic imaging (BDI) is capable of capturing the intracellular dynamics of blastocysts within a relatively short time. Spectroscopic signatures of embryos in the 0.01 Hz - 1 Hz range display responses to external factors before morphology changes take place. Viability evaluation is consistent with results from other non-invasive methods. Biodynamic imaging is a potential tool for selecting high quality embryos in clinical IVF practices.

High sensitivity and specificity of clinical microscopy in rural health facilities in western Kenya under an external quality assurance program.

PubMed

Wafula, Rebeccah; Sang, Edna; Cheruiyot, Olympia; Aboto, Angeline; Menya, Diana; O'Meara, Wendy Prudhomme

2014-09-01

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. © The American Society of Tropical Medicine and Hygiene.

Externalizing Behaviors and Callous-Unemotional Traits: Different Associations With Sleep Quality.

PubMed

Denis, Dan; Akhtar, Reece; Holding, Benjamin C; Murray, Christina; Panatti, Jennifer; Claridge, Gordon; Sadeh, Avi; Barclay, Nicola L; O'Leary, Rachael; Maughan, Barbara; McAdams, Tom A; Rowe, Richard; Eley, Thalia C; Viding, Essi; Gregory, Alice M

2017-08-01

Sleep quality is associated with different aspects of psychopathology, but relatively little research has examined links between sleep quality and externalizing behaviors or callous-unemotional traits. We examined: (1) whether an association exists between sleep quality and externalizing behaviors; (2) whether anxiety mediates this association; (3) whether callous-unemotional traits are associated with sleep quality. Data from two studies were used. Study 1 involved 1556 participants of the G1219 study aged 18-27 years (62% female). Questionnaire measures assessed sleep quality, anxiety, externalizing behaviors, and callous-unemotional traits. Study 2 involved 338 participants aged 18-66 years (65% female). Questionnaires measured sleep quality, externalizing behaviors, and callous-unemotional traits. In order to assess objective sleep quality, actigraphic data were also recorded for a week from a subsample of study 2 participants (n = 43). In study 1, poorer sleep quality was associated with greater externalizing behaviors. This association was partially mediated by anxiety and moderated by levels of callous-unemotional traits. There was no significant relationship between sleep quality and callous-unemotional traits. In study 2, poorer sleep quality, as assessed via self-reported but not objective measures, was associated with higher levels of externalizing behaviors. Furthermore, in study 2, better sleep quality (indicated in both questionnaires and actigraphy measures: lower mean activity, and greater sleep efficiency) was associated with higher levels of callous-unemotional traits. Self-reports of poorer sleep quality are associated with externalizing behaviors, and this association is partially mediated by anxiety. Callous-unemotional traits are not associated with poor sleep and may even be related to better sleep quality. This is an exceptional finding given that poor sleep quality appears to be a characteristic of most psychopathology. © Sleep Research Society 2017. Published by Oxford University Press [on behalf of the Sleep Research Society].

Externalizing Behaviors and Callous-Unemotional Traits: Different Associations With Sleep Quality

PubMed Central

Akhtar, Reece; Holding, Benjamin C; Murray, Christina; Panatti, Jennifer; Claridge, Gordon; Sadeh, Avi; Barclay, Nicola L; O’Leary, Rachael; Maughan, Barbara; McAdams, Tom A; Rowe, Richard; Eley, Thalia C; Viding, Essi

2017-01-01

Abstract Study Objectives Sleep quality is associated with different aspects of psychopathology, but relatively little research has examined links between sleep quality and externalizing behaviors or callous-unemotional traits. We examined: (1) whether an association exists between sleep quality and externalizing behaviors; (2) whether anxiety mediates this association; (3) whether callous-unemotional traits are associated with sleep quality. Methods Data from two studies were used. Study 1 involved 1556 participants of the G1219 study aged 18–27 years (62% female). Questionnaire measures assessed sleep quality, anxiety, externalizing behaviors, and callous-unemotional traits. Study 2 involved 338 participants aged 18–66 years (65% female). Questionnaires measured sleep quality, externalizing behaviors, and callous-unemotional traits. In order to assess objective sleep quality, actigraphic data were also recorded for a week from a subsample of study 2 participants (n = 43). Results In study 1, poorer sleep quality was associated with greater externalizing behaviors. This association was partially mediated by anxiety and moderated by levels of callous-unemotional traits. There was no significant relationship between sleep quality and callous-unemotional traits. In study 2, poorer sleep quality, as assessed via self-reported but not objective measures, was associated with higher levels of externalizing behaviors. Furthermore, in study 2, better sleep quality (indicated in both questionnaires and actigraphy measures: lower mean activity, and greater sleep efficiency) was associated with higher levels of callous-unemotional traits. Conclusions Self-reports of poorer sleep quality are associated with externalizing behaviors, and this association is partially mediated by anxiety. Callous-unemotional traits are not associated with poor sleep and may even be related to better sleep quality. This is an exceptional finding given that poor sleep quality appears to be a characteristic of most psychopathology. PMID:28575510

Conditioning Factors of an Organizational Learning Culture

ERIC Educational Resources Information Center

Rebelo, Teresa Manuela; Gomes, Adelino Duarte

2011-01-01

Purpose: The aim of this study is to assess the relationship between some variables (organizational structure, organizational dimension and age, human resource characteristics, the external environment, strategy and quality) and organizational learning culture and evaluate the way they interact with this kind of culture.…

Recruiting and Retention of Military Personnel: Influences of Quality of Life and Personnel Tempo

DTIC Science & Technology

2009-10-01

with Children Relations with Relatives Neighbourhood Economic Cycle External Labour Market Enlistment Propensity Anticipated QoL Attraction Personal...dispositions Actual QoL (meaning) Individual factors Retention Absenteeism Individual Performance Dowden (2000) QoL Model of Married Marines with

Silicon Photonics Transmitter with SOA and Semiconductor Mode-Locked Laser.

PubMed

Moscoso-Mártir, Alvaro; Müller, Juliana; Hauck, Johannes; Chimot, Nicolas; Setter, Rony; Badihi, Avner; Rasmussen, Daniel E; Garreau, Alexandre; Nielsen, Mads; Islamova, Elmira; Romero-García, Sebastián; Shen, Bin; Sandomirsky, Anna; Rockman, Sylvie; Li, Chao; Sharif Azadeh, Saeed; Lo, Guo-Qiang; Mentovich, Elad; Merget, Florian; Lelarge, François; Witzens, Jeremy

2017-10-24

We experimentally investigate an optical link relying on silicon photonics transmitter and receiver components as well as a single section semiconductor mode-locked laser as a light source and a semiconductor optical amplifier for signal amplification. A transmitter based on a silicon photonics resonant ring modulator, an external single section mode-locked laser and an external semiconductor optical amplifier operated together with a standard receiver reliably supports 14 Gbps on-off keying signaling with a signal quality factor better than 7 for 8 consecutive comb lines, as well as 25 Gbps signaling with a signal quality factor better than 7 for one isolated comb line, both without forward error correction. Resonant ring modulators and Germanium waveguide photodetectors are further hybridly integrated with chip scale driver and receiver electronics, and their co-operability tested. These experiments will serve as the basis for assessing the feasibility of a silicon photonics wavelength division multiplexed link relying on a single section mode-locked laser as a multi-carrier light source.

Ten Years of External Quality Audit in Australia: Evaluating Its Effectiveness and Success

ERIC Educational Resources Information Center

Shah, Mahsood

2012-01-01

External quality audits are now being used in universities across the world to improve quality assurance, accountability for quality education and transparency of public funding of higher education. Some countries such as Australia, New Zealand, United Kingdom, Sweden and Denmark have had external quality audits for more than a decade but there…

Validation of an instrument to measure inter-organisational linkages in general practice.

PubMed

Amoroso, Cheryl; Proudfoot, Judith; Bubner, Tanya; Jayasinghe, Upali W; Holton, Christine; Winstanley, Julie; Beilby, Justin; Harris, Mark F

2007-12-03

Linkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice's linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease. An interview to measure surgery-level (rather than individual clinician-level) clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations). Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models. The resulting General Practice Clinical Linkages Interview (GP-CLI) is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however, comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice. The GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples exploring the impact, outcomes, and facilitators of high quality clinical linkages in general practice.

Symptom reporting in cancer patients: the role of negative affect and experienced social stigma.

PubMed

Koller, M; Kussman, J; Lorenz, W; Jenkins, M; Voss, M; Arens, E; Richter, E; Rothmund, M

1996-03-01

Recent research suggests that patients' appraisal of somatic symptoms is more closely related to emotional variables (particularly negative affect) than to their actual health as determined by external criteria. Sixty surgical cancer patients who at the time of a routine follow-up examination filled out the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire-C30, which included a positive/negative affect scale and a scale tapping into experienced social stigma. Patients' health status was determined in two ways: the examining physician gave a global judgement on a standardized scale at the end of the examination, and an additional two external physicians later rated the patients based on the findings listed in the medical record. Patients' reports of somatic symptoms were strongly correlated with two measures of negative affect (r = 0.75 and r = 0.65, respectively) and with experienced social stigma (r = 0.51). In contrast, the correlations between reported symptoms and the examining or external physicians' ratings were considerably weaker (r = 0.31 and r = 0.19). According to a multiple linear regression with 6 predictors, negative affect was the best single predictor of symptom reporting (beta = 0.68; P < 0.001) and global quality of life (beta = 0.48; P < 0.001). Factor analysis yielded a dimension of somatopsychosocial distress that accounted for 44.1% of the variance and is comprised of reported symptoms (factor loading = 0.86), negative affect (0.90 and 0.82), experienced social stigma (0.74), and global quality of life (0.70). Physicians' ratings and positive affect constituted two additional separate factors. Cancer patients' reporting of somatic symptoms by means of a standardized quality of life questionnaire is closely related to emotional and social distress and is not equivalent to health status as determined from a clinical perspective. Researchers and practitioners have to be aware of this fact when interpreting quality of life data. Furthermore, negative affect deserves attention as an important signal for intervention in tumor follow-up programs.

[Standardization in laboratory hematology by participating in external quality assurance programs].

PubMed

Nazor, Aida; Siftar, Zoran; Flegar-Mestrić, Zlata

2011-09-01

Since 1985, Department of Clinical Chemistry and Laboratory Medicine, Merkur University Hospital, Zagreb, has been participating in the International External Quality Assessment Scheme for Hematology (IEQAS-H) organized by the World Health Organization (WHO). Owing to very good results, in 1987 the Department received a certificate of participation in this control scheme. Department has been cooperating in the external quality assessment program in laboratory hematology which has been continuously performed in Croatia since 1986 by the Committee for External Quality Assessment Schemes under the auspices of the Croatian Society of Medical Biochemists and School of Pharmacy and Biochemistry, University of Zagreb. Nowadays, 186 medical biochemical laboratories are included in the National External Quality Assessment program, which is performed three times per year. Our Department has participated in the international projects of the European Committee for External Quality Assurance Programs in Laboratory Medicine (EQALM).

Higher quality of molecular testing, an unfulfilled priority: Results from external quality assessment for KRAS mutation testing in colorectal cancer.

PubMed

Tembuyser, Lien; Ligtenberg, Marjolijn J L; Normanno, Nicola; Delen, Sofie; van Krieken, J Han; Dequeker, Elisabeth M C

2014-05-01

Precision medicine is now a key element in clinical oncology. RAS mutational status is a crucial predictor of responsiveness to anti-epidermal growth factor receptor agents in metastatic colorectal cancer. In an effort to guarantee high-quality testing services in molecular pathology, the European Society of Pathology has been organizing an annual KRAS external quality assessment program since 2009. In 2012, 10 formalin-fixed, paraffin-embedded samples, of which 8 from invasive metastatic colorectal cancer tissue and 2 artificial samples of cell line material, were sent to more than 100 laboratories from 26 countries with a request for routine KRAS testing. Both genotyping and clinical reports were assessed independently. Twenty-seven percent of the participants genotyped at least 1 of 10 samples incorrectly. In total, less than 5% of the distributed specimens were genotyped incorrectly. Genotyping errors consisted of false negatives, false positives, and incorrectly genotyped mutations. Twenty percent of the laboratories reported a technical error for one or more samples. A review of the written reports showed that several essential elements were missing, most notably a clinical interpretation of the test result, the method sensitivity, and the use of a reference sequence. External quality assessment serves as a valuable educational tool in assessing and improving molecular testing quality and is an important asset for monitoring quality assurance upon incorporation of new biomarkers in diagnostic services. Copyright © 2014 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

Surveys and Benchmarks

ERIC Educational Resources Information Center

Bers, Trudy

2012-01-01

Surveys and benchmarks continue to grow in importance for community colleges in response to several factors. One is the press for accountability, that is, for colleges to report the outcomes of their programs and services to demonstrate their quality and prudent use of resources, primarily to external constituents and governing boards at the state…

Faculty Compensation Systems: Impact on the Quality of Higher Education. ERIC Digest.

ERIC Educational Resources Information Center

Sutton, Terry P.; Bergerson, Peter J.

Faculty compensation is a critical management tool for increasing faculty productivity, improving cost efficiency, and enhancing an institution's public image. Factors that determine faculty compensation include academic rank, faculty productivity, discipline market pay, ability to obtain external grants, seniority or length of service, service in…

Still Balancing Improvement and Accountability? Developments in External Quality Assurance in the Nordic Countries 1996-2006

ERIC Educational Resources Information Center

Dano, Trine; Stensaker, Bjorn

2007-01-01

The role and function of external quality assurance is of great importance for the development of an internal quality culture in higher education. Research has shown that external quality assurance can stimulate but also create obstacles for institutional improvement. To strike a balance between improvement and accountability is, therefore, a key…

External Quality Arrangements for Scotland's Colleges

ERIC Educational Resources Information Center

Her Majesty's Inspectorate of Education, 2008

2008-01-01

This document represents an innovative and radical landmark in the development of external quality arrangements for Scotland's colleges. The quality framework and arrangements for annual engagement, subject-based aspect reports, and external review reflect new thinking nationally, within HMIE, in the Scottish Further and Higher Education Funding…

[The effects of noise on sleep and their possible repercussions on health].

PubMed

Muzet, Alain

2006-11-01

Sleep is a physiological recuperative state susceptible to be disturbed or reduced in length under external stimuli, such as noise, one of the most frequent ambient factors. Sleep disturbance is often accompanied by a reduced quality of the following waking period. The health effects of prolonged exposure to noise concern life quality, as expressed subjectively by the sleeper, as well as probable effect on cardiovascular function through a non specific aggression related to stress.

Predictors for work participation in individuals with an Autism spectrum disorder: a systematic review.

PubMed

Holwerda, Anja; van der Klink, Jac J L; Groothoff, Johan W; Brouwer, Sandra

2012-09-01

Research shows that only about 25% of people with autism are employed. We conducted a systematic review on factors facilitating or hindering work participation of people with autism in longitudinal studies. An extensive search in biomedical and psychological databases yielded 204 articles and 18 satisfied all inclusion criteria. We assessed the methodological quality of included studies using an established criteria list. Seventeen factors were identified and categorized as disease-related factors, personal factors or external factors. Limited cognitive ability was the only significant predictor consistently found for work outcome. Functional independence and institutionalization were both reported by one study to be significantly related to work outcome. Inconsistent findings or non significant findings were reported for the other fourteen factors. These findings emphasize the need for more high quality cohort studies focussing on work participation as the main outcome among people with Autism.

Contextual Factors Related to Implementation and Reach of a Pragmatic Multisite Trial– The My Own Health Report (MOHR) Study

PubMed Central

Balasubramanian, Bijal A.; Heurtin-Roberts, Suzanne; Krasny, Sarah; Rohweder, Catherine; Fair, Kayla; Olmos, Tanya; Stange, Kurt C.; Gorin, Sherri Sheinfeld

2018-01-01

Background Contextual factors relevant to health care improvement studies are important for translating findings to other settings; however, these are rarely collected systematically and reported. This study articulates a prospective method for assessing contextual factors and describes factors related to implementation and patient reach of a pragmatic multisite trial conducted in nine primary care practices. Methods In a qualitative case-series, contextual factors were assessed from the My Own Health Report (MOHR) study, focused on systematically conducting health risk assessments and goal setting for unhealthy behaviors and behavioral health in primary care. Data were collected prospectively at baseline, mid-point, and end of intervention using a template that guided conduct of interviews and observations at practice sites. A multidisciplinary team used an iterative process to summarize themes describing contextual factors related to intervention implementation and patient reach, calculated by dividing the number of patients who completed the MOHR assessment by the number of patients offered MOHR. Results Contextual factors operational both within and external to the practice environment influenced implementation and patient reach over time. These included practice members’ motivations towards the MOHR intervention, practice staff capacity to take on additional responsibilities for implementation, practice information system capacity, external resources to support quality improvement, linkages with community resources, and fit of implementation strategy to patient populations. Conclusions Systematic assessment of contextual factors throughout implementation of quality improvement initiatives is needed to meaningfully interpret findings and translate lessons learned to other health care settings. Thus, knowledge of contextual factors is essential for scaling up of effective improvement strategies. PMID:28484066

Evanescent Microwave Probes on High-Resistivity Silicon and its Application in Characterization of Semiconductors

NASA Technical Reports Server (NTRS)

Tabib-Azar, M.; Akinwande, D.; Ponchak, George E.; LeClair, S. R.

1999-01-01

In this article we report the design, fabrication, and characterization of very high quality factor 10 GHz microstrip resonators on high-resistivity (high-rho) silicon substrates. Our experiments show that an external quality factor of over 13 000 can be achieved on microstripline resonators on high-rho silicon substrates. Such a high Q factor enables integration of arrays of previously reported evanescent microwave probe (EMP) on silicon cantilever beams. We also demonstrate that electron-hole pair recombination and generation lifetimes of silicon can be conveniently measured by illuminating the resonator using a pulsed light. Alternatively, the EMP was also used to nondestructively monitor excess carrier generation and recombination process in a semiconductor placed near the two-dimensional resonator.

[Trend in mortality from external causes in pregnant and postpartum women and its relationship to socioeconomic factors in Colombia, 1998-2010].

PubMed

Salazar, Edwin; Buitrago, Carolina; Molina, Federico; Alzate, Catalina Arango

2015-05-01

Determine the trend in mortality from external causes in pregnant and postpartum women and its relationship to socioeconomic factors. Descriptive study, based on the official registries of deaths reported by the National Statistics Agency, 1998-2010. The trend was analyzed using Poisson regressions. Bivariate correlations and multiple linear regression models were constructed to explore the relationship between mortality and socioeconomic factors: human development index, Gini index, gross domestic product, unsatisfied basic needs, unemployment rate, poverty, extreme poverty, quality of life index, illiteracy rate, and percentage of affiliation to the Social Security System. A total of 2 223 female deaths from external causes were recorded, of which 1 429 occurred during pregnancy and 794 in the postpartum period. The gross mortality rate dropped from 30.7 per 100 000 live births plus fetal deaths in 1998 to 16.7 in 2010. A downward curve with no significant inflection points was shown in the risk of dying from this cause. The multiple linear regression model showed a correlation between mortality and extreme poverty and the illiteracy rate, suggesting that these indicators could explain 89.4% of the change in mortality from external causes in pregnant and postpartum women each year in Colombia. Mortality from external causes in pregnant and postpartum women showed a significant downward trend that may be explained by important socioeconomic changes in the country, including a decrease in extreme poverty and in the illiteracy rate.

42 CFR 438.362 - Exemption from external quality review.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Exemption from external quality review. 438.362 Section 438.362 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.362 Exemption...

42 CFR 438.362 - Exemption from external quality review.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Exemption from external quality review. 438.362 Section 438.362 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.362 Exemption...

[The external evaluation of study quality: the role in maintaining the reliability of laboratory information].

PubMed

Men'shikov, V V

2013-08-01

The external evaluation of quality of clinical laboratory examinations was gradually introduced in USSR medical laboratories since 1970s. In Russia, in the middle of 1990 a unified all-national system of external evaluation quality was organized known as the Federal center of external evaluation of quality at the basis of laboratory of the state research center of preventive medicine. The main positions of policy in this area were neatly formulated in the guidance documents of ministry of Health. Nowadays, the center of external evaluation of quality proposes 100 and more types of control studies and permanently extends their specter starting from interests of different disciplines of clinical medicine. The consistent participation of laboratories in the cycles of external evaluation of quality intrinsically promotes improvement of indicators of properness and precision of analysis results and increases reliability of laboratory information. However, a significant percentage of laboratories does not participate at all in external evaluation of quality or takes part in control process irregularly and in limited number of tests. The managers of a number of medical organizations disregard the application of the proposed possibilities to increase reliability of laboratory information and limit financing of studies in the field of quality control. The article proposes to adopt the national standard on the basis of ISO 17043 "Evaluation of compliance. The common requirements of professional competence testing".

Functional significance of a novel 7-factor model of DSM-5 PTSD symptoms: results from the National Health and Resilience in Veterans study.

PubMed

Pietrzak, Robert H; Tsai, Jack; Armour, Cherie; Mota, Natalie; Harpaz-Rotem, Ilan; Southwick, Steven M

2015-03-15

While posttraumatic stress disorder (PTSD) symptoms in the recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are clustered into four factors, emerging confirmatory factor analytic studies suggest that this disorder is best characterized by seven symptom clusters, including re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptoms. To date, however, data are lacking regarding the relation between this novel model of DSM-5 PTSD symptoms and measures of clinical significance in this population (e.g., functioning). Using data from the National Health and Resilience in Veterans Study (NHRVS), a contemporary, nationally representative sample of 1484 U.S. veterans, we evaluated clinical and functional correlates of a novel 7-factor model of DSM-5 PTSD symptoms. Differential patterns of associations were observed between DSM-5 PTSD symptom clusters, and psychiatric comorbidities, suicidal ideation, hostility, and functioning and quality of life. Anhedonia symptoms, in particular, were strongly related to current depression, as well as reduced mental functioning and quality of life. Externalizing behaviors were most strongly related to hostility, supporting the convergent validity of this construct. Cross-sectional design and employment of self-report measures. These results suggest that a more refined 7-factor model of DSM-5 PTSD symptoms may provide greater specificity in understanding associations with comorbid psychopathology, suicidal ideation, and functioning and quality of life in U.S. veterans. They further suggest that prevention and treatment efforts that target distinct aspects of the PTSD phenotype may be more effective in mitigating key clinical and functional outcomes in this population. Published by Elsevier B.V.

Assessment of the Potential Impacts of Hydraulic Fracturing for Oil and Gas on Drinking Water Resources (External Review Draft)

EPA Science Inventory

This assessment provides a review and synthesis of available scientific literature and data to assess the potential for hydraulic fracturing for oil and gas to impact the quality or quantity of drinking water resources, and identifies factors affecting the frequency or severity o...

A Case Study in Organizational Change: Evaluation in Cooperative Extension

ERIC Educational Resources Information Center

Rennekamp, Roger A.; Engle, Molly

2008-01-01

This chapter examines how factors both internal and external to Cooperative Extension have influenced its commitment and capability to assess the quality and impact of its programs. The authors begin by documenting how the nature of Extension programming has changed dramatically in response to societal needs over the course of the organization's…

Exploration of a Contextual Management Framework for Strategic Learning Alliances

ERIC Educational Resources Information Center

Dealtry, Richard

2008-01-01

Purpose: This article aims to take a further step forward in examining those important business factors that will shape the future of best practice in the quality management of internal and external strategic alliances. Design/methodology/approach: The article presents a speculative scenario on the future of strategic alliances in education,…

Understanding Teacher Change: A National Survey of U.S. Physical Educators

ERIC Educational Resources Information Center

Kern, Ben D.; Graber, Kim C.

2018-01-01

Physical education is critical to addressing childhood obesity, yet many school-based programs do not meet established quality standards and teachers are called upon to change. Little is known about how change is initiated and its associated internal and external factors. Purpose: The purpose of this study was to investigate physical education…

Comprehensive analysis of NAC transcription factors and their expression during cucumber fruit spine development

USDA-ARS?s Scientific Manuscript database

Cucumber (Cucumis sativus L.) is an important vegetable crop worldwide, and fruit trichomes ir spines are an important trait for external fruit quality. The mechanisms underlying spine formation are not well understood, but there is evidence of the involvement of the plant-specific NAC family of tra...

Efficient expulsion of magnetic flux in superconducting radiofrequency cavities for high Q{sub 0} applications

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

Posen, S., E-mail: sposen@fnal.gov; Checchin, M.; Crawford, A. C.

2016-06-07

Even when cooled through its transition temperature in the presence of an external magnetic field, a superconductor can expel nearly all external magnetic flux. This paper presents an experimental study to identify the parameters that most strongly influence flux trapping in high purity niobium during cooldown. This is critical to the operation of superconducting radiofrequency cavities, in which trapped flux degrades the quality factor and therefore cryogenic efficiency. Flux expulsion was measured on a large survey of 1.3 GHz cavities prepared in various ways. It is shown that both spatial thermal gradient and high temperature treatment are critical to expelling externalmore » magnetic fields, while surface treatment has minimal effect. For the first time, it is shown that a cavity can be converted from poor expulsion behavior to strong expulsion behavior after furnace treatment, resulting in a substantial improvement in quality factor. Microscopic investigations are performed to study the relevant changes in the material from this treatment. Future plans are described to build on this result in order to optimize treatment for future cavities.« less

[Minimal provider volume in total knee replacement : an analysis of the external quality assurance program of North Rhine-Westphalia (QS-NRW)].

PubMed

Kostuj, T; Schulze-Raestrup, U; Noack, M; Buckup, K; Smektala, R

2011-05-01

A minimal provider volume for total knee replacement (TKR) was introduced in 2006. Does this lead to an improvenment in quality or not? The records of treatment in the compulsory external quality assurance program of the Land of North Rhine-Westphalia (QS-NRW) were evaluated. A total of 125,324 comparable records from the QS-NRW program were available to determine the appearance of general and surgical complications. In a logistical regression model the risk factors age, gender, ASA classification, comorbidity and duration were taken into account. A significant reduction could only be shown for pneumonia, thrombotic events and lung embolisms as well as vascular injury. In 2006 and 2007 malpositioning of implants was significantly higher and from 2005 to 2008 the number of fractures rose compared to 2004. Deep infections and reoperations did not change significantly during the whole study period. This evaluation could not show an improvement in quality due to the minimal provider volume. Thus the minimal provider volume should not be taken into account as a main criterion to improve quality. Further outcome studies and creating an arthroplasty register in Germany are more useful.

A Public-Private Partnership Develops and Externally Validates a 30-Day Hospital Readmission Risk Prediction Model

PubMed Central

Choudhry, Shahid A.; Li, Jing; Davis, Darcy; Erdmann, Cole; Sikka, Rishi; Sutariya, Bharat

2013-01-01

Introduction: Preventing the occurrence of hospital readmissions is needed to improve quality of care and foster population health across the care continuum. Hospitals are being held accountable for improving transitions of care to avert unnecessary readmissions. Advocate Health Care in Chicago and Cerner (ACC) collaborated to develop all-cause, 30-day hospital readmission risk prediction models to identify patients that need interventional resources. Ideally, prediction models should encompass several qualities: they should have high predictive ability; use reliable and clinically relevant data; use vigorous performance metrics to assess the models; be validated in populations where they are applied; and be scalable in heterogeneous populations. However, a systematic review of prediction models for hospital readmission risk determined that most performed poorly (average C-statistic of 0.66) and efforts to improve their performance are needed for widespread usage. Methods: The ACC team incorporated electronic health record data, utilized a mixed-method approach to evaluate risk factors, and externally validated their prediction models for generalizability. Inclusion and exclusion criteria were applied on the patient cohort and then split for derivation and internal validation. Stepwise logistic regression was performed to develop two predictive models: one for admission and one for discharge. The prediction models were assessed for discrimination ability, calibration, overall performance, and then externally validated. Results: The ACC Admission and Discharge Models demonstrated modest discrimination ability during derivation, internal and external validation post-recalibration (C-statistic of 0.76 and 0.78, respectively), and reasonable model fit during external validation for utility in heterogeneous populations. Conclusions: The ACC Admission and Discharge Models embody the design qualities of ideal prediction models. The ACC plans to continue its partnership to further improve and develop valuable clinical models. PMID:24224068

A policy analysis of the introduction and dissemination of external peer review (visitatie) as a means of professional self-regulation amongst medical specialists in The Netherlands in the period 1985-2000.

PubMed

Lombarts, M J; Klazinga, N S

2001-12-01

By examining the introduction and dissemination of external peer review through site-visits (visitatie) amongst Dutch medical specialists, this paper sets out to deepen our insight into the dynamics of professional self-regulation and health care policy making. We explore how visitatie has been used in the political process between medical specialists and the state, serving as a strategy in protecting the autonomy of physicians. In the late eighties and early nineties, factors both internal as well as external to the medical profession all together determined the start and spread of visitatie. The conflict between state and doctors over the specialists' income, the introduction of the market oriented policies, new visions on quality assurance, the debate on the future of medical specialistic care and a new legal framework on quality assurance, challenged the medical community to find ways to reconfirm the public's trust in the self-regulating mechanism of the profession. One answer is found in carrying out 300-400 visitaties annually. During the past years, many stakeholders have perceived visitatie as a credible instrument in assuring quality patient care. The dynamics of professionalization and measurable impact of visitatie will determine whether or not it is here to stay.

Increasing the marketability and recognition of provider network joint ventures.

PubMed

Sjobeck, S J

1998-08-01

Physicians have been developing provider network joint ventures to market their services jointly to managed care plans, employers, and other purchasers. Over the past few years, external market factors have produced a growing impact on these joint ventures. These external market factors include the Federal government's revised antitrust guidelines, National Committee for Quality Assurance activities, and state and Federal consumer protection laws. Simply responding to these forces may not increase a provider network's marketability unless the network can demonstrate its value in the terms and measurements accepted by the consumer, managed care plans, and provider networks. By doing so, a provider network can not only increase its marketability, but also increase its recognition in the market, improve its competitive advantage, and enhance its return on investment.

Public reporting and the quality of care of German nursing homes.

PubMed

Herr, Annika; Nguyen, Thu-Van; Schmitz, Hendrik

2016-10-01

Since 2009, German nursing homes have been evaluated regularly by an external institution with quality report cards published online. We follow recent debates and argue that most of the information in the report cards does not reliably measure quality of care. However, a subset of up to seven measures does. Do these measures that reflect "risk factors" improve over time? Using a sample of more than 3000 German nursing homes with information on two waves, we assume that the introduction of public reporting is an exogenous institutional change and apply before-after-estimations to obtain estimates for the relation between public reporting and quality. We find a significant improvement of the identified risk factors. Also, the two employed outcome quality indicators improve significantly. The improvements are driven by nursing homes with low quality in the first evaluation. To the extent that this can be interpreted as evidence that public reporting positively affects the (reported) quality in nursing homes, policy makers should carefully choose indicators reflecting care-sensitive quality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Endorsing good quality assurance practices in molecular pathology: risks and recommendations for diagnostic laboratories and external quality assessment providers.

PubMed

Tembuyser, Lien; Dequeker, Elisabeth M C

2016-01-01

Quality assurance is an indispensable element in a molecular diagnostic laboratory. The ultimate goal is to warrant patient safety. Several risks that can compromise high quality procedures are at stake, from sample collection to the test performed by the laboratory, the reporting of test results to clinicians, and the organization of effective external quality assessment schemes. Quality assurance should therefore be safeguarded at each level and should imply a holistic multidisciplinary approach. This review aims to provide an overview of good quality assurance practices and discusses certain risks and recommendations to promote and improve quality assurance for both diagnostic laboratories and for external quality assessment providers. The number of molecular targets is continuously rising, and new technologies are evolving. As this poses challenges for clinical implementation and increases the demand for external quality assessment, the formation of an international association for improving quality assurance in molecular pathology is called for.

Adjuvant radiotherapy for stage I endometrial cancer.

PubMed

Kong, A; Johnson, N; Cornes, P; Simera, I; Collingwood, M; Williams, C; Kitchener, H

2007-04-18

The role of adjuvant radiotherapy (both pelvic external beam radiotherapy and vaginal intracavity brachytherapy) in stage I endometrial cancer following total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO) remains unclear. To assess the efficacy of adjuvant radiotherapy following surgery for stage I endometrial cancer. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CancerLit, Physician Data Query (PDQ) of National Cancer Institute. Handsearching was also carried out where appropriate. Randomised controlled trials (RCTs) which compared adjuvant radiotherapy versus no radiotherapy following surgery for patients with stage I endometrial cancer were included. Quality of the studies was assessed and data collected using a predefined data collection form. The primary endpoint was overall survival. Secondary endpoints were locoregional recurrence, distant recurrence and endometrial cancer death. Data on quality of life (QOL) and morbidity were also collected. A meta-analysis on included trials was performed using the Cochrane Collaboration Review Manager Software 4.2. The meta-analysis was performed on four trials (1770 patients). The addition of pelvic external beam radiotherapy to surgery reduced locoregional recurrence, a relative risk (RR) of 0.28 (95% confidence interval (CI) 0.17 to 0.44, p < 0.00001), which is a 72% reduction in the risk of pelvic relapse (95% CI 56% to 83%) and an absolute risk reduction of 6% (95% CI of 4 to 8%). The number needed to treat (NNT) to prevent one locoregional recurrence is 16.7 patients (95% CI 12.5 to 25). The reduction in the risk of locoregional recurrence did not translate into either a reduction in the risk of distant recurrence or death from all causes or endometrial cancer death. A subgroup analysis of women with multiple high risk factors (including stage 1c and grade 3) showed a trend toward the reduction in the risk of death from all causes and endometrial cancer death in patients who underwent adjuvant external beam radiotherapy. Patients with stage I endometrial carcinoma have different risks of local and distant recurrence depending on the presence of risk factors including stage 1c, grade 3, lymphovascular space invasion and age. Though external beam pelvic radiotherapy reduced locoregional recurrence by 72%, there is no evidence to suggest that it reduced the risk of death. In patients with multiple high risk factors, including stage 1c and grade 3, there was a trend towards a survival benefit and adjuvant external beam radiotherapy may be justified. For patients with only one risk factor, grade 3 or stage 1c, no definite conclusion can be made and data from ongoing studies ( ASTEC; Lukka) are awaited. External beam radiotherapy carries a risk of toxicity and should be avoided in stage 1 endometrial cancer patients with no high risk factors.

Lack of grading agreement among international hemostasis external quality assessment programs

PubMed Central

Olson, John D.; Jennings, Ian; Meijer, Piet; Bon, Chantal; Bonar, Roslyn; Favaloro, Emmanuel J.; Higgins, Russell A.; Keeney, Michael; Mammen, Joy; Marlar, Richard A.; Meley, Roland; Nair, Sukesh C.; Nichols, William L.; Raby, Anne; Reverter, Joan C.; Srivastava, Alok; Walker, Isobel

2018-01-01

Laboratory quality programs rely on internal quality control and external quality assessment (EQA). EQA programs provide unknown specimens for the laboratory to test. The laboratory's result is compared with other (peer) laboratories performing the same test. EQA programs assign target values using a variety of methods statistical tools and performance assessment of ‘pass’ or ‘fail’ is made. EQA provider members of the international organization, external quality assurance in thrombosis and hemostasis, took part in a study to compare outcome of performance analysis using the same data set of laboratory results. Eleven EQA organizations using eight different analytical approaches participated. Data for a normal and prolonged activated partial thromboplastin time (aPTT) and a normal and reduced factor VIII (FVIII) from 218 laboratories were sent to the EQA providers who analyzed the data set using their method of evaluation for aPTT and FVIII, determining the performance for each laboratory record in the data set. Providers also summarized their statistical approach to assignment of target values and laboratory performance. Each laboratory record in the data set was graded pass/fail by all EQA providers for each of the four analytes. There was a lack of agreement of pass/fail grading among EQA programs. Discordance in the grading was 17.9 and 11% of normal and prolonged aPTT results, respectively, and 20.2 and 17.4% of normal and reduced FVIII results, respectively. All EQA programs in this study employed statistical methods compliant with the International Standardization Organization (ISO), ISO 13528, yet the evaluation of laboratory results for all four analytes showed remarkable grading discordance. PMID:29232255

Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review.

PubMed

Smith, Christopher M; Lim Choi Keung, Sarah N; Khan, Mohammed O; Arvanitis, Theodoros N; Fothergill, Rachael; Hartley-Sharpe, Christopher; Wilson, Mark H; Perkins, Gavin D

2017-10-01

Public access defibrillation initiatives make automated external defibrillators available to the public. This facilitates earlier defibrillation of out-of-hospital cardiac arrest victims and could save many lives. It is currently only used for a minority of cases. The aim of this systematic review was to identify barriers and facilitators to public access defibrillation. A comprehensive literature review was undertaken defining formal search terms for a systematic review of the literature in March 2017. Studies were included if they considered reasons affecting the likelihood of public access defibrillation and presented original data. An electronic search strategy was devised searching MEDLINE and EMBASE, supplemented by bibliography and related-article searches. Given the low-quality and observational nature of the majority of articles, a narrative review was performed. Sixty-four articles were identified in the initial literature search. An additional four unique articles were identified from the electronic search strategies. The following themes were identified related to public access defibrillation: knowledge and awareness; willingness to use; acquisition and maintenance; availability and accessibility; training issues; registration and regulation; medicolegal issues; emergency medical services dispatch-assisted use of automated external defibrillators; automated external defibrillator-locator systems; demographic factors; other behavioural factors. In conclusion, several barriers and facilitators to public access defibrillation deployment were identified. However, the evidence is of very low quality and there is not enough information to inform changes in practice. This is an area in urgent need of further high-quality research if public access defibrillation is to be increased and more lives saved. PROSPERO registration number CRD42016035543. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

An evaluation of data-driven motion estimation in comparison to the usage of external-surrogates in cardiac SPECT imaging

PubMed Central

Mukherjee, Joyeeta Mitra; Hutton, Brian F; Johnson, Karen L; Pretorius, P Hendrik; King, Michael A

2014-01-01

Motion estimation methods in single photon emission computed tomography (SPECT) can be classified into methods which depend on just the emission data (data-driven), or those that use some other source of information such as an external surrogate. The surrogate-based methods estimate the motion exhibited externally which may not correlate exactly with the movement of organs inside the body. The accuracy of data-driven strategies on the other hand is affected by the type and timing of motion occurrence during acquisition, the source distribution, and various degrading factors such as attenuation, scatter, and system spatial resolution. The goal of this paper is to investigate the performance of two data-driven motion estimation schemes based on the rigid-body registration of projections of motion-transformed source distributions to the acquired projection data for cardiac SPECT studies. Comparison is also made of six intensity based registration metrics to an external surrogate-based method. In the data-driven schemes, a partially reconstructed heart is used as the initial source distribution. The partially-reconstructed heart has inaccuracies due to limited angle artifacts resulting from using only a part of the SPECT projections acquired while the patient maintained the same pose. The performance of different cost functions in quantifying consistency with the SPECT projection data in the data-driven schemes was compared for clinically realistic patient motion occurring as discrete pose changes, one or two times during acquisition. The six intensity-based metrics studied were mean-squared difference (MSD), mutual information (MI), normalized mutual information (NMI), pattern intensity (PI), normalized cross-correlation (NCC) and entropy of the difference (EDI). Quantitative and qualitative analysis of the performance is reported using Monte-Carlo simulations of a realistic heart phantom including degradation factors such as attenuation, scatter and system spatial resolution. Further the visual appearance of motion-corrected images using data-driven motion estimates was compared to that obtained using the external motion-tracking system in patient studies. Pattern intensity and normalized mutual information cost functions were observed to have the best performance in terms of lowest average position error and stability with degradation of image quality of the partial reconstruction in simulations. In all patients, the visual quality of PI-based estimation was either significantly better or comparable to NMI-based estimation. Best visual quality was obtained with PI-based estimation in 1 of the 5 patient studies, and with external-surrogate based correction in 3 out of 5 patients. In the remaining patient study there was little motion and all methods yielded similar visual image quality. PMID:24107647

External exposome and allergic respiratory and skin diseases.

PubMed

Cecchi, Lorenzo; D'Amato, Gennaro; Annesi-Maesano, Isabella

2018-03-01

Allergies are complex diseases that result from interactions between multiple genetic and environmental factors. However, the increase in allergies observed in the past decades is explained exclusively by environmental changes occurring in the same period. Presently, the exposome, the totality of specific and nonspecific external environmental exposures (external exposome) to which a subject is exposed from preconception onward and their consequences at the organ and cell levels (internal exposome), is being considered to explain the inception, development, and exacerbations of allergic diseases. Among the best-studied environmental factors of the specific external exposome, indoor and outdoor aeroallergens and air pollutants play a key role in the etiopathogenesis of the inflammatory response to allergens and in clinical manifestations of allergic disease. Climate change, urbanization, and loss of biodiversity affect sources, emissions, and concentrations of main aeroallergens and air pollutants and are among the most critical challenges facing the health and quality of life of the still increasing number of allergic patients today and in the coming decades. Thunderstorm-related asthma is a dramatic example of the effects of combined environmental factors and an in vivo model for understanding the mechanisms at work in respiratory allergy. Environment- or lifestyle-driven aberrancies in the gut and skin microbiome composition represent key mediators of allergic diseases. A better knowledge of the effect of the external exposome on allergy development is crucial for urging patients, health professionals, and policymakers to take actions to mitigate the effect of environmental changes and to adapt to them. Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Early cumulative risk predicts externalizing behavior at age 10: The mediating role of adverse parenting.

PubMed

Gach, Emily J; Ip, Ka I; Sameroff, Arnold J; Olson, Sheryl L

2018-02-01

Multiple environmental risk factors in early childhood predict a broad range of adverse developmental outcomes. However, most prior longitudinal research has not illuminated explanatory mechanisms. Our main goals were to examine predictive associations between cumulative ecological risk factors in early childhood and children's later externalizing problems and to determine whether these associations were explained by variations in parenting quality. Participants were 241 children (118 girls) at risk for school-age conduct problems and their parents and teachers. Children were approximately 3 years old at Time 1 (T1) and 10 years old at Time 2 (T2). Reports of contextual risk at T1 were used to develop a cumulative risk index consisting of 6 singular risk variables from 3 ecological levels: social resources (low income; social isolation), family resources (marital aggression; poor total family functioning), and maternal resources (single parent status; poor maternal mental health). At T1, parenting variables were measured (corporal punishment, warm responsiveness, maternal efficacy, and negative perceptions of child behavior). At T2, mothers, fathers, and teachers reported child externalizing problems. Johnson's relative weight analysis revealed that the cumulative risk index was a more powerful predictor of age 10 years externalizing behavior than any of the singular contextual risk variables. Adverse parenting mediated the effects of cumulative risk on later child externalizing problems. Our findings have significant implications for understanding long-term effects of multiple contextual risk factors present in early childhood and for the implementation of positive parenting interventions early on. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Predictors of Trajectories of Epilepsy-Specific Quality of Life among Children Newly Diagnosed with Epilepsy

PubMed Central

Ramsey, Rachelle R.; Loiselle, Kristin; Rausch, Joseph R.; Harrison, Jordan; Modi, Avani C.

2016-01-01

Objective To identify two year trajectories of epilepsy-specific health-related quality of life (HRQOL) among children newly diagnosed with epilepsy and to evaluate the predictive value of a comprehensive set of medical, psychosocial, and family factors. Methods Ninety-four children with epilepsy (8.14 ± 2.37 years of age and 63% male) and their caregivers participated in this study. Caregivers completed the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) and measures of psychological and family functioning at one month post-diagnosis. The QOLCE was also given at eight additional time points during the subsequent two years as a part of a large observational study in children with epilepsy. Adherence data was collected via MEMS TrackCaps and medical information was collected through chart review. Results Unique trajectories were identified for the overall QOLCE scale, as well as the subscales. Most trajectory models for the QOLCE subscales contained at least one at-risk trajectory for children, indicating that there is a subgroup of children experiencing poor long-term HRQOL. Health-related quality of life trajectories remained predominantly stable during the two year period following treatment initiation. Number of AEDs, Internalizing Problems, and Externalizing Problems emerged as the most consistent predictors across the HRQOL domains. Significance Medical and psychosocial interventions, such as cognitive-behavioral strategies, should target modifiable factors (e.g., internalizing symptoms, externalizing symptoms, number of AEDs trialed) shortly after diagnosis to improve HRQOL for children with epilepsy over the course of their disease. PMID:26974247

Quality assessment tools add value.

PubMed

Paul, L

1996-10-01

The rapid evolution of the health care marketplace can be expected to continue as we move closer to the 21st Century. Externally-imposed pressures for cost reduction will increasingly be accompanied by pressure within health care organizations as risk-sharing reimbursement arrangements become more commonplace. Competitive advantage will be available to those organizations that can demonstrate objective value as defined by the cost-quality equation. The tools an organization chooses to perform quality assessment will be an important factor in its ability to demonstrate such value. Traditional quality assurance will in all likelihood continue, but the extent to which quality improvement activities are adopted by the culture of an organization may determine its ability to provide objective evidence of better health status outcomes.

Associations of Perceived Sibling and Parent-Child Relationship Quality with Internalizing and Externalizing Problems: Comparing Indian and Dutch Early Adolescents

ERIC Educational Resources Information Center

Buist, Kirsten L.; Verhoeven, Marjolein; Hoksbergen, René; ter Laak, Jan; Watve, Sujala; Paranjpe, Analpa

2017-01-01

The aims of the present study were (a) to examine whether Dutch and Indian early adolescents differ concerning sibling and parent-child relationship quality and externalizing and internalizing problems, and (b) to compare the associations between sibling and parent-child relationship quality and externalizing and internalizing problems for Indian…

The Influence of Strategy and External Quality Audit on University Performance: An Australian Perspective

ERIC Educational Resources Information Center

Shah, Mahsood; Nair, Sid

2011-01-01

External quality audits have been introduced in many parts of the world including Asia Pacific, Asia, Africa, Europe, and the Middle East. While external quality audits have been introduced for more than a decade in some countries like New Zealand, the United Kingdom (UK), Denmark, and Sweden, there is limited research on the extent to which such…

Systems Perspectives on External Quality Assurance: Implications for Micro-States

ERIC Educational Resources Information Center

Houston, Don; Maniku, Ahmed Ali

2005-01-01

Quality assurance in higher education is a mess: the "problem" of quality is embedded in complex sets of interacting issues that are of concern to many and varied stakeholders. Developing higher education systems that have responded to issues of quality through a "best practice" model of external quality assurance has produced…

Factors influencing the quality of intimate relationships six months after delivery--first-time parents' own views and coping strategies.

PubMed

Ahlborg, Tone; Strandmark, Margaretha

2006-09-01

The aim of this study was to describe and analyze first-time parents' experiences of factors that affect the quality of their intimate relationship and the way they cope with their situation six months after delivery. The method used was inductive qualitative content analysis of two open questions in a larger questionnaire. The data is based on 535 respondents' statements. The factors affecting the quality of the intimate relationship were available or missing and could be classified into four categories. 1. 'Coping by adjustment to parental role', e.g., mutual support as new parents, 2. 'The couple's 'intimacy', i.e., togetherness and love, 3. 'Coping by communication', i.e., verbal and non-verbal mutual confirmation, and 4. 'Coping with external conditions', e.g., by seeking social support. The results are described in a model, which could constitute a basis for the promotion of health in family health care, with the aim, if possible, of preventing unnecessary separations/divorces after couples become parents.

Perceptions of drinking water quality and risk and its effect on behaviour: a cross-national study.

PubMed

Doria, Miguel de França; Pidgeon, Nick; Hunter, Paul R

2009-10-15

There is a growing effort to provide drinking water that has the trust of consumers, but the processes underlying the perception of drinking water quality and risks are still not fully understood. This paper intends to explore the factors involved in public perception of the quality and risks of drinking water. This purpose was addressed with a cross-national mixed-method approach, based on quantitative (survey) and qualitative (focus groups) data collected in the UK and Portugal. The data were analysed using several methods, including structural equation models and generalised linear models. Results suggest that perceptions of water quality and risk result from a complex interaction of diverse factors. The estimation of water quality is mostly influenced by satisfaction with organoleptic properties (especially flavour), risk perception, contextual cues, and perceptions of chemicals (lead, chlorine, and hardness). Risk perception is influenced by organoleptics, perceived water chemicals, external information, past health problems, and trust in water suppliers, among other factors. The use of tap and bottled water to drink was relatively well explained by regression analysis. Several cross-national differences were found and the implications are discussed. Suggestions for future research are provided.

Physical Environmental Adversity and the Protective Role of Maternal Monitoring in Relation to Early Child Conduct Problems

ERIC Educational Resources Information Center

Supplee, Lauren H.; Unikel, Emily B.; Shaw, Daniel S.

2007-01-01

Research on the development of externalizing behaviors during early childhood has focused on child and parenting factors. Fewer studies have investigated effects of aversive features of the micro-level physical environment, such as overcrowding and chaos in the home, and the macro-level environment, such as neighborhood quality. This study extends…

A Special Kind of Ambition: The Role of Personality in The Retention of Academically Elite Teachers

ERIC Educational Resources Information Center

Jones, Brady K.

2018-01-01

Background: Creating greater stability in the teacher labor force and improving teacher quality is an important education policy priority in the United States. While there is a robust literature on the external, environmental reasons teachers stay in or leave the occupation, little is known about the role internal, person-level factors play in…

Design and analysis of a radio frequency extractor in an S-band relativistic klystron amplifier.

PubMed

Zhang, Zehai; Zhang, Jun; Shu, Ting; Qi, Zumin

2012-09-01

A radio frequency (RF) extractor converts the energy of a strongly modulated intense relativistic electron beam (IREB) into the energy of high power microwave in relativistic klystron amplifier (RKA). In the aim of efficiently extracting the energy of the modulated IREB, a RF extractor with all round coupling structure is proposed. Due to the all round structure, the operating transverse magnetic mode can be established easily and its resonant property can be investigated with an approach of group delay time. Furthermore, the external quality factor can be low enough. The design and analysis of the extractor applied in an S-band RKA are carried out, and the performance of the extractor is validated with three-dimensional (3D) particle-in-cell simulations. The extraction efficiency reaches 27% in the simulation with a totally 3D model of the whole RKA. The primary experiments are also carried out and the results show that the RF extractor with the external quality factor of 7.9 extracted 22% of the beam power and transformed it into the high power microwave. Better results are expected after the parasitic mode between the input and middle cavities is suppressed.

Design and analysis of a radio frequency extractor in an S-band relativistic klystron amplifier

NASA Astrophysics Data System (ADS)

Zhang, Zehai; Zhang, Jun; Shu, Ting; Qi, Zumin

2012-09-01

A radio frequency (RF) extractor converts the energy of a strongly modulated intense relativistic electron beam (IREB) into the energy of high power microwave in relativistic klystron amplifier (RKA). In the aim of efficiently extracting the energy of the modulated IREB, a RF extractor with all round coupling structure is proposed. Due to the all round structure, the operating transverse magnetic mode can be established easily and its resonant property can be investigated with an approach of group delay time. Furthermore, the external quality factor can be low enough. The design and analysis of the extractor applied in an S-band RKA are carried out, and the performance of the extractor is validated with three-dimensional (3D) particle-in-cell simulations. The extraction efficiency reaches 27% in the simulation with a totally 3D model of the whole RKA. The primary experiments are also carried out and the results show that the RF extractor with the external quality factor of 7.9 extracted 22% of the beam power and transformed it into the high power microwave. Better results are expected after the parasitic mode between the input and middle cavities is suppressed.

[Quality of life of primary care patients in Rio de Janeiro and São Paulo, Brasil: associations with stressful life events and mental health].

PubMed

Portugal, Flávia Batista; Campos, Mônica Rodrigues; Gonçalves, Daniel Almeida; Mari, Jair de Jesus; Fortes, Sandra Lúcia Correia Lima

2016-02-01

Quality of life (QoL) is a subjective construct, which can be negatively associated with factors such as mental disorders and stressful life events (SLEs). This article seeks to identify the association between socioeconomic and demographic variables, common mental disorders, symptoms suggestive of depression and anxiety, SLEs with QoL in patients attended in Primary Care (PC). It is a transversal study, conducted with 1,466 patients attended in PC centers in the cities of São Paulo and Rio de Janeiro in 2009 and 2010. Bivariate analysis was performed using the T-test and four multiple linear regressions for each QoL domain. The scores for the physical, psychological, social relations and environment domains were, respectively, 64.7; 64.2; 68.5 and 49.1. By means of multivariate analysis, associations of the physical domain were found with health problems and discrimination; of the psychological domain with discrimination; of social relations with financial/structural problems; of external causes and health problems; and of the environment with financial/structural problems, external causes and discrimination. Mental health variables, health problems and financial/structural problems were the factors negatively associated with QoL.

Origin of the Livelihood Dilemma for Local Fisherman in Poyang Lake Wetland: a Ramsar Site in China

NASA Astrophysics Data System (ADS)

Xie, Dongming; Zhou, Guohong; Zhou, Yangming; Chen, Yayun; Jia, Junsong

2018-01-01

Poyang Lake is one of the first Ramsar sites in China; it has plenty of natural resources that support the survival of local residents. However, local fisherman have encountered a livelihood dilemma, as natural resources have declined, obviously because of the change in the ecological environment and anthropic disturbance. We seek to explain what lead to livelihood dilemma to the local fishermen, so semi-structured interviews, questionnaire surveys, Geographic information system (GIS), Remote sensing (RS), Global position system (GPS), and department data were used to analyze the internal and external factors for these dilemmas. The results explained the external factors including the exhaustion of natural resources, the drying up of wetlands, landscape fragmentation, water contamination, and disturbance through anthropic behavior; the internal factors included the ageing of fishermen, poor cultural quality, conservative ideas, and unreasonable fishing practices. Eco-compensation, industry transformation, and capacity innovation may help to resolve livelihood dilemmas for the local fisherman of the Poyang Lake wetlands.

Dimensional structure of DSM-5 posttraumatic stress disorder symptoms: results from the National Health and Resilience in Veterans Study.

PubMed

Tsai, Jack; Harpaz-Rotem, Ilan; Armour, Cherie; Southwick, Steven M; Krystal, John H; Pietrzak, Robert H

2015-05-01

To evaluate the prevalence of DSM-5 posttraumatic stress disorder (PTSD) and factor structure of PTSD symptomatology in a nationally representative sample of US veterans and examine how PTSD symptom clusters are related to depression, anxiety, suicidal ideation, hostility, physical and mental health-related functioning, and quality of life. Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative survey of 1,484 US veterans conducted from September through October 2013. Confirmatory factor analyses were conducted to evaluate the factor structure of PTSD symptoms, and structural equation models were constructed to examine the association between PTSD symptom clusters and external correlates. 12.0% of veterans screened positive for lifetime PTSD and 5.2% for past-month PTSD. A 5-factor dysphoric arousal model and a newly proposed 6-factor model both fit the data significantly better than the 4-factor model of DSM-5. The 6-factor model fit the data best in the full sample, as well as in subsamples of female veterans and veterans with lifetime PTSD. The emotional numbing symptom cluster was more strongly related to depression (P < .001) and worse mental health-related functioning (P < .001) than other symptom clusters, while the externalizing behavior symptom cluster was more strongly related to hostility (P < .001). A total of 5.2% of US veterans screened positive for past-month DSM-5 PTSD. A 6-factor model of DSM-5 PTSD symptoms, which builds on extant models and includes a sixth externalizing behavior factor, provides the best dimensional representation of DSM-5 PTSD symptom clusters and demonstrates validity in assessing health outcomes of interest in this population. © Copyright 2015 Physicians Postgraduate Press, Inc.

External Quality Control for Dried Blood Spot Based C-reactive Protein Assay: Experience from the Indonesia Family Life Survey and the Longitudinal Aging Study in India

PubMed Central

Hu, Peifeng; Herningtyas, Elizabeth H.; Kale, Varsha; Crimmins, Eileen M.; Risbud, Arun R.; McCreath, Heather; Lee, Jinkook; Strauss, John; O’Brien, Jennifer C.; Bloom, David E.; Seeman, Teresa E.

2015-01-01

Measurement of C-reactive protein, a marker of inflammation, in dried blood spots has been increasingly incorporated in community-based social surveys internationally. Although the dried blood spot based CRP assay protocol has been validated in the United States, it remains unclear whether laboratories in other less developed countries can generate C-reactive protein results of similar quality. We therefore conducted external quality monitoring for dried blood spot based C-reactive protein measurement for the Indonesia Family Life Survey and the Longitudinal Aging Study in India. Our results show that dried blood spot based C-reactive protein results in these two countries have excellent and consistent correlations with serum-based values and dried blood spot based results from the reference laboratory in the United States. Even though the results from duplicate samples may have fluctuations in absolute values over time, the relative order of C-reactive protein levels remains similar and the estimates are reasonably precise for population-based studies that investigate the association between socioeconomic factors and health. PMID:25879265

75 FR 16459 - Draft Document Related to the Review of the National Ambient Air Quality Standards for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-01

... Review of the National Ambient Air Quality Standards for Particulate Matter AGENCY: Environmental... Review of the Particulate Matter National Ambient Air Quality Standards--First External Review Draft (75... Particulate Matter National Ambient Air Quality Standards--First External Review Draft (March 2010), please...

CMOS compatible fabrication process of MEMS resonator for timing reference and sensing application

NASA Astrophysics Data System (ADS)

Huynh, Duc H.; Nguyen, Phuong D.; Nguyen, Thanh C.; Skafidas, Stan; Evans, Robin

2015-12-01

Frequency reference and timing control devices are ubiquitous in electronic applications. There is at least one resonator required for each of this device. Currently electromechanical resonators such as crystal resonator, ceramic resonator are the ultimate choices. This tendency will probably keep going for many more years. However, current market demands for small size, low power consumption, cheap and reliable products, has divulged many limitations of this type of resonators. They cannot be integrated into standard CMOS (Complement metaloxide- semiconductor) IC (Integrated Circuit) due to material and fabrication process incompatibility. Currently, these devices are off-chip and they require external circuitries to interface with the ICs. This configuration significantly increases the overall size and cost of the entire electronic system. In addition, extra external connection, especially at high frequency, will potentially create negative impacts on the performance of the entire system due to signal degradation and parasitic effects. Furthermore, due to off-chip packaging nature, these devices are quite expensive, particularly for high frequency and high quality factor devices. To address these issues, researchers have been intensively studying on an alternative for type of resonator by utilizing the new emerging MEMS (Micro-electro-mechanical systems) technology. Recent progress in this field has demonstrated a MEMS resonator with resonant frequency of 2.97 GHz and quality factor (measured in vacuum) of 42900. Despite this great achievement, this prototype is still far from being fully integrated into CMOS system due to incompatibility in fabrication process and its high series motional impedance. On the other hand, fully integrated MEMS resonator had been demonstrated but at lower frequency and quality factor. We propose a design and fabrication process for a low cost, high frequency and a high quality MEMS resonator, which can be integrated into a standard CMOS IC. This device is expected to operate in hundreds of Mhz frequency range; quality factor surpasses 10000 and series motional impedance low enough that could be matching into conventional system without enormous effort. This MEMS resonator can be used in the design of many blocks in wireless and RF (Radio Frequency) systems such as low phase noise oscillator, band pass filter, power amplifier and in many sensing application.

Thoughts on Internal and External Quality Assurance

ERIC Educational Resources Information Center

Zhang, Jianxin

2012-01-01

Quality assurance of higher education is made up of two parts: internal quality assurance (IQA) and external quality assurance (EQA). Both belong to a union of the coexistence and balance of yin and yang. But in reality there exists a paradox of "confusion of quality assurance (QA) subject consciousness, singularity of social QA and lack of QA…

[An information system for injuries from external causes (SILEX): a successful project in El Salvador].

PubMed

Salinas, Oscar; de Cosío, Gerardo; Clavel-Arcas, Carme; Montoya, Jeannette; Serpas, Mario; Morán de García, Silvia; Concha-Eastman, Alberto

2008-12-01

This article examines the stages in developing an information system for injuries from external causes (Sistema de Información de Lesiones de Causa Externa-SILEX), as well as its limitations and achievements. SILEX is a Web-based application for collection, quality control, presentation, and analysis of data available from the hospital system for surveillance of injuries from external causes created by Ministry of Health of El Salvador with data from the hospital emergency services. This system maintains comprehensive information on the injured person-type of injury, intention, injury site, activity being performed at the time of injury, risk factors, etc.-in the form of tables, graphs, and maps, which streamlines the development of intervention plans and prevention initiatives for these types of injuries in El Salvador. This experience is an example of what can be done to close the information gap on injuries by external causes in the Region of the Americas.

Detecting, reporting, and analysis of priority diseases for routine public health surveillance in Liberia.

PubMed

Frimpong, Joseph Asamoah; Amo-Addae, Maame Pokuah; Adewuyi, Peter Adebayo; Hall, Casey Daniel; Park, Meeyoung Mattie; Nagbe, Thomas Knue

2017-01-01

Public health officials depend on timely, complete, and accurate surveillance data for decision making. The quality of data generated from surveillance is highly dependent on external and internal factors which may either impede or enhance surveillance activities. One way of identifying challenges affecting the quality of data generated is to conduct a data quality audit. This case study, based on an audit conducted by residents of the Liberia Frontline Field Epidemiology Training Program, was designed to be a classroom simulation of a data quality audit in a health facility. It is suited to enforce theoretical lectures in surveillance data quality and auditing. The target group is public health trainees, who should be able to complete this exercise in approximately 2 hours and 30 minutes.

Internal and External Factors That Support Children's Minority First Language and English.

PubMed

Pham, Giang; Tipton, Timothy

2018-05-22

Sequential bilingual children in the United States often speak 2 languages that have different social statuses (minority-majority) and separate contexts for learning (home-school). Thus, distinct factors may support the development of each language. This study examined which child internal and external factors were related to vocabulary skills in a minority language versus English. Participants included 69 children, aged 5-8 years, who lived in Southern California, spoke Vietnamese as the home language, and received school instruction in English. All participants had at least 1 foreign-born parent, and most mothers reported limited English proficiency. Parents completed a telephone survey, and children completed measures of receptive and expressive vocabulary in each language. Using correlations and stepwise regression, we examined predictors of vocabulary skills in each language that were internal to the child (age, gender, analytical reasoning, phonological memory) or that pertained to the surrounding environment (cumulative exposure, quantity and quality of input/output). Vietnamese vocabulary outcomes were related to multiple external factors, of which input and enrichment activities were the best predictors. In contrast, English vocabulary outcomes were related to internal factors, of which age and phonological memory were the best predictors. Parental use of Vietnamese contributed to children's Vietnamese vocabulary outcomes but was not related to children's English vocabulary outcomes. Vietnamese exposure does not hinder English development. Children from immigrant families are learning English with or without familial support. Rich and frequent exposure and opportunities for practice are essential for the continued development of a minority first language.

External quality assessment for EGFR mutations in Italy: improvements in performances over the time.

PubMed

Normanno, Nicola; Fenizia, Francesca; Castiglione, Francesca; Barberis, Massimo; Taddei, Gian Luigi; Truini, Mauro; De Rosa, Gaetano; Pinto, Carmine; Marchetti, Antonio

2017-01-01

External quality assessment (EQA) schemes are essential procedures to assess the quality level of laboratories performing molecular testing of the epidermal growth factor receptor ( EGFR ) gene in non-small cell lung cancer. The Italian Association of Medical Oncology (AIOM) and the Italian Society of Pathology (SIAPEC-IAP) organise EGFR EQA programmes to ensure that the Italian laboratories achieve the quality standard levels required. Comparing the 2011, 2013 and 2015 EGFR EQA schemes, it was possible to observe improvements in the methodologies used and the outcomes. The use of direct sequencing was reduced from 78.7% in 2011 to only 14.1% in 2015, whereas the use of pyrosequencing and real-time PCR increased. The number of rounds in which centres using direct sequencing failed was significantly higher than the number of rounds that failed using other methods, both when analysing each single scheme and when combining the three EQAs together. In 2011 and 2013, about 29% of the participants failed the first phase of the programmes, compared with the 13% of centres failing in 2015, suggesting that the switch to more sensitive and robust methods could allow to increase the percentage of good performers. Although the molecular analyses are performed with good quality in Italy, the continuous education carried out by AIOM and SIAPEC-IAP remains a fundamental tool to maintain this quality level.

External quality assessment for EGFR mutations in Italy: improvements in performances over the time

PubMed Central

Normanno, Nicola; Fenizia, Francesca; Castiglione, Francesca; Barberis, Massimo; Taddei, Gian Luigi; Truini, Mauro; De Rosa, Gaetano; Pinto, Carmine; Marchetti, Antonio

2017-01-01

External quality assessment (EQA) schemes are essential procedures to assess the quality level of laboratories performing molecular testing of the epidermal growth factor receptor (EGFR) gene in non-small cell lung cancer. The Italian Association of Medical Oncology (AIOM) and the Italian Society of Pathology (SIAPEC-IAP) organise EGFR EQA programmes to ensure that the Italian laboratories achieve the quality standard levels required. Comparing the 2011, 2013 and 2015 EGFR EQA schemes, it was possible to observe improvements in the methodologies used and the outcomes. The use of direct sequencing was reduced from 78.7% in 2011 to only 14.1% in 2015, whereas the use of pyrosequencing and real-time PCR increased. The number of rounds in which centres using direct sequencing failed was significantly higher than the number of rounds that failed using other methods, both when analysing each single scheme and when combining the three EQAs together. In 2011 and 2013, about 29% of the participants failed the first phase of the programmes, compared with the 13% of centres failing in 2015, suggesting that the switch to more sensitive and robust methods could allow to increase the percentage of good performers. Although the molecular analyses are performed with good quality in Italy, the continuous education carried out by AIOM and SIAPEC-IAP remains a fundamental tool to maintain this quality level. PMID:29181190

Critical and systematic evaluation of data for estimating human exposures to 2,4-dichlorophenoxyacetic acid (2,4-D) - quality and generalizability.

PubMed

LaKind, Judy S; Burns, Carol J; Naiman, Daniel Q; O'Mahony, Cian; Vilone, Giulia; Burns, Annette J; Naiman, Joshua S

2017-01-01

The herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) has been commercially available since the 1940's. Despite decades of data on 2,4-D in food, air, soil, and water, as well as in humans, the quality the quality of these data has not been comprehensively evaluated. Using selected elements of the Biomonitoring, Environmental Epidemiology, and Short-lived Chemicals (BEES-C) instrument (temporal variability, avoidance of sample contamination, analyte stability, and urinary methods of matrix adjustment), the quality of 156 publications of environmental- and biomonitoring-based 2,4-D data was examined. Few publications documented steps were taken to avoid sample contamination. Similarly, most studies did not demonstrate the stability of the analyte from sample collection to analysis. Less than half of the biomonitoring publications reported both creatinine-adjusted and unadjusted urine concentrations. The scope and detail of data needed to assess temporal variability and sources of 2,4-D varied widely across the reviewed studies. Exposures to short-lived chemicals such as 2,4-D are impacted by numerous and changing external factors including application practices and formulations. At a minimum, greater transparency in reporting of quality control measures is needed. Perhaps the greatest challenge for the exposure community is the ability to reach consensus on how to address problems specific to short-lived chemical exposures in observational epidemiology investigations. More extensive conversations are needed to advance our understanding of human exposures and enable interpretation of these data to catch up to analytical capabilities. The problems defined in this review remain exquisitely difficult to address for chemicals like 2,4-D, with short and variable environmental and physiological half-lives and with exposures impacted by numerous and changing external factors.

Infancy Parenting and Externalizing Psychopathology from Childhood through Adulthood: Developmental Trends

ERIC Educational Resources Information Center

Lorber, Michael F.; Egeland, Byron

2009-01-01

Developmental models and previous findings suggest that early parenting is more strongly associated with externalizing problems in early childhood than it is in adolescence. In this article, the authors address whether the association of poor-quality infancy parenting and externalizing problems "rebounds" in adulthood. Poor-quality infancy…

Evaluation of Bluetooth communications for the deployment of assisted living technologies in home environments.

PubMed

McGrath, Michael J; Burns, Adrian; Dishongh, Terry

2007-01-01

Using five different commercially available class one and class two Bluetooth dongles a total of seven homes which represented a cross section of typical Irish homes were surveyed to determine the effect of construction methods, house size, sensor placement, host placement, antenna design and RF interference had on the link quality of Bluetooth enabled sensors. The results obtained indicates there is high variability in the link quality which is determined by the quality of the BT radio, placement of the antenna on both the master and slave, the number of walls which must be penetrated and the construction materials used in the wall. The placement of the sensor was the single biggest factor in determining the link quality. The type of construction used in the interior walls has significant influence also. The final factor of significant influence was the type of antenna used on the Bluetooth dongle. The use of an external antenna gave significantly better range performance than an internal antenna.

Users' acceptance and attitude in regarding electronic medical record at central polyclinic of oil industry in Isfahan, Iran.

PubMed

Tavakoli, Nahid; Shahin, Arash; Jahanbakhsh, Maryam; Mokhtari, Habibollah; Rafiei, Maryam

2013-01-01

Simultaneous with the rapid changes in the technology and information systems, hospitals interest in using them. One of the most common systems in hospitals is electronic medical record (EMR) whose one of uses is providing better health care quality via health information technology. Prior to its use, attempts should be put to identifying factors affecting the acceptance, attitude and utilizing of this technology. The current article aimed to study the effective factors of EMR acceptance by technology acceptance model (TAM) at central polyclinic of Oil Industry in Isfahan. This was a practical, descriptive and regression study. The population research were all EMR users at polyclinic of Oil Industry in 2012 and its sampling was simple random with 62 users. The tool of data collection was a research-made questionnaire based on TAM. The validity of questionnaire has been assigned through the strategy of content validity and health information technology experts' views and its reliability by test-retest. The system users have positive attitude toward using EMR (56.6%). Also, users are not very satisfied with effective external (38.14%) and behavioral factors (47.8%) upon using the system. Perceived ease-of-use (PEU) and perceived usefulness (PU) were at a good level. Lack of relative satisfaction with using of EMR derives from factors such as appearance, screen, data and information quality and terminology. In this study, it is suggested to improve the system and the efficiency of the users through software' external factors development. So that PEU and users' attitude to be changed and moved in positive manner.

External quality mechanisms for health care: summary of the ExPeRT project on visitatie, accreditation, EFQM and ISO assessment in European Union countries. External Peer Review Techniques. European Foundation for Quality Management. International Organization for Standardization.

PubMed

Shaw, C D

2000-06-01

This paper is a summary of the operation, findings and conclusions of a European Union project on external peer review techniques, termed 'ExPeRT', to research the scope, mechanisms and use of external quality mechanisms in the improvement of health care. Many of the themes outlined are described in detail in other papers that have been prepared specifically for this issue of The International Journal for Quality in Health Care. Although the emphasis of this project and of this issue of the Journal is on Europe, the conclusions are more widely relevant.

Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer

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

Morton, Gerard C., E-mail: gerard.morton@sunnybrook.ca; Loblaw, D. Andrew; Chung, Hans

Purpose: To investigate the change in health-related quality of life for men after high-dose-rate brachytherapy and external beam radiotherapy for prostate cancer and the factors associated with this change. Methods and Materials: Eligible patients had clinically localized intermediate-risk prostate cancer. The patients received high-dose-rate brachytherapy as a single 15-Gy implant, followed by external beam radiotherapy to 37.5 Gy in 15 fractions. The patients were monitored prospectively for toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and health-related quality of life (Expanded Prostate Cancer Index Composite [EPIC]). The proportion of patients developing a clinically significant difference in the EPIC domainmore » score (minimally important difference of >0.5 standard deviation) was determined and correlated with the baseline clinical and dosimetric factors. The study accrued 125 patients, with a median follow-up of 24 months. Results: By 24 months, 23% had Grade 2 urinary toxicity and only 5% had Grade 2 bowel toxicity, with no Grade 3 toxicity. The proportion of patients reporting a significant decrease in EPIC urinary, bowel, sexual, and hormonal domain scores was 53%, 51%, 45%, and 40% at 12 months and 57%, 65%, 51%, and 30% at 24 months, respectively. The proportion with a >1 standard deviation decrease in the EPIC urinary, bowel, sexual, and hormonal domain scores was 38%, 36%, 24%, and 20% at 12 months and 46%, 48%, 19%, and 8% at 24 months, respectively. On multivariate analysis, the dose to 10% of the urethra was associated with a decreasing EPIC urinary domain score (p = .0089) and, less strongly (p = .0312) with a decreasing hormonal domain score. No association was found between the prostate volume, bladder dose, or high-dose volume and urinary health-related quality of life. A high baseline International Index of Erectile Function score was associated (p = .0019) with a decreasing sexual domain score. The optimal maximal dose to 10% of the urethra cutpoint for urinary health-related quality of life was 120% of the prescription dose. Conclusion: EPIC was a more sensitive tool for detecting the effects on function and bother than were the generic toxicity scales. The urethral dose had the strongest association with a deteriorating urinary quality of life.« less

Predictors of trajectories of epilepsy-specific quality of life among children newly diagnosed with epilepsy.

PubMed

Ramsey, Rachelle R; Loiselle, Kristin; Rausch, Joseph R; Harrison, Jordan; Modi, Avani C

2016-04-01

The objective of this study was to identify two-year trajectories of epilepsy-specific health-related quality of life (HRQOL) among children newly diagnosed with epilepsy and to evaluate the predictive value of a comprehensive set of medical, psychosocial, and family factors. Ninety-four children with epilepsy (8.14 ± 2.37 years of age and 63% male) and their caregivers participated in this study. Caregivers completed the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) and measures of psychological and family functioning at one month postdiagnosis. The QOLCE was also given at eight additional time points during the subsequent two years as a part of a large observational study in children with epilepsy. Adherence data were collected via MEMS TrackCaps, and medical information was collected through chart review. Unique trajectories were identified for the overall QOLCE scale, as well as the subscales. Most trajectory models for the QOLCE subscales contained at least one at-risk trajectory for children, indicating that there is a subgroup of children experiencing poor long-term HRQOL. Health-related quality-of-life trajectories remained predominantly stable during the two-year period following treatment initiation. The number of AEDs, internalizing problems, and externalizing problems emerged as the most consistent predictors across the HRQOL domains. Medical and psychosocial interventions, such as cognitive-behavioral strategies, should target modifiable factors (e.g., internalizing symptoms, externalizing symptoms, number of AEDs trialed) shortly after diagnosis to improve HRQOL for children with epilepsy over the course of their disease. Copyright © 2016 Elsevier Inc. All rights reserved.

The Effectiveness of the Higher Education Quality Assessment System: Problems and Countermeasures in China

ERIC Educational Resources Information Center

Guangli, Zhou

2016-01-01

The effectiveness of the higher education quality assessment system is essentially a matter of policy evaluation. On the macro level, such a system refers to external quality assessment, which includes government evaluation, quality certification, and university rankings. Depending on the degree of government intervention, the external quality…

Friendship Quality, Peer Group Affiliation, and Peer Antisocial Behavior as Moderators of the Link Between Negative Parenting and Adolescent Externalizing Behavior

PubMed Central

Lansford, Jennifer E.; Criss, Michael M.; Pettit, Gregory S.; Dodge, Kenneth A.; Bates, John E.

2009-01-01

Quality of peer relationships and perceived peer antisocial behavior were examined as moderators of the link between negative parenting and externalizing behavior problems in school from middle childhood to early adolescence. Data on negative parenting (i.e., unilateral parental decision making, low supervision and awareness, and harsh discipline) were collected from 362 parents in the summer preceding the adolescents’ entry into Grade 6. Adolescent reports of positive peer relationships and peer antisocial behavior were assessed in the winter of Grade 7. The outcome measure was teacher report of adolescent externalizing behavior in the spring of Grade 7, controlling for externalizing behavior in Grade 5. High levels of friendship quality and peer group affiliation attenuated the association between unilateral parental decision making and adolescent externalizing behavior in school; this was particularly true when adolescents associated with peers perceived to be low in antisocial behavior. In addition, having low-quality peer relationships and having peers perceived to be highly antisocial further amplified the association between unilateral parental decision making and adolescent externalizing behavior problems. Finally, high levels of friend and peer group antisocial behavior exacerbated the predictiveness of harsh discipline for adolescents’ externalizing behavior. PMID:20209019

[Quality management in intensive care medicine].

PubMed

Martin, J; Braun, J-P

2014-02-01

Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to external quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system.

[Quality management in intensive care medicine].

PubMed

Martin, J; Braun, J-P

2013-09-01

Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system.

Mandarin fruit quality: a review.

PubMed

Goldenberg, Livnat; Yaniv, Yossi; Porat, Ron; Carmi, Nir

2018-01-01

During the last decade, there has been a continuous rise in consumption and global marketing of fresh, easy-to-peel mandarins, with current annual production of nearly 29 million tons. Nevertheless, most of the existing knowledge on quality traits of citrus fruit comes from research conducted on oranges and grapefruit, which are the main products for the citrus juice manufacturing industry; relatively little is yet known regarding the unique fruit quality traits of mandarins, nor about the great diversity in these traits among the various natural sub-groups and varieties of mandarins. In the present review we discuss the physiological, biochemical, and molecular factors governing key fruit quality attributes of mandarins, including fruit colour, size and shape, ease of peeling, seedlessness, flavour, and nutritional quality. Fruit colour, size, and shape contribute to external appearance; peelability and seedlessness to ease of consumption; and flavour and nutritional quality to internal quality. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

Analysing organisational context: case studies on the contribution of absorptive capacity theory to understanding inter-organisational variation in performance improvement.

PubMed

Harvey, Gill; Jas, Pauline; Walshe, Kieran

2015-01-01

Organisational context is frequently cited as an important consideration when implementing and evaluating quality improvement interventions in healthcare, but limited guidance is available on which aspects of context are most influential or modifiable. This paper examines how internal and external contextual factors mediate organisational-level performance improvement through applying the knowledge-based theory of absorptive capacity (AC). Three healthcare case studies are presented. Each case is a UK National Health Service organisation that had been identified as having performance problems. Qualitative data were collected through semi-structured interviews with general and clinical managers within the organisation and members of external teams supporting or overseeing performance improvement (n=22). Interview data were analysed using an existing AC framework from the literature. The organisation with the highest AC showed the quickest and most comprehensive performance improvement. Internal characteristics including strategic priorities, processes for managing information, communication and orientation to learning and development impacted on the organisation's ability to engage successfully with external stakeholders and make use of available knowledge. This enabled the organisation to thrive despite the challenging external environment. Lower levels of AC appeared to delay or limit the improvement trajectory. Developing a more detailed and nuanced understanding of how context influences improvement is an important step towards achieving more effective and sustainable quality improvement programmes in healthcare. AC, with its focus on knowledge and organisational learning, provides a useful way to explore the relationship between context and quality improvement and represents a potentially valuable area for future research and development. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

External Quality Assessment for Rubella Virus RNA Detection Using Armored RNA in China.

PubMed

Zhang, D; Lin, G; Yi, L; Hao, M; Fan, G; Yang, X; Peng, R; Ding, J; Zhang, K; Zhang, R; Li, J

2017-02-01

Although tremendous efforts have been made to reduce rubella incidence, there are still 300 new cases of congenital rubella syndrome daily; thus, rubella infections remain one of the leading causes of preventable congenital birth defects. An effective surveillance system, which could be achieved and maintained by using an external quality assessment program, is critical for prevention and control of this disease. Armored RNAs, which are noninfectious and RNase-resistant, were used for encapsulation of the E1 gene of rubella virus and for preparation of a 10-specimen panel for external quality assessment. Thirty-two laboratories across mainland China that used nucleic acid tests for rubella virus RNA detection were included in the external quality assessment program organized by the National Center for Clinical Laboratories of China. Different kinds of commercial kits were used by the laboratories for nucleic acid extraction and TaqMan real-time reverse-transcription PCR for rubella virus RNA detection; 99.2% sensitivity and 100% specificity were achieved in this external quality assessment program. Most of the participating laboratories obtained accurate results for rubella nucleic acid tests, thereby achieving the quality required for regional rubella and congenital rubella syndrome elimination.

The Effect of Landuse and Other External Factors on Water Quality Within two Creeks in Northern Kentucky

NASA Astrophysics Data System (ADS)

Boateng, S.

2006-05-01

The purpose of this study was to monitor the water quality in two creeks in Northern Kentucky. These are the Banklick Creek in Kenton County and the Woolper Creek in Boone County, Kentucky. The objective was to evaluate the effect of landuse and other external factors on surface water quality. Landuse within the Banklick watershed is industrial, forest and residential (urban) whereas that of Woolper Creek is agricultural and residential (rural). Two testing sites were selected along the Banklick Creek; one site was upstream the confluence with an overflow stream from an adjacent lake; the second site was downstream the confluence. Most of the drainage into the lake is over a near-by industrial park and the urban residential areas of the cities of Elsmere and Erlanger, Kentucky. Four sampling locations were selected within the Woolper Creek watershed to evaluate the effect of channelization and subsequent sedimentation on the health of the creek. Water quality parameters tested for include dissolved oxygen, phosphates, chlorophyll, total suspended sediments (TSS), pH, oxidation reduction potential (ORP), nitrates, and electrical conductivity. Sampling and testing were conducted weekly and also immediately after storm events that occurred before the regular sampling dates. Sampling and testing proceeded over a period of 29 weeks. Biological impact was determined, only in Woolper Creek watershed, by sampling benthic macroinvertebrates once every four weeks. The results showed significant differences in the water quality between the two sites within the Banklick Creek. The water quality may be affected by the stream overflow from the dammed lake. Also, channelization in the Woolper Creek seemed to have adverse effects on the water quality. A retention pond, constructed to prevent sediments from flowing into the Woolper Creek, did not seem to be effective. This is because the water quality downstream of the retention pond was significantly worse than that of the upstream site. The benthic macroinvertebrates sampled indicate worse water quality downstream of the sediment retention pond. Overall, landuse and the channelization have some effect on the water quality in the two creeks.

Focus groups to explore healthcare professionals' experiences of care coordination: towards a theoretical framework for the study of care coordination.

PubMed

Van Houdt, Sabine; Sermeus, Walter; Vanhaecht, Kris; De Lepeleire, Jan

2014-12-24

Strategies to improve care coordination between primary and hospital care do not always have the desired results. This is partly due to incomplete understanding of the key concepts of care coordination. An in-depth analysis of existing theoretical frameworks for the study of care coordination identified 14 interrelated key concepts. In another study, these 14 key concepts were further explored in patients' experiences. Additionally, "patient characteristics" was identified as a new key concept in patients' experiences and the previously identified key concept "quality of relationship" between healthcare professionals was extended to "quality of relationship" with the patient. Together, these 15 interrelated key concepts resulted in a new theoretical framework. The present study aimed at improving our understanding of the 15 previously identified key concepts and to explore potentially previous unidentified key concepts and the links between these by exploring how healthcare professionals experience care coordination. A qualitative design was used. Six focus groups were conducted including primary healthcare professionals involved in the care of patients who had breast cancer surgery at three hospitals in Belgium. Data were analyzed using constant comparative analysis. All 15 previously identified key concepts of care coordination were further explored in healthcare professionals' experiences. Links between these 15 concepts were identified, including 9 newly identified links. The concept "external factors" was linked with all 6 concepts relating to (inter)organizational mechanisms; "task characteristics", "structure", "knowledge and information technology", "administrative operational processes", "cultural factors" and "need for coordination". Five of these concepts related to 3 concepts of relational coordination; "roles", "quality of relationship" and "exchange of information". The concept of "task characteristics" was only linked with "roles" and "exchange of information". The concept "patient characteristics" related with the concepts "need for coordination" and "patient outcome". Outcome was influenced by "roles", "quality of relationship" and "exchange of information". External factors and the (inter)organizational mechanism should enhance "roles" and "quality of relationship" between healthcare professionals and with the patient as well as "exchange of information", and setting and sharing of common "goals" to improve care coordination and quality of care.

75 FR 47595 - Science Advisory Board Staff Office; Notification of a Public Teleconference of the Clean Air...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-06

... Air Quality Standards--Second External Review Draft (June 2010). DATES: The teleconference will be... Standards--Second External Review Draft (June 2010). Background information on previous meetings and... Quality Standards--Second External Review Draft (June 2010) should be directed to Ms. Beth Hassett-Sipple...

75 FR 9206 - Science Advisory Board Staff Office; Notification of a Clean Air Scientific Advisory Committee...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-01

...: Second External Review Draft and EPA's Policy Assessment for the Review of the Carbon Monoxide National Ambient Air Quality Standards: External Review Draft. The chartered CASAC will subsequently hold a public... National Ambient Air Quality Standards: Second External Review Draft and the Policy Assessment for the...

Longitudinal effects of sibling relationship quality on adolescent problem behavior: a cross-ethnic comparison.

PubMed

Buist, Kirsten L; Paalman, Carmen H; Branje, Susan J T; Deković, Maja; Reitz, Ellen; Verhoeven, Marjolein; Meeus, Wim H J; Koot, Hans M; Hale, William W

2014-04-01

The aim of the present study was to examine whether adolescents of Moroccan and Dutch origin differ concerning sibling relationship quality and to examine whether the associations between quality of the sibling relationship and level and change in externalizing and internalizing problem behavior are comparable for Moroccan and Dutch adolescents. Five annual waves of questionnaire data on sibling support and conflict as well as externalizing problems, anxiety and depression were collected from 159 ethnic Moroccan adolescents (Mage = 13.3 years) and from 159 ethnic Dutch adolescents (Mage = 13.0 years). Our findings demonstrated significant mean level differences between the Moroccan and Dutch sample in sibling relationship quality, externalizing problems, and depression, with Moroccan adolescents reporting higher sibling relationship quality and less problem behavior. However, effects of sibling relationship quality on externalizing problems, anxiety, and depression were similar for the Moroccan and Dutch samples. Sibling support was not related to level of externalizing problems, nor to changes in externalizing problems, anxiety, and depression. Additionally, more sibling conflict was related to a higher starting level of and faster decreases in problem behaviors. Our results support the ethnic equivalence model, which holds that the influence of family relationships is similar for different ethnic groups. Moreover, sibling support and conflict affect both the level and the fluctuations in problem behavior over time in specific ethnic groups similarly. Implications for future studies and interventions are subsequently discussed.

Demographic Factors, Temperament and the Quality of the Preschool Environment as Predictors of Daily Cortisol Changes among Finnish Six-Year-Old Children

ERIC Educational Resources Information Center

Sajaniemi, Nina; Suhonen, Eira; Hotulainen, Risto; Tormanen, Minna; Alijoki, Alisa; Nislin, Mari; Kontu, Elina

2014-01-01

A young child's stress-sensitive neurobiological system is immature and open to being shaped by experience. When children enter preschool, external demands on them to adjust are different from the demands they experience at day care. In Finland, the last year before children transfer to the comprehensive school is called preschool. The preschool…

Parental Perceptions of Child Care Quality in Centre-Based and Home-Based Settings: Associations with External Quality Ratings

ERIC Educational Resources Information Center

Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie

2015-01-01

The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…

The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement.

PubMed

Kaplan, Heather C; Provost, Lloyd P; Froehle, Craig M; Margolis, Peter A

2012-01-01

BACKGROUND Quality improvement (QI) efforts have become widespread in healthcare, however there is significant variability in their success. Differences in context are thought to be responsible for some of the variability seen. To develop a conceptual model that can be used by organisations and QI researchers to understand and optimise contextual factors affecting the success of a QI project. 10 QI experts were provided with the results of a systematic literature review and then participated in two rounds of opinion gathering to identify and define important contextual factors. The experts subsequently met in person to identify relationships among factors and to begin to build the model. The Model for Understanding Success in Quality (MUSIQ) is organised based on the level of the healthcare system and identifies 25 contextual factors likely to influence QI success. Contextual factors within microsystems and those related to the QI team are hypothesised to directly shape QI success, whereas factors within the organisation and external environment are believed to influence success indirectly. The MUSIQ framework has the potential to guide the application of QI methods in healthcare and focus research. The specificity of MUSIQ and the explicit delineation of relationships among factors allows a deeper understanding of the mechanism of action by which context influences QI success. MUSIQ also provides a foundation to support further studies to test and refine the theory and advance the field of QI science.

The Effectiveness of External Quality Audits: A Study of Australian Universities

ERIC Educational Resources Information Center

Shah, Mahsood

2013-01-01

External quality audits have been introduced in many countries as part of higher education reforms. This article is based on research on 30 Australian universities to assess the extent to which audits by the Australian Universities Quality Agency (AUQA) have improved quality assurance in the core and support areas of the universities. The article…

Academic Staff Views on External Quality Audit: Post Audit Evaluation in a Private Higher Education College

ERIC Educational Resources Information Center

Shah, Mahsood; Nair, Chenicheri Sid; Stanford, Sue-Ann

2011-01-01

Governments in many countries have funded independent agencies to undertake quality audits of higher education institutions. Such agencies ensure that universities and other higher education providers have effective systems and processes to assure quality assurance in core and support areas. While external quality audits have been in place for a…

Simultaneous signal transmission of different data-rates in a DWDM system employing external injection locking technique

NASA Astrophysics Data System (ADS)

Das, Anindya Sundar; Patra, Ardhendu Sekhar

2014-12-01

A novel architecture of DWDM-PON is proposed and demonstrated for downlink transmission of different data-rates of 622 Mbps, 1 Gbps, 1.25 Gbps and 2.5 Gbps simultaneously over a long-haul single mode fiber (SMF). The data rates are directly modulated by Fabry-Pérot laser diodes (FPLD), which are externally injection locked by asynchronous spontaneous emission (ASE) source. The transmission performances are checked by the bit error rate (BER), Quality (Q) factor and clear eye-diagrams. Since this proposed system consists of one ASE source, FPLDs and depends on the direct modulation technique, it reveals a prominent alternative with advantages in simplicity and cost.

Higher Education Quality Assessment in China: An Impact Study

ERIC Educational Resources Information Center

Liu, Shuiyun

2015-01-01

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

Interrater Reliability in Large-Scale Assessments--Can Teachers Score National Tests Reliably without External Controls?

ERIC Educational Resources Information Center

Pantzare, Anna Lind

2015-01-01

In most large-scale assessment systems a set of rather expensive external quality controls are implemented in order to guarantee the quality of interrater reliability. This study empirically examines if teachers' ratings of national tests in mathematics can be reliable without using monitoring, training, or other methods of external quality…

External validity of a hierarchical dimensional model of child and adolescent psychopathology: Tests using confirmatory factor analyses and multivariate behavior genetic analyses.

PubMed

Waldman, Irwin D; Poore, Holly E; van Hulle, Carol; Rathouz, Paul J; Lahey, Benjamin B

2016-11-01

Several recent studies of the hierarchical phenotypic structure of psychopathology have identified a General psychopathology factor in addition to the more expected specific Externalizing and Internalizing dimensions in both youth and adult samples and some have found relevant unique external correlates of this General factor. We used data from 1,568 twin pairs (599 MZ & 969 DZ) age 9 to 17 to test hypotheses for the underlying structure of youth psychopathology and the external validity of the higher-order factors. Psychopathology symptoms were assessed via structured interviews of caretakers and youth. We conducted phenotypic analyses of competing structural models using Confirmatory Factor Analysis and used Structural Equation Modeling and multivariate behavior genetic analyses to understand the etiology of the higher-order factors and their external validity. We found that both a General factor and specific Externalizing and Internalizing dimensions are necessary for characterizing youth psychopathology at both the phenotypic and etiologic levels, and that the 3 higher-order factors differed substantially in the magnitudes of their underlying genetic and environmental influences. Phenotypically, the specific Externalizing and Internalizing dimensions were slightly negatively correlated when a General factor was included, which reflected a significant inverse correlation between the nonshared environmental (but not genetic) influences on Internalizing and Externalizing. We estimated heritability of the general factor of psychopathology for the first time. Its moderate heritability suggests that it is not merely an artifact of measurement error but a valid construct. The General, Externalizing, and Internalizing factors differed in their relations with 3 external validity criteria: mother's smoking during pregnancy, parent's harsh discipline, and the youth's association with delinquent peers. Multivariate behavior genetic analyses supported the external validity of the 3 higher-order factors by suggesting that the General, Externalizing, and Internalizing factors were correlated with peer delinquency and parent's harsh discipline for different etiologic reasons. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Analytical performance specifications for external quality assessment - definitions and descriptions.

PubMed

Jones, Graham R D; Albarede, Stephanie; Kesseler, Dagmar; MacKenzie, Finlay; Mammen, Joy; Pedersen, Morten; Stavelin, Anne; Thelen, Marc; Thomas, Annette; Twomey, Patrick J; Ventura, Emma; Panteghini, Mauro

2017-06-27

External Quality Assurance (EQA) is vital to ensure acceptable analytical quality in medical laboratories. A key component of an EQA scheme is an analytical performance specification (APS) for each measurand that a laboratory can use to assess the extent of deviation of the obtained results from the target value. A consensus conference held in Milan in 2014 has proposed three models to set APS and these can be applied to setting APS for EQA. A goal arising from this conference is the harmonisation of EQA APS between different schemes to deliver consistent quality messages to laboratories irrespective of location and the choice of EQA provider. At this time there are wide differences in the APS used in different EQA schemes for the same measurands. Contributing factors to this variation are that the APS in different schemes are established using different criteria, applied to different types of data (e.g. single data points, multiple data points), used for different goals (e.g. improvement of analytical quality; licensing), and with the aim of eliciting different responses from participants. This paper provides recommendations from the European Federation of Laboratory Medicine (EFLM) Task and Finish Group on Performance Specifications for External Quality Assurance Schemes (TFG-APSEQA) and on clear terminology for EQA APS. The recommended terminology covers six elements required to understand APS: 1) a statement on the EQA material matrix and its commutability; 2) the method used to assign the target value; 3) the data set to which APS are applied; 4) the applicable analytical property being assessed (i.e. total error, bias, imprecision, uncertainty); 5) the rationale for the selection of the APS; and 6) the type of the Milan model(s) used to set the APS. The terminology is required for EQA participants and other interested parties to understand the meaning of meeting or not meeting APS.

Marketing Strategy Analysis for Small and Medium Scale Business Enterprise (SMEs) for Home Industry Furniture in Leilem, the Regency of Minahasa

NASA Astrophysics Data System (ADS)

Pangemanan, S. A.; Walukow, I. M.

2018-01-01

Leilem is a small village located in Minahasa Regency. This village is well known for furniture products made of Timber. Eventhough the village has been producing various furniture products with high quality since many decades ago, it has not been able to compete with other new entries such furniture from Java, Synthetic Ratan, Plywood and plastic based furniture. The monotonous design and the finishing works done on the furniture have been some of the major issues in the decline of home furniture. The research explores problems and challenges faced by the furniture home Industry. It will also aim at identifying the internal and external factors that prevent the home industry to compete and survive. In the end the research will develop the strategic positioning of the home industry in the midst of competition. The research methodology employs descriptive analysis in which data are collected through observation, interview, and questionnaire. This methodology is combined with IFE (Internal Factor Evaluation) and EFE (External Factor Evaluation) Matrix, SPACE Matrix and SWOT Analysis and QSPM (Quantitative Strategic Planning Matrix). The sample is 66 business people, of 823 craftsmen who are working in this business. The result shows this home industry is very competitive in terms of consistency, but in terms of promotion, product quality, price, product diversification, design training of furniture, management and economic scale, it is lagging behind. The home industry should be able to develop marketing networking, improve design and product quality, promotion and cost control, product diversification and these can only be done by intensive training in managing business and investment.

Financial incentives, quality improvement programs, and the adoption of clinical information technology.

PubMed

Robinson, James C; Casalino, Lawrence P; Gillies, Robin R; Rittenhouse, Diane R; Shortell, Stephen S; Fernandes-Taylor, Sara

2009-04-01

Physician use of clinical information technology (CIT) is important for the management of chronic illness, but has lagged behind expectations. We studied the role of health insurers' financial incentives (including pay-for-performance) and quality improvement initiatives in accelerating adoption of CIT in large physician practices. National survey of all medical groups and independent practice association (IPA) physician organizations with 20 or more physicians in the United States in 2006 to 2007. The response rate was 60.3%. Use of 19 CIT capabilities was measured. Multivariate statistical analysis of financial and organizational factors associated with adoption and use of CIT. Use of information technology varied across physician organizations, including electronic access to laboratory test results (medical groups, 49.3%; IPAs, 19.6%), alerts for potential drug interactions (medical groups, 33.9%; IPAs, 9.5%), electronic drug prescribing (medical groups, 41.9%; IPAs, 25.1%), and physician use of e-mail with patients (medical groups, 34.2%; IPAs, 29.1%). Adoption of CIT was stronger for physician organizations evaluated by external entities for pay-for-performance and public reporting purposes (P = 0.042) and for those participating in quality improvement initiatives (P < 0.001). External incentives and participation in quality improvement initiatives are associated with greater use of CIT by large physician practices.

Maternal mental health over the course of 4 years following childbirth: The contribution of birth circumstances and psycho-social factors.

PubMed

Porat-Zyman, Ginna; Taubman-Ben-Ari, Orit; Morag, Iris; Kuint, Jacob

2018-01-01

The aim of this study is to identify mothers at risk for poorer maternal mental health (MMH) 1 month post-partum and to determine changes in MMH over 4 years in relation to birth circumstances (singleton/twins, full-term/pre-term infant/s, first/non-first child), internal resources (adult attachment styles), and external resources (marital quality and maternal grandmother's support) at 1 month post-partum. The mediating effects of external resources were also investigated. Questionnaires were completed between 2001 and 2012 by 561 Israeli mothers. Shortly after birth, mothers at risk for poorer MMH were those who gave birth prematurely or were characterized by insecure attachment styles, lower marital quality, younger age, or a higher level of education. The mothers with a good prognosis for improvement in MMH were those who had given birth prematurely or were younger, more highly educated, or multiparous. Women with insecure attachment or lower marital quality reported lower MMH one month after delivery that did not improve over time, and the MMH of older or less educated mothers deteriorated over time. Marital quality mitigated or exacerbated the effects of birth circumstances and insecure attachment style on MMH shortly after giving birth. Findings suggested that early interventions may be important to help identify women at risk.

[Analytical quality in biological monitoring of workers exposed to chemicals: experience of the Prevention and Safety at the Workplace Service in Modena].

PubMed

Alpaca, R I Paredes; Migliore, A; Di Rico, R; Canali, Claudia; Rota, Cristina; Trenti, T; Cariani, Elisabetta

2010-01-01

The quality of laboratory data is one of the main factors in guaranteeing efficacy of biological monitoring. To analyze the quality of laboratory data used for biological monitoring of exposed workers. A survey involving 18 companies employing 945 workers in the area of Modena, Italy, was carried out in 2008. Most of the 9 private laboratories receiving biological samples did not perform directly part or all of the laboratory assessments requested, but this was not indicated in the final report. Major problems were observed in the application of internal quality control, and only one laboratory participated in external quality assessment for blood lead measurements. Our results raise major concerns on the traceability and reliability of laboratory assessments performed for biomonitoring of exposed workers. Systematic evaluation of the quality of analytical data would be highly recommendable.

Quality Assurance Reconsidered: A Case Study

ERIC Educational Resources Information Center

Gynnild, Vidar

2007-01-01

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

42 CFR 438.364 - External quality review results.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false External quality review results. 438.364 Section 438.364 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... quality review results. (a) Information that must be produced. The State must ensure that the EQR produces...

42 CFR 438.364 - External quality review results.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false External quality review results. 438.364 Section 438.364 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... quality review results. (a) Information that must be produced. The State must ensure that the EQR produces...

42 CFR 438.364 - External quality review results.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false External quality review results. 438.364 Section 438.364 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... quality review results. (a) Information that must be produced. The State must ensure that the EQR produces...

42 CFR 438.364 - External quality review results.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false External quality review results. 438.364 Section 438.364 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... quality review results. (a) Information that must be produced. The State must ensure that the EQR produces...

42 CFR 438.364 - External quality review results.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false External quality review results. 438.364 Section 438.364 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... quality review results. (a) Information that must be produced. The State must ensure that the EQR produces...

Parenting and Friendship Quality as Predictors of Internalizing and Externalizing Symptoms in Early Adolescence

ERIC Educational Resources Information Center

Gaertner, Alden E.; Fite, Paula J.; Colder, Craig R.

2010-01-01

Research indicates both parents and peers influence child and adolescent adjustment outcomes. Moreover, friendship quality has been found to buffer the influence of parenting on adolescent adjustment, particularly externalizing symptoms. Little to no research, however, has longitudinally examined whether friendship quality moderates the relation…

The Introduction of External Quality Assurance in South African Higher Education: An Analysis of Stakeholder Response

ERIC Educational Resources Information Center

Luckett, Kathy

2007-01-01

This paper analyses the take-up of proposals for a national quality assurance system in South Africa using different approaches to quality assurance to classify stakeholder responses to survey and interview questions. The context of the study was the introduction of an external quality assurance system for South African higher education by an…

We Can't Go Home Again: Insights from a Quarter Century of Experiments in External Academic Quality Assurance

ERIC Educational Resources Information Center

Dill, David D.

2010-01-01

What have we learned from 25 years of experience with external academic quality assurance that can help design more effective framework conditions for assuring academic standards? The key elements appear to be the structure and means of evaluating national academic quality assurance agencies, the nature of academic quality information mandated by…

Perception of recovery of households affected by 2008 Wenchuan earthquake: A structural equation model

PubMed Central

Lin, Le; Wang, Ying; Liu, Tianxue

2017-01-01

Much of the literature on recovery focuses on the economy, the physical environment and infrastructure at a macro level, which may ignore the personal experiences of affected individuals during recovery. This paper combines internal factors at a micro level and external factors at a macro level to model for understanding perception of recovery (PoR). This study focuses on areas devastated by the 2008 Wenchuan earthquake in China. With respect to three recovery-related aspects (house recovery condition (HRC), family recovery power (FRP) and reconstruction investment (RI)), structural equation modeling (SEM) was applied. It was found that the three aspects (FRP, HRC and RI) effectively explain how earthquake affected households perceive recovery. Internal factors associated with FRP contributed the most to favourable PoR, followed by external factors associated with HRC. Findings identified that for PoR the importance of active recovery within households outweighed an advantageous house recovery condition. At the same time, households trapped in unfavourable external conditions would invest more in housing recovery, which result in wealth accumulation and improved quality of life leading to a high level of PoR. In addition, schooling in households showed a negative effect on improving PoR. This research contributes to current debates around post-disaster permanent housing policy. It is implied that a one-size-fits-all policy in disaster recovery may not be effective and more specific assistance should be provided to those people in need. PMID:28854217

The Relationship Between the Genetic and Environmental Influences on Common Externalizing Psychopathology and Mental Wellbeing

PubMed Central

Kendler, Kenneth S.; Myers, John M.; Keyes, Corey L. M.

2012-01-01

To determine the relationship between the genetic and environmental risk factors for externalizing psychopathology and mental wellbeing, we examined detailed measures of emotional, social and psychological wellbeing, and a history of alcohol-related problems and smoking behavior in the last year in 1,386 individual twins from same-sex pairs from the MIDUS national US sample assessed in 1995. Cholesky decomposition analyses were performed with the Mx program. The best fit model contained one highly heritable common externalizing psychopathology factor for both substance use/abuse measures, and one strongly heritable common factor for the three wellbeing measures. Genetic and environmental risk factors for externalizing psychopathology were both negatively associated with levels of mental wellbeing and accounted for, respectively, 7% and 21% of its genetic and environmental influences. Adding internalizing psychopathology assessed in the last year to the model, genetic risk factors unique for externalizing psychopathology were now positively related to levels of mental wellbeing, although accounting for only 5% of the genetic variance. Environmental risk factors unique to externalizing psychopathology continued to be negatively associated with mental wellbeing, accounting for 26% of the environmental variance. When both internalizing psychopathology and externalizing psychopathology are associated with mental wellbeing, the strongest risk factors for low mental wellbeing are genetic factors that impact on both internalizing psychopathology and externalizing psychopathology, and environmental factors unique to externalizing psychopathology. In this model, genetic risk factors for externalizing psychopathology predict, albeit weakly, higher levels of mental wellbeing. PMID:22506307

[Users' and community leaders' perceptions of their capacity to influence the quality of health care: case studies of Colombia and Brazil].

PubMed

Delgado-Gallego, María Eugenia; Vázquez, María Luisa

2009-01-01

Health system reforms in Colombia and Brazil introduced policies that promote social participation in health care quality control. The objective of this paper was to analyze users' and leaders' perceptions of their capacity to achieve changes in the countries' health services. An exploratory and descriptive qualitative study was performed with individual interviews and focus groups of users and leaders in Colombia and Brazil. Most informants perceived themselves as having the capacity to induce changes to improve the quality of health services. They attributed this capacity primarily to internal factors related to their participatory behavior, plus only one external factor, the availability of institutional participatory spaces. The lack of capacity to influence change was only related to passive attitudes and fear of retaliation in Colombia. The existence of a population with high self-perceived capacity to achieve change appears as a potential factor to be strengthened, while institutional democratic space needs to improve in order to enhance the effectiveness of social participation in health policies.

Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review.

PubMed

Keller, Sara C; Tamma, Pranita D; Cosgrove, Sara E; Miller, Melissa A; Sateia, Heather; Szymczak, Julie; Gurses, Ayse P; Linder, Jeffrey A

2018-01-01

In the United States, most antibiotics are prescribed in ambulatory settings. Human factors engineering, which explores interactions between people and the place where they work, has successfully improved quality of care. However, human factors engineering models have not been explored to frame what is known about ambulatory antibiotic stewardship (AS) interventions and barriers and facilitators to their implementation. We conducted a systematic review and searched OVID MEDLINE, Embase, Scopus, Web of Science, and CINAHL to identify controlled interventions and qualitative studies of ambulatory AS and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. This model describes how a work system (ambulatory clinic) contributes to a process (antibiotic prescribing) that leads to outcomes. The work system consists of 5 components, tools and technology, organization, person, tasks, and environment, within an external environment. Of 1,288 abstracts initially identified, 42 quantitative studies and 17 qualitative studies met inclusion criteria. Effective interventions focused on tools and technology (eg, clinical decision support and point-of-care testing), the person (eg, clinician education), organization (eg, audit and feedback and academic detailing), tasks (eg, delayed antibiotic prescribing), the environment (eg, commitment posters), and the external environment (media campaigns). Studies have not focused on clinic-wide approaches to AS. A human factors engineering approach suggests that investigating the role of the clinic's processes or physical layout or external pressures' role in antibiotic prescribing may be a promising way to improve ambulatory AS. © Copyright 2018 by the American Board of Family Medicine.

Facilitators and barriers to exercising among people with osteoarthritis: a phenomenological study.

PubMed

Petursdottir, Unnur; Arnadottir, Solveig A; Halldorsdottir, Sigridur

2010-07-01

Evidence indicates that regular exercise improves the well-being of individuals with osteoarthritis (OA). However, these individuals seem to exercise less frequently than the general population and seem to have limited adherence to exercising. The purposes of this study were: (1) to increase knowledge and understanding of the experience of exercising among individuals with OA and (2) to determine what they perceive as facilitators and barriers to exercising. This study used a qualitative method, based on the Vancouver School of doing phenomenology, involving purposive sampling of 12 individuals and 16 interviews. The participants, 9 women and 3 men, were 50 to 82 years of age. Extended information on exercise behavior among people with OA is presented in a model in which internal and external facilitators and barriers to exercising are delineated. Based on this model, a checklist is proposed for physical therapists' assessment of these factors. Internal factors include individual attributes and personal experience of exercising, whereas external factors include the social and physical environment. The participants expressed how each of these internal and external factors could act both as a facilitator and a barrier to exercise participation and the pattern of exercising; for example, the presence of pain was an important aspect concerning internal barriers to exercising, whereas the hope of less pain was one of the main facilitators. Increased knowledge and understanding of the factors influencing exercise behavior in people with OA can help physical therapists and other health care professionals support them in initiating and maintaining a healthy exercise routine and, consequently, achieving a better quality of life.

75 FR 65480 - Science Advisory Board Staff Office; Notification of Two Public Teleconferences of the Clean Air...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-25

... Quality Standards for NOX and SOX: Second External Review Draft (September 2010) and a teleconference for... the Secondary National Ambient Air Quality Standards for NO X and SO X : Second External Review Draft... External Review Draft (September 2010) should be directed to Dr. Byran Hubbell, OAR, at (919) 541-0621 or...

Interpersonal problems across anxiety, depression, and eating disorders: a transdiagnostic examination.

PubMed

McEvoy, Peter M; Burgess, Melissa M; Page, Andrew C; Nathan, Paula; Fursland, Anthea

2013-06-01

Integrative models of psychopathology suggest that quality of interpersonal relationships is a key determinant of psychological well-being. However, there is a relative paucity of research evaluating the association between interpersonal problems and psychopathology within cognitive behavioural therapy. Partly, this may be due to lack of brief, well-validated, and easily interpretable measures of interpersonal problems that can be used within clinical settings. The aim of the present study was to evaluate the psychometric properties, factor invariance, and external validity of the Inventory of Interpersonal Problems 32 (IIP-32) across anxiety, depression, and eating disorders. Two treatment-seeking samples with principal anxiety and depressive disorders (AD sample, n = 504) and eating disorders (ED sample, n = 339) completed the IIP-32 along with measures of anxiety, depression, and eating disorder symptoms, as well as quality of life (QoL). The previously established eight-factor structure of the IIP-32 provided the best fit for both the AD and ED groups, and was robustly invariant across the two samples. The IIP-32 also demonstrated excellent external validity against well-validated measures of anxiety, depression, and eating disorder symptoms, as well as QoL. The IIP-32 provides a clinically useful measure of interpersonal problems across emotional and ED. © Commonwealth of Australia 2012.

MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard

PubMed Central

Martin-Harris, Bonnie; Brodsky, Martin B.; Michel, Yvonne; Castell, Donald O.; Schleicher, Melanie; Sandidge, John; Maxwell, Rebekah; Blair, Julie

2014-01-01

The aim of this study was to test reliability, content, construct, and external validity of a new modified barium swallowing study (MBSS) tool (MBSImp) that is used to quantify swallowing impairment. Multiple regression, confirmatory factor, and correlation analyses were used to analyze 300 in- and outpatients with heterogeneous medical and surgical diagnoses who were sequentially referred for MBS exams at a university medical center and private tertiary care community hospital. Main outcome measures were the MBSImp and index scores of aspiration, health status, and quality of life. Inter- and intrarater concordance were 80% or greater for blinded scoring of MBSSs. Regression analysis revealed contributions of eight of nine swallow types to impressions of overall swallowing impairment (p ≤ 0.05). Factor analysis revealed 13 significant components (loadings ≥ 0.5) that formed two impairment groupings (oral and pharyngeal). Significant correlations were found between Oral and Pharyngeal Impairment scores and Penetration-Aspiration Scale scores, and indexes of intake status, nutrition, health status, and quality of life. The MBSImp demonstrated clinical practicality, favorable inter- and intrarater reliability following standardized training, content, and external validity. This study reflects potential for establishment of a new standard for quantification and comparison of oropharyngeal swallowing impairment across patient diagnoses as measured on MBSS. PMID:18855050

Users’ acceptance and attitude in regarding electronic medical record at central polyclinic of oil industry in Isfahan, Iran

PubMed Central

Tavakoli, Nahid; Shahin, Arash; Jahanbakhsh, Maryam; Mokhtari, Habibollah; Rafiei, Maryam

2013-01-01

Introduction: Simultaneous with the rapid changes in the technology and information systems, hospitals interest in using them. One of the most common systems in hospitals is electronic medical record (EMR) whose one of uses is providing better health care quality via health information technology. Prior to its use, attempts should be put to identifying factors affecting the acceptance, attitude and utilizing of this technology. The current article aimed to study the effective factors of EMR acceptance by technology acceptance model (TAM) at central polyclinic of Oil Industry in Isfahan. Materials and Methods: This was a practical, descriptive and regression study. The population research were all EMR users at polyclinic of Oil Industry in 2012 and its sampling was simple random with 62 users. The tool of data collection was a research-made questionnaire based on TAM. The validity of questionnaire has been assigned through the strategy of content validity and health information technology experts’ views and its reliability by test-retest. Findings: The system users have positive attitude toward using EMR (56.6%). Also, users are not very satisfied with effective external (38.14%) and behavioral factors (47.8%) upon using the system. Perceived ease-of-use (PEU) and perceived usefulness (PU) were at a good level. Conclusion: Lack of relative satisfaction with using of EMR derives from factors such as appearance, screen, data and information quality and terminology. In this study, it is suggested to improve the system and the efficiency of the users through software’ external factors development. So that PEU and users’ attitude to be changed and moved in positive manner. PMID:24524089

Baseline Assessment of 25-Hydroxyvitamin D Reference Material and Proficiency Testing/External Quality Assurance Material Commutability: A Vitamin D Standardization Program Study.

PubMed

Phinney, Karen W; Sempos, Christopher T; Tai, Susan S-C; Camara, Johanna E; Wise, Stephen A; Eckfeldt, John H; Hoofnagle, Andrew N; Carter, Graham D; Jones, Julia; Myers, Gary L; Durazo-Arvizu, Ramon; Miller, W Greg; Bachmann, Lorin M; Young, Ian S; Pettit, Juanita; Caldwell, Grahame; Liu, Andrew; Brooks, Stephen P J; Sarafin, Kurtis; Thamm, Michael; Mensink, Gert B M; Busch, Markus; Rabenberg, Martina; Cashman, Kevin D; Kiely, Mairead; Galvin, Karen; Zhang, Joy Y; Kinsella, Michael; Oh, Kyungwon; Lee, Sun-Wha; Jung, Chae L; Cox, Lorna; Goldberg, Gail; Guberg, Kate; Meadows, Sarah; Prentice, Ann; Tian, Lu; Brannon, Patsy M; Lucas, Robyn M; Crump, Peter M; Cavalier, Etienne; Merkel, Joyce; Betz, Joseph M

2017-09-01

The Vitamin D Standardization Program (VDSP) coordinated a study in 2012 to assess the commutability of reference materials and proficiency testing/external quality assurance materials for total 25-hydroxyvitamin D [25(OH)D] in human serum, the primary indicator of vitamin D status. A set of 50 single-donor serum samples as well as 17 reference and proficiency testing/external quality assessment materials were analyzed by participating laboratories that used either immunoassay or LC-MS methods for total 25(OH)D. The commutability test materials included National Institute of Standards and Technology Standard Reference Material 972a Vitamin D Metabolites in Human Serum as well as materials from the College of American Pathologists and the Vitamin D External Quality Assessment Scheme. Study protocols and data analysis procedures were in accordance with Clinical and Laboratory Standards Institute guidelines. The majority of the test materials were found to be commutable with the methods used in this commutability study. These results provide guidance for laboratories needing to choose appropriate reference materials and select proficiency or external quality assessment programs and will serve as a foundation for additional VDSP studies.

[Quantitative method for simultaneous assay of four coumarins with one marker in Fraxini Cortex].

PubMed

Feng, Weihong; Wang, Zhimin; Zhang, Qiwei; Liu, Limei; Wang, Jinyu; Yang, Fei

2011-07-01

To establish a new quantitative method for simultaneous determination of multi-coumarins in Fraxini Cortex by using one chemical reference substance, and validate its feasibilities. The new quality evaluation method, quantitative analysis of multi-components by singer-marker (QAMS), was established and validated with Fraxini Cortex. Four main coumarins were selected as analytes to evaluate the quality and their relative correlation factors (RCF) were determined by HPLC-DAD. Within the linear range, the values of RCF at 340 nm of aesculin to asculetin, fraxin and fraxetin were 1.771, 0.799, 1.409, respectively. And the contents of aesculin in samples of Fraxini Cortex were authentically determined by the external standard method, and the contents of the three other coumarins were calculated by their RCF. The contents of these four coumarins in all samples were also determined by the external standard method. Within a certain range, the RCF had a good reproducibility (RSD 2.5%-3.9%). Significant differences were not observed between the quantitative results of two methods. It is feasible and suitable to evaluate the quality of Fraxini Cortex and its Yinpian by QAMS.

External Quality Assessment for Zika Virus Molecular Diagnostic Testing, Brazil.

PubMed

Fischer, Carlo; Pedroso, Celia; Mendrone, Alfredo; Bispo de Filippis, Ana Maria; Vallinoto, Antonio Carlos Rosário; Ribeiro, Bergmann Morais; Durigon, Edison Luiz; Marques, Ernesto T A; Campos, Gubio S; Viana, Isabelle F T; Levi, José Eduardo; Scarpelli, Luciano Cesar; Nogueira, Mauricio Lacerda; Bastos, Michele de Souza; Souza, Nathalia C Santiago; Khouri, Ricardo; Lira, Sanny; Komninakis, Shirley Vasconcelos; Baronti, Cécile; Charrel, Rémi N; Kümmerer, Beate M; Drosten, Christian; Brites, Carlos; de Lamballerie, Xavier; Niedrig, Matthias; Netto, Eduardo Martins; Drexler, Jan Felix

2018-05-01

We conducted an external quality assessment of Zika virus molecular diagnostic tests in Brazil using a new Zika virus standard. Of 15 laboratories, 73% showed limited sensitivity and specificity. Viral load estimates varied significantly. Continuous quality assurance is needed to adequately estimate risk for Zika virus-associated disease and determine patient care.

Do nursing homes for older people have the support they need to provide end-of-life care? A mixed methods enquiry in England

PubMed Central

Seymour, Jane E; Kumar, Arun; Froggatt, Katherine

2011-01-01

Nursing homes are a common site of death, but older residents receive variable quality of end-of-life care. We used a mixed methods design to identify external influences on the quality of end-of-life care in nursing homes. Two qualitative case studies were conducted and a postal survey of 180 nursing homes surrounding the case study sites. In the case studies, qualitative interviews were held with seven members of nursing home staff and 10 external staff. Problems in accessing support for end-of-life care reported in the survey included variable support by general practitioners (GPs), reluctance among GPs to prescribe appropriate medication, lack of support from other agencies, lack of out of hours support, cost of syringe drivers and lack of access to training. Most care homes were implementing a care pathway. Those that were not rated their end-of-life care as in need of improvement or as average. The case studies suggest that critical factors in improving end-of-life care in nursing homes include developing clinical leadership, developing relationships with GPs, the support of ‘key’ external advocates and leverage of additional resources by adoption of care pathway tools. PMID:21282349

External quality assessment of malaria microscopy diagnosis in selected health facilities in Western Oromia, Ethiopia.

PubMed

Sori, Getachew; Zewdie, Olifan; Tadele, Geletta; Samuel, Abdi

2018-06-18

Accurate early diagnosis and prompt treatment are one of the key strategies to control and prevent malaria disease. External quality assessment is the most effective method for evaluation of the quality of malaria microscopy diagnosis. The aim of this study was to assess the quality of malaria microscopy diagnosis and its associated factors in selected public health facility laboratories in East Wollega Zone, Western Ethiopia. Facility-based cross-sectional study design was conducted in 30 randomly selected public health facility laboratories from November 2014 to January 2015 in East Wollega Zone, Western Ethiopia. Ten validated stained malaria panel slides with known Plasmodium species, developmental stage and parasite density were distributed. Data were captured; cleaned and analyzed using SPSS version 20 statistical software-multivariate logistic regressions and the agreement in reading between the peripheral diagnostic centers and the reference laboratory were done using kappa statistics. A total of 30 health facility laboratories were involved in the study and the overall quality of malaria microscopy diagnosis was poor (62.3%). The associated predictors of quality in this diagnosis were in-service training [(AOR = 16, 95% CI (1.3, 1.96)], smearing quality [(AOR = 24, 95% CI (1.8, 3.13)], staining quality [(AOR = 15, 95% CI (2.35, 8.61), parasite detection [(AOR = 9, 95% CI (1.1, 8.52)] and identification skills [(AOR = 8.6, 95% CI (1.21, 1.63)]. Eighteen (60%) of health facility laboratories had in-service trained laboratory professionals on malaria microscopy diagnosis. Overall quality of malaria microscopy diagnosis was poor and a significant gap in this service was observed that could impact on its diagnostic services.

Category 1 external quality assessment program for serum creatinine.

PubMed

González-Lao, Elisabet; Díaz-Garzón, Jorge; Corte, Zoraida; Ricós, Carmen; Perich, Carmen; Álvarez, Virtudes; Simón, Margarita; Minchinela, Joana; García-Lario, José Vicente; Boned, Beatriz; Biosca, Carmen; Cava, Fernando; Fernández-Fernández, Pilar; Fernández-Calle, Pilar

2017-03-01

The Commission of Analytical Quality and the Committee of External Quality Programs of Spanish Society of Laboratory Medicine (SEQC) in collaboration with the Dutch Foundation for the Quality organized the first national category 1 External Quality Assessment Programs (EQAP) pilot study. The aim is to evaluate the standardization of serum creatinine measurements in the Spanish laboratories through a category 1 external quality assurance program with commutable material and reference method assigned values. A total of 87 Spanish laboratories were involved in this program in 2015. Each day a sample control was measured by duplicate during 6 consecutive days. Percentage deviations and coefficients of variation obtained were compared with quality specifications derived from biological variation. A total of 1044 creatinine results were obtained. Laboratories were coded in 11 different method-traceability combinations. Only enzymatic methods get all results within the acceptability limits. To participate in a category 1 EQAP is a valuable tool to assess the standardization degree in our country; a big effort should be made to promote laboratories to change their procedures and to use enzymatic creatinine methods, in order to achieve a satisfactory standardization degree for this important analyte.

[Analysis of the results of the SEIMC External Quality Control Program. Year 2013].

PubMed

de Gopegui Bordes, Enrique Ruiz; Orta Mira, Nieves; Del Remedio Guna Serrano, M; Medina González, Rafael; Rosario Ovies, María; Poveda, Marta; Gimeno Cardona, Concepción

2015-07-01

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) include controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology, molecular microbiology and HIV-1, HCV and HBV viral loads. This manuscript presents the analysis of results obtained of the participants from the 2013 SEIMC External Quality Control Programme, except viral loads controls, that they are summarized in a manuscript abroad. As a whole, the results obtained in 2013 confirm the excellent skill and good technical standards found in previous editions. However, erroneous results can be obtained in any laboratory and in clinically relevant determinations. Once again, the results of this program highlighted the need to implement both internal and external controls in order to assure the maximal quality of the microbiological tests. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Influence of physical activity, sedentary behavior, and diet quality in childhood on the incidence of internalizing and externalizing disorders during adolescence: a population-based cohort study.

PubMed

Wu, XiuYun; Bastian, Kerry; Ohinmaa, Arto; Veugelers, Paul

2018-02-01

Studies among youth suggest that physical inactivity, sedentary behaviors, and poor diet quality are associated with poor mental health. Few population-based studies have investigated these relationships longitudinally. We examined the association between physical activity, sedentary behaviors, and diet quality in childhood and the incidence of internalizing and externalizing disorders throughout adolescence. We linked health behavior survey data from 2003 among 10- to 11-year-old children across Nova Scotia, Canada, with administrative health care data from 2003 to 2011. Students' diet quality was assessed using the Harvard Food Frequency Questionnaire. Physical activity and sedentary behaviors were self-reported, and internalizing and externalizing disorders were diagnosed by a physician. We applied Cox regression to examine the associations of the health behaviors with the incidence of internalizing and externalizing disorders between 2003 and 2011. Of the 4861 participating students, 23.7% and 9.4% had a diagnosis of internalizing and externalizing disorders, respectively. The incidences of internalizing and externalizing disorders were higher among students who were less physically active and spent more time using computers and video games. These findings suggest that promoting an active lifestyle in childhood may contribute to the prevention of both internalizing and externalizing disorders during adolescence. Copyright © 2017 Elsevier Inc. All rights reserved.

Evolving Relationship Structures in Multi-sourcing Arrangements: The Case of Mission Critical Outsourcing

NASA Astrophysics Data System (ADS)

Heitlager, Ilja; Helms, Remko; Brinkkemper, Sjaak

Information Technology Outsourcing practice and research mainly considers the outsourcing phenomenon as a generic fulfilment of the IT function by external parties. Inspired by the logic of commodity, core competencies and economies of scale; assets, existing departments and IT functions are transferred to external parties. Although the generic approach might work for desktop outsourcing, where standardisation is the dominant factor, it does not work for the management of mission critical applications. Managing mission critical applications requires a different approach where building relationships is critical. The relationships involve inter and intra organisational parties in a multi-sourcing arrangement, called an IT service chain, consisting of multiple (specialist) parties that have to collaborate closely to deliver high quality services.

Spiral Chip Implantable Radiator and Printed Loop External Receptor for RF Telemetry in Bio-Sensor Systems

NASA Technical Reports Server (NTRS)

Simons, Rainee N.; Hall, David G.; Miranda, Felix A.

2004-01-01

The paper describes the operation of a patented wireless RF telemetry system, consisting of a bio-MEMS implantable sensor and an external hand held unit, operating over the frequency range of few hundreds of MHz. A MEMS capacitive pressure sensor integrated with a miniature inductor/antenna together constitute the implantable sensor. Signal processing circuits collocated with a printed loop antenna together form the hand held unit, capable of inductively powering and also receiving the telemetry signals from the sensor. The paper in addition, demonstrates a technique to enhance the quality factor and inductance of the inductor in the presence of a lower ground plane and also presents the radiation characteristics of the loop antenna.

Determinants of Quality Perception in Educational Administration: Potential Conflict between the Requirements of Internal and External Customers.

ERIC Educational Resources Information Center

Galloway, R. L.; Wearn, Katrina

1998-01-01

Attempts to measure perceived quality, based on customers' views within the context of a (British) university faculty office, using a modified SERVQUAL instrument. Internal customers demonstrated that perceived quality is driven by task-focused issues, stressing clarity, accuracy, and reliability. External customers, whose usage is more casual,…

When Somebody's Watching: Researching the Workplace Impact of Academic Audit. AIR 2002 Forum Paper.

ERIC Educational Resources Information Center

Palermo, Josephine

The proposed quality assurance framework for higher education in Australia will, for the first time since the early 1990s, introduce a process of external quality monitoring through the auspices of the Australian Universities Quality Agency. There is little research that evaluates the impact of external monitoring on the experiences of staff,…

An Implementation of the Salt-Farm Monitoring System Using Wireless Sensor Network

NASA Astrophysics Data System (ADS)

Ju, Jonggil; Park, Ingon; Lee, Yongwoong; Cho, Jongsik; Cho, Hyunwook; Yoe, Hyun; Shin, Changsun

In producing solar salt, natural environmental factors such as temperature, humidity, solar radiation, wind direction, wind speed and rain are essential elements which influence on the productivity and quality of salt. If we can manage the above mentioned environmental elements efficiently, we could achieve improved results in production of salt with good quality. To monitor and manage the natural environments, this paper suggests the Salt-Farm Monitoring System (SFMS) which is operated with renewable energy power. The system collects environmental factors directly from the environmental measure sensors and the sensor nodes. To implement a stand-alone system, we applied solar cell and wind generator to operate this system. Finally, we showed that the SFMS could monitor the salt-farm environments by using wireless sensor nodes and operate correctly without external power supply.

[Pressing problems of labor hygiene and occupational pathology among office workers].

PubMed

Dudarev, A A; Sorokin, G A

2012-01-01

Northwest public health research center, Ministry of health and social affairs, St.-Petersburg. The article substantiates the conception of "office room", "office worker", estimates the basic diseases and symptoms among office workers (SBS-syndrome, BRI-illnesses, BRS-symptoms). Complex of indoor factors of office environment are analyzed, which influence the health status of personnel--indoor air quality (microclimate, aerosols, chemical, biological pollution, air ionization), external physical factors, ergonomics, intensity and tension of work, psychosocial factors. Comparison of Russian and foreign approaches to the hygienic estimation and rating of these factors was carried out. Owing to inadequacy of Russian hygienic rules to modern requirements, the necessity of working out of a complex of sanitary rules focused particularly on office workers is proved.

The psychosocial adjustment of African American youth from single mother homes: the relative contribution of parents and peers.

PubMed

Chester, Charlene; Jones, Deborah J; Zalot, Alecia; Sterrett, Emma

2007-01-01

This study examined the relative roles of parents and peers in the psychosocial adjustment of African American youth (7-15 years old) from single mother homes (N = 242). Main effects of both positive parenting and peer relationship quality were found for youth depressive symptoms. In addition, a main effect of peer relationship quality and an interaction of Positive Parenting x Peer Relationship Quality emerged for youth externalizing symptoms. When mothers engaged in higher levels of positive parenting behavior, peer relationship quality was not associated with youth externalizing symptomatology. When mothers engaged in lower levels of positive parenting behavior, however, higher peer relationship quality was associated with greater youth externalizing symptomatology. Clinical implications and future research directions are discussed.

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

PubMed

Korfali, Samira Ibrahim; Jurdi, Mey

2007-12-01

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

Development of Handling Qualities Criteria for Rotorcraft with Externally Slung Loads

NASA Technical Reports Server (NTRS)

Hoh, Roger H.; Heffley, Robert K.; Mitchell, David G.

2006-01-01

Piloted simulations were performed on the NASA-Ames Vertical Motion Simulator (VMS) to explore handling qualities issues for large cargo helicopters, particularly focusing on external slung load operations. The purpose of this work was based upon the need to include handling qualities criteria for cargo helicopters in an upgrade to the U.S. Army's rotorcraft handling qualities specification, Aeronautical Design Standard-33 (ADS-33E-PRF). From the VMS results, handling qualities criteria were developed fro cargo helicopters carrying external slung loads in the degraded visual environment (DVE). If satisfied, these criteria provide assurance that the handling quality rating (HQR) will be 4 or better for operations in the DVE, and with a load mass ratio of 0.33 or less. For lighter loads, flying qualities were found to be less dependent on the load geometry and therefore the significance of the criteria is less. For heavier loads, meeting the criteria ensures the best possible handling qualities, albeit Level 2 for load mass ratios greater than 0.33.

Does external evaluation of laboratories improve patient safety?

PubMed

Noble, Michael A

2007-01-01

Laboratory accreditation and External Quality Assessment (also called proficiency testing) are mainstays of laboratory quality assessment and performance. Both practices are associated with examples of improved laboratory performance. The relationship between laboratory performance and improved patient safety is more difficult to assess because of the many variables that are involved with patient outcome. Despite this difficulty, the argument to continue external evaluation of laboratories is too compelling to consider the alternative.

Off-axis spectral beam combining of Bragg reflection waveguide photonic crystal diode lasers

NASA Astrophysics Data System (ADS)

Sun, Fangyuan; Wang, Lijie; Zhao, Yufei; Hou, Guanyu; Shu, Shili; Zhang, Jun; Peng, Hangyu; Tian, Sicong; Tong, Cunzhu; Wang, Lijun

2018-06-01

The spectral beam combining (SBC) of Bragg reflection waveguide photonic crystal (BRW-PC) diode lasers was studied for the first time. An off-axis feedback system was constructed using a stripe mirror and a spatial filter to control beam quality in the external cavity. It was found that the BRW-PC diode lasers with a low divergence and a circular beam provided a simplified and cost-effective SBC. The off-axis feedback broke the beam quality limit of a single element, and an M 2 factor of 3.8 times lower than that of a single emitter in the slow axis was demonstrated.

Determinants of seafarers' fatigue: a systematic review and quality assessment.

PubMed

Dohrmann, Solveig Boeggild; Leppin, Anja

2017-01-01

Fatigue jeopardizes seafarer's health and safety. Thus, knowledge on determinants of fatigue is of great importance to facilitate its prevention. However, a systematic analysis and quality assessment of all empirical evidence specifically for fatigue are still lacking. The aim of the present article was therefore to systematically detect, analyze and assess the quality of this evidence. Systematic searches in ten databases were performed. Searches considered articles published in scholarly journals from 1980 to April 15, 2016. Nineteen out of 98 eligible studies were included in the review. The main reason for exclusion was fatigue not being the outcome variable. Most evidence was available for work time-related factors suggesting that working nights was most fatiguing, that fatigue levels were higher toward the end of watch or shift, and that the 6-h on-6-h off watch system was the most fatiguing. Specific work demands and particularly the psychosocial work environment have received little attention, but preliminary evidence suggests that stress may be an important factor. A majority of 12 studies were evaluated as potentially having a high risk of bias. Realistic countermeasures ought to be established, e.g., in terms of shared or split night shifts. As internal as well as external validity of many study findings was limited, the range of factors investigated was insufficient and few studies investigated more complex interactions between different factors, knowledge derived from studies of high methodological quality investigating different factors, including psychosocial work environments, are needed to support future preventive programs.

Development and validity of a scale to measure workplace culture of health.

PubMed

Kwon, Youngbum; Marzec, Mary L; Edington, Dee W

2015-05-01

To describe the development of and test the validity and reliability of the Workplace Culture of Health (COH) scale. Exploratory factor analysis and confirmatory factor analysis were performed on data from a health care organization (N = 627). To verify the factor structure, confirmatory factor analysis was performed on a second data set from a medical equipment manufacturer (N = 226). The COH scale included a structure of five orthogonal factors: senior leadership and polices, programs and rewards, quality assurance, supervisor support, and coworker support. With regard to construct validity (convergent and discriminant) and reliability, two different US companies showed the same factorial structure, satisfactory fit statistics, and suitable internal and external consistency. The COH scale represents a reliable and valid scale to assess the workplace environment and culture for supporting health.

No objectively measured sleep disturbances in children with attention-deficit/hyperactivity disorder.

PubMed

Bergwerff, Catharina E; Luman, Marjolein; Oosterlaan, Jaap

2016-10-01

The main goal of this study was to gain more insight into sleep disturbances in children with attention-deficit/hyperactivity disorder, using objective measures of sleep quality and quantity. The evidence for sleep problems in children with attention-deficit/hyperactivity disorder thus far is inconsistent, which might be explained by confounding influences of comorbid internalizing and externalizing problems and low socio-economic status. We therefore investigated the mediating and moderating role of these factors in the association between attention-deficit/hyperactivity disorder and sleep problems. To control for the effects of stimulant medication use, all participants were tested free of medication. Sixty-three children with attention-deficit/hyperactivity disorder and 61 typically developing children, aged 6-13 years, participated. Sleep was monitored for one to three school nights using actigraphy. Parent and teacher questionnaires assessed symptoms of attention-deficit/hyperactivity disorder, internalizing behaviour, oppositional defiant disorder and conduct disorder. Results showed no differences between the attention-deficit/hyperactivity disorder and typically developing group in any sleep parameter. Within the attention-deficit/hyperactivity disorder group, severity of attention-deficit/hyperactivity disorder symptoms was not related to sleep quality or quantity. Moderation analyses in the attention-deficit/hyperactivity disorder group showed an interaction effect between attention-deficit/hyperactivity disorder symptoms and internalizing and externalizing behaviour on total sleep time, time in bed and average sleep bout duration. The results of our study suggest that having attention-deficit/hyperactivity disorder is not a risk factor for sleep problems. Internalizing and externalizing behaviour moderate the association between attention-deficit/hyperactivity disorder and sleep, indicating a complex interplay between psychiatric symptoms and sleep. © 2016 European Sleep Research Society.

Out-of-Field Dose Equivalents Delivered by Passively Scattered Therapeutic Proton Beams for Clinically Relevant Field Configurations

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

Wroe, Andrew; Centre for Medical Radiation Physics, University of Wollongong, Wollongong; Clasie, Ben

2009-01-01

Purpose: Microdosimetric measurements were performed at Massachusetts General Hospital, Boston, MA, to assess the dose equivalent external to passively delivered proton fields for various clinical treatment scenarios. Methods and Materials: Treatment fields evaluated included a prostate cancer field, cranial and spinal medulloblastoma fields, ocular melanoma field, and a field for an intracranial stereotactic treatment. Measurements were completed with patient-specific configurations of clinically relevant treatment settings using a silicon-on-insulator microdosimeter placed on the surface of and at various depths within a homogeneous Lucite phantom. The dose equivalent and average quality factor were assessed as a function of both lateral displacement frommore » the treatment field edge and distance downstream of the beam's distal edge. Results: Dose-equivalent value range was 8.3-0.3 mSv/Gy (2.5-60-cm lateral displacement) for a typical prostate cancer field, 10.8-0.58 mSv/Gy (2.5-40-cm lateral displacement) for the cranial medulloblastoma field, 2.5-0.58 mSv/Gy (5-20-cm lateral displacement) for the spinal medulloblastoma field, and 0.5-0.08 mSv/Gy (2.5-10-cm lateral displacement) for the ocular melanoma field. Measurements of external field dose equivalent for the stereotactic field case showed differences as high as 50% depending on the modality of beam collimation. Average quality factors derived from this work ranged from 2-7, with the value dependent on the position within the phantom in relation to the primary beam. Conclusions: This work provides a valuable and clinically relevant comparison of the external field dose equivalents for various passively scattered proton treatment fields.« less

Voice quality after treatment of early vocal cord cancer: a randomized trial comparing laser surgery with radiation therapy.

PubMed

Aaltonen, Leena-Maija; Rautiainen, Noora; Sellman, Jaana; Saarilahti, Kauko; Mäkitie, Antti; Rihkanen, Heikki; Laranne, Jussi; Kleemola, Leenamaija; Wigren, Tuija; Sala, Eeva; Lindholm, Paula; Grenman, Reidar; Joensuu, Heikki

2014-10-01

Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial. Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO2 laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks. Voice quality was assessed at baseline and 6 and 24 months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living. Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment. Three patients in each group had local cancer recurrence within 2 years from randomization. Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option. Copyright © 2014 Elsevier Inc. All rights reserved.

Voice Quality After Treatment of Early Vocal Cord Cancer: A Randomized Trial Comparing Laser Surgery With Radiation Therapy

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

Aaltonen, Leena-Maija, E-mail: leena-maija.aaltonen@hus.fi; Rautiainen, Noora; Sellman, Jaana

Objective: Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial. Methods and Materials: Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO{sub 2} laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks. Voice quality wasmore » assessed at baseline and 6 and 24 months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living. Results: Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment. Three patients in each group had local cancer recurrence within 2 years from randomization. Conclusions: Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option.« less

Effect of training and level of external auditory feedback on the singing voice: volume and quality

PubMed Central

Bottalico, Pasquale; Graetzer, Simone; Hunter, Eric J.

2015-01-01

Background Previous research suggests that classically trained professional singers rely not only on external auditory feedback but also on proprioceptive feedback associated with internal voice sensitivities. Objectives The Lombard Effect in singers and the relationship between Sound Pressure Level (SPL) and external auditory feedback was evaluated for professional and non-professional singers. Additionally, the relationship between voice quality, evaluated in terms of Singing Power Ratio (SPR), and external auditory feedback, level of accompaniment, voice register and singer gender was analyzed. Methods The subjects were 10 amateur or beginner singers, and 10 classically-trained professional or semi-professional singers (10 males and 10 females). Subjects sang an excerpt from the Star-spangled Banner with three different levels of the accompaniment, 70, 80 and 90 dBA, and with three different levels of external auditory feedback. SPL and the SPR were analyzed. Results The Lombard Effect was stronger for non-professional singers than professional singers. Higher levels of external auditory feedback were associated with a reduction in SPL. As predicted, the mean SPR was higher for professional than non-professional singers. Better voice quality was detected in the presence of higher levels of external auditory feedback. Conclusions With an increase in training, the singer’s reliance on external auditory feedback decreases. PMID:26186810

Effect of Training and Level of External Auditory Feedback on the Singing Voice: Volume and Quality.

PubMed

Bottalico, Pasquale; Graetzer, Simone; Hunter, Eric J

2016-07-01

Previous research suggests that classically trained professional singers rely not only on external auditory feedback but also on proprioceptive feedback associated with internal voice sensitivities. The Lombard effect and the relationship between sound pressure level (SPL) and external auditory feedback were evaluated for professional and nonprofessional singers. Additionally, the relationship between voice quality, evaluated in terms of singing power ratio (SPR), and external auditory feedback, level of accompaniment, voice register, and singer gender was analyzed. The subjects were 10 amateur or beginner singers and 10 classically trained professional or semiprofessional singers (10 men and 10 women). Subjects sang an excerpt from the Star-Spangled Banner with three different levels of the accompaniment, 70, 80, and 90 dBA and with three different levels of external auditory feedback. SPL and SPR were analyzed. The Lombard effect was stronger for nonprofessional singers than professional singers. Higher levels of external auditory feedback were associated with a reduction in SPL. As predicted, the mean SPR was higher for professional singers than nonprofessional singers. Better voice quality was detected in the presence of higher levels of external auditory feedback. With an increase in training, the singer's reliance on external auditory feedback decreases. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Quality of life and satisfaction with information after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy: a long-term follow-up study.

PubMed

Nicolaisen, Marianne; Müller, Stig; Patel, Hitendra R H; Hanssen, Tove Aminda

2014-12-01

To assess patients' symptoms, quality of life and satisfaction with information three to four years after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy and to analyse differences between treatment groups and the relationship between disease-specific, health-related and overall quality of life and satisfaction with information. Radical prostate cancer treatments are associated with changes in quality of life. Differences between patients undergoing different treatments in symptoms and quality of life have been reported, but there are limited long-term data comparing radical prostatectomy with radical external beam radiotherapy and postoperative radiotherapy. A cross-sectional survey design was used. The study sample included 143 men treated with radical prostatectomy and/or radical external beam radiotherapy. Quality of life was measured using the 12-item Short Form Health Survey and the 50-item Expanded Prostate Cancer Index Composite Instrument. Questions assessing overall Quality of life and satisfaction with information were included. Descriptive statistics and interference statistical methods were applied to analyse the data. Radical external beam radiotherapy was associated with less urinary incontinence and better urinary function. There were no differences between the groups for disease-specific quality of life sum scores. Sexual quality of life was reported very low in all groups. Disease-specific quality of life and health-related quality of life were associated with overall quality of life. Patients having undergone surgery were more satisfied with information, and there was a positive correlation between quality of life and patient satisfaction. Pretreatment information and patient education lead to better quality of life and satisfaction. This study indicates a need for structured, pretreatment information and follow-up for all men going through radical prostate cancer treatment. Long-term quality of life effects should be considered when planning follow-up and information for men after radical prostate cancer treatment. Structured and organised information/education may increase preparedness for symptoms and bother after the treatment, improve symptom management strategies and result in improved quality of life. © 2014 John Wiley & Sons Ltd.

Separation, identification, quantification, and method validation of anthocyanins in botanical supplement raw materials by HPLC and HPLC-MS.

PubMed

Chandra, A; Rana, J; Li, Y

2001-08-01

A method has been established and validated for identification and quantification of individual, as well as total, anthocyanins by HPLC and LC/ES-MS in botanical raw materials used in the herbal supplement industry. The anthocyanins were separated and identified on the basis of their respective M(+) (cation) using LC/ES-MS. Separated anthocyanins were individually calculated against one commercially available anthocyanin external standard (cyanidin-3-glucoside chloride) and expressed as its equivalents. Amounts of each anthocyanin calculated as external standard equivalent were then multiplied by a molecular-weight correction factor to afford their specific quantities. Experimental procedures and use of a molecular-weight correction factors are substantiated and validated using Balaton tart cherry and elderberry as templates. Cyanidin-3-glucoside chloride has been widely used in the botanical industry to calculate total anthocyanins. In our studies on tart cherry and elderberry, its use as external standard followed by use of molecular-weight correction factors should provide relatively accurate results for total anthocyanins, because of the presence of cyanidin as their major anthocyanidin backbone. The method proposed here is simple and has a direct sample preparation procedure without any solid-phase extraction. It enables selection and use of commercially available anthocyanins as external standards for quantification of specific anthocyanins in the sample matrix irrespective of their commercial availability as analytical standards. It can be used as a template and applied for similar quantification in several anthocyanin-containing raw materials for routine quality control procedures, thus providing consistency in analytical testing of botanical raw materials used for manufacturing efficacious and true-to-the-label nutritional supplements.

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

ERIC Educational Resources Information Center

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

2012-01-01

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

First External Evaluations of Quality Assurance Agencies--Lessons Learned. ENQA Workshop Report 10

ERIC Educational Resources Information Center

Costes, Nathalie; Curvale, Bruno; Kraft, Michael G.; Llavori, Rafael; Malan, Thierry; Szanto, Tibor

2010-01-01

This report is a product of an ENQA (European Association for Quality Assurance in Higher Education) seminar on the first external evaluations of quality assurance agencies, held in Paris in July 2008. The seminar took stock of the achieved reviews of agencies to learn lessons from these first outcomes and, hence, provided a platform for…

Child Diurnal Cortisol Rhythms, Parenting Quality, and Externalizing Behaviors in Preadolescence

PubMed Central

Martin, Christina Gamache; Kim, Hyoun K.; Bruce, Jacqueline; Fisher, Philip A.

2014-01-01

This study examined a neurobiologically–informed model of the emergence of child externalizing behaviors in an ethnically diverse community sample of 232 9–12 year old children. Replicating extensive prior research, our analyses revealed that parents’ inconsistent discipline and poor quality monitoring were predictive of child externalizing behavior. In addition, poor parental monitoring, but not inconsistent discipline, was associated with children having a significantly flatter morning–to–evening cortisol slope, which was in turn, related to higher levels of externalizing behaviors. An indirect effect of parental monitoring on externalizing behaviors, through child diurnal cortisol rhythms, was also supported. These findings highlight the role of the hypothalamic–pituitary–adrenal (HPA) axis and its hormonal end product, cortisol, in the relationship between the caregiving environment and the development of externalizing behaviors. PMID:24485489

Egg shell quality in Japanese quail: characteristics, heritabilities and genetic and phenotypic relationships.

PubMed

Narinc, D; Aygun, A; Karaman, E; Aksoy, T

2015-07-01

The objective of the present study was to estimate heritabilities as well as genetic and phenotypic correlations for egg weight, specific gravity, shape index, shell ratio, egg shell strength, egg length, egg width and shell weight in Japanese quail eggs. External egg quality traits were measured on 5864 eggs of 934 female quails from a dam line selected for two generations. Within the Bayesian framework, using Gibbs Sampling algorithm, a multivariate animal model was applied to estimate heritabilities and genetic correlations for external egg quality traits. The heritability estimates for external egg quality traits were moderate to high and ranged from 0.29 to 0.81. The heritability estimates for egg and shell weight of 0.81 and 0.76 were fairly high. The genetic and phenotypic correlations between egg shell strength with specific gravity, shell ratio and shell weight ranging from 0.55 to 0.79 were relatively high. It can be concluded that it is possible to determine egg shell quality using the egg specific gravity values utilizing its high heritability and fairly high positive correlation with most of the egg shell quality traits. As a result, egg specific gravity may be the choice of selection criterion rather than other external egg traits for genetic improvement of egg shell quality in Japanese quails.

Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis.

PubMed

Asker, Martin; Brooke, Hannah L; Waldén, Markus; Tranaeus, Ulrika; Johansson, Fredrik; Skillgate, Eva; Holm, Lena W

2018-03-26

To assess the evidence for risk factors and prevention measures for shoulder injuries in overhead sports. Systematic review with best-evidence synthesis. Medline (Ovid), PubMed (complementary search), Embase (Elsevier), Cochrane (Wiley), SPORTDiscus (Ebsco) and Web of Science Core Collection (Thomson Reuters), from 1 January 1990 to 15 May 2017. Randomised controlled trials, cohort studies and case-control studies on risk factors or prevention measures for shoulder injuries in overhead sports. The eligible studies were quality assessed using the Scottish Intercollegiate Guidelines Network criteria. Of 4778 studies identified, 38 were eligible for quality review and 17 met the quality criteria to be included in the evidence synthesis. One additional quality study presented a shoulder injury prevention programme. Most studies focused on baseball, lacrosse or volleyball (n=13). The risk factors examined included participation level (competition vs training) (n=10), sex (n=4), biomechanics (n=2) and external workload (n=2). The evidence for all risk factors was limited or conflicting. The effect of the prevention programme within the subgroup of uninjured players at baseline was modest and possibly lacked statistical power. All investigated potential risk factors for shoulder injury in overhead sports had limited evidence, and most were non-modifiable (eg, sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports. CRD42015026850. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Examining extrinsic factors that influence product acceptance: a review.

PubMed

Li, X E; Jervis, S M; Drake, M A

2015-05-01

Drivers of liking (DOL) studies are useful for product development to formulate acceptable products; however, DOL alone are insufficient for understanding why a product is purchased and repurchased, which is ultimately the indication of a successful product. Ultimately sensory attributes drive product success (that is, repeat and continued purchase). However, ignoring the importance of extrinsic factors may neglect the vital product attributes responsible for the initial purchase, which may in turn, affect repeat purchase. The perception of sensory attributes assessed by DOL is mitigated by external perceptions of quality. If the sensory attributes do not deliver based upon the quality cues, the product will not be acceptable. Four key extrinsic factors that affect DOL are the perceived satiety, brand and labeling, price, and the emotional impact to decision making. In order to more thoroughly understand what the DOL for a product is, these 4 product cues should be considered in conjunction with sensory attribute perception to gain a holistic understanding of product acceptance. © 2015 Institute of Food Technologists®

Clinical governance: bridging the gap between managerial and clinical approaches to quality of care

PubMed Central

Buetow, S. A.; Roland, M.

1999-01-01

Clinical governance has been introduced as a new approach to quality improvement in the UK national health service. This article maps clinical governance against a discussion of the four main approaches to measuring and improving quality of care: quality assessment, quality assurance, clinical audit, and quality improvement (including continuous quality improvement). Quality assessment underpins each approach. Whereas clinical audit has, in general, been professionally led, managers have driven quality improvement initiatives. Quality assurance approaches have been perceived to be externally driven by managers or to involve professional inspection. It is discussed how clinical governance seeks to bridge these approaches. Clinical governance allows clinicians in the UK to lead a comprehensive strategy to improve quality within provider organisations, although with an expectation of greatly increased external accountability. Clinical governance aims to bring together managerial, organisational, and clinical approaches to improving quality of care. If successful, it will define a new type of professionalism for the next century. Failure by the professions to seize the opportunity is likely to result in increasingly detailed external control of clinical activity in the UK, as has occurred in some other countries. PMID:10847876

Improvement of coagulation laboratory practice in Thailand: the first-year experience of the national external quality assessment scheme for blood coagulation.

PubMed

Tientadakul, Panutsaya; Opartkiattikul, Nisarat; Wongtiraporn, Wanida

2009-01-01

In Thailand until 2005 there had been no external quality assessment scheme at the national level for blood coagulation tests. Only a few laboratories had an external quality assessment for these tests. In the year 2005, the Thailand National External Quality Assessment Scheme for Blood Coagulation was founded. To describe the establishment of the Thailand National External Quality Assessment Scheme for Blood Coagulation (including problems encountered and solutions), its progression and expansion, and the improvement of coagulation laboratory practice in Thailand during 2 trial surveys and 4 formal surveys conducted in the first 1 1/2 years. Between 2005 and 2006, the external quality assessment samples for prothrombin time/international normalized ratio and activated partial thromboplastin time were distributed to the participants as well as the instructions and suggestions for the improvement of laboratory practice. From the data collected, the all-method coefficient of variation of the international normalized ratio and activated partial thromboplastin time was calculated for each survey. The number of participants increased during the first 1 1/2 years that the surveys were conducted, from 109 to 127. Survey data demonstrate an improvement in response rate and an increase in the number of laboratories that determine their own reference ranges and repeat this for every change of reagent lot, using the appropriate anticoagulant. The increased precision of tests is indicated by the decrease of the all-method coefficient of variation of the international normalized ratio and activated partial thromboplastin time. Examples of individual laboratory improvement through feedback are also described. The improvement of coagulation laboratory practice both through the instructions provided and liaison with participants was observed during the course of this scheme.

Service employees give as they get: internal service as a moderator of the service climate-service outcomes link.

PubMed

Ehrhart, Karen Holcombe; Witt, L A; Schneider, Benjamin; Perry, Sara Jansen

2011-03-01

We lend theoretical insight to the service climate literature by exploring the joint effects of branch service climate and the internal service provided to the branch (the service received from corporate units to support external service delivery) on customer-rated service quality. We hypothesized that service climate is related to service quality most strongly when the internal service quality received is high, providing front-line employees with the capability to deliver what the service climate motivates them to do. We studied 619 employees and 1,973 customers in 36 retail branches of a bank. We aggregated employee perceptions of the internal service quality received from corporate units and the local service climate and external customer perceptions of service quality to the branch level of analysis. Findings were consistent with the hypothesis that high-quality internal service is necessary for branch service climate to yield superior external customer service quality. PsycINFO Database Record (c) 2011 APA, all rights reserved.

User satisfaction with primary health care by region in Brazil: 1st cycle of external evaluation from PMAQ-AB.

PubMed

Protasio, Ane Polline Lacerda; Gomes, Luciano Bezerra; Machado, Liliane Dos Santos; Valença, Ana Maria Gondim

2017-06-01

The National Program for Access and Quality Improvement in Primary Care (Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, PMAQ-AB) aimed to improve healthcare public service quality and satisfaction of health service users. This study's objective was to identify the main factors influencing user satisfaction with primary care (PC) services by region in Brazil. Using secondary data from the 1st Cycle of PMAQ-AB, logistic regression models were developed by region, with user satisfaction as the dependent variable, as defined by cluster analysis. Based on the obtained models, the health unit's ability to solve users' problems and feeling respected by the health providers were the most important factors for user satisfaction in all regions in Brazil. However, other important factors by region included the following: the health unit's hours of operation meeting the user's needs (Northeast); providers asking about family members (North); providers asking about other health needs (Midwest); users being seen without an appointment (South); and users asking questions after the appointment (Southeast). In conclusion, the factors influencing user satisfaction with PC vary according to region and are mainly associated with access quality, meeting users' needs, and work process organization.

Database Quality and Access Issues Relevant to Research Using Anesthesia Information Management System Data.

PubMed

Epstein, Richard H; Dexter, Franklin

2018-07-01

For this special article, we reviewed the computer code, used to extract the data, and the text of all 47 studies published between January 2006 and August 2017 using anesthesia information management system (AIMS) data from Thomas Jefferson University Hospital (TJUH). Data from this institution were used in the largest number (P = .0007) of papers describing the use of AIMS published in this time frame. The AIMS was replaced in April 2017, making this finite sample finite. The objective of the current article was to identify factors that made TJUH successful in publishing anesthesia informatics studies. We examined the structured query language used for each study to examine the extent to which databases outside of the AIMS were used. We examined data quality from the perspectives of completeness, correctness, concordance, plausibility, and currency. Our results were that most could not have been completed without external database sources (36/47, 76.6%; P = .0003 compared with 50%). The operating room management system was linked to the AIMS and was used significantly more frequently (26/36, 72%) than other external sources. Access to these external data sources was provided, allowing exploration of data quality. The TJUH AIMS used high-resolution timestamps (to the nearest 3 milliseconds) and created audit tables to track changes to clinical documentation. Automatic data were recorded at 1-minute intervals and were not editable; data cleaning occurred during analysis. Few paired events with an expected order were out of sequence. Although most data elements were of high quality, there were notable exceptions, such as frequent missing values for estimated blood loss, height, and weight. Some values were duplicated with different units, and others were stored in varying locations. Our conclusions are that linking the TJUH AIMS to the operating room management system was a critical step in enabling publication of multiple studies using AIMS data. Access to this and other external databases by analysts with a high degree of anesthesia domain knowledge was necessary to be able to assess the quality of the AIMS data and ensure that the data pulled for studies were appropriate. For anesthesia departments seeking to increase their academic productivity using their AIMS as a data source, our experiences may provide helpful guidance.

Understanding mother-adolescent conflict discussions: Concurrent and across-time prediction from youths’ dispositions and parenting

PubMed Central

2008-01-01

Adolescence is often thought of as a period during which the quality of parent–child interactions can be relatively stressed and conflictual. There are individual differences in this regard, however, with only a modest percent of youths experiencing extremely conflictual relationships with their parents. Nonetheless, there is relatively little empirical research on factors in childhood or adolescence that predict individual differences in the quality of parent–adolescent interactions when dealing with potentially conflictual issues. Understanding such individual differences is critical because the quality of both parenting and the parent–adolescent relationship is predictive of a range of developmental outcomes for adolescents. The goals of the research were to examine dispositional and parenting predictors of the quality of parents’ and their adolescent children’s emotional displays (anger, positive emotion) and verbalizations (negative or positive) when dealing with conflictual issues, and if prediction over time supported continuity versus discontinuity in the factors related to such conflict. We hypothesized that adolescents’ and parents’ conflict behaviors would be predicted by both childhood and concurrent parenting and child dispositions (and related problem behaviors) and that we would find evidence of both parent- and child-driven pathways. Mothers and adolescents (N = 126, M age = 13 years) participated in a discussion of conflictual issues. A multimethod, multireporter (mother, teacher, and sometimes adolescent reports) longitudinal approach (over 4 years) was used to assess adolescents’ dispositional characteristics (control/regulation, resiliency, and negative emotionality), youths’ externalizing problems, and parenting variables (warmth, positive expressivity, discussion of emotion, positive and negative family expressivity). Higher quality conflict reactions (i.e., less negative and/or more positive) were related to both concurrent and antecedent measures of children’s dispositional characteristics and externalizing problems, with findings for control/regulation and negative emotionality being much more consistent for daughters than sons. Higher quality conflict reactions were also related to higher quality parenting in the past, positive rather than negative parent–child interactions during a contemporaneous nonconflictual task, and reported intensity of conflict in the past month. In growth curves, conflict quality was primarily predicted by the intercept (i.e., initial levels) of dispositional measures and parenting, although maintenance or less decrement in positive parenting, greater decline in child externalizing problems, and a greater increase in control/regulation over time predicted more desirable conflict reactions. In structural equation models in which an aspect of parenting and a child dispositional variable were used to predict conflict reactions, there was continuity of both type of predictors, parenting was a unique predictor of mothers’ (but not adolescents’) conflict reactions (and sometimes mediated the relations of child dispositions to conflict reactions), and child dispositions uniquely predicted adolescents’ reactions and sometimes mothers’ conflict reactions. The findings suggest that parent–adolescent conflict may be influenced by both child characteristics and quality of prior and concurrent parenting, and that in this pattern of relations, child effects are more evident than parent effects. PMID:18702792

Understanding mother-adolescent conflict discussions: concurrent and across-time prediction from youths' dispositions and parenting.

PubMed

Eisenberg, Nancy; Hofer, Claire; Spinrad, Tracy L; Gershoff, Elizabeth T; Valiente, Carlos; Losoya, Sandra H; Zhou, Qing; Cumberland, Amanda; Liew, Jeffrey; Reiser, Mark; Maxon, Elizabeth

2008-01-01

Adolescence is often thought of as a period during which the quality of parent-child interactions can be relatively stressed and conflictual. There are individual differences in this regard, however, with only a modest percent of youths experiencing extremely conflictual relationships with their parents. Nonetheless, there is relatively little empirical research on factors in childhood or adolescence that predict individual differences in the quality of parent-adolescent interactions when dealing with potentially conflictual issues. Understanding such individual differences is critical because the quality of both parenting and the parent-adolescent relationship is predictive of a range of developmental outcomes for adolescents. The goals of the research were to examine dispositional and parenting predictors of the quality of parents' and their adolescent children's emotional displays (anger, positive emotion) and verbalizations (negative or positive) when dealing with conflictual issues, and if prediction over time supported continuity versus discontinuity in the factors related to such conflict. We hypothesized that adolescents' and parents' conflict behaviors would be predicted by both childhood and concurrent parenting and child dispositions (and related problem behaviors) and that we would find evidence of both parent- and child-driven pathways. Mothers and adolescents (N5126, M age513 years) participated in a discussion of conflictual issues. A multimethod, multireporter (mother, teacher, and sometimes adolescent reports) longitudinal approach (over 4 years) was used to assess adolescents' dispositional characteristics (control/ regulation, resiliency, and negative emotionality), youths' externalizing problems, and parenting variables (warmth, positive expressivity, discussion of emotion, positive and negative family expressivity). Higher quality conflict reactions (i.e., less negative and/or more positive) were related to both concurrent and antecedent measures of children's dispositional characteristics and externalizing problems, with findings for control/regulation and negative emotionality being much more consistent for daughters than sons. Higher quality conflict reactions were also related to higher quality parenting in the past, positive rather than negative parent-child interactions during a contemporaneous nonconflictual task, and reported intensity of conflict in the past month. In growth curves, conflict quality was primarily predicted by the intercept (i.e., initial levels) of dispositional measures and parenting, although maintenance or less decrement in positive parenting, greater decline in child externalizing problems, and a greater increase in control/regulation over time predicted more desirable conflict reactions. In structural equation models in which an aspect of parenting and a child dispositional variable were used to predict conflict reactions, there was continuity of both type of predictors, parenting was a unique predictor of mothers' (but not adolescents') conflict reactions (and sometimes mediated the relations of child dispositions to conflict reactions), and child dispositions uniquely predicted adolescents' reactions and sometimes mothers' conflict reactions. The findings suggest that parent-adolescent conflict may be influenced by both child characteristics and quality of prior and concurrent parenting, and that in this pattern of relations, child effects are more evident than parent effects.

The relation of respiratory sinus arrhythmia to later shyness: Moderation by neighborhood quality.

PubMed

Zhang, Hui; Spinrad, Tracy L; Eisenberg, Nancy; Zhang, Linlin

2018-05-21

The purpose of the study was to predict young children's shyness from both internal/biological (i.e., resting respiratory sinus arrhythmia; RSA) and external (i.e., neighborhood quality) factors. Participants were 180 children at 42 (Time 1; T1), 72 (T2), and 84 (T3) months of age. RSA data were obtained at T1 during a neutral film in the laboratory. Mothers reported perceived neighborhood quality at T2 and children's dispositional shyness at T1 and T3. Path analyses indicated that resting RSA interacted with neighborhood quality to predict T3 shyness, even after controlling for earlier family income and T1 shyness. Specifically, high levels of resting RSA predicted low levels of shyness in the context of high neighborhood quality. When neighborhood quality was low, resting RSA was positively related to later shyness. These findings indicate that children's shyness is predicted by more than biological processes and that consideration of the broader context is critical to understanding children's social behavior. © 2018 Wiley Periodicals, Inc.

Biomarker discovery study design for type 1 diabetes in The Environmental Determinants of Diabetes in the Young (TEDDY) study.

PubMed

Lee, Hye-Seung; Burkhardt, Brant R; McLeod, Wendy; Smith, Susan; Eberhard, Chris; Lynch, Kristian; Hadley, David; Rewers, Marian; Simell, Olli; She, Jin-Xiong; Hagopian, Bill; Lernmark, Ake; Akolkar, Beena; Ziegler, Anette G; Krischer, Jeffrey P

2014-07-01

The Environmental Determinants of Diabetes in the Young planned biomarker discovery studies on longitudinal samples for persistent confirmed islet cell autoantibodies and type 1 diabetes using dietary biomarkers, metabolomics, microbiome/viral metagenomics and gene expression. This article describes the details of planning The Environmental Determinants of Diabetes in the Young biomarker discovery studies using a nested case-control design that was chosen as an alternative to the full cohort analysis. In the frame of a nested case-control design, it guides the choice of matching factors, selection of controls, preparation of external quality control samples and reduction of batch effects along with proper sample allocation. Our design is to reduce potential bias and retain study power while reducing the costs by limiting the numbers of samples requiring laboratory analyses. It also covers two primary end points (the occurrence of diabetes-related autoantibodies and the diagnosis of type 1 diabetes). The resulting list of case-control matched samples for each laboratory was augmented with external quality control samples. Copyright © 2013 John Wiley & Sons, Ltd.

Interannual and long-term changes in the trophic state of a multibasin lake: Effects of morphology, climate, winter aeration, and beaver activity

USGS Publications Warehouse

Robertson, Dale M.; Rose, William; Reneau, Paul C.

2016-01-01

Little St. Germain Lake (LSG), a relatively pristine multibasin lake in Wisconsin, USA, was examined to determine how morphologic (internal), climatic (external), anthropogenic (winter aeration), and natural (beaver activity) factors affect the trophic state (phosphorus, P; chlorophyll, CHL; and Secchi depth, SD) of each of its basins. Basins intercepting the main flow and external P sources had highest P and CHL and shallowest SD. Internal loading in shallow, polymictic basins caused P and CHL to increase and SD to decrease as summer progressed. Winter aeration used to eliminate winterkill increased summer internal P loading and decreased water quality, while reductions in upstream beaver impoundments had little effect on water quality. Variations in air temperature and precipitation affected each basin differently. Warmer air temperatures increased productivity throughout the lake and decreased clarity in less eutrophic basins. Increased precipitation increased P in the basins intercepting the main flow but had little effect on the isolated deep West Bay. These relations are used to project effects of future climatic changes on LSG and other temperate lakes.

Child diurnal cortisol rhythms, parenting quality, and externalizing behaviors in preadolescence.

PubMed

Martin, Christina Gamache; Kim, Hyoun K; Bruce, Jacqueline; Fisher, Philip A

2014-02-01

This study examined a neurobiologically informed model of the emergence of child externalizing behaviors in an ethnically diverse community sample of 232 9-12 year old children. Replicating extensive prior research, our analyses revealed that parents' inconsistent discipline and poor quality monitoring were predictive of child externalizing behavior. In addition, poor parental monitoring, but not inconsistent discipline, was associated with children having a significantly flatter morning-to-evening cortisol slope, which was in turn, related to higher levels of externalizing behaviors. An indirect effect of parental monitoring on externalizing behaviors, through child diurnal cortisol rhythms, was also supported. These findings highlight the role of the hypothalamic-pituitary-adrenal (HPA) axis and its hormonal end product, cortisol, in the relationship between the caregiving environment and the development of externalizing behaviors. Copyright © 2013 Elsevier Ltd. All rights reserved.

Teacher-Child Relationships and Children's Externalizing Behaviors in Head Start

ERIC Educational Resources Information Center

Whittaker, Jessica E. Vick; Jones Harden, Brenda

2010-01-01

This study explored the association between teacher-child relationship quality and Head Start children's externalizing behaviors. We also investigated the associations among teacher, student, and classroom characteristics and teacher-child relationship quality. Data were gathered from 100 Head Start children and their teachers. Teacher-child…

Quality of life and burden in caregivers of youth with obsessive-compulsive disorder presenting for intensive treatment

PubMed Central

Wu, Monica S.; Hamblin, Rebecca; Nadeau, Joshua; Simmons, Jessica; Smith, Ashley; Wilson, Meredith; Eken, Stephanie; Small, Brent; Phares, Vicky; Storch, Eric A.

2018-01-01

Background Pediatric obsessive-compulsive disorder (OCD) is associated with deleterious familial effects; caregivers are often enmeshed in the disorder and can experience considerable burden and decreased quality of life (QoL). Consequently, this study examined burden and QoL in caregivers of youth with OCD enrolled in an intensive outpatient or partial hospitalization program. Method The relationships between caregiver QoL and burden and the following variables were investigated: OCD symptom severity, functioning (youth functional impairment, general family functioning), family (family accommodation, parental relationship satisfaction, positive aspects of caregiving), and comorbid psychopathology (caregiver anxiety and depressive symptoms, youth internalizing and externalizing behaviors). Seventy-two child and caregiver dyads completed clinician- and self-rated questionnaires. Results Components of caregiver QoL correlated with caregiver-rated functional impairment, family accommodation, youth externalizing behaviors, and caregiver psychopathology. Aspects of caregiver burden correlated with child OCD symptom severity, functional impairment related to OCD, as well as caregiver and child comorbid psychopathology. Caregiver depressive symptoms predicted caregiver QoL, and caregiver depressive symptoms and child externalizing symptoms both predicted caregiver burden. Caregiver burden did not mediate the relationship between obsessive-compulsive symptom severity and caregiver QoL. Conclusion Ultimately, elucidating factors associated with increased caregiver burden and poorer QoL is pertinent for identifying at-risk families and developing targeted interventions. PMID:29031217

Sustainable interprofessional teamwork needs a team-friendly healthcare system: Experiences from a collaborative Dutch programme.

PubMed

van Dijk-de Vries, Anneke; van Dongen, Jerôme Jean Jacques; van Bokhoven, Marloes Amantia

2017-03-01

The significance of effective interprofessional teamwork to improve the quality of care has been widely recognised. Effective interprofessional teamwork calls on good collaboration between professionals and patients, coordination between professionals, and the development of teamwork over time. Effective development of teams also requires support from the wider organisational context. In a Dutch village, healthcare professionals work closely together, and mutual consultations as well as interprofessional meetings take place on a regular basis. The network was created as a precondition for sustainable interprofessional teamwork in elderly care. However, several external barriers were experienced regarding the supportive structure and cooperative attitude of the healthcare insurer and municipality. The aim of the article is to examine these experience-based issues regarding internal organisation, perspective, and definition of effective teamwork. Complicating factors refer to finding the right key figures, and the different perspectives on team development and team effectiveness. Our conclusion is that the organisation of healthcare insurance companies needs to implement fundamental changes to facilitate an interprofessional care approach. Furthermore, municipalities should work on their vision of the needs and benefits of a fruitful collaboration with interprofessional healthcare teams. The challenge for healthcare teams is to learn to speak the language of external partners. To support the development of interprofessional teams, external parties need to recognise and trust in a shared aim to provide quality of care in an efficient and effective way.

The science of quality improvement implementation: developing capacity to make a difference.

PubMed

Alexander, Jeffrey A; Hearld, Larry R

2011-12-01

Quality improvement (QI) holds promise to improve quality of care; however, organizations often struggle with its implementation. It has been recommended that practitioners, managers, and researchers attempt to increase systematic understanding of the structure, practices, and context of organizations that facilitate or impede the implementation of QI innovations. To critically review the empirical research on QI implementation in health care organizations. A literature review of 107 studies that examined the implementation of QI innovations in health care organizations. Studies were classified into 4 groups based on the types of predictors that were assumed to affect implementation (content of QI innovation, organizational processes, internal context, and external context). Internal context and organizational processes were the most frequently studied categories. External context and organizational process categories exhibited the highest rate of positive effects on QI implementation. The review revealed several important gaps in the QI implementation literature. Studies often lacked clear conceptual frameworks to guide the research, which may hinder efforts to compare relationships across studies. Studies also tended to adopt designs that were narrowly focused on independent effects of predictors and did not include holistic frameworks to capture interactions among the many factors involved in implementation. Other design limitations included the use of cross-sectional designs, single-source data collection, and potential selection bias among study participants.

Impact of traffic intensity and pavement aggregate size on road dust particles loading

NASA Astrophysics Data System (ADS)

Amato, F.; Pandolfi, M.; Alastuey, A.; Lozano, A.; Contreras González, J.; Querol, X.

2013-10-01

Road dust emissions severely hamper PM10 urban air quality and their burden is expected to increase relatively to primary motor exhaust emissions. Beside the large influence of climate and meteorology, the emission potential varies widely also from one road to another due to numerous factors such as traffic conditions, pavement type and external sources. Nevertheless none of these factors is sufficiently known for a reliable description in emission modelling and for decision making in air quality management. In this study we carried out intensive road dust measurement campaigns in South Spain, with the aim of investigating the relationship between emission potential (i.e. road dust load) and traffic intensity, pavement aggregate size and distance from braking zones. Results indicate that, while no impact from braking activity can be drawn on the bulk road dust mass, an increase in traffic intensity or mean pavement aggregate size clearly reduce the single vehicle emission potential.

[Effectiveness of incorporating a quality management system].

PubMed

Seki, Akira; Hankins, Raleigh W; Miya, Tetsumasa

2010-01-01

In 2003, the ISO 15189 international standardization program on the quality and competence of the clinical reference laboratory was introduced. To date, 46 facilities have committed themselves to providing a higher level of medical service by incorporating a quality management system (QMS) and acquiring accreditation. QMS is defined as "setting up a policy and goals pertaining to quality, and adopting an appropriate system," and is a scheme that includes all managerial and technical factors that can affect test results. Regarding the Health Sciences Research Institute Group, 4 facilities have previously received the accreditation described above, but in the process of implementing the QMS, a number of problems have been identified. Here, we report on the effectiveness of adopting such a QMS based on the results of employee questionnaires, internal audits, customer complaint analyses, and external audits by the Japan Accreditation Board for Conformity Assessment (JAB), the official inspection body for accreditation.

Stress Fractures of Tibia Treated with Ilizarov External Fixator.

PubMed

Górski, Radosław; Żarek, Sławomir; Modzelewski, Piotr; Górski, Ryszard; Małdyk, Paweł

2016-08-30

Stress fractures are the result of cyclic loading of the bone, which gradually becomes damaged. Most often they are treated by rest or plaster cast and, in rare cases, by internal fixation. There is little published data on initial reposition followed by stabilization with the Ilizarov apparatus in such fractures. Six patients were treated with an external fixator according to the Ilizarov method for a stress fracture of the tibia between 2007 and 2015. Three patients were initially treated conservatively. Due to increasing tibial deformation, they were qualified for surgical treatment with external stabilization. In the other patients, surgery was the first-line treatment. All patients demonstrated risk factors for a stress fracture. After the surgery, they fully loaded the operated limb. No patient developed malunion, nonunion, infection or venous thrombosis. The average time from the first operation to the removal of the external fixator was 19 weeks. Radiographic and clinical outcomes were satisfactory in all patients. 1. The Ilizarov method allows for successful stabilization of stress fractures of the tibia. 2. It may be a good alternative to internal stabilization, especially in patients with multiple comorbidities which affect bone quality and may impair soft tissue healing.

Relationships between Safe Pesticide Practice and Perceived Benefits and Subjective Norm, and the Moderation Role of Information Acquisition: Evidence from 971 Farmers in China.

PubMed

Wang, Jianhua; Deng, Yuanyuan; Ma, Yuting

2017-08-25

Improper use of pesticides among farmers has caused food safety issues which are serious threats to public health in China. A central question concerns how to motivate farmers to self-regulate their pesticide usage. The paper aims to identify the influence of an internal driving factor, i.e., perceived benefits, and an external driving factor, i.e., subjective norm, on farmers' safe pesticide behaviors, and whether the two factors are moderated by the exposure to information on government policies and the market, based on a sample of 971 farmers selected from 5 Chinese provinces. The results revealed that farmers' safe pesticide usage was predominately driven by perceived benefits whereas external pressure or subjective norm did not play much of a role. Interaction effects were found between the exposure to market information and perceived benefits, and also between subjective norm and exposure to government policy. Extensions agencies are recommended to effectively convey to farmers the benefits to follow safe pesticide practices. Meanwhile, surveillance and monitoring systems should be established so that the prices of their agricultural products are reflected by the quality of the products.

Environmental factors influencing the distribution of total and fecal coliform bacteria in six water storage reservoirs in the Pearl River Delta Region, China.

PubMed

Hong, Huachang; Qiu, Jianwen; Liang, Yan

2010-01-01

The Pearl River Delta (PRD) is one of the most developed and densely populated regions in China. Quantifying the amount of pathogens in the source of drinking water is important for improving water quality. We collected water samples from six major water storage reservoirs in the PRD region in both wet and dry seasons in 2006. Results showed that external environmental factors, such as precipitation, location, as well as the internal environmental factors, i.e., physicochemical properties of the water, were closely related with the distribution of coliforms. Seasonally, the coliform bacterial concentrations in wet season were one to two orders of magnitude greater than those in dry season. Spatially, coliform bacterial levels in reservoirs near urban and industrial areas were significantly higher (p < 0.05) than those in remote areas. Correlation analyses showed that the levels of coliforms had close relationships with pH, temperature, suspended solid, organic and inorganic nutrients in water. Principal components analysis further demonstrated that total coliforms in the reservoirs were closely related with water physicochemical properties, while fecal coliforms were more associated with external input brought in by seasonal runoff.

The effects of internal and external control factors on college students' marijuana use and cessation of use.

PubMed

Lo, C C; Globetti, G

1995-01-01

The purpose of this study was to examine how selected internal and external control variables influence lifetime use, frequency of use, and cessation of use of marijuana. The internal control factor, comprising the variables 1) perceived risk of marijuana use and 2) attitudes toward prohibition of marijuana use, refers to a built-in personal tendency toward conventionality. The external control factor refers to social-environmental forces which discourage marijuana use. External control is indicated by factors including the number of extra-curricular activities in which an individual is involved; place of residence; the availability of marijuana; peer attitudes toward marijuana use; the number of an individual's friends who use marijuana; and the number of occasions on which an individual has observed others using marijuana. The study's results show that both internal and external control factors are significant predictors of the frequency of marijuana use. The external control factor, however, plays a more important role in explaining lifetime marijuana use and cessation of marijuana use.

Using Statistical Process Control to Drive Improvement in Neonatal Care: A Practical Introduction to Control Charts.

PubMed

Gupta, Munish; Kaplan, Heather C

2017-09-01

Quality improvement (QI) is based on measuring performance over time, and variation in data measured over time must be understood to guide change and make optimal improvements. Common cause variation is natural variation owing to factors inherent to any process; special cause variation is unnatural variation owing to external factors. Statistical process control methods, and particularly control charts, are robust tools for understanding data over time and identifying common and special cause variation. This review provides a practical introduction to the use of control charts in health care QI, with a focus on neonatology. Copyright © 2017 Elsevier Inc. All rights reserved.

Air Quality Criteria for Ozone and Related Photochemical Oxidants (First External Review Draft)

EPA Science Inventory

This first external review draft of the Air Quality Criteria for Ozone and Related Photochemical Oxidants (Ozone Criteria Document) is being released in January 2005 for public comment and for review by EPA's Clean A...

Air Quality Criteria for Ozone and Related Photochemical Oxidants (Second External Review Draft)

EPA Science Inventory

This second external review draft of the Air Quality Criteria for Ozone and Related Photochemical Oxidants, Volumes I-III (Ozone Criteria Document) is being released for public comment and for review by EPA's Clean Air Scientific Advisory Committee (CASAC) r...

Child Reactivity Moderates the Over-Time Association between Mother-Child Conflict Quality and Externalizing Problems

ERIC Educational Resources Information Center

Nelson, Jackie A.

2015-01-01

Constructive parent-child conflict interactions that teach children to problem-solve and negotiate can enhance children's social adjustment. This paper identifies constructive and destructive qualities of mother-child conflict and explores whether child temperament moderated associations with changes in externalizing problems over time. One…

Higher Education Quality: Perception Differences among Internal and External Stakeholders

ERIC Educational Resources Information Center

Abidin, Munirul

2015-01-01

Conceptually, education quality of higher education can be determined by evaluation of their stakeholders's satisfaction level. The purpose of this study is to describe how students as external stakeholder and lecturers as internal stakeholder, perceived their satisfaction of learning experience in the university. This study was conducted in…

AIR QUALITY CRITERIA FOR PARTICULATE MATTER, VOLUMES I-III, (EXTERNAL REVIEW DRAFT, 1995)

EPA Science Inventory

There is no abstract available for these documents.

If further information is requested, please refer to the bibliographic citation and contact the Technical Information Staff at the number listed above.

• Air Quality Criteria for Particulate Matter, Volume I, Extern...

• Factors Influencing Mini-CEX Rater Judgments and Their Practical Implications: A Systematic Literature Review.

  PubMed

  Lee, Victor; Brain, Keira; Martin, Jenepher

  2017-06-01

  At present, little is known about how mini-clinical evaluation exercise (mini-CEX) raters translate their observations into judgments and ratings. The authors of this systematic literature review aim both to identify the factors influencing mini-CEX rater judgments in the medical education setting and to translate these findings into practical implications for clinician assessors. The authors searched for internal and external factors influencing mini-CEX rater judgments in the medical education setting from 1980 to 2015 using the Ovid MEDLINE, PsycINFO, ERIC, PubMed, and Scopus databases. They extracted the following information from each study: country of origin, educational level, study design and setting, type of observation, occurrence of rater training, provision of feedback to the trainee, research question, and identified factors influencing rater judgments. The authors also conducted a quality assessment for each study. Seventeen articles met the inclusion criteria. The authors identified both internal and external factors that influence mini-CEX rater judgments. They subcategorized the internal factors into intrinsic rater factors, judgment-making factors (conceptualization, interpretation, attention, and impressions), and scoring factors (scoring integration and domain differentiation). The current theories of rater-based judgment have not helped clinicians resolve the issues of rater idiosyncrasy, bias, gestalt, and conflicting contextual factors; therefore, the authors believe the most important solution is to increase the justification of rater judgments through the use of specific narrative and contextual comments, which are more informative for trainees. Finally, more real-world research is required to bridge the gap between the theory and practice of rater cognition.

• Relating Child Care during Infancy to Externalizing and Internalizing Behaviors in Toddlerhood: How Specific Features of Child Care Quality Matter Depending on a Child's Gender and Temperament

  ERIC Educational Resources Information Center

  Lemay, Lise; Bigras, Nathalie; Bouchard, Caroline

  2014-01-01

  This study explored whether the relationships between specific features of child care quality and externalizing and internalizing behaviors in 24-month-old children are moderated by gender and temperament. Questionnaires were used to record children's gender and measure their temperament. Child care quality was observed with the "Échelles…

Contrasting Eutrophication Risks and Countermeasures in Different Water Bodies: Assessments to Support Targeted Watershed Management.

PubMed

Li, Tong; Chu, Chunli; Zhang, Yinan; Ju, Meiting; Wang, Yuqiu

2017-06-29

Eutrophication is a major problem in China. To combat this issue, the country needs to establish water quality targets, monitoring systems, and intelligent watershed management. This study explores a new watershed management method. Water quality is first assessed using a single factor index method. Then, changes in total nitrogen/total phosphorus (TN/TP) are analyzed to determine the limiting factor. Next, the study compares the eutrophication status of two water function districts, using a comprehensive nutritional state index method and geographic information system (GIS) visualization. Finally, nutrient sources are qualitatively analyzed. Two functional water areas in Tianjin, China were selected and analyzed: Qilihai National Wetland Nature Reserve and Yuqiao Reservoir. The reservoir is a drinking water source. Results indicate that total nitrogen (TN) and total phosphorus (TP) pollution are the main factors driving eutrophication in the Qilihai Wetland and Yuqiao Reservoir. Phosphorus was the limiting factor in the Yuqiao Reservoir; nitrogen was the limiting factor in the Qilihai Wetland. Pollution in Qilihai Wetland is more serious than in Yuqiao Reservoir. The study found that external sources are the main source of pollution. These two functional water areas are vital for Tianjin; as such, the study proposes targeted management measures.

Work System Assessment to Facilitate the Dissemination of a Quality Improvement Program for Optimizing Blood Culture Use: A Case Study Using a Human Factors Engineering Approach.

PubMed

Xie, Anping; Woods-Hill, Charlotte Z; King, Anne F; Enos-Graves, Heather; Ascenzi, Judy; Gurses, Ayse P; Klaus, Sybil A; Fackler, James C; Milstone, Aaron M

2017-11-20

Work system assessments can facilitate successful implementation of quality improvement programs. Using a human factors engineering approach, we conducted a work system assessment to facilitate the dissemination of a quality improvement program for optimizing blood culture use in pediatric intensive care units at 2 hospitals. Semistructured face-to-face interviews were conducted with clinicians from Johns Hopkins All Children's Hospital and University of Virginia Medical Center. Interview data were analyzed using qualitative content analysis. Blood culture-ordering practices are influenced by various work system factors, including people, tasks, tools and technologies, the physical environment, organizational conditions, and the external environment. A clinical decision-support tool could facilitate implementation by (1) standardizing blood culture-ordering practices, (2) ensuring that prescribing clinicians review the patient's condition before ordering a blood culture, (3) facilitating critical thinking, and (4) empowering nurses to communicate with physicians and advocate for adherence to blood culture-ordering guidelines. The success of interventions for optimizing blood culture use relies heavily on the local context. A work system analysis using a human factors engineering approach can identify key areas to be addressed for the successful dissemination of quality improvement interventions. © The Author 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Physics and material science of ultra-high quality factor superconducting resonator

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

Vostrikov, Alexander

2015-08-01

The nitrogen doping into niobium superconducting radio frequency cavity walls aiming to improve the fundamental mode quality factor is the subject of the research in the given work. Quantitative nitrogen diffusion into niobium model calculating the concentration profile was developed. The model estimations were confirmed with secondary ion mass spectrometry technique measurements. The model made controlled nitrogen doping recipe optimization possible. As a result the robust reproducible recipe for SRF cavity walls treatment with nitrogen doping was developed. The cavities produced with optimized recipe met LCLS–II requirements on quality factor of 2.7 ∙ 10 10 at acceleration field of 16more » MV/m. The microscopic effects of nitrogen doping on superconducting niobium properties were studied with low energy muon spin rotation technique and magnetometer measurements. No significant effect of nitrogen on the following features was found: electron mean free path, magnetic field penetration depth, and upper and surface critical magnetic fields. It was detected that for nitrogen doped niobium samples magnetic flux starts to penetrate inside the superconductor at lower external magnetic field value compared to the low temperature baked niobium ones. This explains lower quench field of SRF cavities treated with nitrogen. Quality factor improvement of fundamental mode forced to analyze the high order mode (HOM) impact on the particle beam dynamics. Both resonant and cumulative effects caused by monopole and dipole HOMs respectively are found to be negligible within the requirements for LCLS–II.« less

Parent beliefs and children's social-behavioral functioning: the mediating role of parent-teacher relationships.

PubMed

Kim, Elizabeth Moorman; Sheridan, Susan M; Kwon, Kyongboon; Koziol, Natalie

2013-04-01

This research investigated whether parent-teacher relationship quality mediated the relation between parents' motivational beliefs and children's adaptive functioning and externalizing behaviors. The sample consisted of kindergarten through third-grade children with behavioral concerns (N=206). Parents reported on their motivational beliefs (i.e., role construction and efficacy), and teachers reported on the quality of their relationships with parents and children's adaptive functioning (i.e., social and adaptive skills) and externalizing behaviors. Results indicated that parents' motivational beliefs were related significantly and positively to children's adaptive functioning and negatively to children's externalizing behaviors. Parents' motivational beliefs were also significantly associated with enhanced parent-teacher relationship quality. There was a significant medium-sized indirect effect of parents' motivational beliefs on children's adaptive functioning through parent-teacher relationship quality (k(2)=.12) and a small indirect effect of parents' motivational beliefs on children's externalizing behaviors (k(2)=.05). This research suggests that parent-teacher relationship quality may be one mechanism by which the benefits of parents' motivational beliefs are transmitted to children. Copyright © 2013 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Governing the quality and safety of healthcare: A conceptual framework.

PubMed

Brown, Alison; Dickinson, Helen; Kelaher, Margaret

2018-04-01

Recent research has advanced understanding of corporate governance of healthcare quality, highlighting the need for future empirical work to develop beyond a focus on board composition to a more detailed exploration of the internal workings of governance that influence board engagement and activities. This paper proposes a conceptual framework to guide empirical research examining the work of board and senior management in governing healthcare quality. To generate this framework, existing conceptual approaches and key constructs influencing effectiveness are identified in the governance literature. Commonalities between governance and team effectiveness literature are mapped and suggest a number of key constructs in the team effectiveness literature are applicable to, but not yet fully explored, within the governance literature. From these we develop a healthcare governance conceptual framework encompassing both literatures, that outlines input and mediating factors influencing governance. The mapping process highlights gaps in research related to board dynamics and external influences that require further investigation. Organizing the multiple complex factors that influence governance of healthcare quality in a conceptual framework brings a new perspective to structuring theory-led research and informing future policy initiatives. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Influence of External and Internal Factors on Forming the System of Managers' Professional Development at Transnational Corporations in Poland

ERIC Educational Resources Information Center

Banit, Olga

2017-01-01

The author performs analysis of external and internal factors that influence organization of the system of Polish managers' professional development. These factors can be united into two groups. We will attribute the factors formed under the influence of external factors to the first group, to the second--the internal ones. So, due to the dynamic…

[Development of methods and instruments for external quality assurance in inpatient parent-child rehabilitation and prevention].

PubMed

Neuderth, S; Lukasczik, M; Musekamp, G; Gerlich, C; Saupe-Heide, M; Löbmann, R; Vogel, H

2013-02-01

There so far is no standardized program for external quality assurance in inpatient parent-child prevention and rehabilitation in Germany. Therefore, instruments and methods of external quality assurance were developed and evaluated on behalf of the federal-level health insurance institutions. On the level of structure quality, a modular questionnaire for assessing structural features of rehabilitation/prevention centers, basic and allocation criteria as well as a checklist for visitations were developed. Structural data were collected in a nationwide survey of parent-child prevention and rehabilitation centers. Process and outcome quality data were collected in n=38 centers. Process quality was assessed using multiple methods (process-related structural features, case-related routine documentation, and incident-related patient questionnaires). Outcome quality was measured via patient questionnaires (n=1 799 patients). We used a multi-level modelling approach by adjusting relevant confounders on institutional and patient levels. The methods, instruments and analyzing procedures developed for measuring quality on the level of structure, processes and outcomes were adjusted in cooperation with all relevant stakeholders. Results are exemplarily presented for all quality assurance tools. For most of the risk-adjusted outcome parameters, we found no significant differences between institutions. For the first time, a comprehensive, standardized and generally applicable set of methods and instruments for routine use in comparative quality measurement of inpatient parent-child prevention and rehabilitation is available. However, it should be considered that the very heterogeneous field of family-oriented measures can not be covered entirely by an external quality assurance program. Therefore, methods and instruments have to be adapted continuously to the specifics of this area of health care and to new developments. © Georg Thieme Verlag KG Stuttgart · New York.

Three Rounds of External Quality Assessment in France to Evaluate the Performance of 28 Platforms for Multiparametric Molecular Testing in Metastatic Colorectal and Non-Small Cell Lung Cancer.

PubMed

Dequeker, Elisabeth M C; Keppens, Cleo; Egele, Caroline; Delen, Sofie; Lamy, Aude; Lemoine, Antoinette; Sabourin, Jean-Christophe; Andrieu, Catherine; Ligtenberg, Marjolijn; Fetique, Dominique; Tops, Bastiaan; Descarpentries, Clotilde; Blons, Hélène; Denoux, Yves; Aube, Cécile; Penault-Llorca, Frederique; Hofman, Paul; Leroy, Karen; Le Marechal, Cédric; Doucet, Laurent; Duranton-Tanneur, Valérie; Pedeutour, Florence; Soubeyran, Isabelle; Côté, Jean-François; Emile, Jean-François; Vignaud, Jean-Michel; Monhoven, Nathalie; Haddad, Véronique; Laurent-Puig, Pierre; van Krieken, Han; Nowak, Frederique; Lonchamp, Etienne; Bellocq, Jean-Pierre; Rouleau, Etienne

2016-03-01

Personalized medicine has gained increasing importance in clinical oncology, and several clinically important biomarkers are implemented in routine practice. In an effort to guarantee high quality of molecular testing in France, three subsequent external quality assessment rounds were organized at the initiative of the National Cancer Institute between 2012 and 2014. The schemes included clinically relevant biomarkers for metastatic colorectal (KRAS, NRAS, BRAF, PIK3CA, microsatellite instability) and non-small cell lung cancer (EGFR, KRAS, BRAF, PIK3CA, ERBB2), and they represent the first multigene/multicancer studies throughout Europe. In total, 56 laboratories coordinated by 28 regional molecular centers participated in the schemes. Laboratories received formalin-fixed, paraffin-embedded samples and were asked to use routine methods for molecular testing to predict patient response to targeted therapies. They were encouraged to return results within 14 calendar days after sample receipt. Both genotyping and reporting were evaluated separately. During the three external quality assessment rounds, mean genotype scores were all above the preset standard of 90% for all biomarkers. Participants were mainly challenged in case of rare insertions or deletions. Assessment of the written reports showed substantial progress between the external quality assessment schemes on multiple criteria. Several essential elements such as the clinical interpretation of test results and the reason for testing still require improvement by continued external quality assessment education. Copyright © 2016 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

Do executive functions explain the covariance between internalizing and externalizing behaviors?

PubMed

Hatoum, Alexander S; Rhee, Soo Hyun; Corley, Robin P; Hewitt, John K; Friedman, Naomi P

2017-11-16

This study examined whether executive functions (EFs) might be common features of internalizing and externalizing behavior problems across development. We examined relations between three EF latent variables (a common EF factor and factors specific to updating working memory and shifting sets), constructed from nine laboratory tasks administered at age 17, to latent growth intercept (capturing stability) and slope (capturing change) factors of teacher- and parent-reported internalizing and externalizing behaviors in 885 individual twins aged 7 to 16 years. We then estimated the proportion of intercept-intercept and slope-slope correlations predicted by EF as well as the association between EFs and a common psychopathology factor (P factor) estimated from all 9 years of internalizing and externalizing measures. Common EF was negatively associated with the intercepts of teacher-rated internalizing and externalizing behavior in males, and explained 32% of their covariance; in the P factor model, common EF was associated with the P factor in males. Shifting-specific was positively associated with the externalizing slope across sex. EFs did not explain covariation between parent-rated behaviors. These results suggest that EFs are associated with stable problem behavior variation, explain small proportions of covariance, and are a risk factor that that may depend on gender.

[Discussion on developing a data management plan and its key factors in clinical study based on electronic data capture system].

PubMed

Li, Qing-na; Huang, Xiu-ling; Gao, Rui; Lu, Fang

2012-08-01

Data management has significant impact on the quality control of clinical studies. Every clinical study should have a data management plan to provide overall work instructions and ensure that all of these tasks are completed according to the Good Clinical Data Management Practice (GCDMP). Meanwhile, the data management plan (DMP) is an auditable document requested by regulatory inspectors and must be written in a manner that is realistic and of high quality. The significance of DMP, the minimum standards and the best practices provided by GCDMP, the main contents of DMP based on electronic data capture (EDC) and some key factors of DMP influencing the quality of clinical study were elaborated in this paper. Specifically, DMP generally consists of 15 parts, namely, the approval page, the protocol summary, role and training, timelines, database design, creation, maintenance and security, data entry, data validation, quality control and quality assurance, the management of external data, serious adverse event data reconciliation, coding, database lock, data management reports, the communication plan and the abbreviated terms. Among them, the following three parts are regarded as the key factors: designing a standardized database of the clinical study, entering data in time and cleansing data efficiently. In the last part of this article, the authors also analyzed the problems in clinical research of traditional Chinese medicine using the EDC system and put forward some suggestions for improvement.

Goal Management Training Combined With External Cuing as a Means to Improve Emotional Regulation, Psychological Functioning, and Quality of Life in Patients With Acquired Brain Injury: A Randomized Controlled Trial.

PubMed

Tornås, Sveinung; Løvstad, Marianne; Solbakk, Anne-Kristin; Schanke, Anne-Kristine; Stubberud, Jan

2016-11-01

To investigate whether goal management training (GMT) expanded to include external cuing and an emotional regulation module is associated with improved emotional regulation, psychological functioning, and quality of life (QOL) after chronic acquired brain injury (ABI). Randomized controlled trial with blinded outcome assessment at baseline, posttraining, and 6-month follow-up. Outpatient. Persons with ABI and executive dysfunction (N=70; 64% traumatic brain injury; 52% men; mean age ± SD, 43±13y; mean time since injury ± SD, 8.1±9.4y). Eight sessions of GMT in groups, including a new module addressing emotional regulation, and external cuing. A psychoeducative control condition (Brain Health Workshop) was matched on amount of training, therapist contact, and homework. Emotional regulation was assessed with the Brain Injury Rehabilitation Trust Regulation of Emotions Questionnaire, the Emotional Control subscale and the Emotion Regulation factor (Behavior Rating Inventory of Executive Function-Adult Version), and the Positive and Negative Affect subscales from the Dysexecutive Questionnaire. Secondary outcome measures included psychological distress (Hopkins Symptom Checklist-25) and QOL (Quality of Life After Brain Injury Scale). Findings indicated beneficial effects of GMT on emotional regulation skills in everyday life and in QOL 6 months posttreatment. No intervention effects on measures of psychological distress were registered. GMT is a promising intervention for improving emotional regulation after ABI, even in the chronic phase. More research using objective measures of emotional regulation is needed to investigate the efficacy of this type of training. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

An approach for estimating measurement uncertainty in medical laboratories using data from long-term quality control and external quality assessment schemes.

PubMed

Padoan, Andrea; Antonelli, Giorgia; Aita, Ada; Sciacovelli, Laura; Plebani, Mario

2017-10-26

The present study was prompted by the ISO 15189 requirements that medical laboratories should estimate measurement uncertainty (MU). The method used to estimate MU included the: a) identification of quantitative tests, b) classification of tests in relation to their clinical purpose, and c) identification of criteria to estimate the different MU components. Imprecision was estimated using long-term internal quality control (IQC) results of the year 2016, while external quality assessment schemes (EQAs) results obtained in the period 2015-2016 were used to estimate bias and bias uncertainty. A total of 263 measurement procedures (MPs) were analyzed. On the basis of test purpose, in 51 MPs imprecision only was used to estimate MU; in the remaining MPs, the bias component was not estimable for 22 MPs because EQAs results did not provide reliable statistics. For a total of 28 MPs, two or more MU values were calculated on the basis of analyte concentration levels. Overall, results showed that uncertainty of bias is a minor factor contributing to MU, the bias component being the most relevant contributor to all the studied sample matrices. The model chosen for MU estimation allowed us to derive a standardized approach for bias calculation, with respect to the fitness-for-purpose of test results. Measurement uncertainty estimation could readily be implemented in medical laboratories as a useful tool in monitoring the analytical quality of test results since they are calculated using a combination of both the long-term imprecision IQC results and bias, on the basis of EQAs results.

Frequency stability of maser oscillators operated with cavity Q. [hydrogen and rubidium masers

NASA Technical Reports Server (NTRS)

Tetu, M.; Tremblay, P.; Lesage, P.; Petit, P.; Audoin, C.

1982-01-01

The short term frequency stability of masers equipped with an external feedback loop to increase the cavity quality factor was studied. The frequency stability of a hydrogen and a rubidium maser were measured and compared with theoretical evaluation. It is shown that the frequency stability passes through an optimum when the cavity Q is varied. Long term fluctuations are discussed and the optimum mid term frequency stability achievably by small size active and passive H-masers is considered.

An uncertainty analysis of air pollution externalities from road transport in Belgium in 2010.

PubMed

Int Panis, L; De Nocker, L; Cornelis, E; Torfs, R

2004-12-01

Although stricter standards for vehicles will reduce emissions to air significantly by 2010, a number of problems will remain, especially related to particulate concentrations in cities, ground-level ozone, and CO(2). To evaluate the impacts of new policy measures, tools need to be available that assess the potential benefits of these measures in terms of the vehicle fleet, fuel choice, modal choice, kilometers driven, emissions, and the impacts on public health and related external costs. The ExternE accounting framework offers the most up to date and comprehensive methodology to assess marginal external costs of energy-related pollutants. It combines emission models, air dispersion models at local and regional scales with dose-response functions and valuation rules. Vito has extended this accounting framework with data and models related to the future composition of the vehicle fleet and transportation demand to evaluate the impact of new policy proposals on air quality and aggregated (total) external costs by 2010. Special attention was given to uncertainty analysis. The uncertainty for more than 100 different parameters was combined in Monte Carlo simulations to assess the range of possible outcomes and the main drivers of these results. Although the impacts from emission standards and total fleet mileage look dominant at first, a number of other factors were found to be important as well. This includes the number of diesel vehicles, inspection and maintenance (high-emitter cars), use of air conditioning, and heavy duty transit traffic.

[The relevance of internal and external participation for patient satisfaction].

PubMed

Zimmermann, L; Michaelis, M; Quaschning, K; Müller, C; Körner, M

2014-08-01

Patient satisfaction is an essential quality and outcome criteria for patient-centered treatment of chronic diseases. For successful implementation of integrated patient-centered care it is important to take the needs and expectations of the patients into consideration in the treatment process and to involve them in decision-making (external participation), as well as establishing patient-centered collaboration within the team and organization (internal participation). This study examines in what respect patient satisfaction can be predicted through parameters that focus on the personal needs of the individual or internal and external participation. To this end we used a multicenter cross-sectional study to collect evaluations from N=329 patients with different chronic diseases in 11 rehabilitation clinics. Patient satisfaction (ZUF-8) served as the criterion, and the predictors were external participation (PEF-FB-9), satisfaction with decision-making (Man-Son-Hing Scale) and internal participation (Internal Participation Scale), socio-demographic factors and rehabilitation status (IRES-24). The data were analyzed statistically using multiple linear regression. A high degree of variance of patient satisfaction could be explained by the parameters applied (Goodness-of-fit: R²corrected=47.3%). The strongest predictors of satisfaction were internal participation (Beta=0.44, p<0.001) and satisfaction with the decision-making (Beta=0.36, p<0.001). The study provides initial indications of the positive effects of internal and external participation. Further studies are necessary to substantiate the connection between internal and external participation and patient satisfaction. © Georg Thieme Verlag KG Stuttgart · New York.

Externalizing symptoms, effortful control, and intrusive parenting: A test of bidirectional longitudinal relations during early childhood.

PubMed

Eisenberg, Nancy; Taylor, Zoe E; Widaman, Keith F; Spinrad, Tracy L

2015-11-01

At approximately 30, 42, and 54 months of age (N = 231), the relations among children's externalizing symptoms, intrusive maternal parenting, and children's effortful control (EC) were examined. Both intrusive parenting and low EC have been related to psychopathology, but children's externalizing problems and low EC might affect the quality of parenting and one another. Mothers' intrusive behavior with their children was assessed with observations, children's EC was measured with mothers' and caregivers' reports, and children's externalizing symptoms were assessed with mothers', fathers', and caregivers' reports. In a structural equation panel model, bidirectional relations between intrusive parenting and EC were found: EC at 30 and 42 months predicted low levels of intrusive parenting a year later, controlling for prior levels of parenting and vice versa. Moreover, high levels of children's externalizing problems at both 30 and 42 months negatively predicted EC a year later, controlling for prior levels of EC. Although externalizing problems positively predicted high EC over time, this appeared to be a suppression effect because these variables had a strong negative pattern in the zero-order correlations. Moreover, when controlling for the stability of intrusive parenting, EC, and externalizing (all exhibited significant stability across time) and the aforementioned cross-lagged predictive paths, EC and externalizing problems were still negatively related within the 54-month assessment. The findings are consistent with the view that children's externalizing behavior undermines their EC and contributes to intrusive mothering and that relations between intrusive parenting and EC are bidirectional across time. Thus, interventions that focus on modifying children's externalizing problems (as well as the quality of parenting) might affect the quality of parenting they receive and, hence, subsequent problems with adjustment.

Compact 3D quantum memory

NASA Astrophysics Data System (ADS)

Xie, Edwar; Deppe, Frank; Renger, Michael; Repp, Daniel; Eder, Peter; Fischer, Michael; Goetz, Jan; Pogorzalek, Stefan; Fedorov, Kirill G.; Marx, Achim; Gross, Rudolf

2018-05-01

Superconducting 3D microwave cavities offer state-of-the-art coherence times and a well-controlled environment for superconducting qubits. In order to realize at the same time fast readout and long-lived quantum information storage, one can couple the qubit to both a low-quality readout and a high-quality storage cavity. However, such systems are bulky compared to their less coherent 2D counterparts. A more compact and scalable approach is achieved by making use of the multimode structure of a 3D cavity. In our work, we investigate such a device where a transmon qubit is capacitively coupled to two modes of a single 3D cavity. External coupling is engineered so that the memory mode has an about 100 times larger quality factor than the readout mode. Using an all-microwave second-order protocol, we realize a lifetime enhancement of the stored state over the qubit lifetime by a factor of 6 with a fidelity of approximately 80% determined via quantum process tomography. We also find that this enhancement is not limited by fundamental constraints.

A Review of Auditing Methods Applied to the Content of Controlled Biomedical Terminologies

PubMed Central

Zhu, Xinxin; Fan, Jung-Wei; Baorto, David M.; Weng, Chunhua; Cimino, James J.

2012-01-01

Although controlled biomedical terminologies have been with us for centuries, it is only in the last couple of decades that close attention has been paid to the quality of these terminologies. The result of this attention has been the development of auditing methods that apply formal methods to assessing whether terminologies are complete and accurate. We have performed an extensive literature review to identify published descriptions of these methods and have created a framework for characterizing them. The framework considers manual, systematic and heuristic methods that use knowledge (within or external to the terminology) to measure quality factors of different aspects of the terminology content (terms, semantic classification, and semantic relationships). The quality factors examined included concept orientation, consistency, non-redundancy, soundness and comprehensive coverage. We reviewed 130 studies that were retrieved based on keyword search on publications in PubMed, and present our assessment of how they fit into our framework. We also identify which terminologies have been audited with the methods and provide examples to illustrate each part of the framework. PMID:19285571

[Quality assurance in geriatric rehabilitation--approaches and methods].

PubMed

Deckenbach, B; Borchelt, M; Steinhagen-Thiessen, E

1997-08-01

It did not take the provisions of the 5th Book of the Social Code for quality assurance issues to gain significance in the field of geriatric rehabilitation as well. While in the surgical specialties, experience in particular with external quality assurance have already been gathered over several years now, suitable concepts and methods for the new Geriatric Rehabilitation specialty are still in the initial stages of development. Proven methods from the industrial and service sectors, such as auditing, monitoring and quality circles, can in principle be drawn on for devising geriatric rehabilitation quality assurance schemes; these in particular need to take into account the multiple factors influencing the course and outcome of rehabilitation entailed by multimorbidity and multi-drug use; the eminent role of the social environment; therapeutic interventions by a multidisciplinary team; as well as the multi-dimensional nature of rehabilitation outcomes. Moreover, the specific conditions of geriatric rehabilitation require development not only of quality standards unique to this domain but also of quality assurance procedures specific to geriatrics. Along with a number of other methods, standardized geriatric assessment will play a crucial role in this respect.

Is It Possible? Investigating the Influence of External Quality Audit on University Performance

ERIC Educational Resources Information Center

Carr, Sarah; Hamilton, Emma; Meade, Phil

2005-01-01

This paper explores whether it is possible to isolate independent effects of external quality audit (EQA) and concludes that effectiveness evaluations have a stronger foundation when the combined effects of university governance and management initiatives and government initiatives are examined together with EQA. The issue of how successful these…

UK PhD Assessment in Accounting and Finance: Social Capital in Action

ERIC Educational Resources Information Center

Smith, Sarah Jane; Urquhart, Vivien

2018-01-01

Assessment lies at the centre of PhD degree quality standards, with quality assurance relying on independent external examiners. This study investigates the role of the viva and the selection of external examiners from within the accounting and finance discipline across UK institutions. A questionnaire survey and follow-up interviews with…

42 CFR 438.362 - Exemption from external quality review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Exemption from external quality review. 438.362 Section 438.362 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Medicaid contract has been in effect for at least 2 consecutive years before the effective date of the...

[Clinicofunctional condition and quality of life in patients with chronic obstructive pulmonary disease before and after outpatient treatment with fenspiride].

PubMed

Butorov, S I; Butorov, I V; Bodrug, N I; Krushka, S I; Tofan, E F

2008-01-01

To study effects of long-term administration of fenspiride in combination with broncholytic drugs on dynamics of clinical symptoms, external respiration function and quality of life in patients with chronic obstructive pulmonary disease (COPD). A comparative randomized trial of fenspiride used for 6 months in combination with broncholytic drugs enrolled 68 COPD patients. A clinical status, external respiration function were examined. Quality of life was evaluated with WHO questionnaire WHOQOL-100. Addition of fenspiride to combined treatment of COPD attenuates COPD symptoms, normalizes blood biochemistry, improves external respiration function, raises exercise tolerance. Quality of life improved by physical and mental state scales. Fenspiride addition to COPD treatment improves efficacy of the standard treatment and is recommended for treatment of COPD of stage I and II in combination with broncholytic drugs.

Fear of abandonment as a mediator of the relations between divorce stressors and mother-child relationship quality and children's adjustment problems.

PubMed

Wolchik, Sharlene A; Tein, Jenn-Yun; Sandler, Irwin N; Doyle, Kathryn W

2002-08-01

This study examines whether fear of abandonment mediates the prospective relations between divorce stressors and mother-child relationship quality and adjustment problems of children of divorce. Participants were 216 children, ages 8-12, and their primary residential mothers. Children reported on divorce stressors and fear of abandonment; mothers and children reported on mother-child relationship quality and internalizing and externalizing problems. Structural equation models indicated that Time 1 fear of abandonment mediated the relation between Time 1 divorce stressors and Time 2 internalizing and externalizing problems. Time 1 fear of abandonment also mediated the relation between Time 1 mother-child relationship quality and Time 2 internalizing and externalizing problems. Implications of these results for understanding variability in children's postdivorce adjustment problems and interventions for divorced families are discussed.

Environmental And Quality Management System In The Context Of Sustainable Development

NASA Astrophysics Data System (ADS)

Rusko, Miroslav

2015-06-01

Growing load and deterioration of the environment can be interpreted as a result of some external effects interventions. While the positive externalities influence the positive productional and utilizational functions of other subjects, the negative externalities influence the negative ones. Both types of external effects can act as parcial or global externalities. Linking of environmental issues to economy and finance is an important sphere.

[In-house team seminars: working together as a team--from data and statistics to quality development].

PubMed

Berlage, Silvia; Wenzlaff, Paul; Damm, Gabriele; Sens, Brigitte

2010-01-01

The concept of the "ZQ In-house Seminars" provided by external trainers/experts pursues the specific aim to enable all healthcare staff members of hospital departments to analyse statistical data--especially from external quality measurements--and to initiate in-hospital measures of quality improvement based on structured team work. The results of an evaluation in Lower Saxony for the period between 2004 and 2008 demonstrate a sustainable increase in outcome quality of care and a strengthening of team and process orientation in clinical care.

Megavoltage planar and cone-beam imaging with low-Z targets: dependence of image quality improvement on beam energy and patient separation.

PubMed

Robar, James L; Connell, Tanner; Huang, Weihong; Kelly, Robin G

2009-09-01

The purpose of this study is to investigate the improvement of megavoltage planar and cone-beam CT (CBCT) image quality with the use of low atomic number (Z) external targets in the linear accelerator. In this investigation, two experimental megavoltage imaging beams were generated by using either 3.5 or 7.0 MeV electrons incident on aluminum targets installed above the level of the carousel in a linear accelerator (2100EX, Varian Medical, Inc., Palo Alto, CA). Images were acquired using an amorphous silicon detector panel. Contrast-to-noise ratio (CNR) in planar and CBCT images was measured as a function of dose and a comparison was made between the imaging beams and the standard 6 MV therapy beam. Phantoms of variable diameter were used to examine the loss of contrast due to beam hardening. Porcine imaging was conducted to examine qualitatively the advantages of the low-Z target approach in CBCT. In CBCT imaging CNR increases by factors as high as 2.4 and 4.3 for the 7.0 and 3.5 MeV/Al beams, respectively, compared to images acquired with 6 MV. Similar factors of improvement are observed in planar imaging. For the imaging beams, beam hardening causes a significant loss of the contrast advantage with increasing phantom diameter; however, for the 3.5 MeV/Al beam and a phantom diameter of 25 cm, a contrast advantage remains, with increases of contrast by factors of 1.5 and 3.4 over 6 MV for bone and lung inhale regions, respectively. The spatial resolution is improved slightly in CBCT images for the imaging beams. CBCT images of a porcine cranium demonstrate qualitatively the advantages of the low-Z target approach, showing greater contrast between tissues and improved visibility of fine detail. The use of low-Z external targets in the linear accelerator improves megavoltage planar and CBCT image quality significantly. CNR may be increased by a factor of 4 or greater. Improvement of the spatial resolution is also apparent.

Association Between Echocardiography Laboratory Accreditation and the Quality of Imaging and Reporting for Valvular Heart Disease.

PubMed

Thaden, Jeremy J; Tsang, Michael Y; Ayoub, Chadi; Padang, Ratnasari; Nkomo, Vuyisile T; Tucker, Stephen F; Cassidy, Cynthia S; Bremer, Merri; Kane, Garvan C; Pellikka, Patricia A

2017-08-01

It is presumed that echocardiographic laboratory accreditation leads to improved quality, but there are few data. We sought to compare the quality of echocardiographic examinations performed at accredited versus nonaccredited laboratories for the evaluation of valvular heart disease. We enrolled 335 consecutive valvular heart disease subjects who underwent echocardiography at our institution and an external accredited or nonaccredited institution within 6 months. Completeness and quality of echocardiographic reports and images were assessed by investigators blinded to the external laboratory accreditation status and echocardiographic results. Compared with nonaccredited laboratories, accredited sites more frequently reported patient sex (94% versus 78%; P <0.001), height and weight (96% versus 63%; P <0.001), blood pressure (86% versus 39%; P <0.001), left ventricular size (96% versus 83%; P <0.001), right ventricular size (94% versus 80%; P =0.001), and right ventricular function (87% versus 73%; P =0.006). Accredited laboratories had higher rates of complete and diagnostic color (58% versus 35%; P =0.002) and spectral Doppler imaging (45% versus 21%; P <0.0001). Concordance between external and internal grading of external studies was improved when diagnostic quantification was performed (85% versus 69%; P =0.003), and in patients with mitral regurgitation, reproducibility was improved with higher quality color Doppler imaging. Accredited echocardiographic laboratories had more complete reporting and better image quality, while echocardiographic quantification and color Doppler image quality were associated with improved concordance in grading valvular heart disease. Future quality improvement initiatives should highlight the importance of high-quality color Doppler imaging and echocardiographic quantification to improve the accuracy, reproducibility, and quality of echocardiographic studies for valvular heart disease. © 2017 American Heart Association, Inc.

The WHO AFRO external quality assessment programme (EQAP): Linking laboratory networks through EQA programmes.

PubMed

Boeras, Debrah I; Peeling, Rosanna W; Onyebujoh, Philip; Yahaya, Ali A; Gumede-Moeletsi, Hieronyma N; Ndihokubwayo, Jean B

2016-01-01

External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing. An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events of international public health importance.

The WHO AFRO external quality assessment programme (EQAP): Linking laboratory networks through EQA programmes

PubMed Central

Yahaya, Ali A.; Gumede-Moeletsi, Hieronyma N.

2016-01-01

External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing. An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events of international public health importance. PMID:28879135

Engineering Strategies and Methods for Avoiding Air-Quality Externalities: Dispersion Modeling, Home Energy Conservation, and Scenario Planning

NASA Astrophysics Data System (ADS)

Knox, Andrew James

Energy conservation can improve air quality by reducing emissions from fuel combustion. The human health value retained through better air quality can then offset the cost of energy conservation. Through this thesis' innovative yet widely-accessible combination of air pollution dispersion modeling and atmospheric chemistry, it is estimated that the health value retained by avoiding emissions from Ontario's former coal-fired generating stations is 5.74/MWh (using an upper-bound value of 265,000 per year of life lost). This value is combined with energy modeling of homes in the first-ever assessment of the air-quality health benefits of low-energy buildings. It is shown that avoided health damages can equal 7% of additional construction costs of energy efficient buildings in Ontario. At 7%, health savings are a significant item in the cost analysis of efficient buildings. Looking to energy efficiency in the context of likely future low-resource natural gas scenarios, building efficient buildings today is shown to be more economically efficient than any building retrofit option. Considering future natural gas scarcity in the context of Ontario's Long-Term Energy Plan reveals that Ontario may be forced to return to coal-fired electricity. Projected coal use would result in externalities greater than $600 million/year; 80% more than air-quality externalities from Ontario's electricity in 1985. Radically aggressive investment in electricity conservation (75% reduction per capita by 2075) is one promising path forward that keeps air-quality externalities below 1985 levels. Non-health externalities are an additional concern, the quantification, and ultimately monetization, of which could be practical using emerging air pollution monitoring technologies. Energy, conservation, energy planning, and energy's externalities form a complex situation in which today's decisions are critical to a successful future. It is clear that reducing the demand for energy is essential and that there are economically efficient conservation opportunities, particularly in the building sector, being missed.

Patterns of Sensitivity to Parenting and Peer Environments: Early Temperament and Adolescent Externalizing Behavior.

PubMed

Tung, Irene; Noroña, Amanda N; Morgan, Julia E; Caplan, Barbara; Lee, Steve S; Baker, Bruce L

2018-03-14

Although parenting behavior and friendship quality predict adolescent externalizing behaviors (EBs), individual differences in temperament may differentially affect susceptibility to these factors over time. In a multi-method and multi-informant study of 141 children followed prospectively from toddlerhood to adolescence, we tested the independent and interactive associations of age 3 reactive temperament (e.g., negative emotionality) and age 13 observed parenting (i.e., positive and negative behavior) and friendship (i.e., conflict and warmth), with multi-informant ratings of age 15 aggression and rule-breaking behavior. Negative parenting predicted growth in parent-rated EB, but only for adolescents with early reactive temperament. Temperament did not affect sensitivity to positive parenting or friendship. Results are discussed in the context of differential susceptibility theory and intervention implications for adolescents. © 2018 Society for Research on Adolescence.

Space Shuttle - Bringing cryohydrogen technology down to earth. [details of LH2 and LO2 technology and External Tank design

NASA Technical Reports Server (NTRS)

Odom, J. B.

1978-01-01

The External Tank must provide a safe storage container for both LH2 and LO2, a means of maintaining propellant quality in order to meet the engine pump net positive suction pressure requirements, and a structural strong-back for the Space Shuttle system, all at the minimum recurring cost and weight, while maintaining quality and reliability. The present paper summarizes External Tank design features and discusses the advantages of using LH2 and LO2 for the Space Shuttle system.

Can a combination of average of normals and "real time" External Quality Assurance replace Internal Quality Control?

PubMed

Badrick, Tony; Graham, Peter

2018-03-28

Internal Quality Control and External Quality Assurance are separate but related processes that have developed independently in laboratory medicine over many years. They have different sample frequencies, statistical interpretations and immediacy. Both processes have evolved absorbing new understandings of the concept of laboratory error, sample material matrix and assay capability. However, we do not believe at the coalface that either process has led to much improvement in patient outcomes recently. It is the increasing reliability and automation of analytical platforms along with improved stability of reagents that has reduced systematic and random error, which in turn has minimised the risk of running less frequent IQC. We suggest that it is time to rethink the role of both these processes and unite them into a single approach using an Average of Normals model supported by more frequent External Quality Assurance samples. This new paradigm may lead to less confusion for laboratory staff and quicker responses to and identification of out of control situations.

Spatiotemporal Patterns of the Use of Urban Green Spaces and External Factors Contributing to Their Use in Central Beijing

PubMed Central

Li, Fangzheng; Zhang, Fen; Li, Xiong; Wang, Peng; Liang, Junhui; Mei, Yuting; Cheng, Wenwen; Qian, Yun

2017-01-01

Urban green spaces encourage outdoor activity and social communication that contribute to the health of local residents. Examining the relationship between the use of urban green spaces and factors influencing their utilization can provide essential references for green space site selection in urban planning. In contrast to previous studies that focused on internal factors, this study highlights the external factors (traffic convenience, population density and commercial facilities) contributing to the use of urban green spaces. We conducted a spatiotemporal analysis of the distribution of visitors in 208 selected green spaces in central Beijing. We examined the relationship between the spatial pattern of visitor distribution within urban green spaces and external factors, using the Gini coefficient, kernel density estimation, and geographical detectors. The results of the study were as follows. The spatial distribution of visitors within central Beijing’s green spaces was concentrated, forming different agglomerations. The three examined external factors are all associated with the use of green spaces. Among them, commercial facilities are the important external factor associated with the use of green spaces. For the selection of sites for urban green spaces, we recommend consideration of external factors in order to balance urban green space utilization. PMID:28264451

Spatiotemporal Patterns of the Use of Urban Green Spaces and External Factors Contributing to Their Use in Central Beijing.

PubMed

Li, Fangzheng; Zhang, Fen; Li, Xiong; Wang, Peng; Liang, Junhui; Mei, Yuting; Cheng, Wenwen; Qian, Yun

2017-02-27

Urban green spaces encourage outdoor activity and social communication that contribute to the health of local residents. Examining the relationship between the use of urban green spaces and factors influencing their utilization can provide essential references for green space site selection in urban planning. In contrast to previous studies that focused on internal factors, this study highlights the external factors (traffic convenience, population density and commercial facilities) contributing to the use of urban green spaces. We conducted a spatiotemporal analysis of the distribution of visitors in 208 selected green spaces in central Beijing. We examined the relationship between the spatial pattern of visitor distribution within urban green spaces and external factors, using the Gini coefficient, kernel density estimation, and geographical detectors. The results of the study were as follows. The spatial distribution of visitors within central Beijing's green spaces was concentrated, forming different agglomerations. The three examined external factors are all associated with the use of green spaces. Among them, commercial facilities are the important external factor associated with the use of green spaces. For the selection of sites for urban green spaces, we recommend consideration of external factors in order to balance urban green space utilization.

7 CFR 14.6 - Criteria for determining the primary purpose of payments with respect to potential exclusion from...

Code of Federal Regulations, 2013 CFR

2013-01-01

... quality of the natural external or extrinsic conditions directly or indirectly affecting people. (2... their lives. (d) Restoring the environment. (1) Payments shall be considered to be made primarily for... practices undertaken to reestablish, return, or enhance the quantity or quality of the natural external or...

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…

External Quality Assessments for Microbiologic Diagnosis of Diphtheria in Europe

PubMed Central

Both, Leonard; Neal, Shona; De Zoysa, Aruni; Mann, Ginder; Czumbel, Ida

2014-01-01

The European Diphtheria Surveillance Network (EDSN) ensures the reliable epidemiological and microbiologic assessment of disease prevalence in the European Union. Here, we describe a survey of current diagnostic techniques for diphtheria surveillance conducted across the European Union and report the results from three external quality assessment (EQA) schemes performed between 2010 and 2014. PMID:25297336

The Impact of External Quality Assessment on Universities: The Estonian Experience

ERIC Educational Resources Information Center

Vilgats, Birgit; Heidmets, Mati

2011-01-01

This article seeks to establish what impact external quality assessment had on universities in Estonia between 1997 and 2009. It is based on a study of the analysis of experts' reports of curricula accreditation and interviews with university and programme managers, undertaken between 2007 and 2009. The study included an analysis of 12 curricula…

External Quality Arrangements for the Review of Modern Apprenticeship Off-the-Job Training

ERIC Educational Resources Information Center

Education Scotland, 2015

2015-01-01

This publication provides a quality framework to provide a structure for external review of Modern Apprenticeship off-the-job training.? The indicators in this framework are arranged under three key principles, addressing five questions which Education Scotland is adopting for evaluation purposes. These are underpinned by a wider principle on the…

[Analysis of the results of the SEIMC External Quality Control Program. Year 2012].

PubMed

de Gopegui Bordes, Enrique Ruiz; Guna Serrano, M del Remedio; Orta Mira, Nieves; Ovies, María Rosario; Poveda, Marta; Gimeno Cardona, Concepción

2014-02-01

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) include controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology and molecular microbiology. This article presents the most relevant conclusions and lessons from the 2012 controls. As a whole, the results obtained in 2012 confirm the excellent skill and good technical standards found in previous editions. However, erroneous results can be obtained in any laboratory and in clinically relevant determinations. Once again, the results of this program highlighted the need to implement both internal and external controls in order to assure the maximal quality of the microbiological tests. Copyright © 2014 Elsevier España, S.L. All rights reserved.

[Analysis of the results of the 2010 External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology].

PubMed

Ruiz de Gopegui Bordes, Enrique; Serrano, M del Remedio Guna; Orta Mira, Nieves; Ovies, María Rosario; Poveda, Marta; Cardona, Concepción Gimeno

2011-12-01

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology includes controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology and molecular microbiology. This article presents the most important conclusions and lessons of the 2010 controls. As a whole, the results obtained in 2010 confirm the excellent skill and good technical standards found in previous years. However, erroneous results can be obtained in any laboratory and in clinically relevant determinations. The results of this program highlight the need to implement both internal and external controls to ensure maximal quality of microbiological tests(1). Copyright © 2011 Elsevier España S.L. All rights reserved.

[Analysis of the results of the SEIMC External Quality Control Program. Year 2014].

PubMed

Gopegui Bordes, Enrique Ruiz de; Guna Serrano, M Del Remedio; Orta Mira, Nieves; Medina González, Rafael; Rosario Ovies, María; Poveda, Marta; Gimeno Cardona, Concepción

2016-07-01

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) include controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology and molecular microbiology. This article presents the most relevant conclusions and lessons from the 2014 controls. As a whole, the results obtained in 2014 confirm the excellent skill and good technical standards found in previous editions. However, erroneous results can be obtained in any laboratory and in clinically relevant determinations. Once again, the results of the SEIMC program highlighted the need to implement both internal and external controls in order to assure the maximal quality of the microbiological tests. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Final report on LDRD project : narrow-linewidth VCSELs for atomic microsystems.

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

Chow, Weng Wah; Geib, Kent Martin; Peake, Gregory Merwin

2011-09-01

Vertical-cavity surface-emitting lasers (VCSELs) are well suited for emerging photonic microsystems due to their low power consumption, ease of integration with other optical components, and single frequency operation. However, the typical VCSEL linewidth of 100 MHz is approximately ten times wider than the natural linewidth of atoms used in atomic beam clocks and trapped atom research, which degrades or completely destroys performance in those systems. This report documents our efforts to reduce VCSEL linewidths below 10 MHz to meet the needs of advanced sub-Doppler atomic microsystems, such as cold-atom traps. We have investigated two complementary approaches to reduce VCSEL linewidth:more » (A) increasing the laser-cavity quality factor, and (B) decreasing the linewidth enhancement factor (alpha) of the optical gain medium. We have developed two new VCSEL devices that achieved increased cavity quality factors: (1) all-semiconductor extended-cavity VCSELs, and (2) micro-external-cavity surface-emitting lasers (MECSELs). These new VCSEL devices have demonstrated linewidths below 10 MHz, and linewidths below 1 MHz seem feasible with further optimization.« less

Higher prices, higher quality? Evidence from German nursing homes.

PubMed

Herr, Annika; Hottenrott, Hanna

2016-02-01

This study investigates the relationship between prices and quality of 7400 German nursing homes. We use a cross section of public quality reports for all German nursing homes, which had been evaluated between 2010 and 2013 by external institutions. Our analysis is based on multivariate regressions in a two stage least squares framework, where we instrument prices to explain their effect on quality controlling for income, nursing home density, demographics, labour market characteristics, and infrastructure at the regional level. Descriptive analysis shows that prices and quality do not only vary across nursing homes, but also across counties and federal states and that quality and prices correlate positively. Second, the econometric analysis, which accounts for the endogenous relation between negotiated price and reported quality, shows that quality indeed positively depends on prices. In addition, more places in nursing homes per people in need are correlated with both lower prices and higher quality. Finally, unobserved factors at the federal state level capture some of the variation of reported quality across nursing homes. Our results suggest that higher prices increase quality. Furthermore, since reported quality and prices vary substantially across federal states, we conclude that the quality and prices of long-term care facilities may well be compared within federal states but not across. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

DSM-IV Personality Disorders and Associations with Externalizing and Internalizing Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

PubMed Central

Harford, Thomas C.; Chen, Chiung M.; Saha, Tulshi D.; Smith, Sharon M.; Ruan, W. June; Grant, Bridget F.

2013-01-01

Background Although associations between personality disorders and psychiatric disorders are well established in general population studies, their association with liability dimensions for externalizing and internalizing disorders has not been fully assessed. The purpose of this study is to examine associations between personality disorders (PDs) and lifetime externalizing and internalizing Axis I disorders. Methods Data were obtained from the total sample of 34,653 respondents from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drawing on the literature, a 3-factor exploratory structural equation model was selected to simultaneously assess the measurement relations among DSM-IV Axis I substance use and mood and anxiety disorders and the structural relations between the latent internalizing-externalizing dimensions and DSM-IV PDs, adjusting for gender, age, race/ethnicity, and marital status. Results Antisocial, histrionic, and borderline PDs were strong predictors for the externalizing factor, while schizotypal, borderline, avoidant, and obsessive-compulsive PDs had significantly larger effects on the internalizing fear factor when compared to the internalizing misery factor. Paranoid, schizoid, narcissistic, and dependent PDs provided limited discrimination between and among the three factors. An overarching latent factor representing general personality dysfunction was significantly greater on the internalizing fear factor followed by the externalizing factor, and weakest for the internalizing misery factor. Conclusion Personality disorders offer important opportunities for studies on the externalizing-internalizing spectrum of common psychiatric disorders. Future studies based on panic, anxiety, and depressive symptoms may elucidate PD associations with the internalizing spectrum of disorders. PMID:23932575

DSM-IV personality disorders and associations with externalizing and internalizing disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

PubMed

Harford, Thomas C; Chen, Chiung M; Saha, Tulshi D; Smith, Sharon M; Ruan, W June; Grant, Bridget F

2013-11-01

Although associations between personality disorders and psychiatric disorders are well established in general population studies, their association with liability dimensions for externalizing and internalizing disorders has not been fully assessed. The purpose of this study is to examine associations between personality disorders (PDs) and lifetime externalizing and internalizing Axis I disorders. Data were obtained from the total sample of 34,653 respondents from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drawing on the literature, a 3-factor exploratory structural equation model was selected to simultaneously assess the measurement relations among DSM-IV Axis I substance use and mood and anxiety disorders and the structural relations between the latent internalizing-externalizing dimensions and DSM-IV PDs, adjusting for gender, age, race/ethnicity, and marital status. Antisocial, histrionic, and borderline PDs were strong predictors for the externalizing factor, while schizotypal, borderline, avoidant, and obsessive-compulsive PDs had significantly larger effects on the internalizing fear factor when compared to the internalizing misery factor. Paranoid, schizoid, narcissistic, and dependent PDs provided limited discrimination between and among the three factors. An overarching latent factor representing general personality dysfunction was significantly greater on the internalizing fear factor followed by the externalizing factor, and weakest for the internalizing misery factor. Personality disorders offer important opportunities for studies on the externalizing-internalizing spectrum of common psychiatric disorders. Future studies based on panic, anxiety, and depressive symptoms may elucidate PD associations with the internalizing spectrum of disorders. Published by Elsevier Ltd.

Multicentre validation of IMRT pre-treatment verification: comparison of in-house and external audit.

PubMed

Jornet, Núria; Carrasco, Pablo; Beltrán, Mercè; Calvo, Juan Francisco; Escudé, Lluís; Hernández, Victor; Quera, Jaume; Sáez, Jordi

2014-09-01

We performed a multicentre intercomparison of IMRT optimisation and dose planning and IMRT pre-treatment verification methods and results. The aims were to check consistency between dose plans and to validate whether in-house pre-treatment verification results agreed with those of an external audit. Participating centres used two mock cases (prostate and head and neck) for the intercomparison and audit. Compliance to dosimetric goals and total number of MU per plan were collected. A simple quality index to compare the different plans was proposed. We compared gamma index pass rates using the centre's equipment and methodology to those of an external audit. While for the prostate case, all centres fulfilled the dosimetric goals and plan quality was homogeneous, that was not the case for the head and neck case. The number of MU did not correlate with the plan quality index. Pre-treatment verifications results of the external audit did not agree with those of the in-house measurements for two centres: being within tolerance for in-house measurements and unacceptable for the audit or the other way round. Although all plans fulfilled dosimetric constraints, plan quality is highly dependent on the planner expertise. External audits are an excellent tool to detect errors in IMRT implementation and cannot be replaced by intercomparison using results obtained by centres. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Comorbidity in illness-induced posttraumatic stress disorder versus posttraumatic stress disorder due to external events in a nationally representative study.

PubMed

Sommer, Jordana L; Mota, Natalie; Edmondson, Donald; El-Gabalawy, Renée

2018-05-10

The current study compared physical and mental health characteristics and quality of life of illness-induced posttraumatic stress disorder (PTSD) versus those with PTSD due to external traumatic events in a population-based sample. PTSD was assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5) using DSM-5 criteria in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Participants with past-year PTSD (n = 1779) were categorized into two groups: illness-induced (6.5%) and other trauma-induced PTSD (92.9%) based on index trauma. Group differences in physical health, mental health, and quality of life were estimated using multiple logistic and linear regressions with adjustment for demographics and medical morbidity. Compared to PTSD due to external events, illness-induced PTSD had higher rates of life-threatening illness in the past year. Illness-induced PTSD compared to PTSD due to external events was associated with reduced odds of depressive/bipolar disorders and antisocial personality disorder, but increased odds of cannabis use disorder. The groups did not differ on quality of life after accounting for medical morbidity. Illness-induced PTSD is common among American adults and has a similar impact on quality of life as PTSD due to external events, but may have distinct mental health correlates. Copyright © 2018 Elsevier Inc. All rights reserved.

Extension Procedures for Confirmatory Factor Analysis

ERIC Educational Resources Information Center

Nagy, Gabriel; Brunner, Martin; Lüdtke, Oliver; Greiff, Samuel

2017-01-01

We present factor extension procedures for confirmatory factor analysis that provide estimates of the relations of common and unique factors with external variables that do not undergo factor analysis. We present identification strategies that build upon restrictions of the pattern of correlations between unique factors and external variables. The…

Evidence for preferential flux flow at the grain boundaries of superconducting RF-quality niobium

NASA Astrophysics Data System (ADS)

Sung, Z.-H.; Lee, P. J.; Gurevich, A.; Larbalestier, D. C.

2018-04-01

The question of whether grain boundaries (GBs) in niobium can be responsible for lowered operating field (B RF) or quality factor (Q 0) in superconducting radio frequency (SRF) cavities is still controversial. Here, we show by direct DC transport across planar GBs isolated from a slice of very large-grain SRF-quality Nb that vortices can preferentially flow along the grain boundary when the external magnetic field lies in the GB plane. However, increasing the misalignment between the GB plane and the external magnetic field vector markedly reduces preferential flux flow along the GB. Importantly, we find that preferential GB flux flow is more prominent for a buffered chemical polished than for an electropolished bi-crystal. The voltage-current characteristics of GBs are similar to those seen in low angle grain boundaries of high temperature superconductors where there is clear evidence of suppression of the superconducting order parameter at the GB. While local weakening of superconductivity at GBs in cuprates and pnictides is intrinsic, deterioration of current transparency of GBs in Nb appears to be extrinsic, since the polishing method clearly affect the local GB degradation. The dependence of preferential GB flux flow on important cavity preparation and experimental variables, particularly the final chemical treatment and the angle between the magnetic field and the GB plane, suggests two more reasons why real cavity performance can be so variable.

A sediment resuspension and water quality model of Lake Okeechobee

USGS Publications Warehouse

James, R.T.; Martin, J.; Wool, T.; Wang, P.-F.

1997-01-01

The influence of sediment resuspension on the water quality of shallow lakes is well documented. However, a search of the literature reveals no deterministic mass-balance eutrophication models that explicitly include resuspension. We modified the Lake Okeeehobee water quality model - which uses the Water Analysis Simulation Package (WASP) to simulate algal dynamics and phosphorus, nitrogen, and oxygen cycles - to include inorganic suspended solids and algorithms that: (1) define changes in depth with changes in volume; (2) compute sediment resuspension based on bottom shear stress; (3) compute partition coefficients for ammonia and ortho-phosphorus to solids; and (4) relate light attenuation to solids concentrations. The model calibration and validation were successful with the exception of dissolved inorganic nitrogen species which did not correspond well to observed data in the validation phase. This could be attributed to an inaccurate formulation of algal nitrogen preference and/or the absence of nitrogen fixation in the model. The model correctly predicted that the lake is lightlimited from resuspended solids, and algae are primarily nitrogen limited. The model simulation suggested that biological fluxes greatly exceed external loads of dissolved nutrients; and sedimentwater interactions of organic nitrogen and phosphorus far exceed external loads. A sensitivity analysis demonstrated that parameters affecting resuspension, settling, sediment nutrient and solids concentrations, mineralization, algal productivity, and algal stoichiometry are factors requiring further study to improve our understanding of the Lake Okeechobee ecosystem.

Prediction of Success in External Cephalic Version under Tocolysis: Still a Challenge.

PubMed

Vaz de Macedo, Carolina; Clode, Nuno; Mendes da Graça, Luís

2015-01-01

External cephalic version is a procedure of fetal rotation to a cephalic presentation through manoeuvres applied to the maternal abdomen. There are several prognostic factors described in literature for external cephalic version success and prediction scores have been proposed, but their true implication in clinical practice is controversial. We aim to identify possible factors that could contribute to the success of an external cephalic version attempt in our population. We retrospectively examined 207 consecutive external cephalic version attempts under tocolysis conducted between January 1997 and July 2012. We consulted the department's database for the following variables: race, age, parity, maternal body mass index, gestational age, estimated fetal weight, breech category, placental location and amniotic fluid index. We performed descriptive and analytical statistics for each variable and binary logistic regression. External cephalic version was successful in 46.9% of cases (97/207). None of the included variables was associated with the outcome of external cephalic version attempts after adjustment for confounding factors. We present a success rate similar to what has been previously described in literature. However, in contrast to previous authors, we could not associate any of the analysed variables with success of the external cephalic version attempt. We believe this discrepancy is partly related to the type of statistical analysis performed. Even though there are numerous prognostic factors identified for the success in external cephalic version, care must be taken when counselling and selecting patients for this procedure. The data obtained suggests that external cephalic version should continue being offered to all eligible patients regardless of prognostic factors for success.

Factor Structure of the PTSD Checklist for DSM-5: Relationships Among Symptom Clusters, Anger, and Impulsivity.

PubMed

Armour, Cherie; Contractor, Ateka; Shea, Tracie; Elhai, Jon D; Pietrzak, Robert H

2016-02-01

Scarce data are available regarding the dimensional structure of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) posttraumatic stress disorder (PTSD) symptoms and how factors relate to external constructs. We evaluated six competing models of DSM-5 PTSD symptoms, including Anhedonia, Externalizing Behaviors, and Hybrid models, using confirmatory factor analyses in a sample of 412 trauma-exposed college students. We then examined whether PTSD symptom clusters were differentially related to measures of anger and impulsivity using Wald chi-square tests. The seven-factor Hybrid model was deemed optimal compared with the alternatives. All symptom clusters were associated with anger; the strongest association was between externalizing behaviors and anger (r = 0.54). All symptom clusters, except re-experiencing and avoidance, were associated with impulsivity, with the strongest association between externalizing behaviors and impulsivity (r = 0.49). A seven-factor Hybrid model provides superior fit to DSM-5 PTSD symptom data, with the externalizing behaviors factor being most strongly related to anger and impulsivity.

Friends' knowledge of youth internalizing and externalizing adjustment: accuracy, bias, and the influences of gender, grade, positive friendship quality, and self-disclosure.

PubMed

Swenson, Lance P; Rose, Amanda J

2009-08-01

Some evidence suggests that close friends may be knowledgeable of youth's psychological adjustment. However, friends are understudied as reporters of adjustment. The current study examines associations between self- and friend-reports of internalizing and externalizing adjustment in a community sample of fifth-, eighth-, and eleventh-grade youth. The study extends prior work by considering the degree to which friends' reports of youth adjustment are accurate (i.e., predicted by youths' actual adjustment) versus biased (i.e., predicted by the friend reporters' own adjustment). Findings indicated stronger bias effects than accuracy effects, but the accuracy effects were significant for both internalizing and externalizing adjustment. Additionally, friends who perceived their relationships as high in positive quality, friends in relationships high in disclosure, and girls perceived youths' internalizing symptoms most accurately. Knowledge of externalizing adjustment was not influenced by gender, grade, relationship quality, or self-disclosure. Findings suggest that friends could play an important role in prevention efforts.

[Uncertainty of cross calibration-applied beam quality conversion factor for the Japan Society of Medical Physics 12].

PubMed

Kinoshita, Naoki; Kita, Akinobu; Takemura, Akihiro; Nishimoto, Yasuhiro; Adachi, Toshiki

2014-09-01

The uncertainty of the beam quality conversion factor (k(Q,Q0)) of standard dosimetry of absorbed dose to water in external beam radiotherapy 12 (JSMP12) is determined by combining the uncertainty of each beam quality conversion factor calculated for each type of ionization chamber. However, there is no guarantee that ionization chambers of the same type have the same structure and thickness, so there may be individual variations. We evaluated the uncertainty of k(Q,Q0) for JSMP12 using an ionization chamber dosimeter and linear accelerator without a specific device or technique in consideration of the individual variation of ionization chambers and in clinical radiation field. The cross calibration formula was modified and the beam quality conversion factor for the experimental values [(k(Q,Q0))field] determined using the modified formula. It's uncertainty was calculated to be 1.9%. The differences between (k(Q,Q0))field of experimental values and k(Q,Q0) for Japan Society of Medical Physics 12 (JSMP12) were 0.73% and 0.88% for 6- and 10-MV photon beams, respectively, remaining within ± 1.9%. This showed k(Q,Q0) for JSMP12 to be consistent with (k(Q,Q0))field of experimental values within the estimated uncertainty range. Although inter-individual differences may be generated, even when the same type of ionized chamber is used, k(Q,Q0) for JSMP12 appears to be consistent within the estimated uncertainty range of (k(Q,Q0)field.

40 CFR Table 29 to Subpart G of... - Seal Related Factors for External Floating Roof Vessels

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 9 2011-07-01 2011-07-01 false Seal Related Factors for External..., and Wastewater Pt. 63, Subpt. G, Table 29 Table 29 to Subpart G of Part 63—Seal Related Factors for External Floating Roof Vessels Seal type Welded vessels KS N Riveted vessels KS N Metallic shoe seal...

40 CFR Table 29 to Subpart G of... - Seal Related Factors for External Floating Roof Vessels

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Seal Related Factors for External..., and Wastewater Pt. 63, Subpt. G, Table 29 Table 29 to Subpart G of Part 63—Seal Related Factors for External Floating Roof Vessels Seal type Welded vessels KS N Riveted vessels KS N Metallic shoe seal...

The influence of perceived parenting styles on socio-emotional development from pre-puberty into puberty.

PubMed

Ong, Min Yee; Eilander, Janna; Saw, Seang Mei; Xie, Yuhuan; Meaney, Michael J; Broekman, Birit F P

2018-01-01

The relative impact of parenting on socio-emotional development of children has rarely been examined in a longitudinal context. This study examined the association between perceived parenting styles and socio-emotional functioning from childhood to adolescence. We hypothesized that optimal parenting associated with improvement in socio-emotional functioning from childhood into early adulthood, especially for those with more behavioral problems in childhood. Children between ages 7 and 9 years were recruited for the Singapore Cohort Study of Risk Factors for Myopia (SCORM). Nine years later, 700 out of 1052 subjects were followed up (67%). During childhood, parents completed the Child Behavior Checklist (CBCL), while young adults completed the Youth Self-Report (YSR) and Parental Bonding Instrument (PBI). Perceived optimal parental care resulted in less internalizing and externalizing problems in early adulthood in comparison to non-optimal parental care styles. Perceived optimal paternal parenting, but not maternal parenting, in interaction with childhood externalizing problems predicted externalizing symptoms in early adulthood. No significant interactions were found between perceived parenting styles and internalizing problems. In conclusion, perceived parental care associates with the quality of socio-emotional development, while optimal parenting by the father is especially important for children with more externalizing problems in childhood.

[Evaluation of external quality assurance in accordance with sect. 137 SGB V at the Carl Gustav Carus university hospital in Dresden].

PubMed

Petzold, Thomas; Steinwitz, Adrienne; Schmitt, Jochen; Eberlein-Gonska, Maria

2013-01-01

Obligatory external quality assurance is an established method used to ensure the quality of inpatient care in Germany. The comprehensive approach is unique in international comparison. In addition to the statutory requirement, the health insurance funds require this form of external quality control in order to foster quality-based competition between hospitals. Ever since its introduction, healthcare providers have scrutinised the effects of the mandatory use of this survey. The study was based on all patients in the University Hospital Dresden, for whom a quality assurance sheet (n = 45,639) had to be recorded between 2003 and 2011. The documentation of these sheets was carried out by specially trained personnel. For each performance area, the duration of the documentation quality sheets was assessed, and a descriptive analysis of all quality assurance sheets was conducted. In the presence of statistical significance the so-called "Structured Dialogues" were analysed. Over the whole period, 167 statistically noticeable problems occurred. Nine of these have been rated as noticeable problems in medical quality by the specialised working groups of the project office quality assurance (PGSQS) at the Saxon State Medical Association (SLÄK). The remaining 158 statistical anomalies included 25 documentation errors; 96 were classified as statistically significant, and only 37 were marked to indicate that re-observation by the PGSQS was required. The total effort estimate for the documentation of quality assurance sheets was approximately 1,420 working days in the observation period. As far as the quality of patient care is concerned, the results can be considered positive because only a small number of quality indicators indicate noticeable qualitative problems. This statement is based primarily on the comparison of the groups of Saxony and Germany, which are included in the quality report of external quality assurance in accordance with sect. 137 SGB V. The majority of noticeable statistical problems were due to documentation errors. Other noticeable statistical problems that are medically indicated, but without effect on the extramural care to patients, recurrently occur with the respective quality indicators. Examples include the postoperative mobility indicators of the implementation of endoprostheses which cannot be used to draw conclusions about patient outcomes. Information on the quality of life as well as the post-hospital course of disease would be important in this context, but is still lacking. The use of external quality assurance data in accordance with sect. 137 SGB V for evaluation research has so far been handled quite restrictively. Thus, in-depth analyses on the quality of treatment cannot be derived. Copyright © 2013. Published by Elsevier GmbH.

Failure of Colorectal Surgical Site Infection Predictive Models Applied to an Independent Dataset: Do They Add Value or Just Confusion?

PubMed

Bergquist, John R; Thiels, Cornelius A; Etzioni, David A; Habermann, Elizabeth B; Cima, Robert R

2016-04-01

Colorectal surgical site infections (C-SSIs) are a major source of postoperative morbidity. Institutional C-SSI rates are modeled and scrutinized, and there is increasing movement in the direction of public reporting. External validation of C-SSI risk prediction models is lacking. Factors governing C-SSI occurrence are complicated and multifactorial. We hypothesized that existing C-SSI prediction models have limited ability to accurately predict C-SSI in independent data. Colorectal resections identified from our institutional ACS-NSQIP dataset (2006 to 2014) were reviewed. The primary outcome was any C-SSI according to the ACS-NSQIP definition. Emergency cases were excluded. Published C-SSI risk scores: the National Nosocomial Infection Surveillance (NNIS), Contamination, Obesity, Laparotomy, and American Society of Anesthesiologists (ASA) class (COLA), Preventie Ziekenhuisinfecties door Surveillance (PREZIES), and NSQIP-based models were compared with receiver operating characteristic (ROC) analysis to evaluate discriminatory quality. There were 2,376 cases included, with an overall C-SSI rate of 9% (213 cases). None of the models produced reliable and high quality C-SSI predictions. For any C-SSI, the NNIS c-index was 0.57 vs 0.61 for COLA, 0.58 for PREZIES, and 0.62 for NSQIP: all well below the minimum "reasonably" predictive c-index of 0.7. Predictions for superficial, deep, and organ space SSI were similarly poor. Published C-SSI risk prediction models do not accurately predict C-SSI in our independent institutional dataset. Application of externally developed prediction models to any individual practice must be validated or modified to account for institution and case-mix specific factors. This questions the validity of using externally or nationally developed models for "expected" outcomes and interhospital comparisons. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Assessment of Reference Height Models on Quality of Tandem-X dem

NASA Astrophysics Data System (ADS)

Mirzaee, S.; Motagh, M.; Arefi, H.

2015-12-01

The aim of this study is to investigate the effect of various Global Digital Elevation Models (GDEMs) in producing high-resolution topography model using TanDEM-X (TDX) Coregistered Single Look Slant Range Complex (CoSSC) images. We selected an image acquired on Jun 12th, 2012 over Doroud region in Lorestan, west of Iran and used 4 external digital elevation models in our processing including DLR/ASI X-SAR DEM (SRTM-X, 30m resolution), ASTER GDEM Version 2 (ASTER-GDEMV2, 30m resolution), NASA SRTM Version 4 (SRTM-V4, 90m resolution), and a local photogrammetry-based DEM prepared by National Cartographic Center (NCC DEM, 10m resolution) of Iran. InSAR procedure for DEM generation was repeated four times with each of the four external height references. The quality of each external DEM was initially assessed using ICESat filtered points. Then, the quality of, each TDX-based DEM was assessed using the more precise external DEM selected in the previous step. Results showed that both local (NCC) DEM and SRTM X-band performed the best (RMSE< 9m) for TDX-DEM generation. In contrast, ASTER GDEM v2 and SRTM C-band v4 showed poorer quality.

Improving the efficiency of quantitative (1)H NMR: an innovative external standard-internal reference approach.

PubMed

Huang, Yande; Su, Bao-Ning; Ye, Qingmei; Palaniswamy, Venkatapuram A; Bolgar, Mark S; Raglione, Thomas V

2014-01-01

The classical internal standard quantitative NMR (qNMR) method determines the purity of an analyte by the determination of a solution containing the analyte and a standard. Therefore, the standard must meet the requirements of chemical compatibility and lack of resonance interference with the analyte as well as a known purity. The identification of such a standard can be time consuming and must be repeated for each analyte. In contrast, the external standard qNMR method utilizes a standard with a known purity to calibrate the NMR instrument. The external standard and the analyte are measured separately, thereby eliminating the matter of chemical compatibility and resonance interference between the standard and the analyte. However, the instrumental factors, including the quality of NMR tubes, must be kept the same. Any deviations will compromise the accuracy of the results. An innovative qNMR method reported herein utilizes an internal reference substance along with an external standard to assume the role of the standard used in the traditional internal standard qNMR method. In this new method, the internal reference substance must only be chemically compatible and be free of resonance-interference with the analyte or external standard whereas the external standard must only be of a known purity. The exact purity or concentration of the internal reference substance is not required as long as the same quantity is added to the external standard and the analyte. The new method reduces the burden of searching for an appropriate standard for each analyte significantly. Therefore the efficiency of the qNMR purity assay increases while the precision of the internal standard method is retained. Copyright © 2013 Elsevier B.V. All rights reserved.

How does context affect intimate relationships? linking external stress and cognitive processes within marriage.

PubMed

Neff, Lisa A; Karney, Benjamin R

2004-02-01

Stressors external to the marriage frequently affect the way spouses evaluate their marital quality. To date, however, understanding of the interplay between external stress and internal relationship processes has been limited in two ways. First, research has generally examined only the short-term consequences of stress. Second, the mechanisms through which external stressors influence relationship outcomes are unclear. This study addressed both limitations by examining relationship cognitions that may mediate the effects of external stress throughout 4 years of marriage. Analyses confirmed that stressful experiences were associated with the trajectory of marital quality overtime. Furthermore, both the content and the organization of spouses' specific relationship cognitions mediated this effect. That is, stress negatively influenced the nature of spouses' marital perceptions as well as the way spouses interpreted and processed those perceptions. These findings draw attention to ways that the context of relationships shapes and constrains relationship processes.

A multi-methodological approach to study the temporal and spatial distribution of air quality related to road transport emissions in Madrid, Spain

NASA Astrophysics Data System (ADS)

Perez, Pedro; Miranda, Regina

2013-04-01

The traffic-related atmospheric emissions, composition and transport of greenhouse gases (GHGs) and air toxic pollutants (ATPs), are an important environmental problem that affect climate change and air pollution in Madrid, Spain. Carbon dioxide (CO2) affects the regional weather and particularly fine particle matter (PM) translocate to the people resulting in local health problems. As the main source of emissions comes from road transport, and subsequent combustion of fossil fuels, air quality deterioration may be elevated during weekdays and peak hours. We postulate that traffic-related air quality (CO2, methane CH4, PM, volatile organic compounds VOCs, nitrogen oxides NOx and carbon monoxide CO contents) impairs epidemiology in part via effects on health and disease development, likely increasing the external costs of transport in terms of climate change and air pollution. First, the paper intends to estimate the local air quality related to the road transport emissions of weeks over a domain covering Madrid (used as a case study). The local air quality model (LAQM) is based on gridded and shaped emission fields. The European Environmental Agency (EEA) COPERT modeling system will provide GHGs and ATPs gridded and shaped emission data and mobile source parameters, available for Madrid from preliminary emission inventory records of the Municipality of Madrid and from disaggregated traffic counts of the Traffic Engineering Company and the Metropolitan Company of Metro (METRO-Madrid). The paper intends to obtain estimates of GHGs and ATPs concentrations commensurate with available ground measurements, 24-hour average values, from the Municipality of Madrid. The comparison between estimated concentrations and measurements must show small errors (e.g. fractional error, fractional bias and coefficient of determination). The paper's expected results must determine spatial and temporal patterns in Madrid. The estimates will be used to cross check the primary local emission inventory, together with the mobile source's parameters and the disaggregated transport activity data. The paper will also identify emission and concentration differences and gradients of certain magnitude/factor (e.g. comparison between estimated ATPs hourly concentrations in Madrid City Center and in the peripheries). Furthermore, because of the higher contribution of road mobile sources to GHGs and ATPs emissions in Madrid, small gradients between urban highways and residential areas will be expected. Second, the paper objectives are to develop valid methods and approaches to measure air quality and to develop valid road transport emission inventories to assess correlations between external costs, epidemiology and emissions in order to reveal how traffic pollution affects people exposure to key contaminants and disease development, and identify susceptible emission scenarios and health impacts. We have conducted general emission inventory studies providing preliminary evidence of regional road transport air pollution impacts on external cost growth and disease development. Third, we also aim to demonstrate short and long-term impacts of road transport emissions on external costs development using innovative multi-methodological methods interfaced with environmental chemistry and meteorology following meteorological and chemical fields with contrasting high/low traffic emissions in several linked components involving: air pollutant assessment using local measurements, height of the boundary layer, meteorological environment interactions on external costs and epidemiology, mapping of Madrid (identifying gradients of emissions), integrative causal modeling using statistical models, and trend and scenario analyses on external costs and impacts on human health. Meteorological and chemical fields will be obtained from local records collected by surface meteorological and air quality stations. These two sets of fields define the horizontal and vertical profiles of GHGs and ATPs of Madrid based on air quality ground (initial conditions) and vertical (boundary conditions) measurements and modulate air concentration estimates

Anterior segment and external ocular disorders associated with HIV infections in the era of HAART in Chiang Mai University Hospital, a prospective descriptive cross sectional study.

PubMed

Singalavanija, Tassapol; Ausayakhun, Somsanguan; Tangmonkongvoragul, Chulaluck

2018-01-01

Human immunodeficiency virus (HIV) causes impairment to the human immune system which leads to immunocompromised conditions, including ocular complications. Several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae organ such as dry eye, blepharitis which reduce quality of life of patients. In present, potent antiretroviral therapies HAART (highly active antiretroviral therapy) has improved the length and quality of life which may lead to an increased prevalence of anterior segment ocular disorders. Hence, this study has been undertaken to identify the prevalence and associated factors of anterior segment and external ocular disorder in HIV infected patients in the era of HAART. A prospective descriptive cross sectional study was carried out in HIV positive patients conducted at the Department of Ophthalmology, Chiang Mai University Hospital, from February 2014 to October 2015. Detail history and ocular examination was carried out to examine for anterior segment and external ocular disorders. A total number of 363 patients were included for this prospective cross-sectional study. From the total of 363 patients, 123 patients had an anterior segment and external ocular disorder which account as the prevalence of 33.9%. The most common anterior segment manifestations was dry eye seen in 36 patients (9.9%), followed by posterior blepharitis (Meibomian gland dysfunction) seen in 23 patients (6.3%) and anterior blepharitis seen in 12 patients (3.3%). Other ocular complications included microvasculopathy, immune recovery uveitis, conjunctivitis, papilloma, anterior uveitis, corneal ulcer, nevus, trichiasis, molluscum contangiosum, Kaposi sarcoma, interstitial keratitis, conjunctival lymphangiectasia, dacryocystitis, vernal keratoconjunctivitis and eyelid penicilosis. In this study, the prevalance of anterior segment disorders was higher than in the preHAART era. Dry eye, blepharitis and uveitis were the top three most common anterior segment disorders in the HAART era. The statistical analysis showed no association between age, sex, CD4 count, duration of infection or receiving HAART and anterior segment disorders. Anterior segment abnormalities reduce the quality of life of patients, so ophthalmologists have to be aware and complete ocular examination should be performed in all HIV infected patients.

Anterior segment and external ocular disorders associated with HIV infections in the era of HAART in Chiang Mai University Hospital, a prospective descriptive cross sectional study

PubMed Central

Ausayakhun, Somsanguan

2018-01-01

Human immunodeficiency virus (HIV) causes impairment to the human immune system which leads to immunocompromised conditions, including ocular complications. Several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae organ such as dry eye, blepharitis which reduce quality of life of patients. In present, potent antiretroviral therapies HAART (highly active antiretroviral therapy) has improved the length and quality of life which may lead to an increased prevalence of anterior segment ocular disorders. Hence, this study has been undertaken to identify the prevalence and associated factors of anterior segment and external ocular disorder in HIV infected patients in the era of HAART. A prospective descriptive cross sectional study was carried out in HIV positive patients conducted at the Department of Ophthalmology, Chiang Mai University Hospital, from February 2014 to October 2015. Detail history and ocular examination was carried out to examine for anterior segment and external ocular disorders. A total number of 363 patients were included for this prospective cross-sectional study. From the total of 363 patients, 123 patients had an anterior segment and external ocular disorder which account as the prevalence of 33.9%. The most common anterior segment manifestations was dry eye seen in 36 patients (9.9%), followed by posterior blepharitis (Meibomian gland dysfunction) seen in 23 patients (6.3%) and anterior blepharitis seen in 12 patients (3.3%). Other ocular complications included microvasculopathy, immune recovery uveitis, conjunctivitis, papilloma, anterior uveitis, corneal ulcer, nevus, trichiasis, molluscum contangiosum, Kaposi sarcoma, interstitial keratitis, conjunctival lymphangiectasia, dacryocystitis, vernal keratoconjunctivitis and eyelid penicilosis. In this study, the prevalance of anterior segment disorders was higher than in the preHAART era. Dry eye, blepharitis and uveitis were the top three most common anterior segment disorders in the HAART era. The statistical analysis showed no association between age, sex, CD4 count, duration of infection or receiving HAART and anterior segment disorders. Anterior segment abnormalities reduce the quality of life of patients, so ophthalmologists have to be aware and complete ocular examination should be performed in all HIV infected patients. PMID:29466424

Contrasting Eutrophication Risks and Countermeasures in Different Water Bodies: Assessments to Support Targeted Watershed Management

PubMed Central

Li, Tong; Chu, Chunli; Zhang, Yinan; Ju, Meiting; Wang, Yuqiu

2017-01-01

Eutrophication is a major problem in China. To combat this issue, the country needs to establish water quality targets, monitoring systems, and intelligent watershed management. This study explores a new watershed management method. Water quality is first assessed using a single factor index method. Then, changes in total nitrogen/total phosphorus (TN/TP) are analyzed to determine the limiting factor. Next, the study compares the eutrophication status of two water function districts, using a comprehensive nutritional state index method and geographic information system (GIS) visualization. Finally, nutrient sources are qualitatively analyzed. Two functional water areas in Tianjin, China were selected and analyzed: Qilihai National Wetland Nature Reserve and Yuqiao Reservoir. The reservoir is a drinking water source. Results indicate that total nitrogen (TN) and total phosphorus (TP) pollution are the main factors driving eutrophication in the Qilihai Wetland and Yuqiao Reservoir. Phosphorus was the limiting factor in the Yuqiao Reservoir; nitrogen was the limiting factor in the Qilihai Wetland. Pollution in Qilihai Wetland is more serious than in Yuqiao Reservoir. The study found that external sources are the main source of pollution. These two functional water areas are vital for Tianjin; as such, the study proposes targeted management measures. PMID:28661417

Relative contributions of external forcing factors to circulation and hydrographic properties in a micro-tidal bay

NASA Astrophysics Data System (ADS)

Yoon, Seokjin; Kasai, Akihide

2017-11-01

The dominant external forcing factors influencing estuarine circulation differ among coastal environments. A three-dimensional regional circulation model was developed to estimate external influence indices and relative contributions of external forcing factors such as external oceanic forcing, surface heat flux, wind stress, and river discharge to circulation and hydrographic properties in Tango Bay, Japan. Model results show that in Tango Bay, where the Tsushima Warm Current passes offshore of the bay, under conditions of strong seasonal winds and river discharge, the water temperature and salinity are strongly influenced by surface heat flux and river discharge in the surface layer, respectively, while in the middle and bottom layers both are mainly controlled by open boundary conditions. The estuarine circulation is comparably influenced by all external forcing factors, the strong current, surface heat flux, wind stress, and river discharge. However, the influence degree of each forcing factor varies with temporal variations in external forcing factors as: the influence of open boundary conditions is higher in spring and early summer when the stronger current passes offshore of the bay, that of surface heat flux reflects the absolute value of surface heat flux, that of wind stress is higher in late fall and winter due to strong seasonal winds, and that of river discharge is higher in early spring due to snow-melting and summer and early fall due to flood events.

A rapid communication from the AAPM Task Group 201: recommendations for the QA of external beam radiotherapy data transfer. AAPM TG 201: quality assurance of external beam radiotherapy data transfer.

PubMed

Siochi, R Alfredo; Balter, Peter; Bloch, Charles D; Santanam, Lakshmi; Blodgett, Kurt; Curran, Bruce H; Engelsman, Martijn; Feng, Wenzheng; Mechalakos, Jim; Pavord, Dan; Simon, Tom; Sutlieff, Steven; Zhu, X Ronald

2010-12-04

The transfer of radiation therapy data among the various subsystems required for external beam treatments is subject to error. Hence, the establishment and management of a data transfer quality assurance program is strongly recommended. It should cover the QA of data transfers of patient specific treatments, imaging data, manually handled data and historical treatment records. QA of the database state (logical consistency and information integrity) is also addressed to ensure that accurate data are transferred.

Classification of java tea (Orthosiphon aristatus) quality using FTIR spectroscopy and chemometrics

NASA Astrophysics Data System (ADS)

Heryanto, R.; Pradono, D. I.; Marlina, E.; Darusman, L. K.

2017-05-01

Java tea (Orthosiphon aristatus) is a plant that widely used as a medicinal herb in Indonesia. Its quality is varying depends on various factors, such as cultivating area, climate and harvesting time. This study aimed to investigate the effectiveness of FTIR spectroscopy coupled with chemometrics for discriminating the quality of java tea from different cultivating area. FTIR spectra of ethanolic extracts were collected from five different regions of origin of java tea. Prior to chemometrics evaluation, spectra were pre-processed by using baselining, normalization and derivatization. Principal Components Analysis (PCA) was used to reduce the spectra to two PCs, which explained 73% of the total variance. Score plot of two PCs showed groupings of the samples according to their regions of origin. Furthermore, Partial Least Squares-Discriminant Analysis (PLSDA) was applied to the pre-processed data. The approach produced an external validation success rate of 100%. This study shows that FTIR analysis and chemometrics has discriminatory power to classify java tea based on its quality related to the region of origin.

Study on Quality Standard of Processed Curcuma Longa Radix

PubMed Central

Zhao, Yongfeng; Quan, Liang; Zhou, Haiting; Cao, Dong; Li, Wenbing; Yang, Zhuo

2017-01-01

To control the quality of Curcuma Longa Radix by establishing quality standards, this paper increased the contents of extract and volatile oil determination. Meanwhile, the curcumin was selected as the internal marker, and the relative correlation factors (RCFs) of demethoxycurcumin and bisdemethoxycurcumin were established by high performance liquid chromatography (HPLC). The contents of multicomponents were calculated based on their RCFs. The rationality and feasibility of the methods were evaluated by comparison of the quantitative results between external standard method (ESM) and quantitative analysis of multicomponents by single-marker (QAMS). Ethanol extracts ranged from 9.749 to 15.644% and the mean value was 13.473%. The volatile oil ranged from 0.45 to 0.90 mL/100 g and the mean value was 0.66 mL/100 g. This method was accurate and feasible and could provide a reference for further comprehensive and effective control of the quality standard of Curcuma Longa Radix and its processed products. PMID:29375640

Medical information on the internet: a tool for measuring consumer perception of quality aspects.

PubMed

Dubowicz, Arthur; Schulz, Peter J

2015-03-30

Most of adult Internet users have searched for health information on the Internet. The Internet has become one of the most important sources for health information and treatment advice. In most cases, the information found is not verified with a medical doctor, but judged by the "online-diagnosers" independently. Facing this situation, public health authorities raise concern over the quality of medical information laypersons can find on the Internet. The objective of the study was aimed at developing a measure to evaluate the credibility of websites that offer medical advice and information. The measure was tested in a quasi-experimental study on two sleeping-disorder websites of different quality. There were 45 survey items for rating the credibility of websites that were tested in a quasi-experimental study with a random assignment of 454 participants to either a high- or a low-quality website exposure. Using principal component analysis, the original items were reduced to 13 and sorted into the factors: trustworthiness, textual deficits of the content, interferences (external links on the Web site), and advertisements. The first two factors focus more on the provided content itself, while the other two describe the embedding of the content into the website. The 45 survey items had been designed previously using exploratory observations and literature research. The final scale showed adequate power and reliability for all factors. The loadings of the principal component analysis ranged satisfactorily (.644 to .854). Significant differences at P<.001 were found between the low- and high-quality groups. Advertisements on the website were rated as disturbing in both experimental conditions, meaning that they do not differentiate between good and bad information. The scale reliably distinguished high- and low-quality of medical advice given on websites.

Review: DNA Barcoding and Chromatography Fingerprints for the Authentication of Botanicals in Herbal Medicinal Products

PubMed Central

2017-01-01

In the last two decades, there has been a tremendous increase in the global use of herbal medicinal products (HMPs) due to their claimed health benefits. This has led to increase in their demand and consequently, also, resulted in massive adulteration. This is due to the fact that most of the traditional methods cannot identify closely related species in a process product form. Therefore the urgent need for simple and rapid identification methods resulted in the discovery of a novel technique. DNA barcoding is a process that uses short DNA sequence from the standard genome for species identification. This technique is reliable and is not affected by external factors such as climates, age, or plant part. The difficulties in isolation of DNA of high quality in addition to other factors are among the challenges encountered using the DNA barcoding in the authentication of HMP. These limitations indicated that using DNA barcoding alone may ineffectively authenticate the HMP. Therefore, the combination of DNA barcoding with chromatographic fingerprint, a popular and generally accepted technique for the assessment and quality control of HMP, will offer an efficient solution to effectively evaluate the authenticity and quality consistency of HMP. Detailed and quality information about the main composition of the HMPs will help to ascertain their efficacy and safety as these are very important for quality control. PMID:28536641

75 FR 19971 - Science Advisory Board Staff Office; Notification of a Public Teleconference of the Clean Air...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-16

... Quality Standards--First External Review Draft (March 2010). DATES: The teleconference will be held on May... assessment documents titled Particulate Matter Urban-Focused Visibility Assessment: Second External Review Draft (January 2010) and Quantitative Health Risk Assessment for Particulate Matter: Second External...

Local perceptions on factors influencing the introduction of international healthcare accreditation in Pakistan.

PubMed

Sax, Sylvia; Marx, Michael

2014-12-01

One contributor to poor health outcomes in developing countries is weak health systems; key to strengthening them are interventions to improve quality of health services. Though the value of healthcare accreditation is increasingly recognized, there are few case studies exploring its adaptation in developing countries. The aim of our study in Pakistan was to identify perceived factors influencing the adaptation of international healthcare accreditation within a developing country context. We used qualitative methods including semi-structured interviews, a structured group discussion, focus groups and non-participant observation of management meetings. Data analysis used a grounded theory approach and a conceptual framework adapted from implementation science. Using our conceptual framework categories of 'inner' and 'outer' setting, we found six perceived inner health system factors that could influence the introduction of healthcare accreditation and two 'outer' setting factors, perceived as external to the health system but able to influence its introduction. Our research identified that there is no 'one size fits all' approach to introducing healthcare accreditation as a means to improve healthcare quality. Those planning to support healthcare accreditation, such as national and provincial ministries and international development partners, need to understand how the three components of healthcare accreditation fit into the local health system and into the broader political and social environment. In our setting this included moving to supportive and transparent external evaluation mechanisms, with a first step of using locally developed and agreed standards. In addition, sustainable implementation of the three components was seen as a major challenge, especially establishment of a well-managed, transparent accreditation agency able to lead processes such as training and support for peer surveyors. Consideration of local change mechanisms and cultural practices is important in designing a local accreditation approach. The results of our study are important for health systems strengthening in Pakistan and in other developing countries. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Secular Orbit Evolution in Systems with a Strong External Perturber—A Simple and Accurate Model

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

Andrade-Ines, Eduardo; Eggl, Siegfried, E-mail: eandrade.ines@gmail.com, E-mail: siegfried.eggl@jpl.nasa.gov

We present a semi-analytical correction to the seminal solution for the secular motion of a planet’s orbit under gravitational influence of an external perturber derived by Heppenheimer. A comparison between analytical predictions and numerical simulations allows us to determine corrective factors for the secular frequency and forced eccentricity in the coplanar restricted three-body problem. The correction is given in the form of a polynomial function of the system’s parameters that can be applied to first-order forced eccentricity and secular frequency estimates. The resulting secular equations are simple, straight forward to use, and improve the fidelity of Heppenheimers solution well beyond higher-ordermore » models. The quality and convergence of the corrected secular equations are tested for a wide range of parameters and limits of its applicability are given.« less

Electrical Manipulation of Spin Qubits in Li-doped Si

NASA Astrophysics Data System (ADS)

Petukhov, Andre; Pendo, Luke; Handberg, Erin; Smelyanskiy, Vadim

2011-03-01

We propose a complete quantum computing scheme based on Li donors in Si under external biaxial stress. The qubits are encoded on the ground state Zeeman doublets and coupled via long-range spin-spin interaction mediated by acoustic phonons. This interaction is unique for Li donors in Si due to their inverted electronic structure. Our scheme takes advantage of the fact that the energy level spacing in 1 s Li-donor manifold is comparable with the magnitude of the spin-orbit interaction. As a result the Li spin qubits can be placed 100 nm apart and manipulated by a combination of external electric field and microwave field impulses. We present a specially-designed sequence of the electric field impulses which allows for a typical time of a two-qubit gate ~ ~1~ μ s and a quality factor ~10-6 . These estimates are derived from detailed microscopic calculations of the quadratic Stark effect and electron-phonon decoherence times.

Alcohol-related Genes Show an Enrichment of Associations with a Persistent Externalizing Factor

PubMed Central

Ashenhurst, James R.; Harden, K. Paige; Corbin, William R.; Fromme, Kim

2016-01-01

Research using twins has found that much of the variability in externalizing phenotypes – including alcohol and drug use, impulsive personality traits, risky sex and property crime – is explained by genetic factors. Nevertheless, identification of specific genes and variants associated with these traits has proven to be difficult, likely because individual differences in externalizing are explained by many genes of small individual effect. Moreover, twin research indicates that heritable variance in externalizing behaviors is mostly shared across the externalizing spectrum rather than specific to any behavior. We use a longitudinal, “deep phenotyping” approach to model a general externalizing factor reflecting persistent engagement in a variety of socially problematic behaviors measured at eleven assessment occasions spanning early adulthood (ages 18 to 28). In an ancestrally homogenous sample of non-Hispanic Whites (N = 337), we then tested for enrichment of associations between the persistent externalizing factor and a set of 3,281 polymorphisms within 104 genes that were previously identified as associated with alcohol-use behaviors. Next we tested for enrichment among domain-specific factors (e.g., property crime) composed of residual variance not accounted for by the common factor. Significance was determined relative to bootstrapped empirical thresholds derived from permutations of phenotypic data. Results indicated significant enrichment of genetic associations for persistent externalizing, but not for domain-specific factors. Consistent with twin research findings, these results suggest that genetic variants are broadly associated with externalizing behaviors rather than unique to specific behaviors. General Scientific Summary This study shows that variation in 104 genes is associated with socially problematic “externalizing” behavior, including substance misuse, property crime, risky sex, and aspects of impulsive personality. Importantly, this association was with the common variation across these behaviors rather than with the variation unique to any given behavior. The manuscript demonstrates a potentially advantageous technique for relating sets of hypothesized genes to complex traits or behaviors. PMID:27505405

External quality assessment for KRAS testing is needed: setup of a European program and report of the first joined regional quality assessment rounds.

PubMed

Bellon, Ellen; Ligtenberg, Marjolijn J L; Tejpar, Sabine; Cox, Karen; de Hertogh, Gert; de Stricker, Karin; Edsjö, Anders; Gorgoulis, Vassilis; Höfler, Gerald; Jung, Andreas; Kotsinas, Athanassios; Laurent-Puig, Pierre; López-Ríos, Fernando; Hansen, Tine Plato; Rouleau, Etienne; Vandenberghe, Peter; van Krieken, Johan J M; Dequeker, Elisabeth

2011-01-01

The use of epidermal growth factor receptor-targeting antibodies in metastatic colorectal cancer has been restricted to patients with wild-type KRAS tumors by the European Medicines Agency since 2008, based on data showing a lack of efficacy and potential harm in patients with mutant KRAS tumors. In an effort to ensure optimal, uniform, and reliable community-based KRAS testing throughout Europe, a KRAS external quality assessment (EQA) scheme was set up. The first large assessment round included 59 laboratories from eight different European countries. For each country, one regional scheme organizer prepared and distributed the samples for the participants of their own country. The samples included unstained sections of 10 invasive colorectal carcinomas with known KRAS mutation status. The samples were centrally validated by one of two reference laboratories. The laboratories were allowed to use their own preferred method for histological evaluation, DNA isolation, and mutation analysis. In this study, we analyze the setup of the KRAS scheme. We analyzed the advantages and disadvantages of the regional scheme organization by analyzing the outcome of genotyping results, analysis of tumor percentage, and written reports. We conclude that only 70% of laboratories correctly identified the KRAS mutational status in all samples. Both the false-positive and false-negative results observed negatively affect patient care. Reports of the KRAS test results often lacked essential information. We aim to further expand this program to more laboratories to provide a robust estimate of the quality of KRAS testing in Europe, and provide the basis for remedial measures and harmonization.

The Indirect Effect of Family Cohesion on Children's Weight Status through Maternal Quality of Life and Children's Internalizing and Externalizing Symptoms

ERIC Educational Resources Information Center

Frontini, Roberta; Haycraft, Emma; Canavarro, Maria Cristina; Moreira, Helena

2017-01-01

Background: Obesity has serious psychosocial consequences for youth and family members and has reached epidemic levels in Portugal. Objective: This study had two goals: (1) to investigate differences in family cohesion, mothers' quality of life (QoL), and externalizing/internalizing symptoms between children/adolescents with healthy-weight and…

Assessing the Organisational Impact of External Quality Assurance: Hypothesising Key Dimensions and Mechanisms

ERIC Educational Resources Information Center

Stensaker, Bjørn; Leiber, Theodor

2015-01-01

The aim of the article is to provide a framework in which the organisational impact of external quality assurance (EQA) can be assessed. Based on existing studies of the impact of EQA in universities and colleges it is suggested that greater systematisation of how impact is measured is needed for a better understanding of how EQA can be used as a…

Longitudinal Associations between Externalizing Problems and Student-Teacher Relationship Quality for Young Children with ASD

ERIC Educational Resources Information Center

Eisenhower, Abbey S.; Blacher, Jan; Bush Hurst, Hillary

2015-01-01

The associations between student-teacher relationship (STR) quality and externalizing behavior problems in school were examined among 166 children with ASD (82% boys, ages 4-7 years) across three assessments over a 1.5-year period; IQs in the sample range from 50 to 139 (M = 88.7). Unlike other non-ASD populations, the association between STR…

Implementation of the External Quality Assessment Program in Brazil.

PubMed

Fleury, Marcos Kneip; Menezes, Maria Elizabeth; Correa, José Abol

2017-02-15

The External Quality Assessment (EQA) in Brazil is performed by the National Health Ministry for diseases that are under supervision of Public Health Department. In addition to the government program, the Brazilian Society of Clinical Analysis and the Brazilian Society of Medical Pathology are allowed to provide their programs under the Supervision of National Agency for Sanitary Surveillance (ANVISA) that regulates laboratories to perform EQA programs.

Quantitative phosphoproteomic analysis of caprine muscle with high and low meat quality.

PubMed

Liu, Manshun; Wei, Yanchao; Li, Xin; Quek, Siew Young; Zhao, Jing; Zhong, Huazhen; Zhang, Dequan; Liu, Yongfeng

2018-07-01

During the conversion of muscle to meat, protein phosphorylation can regulate various biological processes that have important effects on meat quality. To investigate the phosphorylation pattern of protein on rigor mortis, goat longissimus thoracis and external intercostals were classified into two groups (high quality and low quality), and meat quality was evaluated according to meat quality attributes (Warner-Bratzler shear force, Color, pH and drip loss). A quantitative mass spectrometry-based phosphoproteomic study was conducted to analyze the caprine muscle at 12h postmortem applying the TiO 2 -SIMAC-HILIC (TiSH) phosphopeptide enrichment strategy. A total of 2125 phosphopeptides were identified from 750 phosphoproteins. Among them, 96 proteins had differed in phosphorylation levels. The majority of these proteins are involved in glucose metabolism and muscle contraction. The differential phosphorylation level of proteins (PFK, MYL2 and HSP27) in two groups may be the crucial factors of regulating muscle rigor mortis. This study provides a comprehensive view for the phosphorylation status of caprine muscle at rigor mortis, it also gives a better understanding of the regulation of protein phosphorylation on various biological processes that affect the final meat quality attributes. Copyright © 2018. Published by Elsevier Ltd.

An overview of the European Organization for External Quality Assurance Providers in Laboratory Medicine (EQALM)

PubMed Central

Stavelin, Anne; Albe, Xavier; Meijer, Piet; Sarkany, Erika; MacKenzie, Finlay

2017-01-01

The European Organisation for External Quality Assurance Providers in Laboratory Medicine (EQALM) was founded in 1996 and currently has members from 29 European countries and 6 countries from outside Europe. EQALM provides a forum for co-operation and exchange of knowledge on quality-related matters in laboratory medicine, especially with regard to external quality assessment (EQA) programs in Europe. In addition, EQALM represent the EQA providers in laboratory medicine at European level vis-ŕ-vis political, professional, scientific and other bodies, including patients’ organisations. To this end EQALM promotes activities such as organizing meetings with scientific and practical themes for members and other interested parties, issuing scientific publications, developing EQA projects and representing laboratory medicine EQA activities within other organisations and networks. EQALM is active in scientific and educational activity in different fields such as survey frequency, haematology, haemostasis, microbiology, nomenclature, virtual microscopy, traceability, accreditation, and quality assurance of the total testing process. The aim of this paper is to give an overview of the EQALM organisation. PMID:28392724

Family factors contributing to emotional and behavioral problems in Korean adolescents with epilepsy.

PubMed

Han, Su-Hyun; Lee, Sang-Ahm; Eom, Soyong; Kim, Heung-Dong

2016-03-01

We aimed to determine whether different aspects of family functioning are associated with emotional and behavioral problems in adolescents with epilepsy and, if not, to document any indirect associations mediated by other family factors. This was a cross-sectional, multicenter study. A total of 297 adolescents with epilepsy and their parents participated. Adolescent psychopathology was measured using the Youth Self-Report. Family factors were classified into proximal (parent-child interaction), distal (parent characteristics), and contextual factors (family characteristics) in accordance to their level of proximity to the adolescent's everyday life. Regression analyses were used to analyze the unique and combined predictive power of family factors in relation to psychopathology. In total, 44 (14.8%) and 51 (17.2%) adolescents with epilepsy scored above the borderline cutoff (T-score ≥ 60) of internalizing and externalizing problems, respectively. Proximal and distal factors were independently associated with both internalizing and externalizing problems. High levels of parental depressive mood and parental overcontrol were the strongest factors contributing to internalizing and externalizing problems, respectively. Contextual factors were indirectly associated with both internalizing and externalizing problems through more proximal factors. Both proximal and distal family factors affect psychopathology in Korean adolescents with epilepsy. Parental feelings of depression and parental overcontrol are the strongest factors contributing to internalizing and externalizing problems, respectively. Copyright © 2016 Elsevier Inc. All rights reserved.

Sex Differences in the Longitudinal Relations among Family Risk Factors and Childhood Externalizing Symptoms

ERIC Educational Resources Information Center

Blatt-Eisengart, Ilana; Drabick, Deborah A. G.; Monahan, Kathryn C.; Steinberg, Laurence

2009-01-01

Despite potential sex differences in base rates, predictors, and maintaining processes for children's externalizing behaviors, little prospective research has examined sex differences in the relations between concurrent, proximal family risk factors and children's externalizing behaviors. The current study examined the relations among maternal…

Structure and Etiology of Co-Occurring Internalizing and Externalizing Disorders in Adolescents

ERIC Educational Resources Information Center

Cosgrove, Victoria E.; Rhee, Soo H.; Gelhorn, Heather L.; Boeldt, Debra; Corley, Robin C.; Ehringer, Marissa A.; Young, Susan E.; Hewitt, John K.

2011-01-01

Several studies suggest that a two-factor model positing internalizing and externalizing factors explains the interrelationships among psychiatric disorders. However, it is unclear whether the covariation between internalizing and externalizing disorders is due to common genetic or environmental influences. We examined whether a model positing two…

Importance of interactions between food quality, quantity, and gut transit time on consumer feeding, growth, and trophic dynamics.

PubMed

Mitra, Aditee; Flynn, Kevin J

2007-05-01

Ingestion kinetics of animals are controlled by both external food availability and feedback from the quantity of material already within the gut. The latter varies with gut transit time (GTT) and digestion of the food. Ingestion, assimilation efficiency, and thus, growth dynamics are not related in a simple fashion. For the first time, the important linkage between these processes and GTT is demonstrated; this is achieved using a biomass-based, mechanistic multinutrient model fitted to experimental data for zooplankton growth dynamics when presented with food items of varying quality (stoichiometric composition) or quantity. The results show that trophic transfer dynamics will vary greatly between the extremes of feeding on low-quantity/high-quality versus high-quantity/low-quality food; these conditions are likely to occur in nature. Descriptions of consumer behavior that assume a constant relationship between the kinetics of grazing and growth irrespective of food quality and/or quantity, with little or no recognition of the combined importance of these factors on consumer behavior, may seriously misrepresent consumer activity in dynamic situations.

Dynamical signatures of collective quality grading in a social activity: attendance to motion pictures.

PubMed

Escobar, Juan V; Sornette, Didier

2015-01-01

We investigate the laws governing people's decisions and interactions by studying the collective dynamics of a well-documented social activity for which there exist ample records of the perceived quality: the attendance to movie theaters in the US. We picture the flows of attendance as impulses or "shocks" driven by external factors that in turn can create new cascades of attendances through direct recommendations whose effectiveness depends on the perceived quality of the movies. This corresponds to an epidemic branching model comprised of a decaying exponential function determining the time between cause and action, and a cascade of actions triggered by previous ones. We find that the vast majority of the ~3,500 movies studied fit our model remarkably well. From our results, we are able to translate a subjective concept such as movie quality into a probability of the deriving individual activity, and from it we build concrete quantitative predictions. Our analysis opens up the possibility of understanding other collective dynamics for which the perceived quality or appeal of an action is also known.

Dynamical Signatures of Collective Quality Grading in a Social Activity: Attendance to Motion Pictures

PubMed Central

Escobar, Juan V.; Sornette, Didier

2015-01-01

We investigate the laws governing people’s decisions and interactions by studying the collective dynamics of a well-documented social activity for which there exist ample records of the perceived quality: the attendance to movie theaters in the US. We picture the flows of attendance as impulses or “shocks” driven by external factors that in turn can create new cascades of attendances through direct recommendations whose effectiveness depends on the perceived quality of the movies. This corresponds to an epidemic branching model comprised of a decaying exponential function determining the time between cause and action, and a cascade of actions triggered by previous ones. We find that the vast majority of the ~3,500 movies studied fit our model remarkably well. From our results, we are able to translate a subjective concept such as movie quality into a probability of the deriving individual activity, and from it we build concrete quantitative predictions. Our analysis opens up the possibility of understanding other collective dynamics for which the perceived quality or appeal of an action is also known. PMID:25612292

External Quality Monitoring of the Cervical Cytopathological Exams in the Rio de Janeiro City.

PubMed

Rocha, Vânia Stiepanowez de Oliveira; Malfacini, Solange da Silva; Gomes, Alex Moreira; Rocha, Cláudia Ramos Marques da

2018-06-20

 To discuss the implementation and contributions of the External Quality Monitoring in the city of Rio de Janeiro and to analyze the performance of the main providers of cervical cytopathology in this city from September 2013 to March 2017, here referred to as "Alpha laboratory" and "Beta laboratory."  Observational, cross-sectional, retrospective study using information from the Cervical Cancer Control Information System (SISCOLO, in the Portuguese acronym), municipal coordination module, External Quality Monitoring report. The proportions of false positives, false negatives, unsatisfactory samples and rejected samples were estimated. The agreement among the observers was analyzed through the Kappa index and the reduction of disagreements in the period for each laboratory studied, comparing the results of each cycle.  A total of 19,158 examinations were selected, of which 19,130 (99.85%) were monitored, 16.649 (87, 03%) were reviewed by the External Quality Monitoring Unit, 2,481 (12,97%) were rejected and 441 (2,65%) were considered unsatisfactory. The "Beta laboratory" presented excellent concordance in all cycles; the "Alpha laboratory" had good concordance in the first two cycles (K = 0.76 and 0.79), becoming excellent in the following four cycles. The average Kappa index was 0.85, with median of 0.86. The percentage of diagnostic disagreement was 6.63% of the reviewed exams, of which 5.38% required a change of conduct CONCLUSION:  External Quality Monitoring is an exercise in diagnostic improvement, and its implementation was fundamental to ensure the reliability of the cytopathological exams in the city of Rio de Janeiro. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

Interpreting biomarker data from the COPHES/DEMOCOPHES twin projects: Using external exposure data to understand biomarker differences among countries

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

Smolders, R., E-mail: roel.smolders@vito.be; Den Hond, E.; Koppen, G.

In 2011 and 2012, the COPHES/DEMOCOPHES twin projects performed the first ever harmonized human biomonitoring survey in 17 European countries. In more than 1800 mother–child pairs, individual lifestyle data were collected and cadmium, cotinine and certain phthalate metabolites were measured in urine. Total mercury was determined in hair samples. While the main goal of the COPHES/DEMOCOPHES twin projects was to develop and test harmonized protocols and procedures, the goal of the current paper is to investigate whether the observed differences in biomarker values among the countries implementing DEMOCOPHES can be interpreted using information from external databases on environmental quality andmore » lifestyle. In general, 13 countries having implemented DEMOCOPHES provided high-quality data from external sources that were relevant for interpretation purposes. However, some data were not available for reporting or were not in line with predefined specifications. Therefore, only part of the external information could be included in the statistical analyses. Nonetheless, there was a highly significant correlation between national levels of fish consumption and mercury in hair, the strength of antismoking legislation was significantly related to urinary cotinine levels, and we were able to show indications that also urinary cadmium levels were associated with environmental quality and food quality. These results again show the potential of biomonitoring data to provide added value for (the evaluation of) evidence-informed policy making. - Highlights: • External data was collected to interpret HBM data from DEMOCOPHES. • Hg in hair could be related to fish consumption across different countries. • Urinary cotinine was related to strictness of anti-smoking legislation. • Urinary Cd was borderline significantly related to air and food quality. • Lack of comparable data among countries hampered the analysis.« less

Childhood trauma and resilience in psoriatic patients: A preliminary report.

PubMed

Crosta, Maria Luigia; De Simone, Clara; Di Pietro, Salvatore; Acanfora, Mariateresa; Caldarola, Giacomo; Moccia, Lorenzo; Callea, Antonino; Panaccione, Isabella; Peris, Ketty; Rinaldi, Lucio; Janiri, Luigi; Di Nicola, Marco

2018-03-01

Psoriasis is a chronic inflammatory skin disease with a complex etiology, involving the immune system, genetic factors, and external/internal triggers, with psychosomatic aspects. The aim of the study was to investigate childhood trauma and resilience in a psoriatic sample compared with healthy controls. Correlations between childhood trauma, resilience, quality of life, clinical data and psoriatic features were also evaluated. Seventy-seven psoriatic patients and seventy-six homogeneous healthy controls were enrolled. We used the Psoriasis Area and Severity Index (PASI) to assess the severity of psoriasis and the Skindex-29 to measure health-related quality of life. The psychometric battery included the Childhood Trauma Questionnaire (CTQ) and the Connor-Davidson Resilience Scale (CD-Risc) to assess trauma exposure and resilience, respectively. Psoriatic patients showed a significant prevalence of childhood trauma and a lower resilience level compared to healthy controls. Associations between traumatic experiences, low resilience and reduced quality of life in psoriatic subjects were also observed. A multidisciplinary approach is helpful to investigate clinical aspects, trigger factors and psychophysiological stress response in psoriatic subjects. Improving resilience with an early psychological intervention focused on self-motivation and strengthening of self-efficacy could facilitate the management of psoriasis. Copyright © 2018 Elsevier Inc. All rights reserved.

Quality management, a directive approach to patient safety.

PubMed

Ayuso-Murillo, Diego; de Andrés-Gimeno, Begoña; Noriega-Matanza, Concha; López-Suárez, Rafael Jesús; Herrera-Peco, Ivan

Nowadays the implementation of effective quality management systems and external evaluation in healthcare is a necessity to ensure not only transparency in activities related to health but also access to health and patient safety. The key to correctly implementing a quality management system is support from the managers of health facilities, since it is managers who design and communicate to health professionals the strategies of action involved in quality management systems. This article focuses on nursing managers' approach to quality management through the implementation of cycles of continuous improvement, participation of improvement groups, monitoring systems and external evaluation quality models (EFQM, ISO). The implementation of a quality management system will enable preventable adverse effects to be minimized or eliminated, and promote patient safety and safe practice by health professionals. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

[Quality management in pathology--an executive function and political implications].

PubMed

Turzynski, A

2013-09-01

Quality management (QM) is primarily an in-house executive function. It conduces to ensure a high quality service and has the external object to satisfy customer expectations. In Germany the implementation of quality management systems (QMS) is made compulsory for all medical facilities by law. However, details are not regulated and there is no need to certify the in-house QMS. Within the last 10 years many pathology institutions have become certified or accredited and have implemented voluntary measures of external quality assurance, such as quality circles and round robin trials. For non-certified institutions it might be helpful to be guided by established QM standards like the ISO 9001:2008. The fundamental concepts of QM, some pathology-specific aspects and some implications for the professional associations are discussed in this article.

Quality and Safety in Health Care, Part XIV: The External Environment and Research for Diagnostic Processes.

PubMed

Harolds, Jay A

2016-09-01

The work system in which diagnosis takes place is affected by the external environment, which includes requirements such as certification, accreditation, and regulations. How errors are reported, malpractice, and the system for payment are some other aspects of the external environment. Improving the external environment is expected to decrease errors in diagnosis. More research on improving the diagnostic process is needed.

External built residential environment characteristics that affect mental health of adults.

PubMed

Ochodo, Charles; Ndetei, D M; Moturi, W N; Otieno, J O

2014-10-01

External built residential environment characteristics include aspects of building design such as types of walls, doors and windows, green spaces, density of houses per unit area, and waste disposal facilities. Neighborhoods that are characterized by poor quality external built environment can contribute to psychosocial stress and increase the likelihood of mental health disorders. This study investigated the relationship between characteristics of external built residential environment and mental health disorders in selected residences of Nakuru Municipality, Kenya. External built residential environment characteristics were investigated for 544 residents living in different residential areas that were categorized by their socioeconomic status. Medically validated interview schedules were used to determine mental health of residents in the respective neighborhoods. The relationship between characteristics of the external built residential environment and mental health of residents was determined by multivariable logistic regression analyses and chi-square tests. The results show that walling materials used on buildings, density of dwelling units, state of street lighting, types of doors, states of roofs, and states of windows are some built external residential environment characteristics that affect mental health of adult males and females. Urban residential areas that are characterized by poor quality external built environment substantially expose the population to daily stressors and inconveniences that increase the likelihood of developing mental health disorders.

Quality of herbal medicines: challenges and solutions.

PubMed

Zhang, Junhua; Wider, Barbara; Shang, Hongcai; Li, Xuemei; Ernst, Edzard

2012-01-01

The popularity of herbal medicines has risen worldwide. This increase in usage renders safety issues important. Many adverse events of herbal medicines can be attributed to the poor quality of the raw materials or the finished products. Different types of herbal medicines are associated with different problems. Quality issues of herbal medicines can be classified into two categories: external and internal. In this review, external issues including contamination (e.g. toxic metals, pesticides residues and microbes), adulteration and misidentification are detailed. Complexity and non-uniformity of the ingredients in herbal medicines are the internal issues affecting the quality of herbal medicines. Solutions to the raised problems are discussed. The rigorous implementation of Good Agricultural and Collection Practices (GACP) and Good Manufacturing Practices (GMP) would undoubtedly reduce the risk of external issues. Through the use of modern analytical methods and pharmaceutical techniques, previously unsolved internal issues have become solvable. Standard herbal products can be manufactured from the standard herbal extracts. Copyright © 2011 Elsevier Ltd. All rights reserved.

The obese gut microbiome across the epidemiologic transition.

PubMed

Dugas, Lara R; Fuller, Miles; Gilbert, Jack; Layden, Brian T

2016-01-01

The obesity epidemic has emerged over the past few decades and is thought to be a result of both genetic and environmental factors. A newly identified factor, the gut microbiota, which is a bacterial ecosystem residing within the gastrointestinal tract of humans, has now been implicated in the obesity epidemic. Importantly, this bacterial community is impacted by external environmental factors through a variety of undefined mechanisms. We focus this review on how the external environment may impact the gut microbiota by considering, the host's geographic location 'human geography', and behavioral factors (diet and physical activity). Moreover, we explore the relationship between the gut microbiota and obesity with these external factors. And finally, we highlight here how an epidemiologic model can be utilized to elucidate causal relationships between the gut microbiota and external environment independently and collectively, and how this will help further define this important new factor in the obesity epidemic.

[Analysis of the results of the SEIMC External Quality Control Program. Year 2011].

PubMed

Ruiz de Gopegui Bordes, Enrique; Guna Serrano, M del Remedio; Orta Mira, Nieves; Ovies, María Rosario; Poveda, Marta; Gimeno Cardona, Concepción

2013-02-01

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica [SEIMC]) includes controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology, and molecular microbiology. This article presents the most relevant conclusions and lessons from the 2011 controls. Overall, the results obtained in 2011 confirm the excellent skill and good technical standards found in previous years. Nevertheless, erroneous results can be obtained in any laboratory and in clinically relevant determinations. The results of this program highlight the need to implement both internal and external controls, such as those offered by the SEIMC program, in order to ensure maximal quality of microbiological tests. Copyright © 2013 Elsevier España, S.L. All rights reserved.

[Quality management in a public health agency].

PubMed

Villalbí, Joan R; Ballestín, Manuela; Casas, Conrad; Subirana, Teresa

2012-01-01

This article describes the introduction of quality improvement actions in a public health organization. After ISO 17025 accreditation, which was legally mandated, was granted to the official control laboratory, the management decided to expand a quality policy in 2003, through a series of actions based on process analysis and proposals for improvement, further definition of standard operating procedures, exploration of users' opinions, the creation of improvement groups, and external audits or certification. The organizational response to these initiatives was diverse. External audit or certification of services seems to be the most powerful tool for change. Costing studies showed that up to 75% of the total expenditure of the agency in 2010 was spent on public health services subject to external audit or certification. Copyright © 2011 SESPAS. Published by Elsevier España, S.L. All rights reserved.

External Factors, Internal Factors and Self-Directed Learning Readiness

ERIC Educational Resources Information Center

Ramli, Nurjannah; Muljono, Pudji; Afendi, Farit M.

2018-01-01

There are many factors which affect the level of self-directed learning readiness. This study aims to investigate the relationship between external factors, internal factors and self-directed learning readiness. This study was carried out by using a census method for fourth year students of medical program of Tadulako University. Data were…

[Determination of five naphthaquinones in Arnebia euchroma by quantitative analysis multi-components with single-marker].

PubMed

Zhao, Wen-Wen; Wu, Zhi-Min; Wu, Xia; Zhao, Hai-Yu; Chen, Xiao-Qing

2016-10-01

This study is to determine five naphthaquinones (acetylshikonin, β-acetoxyisovalerylalkannin, isobutylshikonin, β,β'-dimethylacrylalkannin,α-methyl-n-butylshikonin） by quantitative analysis of multi-components with a single marker (QAMS). β,β'-Dimethylacrylalkannin was selected as the internal reference substance, and the relative correlation factors (RCFs) of acetylshikonin, β-acetoxyisovalerylalkannin, isobutylshikonin and α-methyl-n-butylshikonin were calculated. Then the ruggedness of relative correction factors was tested on different instruments and columns. Meanwhile, 16 batches of Arnebia euchroma were analyzed by external standard method (ESM) and QAMS, respectively. The peaks were identifited by LC-MS. The ruggedness of relative correction factors was good. And the analytical results calculated by ESM and QAMS showed no difference. The quantitative method established was feasible and suitable for the quality evaluation of A. euchroma. Copyright© by the Chinese Pharmaceutical Association.

Examining the Assessment Literacy of External Examiners

ERIC Educational Resources Information Center

Medland, Emma

2015-01-01

External scrutiny of higher education courses is evident globally, but the use of an external examiner from another institution for the purposes of quality assurance has been a distinguishing feature of UK higher education since the 1830s. However, the changing higher education context has led to mounting criticism of the system and the…

78 FR 14538 - Notification of a Public Teleconference of the Clean Air Scientific Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-06

... Assessment for Lead (Third External Review Draft--November 2012) and EPA's Policy Assessment for the Review of the Lead National Ambient Air Quality Standards (First External Review Draft--January 2013). DATES... CASAC will hold a public teleconference review its draft letters on EPA's third external review draft of...

Physical activity promotion in Latin American populations: a systematic review on issues of internal and external validity

PubMed Central

2014-01-01

The purpose of this review was to determine the degree to which physical activity interventions for Latin American populations reported on internal and external validity factors using the RE-AIM framework (reach & representativeness, effectiveness, adoption, implementation, maintenance). We systematically identified English (PubMed; EbscoHost) and Spanish (SCIELO; Biblioteca Virtual en Salud) language studies published between 2001 and 2012 that tested physical activity, exercise, or fitness promotion interventions in Latin American populations. Cross-sectional/descriptive studies, conducted in Brazil or Spain, published in Portuguese, not including a physical activity/fitness/exercise outcome, and with one time point assessment were excluded. We reviewed 192 abstracts and identified 46 studies that met the eligibility criteria (34 in English, 12 in Spanish). A validated 21-item RE-AIM abstraction tool was used to determine the quality of reporting across studies (0-7 = low, 8-14 = moderate, and 15-21 = high). The number of indicators reported ranged from 3–14 (mean = 8.1 ± 2.6), with the majority of studies falling in the moderate quality reporting category. English and Spanish language articles did not differ on the number of indicators reported (8.1 vs. 8.3, respectively). However, Spanish articles reported more across reach indicators (62% vs. 43% of indicators), while English articles reported more across effectiveness indicators (69% vs 62%). Across RE-AIM dimensions, indicators for reach (48%), efficacy/effectiveness (67%), and implementation (41%) were reported more often than indicators of adoption (25%) and maintenance (10%). Few studies reported on the representativeness of participants, staff that delivered interventions, or the settings where interventions were adopted. Only 13% of the studies reported on quality of life and/or potential negative outcomes, 20% reported on intervention fidelity, and 11% on cost of implementation. Outcomes measured after six months of intervention, information on continued delivery and institutionalization of interventions, were also seldom reported. Regardless of language of publication, physical activity intervention research for Latin Americans should increase attention to and measurement of external validity and cost factors that are critical in the decision making process in practice settings and can increase the likelihood of translation into community or clinical practice. PMID:24938641

Physical activity promotion in Latin American populations: a systematic review on issues of internal and external validity.

PubMed

Galaviz, Karla I; Harden, Samantha M; Smith, Erin; Blackman, Kacie Ca; Berrey, Leanna M; Mama, Scherezade K; Almeida, Fabio A; Lee, Rebecca E; Estabrooks, Paul A

2014-06-17

The purpose of this review was to determine the degree to which physical activity interventions for Latin American populations reported on internal and external validity factors using the RE-AIM framework (reach & representativeness, effectiveness, adoption, implementation, maintenance). We systematically identified English (PubMed; EbscoHost) and Spanish (SCIELO; Biblioteca Virtual en Salud) language studies published between 2001 and 2012 that tested physical activity, exercise, or fitness promotion interventions in Latin American populations. Cross-sectional/descriptive studies, conducted in Brazil or Spain, published in Portuguese, not including a physical activity/fitness/exercise outcome, and with one time point assessment were excluded. We reviewed 192 abstracts and identified 46 studies that met the eligibility criteria (34 in English, 12 in Spanish). A validated 21-item RE-AIM abstraction tool was used to determine the quality of reporting across studies (0-7 = low, 8-14 = moderate, and 15-21 = high). The number of indicators reported ranged from 3-14 (mean = 8.1 ± 2.6), with the majority of studies falling in the moderate quality reporting category. English and Spanish language articles did not differ on the number of indicators reported (8.1 vs. 8.3, respectively). However, Spanish articles reported more across reach indicators (62% vs. 43% of indicators), while English articles reported more across effectiveness indicators (69% vs 62%). Across RE-AIM dimensions, indicators for reach (48%), efficacy/effectiveness (67%), and implementation (41%) were reported more often than indicators of adoption (25%) and maintenance (10%). Few studies reported on the representativeness of participants, staff that delivered interventions, or the settings where interventions were adopted. Only 13% of the studies reported on quality of life and/or potential negative outcomes, 20% reported on intervention fidelity, and 11% on cost of implementation. Outcomes measured after six months of intervention, information on continued delivery and institutionalization of interventions, were also seldom reported. Regardless of language of publication, physical activity intervention research for Latin Americans should increase attention to and measurement of external validity and cost factors that are critical in the decision making process in practice settings and can increase the likelihood of translation into community or clinical practice.

The use of on-site visits to assess compliance and implementation of quality management at hospital level.

PubMed

Wagner, C; Groene, O; Dersarkissian, M; Thompson, C A; Klazinga, N S; Arah, O A; Suñol, R

2014-04-01

Stakeholders of hospitals often lack standardized tools to assess compliance with quality management strategies and the implementation of clinical quality activities in hospitals. Such assessment tools, if easy to use, could be helpful to hospitals, health-care purchasers and health-care inspectorates. The aim of our study was to determine the psychometric properties of two newly developed tools for measuring compliance with process-oriented quality management strategies and the extent of implementation of clinical quality strategies at the hospital level. We developed and tested two measurement instruments that could be used during on-site visits by trained external surveyors to calculate a Quality Management Compliance Index (QMCI) and a Clinical Quality Implementation Index (CQII). We used psychometric methods and the cross-sectional data to explore the factor structure, reliability and validity of each of these instruments. The sample consisted of 74 acute care hospitals selected at random from each of 7 European countries. The psychometric properties of the two indices (QMCI and CQII). Overall, the indices demonstrated favourable psychometric performance based on factor analysis, item correlations, internal consistency and hypothesis testing. Cronbach's alpha was acceptable for the scales of the QMCI (α: 0.74-0.78) and the CQII (α: 0.82-0.93). Inter-scale correlations revealed that the scales were positively correlated, but distinct. All scales added sufficient new information to each main index to be retained. This study has produced two reliable instruments that can be used during on-site visits to assess compliance with quality management strategies and implementation of quality management activities by hospitals in Europe and perhaps other jurisdictions.

Deaths from nasopharyngeal cancer among waiters and waitresses in Chinese restaurants.

PubMed

Yu, Ignatius T S; Chiu, Yuk-lan; Wong, Tze-wai; Tang, Jin-ling

2004-10-01

Previous studies have shown that waiters have a high risk of developing cancers of the buccal cavity and pharynx, but nasopharyngeal cancer (NPC) has not been specifically studied. This study was carried out to investigate whether waiters/waitresses in Chinese restaurants have an increased risk of dying from NPC. A mortality odds ratio study was used to estimate the relative risk of dying from NPC for waiters/waitresses working in Chinese restaurants in Hong Kong during the period 1986-1995, using the general population as the external comparison group and deceased kitchen workers as an internal comparison group. Cases were deaths from NPC and the controls were deaths from the selected sets of reference causes. Seventeen deaths from NPC were identified among 415 deceased waiters and four NPC deaths occurred among 140 deceased waitresses. The adjusted mortality odds ratio (aMOR) for NPC was increased among waiters, being 3.02 (95% CI 1.82-5.00) and 2.61 (95% CI 1.02-6.69) in the external and internal comparisons, respectively. For waitresses, the aMOR was 4.58 (95% CI 1.63-12.86) in the external comparison. Analysis by duration of union membership suggested a dose-response relationship. An increased risk of dying from NPC was observed among waiters/waitresses and could not be fully explained by bias or confounding factors. Possible risk factors related to poor indoor air quality in the service areas of Chinese restaurants in Hong Kong should be further investigated.

P300 amplitude as an indicator of externalizing in adolescent males

PubMed Central

PATRICK, CHRISTOPHER J.; BERNAT, EDWARD M.; MALONE, STEPHEN M.; IACONO, WILLIAM G.; KRUEGER, ROBERT F.; MCGUE, MATT

2008-01-01

Reduced P300 amplitude is reliably found in individuals with a personal or family history of alcohol problems. However, alcoholism is part of a broader externalizing spectrum that includes other substance use and antisocial disorders. We hypothesized that reduced P300 is an indicator of the common factor that underlies disorders within this spectrum. Community males (N=969) were assessed at age 17 in a visual oddball task. Externalizing was defined as the common factor underlying symptoms of alcohol dependence, drug dependence, nicotine dependence, conduct disorder, and adult antisocial behavior. A robust association was found between reduced P300 amplitude and the externalizing factor, and this relation accounted for links between specific externalizing disorders and P300. Our findings indicate that reduced P300 amplitude is an indicator of the broad neurobiological vulnerability that underlies disorders within the externalizing spectrum. PMID:16629688

Internal quality control indicators of cervical cytopathology exams performed in laboratories monitored by the External Quality Control Laboratory.

PubMed

Ázara, Cinara Zago Silveira; Manrique, Edna Joana Cláudio; Tavares, Suelene Brito do Nascimento; de Souza, Nadja Lindany Alves; Amaral, Rita Goreti

2014-09-01

To evaluate the impact of continued education provided by an external quality control laboratory on the indicators of internal quality control of cytopathology exams. The internal quality assurance indicators for cytopathology exams from 12 laboratories monitored by the External Quality Control Laboratory were evaluated. Overall, 185,194 exams were included, 98,133 of which referred to the period preceding implementation of a continued education program, while 87,061 referred to the period following this intervention. Data were obtained from the Cervical Cancer Database of the Brazilian National Health Service. Following implementation of the continued education program, the positivity index (PI) remained within recommended limits in four laboratories. In another four laboratories, the PI progressed from below the limits to within the recommended standards. In one laboratory, the PI remained low, in two laboratories, it remained very low, and in one, it increased from very low to low. The percentage of exams compatible with a high-grade squamous intraepithelial lesion (HSIL) remained within the recommended limits in five laboratories, while in three laboratories it progressed from below the recommended levels to >0.4% of the total number of satisfactory exams, and in four laboratories it remained below the standard limit. Both the percentage of atypical squamous cells of undetermined significance (ASC-US) in relation to abnormal exams, and the ratio between ASC-US and intraepithelial lesions remained within recommended levels in all the laboratories investigated. An improvement was found in the indicators represented by the positivity index and the percentage of exams compatible with a high-grade squamous intraepithelial lesion, showing that the role played by the external quality control laboratory in providing continued education contributed towards improving laboratory staff skills in detecting cervical cancer precursor lesions.

External quality assessment of Giemsa-stained blood film microscopy for the diagnosis of malaria and sleeping sickness in the Democratic Republic of the Congo

PubMed Central

Mukadi, Pierre; Gillet, Philippe; Lukuka, Albert; Atua, Benjamin; Sheshe, Nicole; Kanza, Albert; Mayunda, Jean Bosco; Mongita, Briston; Senga, Raphaël; Ngoyi, John; Muyembe, Jean-Jacques; Jacobs, Jan

2013-01-01

Abstract Objective To report the findings of a second external quality assessment of Giemsa-stained blood film microscopy in the Democratic Republic of the Congo, performed one year after the first. Methods A panel of four slides was delivered to diagnostic laboratories in all provinces of the country. The slides contained: (i) Plasmodium falciparum gametocytes; (ii) P. falciparum trophozoites (reference density: 113 530 per µl); (iii) Trypanosoma brucei subspecies; and (iv) no parasites. Findings Of 356 laboratories contacted, 277 (77.8%) responded. Overall, 35.0% of the laboratories reported all four slides correctly but 14.1% reported correct results for 1 or 0 slides. Major errors included not diagnosing trypanosomiasis (50.4%), not recognizing P. falciparum gametocytes (17.5%) and diagnosing malaria from the slide with no parasites (19.0%). The frequency of serious errors in assessing parasite density and in reporting false-positive results was lower than in the previous external quality assessment: 17.2% and 52.3%, respectively, (P < 0.001) for parasite density and 19.0% and 33.3%, respectively, (P < 0.001) for false-positive results. Laboratories that participated in the previous quality assessment performed better than first-time participants and laboratories in provinces with a high number of sleeping sickness cases recognized trypanosomes more frequently (57.0% versus 31.2%, P < 0.001). Malaria rapid diagnostic tests were used by 44.3% of laboratories, almost double the proportion observed in the previous quality assessment. Conclusion The overall quality of blood film microscopy was poor but was improved by participation in external quality assessments. The failure to recognize trypanosomes in a country where sleeping sickness is endemic is a concern. PMID:24052681

Internalizing and externalizing problems in adolescence: general and dimension-specific effects of familial loadings and preadolescent temperament traits.

PubMed

Ormel, J; Oldehinkel, A J; Ferdinand, R F; Hartman, C A; De Winter, A F; Veenstra, R; Vollebergh, W; Minderaa, R B; Buitelaar, J K; Verhulst, F C

2005-12-01

We investigated the links between familial loading, preadolescent temperament, and internalizing and externalizing problems in adolescence, hereby distinguishing effects on maladjustment in general versus dimension-specific effects on either internalizing or externalizing problems. In a population-based sample of 2230 preadolescents (10-11 years) familial loading (parental lifetime psychopathology) and offspring temperament were assessed at baseline by parent report, and offspring psychopathology at 2.5-years follow-up by self-report, teacher report and parent report. We used purified measures of temperament and psychopathology and partialled out shared variance between internalizing and externalizing problems. Familial loading of internalizing psychopathology predicted offspring internalizing but not externalizing problems, whereas familial loading of externalizing psychopathology predicted offspring externalizing but not internalizing problems. Both familial loadings were associated with Frustration, low Effortful Control, and Fear. Frustration acted as a general risk factor predicting severity of maladjustment; low Effortful Control and Fear acted as dimension-specific risk factors that predicted a particular type of psychopathology; whereas Shyness, High-Intensity Pleasure, and Affiliation acted as direction markers that steered the conditional probability of internalizing versus externalizing problems, in the event of maladjustment. Temperament traits mediated one-third of the association between familial loading and psychopathology. Findings were robust across different composite measures of psychopathology, and applied to girls as well as boys. With regard to familial loading and temperament, it is important to distinguish general risk factors (Frustration) from dimension-specific risk factors (familial loadings, Effortful Control, Fear), and direction markers that act as pathoplastic factors (Shyness, High-Intensity Pleasure, Affiliation) from both types of risk factors. About one-third of familial loading effects on psychopathology in early adolescence are mediated by temperament.

Analysis of Environmental Stress Factors Using an Artificial Growth System and Plant Fitness Optimization

PubMed Central

Lee, Meonghun; Yoe, Hyun

2015-01-01

The environment promotes evolution. Evolutionary processes represent environmental adaptations over long time scales; evolution of crop genomes is not inducible within the relatively short time span of a human generation. Extreme environmental conditions can accelerate evolution, but such conditions are often stress inducing and disruptive. Artificial growth systems can be used to induce and select genomic variation by changing external environmental conditions, thus, accelerating evolution. By using cloud computing and big-data analysis, we analyzed environmental stress factors for Pleurotus ostreatus by assessing, evaluating, and predicting information of the growth environment. Through the indexing of environmental stress, the growth environment can be precisely controlled and developed into a technology for improving crop quality and production. PMID:25874206

Formation and Change of Chloroplast-Located Plant Metabolites in Response to Light Conditions.

PubMed

Chen, Yiyong; Zhou, Bo; Li, Jianlong; Tang, Hao; Tang, Jinchi; Yang, Ziyin

2018-02-26

Photosynthesis is the central energy conversion process for plant metabolism and occurs within mature chloroplasts. Chloroplasts are also the site of various metabolic reactions involving amino acids, lipids, starch, and sulfur, as well as where the production of some hormones takes place. Light is one of the most important environmental factors, acting as an essential energy source for plants, but also as an external signal influencing their growth and development. Plants experience large fluctuations in the intensity and spectral quality of light, and many attempts have been made to improve or modify plant metabolites by treating them with different light qualities (artificial lighting) or intensities. In this review, we discuss how changes in light intensity and wavelength affect the formation of chloroplast-located metabolites in plants.

What do external consultants from private and not-for-profit companies offer healthcare commissioners? A qualitative study of knowledge exchange

PubMed Central

Wye, Lesley; Brangan, Emer; Cameron, Ailsa; Gabbay, John; Klein, Jonathan H; Anthwal, Rachel; Pope, Catherine

2015-01-01

Objectives The use of external consultants from private and not-for-profit providers in the National Health Service (NHS) is intended to improve the quality of commissioning. The aim of this study was to learn about the support offered to healthcare commissioners, how external consultants and their clients work together and the perceived impact on the quality of commissioning. Setting NHS commissioning organisations and private and not-for-profit providers. Design Mixed methods case study of eight cases. Data collection 92 interviews with external consultants (n=36), their clients (n=47) and others (n=9). Observation of 25 training events and meetings. Documentation, for example, meeting minutes and reports. Analysis Constant comparison. Data were coded, summarised and analysed by the research team with a coding framework to facilitate cross-case comparison. Results In the four contracts presented here, external providers offered technical solutions (eg, software tools), outsourcing and expertise including project management, data interpretation and brokering relationships with experts. In assessing perceived impact on quality of commissioning, two contracts had limited value, one had short-term benefits and one provided short and longer term benefits. Contracts with commissioners actively learning, embedding and applying new skills were more valued. Other elements of success were: (1) addressing clearly agreed problems of relevance to managerial and operational staff (2) solutions co-produced at all organisational levels (3) external consultants working directly with clients to interpret data outputs to inform locally contextualised commissioning strategies. Without explicit knowledge exchange strategies, outsourcing commissioning to external providers resulted in the NHS clients becoming dependent. Conclusions NHS commissioning will be disadvantaged if commissioners both fail to learn in the short term from the knowledge of external providers and in the longer term lose local skills. Knowledge exchange mechanisms are a vital component of commissioning and should be embedded in external provider contracts. PMID:25716174

The Relevance of External Quality Assessment for Molecular Testing for ALK Positive Non-Small Cell Lung Cancer: Results from Two Pilot Rounds Show Room for Optimization

PubMed Central

Tembuyser, Lien; Tack, Véronique; Zwaenepoel, Karen; Pauwels, Patrick; Miller, Keith; Bubendorf, Lukas; Kerr, Keith; Schuuring, Ed; Thunnissen, Erik; Dequeker, Elisabeth M. C.

2014-01-01

Background and Purpose Molecular profiling should be performed on all advanced non-small cell lung cancer with non-squamous histology to allow treatment selection. Currently, this should include EGFR mutation testing and testing for ALK rearrangements. ROS1 is another emerging target. ALK rearrangement status is a critical biomarker to predict response to tyrosine kinase inhibitors such as crizotinib. To promote high quality testing in non-small cell lung cancer, the European Society of Pathology has introduced an external quality assessment scheme. This article summarizes the results of the first two pilot rounds organized in 2012–2013. Materials and Methods Tissue microarray slides consisting of cell-lines and resection specimens were distributed with the request for routine ALK testing using IHC or FISH. Participation in ALK FISH testing included the interpretation of four digital FISH images. Results Data from 173 different laboratories was obtained. Results demonstrate decreased error rates in the second round for both ALK FISH and ALK IHC, although the error rates were still high and the need for external quality assessment in laboratories performing ALK testing is evident. Error rates obtained by FISH were lower than by IHC. The lowest error rates were observed for the interpretation of digital FISH images. Conclusion There was a large variety in FISH enumeration practices. Based on the results from this study, recommendations for the methodology, analysis, interpretation and result reporting were issued. External quality assessment is a crucial element to improve the quality of molecular testing. PMID:25386659

The relevance of external quality assessment for molecular testing for ALK positive non-small cell lung cancer: results from two pilot rounds show room for optimization.

PubMed

Tembuyser, Lien; Tack, Véronique; Zwaenepoel, Karen; Pauwels, Patrick; Miller, Keith; Bubendorf, Lukas; Kerr, Keith; Schuuring, Ed; Thunnissen, Erik; Dequeker, Elisabeth M C

2014-01-01

Molecular profiling should be performed on all advanced non-small cell lung cancer with non-squamous histology to allow treatment selection. Currently, this should include EGFR mutation testing and testing for ALK rearrangements. ROS1 is another emerging target. ALK rearrangement status is a critical biomarker to predict response to tyrosine kinase inhibitors such as crizotinib. To promote high quality testing in non-small cell lung cancer, the European Society of Pathology has introduced an external quality assessment scheme. This article summarizes the results of the first two pilot rounds organized in 2012-2013. Tissue microarray slides consisting of cell-lines and resection specimens were distributed with the request for routine ALK testing using IHC or FISH. Participation in ALK FISH testing included the interpretation of four digital FISH images. Data from 173 different laboratories was obtained. Results demonstrate decreased error rates in the second round for both ALK FISH and ALK IHC, although the error rates were still high and the need for external quality assessment in laboratories performing ALK testing is evident. Error rates obtained by FISH were lower than by IHC. The lowest error rates were observed for the interpretation of digital FISH images. There was a large variety in FISH enumeration practices. Based on the results from this study, recommendations for the methodology, analysis, interpretation and result reporting were issued. External quality assessment is a crucial element to improve the quality of molecular testing.

Rules and regulations as potential moderator on the relationship between organizational internal and external factors with effective construction risk management in Nigerian construction companies: A proposed framework

NASA Astrophysics Data System (ADS)

Adeleke, A. Q.; Bahaudin, A. Y.; Kamaruddeen, A. M.

2016-08-01

Certain organizational internal and external factors have been found to influence effective construction risk management within the construction company which has contributed to massive risk occurrence on the projects. Yet, the influence of the organizational factors such as effective communication, team competency with skills, active leadership, political factor, organizational culture, technology factor and economic factor on effective construction risk management among the construction companies operating in Abuja and Lagos state Nigeria have not received considerable attention. More so, a moderating variable is proposed. This paper proposes rules and regulations as the potential moderator on the relationship between organisational internal factors, external factors and effective construction risk management.

External Stakeholders' Roles and Factors Influencing Their Participation in Developing Generic Skills for Students in Vietnamese Universities

ERIC Educational Resources Information Center

Nghia, Tran Le Huu

2018-01-01

External stakeholders have increasingly participated in instructional and training activities in higher education; however, their contribution has not yet been adequately documented, especially in non-Western university contexts. This article reports a study that examined external stakeholders' roles and factors influencing their participation in…

An empirical study to determine factors that motivate and limit the implementation of ICT in healthcare environments.

PubMed

Gururajan, Raj; Hafeez-Baig, Abdul

2014-12-23

The maturity and usage of wireless technology has influenced health services, and this has raised expectations from users that healthcare services will become more affordable due to technology growth. There is increasing evidence to justify this expectation, as telehealth is becoming more and more prevalent in many countries. Thus, health services are now offered beyond the boundaries of traditional hospitals, giving rise to many external factors dictating their quality. This has led us to investigate the factors that motivate and limit the implementation of ICT applications in the healthcare domain. We used a mixed method approach with the qualitative aspects leading the quantitative aspects. The main reason for this approach was to understand and explore the domain through the qualitative aspects as we could be part of the discussion. Then we conducted a quantitative survey to extract more responses in order to justify the claims explored in the qualitative process. We found that there are a number of internal and external factors influencing ICT adoption in the healthcare environment so that services can be provided via ICT tools. These factors were grouped under factors contributing to improved outcomes, efficiency and the management of technology. We conceptualised that these three groups of factors drive ICT implementation to assure health services. The main lesson learned from this research was that Information Systems discipline needs to urgently consider health informatics as a serious growth area. We also found that as IS researchers, we need to 'mix' with the health environment in order to understand the environment and then develop suitable methods to answer posited research questions.

The volleyball athlete's shoulder: biomechanical adaptations and injury associations.

PubMed

Challoumas, Dimitrios; Stavrou, Antonio; Dimitrakakis, Georgios

2017-06-01

In volleyball, the dominant shoulder of the athlete undergoes biomechanical and morphological adaptations; however, definitive conclusions about their exact nature, aetiology, purpose and associations with shoulder injury have not been reached. We present a systematic review of the existing literature describing biomechanical adaptations in the dominant shoulders of volleyball players and factors that may predispose to shoulder pain/injury. A thorough literature search via Medline, EMBASE and SCOPUS was conducted for original studies of volleyball players and 15 eligible articles were identified. Assessment of study quality was performed using the STROBE statement. The reviewed literature supports the existence of a glenohumeral internal rotation deficit (GIRD) and a possible (and less pronounced) external rotation gain in the dominant vs. the non-dominant shoulder of volleyball athletes. Unlike other overhead sports, the GIRD in volleyball athletes appears to be anatomical as a response to the repetitive overhead movements and not to be associated with shoulder pain/injury. Additionally, the dominant shoulder exhibits muscular imbalance, which appears to be a significant risk factor for shoulder pain. Strengthening of the external rotators should be used alongside shoulder stretching and joint mobilisations, core strengthening and optimisation of spike technique as part of injury management and prevention programmes.

42 CFR 460.140 - Additional quality assessment activities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Additional quality assessment activities. 460.140... FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.140 Additional quality assessment activities. A PACE organization must meet external quality assessment and reporting requirements...

An exploratory study of factors that affect the performance and usage of rapid diagnostic tests for malaria in the Limpopo Province, South Africa.

PubMed

Moonasar, Devanand; Goga, Ameena Ebrahim; Frean, John; Kruger, Philip; Chandramohan, Daniel

2007-06-02

Malaria rapid diagnostic tests (RDTs) are relatively simple to perform and provide results quickly for making treatment decisions. However, the accuracy and application of RDT results depends on several factors such as quality of the RDT, storage, transport and end user performance. A cross sectional survey to explore factors that affect the performance and use of RDTs was conducted in the primary care facilities in South Africa. This study was conducted in three malaria risk sub-districts of the Limpopo Province, in South Africa. Twenty nurses were randomly selected from 17 primary health care facilities, three nurses from hospitals serving the study area and 10 other key informants, representing the managers of the malaria control programmes, routine and research laboratories, were interviewed, using semi-structured questionnaires. There was a high degree of efficiency in ordering and distribution of RDTs, however only 13/20 (65%) of the health facilities had appropriate air-conditioning and monitoring of room temperatures. Sixty percent (12/20) of the nurses did not receive any external training on conducting and interpreting RDT. Fifty percent of nurses (10/20) reported RDT stock-outs. Only 3/20 nurses mentioned that they periodically checked quality of RDT. Fifteen percent of nurses reported giving antimalarial drugs even if the RDT was negative. Storage, quality assurance, end user training and use of RDT results for clinical decision making in primary care facilities in South Africa need to be improved. Further studies of the factors influencing the quality control of RDTs, their performance of RDTs and the ways to improve their use of RDTs are needed.

An exploratory study of factors that affect the performance and usage of rapid diagnostic tests for malaria in the Limpopo Province, South Africa

PubMed Central

Moonasar, Devanand; Goga, Ameena Ebrahim; Frean, John; Kruger, Philip; Chandramohan, Daniel

2007-01-01

Background Malaria rapid diagnostic tests (RDTs) are relatively simple to perform and provide results quickly for making treatment decisions. However, the accuracy and application of RDT results depends on several factors such as quality of the RDT, storage, transport and end user performance. A cross sectional survey to explore factors that affect the performance and use of RDTs was conducted in the primary care facilities in South Africa. Methods This study was conducted in three malaria risk sub-districts of the Limpopo Province, in South Africa. Twenty nurses were randomly selected from 17 primary health care facilities, three nurses from hospitals serving the study area and 10 other key informants, representing the managers of the malaria control programmes, routine and research laboratories, were interviewed, using semi-structured questionnaires. Results There was a high degree of efficiency in ordering and distribution of RDTs, however only 13/20 (65%) of the health facilities had appropriate air-conditioning and monitoring of room temperatures. Sixty percent (12/20) of the nurses did not receive any external training on conducting and interpreting RDT. Fifty percent of nurses (10/20) reported RDT stock-outs. Only 3/20 nurses mentioned that they periodically checked quality of RDT. Fifteen percent of nurses reported giving antimalarial drugs even if the RDT was negative. Conclusion Storage, quality assurance, end user training and use of RDT results for clinical decision making in primary care facilities in South Africa need to be improved. Further studies of the factors influencing the quality control of RDTs, their performance of RDTs and the ways to improve their use of RDTs are needed. PMID:17543127

Optical Characterization of Lorentz Force Based CMOS-MEMS Magnetic Field Sensor

PubMed Central

Dennis, John Ojur; Ahmad, Farooq; Khir, M. Haris Bin Md; Hamid, Nor Hisham Bin

2015-01-01

Magnetic field sensors are becoming an essential part of everyday life due to the improvements in their sensitivities and resolutions, while at the same time they have become compact, smaller in size and economical. In the work presented herein a Lorentz force based CMOS-MEMS magnetic field sensor is designed, fabricated and optically characterized. The sensor is fabricated by using CMOS thin layers and dry post micromachining is used to release the device structure and finally the sensor chip is packaged in DIP. The sensor consists of a shuttle which is designed to resonate in the lateral direction (first mode of resonance). In the presence of an external magnetic field, the Lorentz force actuates the shuttle in the lateral direction and the amplitude of resonance is measured using an optical method. The differential change in the amplitude of the resonating shuttle shows the strength of the external magnetic field. The resonance frequency of the shuttle is determined to be 8164 Hz experimentally and from the resonance curve, the quality factor and damping ratio are obtained. In an open environment, the quality factor and damping ratio are found to be 51.34 and 0.00973 respectively. The sensitivity of the sensor is determined in static mode to be 0.034 µm/mT when a current of 10 mA passes through the shuttle, while it is found to be higher at resonance with a value of 1.35 µm/mT at 8 mA current. Finally, the resolution of the sensor is found to be 370.37 µT. PMID:26225972

Optical Characterization of Lorentz Force Based CMOS-MEMS Magnetic Field Sensor.

PubMed

Dennis, John Ojur; Ahmad, Farooq; Khir, M Haris Bin Md; Bin Hamid, Nor Hisham

2015-07-27

Magnetic field sensors are becoming an essential part of everyday life due to the improvements in their sensitivities and resolutions, while at the same time they have become compact, smaller in size and economical. In the work presented herein a Lorentz force based CMOS-MEMS magnetic field sensor is designed, fabricated and optically characterized. The sensor is fabricated by using CMOS thin layers and dry post micromachining is used to release the device structure and finally the sensor chip is packaged in DIP. The sensor consists of a shuttle which is designed to resonate in the lateral direction (first mode of resonance). In the presence of an external magnetic field, the Lorentz force actuates the shuttle in the lateral direction and the amplitude of resonance is measured using an optical method. The differential change in the amplitude of the resonating shuttle shows the strength of the external magnetic field. The resonance frequency of the shuttle is determined to be 8164 Hz experimentally and from the resonance curve, the quality factor and damping ratio are obtained. In an open environment, the quality factor and damping ratio are found to be 51.34 and 0.00973 respectively. The sensitivity of the sensor is determined in static mode to be 0.034 µm/mT when a current of 10 mA passes through the shuttle, while it is found to be higher at resonance with a value of 1.35 µm/mT at 8 mA current. Finally, the resolution of the sensor is found to be 370.37 µT.

Markov model of the loan portfolio dynamics considering influence of management and external economic factors

NASA Astrophysics Data System (ADS)

Bozhalkina, Yana; Timofeeva, Galina

2016-12-01

Mathematical model of loan portfolio in the form of a controlled Markov chain with discrete time is considered. It is assumed that coefficients of migration matrix depend on corrective actions and external factors. Corrective actions include process of receiving applications, interaction with existing solvent and insolvent clients. External factors are macroeconomic indicators, such as inflation and unemployment rates, exchange rates, consumer price indices, etc. Changes in corrective actions adjust the intensity of transitions in the migration matrix. The mathematical model for forecasting the credit portfolio structure taking into account a cumulative impact of internal and external changes is obtained.

RELATIONS BETWEEN PSYCHOPATHY FACETS AND EXTERNALIZING IN A CRIMINAL OFFENDER SAMPLE

PubMed Central

Patrick, Christopher J.; Hicks, Brian M.; Krueger, Robert F.; Lang, Alan R.

2008-01-01

The construct of psychopathy is viewed as comprising distinctive but correlated affective-interpersonal and social deviance facets. Here, we examined these facets of Hare's Psychopathy Checklist-Revised (PCL-R) in terms of their associations with the externalizing dimension of adult psychopathology, defined as the common factor underlying symptoms of conduct disorder, adult antisocial behavior, alcohol use/abuse, and drug abuse, along with disinhibitory personality traits. Correlational analyses revealed a strong relationship between this externalizing dimension and the social deviance facet of psychopathy (r = .84), and a lesser relationship with the emotional-interpersonal component (r = .44). Structural models controlling for the moderate overlap between the PCL-R factors revealed that externalizing was substantially related to the unique variance in the social deviance features of psychopathy, but unrelated to the unique variance of the emotional and interpersonal features whether modeled together or as separate factors. These results indicate that the social deviance factor of the PCL-R reflects the externalizing dimension of psychopathology, whereas the emotional-interpersonal component taps something distinct aside from externalizing. In addition, based on our finding of an association between PCL-R social deviance and externalizing, we were able to predict new relations between this facet of psychopathy and criterion variables, including nicotine use and gambling, that have previously been linked to externalizing. Implications for future research on the causes and correlates of psychopathy are discussed. PMID:16178678

Barriers to the implementation of research perceived by nurses from Osakidetza.

PubMed

Cidoncha-Moreno, M Ángeles; Ruíz de Alegría-Fernandez de Retana, Begoña

To understand the barriers to implementing nursing research findings into practice, as perceived by the nurses working in Osakidetza and to analyze if the workplace factor and time worked affect the perception of these barriers. Cross-sectional study. BARRIERS Scale questionnaire was given to a representative sample of 1,572 Basque Health Service nurses, stratified and randomized, according to scope of work and job responsibility (response rate: 43.76%). According to the research results, the first important barrier was "insufficient time on the job to implement new ideas". Nurses have perceived the organizational factor as the most important barrier in their practice. Nurses in "Special hospital departments" perceived more barriers in the "quality of research" factor than those working in "Primary Care". Years of service showed a slight influence. The nurses stated that external factors related to the organization principally interfered in implementing results into clinical practice. They placed lack of critical reading training second. Working environment and seniority mark differences in the perception of barriers. This study may help to develop strategies for planning training programs to facilitate the use of research in clinical practice, in order to provide quality care. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

[FEATURES OF EATING BEHAVIOR IN PERSONS WITH NORMAL AND INCREASED BODY WEIGHT].

PubMed

Shevchenko, Yu; Vesnina, L; Kaydashev, I

2015-01-01

Using the Dutch Eating Behavior Questionnaire (DEBQ) and Three-factor Eating Questionnaire-R18 (TFEQ-RI8), we defined the peculiarities of eating behavior and their impact on quality of life in young people aged 18-25 years. All participants were divided into two groups according to body mass index (BMI). The control group included 41 persons with normal body weight (BMI 18.5-24.9 kg/m2). The group of young adults with increased body weight (BMI over 25 kg/M2) consisted of 27 persons. We found eating behavior disorders in 85,19 % of overweight people and in 41,46 % of persons with normal weight. The restrictive eating behaviors as well as a significant percentage of violations by external type had predominated in overweight individuals by the structure of disorders. The external and restrictive types of eating behavior disorders were predominated in persons with normal weight. Investigation of quality of life using the SF-36 questionnaire showed a significantly decline in the physical role functioning and pain. Index of general physical health component, being not high enough in both groups, was significantly lower in overweight people with 52.70 points against 56.11. We concluded that the eating behavior disorders in persons with normal weight and in overweight people required an individual approach to forming healthy lifestyle and fixing broken food stereotype. It will counteract the further increase of body weight and contribute to improving the quality of life.

Evidence for preferential flux flow at the grain boundaries of superconducting RF-quality niobium

DOE PAGES

Sung, Z. -H.; Lee, P. J.; Gurevich, A.; ...

2018-02-19

Here, the question of whether grain boundaries (GBs) in niobium can be responsible for lowered operating field (B RF) or quality factor (Q 0) in superconducting radio-frequency (SRF) cavities is still controversial. Here, we show by direct DC transport across planar grain boundaries isolated from a slice of very large-grain SRF-quality Nb that vortices can preferentially flow along the grain boundary when the external magnetic field lies in the GB plane. However, increasing the misalignment between the GB plane and the external magnetic field vector markedly reduces preferential flux flow along GB. Importantly, we find that preferential GB flux flowmore » is more prominent for a buffered chemical polished than for an electropolished bi-crystal. The voltage-current characteristics of GBs are similar to those seen in low angle grain boundaries of high temperature superconductors where there is clear evidence of suppression of the superconducting order parameter at the GB. While local weakening of superconductivity at GBs in cuprates and pnictides is intrinsic, deterioration of current transparency of GBs in Nb appears to be extrinsic, since the polishing method clearly affect the local GB degradation. The dependence of preferential GB flux flow on important cavity preparation and experimental variables, particularly, the final chemical treatment and the angle between the magnetic field and the GB plane, suggests two more reasons why real cavity performance can be so variable.« less

Evidence for preferential flux flow at the grain boundaries of superconducting RF-quality niobium

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

Sung, Z. -H.; Lee, P. J.; Gurevich, A.

Here, the question of whether grain boundaries (GBs) in niobium can be responsible for lowered operating field (B RF) or quality factor (Q 0) in superconducting radio-frequency (SRF) cavities is still controversial. Here, we show by direct DC transport across planar grain boundaries isolated from a slice of very large-grain SRF-quality Nb that vortices can preferentially flow along the grain boundary when the external magnetic field lies in the GB plane. However, increasing the misalignment between the GB plane and the external magnetic field vector markedly reduces preferential flux flow along GB. Importantly, we find that preferential GB flux flowmore » is more prominent for a buffered chemical polished than for an electropolished bi-crystal. The voltage-current characteristics of GBs are similar to those seen in low angle grain boundaries of high temperature superconductors where there is clear evidence of suppression of the superconducting order parameter at the GB. While local weakening of superconductivity at GBs in cuprates and pnictides is intrinsic, deterioration of current transparency of GBs in Nb appears to be extrinsic, since the polishing method clearly affect the local GB degradation. The dependence of preferential GB flux flow on important cavity preparation and experimental variables, particularly, the final chemical treatment and the angle between the magnetic field and the GB plane, suggests two more reasons why real cavity performance can be so variable.« less

[Study on influence of different storage environments and packaging materials on quality of Citri Reticulatae Pericarpium].

PubMed

Luo, Jiao-Yang; Zhou, Wen-Ju; Li, Kun-Lun; Zhao, Ming; Yang, Mei-Hua

2018-03-01

Traditional Chinese herbs are readily contaminated by mold that produced mycotoxins which are closly related to the herbs' external factors and external environments during the storage process. In this study, Citri Reticulatae Pericarpium was used as example, and the characteristics of traits, water content, active components (naringin, hesperidin, sinensetin, naringin, tangeretin) and the accumulation of aflatoxins (AFs) were selected as the evaluation indexes. Citri Reticulatae Pericarpium was stored under different environments and packaging materials for 12 months, and then the quality changes and mildew of Citri Reticulatae Pericarpium were examined. The results showed that the color of Citri Reticulatae Pericarpium was deepened after storage, but without mildew phenomenon. Besides, the sample storage in kraft paper and woven bags had varying degrees of moth phenomenon after 12 months storage, and the water content exceeded the limit of Chinese Pharmacopoeia. In addition, the contents of the five active constituents obviously decreased, especially for hesperidin, which did not meet the pharmacopoeia standard after storage. AFs were not detected in any of the tested samples. According to the results, we conclude that low temperature and humidity environment is more suitable for the storage of Citri Reticulatae Pericarpium, and that packaging materials should be further investigated. This study is of great significance for preventing the mold to contaminate the traditional Chinese medicine and ensuring the quality, effectiveness and safety of TCMs. Copyright© by the Chinese Pharmaceutical Association.

Testing Models of Psychopathology in Preschool-aged Children Using a Structured Interview-based Assessment

PubMed Central

Dougherty, Lea R.; Bufferd, Sara J.; Carlson, Gabrielle A.; Klein, Daniel N.

2014-01-01

A number of studies have found that broadband internalizing and externalizing factors provide a parsimonious framework for understanding the structure of psychopathology across childhood, adolescence, and adulthood. However, few of these studies have examined psychopathology in young children, and several recent studies have found support for alternative models, including a bi-factor model with common and specific factors. The present study used parents’ (typically mothers’) reports on a diagnostic interview in a community sample of 3-year old children (n=541; 53.9 % male) to compare the internalizing-externalizing latent factor model with a bi-factor model. The bi-factor model provided a better fit to the data. To test the concurrent validity of this solution, we examined associations between this model and paternal reports and laboratory observations of child temperament. The internalizing factor was associated with low levels of surgency and high levels of fear; the externalizing factor was associated with high levels of surgency and disinhibition and low levels of effortful control; and the common factor was associated with high levels of surgency and negative affect and low levels of effortful control. These results suggest that psychopathology in preschool-aged children may be explained by a single, common factor influencing nearly all disorders and unique internalizing and externalizing factors. These findings indicate that shared variance across internalizing and externalizing domains is substantial and are consistent with recent suggestions that emotion regulation difficulties may be a common vulnerability for a wide array of psychopathology. PMID:24652485

[Quality management and consumer orientation: survey of referring pediatricians of a Berlin pediatric clinic].

PubMed

Lüthy, A; Lotze, I; Leiske, M; Rossi, R

2000-01-01

Quality management in hospitals not only includes performance according to international medical standards but also the optimization of processes regarding internal staff as well as external customers. Total Quality Management (TQM) and the Business Excellence Model of the European Foundation of Quality Management (EFQM) require continuous evaluation of customer satisfaction. Specialists and family physician as external customers influence the patient's choice of a hospital. The aim of the present study is to evaluate the satisfaction of admitting physicians of a children's hospital with the help of a questionnaire. The results describe their needs and their level of satisfaction regarding service, information, cooperation and communication within the hospital.

[eLearning-radiology.com--sustainability for quality assurance].

PubMed

Ketelsen, D; Talanow, R; Uder, M; Grunewald, M

2009-04-01

The aim of the study was to analyze the availability of published radiological e-learning tools and to establish a solution for quality assurance. Substantial pubmed research was performed to identify radiological e-learning tools. 181 e-learning programs were selected. As examples two databases expanding their programs with external links, Compare (n = 435 external links) and TNT-Radiology (n = 1078 external links), were evaluated. A concept for quality assurance was developed by an international taskforce. At the time of assessment, 56.4 % (102 / 181) of the investigated e-learning tools were accessible at their original URL. A subgroup analysis of programs published 5 to 8 years ago showed significantly inferior availability to programs published 3 to 5 years ago (p < 0.01). The analysis of external links showed 49.2 % and 61.0 % accessible links for the programs Compare (published 2003) and TNT-Radiology (published 2006), respectively. As a consequence, the domain www.eLearning-radiology.com was developed by the taskforce and published online. This tool allows authors to present their programs and users to evaluate the e-learning tools depending on several criteria in order to remove inoperable links and to obtain information about the complexity and quality of the e-learning tools. More than 50 % of investigated radiological e-learning tools on the Internet were not accessible after a period of 5 to 8 years. As a consequence, an independent, international tool for quality assurance was designed and published online under www.eLearning-radiology.com .

Spices Coffee : Innovation Strategy To Increase Quality On Powder Coffee Farmers

NASA Astrophysics Data System (ADS)

Amir, I. T.; Indah, P. N.; Widayanti, S.

2018-01-01

The purpose of the study is a) to analyze the condition of internal environment industry spices coffee, b) to analyze the condition of the external environment industry spices coffee, and c) to determine the technological innovation strategy spices coffee in order to improve the competitiveness of the coffee people. Most of the coffee grown in Tutur district is cultivated by smallholder farms, resulting in low quality. The strategy of coffee spice agro-industry aims to increase the added value of the products so that farmers obtain higher coffee prices. Activities include the provision of raw materials, processing, supply of final products, and marketing.The results showed that the internal environmental conditions that have the highest value is the strengthen factors. The highest score of strengthen factors is the availability of coffee, availability of labor and communications group. The highest score of opportunity factors is technological assistance from the government and other government support for the development of people’s coffee industry and high market potential. The development of agrotourism should improve as well as expand the network to seize market. The strategy should be applied in the development of spices coffee industry is to support aggressive growth (Growth-oriented strategy).

External Accountability of Collaborative Arrangements; A Case Study of a Multi Academy Trust in England

ERIC Educational Resources Information Center

Ehren, Melanie C. M.; Godfrey, David

2017-01-01

This paper explores the impact of external accountability on four mechanisms of network-internal quality control and the properties of (mandated) inter-organizational networks. An explorative case study approach examines the external accountability of a newly established educational network (MAT) and how schools and the Trust are held accountable…

Trajectories of Classroom Externalizing Behavior: Contributions of Child Characteristics, Family Characteristics, and the Teacher-Child Relationship during the School Transition

ERIC Educational Resources Information Center

Silver, R.B.; Measelle, J.R.; Armstrong, J.M.; Essex, M.J.

2005-01-01

The unique and interactive contributions of past externalizing behavior, negative parenting, and teacher-child relationship quality to externalizing behavior trajectories after the transition to school were examined. In a sample of 283 children, random regression analyses indicated that conflict in the teacher-child relationship during the school…

KRAS mutations testing in colorectal carcinoma patients in Italy: from guidelines to external quality assessment.

PubMed

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

2011-01-01

Monoclonal antibodies directed against the epidermal growth factor receptor (EGFR) have been approved for the treatment of patients with metastatic colorectal carcinoma (mCRC) that do not carry KRAS mutations. Therefore, KRAS testing has become mandatory to chose the most appropriate therapy for these patients. In order to guarantee the possibility for mCRC patients to receive an high quality KRAS testing in every Italian region, the Italian Association of Medical Oncology (AIOM) and the Italian Society of Pathology and Cytopathology -Italian division of the International Academy of Pathology (SIAPEC-IAP) started a program to improve KRAS testing. AIOM and SIAPEC identified a large panel of Italian medical oncologists, pathologists and molecular biologists that outlined guidelines for KRAS testing in mCRC patients. These guidelines include specific information on the target patient population, the biological material for molecular analysis, the extraction of DNA, and the methods for the mutational analysis that are summarized in this paper. Following the publication of the guidelines, the scientific societies started an external quality assessment scheme for KRAS testing. Five CRC specimens with known KRAS mutation status were sent to the 59 centers that participated to the program. The samples were validated by three referral laboratories. The participating laboratories were allowed to use their own preferred method for DNA extraction and mutational analysis and were asked to report the results within 4 weeks. The limit to pass the quality assessment was set at 100% of true responses. In the first round, only two centers did not pass (3%). The two centers were offered to participate to a second round and both centers failed again to pass. The results of this first Italian quality assessment for KRAS testing suggest that KRAS mutational analysis is performed with good quality in the majority of Italian centers. © 2011 Normanno et al.

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

PubMed Central

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

2011-01-01

Background Monoclonal antibodies directed against the epidermal growth factor receptor (EGFR) have been approved for the treatment of patients with metastatic colorectal carcinoma (mCRC) that do not carry KRAS mutations. Therefore, KRAS testing has become mandatory to chose the most appropriate therapy for these patients. Methodology/Principal Findings In order to guarantee the possibility for mCRC patients to receive an high quality KRAS testing in every Italian region, the Italian Association of Medical Oncology (AIOM) and the Italian Society of Pathology and Cytopathology -Italian division of the International Academy of Pathology (SIAPEC-IAP) started a program to improve KRAS testing. AIOM and SIAPEC identified a large panel of Italian medical oncologists, pathologists and molecular biologists that outlined guidelines for KRAS testing in mCRC patients. These guidelines include specific information on the target patient population, the biological material for molecular analysis, the extraction of DNA, and the methods for the mutational analysis that are summarized in this paper. Following the publication of the guidelines, the scientific societies started an external quality assessment scheme for KRAS testing. Five CRC specimens with known KRAS mutation status were sent to the 59 centers that participated to the program. The samples were validated by three referral laboratories. The participating laboratories were allowed to use their own preferred method for DNA extraction and mutational analysis and were asked to report the results within 4 weeks. The limit to pass the quality assessment was set at 100% of true responses. In the first round, only two centers did not pass (3%). The two centers were offered to participate to a second round and both centers failed again to pass. Conclusions The results of this first Italian quality assessment for KRAS testing suggest that KRAS mutational analysis is performed with good quality in the majority of Italian centers. PMID:22216189

External quality assessment of clinical laboratories in the United Kingdom

PubMed Central

Whitehead, TP; Woodford, FP

1981-01-01

A review is given of the National External Quality Assessment Schemes (NEQASs) in various pathology disciplines in the United Kingdom, with a discussion of the relative roles of the DHSS, individual laboratory scientists, and the relevant professional bodies. Principles of operation and scientific problems in the design of NEQASs in different disciplines are described and contrasted, and some comparisons with the experience in other European countries and the USA are drawn. PMID:7024326

Design and implementation of an external quality assessment program for HIV viral load measurements using dried blood spots.

PubMed

Prach, Lisa M; Puren, Adrian; Lippman, Sheri A; Carmona, Sergio; Stephenson, Sophie; Cutler, Ewalde; Barnhart, Scott; Liegler, Teri

2015-03-01

An external quality assurance program was developed for HIV-1 RNA viral load measurements taken from dried blood spots using a reference panel and field-collected specimens. The program demonstrated that accurate and reproducible quantitation can be obtained from field-collected specimens. Residual proviral DNA may confound interpretation in virologically suppressed subjects. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Parents' work-family experiences and children's problem behaviors: The mediating role of the parent-child relationship.

PubMed

Vieira, Joana M; Matias, Marisa; Ferreira, Tiago; Lopez, Frederick G; Matos, Paula Mena

2016-06-01

Studies on the impact of work-family dynamics on both parenting and children's outcomes are scarce. The present study addressed this gap by exploring how parents' negative (conflicting) and positive (enriching) experiencing of work and family roles related to children's internalizing and externalizing problem behaviors through its association with the quality of parent-child relationships. A sample of 317 dual-earner couples with preschool children was used to conduct a dyadic analysis of both within- and cross-dyad influences of parents' work-family experiences on child problem behaviors. Our results indicated that the way parents balance work and family is associated with their parent-child relationships, which in turn is differentially linked with their children's behaviors. We found that mothers' work-family conflict (WFC) contributed to children's externalization difficulties through its detrimental associations with their own and with their partners' parent-child relationship quality. By contrast, mothers' work-family enrichment (WFE) was negatively linked to children's externalization difficulties through its positive link with the mother-child relationship. Fathers' experience of WFC was associated with both children's internalization and externalization difficulties through its negative association with their own father-child relationship quality. In addition, fathers' experience of WFE also linked to children's externalization difficulties, but only indirectly, via its positive association with the quality of their relationship with the child. Further implications of these findings for advancing understanding of the impact of work-family dynamics on intrafamily relationships, as well as for individual and organizational interventions, are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Validity of self-assessment in a quality improvement collaborative in Ecuador.

PubMed

Hermida, Jorge; Broughton, Edward I; Miller Franco, Lynne

2011-12-01

Health care quality improvement (QI) efforts commonly use self-assessment to measure compliance with quality standards. This study investigates the validity of self-assessment of quality indicators. Cross sectional. A maternal and newborn care improvement collaborative intervention conducted in health facilities in Ecuador in 2005. Four external evaluators were trained in abstracting medical records to calculate six indicators reflecting compliance with treatment standards. About 30 medical records per month were examined at 12 participating health facilities for a total of 1875 records. The same records had already been reviewed by QI teams at these facilities (self-assessment). Overall compliance, agreement (using the Kappa statistic), sensitivity and specificity were analyzed. We also examined patterns of disagreement and the effect of facility characteristics on levels of agreement. External evaluators reported compliance of 69-90%, while self-assessors reported 71-92%, with raw agreement of 71-95% and Kappa statistics ranging from fair to almost perfect agreement. Considering external evaluators as the gold standard, sensitivity of self-assessment ranged from 90 to 99% and specificity from 48 to 86%. Simpler indicators had fewer disagreements. When disagreements occurred between self-assessment and external valuators, the former tended to report more positive findings in five of six indicators, but this tendency was not of a magnitude to change program actions. Team leadership, understanding of the tools and facility size had no overall impact on the level of agreement. When compared with external evaluation (gold standard), self-assessment was found to be sufficiently valid for tracking QI team performance. Sensitivity was generally higher than specificity. Simplifying indicators may improve validity.

Personality and the latent structure of PTSD comorbidity

PubMed Central

Miller, Mark W.; Wolf, Erika J.

2012-01-01

This study examined the structure of PTSD comorbidity and its relationship to personality in a sample of 214 veterans using data from diagnostic interviews and the Multidimensional Personality Questionnaire-Brief Form (MPQ-BF; Patrick, Curtin, & Tellegen, 2002). Confirmatory factor analyses supported a three factor model composed of Externalizing, Fear and Distress factors. Analyses that examined the location of borderline personality disorder revealed significant cross-loadings for this disorder on both Externalizing and Distress. Structural equation models showed trait negative emotionality to be significantly related to all three comorbidity factors whereas positive emotionality and constraint evidenced specific associations with Distress and Externalizing, respectively. These results shed new light on the location of borderline personality disorder within the internalizing/externalizing model and clarify the relative influence of broad dimensions of personality on patterns of comorbidity. PMID:22480716

External and internal factors influencing happiness in elite collegiate athletes.

PubMed

Denny, Katherine G; Steiner, Hans

2009-03-01

When under conditions of high demand and allostatic load, are happiness and satisfaction in four domains (family, friends, academics, recreation) influenced more by external or internal factors? Do student-athletes who lead exceedingly complicated lives report happiness as a function of athletic achievement or internal disposition? Stanford student-athletes (N=140) were studied with a standardized questionnaire which examined internal factors ((1) locus of control, (2) mindfulness, (3) self-restraint, and (4) self-esteem) to see whether they better account for happiness than external factors (playing time, scholarship). As predicted, internal factors were more powerful correlates of happiness when holding constant demographics. Regression models differed for different aspects of happiness, but the main postulated result of internal versus external was maintained throughout. These findings have implications for how well athletes cope with adversity which, in turn, could shed light on the development of traits that may provide a buffer against adversity and build resilience.

External Quality Assurance Programs Managed by the U.S. Geological Survey in Support of the National Atmospheric Deposition Program/Mercury Deposition Network

USGS Publications Warehouse

Latysh, Natalie E.; Wetherbee, Gregory A.

2007-01-01

The U.S. Geological Survey (USGS) Branch of Quality Systems operates external quality assurance programs for the National Atmospheric Deposition Program/Mercury Deposition Network (NADP/MDN). Beginning in 2004, three programs have been implemented: the system blank program, the interlaboratory comparison program, and the blind audit program. Each program was designed to measure error contributed by specific components in the data-collection process. The system blank program assesses contamination that may result from sampling equipment, field exposure, and routine handling and processing of the wet-deposition samples. The interlaboratory comparison program evaluates bias and precision of analytical results produced by the Mercury Analytical Laboratory (HAL) for the NADP/MDN, operated by Frontier GeoSciences, Inc. The HAL's performance is compared with the performance of five other laboratories. The blind audit program assesses bias and variability of MDN data produced by the HAL using solutions disguised as environmental samples to ascertain true laboratory performance. This report documents the implementation of quality assurance procedures for the NADP/MDN and the operating procedures for each of the external quality assurance programs conducted by the USGS. The USGS quality assurance information provides a measure of confidence to NADP/MDN data users that measurement variability is distinguished from environmental signals.

Systematic Review of Plant-Based Homeopathic Basic Research: An Update.

PubMed

Ücker, Annekathrin; Baumgartner, Stephan; Sokol, Anezka; Huber, Roman; Doesburg, Paul; Jäger, Tim

2018-05-01

 Plant-based test systems have been described as a useful tool for investigating possible effects of homeopathic preparations. The last reviews of this research field were published in 2009/2011. Due to recent developments in the field, an update is warranted. Publications on plant-based test systems were analysed with regard to publication quality, reproducibility and potential for further research.  A literature search was conducted in online databases and specific journals, including publications from 2008 to 2017 dealing with plant-based test systems in homeopathic basic research. To be included, they had to contain statistical analysis and fulfil quality criteria according to a pre-defined manuscript information score (MIS). Publications scoring at least 5 points (maximum 10 points) were assumed to be adequate. They were analysed for the use of adequate controls, outcome and reproducibility.  Seventy-four publications on plant-based test systems were found. Thirty-nine publications were either abstracts or proceedings of conferences and were excluded. From the remaining 35 publications, 26 reached a score of 5 or higher in the MIS. Adequate controls were used in 13 of these publications. All of them described specific effects of homeopathic preparations. The publication quality still varied: a substantial number of publications (23%) did not adequately document the methods used. Four reported on replication trials. One replication trial found effects of homeopathic preparations comparable to the original study. Three replication trials failed to confirm the original study but identified possible external influencing factors. Five publications described novel plant-based test systems. Eight trials used systematic negative control experiments to document test system stability.  Regarding research design, future trials should implement adequate controls to identify specific effects of homeopathic preparations and include systematic negative control experiments. Further external and internal replication trials, and control of influencing factors, are needed to verify results. Standardised test systems should be developed. The Faculty of Homeopathy.

Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials.

PubMed

Norris, S L; Engelgau, M M; Narayan, K M

2001-03-01

To systematically review the effectiveness of self-management training in type 2 diabetes. MEDLINE, Educational Resources Information Center (ERIC), and Nursing and Allied Health databases were searched for English-language articles published between 1980 and 1999. Studies were original articles reporting the results of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes. Relevant data on study design, population demographics, interventions, outcomes, methodological quality, and external validity were tabulated. Interventions were categorized based on educational focus (information, lifestyle behaviors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills; lifestyle behaviors, psychological outcomes, and quality of life; glycemic control; cardiovascular disease risk factors; and economic measures and health service utilization. A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, frequency and accuracy of self-monitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up (<6 months). Effects of interventions on lipids, physical activity, weight, and blood pressure were variable. With longer follow-up, interventions that used regular reinforcement throughout follow-up were sometimes effective in improving glycemic control. Educational interventions that involved patient collaboration may be more effective than didactic interventions in improving glycemic control, weight, and lipid profiles. No studies demonstrated the effectiveness of self-management training on cardiovascular disease-related events or mortality; no economic analyses included indirect costs; few studies examined health-care utilization. Performance, selection, attrition, and detection bias were common in studies reviewed, and external generalizability was often limited. Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life.

In fatal pursuit of immortal fame: Peer competition and early mortality of music composers.

PubMed

Borowiecki, Karol Jan; Kavetsos, Georgios

2015-06-01

We investigate the impact of peer competition on longevity using a unique historical data set of 144 prominent music composers born in the 19th century. We approximate for peer competition measuring (a) the number or (b) the share of composers located in the same area and time, (c) the time spent in one of the main cities for classical music, and (d) the quality of fellow composers. These measures suggest that composers' longevity is reduced, if they located in agglomerations with a larger group of peers or of a higher quality. The point estimates imply that, all else equal, a one percent increase in the number of composers reduces composer longevity by ∼ 7.2 weeks. Our analysis showed that the utilized concentration measures are stronger than the personal factors in determining longevity, indicating that individuals' backgrounds have minimal impact on mitigating the effect of experienced peer pressure. The negative externality of peer competition is experienced in all cities, fairly independent of their population size. Our results are reaffirmed using an instrumental variable approach and are consistent throughout a range of robustness tests. In addition to the widely known economic benefits associated with competition, these findings suggest that significant negative welfare externalities exist as well. Copyright © 2015 Elsevier Ltd. All rights reserved.

The SATISPSY-22: development and validation of a French hospitalized patients' satisfaction questionnaire in psychiatry.

PubMed

Zendjidjian, X Y; Auquier, P; Lançon, C; Loundou, A; Parola, N; Faugère, M; Boyer, L

2015-01-01

The aim of our study was to develop a specific French self-administered instrument for measuring hospitalized patients' satisfaction in psychiatry based on exclusive patient point of view: the SATISPSY-22. The development of the SATISPSY was undertaken in three steps: item generation, item reduction, and validation. The content of the SATISPSY was derived from 80 interviews with patients hospitalized in psychiatry. Using item response and classical test theories, item reduction was performed in 2 hospitals on 270 responders. The validation was based on construct validity, reliability, and some aspects of external validity. The SATISPSY contains 22 items describing 6 dimensions (staff, quality of care, personal experience, information, activity, and food). The six-factor structure accounted for 78.0% of the total variance. Each item achieved the 0.40 standard for item-internal consistency, and the Cronbach's alpha coefficients were>0.70. Scores of dimensions were strongly positively correlated with Visual Analogue Scale scores. Significant associations with socioeconomic and clinical indicators showed good discriminant and external validity. INFIT statistics were ranged from 0.71 to 1.25. The SATISPSY-22 presents satisfactory psychometric properties, enabling patient feedback to be incorporated in a continuous quality health care improvement strategy. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Quality Assurance in Post-Secondary Education: Some Common Approaches

ERIC Educational Resources Information Center

Law, Dennis Chung Sea

2010-01-01

Purpose: The common approaches to quality assurance (QA), as practiced by most post-secondary education institutions for internal quality monitoring and most QA authorities for external quality monitoring (EQM), have been considered by many researchers as having largely failed to address the essence of educational quality. The purpose of this…

Asian Students in Australia: Sources of the Academic Self

ERIC Educational Resources Information Center

Yeung, Alexander Seeshing; McInerney, Dennis M.; Ali, Jinnat

2014-01-01

Students' motivation is known to be influenced by both internally referenced and externally referenced factors. Internally referenced factors include self-processes (sense of competence and affect), whereas externally referenced factors include significant others (parents, peers and teachers). Using the Facilitating Conditions Questionnaire, the…

Responding to the Language Challenge: Kaiser Permanente's Approach

PubMed Central

Meyers, Kate; Tang, Gayle; Fernandez, Alicia

2009-01-01

Objective: To inform current debates on improving health care quality for patients with limited English proficiency by identifying the drivers and processes for one large health care delivery system's implementation of particular models, key success factors, and remaining challenges for the field. Study Design: A qualitative case study of the Kaiser Permanente (KP) San Francisco Medical Center's approach to developing linguistic access services and subsequent organizationwide initiatives. Methods: We conducted semistructured interviews with eight current and former clinical and administrative leaders from the KP San Francisco Medical Center and national headquarters. Interviews were analyzed for key themes. Results: KP San Francisco Medical Center developed linguistic and cultural services in response to a confluence of external and internal factors, including changing demographics, care quality challenges, and patient and clinician satisfaction issues. Early strategies included development of language-specific care modules focused on Chinese- and Spanish-speaking members while meeting broader linguistic access and cultural-competency needs through a centralized Multicultural Services Center. Additional approaches across KP regions have focused on improving interpreter services, optimizing use of bilingual staff, and creating a translation infrastructure to improve quality and reduce redundancy in written translation efforts. Conclusions: KP's experiences developing linguistic and cultural care and services since the 1990s provide lessons about decision-making processes and approaches that may guide other health systems, insurers, and policy makers striving to improve care quality and safety for patients with limited English proficiency. PMID:20740094

The impact of disaster work on community volunteers: The role of peri-traumatic distress, level of personal affectedness, sleep quality and resource loss, on post-traumatic stress disorder symptoms and subjective health.

PubMed

Thormar, Sigridur B; Gersons, Berthold P R; Juen, Barbara; Djakababa, Maria Nelden; Karlsson, Thorlakur; Olff, Miranda

2014-12-01

Disaster work has shown to cause PTSD symptoms and subjective health complaints in professional emergency personnel. However, very little is known about how disaster work affects community volunteers. This first time longitudinal study examined factors contributing to post-traumatic stress disorder symptoms (PTSD) and subjective health complaints in volunteers working in an earthquake setting. At six and eighteen months post disaster, a sample of 506 Indonesian Red Cross volunteers were assessed using the Impact of Event Scale-Revised and the Subjective Health Complaints Inventory. Factors analyzed in relation to the outcomes included: peri-traumatic distress, level of personal affectedness by the disaster, sleep quality and loss of resources as a consequence of the disaster. At 18 months post-disaster the findings showed high levels of PTSD symptoms and subjective health complaints. Quality of sleep was related to both outcomes but resource loss only to PTSD symptoms. Neither peri-traumatic distress nor level of affectedness by the disaster (external versus directly affected volunteers), were predictive of symptoms. This study indicates that characteristics of disaster work e.g. low quality of sleep, may be an important contributor to PTSD symptoms and subjective health complaints in volunteers. Copyright © 2014 Elsevier Ltd. All rights reserved.

External Quality Assessment for KRAS Testing Is Needed: Setup of a European Program and Report of the First Joined Regional Quality Assessment Rounds

PubMed Central

Bellon, Ellen; Ligtenberg, Marjolijn J.L.; Tejpar, Sabine; Cox, Karen; de Hertogh, Gert; de Stricker, Karin; Edsjö, Anders; Gorgoulis, Vassilis; Höfler, Gerald; Jung, Andreas; Kotsinas, Athanassios; Laurent-Puig, Pierre; López-Ríos, Fernando; Hansen, Tine Plato; Rouleau, Etienne; Vandenberghe, Peter; van Krieken, Johan J.M.

2011-01-01

The use of epidermal growth factor receptor–targeting antibodies in metastatic colorectal cancer has been restricted to patients with wild-type KRAS tumors by the European Medicines Agency since 2008, based on data showing a lack of efficacy and potential harm in patients with mutant KRAS tumors. In an effort to ensure optimal, uniform, and reliable community-based KRAS testing throughout Europe, a KRAS external quality assessment (EQA) scheme was set up. The first large assessment round included 59 laboratories from eight different European countries. For each country, one regional scheme organizer prepared and distributed the samples for the participants of their own country. The samples included unstained sections of 10 invasive colorectal carcinomas with known KRAS mutation status. The samples were centrally validated by one of two reference laboratories. The laboratories were allowed to use their own preferred method for histological evaluation, DNA isolation, and mutation analysis. In this study, we analyze the setup of the KRAS scheme. We analyzed the advantages and disadvantages of the regional scheme organization by analyzing the outcome of genotyping results, analysis of tumor percentage, and written reports. We conclude that only 70% of laboratories correctly identified the KRAS mutational status in all samples. Both the false-positive and false-negative results observed negatively affect patient care. Reports of the KRAS test results often lacked essential information. We aim to further expand this program to more laboratories to provide a robust estimate of the quality of KRAS testing in Europe, and provide the basis for remedial measures and harmonization. PMID:21441573

Characterization of the evolution of the pharmaceutical regulatory environment.

PubMed

Shafiei, Nader; Ford, James L; Morecroft, Charles W; Lisboa, Paulo J; Taylor, Mark J

2013-01-01

This paper is part of a research study that is intended to identify pharmaceutical quality risks induced by the ongoing transformation in the industry. This study establishes the current regulatory context by characterizing the development of the pharmaceutical regulatory environment. The regulatory environment is one of the most important external factors that affects a company's organization, processes, and technological strategy. This is especially the case with the pharmaceutical industry, where its products affect the quality of life of the consumers. The quantitative analysis of regulatory events since 1813 and review of the associated literature resulted in identification of six factors influencing the regulatory environment, namely public health protection, public health promotion, crisis management, harmonization, innovation, and modernization. From 1813 to the 1970s the focus of regulators was centered on crisis management and public health protection-a basic mission that has remained consistent over the years. Since the 1980s a gradual move in the regulatory environment towards a greater focus on public health promotion, international harmonization, innovation, and agency modernization may be seen. The pharmaceutical industry is currently going through changes that affect the way it performs its research, manufacturing, and regulatory activities. The impact of these changes on the approaches to quality risk management requires more understanding. The authors are engaged in research to identify elements of the changes that influence pharmaceutical quality. As quality requirements are an integral part of the pharmaceutical regulations, a comprehensive understanding of these regulations is seen as the first step. The results of this study show that (i) public health protection, public health promotion, crisis management, harmonization, innovation, and modernization are factors that affect regulations in the pharmaceutical industry; (ii) the regulators' main mission of public health protection has remained a constant feature over the years; and (iii) since the 1970s other factors such as public health promotion, international harmonization, innovation, and agency modernization are playing more important role in regulatory agency thinking and actions.

Quantifying effects of hydrological and water quality disturbances on fish with food-web modeling

NASA Astrophysics Data System (ADS)

Zhao, Changsen; Zhang, Yuan; Yang, Shengtian; Xiang, Hua; Sun, Ying; Yang, Zengyuan; Yu, Qiang; Lim, Richard P.

2018-05-01

Accurately delineating the effects of hydrological and water quality habitat factors on the aquatic biota will significantly assist the management of water resources and restoration of river ecosystems. However, current models fail to comprehensively consider the effects of multiple habitat factors on the development of fish species. In this study, a dynamic framework for river ecosystems was set up to explore the effects of multiple habitat factors in terms of hydrology and water quality on the fish community in rivers. To achieve this the biomechanical forms of the relationships between hydrology, water quality, and aquatic organisms were determined. The developing processes of the food web without external disturbance were simulated by 208 models, constructed using Ecopath With Ecosim (EWE). These models were then used to analyze changes in biomass (ΔB) of two representative fish species, Opsariichthys bidens and Carassius auratus, which are widely distributed in Asia, and thus have attracted the attention of scholars and stakeholders, due to the consequence of habitat alteration. Results showed that the relationship between the changes in fish biomass and key habitat factors can be expressed in a unified form. T-tests for the unified form revealed that the means of the two data sets of simulated and observed ΔB for these two fish species (O. bidens and C. auratus) were equal at the significance level of 5%. Compared with other ecological dynamic models, our framework includes theories that are easy to understand and has modest requirements for assembly and scientific expertise. Moreover, this framework can objectively assess the influence of hydrological and water quality variance on aquatic biota with simpler theory and little expertise. Therefore, it is easy to be put into practice and can provide a scientific support for decisions in ecological restoration made by river administrators and stakeholders across the world.

Nonpoint sources as external threats to coastal water quality: lessons from Park Service experience

USGS Publications Warehouse

Burroughs, R.H.

1993-01-01

Program design for nonpoint source control was considered through an analogous problem, external threats to national parks. Nonpoint sources are diffuse land activities that degrade water quality, and recent federal legislation seeks to limit them in coastal areas. External threats occur outside a park boundary but affect the purposes for, or resources within, a park. They have been subject to federal management for many decades. Nonpoint sources are a class of external threat. Therefore, programs to limit them should consider techniques used in part protection. These park techniques include 'hard approaches', which rely on power, usually through legal devices, and 'soft approaches', which utilize shared values and objectives. A linked approach, as exemplified at the Cape Cod National Seashore, appears most promising. In a linked approach, if a soft approach fails, the manager of the protected unit is empowered to take an alternative hard action to protect the resource.

Using a Template to Facilitate External Peer Preview of Curriculum: A Variation on the PRoT Theme

ERIC Educational Resources Information Center

Sealey, Rebecca

2013-01-01

Peer reviewing of teaching and curriculum in Higher Education is a common practice aimed at both quality assurance and professional development. External review of curriculum prior to implementation appears less common. The aim of this project was to develop, implement and evaluate a user-friendly process for external peer preview of teaching…

Exploring the relationship between volunteering and hospice sustainability in the UK: a theoretical model.

PubMed

Scott, Ros; Jindal-Snape, Divya; Manwaring, Gaye

2018-05-02

To explore the relationship between volunteering and the sustainability of UK voluntary hospices. A narrative literature review was conducted to inform the development of a theoretical model. Eight databases were searched: CINAHL (EBSCO), British Nursing Index, Intute: Health and Life Sciences, ERIC, SCOPUS, ASSIA (CSA), Cochrane Library and Google Scholar. A total of 90 documents were analysed. Emerging themes included the importance of volunteering to the hospice economy and workforce, the quality of services, and public and community support. Findings suggest that hospice sustainability is dependent on volunteers; however, the supply and retention of volunteers is affected by internal and external factors. A theoretical model was developed to illustrate the relationship between volunteering and hospice sustainability. It demonstrates the factors necessary for hospice sustainability and the reciprocal impact that these factors and volunteering have on each other. The model has a practical application as an assessment framework and strategic planning tool.

Factors Influencing New RNs' Supervisory Performance in Long-Term Care Facilities.

PubMed

Prentice, Dawn; Boscart, Veronique; McGilton, Katherine S; Escrig, Astrid

2017-12-01

In long-term care facilities (LTCF), registered nurses (RNs) perform both clinical and supervisory roles as part of a team aiming to provide high-quality care to residents. The residents have several co-morbidities and complex care needs. Unfortunately, new RNs receive minimal preparation in gerontology and supervisory experience during their program, leading to low retention rates and affecting resident outcomes. This qualitative study explored factors that influence supervisory performance of new RNs in LTCF from the perspective of 24 participants from Ontario, Canada. Data were collected through individual interviews, followed by a directed content analysis. Three levels of influences were identified: personal influences, organizational influences, and external influences. Each level presented with sub-elements, further describing the factors that impact the supervisory performance of the new RN. To retain new RNs in LTC, organizations must provide additional gerontological education and mentoring for new RNs to flourish in their supervisory roles.

Gender identity outcomes in children with disorders/differences of sex development: Predictive factors.

PubMed

Bakula, Dana M; Mullins, Alexandria J; Sharkey, Christina M; Wolfe-Christensen, Cortney; Mullins, Larry L; Wisniewski, Amy B

2017-06-01

Disorders/differences of sex development (DSD) comprise multiple congenital conditions in which chromosomal, gonadal, and/or anatomical sex are discordant. The prediction of future gender identity (i.e., self-identifying as male, female, or other) in children with DSD can be imprecise, and current knowledge about the development of gender identity in people with, and without DSD, is limited. However, sex of rearing is the strongest predictor of gender identity for the majority of individuals with various DSD conditions. When making decisions regarding sex of rearing biological factors (e.g., possession of a Y chromosome, degree and duration of pre- and postnatal androgen exposure, phenotypic presentation of the external genitalia, and fertility potential), social and cultural factors, as well as quality of life should be considered. Information on gender identity outcomes across a range of DSD diagnoses is presented to aid in sex of rearing assignment. Copyright © 2017 Elsevier Inc. All rights reserved.

Respiratory Sinus Arrhythmia Moderates the Relation between Parent-Adolescent Relationship Quality and Adolescents' Social Adjustment.

PubMed

Van der Graaff, Jolien; Meeus, Wim; de Wied, Minet; van Boxtel, Anton; van Lier, Pol; Branje, Susan

2016-02-01

This 2-wave longitudinal study aimed (1) to investigate whether high resting RSA predicted adolescents' lower externalizing behavior and higher empathic concern, and (2) to address the potential moderating role of resting RSA in the association between parent-adolescent relationship quality and adolescents' externalizing behavior and empathic concern. In a sample of 379 adolescents (212 boys, 167 girls), resting RSA was assessed during a laboratory session, and adolescents reported on parental support, negative interaction with parents, empathic concern and externalizing behavior during a home visit. We found no support for high resting RSA predicting low externalizing behavior or high empathic concern. However, in line with our hypotheses, we did find several instances of RSA functioning as a moderator, although the interaction patterns varied. First, negative interaction with parents was a negative predictor of externalizing behavior for girls low in resting RSA, whereas the association was non-significant for girls with high RSA. Second, higher negative interaction with parents predicted lower empathic concern for boys high in resting RSA, whereas the association was reversed for boys with low resting RSA. Third, parental support was a positive predictor of empathic concern for girls high in resting RSA, whereas the association was non-significant for girls low in resting RSA. The findings suggest that adolescents with different levels of resting RSA respond differentially to relationship quality with parents.

ANMCO/AIIC/SIT Consensus Information Document: definition, precision, and suitability of electrocardiographic signals of electrocardiographs, ergometry, Holter electrocardiogram, telemetry, and bedside monitoring systems.

PubMed

Gulizia, Michele Massimo; Casolo, Giancarlo; Zuin, Guerrino; Morichelli, Loredana; Calcagnini, Giovanni; Ventimiglia, Vincenzo; Censi, Federica; Caldarola, Pasquale; Russo, Giancarmine; Leogrande, Lorenzo; Franco Gensini, Gian

2017-05-01

The electrocardiogram (ECG) signal can be derived from different sources. These include systems for surface ECG, Holter monitoring, ergometric stress tests, and telemetry systems and bedside monitoring of vital parameters, which are useful for rhythm and ST-segment analysis and ECG screening of electrical sudden cardiac death predictors. A precise ECG diagnosis is based upon correct recording, elaboration, and presentation of the signal. Several sources of artefacts and potential external causes may influence the quality of the original ECG waveforms. Other factors that may affect the quality of the information presented depend upon the technical solutions employed to improve the signal. The choice of the instrumentations and solutions used to offer a high-quality ECG signal are, therefore, of paramount importance. Some requirements are reported in detail in scientific statements and recommendations. The aim of this consensus document is to give scientific reference for the choice of systems able to offer high quality ECG signal acquisition, processing, and presentation suitable for clinical use.

ANMCO/AIIC/SIT Consensus Information Document: definition, precision, and suitability of electrocardiographic signals of electrocardiographs, ergometry, Holter electrocardiogram, telemetry, and bedside monitoring systems

PubMed Central

Casolo, Giancarlo; Zuin, Guerrino; Morichelli, Loredana; Calcagnini, Giovanni; Ventimiglia, Vincenzo; Censi, Federica; Caldarola, Pasquale; Russo, Giancarmine; Leogrande, Lorenzo; Franco Gensini, Gian

2017-01-01

Abstract The electrocardiogram (ECG) signal can be derived from different sources. These include systems for surface ECG, Holter monitoring, ergometric stress tests, and telemetry systems and bedside monitoring of vital parameters, which are useful for rhythm and ST-segment analysis and ECG screening of electrical sudden cardiac death predictors. A precise ECG diagnosis is based upon correct recording, elaboration, and presentation of the signal. Several sources of artefacts and potential external causes may influence the quality of the original ECG waveforms. Other factors that may affect the quality of the information presented depend upon the technical solutions employed to improve the signal. The choice of the instrumentations and solutions used to offer a high-quality ECG signal are, therefore, of paramount importance. Some requirements are reported in detail in scientific statements and recommendations. The aim of this consensus document is to give scientific reference for the choice of systems able to offer high quality ECG signal acquisition, processing, and presentation suitable for clinical use. PMID:28751842

Level of Adoption of Quality Management Systems Into the Mexican Pork Industry

NASA Astrophysics Data System (ADS)

Maldonado-Siman, Em; Ruíz-Flores, Agustín; Núñez-Domínguez, Rafael; González-Alcorta, Mariano; Hernández-Rodríguez, Bertha Alicia

This research studies the characteristics of the Mexican pork sector; adoption status of quality management systems, and product destinations. Ninety six percent of fifty enterprises have fully answered a questionnaire. Ninety percent are small and medium-sized, the rest are large-sized firms. Nineteen percent of them have totally adopted HACCP, sixty three percent are implementing or planning to do it, the rest have no plans to adopt it. Thirteen percent of the enterprises had ISO 9000. Thirty four percent of their sales go to supermarkets, 57% to other retail chains and 9% to exportation. Product destinations are mainly Central America, United States of America, Asia and Mexico. To improve efficiency and the quality of process it is necessary to implement HACCP. Besides, customers and legal requirements are the external factors, which result in this adoption. In the process of implementing, there are some problems, such as staff motivation and training. The results suggest that HACCP system operating is important for the Mexican pork industry. It also has relevant implications in domestic trade. It is necessary to encourage adoption of quality management systems in the sector.

Toward development of a comprehensive external quality assurance program for polyfunctional intracellular cytokine staining assays

PubMed Central

Staats, Janet S.; Enzor, Jennifer H.; Sanchez, Ana M.; Rountree, Wes; Chan, Cliburn; Jaimes, Maria; Chan, Ray Chun-Fai; Gaur, Amitabh; Denny, Thomas N.; Weinhold, Kent J.

2014-01-01

The External Quality Assurance Program Oversight Laboratory (EQAPOL) Flow Cytometry Program assesses the proficiency of NIH/NIAID/DAIDS-supported and potentially other interested research laboratories in performing Intracellular Cytokine Staining (ICS) assays. The goal of the EQAPOL Flow Cytometry External Quality Assurance Program (EQAP) is to provide proficiency testing and remediation for participating sites. The program is not punitive; rather, EQAPOL aims to help sites identify areas for improvement. EQAPOL utilizes a highly standardized ICS assay to minimize variability and readily identify those sites experiencing technical difficulties with their assays. Here, we report the results of External Proficiency 3 (EP3) where participating sites performed a 7-color ICS assay. On average, sites perform well in the Flow Cytometry EQAP (median score is “Good”). The most common technical issues identified by the program involve protocol adherence and data analysis; these areas have been the focus of site remediation. The EQAPOL Flow Cytometry team is now in the process of expanding the program to 8-color ICS assays. Evaluating polyfunctional ICS responses would align the program with assays currently being performed in support of HIV immune monitoring assays. PMID:24968072

Factors affecting the quality of fish caught by Native Americans in the Zone 6 fishery 1991 through 1993

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

Abernethy, C.S.

1994-09-01

A program to monitor the salmon and steelhead (Oncorhynchus spp.) fishery in the lower Columbia River (Zone 6 fishery) was initiated in 1991 to respond to questions and comments frequently made by Native Americans at public meetings. Native Americans were concerned that the quality of the Columbia River had deteriorated and that the poor environmental conditions had affected the health and quality of fish they relied on for subsistence, ceremonial, religious, and commercial purposes. They also feared that eating contaminated fish might endanger the health of their children and future generations. Operations at the Hanford Site were listed as onemore » of many causes of the deteriorating environment. Fisheries pathologists concluded that most of the external symptoms on fish were related to bacterial infection of gill net abrasions and pre-spawning trauma, and were not caused by pollution or contamination of the Columbia River. The pathologists also stated that consumption of the fish posed no threat to human consumers.« less

Predictors of acceptance of offered care management intervention services in a quality improvement trial for dementia.

PubMed

Kaisey, Marwa; Mittman, Brian; Pearson, Marjorie; Connor, Karen I; Chodosh, Joshua; Vassar, Stefanie D; Nguyen, France T; Vickrey, Barbara G

2012-10-01

Care management approaches have been proven to improve outcomes for patients with dementia and their family caregivers (dyads). However, acceptance of services in these programs is incomplete, impacting effectiveness. Acceptance may be related to dyad as well as healthcare system characteristics, but knowledge about factors associated with program acceptance is lacking. This study investigates patient, caregiver, and healthcare system characteristics associated with acceptance of offered care management services. This study analyzed data from the intervention arm of a cluster randomized controlled trial of a comprehensive dementia care management intervention. There were 408 patient-caregiver dyads enrolled in the study, of which 238 dyads were randomized to the intervention. Caregiver, patient, and health system factors associated with participation in offered care management services were assessed through bivariate and multivariate regression analyses. Out of the 238 dyads, 9 were ineligible for this analysis, leaving data of 229 dyads in this sample. Of these, 185 dyads accepted offered care management services, and 44 dyads did not. Multivariate analyses showed that higher likelihood of acceptance of care management services was uniquely associated with cohabitation of caregiver and patient (p < 0.001), lesser severity of dementia (p = 0.03), and higher patient comorbidity (p = 0.03); it also varied across healthcare organization sites. Understanding factors that influence care management participation could result in increased adoption of successful programs to improve quality of care. Using these factors to revise both program design as well as program promotion may also benefit external validity of future quality improvement research trials. Copyright © 2011 John Wiley & Sons, Ltd.

Standards and Quality in Higher Education. Higher Education Policy Series 37.

ERIC Educational Resources Information Center

Brennan, John, Ed.; de Vries, Peter, Ed.; Williams, Ruth, Ed.

The papers in this book reflect current debates on academic standards and quality assurance, and speak from the perspective of institutional leaders and national quality bodies and higher education researchers. Included are reports on the progress of several international quality initiatives and studies on the impact of external quality assurance…

Using Quality Schemes in Adult and Community Learning: A Guide for Managers.

ERIC Educational Resources Information Center

Ewens, David; Watters, Kate

This document examines adult and community learning (ACL) and quality programs across England. The difficulties faced by local education agencies' ACL services in delivering quality are noted, along with ways quality improvement has been supported. Quality programs--whether internal or external, based on awards, or used as diagnostic tools--are…

A Study on Students' Satisfaction Based on Quality Standards of Accreditation in Higher Education

ERIC Educational Resources Information Center

Neelaveni, C.; Manimaran S.

2015-01-01

Quality standards are evaluated by the Higher Educational Institutions by self evaluation at different levels and are also assessed by external agencies. Application of quality standards in administrative practices have been associated with the quality of higher education. To improve the quality of administrative practices, evaluation scales are…

Development of an evidence-based approach to external quality assurance for breast cancer hormone receptor immunohistochemistry: comparison of reference values.

PubMed

Makretsov, Nikita; Gilks, C Blake; Alaghehbandan, Reza; Garratt, John; Quenneville, Louise; Mercer, Joel; Palavdzic, Dragana; Torlakovic, Emina E

2011-07-01

External quality assurance and proficiency testing programs for breast cancer predictive biomarkers are based largely on traditional ad hoc design; at present there is no universal consensus on definition of a standard reference value for samples used in external quality assurance programs. To explore reference values for estrogen receptor and progesterone receptor immunohistochemistry in order to develop an evidence-based analytic platform for external quality assurance. There were 31 participating laboratories, 4 of which were previously designated as "expert" laboratories. Each participant tested a tissue microarray slide with 44 breast carcinomas for estrogen receptor and progesterone receptor and submitted it to the Canadian Immunohistochemistry Quality Control Program for analysis. Nuclear staining in 1% or more of the tumor cells was a positive score. Five methods for determining reference values were compared. All reference values showed 100% agreement for estrogen receptor and progesterone receptor scores, when indeterminate results were excluded. Individual laboratory performance (agreement rates, test sensitivity, test specificity, positive predictive value, negative predictive value, and κ value) was very similar for all reference values. Identification of suboptimal performance by all methods was identical for 30 of 31 laboratories. Estrogen receptor assessment of 1 laboratory was discordant: agreement was less than 90% for 3 of 5 reference values and greater than 90% with the use of 2 other reference values. Various reference values provide equivalent laboratory rating. In addition to descriptive feedback, our approach allows calculation of technical test sensitivity and specificity, positive and negative predictive values, agreement rates, and κ values to guide corrective actions.

Internal medicine residency redesign: proposal of the Internal Medicine Working Group.

PubMed

Horwitz, Ralph I; Kassirer, Jerome P; Holmboe, Eric S; Humphrey, Holly J; Verghese, Abraham; Croft, Carol; Kwok, Minjung; Loscalzo, Joseph

2011-09-01

Concerned with the quality of internal medicine training, many leaders in the field assembled to assess the state of the residency, evaluate the decline in interest in the specialty, and create a framework for invigorating the discipline. Although many external factors are responsible, we also found ourselves culpable: allowing senior role models to opt out of important training activities, ignoring a progressive atrophy of bedside skills, and focusing on lock-step curricula, lectures, and compiled diagnostic and therapeutic strategies. The group affirmed its commitment to a vision of internal medicine rooted in science and learned with mentors at the bedside. Key factors for new emphasis include patient-centered small group teaching, greater incorporation of clinical epidemiology and health services research, and better schedule control for trainees. Because previous proposals were weakened by lack of evidence, we propose to organize the Cooperative Educational Studies Group, a pool of training programs that will collect a common data set describing their programs, design interventions to be tested rigorously in multi-methodological approaches, and at the same time produce knowledge about high-quality practice. Copyright © 2011 Elsevier Inc. All rights reserved.

Analytical study of the acoustic field in a spherical resonator for single bubble sonoluminescence.

PubMed

Dellavale, Damián; Urteaga, Raúl; Bonetto, Fabián J

2010-01-01

The acoustic field in the liquid within a spherical solid shell is calculated. The proposed model takes into account Stoke's wave equation in the viscous fluid, the membrane theory to describe the solid shell motion and the energy loss through the external couplings of the system. A point source at the resonator center is included to reproduce the acoustic emission of a sonoluminescence bubble. Particular calculations of the resulting acoustic field are performed for viscous liquids of interest in single bubble sonoluminescence. The model reveals that in case of radially symmetric modes of low frequency, the quality factor is mainly determined by the acoustic energy flowing through the mechanical coupling of the resonator. Alternatively, for high frequency modes the quality factor is mainly determined by the viscous dissipation in the liquid. Furthermore, the interaction between the bubble acoustic emission and the resonator modes is analyzed. It was found that the bubble acoustic emission produces local maxima in the resonator response. The calculated amplitudes and relative phases of the harmonics constituting the bubble acoustic environment can be used to improve multi-frequency driving in sonoluminescence.

Refinements in the hierarchical structure of externalizing psychiatric disorders: Patterns of lifetime liability from mid-adolescence through early adulthood.

PubMed

Farmer, Richard F; Seeley, John R; Kosty, Derek B; Lewinsohn, Peter M

2009-11-01

Research on hierarchical modeling of psychopathology has frequently identified 2 higher order latent factors, internalizing and externalizing. When based on the comorbidity of psychiatric diagnoses, the externalizing domain has usually been modeled as a single latent factor. Multivariate studies of externalizing symptom features, however, suggest multidimensionality. To address this apparent contradiction, confirmatory factor analytic methods and information-theoretic criteria were used to evaluate 4 theoretically plausible measurement models based on lifetime comorbidity patterns of 7 putative externalizing disorders. Diagnostic information was collected at 4 assessment waves from an age-based cohort of 816 persons between the ages of 14 and 33. A 2-factor model that distinguished oppositional behavior disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder) from social norm violation disorders (conduct disorder, adult antisocial behavior, alcohol use disorder, cannabis use disorder, hard drug use disorder) demonstrated consistently good fit and superior approximating abilities. Analyses of psychosocial outcomes measured at the last assessment wave supported the validity of this 2-factor model. Implications of this research for the theoretical understanding of domain-related disorders and the organization of classification systems are discussed. PsycINFO Database Record 2009 APA, all rights reserved.

[External therapy of plasma cell mastitis by jiuyi powder using partial least-squares discriminant analysis: a safety analysis].

PubMed

Ye, Mei-na; Yang, Ming; Cheng, Yi-qin; Wang, Bing; Zhu, Ying; Xia, Ya-ru; Meng, Tian; Chen, Hao; Chen, Li-ying; Cheng, Hong-feng

2015-04-01

To evaluate the safety and the clinical value of external use of jiuyi Powder (JP) in treating plasma cell mastitis using partial least-squares discriminant analysis (PLSDA). Totally 50 patients with plasma cell mastitis treated by external use of JP were observed and biochemical examinations of blood and urine detected before application, at day 4 after application, at day 1 and 14 after discontinuation. Blood mercury and urinary mercury were detected before application, at day 1, 4, and 7 after application, at day 1 and 14 after discontinuation. Urinary mercury was also detected at 28 after discontinuation and 3 months after discontinuation. The information of wound, days of external application and the total dosage of external application were recorded before application, at day 1, 4, and 7 after application, as well as at day 1 after discontinuation. Then a discriminant model covering potential safety factors was set up by PLSDA after screening safety indices with important effects. The applicability of the model was assessed using area under ROC curve. Potential safety factors were assessed using variable importance in the projection (VIP). Urinary β2-microglobulin (β2-MG), urinary N-acetyl-β-D-glucosaminidase (NAG), 24 h urinary protein, and urinary α1-microglobulin (α1-MG) were greatly affected by external use of JP in treating plasma cell mastitis. The accuracy rate of PLSDA discriminate model was 74. 00%. The sensitivity, specificity, and the area under ROC curve was 0. 7826, 0. 7037, and 0. 8084, respectively. Three factors with greater effect on the potential safety were screened as follows: pre-application volume of the sore cavity, days of external application, and the total dosage of external application. PLSDA method could be used in analyzing bioinformation of clinical Chinese medicine. Urinary β2-MG and urinary NAG were two main safety monitoring indices. Days of external application and the total dosage of external application were main factors influencing blood mercury and urine mercury. A safety classification simulation model of treating plasma cell mastitis by external therapy of JP was established by the two factors, which could be used to assess the safety of external application of JP to some extent.

76 FR 8804 - Agency Information Collection Activities: Revision and Approval of Information Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-15

... of external factors on Project expectations. Including an ex post examination of project... consist of a narrative discussion detailing project successes and/or the influence of external factors on...

SU-E-T-223: Computed Radiography Dose Measurements of External Radiotherapy Beams

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

Aberle, C; Kapsch, R

2015-06-15

Purpose: To obtain quantitative, two-dimensional dose measurements of external radiotherapy beams with a computed radiography (CR) system and to derive volume correction factors for ionization chambers in small fields. Methods: A commercial Kodak ACR2000i CR system with Kodak Flexible Phosphor Screen HR storage foils was used. Suitable measurement conditions and procedures were established. Several corrections were derived, including image fading, length-scale corrections and long-term stability corrections. Dose calibration curves were obtained for cobalt, 4 MV, 8 MV and 25 MV photons, and for 10 MeV, 15 MeV and 18 MeV electrons in a water phantom. Inherent measurement inhomogeneities were studiedmore » as well as directional dependence of the response. Finally, 2D scans with ionization chambers were directly compared to CR measurements, and volume correction factors were derived. Results: Dose calibration curves (0.01 Gy to 7 Gy) were obtained for multiple photon and electron beam qualities. For each beam quality, the calibration curves can be described by a single fit equation over the whole dose range. The energy dependence of the dose response was determined. The length scale on the images was adjusted scan-by-scan, typically by 2 percent horizontally and by 3 percent vertically. The remaining inhomogeneities after the system’s standard calibration procedure were corrected for. After correction, the homogeneity is on the order of a few percent. The storage foils can be rotated by up to 30 degrees without a significant effect on the measured signal. First results on the determination of volume correction factors were obtained. Conclusion: With CR, quantitative, two-dimensional dose measurements with a high spatial resolution (sub-mm) can be obtained over a large dose range. In order to make use of these advantages, several calibrations, corrections and supporting measurements are needed. This work was funded by the European Metrology Research Programme (EMRP) project HLT09 MetrExtRT Metrology for Radiotherapy using Complex Radiation Fields.« less

Research on the Relationships between Chinese Journal Impact Factors and External Web Link Counts and Web Impact Factors

ERIC Educational Resources Information Center

An, Lu; Qiu, Junping

2004-01-01

Journal impact factors (JIFs) as determined by the Institute for Scientific and Technological Information of China (ISTIC) of forty-two Chinese engineering journals were compared with external Web link counts, obtained from Lycos, and Web Impact Factors (WIFs) of corresponding journal Web sites to determine if any significant correlation existed…

"Sustaining the Shrinking City: Concepts, Dynamics and ...

EPA Pesticide Factsheets

Sustainability can be broadly defined as the resilient outcome of the interaction among social equity, economic stability, and environmental quality factors. For example, the utilization of natural resource capitals are constrained by economic forces, and further modulated by social norms and perceptions. Nowhere is this more apparent than in cities, where the social, economic and environmental capital within the city and in its supporting region may wax and wane due to internal dynamics and external drivers. These changes may be charted as shifts in land use, the type and qualities of infrastructure, population and its demography, and other characteristics that drive the trajectory of a city toward shrinkage. Our authors will discuss how fluxes of different capitals (social, cultural, financial, technological, natural resources, governance/political) might align or substitute for each other to create conditions in the structure and function of city to attain a sustainable size after undergoing a rapid depopulation. Other authors focus on how the misalignment of capitals can doom a city to shrink uncontrollably, and in combination with shifts in environmental quality, the may destroy a city’s ability to function as an integrative center for social and economic interactions. We see this special issue as an attractive venue for data-based research on environmental factors as they impact change in the socio-cultural, economic, political, and physiographic feature

Characteristics of health care organizations associated with learning and development: lessons from a pilot study.

PubMed

Nyström, Monica

2009-01-01

Characteristics of health care organizations associated with an ability to learn from experiences and to develop and manage change were explored in this study. Understanding of these characteristics is necessary to identify factors influencing success in learning from the past and achieving future health care quality objectives. A literature review of the quality improvement, strategic organizational development and change management, organizational learning, and microsystems fields identified 20 organizational characteristics, grouped under (a) organizational systems, (b) key actors, and (c) change management processes. Qualitative methods, using interviews, focus group reports, and archival records, were applied to find associations between identified characteristics and 6 Swedish health care units externally evaluated as delivering high-quality care. Strong support for a characteristic was defined as units having more than 4 sources describing the characteristic as an important success factor. Eighteen characteristics had strong support from at least 2 units. The strongest evidence was found for the following: (i) key actors have long-term commitment, provide support, and make sense of ambiguous situations; (ii) organizational systems encourage employee commitment, participation, and involvement; and (iii) change management processes are employed systematically. Based on the results, a new model of "characteristics associated with learning and development in health care organizations" is proposed.

What do external consultants from private and not-for-profit companies offer healthcare commissioners? A qualitative study of knowledge exchange.

PubMed

Wye, Lesley; Brangan, Emer; Cameron, Ailsa; Gabbay, John; Klein, Jonathan H; Anthwal, Rachel; Pope, Catherine

2015-02-25

The use of external consultants from private and not-for-profit providers in the National Health Service (NHS) is intended to improve the quality of commissioning. The aim of this study was to learn about the support offered to healthcare commissioners, how external consultants and their clients work together and the perceived impact on the quality of commissioning. NHS commissioning organisations and private and not-for-profit providers. Mixed methods case study of eight cases. 92 interviews with external consultants (n=36), their clients (n=47) and others (n=9). Observation of 25 training events and meetings. Documentation, for example, meeting minutes and reports. Constant comparison. Data were coded, summarised and analysed by the research team with a coding framework to facilitate cross-case comparison. In the four contracts presented here, external providers offered technical solutions (eg, software tools), outsourcing and expertise including project management, data interpretation and brokering relationships with experts. In assessing perceived impact on quality of commissioning, two contracts had limited value, one had short-term benefits and one provided short and longer term benefits. Contracts with commissioners actively learning, embedding and applying new skills were more valued. Other elements of success were: (1) addressing clearly agreed problems of relevance to managerial and operational staff (2) solutions co-produced at all organisational levels (3) external consultants working directly with clients to interpret data outputs to inform locally contextualised commissioning strategies. Without explicit knowledge exchange strategies, outsourcing commissioning to external providers resulted in the NHS clients becoming dependent. NHS commissioning will be disadvantaged if commissioners both fail to learn in the short term from the knowledge of external providers and in the longer term lose local skills. Knowledge exchange mechanisms are a vital component of commissioning and should be embedded in external provider contracts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Siblings versus parents and friends: longitudinal linkages to adolescent externalizing problems.

PubMed

Defoe, Ivy N; Keijsers, Loes; Hawk, Skyler T; Branje, Susan; Dubas, Judith Semon; Buist, Kirsten; Frijns, Tom; van Aken, Marcel A G; Koot, Hans M; van Lier, Pol A C; Meeus, Wim

2013-08-01

It is well documented that friends' externalizing problems and negative parent-child interactions predict externalizing problems in adolescence, but relatively little is known about the role of siblings. This four-wave, multi-informant study investigated linkages of siblings' externalizing problems and sibling-adolescent negative interactions on adolescents' externalizing problems, while examining and controlling for similar linkages with friends and parents. Questionnaire data on externalizing problems and negative interactions were annually collected from 497 Dutch adolescents (M = 13.03 years, SD = 0.52, at baseline), as well as their siblings, mothers, fathers, and friends. Cross-lagged panel analyses revealed modest unique longitudinal paths from sibling externalizing problems to adolescent externalizing problems, for male and female adolescents, and for same-sex and mixed-sex sibling dyads, but only from older to younger siblings. Moreover, these paths were above and beyond significant paths from mother-adolescent negative interaction and friend externalizing problems to adolescent externalizing problems, 1 year later. No cross-lagged paths existed between sibling-adolescent negative interaction and adolescent externalizing problems. Taken together, it appears that especially older sibling externalizing problems may be a unique social risk factor for adolescent externalizing problems, equal in strength to significant parents' and friends' risk factors. © 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.

Siblings versus parents and friends: longitudinal linkages to adolescent externalizing problems

PubMed Central

Defoe, Ivy N; Keijsers, Loes; Hawk, Skyler T; Branje, Susan; Dubas, Judith Semon; Buist, Kirsten; Frijns, Tom; van Aken, Marcel AG; Koot, Hans M; van Lier, Pol AC; Meeus, Wim

2013-01-01

Background: It is well documented that friends’ externalizing problems and negative parent–child interactions predict externalizing problems in adolescence, but relatively little is known about the role of siblings. This four-wave, multi-informant study investigated linkages of siblings’ externalizing problems and sibling–adolescent negative interactions on adolescents’ externalizing problems, while examining and controlling for similar linkages with friends and parents. Methods: Questionnaire data on externalizing problems and negative interactions were annually collected from 497 Dutch adolescents (M = 13.03 years, SD = 0.52, at baseline), as well as their siblings, mothers, fathers, and friends. Results: Cross-lagged panel analyses revealed modest unique longitudinal paths from sibling externalizing problems to adolescent externalizing problems, for male and female adolescents, and for same-sex and mixed-sex sibling dyads, but only from older to younger siblings. Moreover, these paths were above and beyond significant paths from mother–adolescent negative interaction and friend externalizing problems to adolescent externalizing problems, 1 year later. No cross-lagged paths existed between sibling–adolescent negative interaction and adolescent externalizing problems. Conclusions: Taken together, it appears that especially older sibling externalizing problems may be a unique social risk factor for adolescent externalizing problems, equal in strength to significant parents’ and friends’ risk factors. PMID:23398022

[Assessment of the impact of socio-economic factors on the health state of the population of the Sverdlovsk region in the system of social-hygienic monitoring].

PubMed

Derstuganova, T M; VelichkovskiĬ, B T; Varaksin, A N; Gurvich, V B; Malykh, O L; Kochneva, N I; Iarushin, S V

2013-01-01

There was investigated the impact of socioeconomic factors on medical and demographic processes in working age population. For the assessment of the impact of living conditions and environmental factors on mortality rate in a population of the Sverdlovsk region factor-typological, correlation and regression analyzes were applied There was shown an availability of statistically significant correlation relationships between mortality of the population of working age and socio-economic characteristics (degree of home improvement, quality of medical care, the level of social tension, the level of the demographic load), as well as between their increments with taking into account the time shifts. The effect of the value of the purchasing power on the mortality rate of the working population has been established The purchasing power was shown to be connected with a mortality rate of working population from external causes more stronger than death from all causes.

Follow-Up of External Quality Controls for PCR-Based Diagnosis of Whooping Cough in a Hospital Laboratory Network (Renacoq) and in Other Hospital and Private Laboratories in France.

PubMed

Guillot, Sophie; Guiso, Nicole

2016-08-01

The French National Reference Centre (NRC) for Whooping Cough carried out an external quality control (QC) analysis in 2010 for the PCR diagnosis of whooping cough. The main objective of the study was to assess the impact of this QC in the participating laboratories through a repeat analysis in 2012. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Birth order rank as a moderator of the relation between behavior problems among children with an autism spectrum disorder and their siblings.

PubMed

Tomeny, Theodore S; Barry, Tammy D; Bader, Stephanie H

2014-02-01

Variability within the literature investigating typically-developing siblings of children with an autism spectrum disorder suggests that the quality of sibling outcomes may depend on specific factors. For this study, 42 parents of a child with an autism spectrum disorder and a typically- developing sibling provided data via online questionnaires. Birth order rank of the child with an autism spectrum disorder significantly moderated the relation between externalizing behaviors in children with an autism spectrum disorder and externalizing behaviors in their typically-developing siblings. Children with an autism spectrum disorder and higher levels of behavior problems had typically-developing siblings with higher levels of behavior problems only when the child with an autism spectrum disorder was older. These results provide a hint of clarification about the complex nature of sibling relations, but a great deal more research is needed to further examine outcomes of typically-developing siblings of children with an autism spectrum disorder.

How nurses and their work environment affect patient experiences of the quality of care: a qualitative study

PubMed Central

2014-01-01

Background Healthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The main focus of this research was to comprehend the views of Dutch nurses on how their work and their work environment contribute to positive patient experiences. Methods A descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic analysis. Results The nurses mentioned essential elements that they believe would improve patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They also mentioned several inhibiting factors, such as cost-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care. Conclusions According to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would result in more positive patient experiences. However, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and they experience a conflict between these two approaches. Nurses must gain autonomy over their own practice in order to improve patient experiences. PMID:24923663

76 FR 23850 - Agency Information Collection Activities: Approval of a Revision in Information Collection(s...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

... successes and/or the influence of external factors on Project expectations. Including an ex post examination... narrative discussion detailing project successes and/or the influence of external factors on project...

Understanding the external pressure and behavior of commercial banks' environmental risk management: an empirical study undertaken in the Yangtze River delta of China.

PubMed

Liu, Yong; Lin, Zhongguo

2014-04-01

The present study employed a quantitative survey to ascertain whether the external pressure of environmental risk management (ERM) on commercial banks was a contributing factor to their ERM behavior. Data was obtained using questionnaires from 204 branches of commercial banks located in the Yangtze River Delta of China. The relationship between external pressure and behavior was tested using a linear structural relations model through path analysis. The results revealed that external pressure of ERM was significantly and positively related to the behavior and that pressure from governmental regulations was the most important contributing factor in the passive feedback behavior and preventive behavior of commercial banks. The pressure from markets was the most important contributing factor in banks' active participation behavior; the pressure from community and NGOs was the most important contributing factor in their enthusiastic behavior.

A review of privacy and usability issues in mobile health systems: Role of external factors.

PubMed

Katusiime, Jane; Pinkwart, Niels

2017-10-01

The increased penetration of mobile devices has created opportunities in the health sector and led to emerging of mobile health systems. As much as the mobile health systems have registered tremendous progress, they have been faced with privacy and usability issues. Due to the sensitivity of health information, there is an ethical need to equip mobile health systems with adequate privacy measures. However, these systems should also be useable by the intended users. Even though many researchers are working on solutions, the issues still persist. External factors such as cultural differences have also contributed to the issues, yet they have been under researched. In this article, we conduct a systematic literature review of 22 articles, categorize and present privacy and usability issues and possible solutions. We then discuss the relevance and implications of external factors to the findings on privacy and usability. We end with recommendations to address these external factors.

Locus of control, quality of life, anxiety, and depression among Malaysian breast cancer patients: The mediating role of uncertainty.

PubMed

Pahlevan Sharif, Saeed

2017-04-01

The main objective of this study was to investigate the mediating role of uncertainty in the relationship between locus of control with quality of life, anxiety, and depression. A descriptive and correlational survey was conducted in a private hospital in Kuala Lumpur, Malaysia. A convenience sample of 118 Malaysian breast cancer patients voluntarily participated in the study and responded to a set of questionnaires including: socio-demographic questionnaire, the short form of Locus of Control Scale, the Functional Assessment of Cancer Therapy-Breast (FACT-B), the Hospital Anxiety and Depression Scale (HADS), and the Short-Form Mishel Uncertainty in Illness Scale (SF-MUIS). The results revealed that breast cancer patients with higher internal locus of control and lower external locus of control experience a higher quality of life, lower anxiety, and lower depression. Also, uncertainty mediated the relationship between locus of control with quality of life and depression (quasi-significant). The findings indicated the need for early, targeted psychological interventions seeking to gradually shift cancer patients' locus of control from external to internal in order to improve their quality of life and reduce their depression and anxiety. Moreover, health care providers by providing relevant information to cancer patients, especially for externally oriented patients, can reduce their uncertainty which in turn would improve their quality of life. Copyright © 2017 Elsevier Ltd. All rights reserved.

Factors affecting construction performance: exploratory factor analysis

NASA Astrophysics Data System (ADS)

Soewin, E.; Chinda, T.

2018-04-01

The present work attempts to develop a multidimensional performance evaluation framework for a construction company by considering all relevant measures of performance. Based on the previous studies, this study hypothesizes nine key factors, with a total of 57 associated items. The hypothesized factors, with their associated items, are then used to develop questionnaire survey to gather data. The exploratory factor analysis (EFA) was applied to the collected data which gave rise 10 factors with 57 items affecting construction performance. The findings further reveal that the items constituting ten key performance factors (KPIs) namely; 1) Time, 2) Cost, 3) Quality, 4) Safety & Health, 5) Internal Stakeholder, 6) External Stakeholder, 7) Client Satisfaction, 8) Financial Performance, 9) Environment, and 10) Information, Technology & Innovation. The analysis helps to develop multi-dimensional performance evaluation framework for an effective measurement of the construction performance. The 10 key performance factors can be broadly categorized into economic aspect, social aspect, environmental aspect, and technology aspects. It is important to understand a multi-dimension performance evaluation framework by including all key factors affecting the construction performance of a company, so that the management level can effectively plan to implement an effective performance development plan to match with the mission and vision of the company.

Spanish cross-cultural adaptation and psychometric properties of the Schizophrenia Quality of Life short-version questionnaire (SQoL18) in 3 middle-income countries: Bolivia, Chile and Peru.

PubMed

Caqueo-Urízar, Alejandra; Boyer, Laurent; Boucekine, Mohamed; Auquier, Pascal

2014-10-01

The aim of this study was to adapt the Schizophrenia - Quality of Life short-version questionnaire (SQoL18) for use in three middle-income countries in Latin America and to evaluate the factor structure, reliability, and external validity of this questionnaire. The SQoL18 was translated into Spanish using a well-validated forward-backward process. We evaluated the psychometric properties of the SQoL18 in a sample of 253 patients with schizophrenia attending outpatient mental health services in three Latin American countries. For participants in each country (Bolivia, N=83; Chile, N=85; Peru, N=85), psychometric properties were compared to those reported from the reference population (507 patients with schizophrenia) assessed in the validation study. In addition, differential item functioning (DIF) analyses were performed to see whether all items behave in the same way in each country. Factor analysis performed in the 3 countries showed that the questionnaire's structure adequately matched the initial structure of the SQoL18. The unidimensionality of the dimensions was preserved, and the internal/external validity indices were close to those of the reference population. However, one dimension of the SQoL18 (resilience) presented some unsatisfactory properties including low Cronbach's alpha coefficients, one INFIT value higher than 1.2, and one item showing DIF between the 3 countries. These results demonstrate the satisfactory acceptability and psychometric properties of the SQoL18, suggesting the relevance of this questionnaire among patients with schizophrenia in these 3 Latin American countries. Copyright © 2014 Elsevier B.V. All rights reserved.

"I don't want them to look at me and think of my illness, I just want them to look at me and see me": Child perspectives on the challenges associated with disclosing an epilepsy diagnosis to others.

PubMed

Benson, Ailbhe; Lambert, Veronica; Gallagher, Pamela; Shahwan, Amre; Austin, Joan K

2015-12-01

Disclosure of a concealable stigmatized identity, such as epilepsy, to those external to the nuclear family can be complex. Among children living with epilepsy (CWE), diagnosis disclosure has been identified as a quality-of-life issue and a source of psychosocial distress. Despite this, limited empirical evidence exists regarding the disclosure experiences of CWE. This study aimed to identify the contextual factors that act as challenges for CWE when disclosing their epilepsy diagnosis to others external to the nuclear family. This qualitative exploratory study consisted of individual interviews with 29 CWE (aged 6-16 years; mean age=11.17 years; S.D.=2.85). Participants were recruited from a tertiary referral unit in the neurology department of a pediatric hospital and through a national epilepsy association. Interviews were audiotaped and transcribed verbatim. Data were thematically analyzed. The five main challenges to epilepsy diagnosis disclosure for children were: 1) CWE's desire for normalcy, 2) out of sight but in the mind, 3) contending with negative responses to disclosure, 4) the complexity of epilepsy, and 5) self and others' perceptions of epilepsy. These findings provide valuable insight into the factors that present difficulties and impede epilepsy diagnosis disclosure among CWE. Such knowledge is important in informing engagements between health-care professionals (HCPs) and CWE. In particular, HCPs should remain cognisant of the challenges CWE face as they: (i) strive for normalcy and (ii) grapple with comprehending their complex neurological condition. Tackling such disclosure challenges could serve to enhance life quality, improve CWE's openness with others about epilepsy, and consequently work toward reducing epilepsy-related misconceptions and stigma. Copyright © 2015 Elsevier Inc. All rights reserved.

[Coronary artery bypass surgery: methods of performance monitoring and quality control].

PubMed

Albert, A; Sergeant, P; Ennker, J

2009-10-01

The strength of coronary bypass operations depends on the preservation of their benefits regarding freedom of symptoms, quality of life and survival, over decades. Significant variability of the results of an operative intervention according to the hospital or the operating surgeon is considered a weakness in the procedure. The external quality insurance tries to reach a transparent service providing market through hospital ranking comparability. Widely available information and competition will promote the improvement of the whole quality. The structured dialog acts as a control instrument for the BQS (Federal Quality Insurance). It is launched in case of deviations from the standard references or statistically significant differences between the results of the operations in any hospital and the average notational results. In comparison to the external control the hospital internal control has greater ability to reach a medically useful statement regarding the results of the treatment and to correct the mistakes in time. An online information portal based on a departmental databank (DataWarehouse, DataMart) is an attractive solution for the physician in order to get transparently and timely informed about the variability in the performance.The individual surgeon significantly influences the short- and long-term treatment results. Accordingly, selection, targeted training and performance measurements are necessary.Strict risk management and failure analysis of individual cases are included in the methods of internal quality control aiming to identify and correct the inadequacies in the system and the course of treatment. According to the international as well as our own experience, at least 30% of the mortalities after bypass operations are avoidable. A functioning quality control is especially important in minimally invasive interventions because they are often technically more demanding in comparison to the conventional procedures. In the field of OPCAB surgery, the special advantages of the procedure can be utilised to reach a nearly complete avoidance of postoperative stroke through combining the procedure with aorta no-touch technique. The long-term success of the bypass operation depends on the type of bypass material in additions to many other factors. Both internal mammary arteries are considered the most durable.Using an operation preparation check contributes to the operative success.

An Investigation of Relationships between Internal and External Factors Affecting Technology Integration in Classrooms

ERIC Educational Resources Information Center

Hur, Jung Won; Shannon, David; Wolf, Sara

2016-01-01

Various factors affecting technology integration have been identified, but little research has examined the relationships between factors, especially internal and external ones, and whether they directly or indirectly influenced each other. To fill this research gap, this study examined the significance and relationships of five factors…

MBA Quality Signals.

ERIC Educational Resources Information Center

Chapman, Randall S.

1998-01-01

A study identified quality signals for master's programs in business administration (MBAs). Traditional scholarly oriented academic signals are apparently not valued as such by external customer groups. MBA academic quality appears to be a multidimensional construct, with subdimensions of real-worldness; placement; student satisfaction; and…

Outcome quality of in-patient cardiac rehabilitation in elderly patients--identification of relevant parameters.

PubMed

Salzwedel, Annett; Nosper, Manfred; Röhrig, Bernd; Linck-Eleftheriadis, Sigrid; Strandt, Gert; Völler, Heinz

2014-02-01

Outcome quality management requires the consecutive registration of defined variables. The aim was to identify relevant parameters in order to objectively assess the in-patient rehabilitation outcome. From February 2009 to June 2010 1253 patients (70.9 ± 7.0 years, 78.1% men) at 12 rehabilitation clinics were enrolled. Items concerning sociodemographic data, the impairment group (surgery, conservative/interventional treatment), cardiovascular risk factors, structural and functional parameters and subjective health were tested in respect of their measurability, sensitivity to change and their propensity to be influenced by rehabilitation. The majority of patients (61.1%) were referred for rehabilitation after cardiac surgery, 38.9% after conservative or interventional treatment for an acute coronary syndrome. Functionally relevant comorbidities were seen in 49.2% (diabetes mellitus, stroke, peripheral artery disease, chronic obstructive lung disease). In three key areas 13 parameters were identified as being sensitive to change and subject to modification by rehabilitation: cardiovascular risk factors (blood pressure, low-density lipoprotein cholesterol, triglycerides), exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure, angina pectoris) and subjective health (IRES-24 (indicators of rehabilitation status): pain, somatic health, psychological well-being and depression as well as anxiety on the Hospital Anxiety and Depression Scale). The outcome of in-patient rehabilitation in elderly patients can be comprehensively assessed by the identification of appropriate key areas, that is, cardiovascular risk factors, exercise capacity and subjective health. This may well serve as a benchmark for internal and external quality management.

External Validation of the Acoustic Voice Quality Index Version 03.01 With Extended Representativity.

PubMed

Barsties, Ben; Maryn, Youri

2016-07-01

The Acoustic Voice Quality Index (AVQI) is an objective method to quantify the severity of overall voice quality in concatenated continuous speech and sustained phonation segments. Recently, AVQI was successfully modified to be more representative and ecologically valid because the internal consistency of AVQI was balanced out through equal proportion of the 2 speech types. The present investigation aims to explore its external validation in a large data set. An expert panel of 12 speech-language therapists rated the voice quality of 1058 concatenated voice samples varying from normophonia to severe dysphonia. The Spearman rank-order correlation coefficients (r) were used to measure concurrent validity. The AVQI's diagnostic accuracy was evaluated with several estimates of its receiver operating characteristics (ROC). Finally, 8 of the 12 experts were chosen because of reliability criteria. A strong correlation was identified between AVQI and auditoryperceptual rating (r = 0.815, P = .000). It indicated that 66.4% of the auditory-perceptual rating's variation was explained by AVQI. Additionally, the ROC results showed again the best diagnostic outcome at a threshold of AVQI = 2.43. This study highlights external validation and diagnostic precision of the AVQI version 03.01 as a robust and ecologically valid measurement to objectify voice quality. © The Author(s) 2016.

External bone marrow cytological examination quality assurance (EQAhem)--summary after 6 years in Poland.

PubMed

Lewandowski, Krzysztof; Kurpierz, Katarzyna; Sledzinska, Anna

2015-10-01

Bone marrow macroscopic examination remains one of the most difficult and subjective laboratory assessments in hematology. Only a few external quality assurance programs in the field are present worldwide. We have developed an external quality assurance program EQAhem that allows assessment of the whole process of bone marrow examination. The program participants assess blood and bone marrow smears from the patient, identify selected cells from photographs provided to them, and interpret the microscopic results. In this article, the results of the EQAhem program in Poland from 6 years are summarized. During this time, 62 labs were assessed in total, and positive results were achieved by 89.25 % labs, taking into account all tests. Correct responses with respect to the percentage of cell count were provided by ca. 77.5 % labs. Slightly worse results were obtained when megakaryocyte count and cell identification from photographs were tested. The worst results were obtained in case of dysplasia assessment and clinical interpretation of microscopic examination (54.1 and 58.6 % correct responses, respectively). EQAhem delivers precise information about the quality of bone marrow examinations performed in Poland and has a substantial educational value. We believe that after 6 years, EQAhem has significantly improved the quality of bone marrow microscopic examinations performed in Poland.

Factors associated with external and internal lymphedema in patients with head-and-neck cancer.

PubMed

Deng, Jie; Ridner, Sheila H; Dietrich, Mary S; Wells, Nancy; Wallston, Kenneth A; Sinard, Robert J; Cmelak, Anthony J; Murphy, Barbara A

2012-11-01

The purpose of this study was to examine factors associated with the presence of secondary external and internal lymphedema in patients with head-and-neck cancer (HNC). The sample included 81 patients ≥3 months after HNC treatment. Physical and endoscopic examinations were conducted to determine if participants had external, internal, and/or combined head-and-neck lymphedema. Logistic regression analysis was used to examine the factors associated with the presence of lymphedema. The following factors were statistically significantly associated with presence of lymphedema: (1) location of tumor associated with presence of external (P=.009) and combined lymphedema (P=.032); (2) time since end of HNC treatment associated with presence of external (P=.004) and combined lymphedema (P=.005); (3) total dosage of radiation therapy (P=.010) and days of radiation (P=.017) associated with the presence of combined lymphedema; (4) radiation status of surgical bed was associated with the presence of internal lymphedema, including surgery with postoperative radiation (P=.030) and (salvage) surgery in the irradiated field (P=.008); and (5) number of treatment modalities associated with external (P=.002), internal (P=.039), and combined lymphedema (P=.004). No demographic, health behavior-related, or comorbidity factors were associated with the presence of lymphedema in the sample. Select tumor and treatment parameters are associated with increased occurrence of lymphedema in patients with HNC. Larger and longitudinal studies are needed to identify adjusted effects and causative risk factors contributing to the development of lymphedema in patients with HNC. Copyright © 2012 Elsevier Inc. All rights reserved.

External quality assessment on detection of hepatitis C virus RNA in clinical laboratories of China.

PubMed

Wang, Lu-nan; Zhang, Rui; Shen, Zi-yu; Chen, Wen-xiang; Li, Jin-ming

2008-06-05

As with many studies carried out in European countries, a quality assurance program has been established by the National Center for Clinical Laboratories in China (NCCL). The results showed that the external quality assessment significantly improves laboratory performance for quantitative evaluation of hepatitis C virus (HCV) RNA. Serum panels were delivered twice annually to the clinical laboratories which performed HCV RNA detection in China. Each panel made up of 5 coded samples. All laboratories were requested to carry out the detection within the required time period and report on testing results which contained qualitative and/or quantitative test findings, reagents used and relevant information about apparatus. All the positive samples were calibrated against the first International Standard for HCV RNA in a collaborative study and the range of comparison target value (TG) designated as +/- 0.5 log. The numbers of laboratories reporting on qualitative testing results for the first and second time external quality assessment were 168 and 167 in the year of 2003 and increased to 209 and 233 in 2007; the numbers of laboratories reporting on quantitative testing results were 134 and 147 in 2003 and rose to 340 and 339 in 2007. Deviation between the mean value for quantitative results at home in 2003 and the target value was above 0.5 log, which was comparatively high. By 2007, the target value was close to the national average except for the low concentrated specimens (10(3) IU/ml). The percentage of results within the range of GM +/- 0.5 log(10) varied from 8.2% to 93.5%. Some laboratories had some difficulties in the exact quantification of the lowest (3.00 log IU/ml) as well as of the highest viral levels (6.37 log IU/ml) values, very near to the limits of the dynamic range of the assays. The comparison of these results with the previous study confirms that a regular participation in external quality assessment (EQA) assures the achievement of a high proficiency level in the diagnosis of HCV infection. During the 5-year external quality assessment, sensitivity and accuracy of detection in most of the clinical laboratories have been evidently improved and the quality of kits has also been substantially improved.

Assessing the Quality of PhD Dissertations. A Survey of External Committee Members

ERIC Educational Resources Information Center

Kyvik, Svein; Thune, Taran

2015-01-01

This article reports on a study of the quality assessment of doctoral dissertations, and asks whether examiner characteristics influence assessment of research quality in PhD dissertations. Utilising a multi-dimensional concept of quality of PhD dissertations, we look at differences in assessment of research quality, and particularly test whether…

Pinpointing Chinese Early Childhood Teachers' Professional Development Needs through Self-Evaluation and External Observation of Classroom Quality

ERIC Educational Resources Information Center

Hu, Bi Ying; Zhou, Yisu; Li, Kejian

2014-01-01

This study compared Chinese kindergarten teachers' values and perceptions of program quality with trained raters' assessments of quality in order to gain insights into effective professional development for improving teacher quality. A total of 284 Chinese kindergarten teachers self-assessed the quality of their classroom teaching and rated their…

Quality Assurance of Quality Assurance Agencies from an Asian Perspective: Regulation, Autonomy and Accountability

ERIC Educational Resources Information Center

Hou, Angela Yung-Chi; Ince, Martin; Tsai, Sandy; Chiang, Chung Lin

2015-01-01

As quality guardians of higher education, quality assurance agencies are required to guarantee the credibility of the review process and to ensure the objectivity and transparency of their decisions and recommendations. These agencies are therefore expected to use a range of internal and external approaches to prove the quality of their review…

[Quality of data on deaths from external causes in a medium-sized city in Minas Gerais State, Brazil].

PubMed

Melo, Cristiane Magalhães de; Bevilacqua, Paula Dias; Barletto, Marisa; França, Elisabeth Barboza

2014-09-01

This study aimed to assess the quality of data on deaths from external causes in Viçosa, Minas Gerais State, Brazil, from 2000 to 2009, and the completeness of the Mortality Information System (SIM). The data were obtained from the SIM of the Municipal Health Department, municipal police enquiries, and local newspaper articles, resulting in a databank with 495 deaths from external causes. The results showed a high proportion of deaths with indeterminate intent (21%) in the SIM, suggesting problems with quality of information. Comparison of data from the SIM and police department detected problems with coverage in the SIM (21%) and thus in the official statistics on mortality from accidents and violence. The results emphasize the importance of searches in other data sources to upgrade the SIM and expand its coverage, and especially the need for studies to identify and analyze problems faced by small and medium-sized cities in the production of mortality data.

[Guideline compliance in hip fracture: results of an external quality-assurance program in North Rhine Westphalia: 2003-2005].

PubMed

Schulze Raestrup, U; Grams, A; Smektala, R

2008-02-01

Whereas the Scottish guidelines are audited annually, nobody evaluates guideline compliance in Germany. Thus, can external quality assurance data pursuant to section 137 of the German Social Code Book V be suitable for auditing guideline compliance? From North Rhine Westphalia, a total of 48,831 cases of femoral fractures near the hip joint were evaluated. Compliance with the guidelines was determined based on preoperative hospital stay, thrombosis, and antibiotic prophylaxis. Guideline rationale was reviewed in terms of mortality and thromboembolism rate. Sixty-four percent of the interventions were performed in a timely manner. Thrombosis prophylaxis was given in 99% of cases. Antibiotics were given as a single shot. There was no connection between mortality and thromboembolism rates or time to surgery. Guideline compliance is similar in German and Scotland. The external quality assurance data are suitable for evaluating guideline compliance. The literature recommends a short time to surgery. Given the short observation period, it was not possible to demonstrate any improvement in outcomes.

Self-reported quality of life measure is reliable and valid in adult patients suffering from schizophrenia with executive impairment.

PubMed

Baumstarck, Karine; Boyer, Laurent; Boucekine, Mohamed; Aghababian, Valérie; Parola, Nathalie; Lançon, Christophe; Auquier, Pascal

2013-06-01

Impaired executive functions are among the most widely observed in patients suffering from schizophrenia. The use of self-reported outcomes for evaluating treatment and managing care of these patients has been questioned. The aim of this study was to provide new evidence about the suitability of self-reported outcome for use in this specific population by exploring the internal structure, reliability and external validity of a specific quality of life (QoL) instrument, the Schizophrenia Quality of Life questionnaire (SQoL18). cross-sectional study. age over 18 years, diagnosis of schizophrenia according to the DSM-IV criteria. sociodemographic (age, gender, and education level) and clinical data (duration of illness, Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia); QoL (SQoL18); and executive performance (Stroop test, lexical and verbal fluency, and trail-making test). Non-impaired and impaired populations were defined for each of the three tests. For the six groups, psychometric properties were compared to those reported from the reference population assessed in the validation study. One hundred and thirteen consecutive patients were enrolled. The factor analysis performed in the impaired groups showed that the questionnaire structure adequately matched the initial structure of the SQoL18. The unidimensionality of the dimensions was preserved, and the internal/external validity indices were close to those of the non-impaired groups and the reference population. Our study suggests that executive dysfunction did not compromise the reliability or validity of self-reported disease-specific QoL questionnaire. Copyright © 2013 Elsevier B.V. All rights reserved.

7 CFR 51.1561 - Serious damage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... any combination of defects, which seriously detracts from the edible or marketing quality, or the internal or external appearance of the potato, or any external defect which cannot be removed without a...

Risk factors for suicide in offspring bereaved by sudden parental death from external causes.

PubMed

Burrell, Lisa Victoria; Mehlum, Lars; Qin, Ping

2017-11-01

Parentally bereaved offspring have an increased suicide risk as a group, but the ability to identify specific individuals at risk on the basis of risk and protective factors is limited. The present study aimed to investigate to what degree different risk factors influence suicide risk in offspring bereaved by parental death from external causes. Based on Norwegian registers, individual-level data were retrieved for 375 parentally bereaved suicide cases and 7500 parentally bereaved gender- and age-matched living controls. Data were analysed with conditional logistic regression. Bereaved offspring with low social support, indicated by offspring's single status and repeated changes in marital status and residence, had a significantly increased suicide risk compared to bereaved offspring with high social support. Moreover, low socioeconomic status, having an immigration background, having lost both parents and loss due to suicide significantly increased suicide risk. Several variables relevant to bereavement outcome, such as coping mechanisms and the quality of the parent-offspring relationship are impossible to examine by utilizing population registers. Moreover, the availability of data did not enable the measurement of marital stability and residence stability across the entire lifespan for older individuals. Healthcare professionals should be aware of the additional risk posed by the identified risk factors and incorporate this knowledge into existing practice and risk assessment in order to identify individuals at risk and effectively target bereaved family and friends for prevention and intervention programs. Ideal follow-up for bereaved families should include a specific focus on mobilizing social support. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of interface pressure distribution on human sleep quality.

PubMed

Chen, Zongyong; Li, Yuqian; Liu, Rong; Gao, Dong; Chen, Quanhui; Hu, Zhian; Guo, Jiajun

2014-01-01

High sleep quality promotes efficient performance in the following day. Sleep quality is influenced by environmental factors, such as temperature, light, sound and smell. Here, we investigated whether differences in the interface pressure distribution on healthy individuals during sleep influenced sleep quality. We defined four types of pressure models by differences in the area distribution and the subjective feelings that occurred when participants slept on the mattresses. One type of model was showed "over-concentrated" distribution of pressure; one was displayed "over-evenly" distributed interface pressure while the other two models were displayed intermediate distribution of pressure. A polysomnography analysis demonstrated an increase in duration and proportion of non-rapid-eye-movement sleep stages 3 and 4, as well as decreased number of micro-arousals, in subjects sleeping on models with pressure intermediately distributed compared to models with over-concentrated or over-even distribution of pressure. Similarly, higher scores of self-reported sleep quality were obtained in subjects sleeping on the two models with intermediate pressure distribution. Thus, pressure distribution, at least to some degree, influences sleep quality and self-reported feelings of sleep-related events, though the underlying mechanisms remain unknown. The regulation of pressure models imposed by external sleep environment may be a new direction for improving sleep quality. Only an appropriate interface pressure distribution is beneficial for improving sleep quality, over-concentrated or -even distribution of pressure do not help for good sleep.

Relative importance and interrelations between psychosocial factors and individualized quality of life of hemodialysis patients.

PubMed

Tovbin, David; Gidron, Yori; Jean, Tzipora; Granovsky, Ricardo; Schnieder, Alla

2003-09-01

Since quality of life (QOL) of hemodialysis (HD) patients is low and frequently difficult to improve by medical therapy, it is important to identify psychosocial correlates and life-domains important for HD patients' QOL. Our hypothesis was that psychosocial factors reflecting appraisal, external and internal resources/impediments correlate with QOL and compensate for adverse effects of disease-related variables on QOL. Forty-eight chronic HD-patients identified and rank-ordered life-domains important for QOL and rated their level of satisfaction with those domains. This was performed using a slightly modified version of the Self-Evaluated Individualized QOL (SEiQOL) Scale. Psychosocial factors included perceived-control (PC), social-support and hostility. Demographic and disease-related factors included age, gender, cardiovascular disease (CVD), diabetes, hematocrit, albumin and C-reactive protein. QOL was significantly correlated with PC (r = 0.65) and social-support (r = 0.38), and inversely correlated with hostility (r = -0.31), diabetes and hypoalbuminemia (all at least p < 0.05). PC mediated effects of certain variables (e.g., albumin, gender, hostility) and moderated effects of little social-support and hypoalbuminemia on QOL. Patients' most important QOL domains were health, with which satisfaction was lowest, followed by family, with which satisfaction was highest. Pending replication with larger samples, assessment and enhancement of PC may improve HD patients' QOL.

Early problem behavior among children from low-income, mother-headed families: a multiple risk perspective.

PubMed

Olson, Sheryl L; Ceballo, Rosario; Park, Curie

2002-12-01

Examined proximal and contextual factors most strongly related to externalizing behavior among young children growing up in low-income, mother-headed families. Participants were 50 low-income single mothers and their preschool-age children who were visited twice in the home setting. Measures of proximal (low levels of supportive parenting, high levels of punitive disciplinary practices, low levels of maternal emotional well-being) and contextual (low maternal support, high levels of family stress) risk were assessed in relation to maternal reports of child externalizing behavior and an index of negative child behavior during a clean-up task. Child defiance during the clean-up task was highly associated with punitive maternal control in the same situation but had no other direct correlates. However, multiple risk factors representing both proximal and contextual variables were associated with variations in children's behavior problem scores. Mothers of children with high behavior problem scores reported lower feelings of self-efficacy in handling child care and emotional stressors, more frequent use of punitive child disciplinary practices, and lower feelings of satisfaction with the quality of their supportive resources than others. Maternal self-evaluations of coping efficacy mediated the relation between perceived support and child behavior problems, suggesting that constructs of personal control are important to represent in future studies of highly stressed parents.

Influence of phosphorus management on melon (Cucumis melo L.) fruit quality.

PubMed

Martuscelli, Maria; Di Mattia, Carla; Stagnari, Fabio; Speca, Stefano; Pisante, Michele; Mastrocola, Dino

2016-06-01

At harvest time, melon quality is related to internal and external parameters, which are very important for consumer attractiveness and marketable yield. Several agronomic factors can affect the quality of melon fruits and among them mineral availability may play a significant role. Therefore the aim of the work was to investigate the effect of phosphorus fertigation on melon fruit (Cucumis melo L.) qualitative characteristics, such as fruit size and yield, pulp colour and firmness, aroma and taste, as well as the accumulation of bioactive antioxidant compounds, namely phenols and carotenoids, and their antiradical properties. Results allowed us to extrapolate the optimal P doses to be used for melon fertigation, to achieve high yield and fruit quality characteristics. Modelling the optimal P dose allowed us to maximize yield and resulted in around 257 kg P2 O5 ha(-1) , even if the quality indices relating to carotenoid content, texture and colour of the melon flesh were not significantly different between samples fertigated with the two highest levels tested. It can be assumed that the level of 200 kg P2 O5 ha(-1) would be a good compromise between optimization of agronomic performance and melon fruit quality. © 2015 Society of Chemical Industry. © 2015 Society of Chemical Industry.

Multi-centre audit of VMAT planning and pre-treatment verification.

PubMed

Jurado-Bruggeman, Diego; Hernández, Victor; Sáez, Jordi; Navarro, David; Pino, Francisco; Martínez, Tatiana; Alayrach, Maria-Elena; Ailleres, Norbert; Melero, Alejandro; Jornet, Núria

2017-08-01

We performed a multi-centre intercomparison of VMAT dose planning and pre-treatment verification. The aims were to analyse the dose plans in terms of dosimetric quality and deliverability, and to validate whether in-house pre-treatment verification results agreed with those of an external audit. The nine participating centres encompassed different machines, equipment, and methodologies. Two mock cases (prostate and head and neck) were planned using one and two arcs. A plan quality index was defined to compare the plans and different complexity indices were calculated to check their deliverability. We compared gamma index pass rates using the centre's equipment and methodology to those of an external audit (global 3D gamma, absolute dose differences, 10% of maximum dose threshold). Log-file analysis was performed to look for delivery errors. All centres fulfilled the dosimetric goals but plan quality and delivery complexity were heterogeneous and uncorrelated, depending on the manufacturer and the planner's methodology. Pre-treatment verifications results were within tolerance in all cases for gamma 3%-3mm evaluation. Nevertheless, differences between the external audit and in-house measurements arose due to different equipment or methodology, especially for 2%-2mm criteria with differences up to 20%. No correlation was found between complexity indices and verification results amongst centres. All plans fulfilled dosimetric constraints, but plan quality and complexity did not correlate and were strongly dependent on the planner and the vendor. In-house measurements cannot completely replace external audits for credentialing. Copyright © 2017 Elsevier B.V. All rights reserved.

The responsiveness of the International Prostate Symptom Score, Incontinence Impact Questionnaire-7 and Depression, Anxiety and Stress Scale-21 in patients with lower urinary tract symptoms.

PubMed

Choi, Edmond P H; Chin, Weng Yee; Lam, Cindy L K; Wan, Eric Y F

2015-08-01

To examine the responsiveness of a combined symptom severity and health-related quality of life measure, condition-specific health-related quality of life measure and mental health measure in patients with lower urinary tract symptoms. To establish the responsiveness of measures that accurately capture the change in health status of patients is crucial before any longitudinal studies can be appropriately planned and evaluated. Prospective longitudinal observational study. 402 patients were surveyed at baseline and 1-year using the International Prostate Symptom Score, the Incontinence Impact Questionnaire-7 and Depression, Anxiety and Stress Scales-21. The internal and external responsiveness were assessed. Surveys were conducted from March 2013-July 2014. In participants with improvements, the internal responsiveness for detecting positive changes was satisfactory in males and females for all scales, expect for the Depression subscale. The health-related quality of life question of the International Prostate Symptom Score was more externally responsive than the Incontinence Impact Questionnaire-7. The International Prostate Symptom Score and Anxiety and Stress subscales were more responsive in males than in females. The symptom questions of the International Prostate Symptom Score and Anxiety and Stress subscales were not externally responsive in females. The health-related quality of life question of the International Prostate Symptom Score outperformed the Incontinence Impact Questionnaire-7 in both males and females, in terms of external responsiveness. © 2015 John Wiley & Sons Ltd.

Competition, Speculative Risks, and IT Security Outsourcing

NASA Astrophysics Data System (ADS)

Cezar, Asunur; Cavusoglu, Huseyin; Raghunathan, Srinivasan

Information security management is becoming a more critical and, simultaneously, a challenging function for many firms. Even though many security managers are skeptical about outsourcing of IT security, others have cited reasons that are used for outsourcing of traditional IT functions for why security outsourcing is likely to increase. Our research offers a novel explanation, based on competitive externalities associated with IT security, for firms' decisions to outsource IT security. We show that if competitive externalities are ignored, then a firm will outsource security if and only if the MSSP offers a quality (or a cost) advantage over in-house operations, which is consistent with the traditional explanation for security outsourcing. However, a higher quality is neither a prerequisite nor a guarantee for a firm to outsource security. The competitive risk environment and the nature of the security function outsourced, in addition to quality, determine firms' outsourcing decisions. If the reward from the competitor's breach is higher than the loss from own breach, then even if the likelihood of a breach is higher under the MSSP the expected benefit from the competitive demand externality may offset the loss from the higher likelihood of breaches, resulting in one or both firms outsourcing security. The incentive to outsource security monitoring is higher than that of infrastructure management because the MSSP can reduce the likelihood of breach on both firms and thus enhance the demand externality effect. The incentive to outsource security monitoring (infrastructure management) is higher (lower) if either the likelihood of breach on both firms is lower (higher) when security is outsourced or the benefit (relative to loss) from the externality is higher (lower). The benefit from the demand externality arising out of a security breach is higher when more of the customers that leave the breached firm switch to the non-breached firm.

AIR QUALITY CRITERIA CARBON MONOXIDE, EXTERNAL REVIEW DRAFT

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) promulgates the National Ambient Air Quality Standards (NAAQS) on the basis of scientific information contained in criteria documents. The last air quality criteria document for carbon monoxide (CO) was completed by EPA in 1991. This...

Multi-institutional Prospective Evaluation of Bowel Quality of Life After Prostate External Beam Radiation Therapy Identifies Patient and Treatment Factors Associated With Patient-Reported Outcomes: The PROSTQA Experience

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

Hamstra, Daniel A., E-mail: dhamm@med.umich.edu; Conlon, Anna S.C.; Daignault, Stephanie

Purpose: To evaluate patients treated with external beam radiation therapy as part of the multicenter Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROSTQA), to identify factors associated with posttreatment patient-reported bowel health-related quality of life (HRQOL). Methods and Materials: Pretreatment characteristics and treatment details among 292 men were evaluated using a general linear mixed model for their association with measured HRQOL by the Expanded Prostate Cancer Index Composite instrument through 2 years after enrollment. Results: Bowel HRQOL had a median score of 100 (interquartile range 91.7-100) pretreatment and 95.8 (interquartile range 83.3-100) at 2 years, representing new moderate/bigmore » problems in 11% for urgency, 7% for frequency, 4% for bloody stools, and 8% for an overall bowel problems. Baseline bowel score was the strongest predictor for all 2-year endpoints. In multivariable models, a volume of rectum ≥25% treated to 70 Gy (V70) yielded a clinically significant 9.3-point lower bowel score (95% confidence interval [CI] 16.8-1.7, P=.015) and predicted increased risks for moderate to big fecal incontinence (P=.0008). No other radiation therapy treatment-related variables influenced moderate to big changes in rectal HRQOL. However, on multivariate analyses V70 ≥25% was associated with increases in small, moderate, or big problems with the following: incontinence (3.9-fold; 95% CI 1.1-13.4, P=.03), rectal bleeding (3.6-fold; 95% CI 1.3-10.2, P=.018), and bowel urgency (2.9-fold; 95% CI 1.1-7.6, P=.026). Aspirin use correlated with a clinically significant 4.7-point lower bowel summary score (95% CI 9.0-0.4, P=.03) and an increase in small, moderate, or big problems with bloody stools (2.8-fold; 95% CI 1.2-6.4, P=.018). Intensity modulated radiation therapy was associated with higher radiation therapy doses to the prostate and lower doses to the rectum but did not independently correlate with bowel HRQOL. Conclusion: After contemporary dose-escalated external beam radiation therapy up to 11% of patients have newly identified moderate/big problems with bowel HRQOL 2 years after treatment. Bowel HRQOL is related to baseline function, rectal V70, and aspirin use. Finally, our findings validate the commonly utilized cut-point of rectal V70 ≥25% as having significant impact on patient-reported outcomes.« less

Possible causes of data model discrepancy in the temperature history of the last Millennium.

PubMed

Neukom, Raphael; Schurer, Andrew P; Steiger, Nathan J; Hegerl, Gabriele C

2018-05-15

Model simulations and proxy-based reconstructions are the main tools for quantifying pre-instrumental climate variations. For some metrics such as Northern Hemisphere mean temperatures, there is remarkable agreement between models and reconstructions. For other diagnostics, such as the regional response to volcanic eruptions, or hemispheric temperature differences, substantial disagreements between data and models have been reported. Here, we assess the potential sources of these discrepancies by comparing 1000-year hemispheric temperature reconstructions based on real-world paleoclimate proxies with climate-model-based pseudoproxies. These pseudoproxy experiments (PPE) indicate that noise inherent in proxy records and the unequal spatial distribution of proxy data are the key factors in explaining the data-model differences. For example, lower inter-hemispheric correlations in reconstructions can be fully accounted for by these factors in the PPE. Noise and data sampling also partly explain the reduced amplitude of the response to external forcing in reconstructions compared to models. For other metrics, such as inter-hemispheric differences, some, although reduced, discrepancy remains. Our results suggest that improving proxy data quality and spatial coverage is the key factor to increase the quality of future climate reconstructions, while the total number of proxy records and reconstruction methodology play a smaller role.

Smartphones as image processing systems for prosthetic vision.

PubMed

Zapf, Marc P; Matteucci, Paul B; Lovell, Nigel H; Suaning, Gregg J

2013-01-01

The feasibility of implants for prosthetic vision has been demonstrated by research and commercial organizations. In most devices, an essential forerunner to the internal stimulation circuit is an external electronics solution for capturing, processing and relaying image information as well as extracting useful features from the scene surrounding the patient. The capabilities and multitude of image processing algorithms that can be performed by the device in real-time plays a major part in the final quality of the prosthetic vision. It is therefore optimal to use powerful hardware yet to avoid bulky, straining solutions. Recent publications have reported of portable single-board computers fast enough for computationally intensive image processing. Following the rapid evolution of commercial, ultra-portable ARM (Advanced RISC machine) mobile devices, the authors investigated the feasibility of modern smartphones running complex face detection as external processing devices for vision implants. The role of dedicated graphics processors in speeding up computation was evaluated while performing a demanding noise reduction algorithm (image denoising). The time required for face detection was found to decrease by 95% from 2.5 year old to recent devices. In denoising, graphics acceleration played a major role, speeding up denoising by a factor of 18. These results demonstrate that the technology has matured sufficiently to be considered as a valid external electronics platform for visual prosthetic research.

Out Drinking the Joneses: Neighborhood Factors Moderating the Effects of Drinking on Relationship Quality over the First Four Years of Marriage.

PubMed

Crasta, Dev; Funk, Janette L; Lee, Soonhee; Rogge, Ronald D

2017-12-27

Neighborhood quality has been cross-sectionally linked to both relationship behaviors and relationship well-being. Consistent with the Vulnerability Stress-Adaptation model of relationship functioning (Karney & Bradbury, 1995), we hypothesized that associations between social behaviors (e.g., drinking) and relationship quality could be moderated by neighborhood factors. Specifically, we characterized neighborhoods along multiple dimensions using multiple methods (self-report, census) to investigate how neighborhood factors might clarify ambiguous effects of alcohol use on marital functioning. A nationally recruited sample of 303 newlywed couples completed a baseline assessment around the time of marriage and was then assessed yearly across the first 4 years of marriage (94% retention). Three level HLM slope-intercept models were used to model changes in relationship satisfaction across the first 4 years of marriage. Results suggested that, for couples living in highly disordered neighborhoods, positive shifts in overall levels of drinking within specific waves of assessment were associated with corresponding negative shifts in satisfaction whereas in neighborhoods without perceived disorder, this effect was reversed. For couples living in neighborhoods with low levels of domestic structures (high census rates of single renters without children), within-couple discrepancies favoring higher rates of husband drinking in specific waves predicted poorer relationship quality for both partners in those same waves whereas those same discrepancies predicted higher satisfaction in high domesticity neighborhoods (high census rates of married homeowners with children). The findings provide insight into the different roles of alcohol use in relationship maintenance and highlight the importance of using external context to understand intradyadic processes. © 2017 Family Process Institute.

Quality Assurance in Higher Education: Proposals for Consultation.

ERIC Educational Resources Information Center

Higher Education Funding Council for England, Bristol.

This document sets out for consultation proposals for a revised method for quality assurance of teaching and learning in higher education. The proposals cover: (1) the objectives and principles of quality assurance; (2) an approach to quality assurance based on external audit principles; (3) the collection and publication of information; (4)…

Towards a Culture of Quality. Perspectives on Distance Education

ERIC Educational Resources Information Center

Koul, Badri N., Ed.; Kanwar, Asha, Ed.

2006-01-01

This third publication on the theme of quality in the Commonwealth of Learning Perspectives on Distance Education series widens the discussion beyond external quality assurance processes to a more generic focus on a "culture of quality." It is an extension of the earlier two publications, which came out in 1994 and 1997 and drew…

RAS screening in colorectal cancer: a comprehensive analysis of the results from the UK NEQAS colorectal cancer external quality assurance schemes (2009-2016).

PubMed

Richman, Susan D; Fairley, Jennifer; Butler, Rachel; Deans, Zandra C

2017-12-01

Evidence strongly indicates that extended RAS testing should be undertaken in mCRC patients, prior to prescribing anti-EGFR therapies. With more laboratories implementing testing, the requirement for External Quality Assurance schemes increases, thus ensuring high standards of molecular analysis. Data was analysed from 15 United Kingdom National External Quality Assessment Service (UK NEQAS) for Molecular Genetics Colorectal cancer external quality assurance (EQA) schemes, delivered between 2009 and 2016. Laboratories were provided annually with nine colorectal tumour samples for genotyping. Information on methodology and extent of testing coverage was requested, and scores given for genotyping, interpretation and clerical accuracy. There has been a sixfold increase in laboratory participation (18 in 2009 to 108 in 2016). For RAS genotyping, fewer laboratories now use Roche cobas®, pyrosequencing and Sanger sequencing, with more moving to next generation sequencing (NGS). NGS is the most commonly employed technology for BRAF and PIK3CA mutation screening. KRAS genotyping errors were seen in ≤10% laboratories, until the 2014-2015 scheme, when there was an increase to 16.7%, corresponding to a large increase in scheme participants. NRAS genotyping errors peaked at 25.6% in the first 2015-2016 scheme but subsequently dropped to below 5%. Interpretation and clerical accuracy scores have been consistently good throughout. Within this EQA scheme, we have observed that the quality of molecular analysis for colorectal cancer has continued to improve, despite changes in the required targets, the volume of testing and the technologies employed. It is reassuring to know that laboratories clearly recognise the importance of participating in EQA schemes.

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

Experience of using MOSFET detectors for dose verification measurements in an end-to-end 192Ir brachytherapy quality assurance system.

PubMed

Persson, Maria; Nilsson, Josef; Carlsson Tedgren, Åsa

Establishment of an end-to-end system for the brachytherapy (BT) dosimetric chain could be valuable in clinical quality assurance. Here, the development of such a system using MOSFET (metal oxide semiconductor field effect transistor) detectors and experience gained during 2 years of use are reported with focus on the performance of the MOSFET detectors. A bolus phantom was constructed with two implants, mimicking prostate and head & neck treatments, using steel needles and plastic catheters to guide the 192 Ir source and house the MOSFET detectors. The phantom was taken through the BT treatment chain from image acquisition to dose evaluation. During the 2-year evaluation-period, delivered doses were verified a total of 56 times using MOSFET detectors which had been calibrated in an external 60 Co beam. An initial experimental investigation on beam quality differences between 192 Ir and 60 Co is reported. The standard deviation in repeated MOSFET measurements was below 3% in the six measurement points with dose levels above 2 Gy. MOSFET measurements overestimated treatment planning system doses by 2-7%. Distance-dependent experimental beam quality correction factors derived in a phantom of similar size as that used for end-to-end tests applied on a time-resolved measurement improved the agreement. MOSFET detectors provide values stable over time and function well for use as detectors for end-to-end quality assurance purposes in 192 Ir BT. Beam quality correction factors should address not only distance from source but also phantom dimensions. Copyright © 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Internal and external environmental factors affecting the performance of hospital-based home nursing care.

PubMed

Noh, J-W; Kwon, Y-D; Yoon, S-J; Hwang, J-I

2011-06-01

Numerous studies on HNC services have been carried out by signifying their needs, efficiency and effectiveness. However, no study has ever been performed to determine the critical factors associated with HNC's positive results despite the deluge of positive studies on the service. This study included all of the 89 training hospitals that were practising HNC service in Korea as of November 2006. The input factors affecting the performance were classified as either internal or external environmental factors. This analysis was conducted to understand the impact that the corresponding factors had on performance. Data were analysed by using multiple linear regressions. The internal and external environment variables affected the performance of HNC based on univariate analysis. The meaningful variables were internal environmental factors. Specifically, managerial resource (the number of operating beds and the outpatient/inpatient ratio) were meaningful when the multiple linear regression analysis was performed. Indeed, the importance of organizational culture (the passion of HNC nurses) was significant. This study, considering the limited market size of Korea, illustrates that the critical factor for the development of hospital-led HNC lies with internal environmental factors rather than external ones. Among the internal environmental factors, the hospitals' managerial resource-related factors (specifically, the passion of nurses) were the most important contributing element. © 2011 The Authors. International Nursing Review © 2011 International Council of Nurses.

Challenges for health care development in Croatia.

PubMed

Ostojić, Rajko; Bilas, Vlatka; Franc, Sanja

2012-09-01

The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services.

International Accreditations as Drivers of Business School Quality Improvement

ERIC Educational Resources Information Center

Bryant, Michael

2013-01-01

Business schools are under pressure to implement continuous improvement and quality assurance processes to remain competitive in a globalized higher education market. Drivers for quality improvement include external, environmental pressures, regulatory bodies such as governments, and, increasingly, voluntary accreditation agencies such as AACSB…

External quality assurance for HIV point-of-care testing in Africa: A collaborative country-partner approach to strengthen diagnostic services

PubMed Central

2016-01-01

It is important to consider the role of diagnostics and the critical need for quality diagnostics services in resource-limited settings. Accurate diagnostic tests play a key role in patient management and the prevention and control of most infectious diseases. As countries plan for implementation of HIV early infant diagnosis and viral load point-of-care testing, the London School of Hygiene & Tropical Medicine has worked with countries and partners with an interest in external quality assurance to support quality point-of-care testing on the continent. Through a series of collaborative consultations and workshops, the London School of Hygiene & Tropical Medicine has gathered lessons learned, tools, and resources and developed quality assurance models that will support point-of-care testing. The London School of Hygiene & Tropical Medicine is committed to the continued advancement of laboratory diagnostics in Africa and quality laboratory services and point-of-care testing. PMID:28879132

Validation of the self regulation questionnaire as a measure of health in quality of life research

PubMed Central

2009-01-01

Objectives Several epidemiological studies address psychosomatic 'self regulation' as a measure of quality of life aspects. However, although widely used in studies with a focus on complementary cancer treatment, and recognized to be associated with better survival of cancer patients, it is unclear what the 'self regulation' questionnaire exactly measures. Design and setting In a sample of 444 individuals (27% healthy, 33% cancer, 40% other internal diseases), we performed reliability and exploratory factor analyses, and correlated the 16-item instrument with external measures such as the Hospital Anxiety and Depression Scale, the Herdecke Quality of Life questionnaire, and autonomic regulation questionnaire. Results The 16-item pool had a very good internal consistency (Cronbach's alpha = 0.948) and satisfying/good (rrt = 0.796) test-retest reliability after 3 months. Exploratory factor analysis indicated 2 sub-constructs: (1) Ability to change behaviour in order to reach goals, and (2) Achieve satisfaction and well-being. Both sub-scales correlated well with quality of life aspects, particularly with Initiative Power/Interest, Social Interactions, Mental Balance, and negatively with anxiety and depression. Conclusions The Self Regulation Questionnaire (SRQ) was found to be a valid and reliable tool which measures unique psychosomatic abilities. Self regulation deals with competence and autonomy and can be regarded as a problem solving capacity in terms of an active adaptation to stressful situations to restore wellbeing. The tool is an interesting option to be used particularly in complementary medicine research with a focus on behavioural modification. PMID:19541580

Achieving donor repetition and motivation by block leaders among current blood donors.

PubMed

Martín-Santana, Josefa D; Beerli-Palacio, Asunción

2012-12-01

This paper presents an explicative model on the recommendation of donating blood made to relatives and friends by current donors. This model establishes satisfaction and intention to return as direct antecedents, and the quality perceived in the donation process and the existence of inhibitors as indirect antecedents. The results show that (1) the perceived quality has a positive influence on satisfaction and intention to return; (2) the intention to donate again depends positively on satisfaction, but negatively on the existence of internal and external inhibitors; and lastly (3) the recommendation to donate depends on donor satisfaction and their intention to return to donate, this being the most influential factor. At the same time, we contrasted how the model does not vary, whether it is a first-time donor or a repeat donor. Copyright © 2012 Elsevier Ltd. All rights reserved.

Outcomes in transfusion.

PubMed

Sherman, L A

1999-07-01

Outcomes data in medicine can be limited by subjective methodologic issues such as poor selection of end points and use of nonvalidated systems for quality adjustment. Blood transfusion analyses are further complicated by the fact that transfusion seldom is primary therapy but is usually supportive or adjunctive. Thus, much of the outcome data in transfusion medicine are either unavailable or in one of two areas. The first area is prevention of bad sequelae of various cytopenias or factor deficiencies. The second is decreasing adverse effects of transfusion itself. A different useful area for outcome and root cause approaches in individual institutions is examining preanalytical and postanalytical processes of their own. Examples are sample labeling accuracy, quality and timeliness of blood suppliers, internal delivery processes and times, and product wastage. Use review can be changed to real time from retrospective time. By reducing complaints about service to objective data, realistic change can be made in internal and external processes.

Implementation of cold risk management in occupational safety, occupational health and quality practices. Evaluation of a development process and its effects at the finnish maritime administration.

PubMed

Risikko, Tanja; Remes, Jouko; Hassi, Juhani

2008-01-01

Cold is a typical environmental risk factor in outdoor work in northern regions. It should be taken into account in a company's occupational safety, health and quality systems. A development process for improving cold risk management at the Finnish Maritime Administration (FMA) was carried out by FMA and external experts. FMA was to implement it. Three years after the development phase, the outcomes and implementation were evaluated. The study shows increased awareness about cold work and few concrete improvements. Concrete improvements in occupational safety and health practices could be seen in the pilot group. However, organization-wide implementation was insufficient, the main reasons being no organization-wide practices, unclear process ownership, no resources and a major reorganization process. The study shows a clear need for expertise supporting implementation. The study also presents a matrix for analyzing the process.

Design of an rf quadrupole for Landau damping

NASA Astrophysics Data System (ADS)

Papke, K.; Grudiev, A.

2017-08-01

The recently proposed superconducting quadrupole resonator for Landau damping in accelerators is subjected to a detailed design study. The optimization process of two different cavity types is presented following the requirements of the High Luminosity Large Hadron Collider (HL-LHC) with the main focus on quadrupolar strength, surface peak fields, and impedance. The lower order and higher order mode (LOM and HOM) spectrum of the optimized cavities is investigated and different approaches for their damping are proposed. On the basis of an example the first two higher order multipole errors are calculated. Likewise on this example the required rf power and optimal external quality factor for the input coupler is derived.

Scanning thermal microscopy based on a quartz tuning fork and a micro-thermocouple in active mode (2ω method).

PubMed

Bontempi, Alexia; Nguyen, Tran Phong; Salut, Roland; Thiery, Laurent; Teyssieux, Damien; Vairac, Pascal

2016-06-01

A novel probe for scanning thermal microscope using a micro-thermocouple probe placed on a Quartz Tuning Fork (QTF) is presented. Instead of using an external deflection with a cantilever beam for contact detection, an original combination of piezoelectric resonator and thermal probe is employed. Due to a non-contact photothermal excitation principle, the high quality factor of the QTF allows the probe-to-surface contact detection. Topographic and thermal scanning images obtained on a specific sample points out the interest of our system as an alternative to cantilevered resistive probe systems which are the most spread.

Prescription Proportion of Pomegranate Extract Gallic Acid Gel by Orthogonal Design

NASA Astrophysics Data System (ADS)

Fan, Gaofu; Liu, Xiushu; Tang, Jie; Gong, Jumei; Fu, Entao; Cai, Yuhua; Xu, Zhenguo

2018-05-01

The aim of the present work was to optimize the formulation of pomegranate extract gallic acid gel by orthogonal design. Using orthogonal design, propylene glycol, carbomer-940 and gel pH level as influencing factors, the evaluation key index was external apearance malleability, uniformity, and eccentric for gel, and the optimum formula was selected. The present findings suggest that 10% propylene glycol, 1.5% Carbopol-940, and gel pH in the range of 4.5∼5.5, and the indexes of the optimal. The inclusion complexes showed that after the orthogonal design, the preparation process was simple, stable and controllable quality, with production feasibility.

Scanning thermal microscopy based on a quartz tuning fork and a micro-thermocouple in active mode (2ω method)

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

Bontempi, Alexia; Nguyen, Tran Phong; Salut, Roland

A novel probe for scanning thermal microscope using a micro-thermocouple probe placed on a Quartz Tuning Fork (QTF) is presented. Instead of using an external deflection with a cantilever beam for contact detection, an original combination of piezoelectric resonator and thermal probe is employed. Due to a non-contact photothermal excitation principle, the high quality factor of the QTF allows the probe-to-surface contact detection. Topographic and thermal scanning images obtained on a specific sample points out the interest of our system as an alternative to cantilevered resistive probe systems which are the most spread.

Culture, communication and safety: lessons from the airline industry.

PubMed

d'Agincourt-Canning, Lori G; Kissoon, Niranjan; Singal, Mona; Pitfield, Alexander F

2011-06-01

Communication is a critical component of effective teamwork and both are essential elements in providing high quality of care to patients. Yet, communication is not an innate skill but a process influenced by internal (personal/cultural values) as well as external (professional roles and hierarchies) factors. To provide illustrative cases, themes and tools for improving communication. Literature review and consensus opinion based on extensive experience. Professional autonomy should be de-emphasized. Tools such as SBAR and simulation are important in communication and teamwork. Tools designed to improve communication and safety in the aviation industry may have applicability to the pediatric intensive care unit.

Monitoring Diffuse Impacts: Australian Tourism Developments.

PubMed

Warnken; Buckley

2000-04-01

/ The scientific quality of monitoring for diffuse environmental impacts has rarely been quantified. This paper presents an analysis of all formal environmental monitoring programs for Australian tourism developments over a 15-year period from 1980 to 1995. The tourism sector provides a good test bed for this study because tourism developments are (1) often adjacent to or even within conservation reserves and other relatively undisturbed natural environments, and (2) often clustered, with resulting cumulative impacts that require detection at an early stage. Here we analyze the precision and reliability with which monitoring programs as actually implemented can detect diffuse environmental impacts against natural variation. Of 175 Australian tourism developments subject to EIA from 1980 to 1993 inclusive, only 13 were subject to formal monitoring. Only 44 individual parameters, in total, were monitored for all these developments together. No baseline monitoring was conducted for nine of the 44 parameters. For the remaining 35, only one was monitored for a full year. Before, after, control, impact, paired sampling (BACIP) monitoring designs were used for 24 of the 44 parameters, and power analysis in 10. The scientific quality of monitoring was significantly better for developments subject to control by the Great Barrier Reef Marine Park Authority (GBRMPA). The key factor appears to be the way in which GBRMPA uses external referees and manages external consultants. The GBRMPA model merits wider adoption.

Endoluminal MR-guided ultrasonic applicator embedding cylindrical phased-array transducers and opposed-solenoid detection coil.

PubMed

Rata, Mihaela; Birlea, Vlad; Murillo, Adriana; Paquet, Christian; Cotton, François; Salomir, Rares

2015-01-01

MR-guided high-intensity contact ultrasound (HICU) was suggested as an alternative therapy for esophageal and rectal cancer. To offer high-quality MR guidance, two prototypes of receive-only opposed-solenoid coil were integrated with 64-element cylindrical phased-array ultrasound transducers (rectal/esophageal). The design of integrated coils took into account the transducer geometry (360° acoustic window within endoluminal space). The rectal coil was sealed on a plastic support and placed reversibly on the transducer head. The esophageal coil was fully embedded within the transducer head, resulting in one indivisible device. Comparison of integrated versus external coils was performed on a clinical 1.5T scanner. The integrated coils showed higher sensitivity compared with the standard extracorporeal coil with factors of up to 7.5 (rectal applicator) and 3.3 (esophageal applicator). High-resolution MR images for both anatomy (voxel 0.4 × 0.4 × 5 mm(3)) and thermometry (voxel 0.75 × 0.75 × 8 mm(3), 2 s/image) were acquired in vivo with the rectal endoscopic device. The temperature feedback loop accurately controlled multiple control points over the region of interest. This study showed significant improvement of MR data quality using endoluminal integrated coils versus standard external coil. Inframillimeter spatial resolution and accurate feedback control of MR-guided HICU thermotherapy were achieved. © 2014 Wiley Periodicals, Inc.

Wind seismic noise introduced by external infrastructure: field data and transfer mechanism

NASA Astrophysics Data System (ADS)

Martysevich, Pavel; Starovoyt, Yuri

2017-04-01

Background seismic noise generated by wind was analyzed at six co-located seismic and infrasound arrays with the use of the wind speed data. The main factors affecting the noise level were identified as (a) external structures as antenna towers for intrasite communication, vegetation and heavy solar panels fixtures, (b) borehole casing and (c) local lithology. The wind-induced seismic noise peaks in the spectra can be predicted by combination of inverted pendulum model for antenna towers and structures used to support solar panels, free- or clamped-tube resonance of the borehole casing and is dependent on the type of sedimentary upper layer. Observed resonance frequencies are in agreement with calculated clamped / free tube modes for towers and borehole casings. Improvement of the seismic data quality can be achieved by minimizing the impact of surrounding structures close to seismic boreholes. The need and the advantage of the borehole installation may vanish and appear to be even not necessary at locations with non-consolidated sediments because the impact of surrounding structures on seismic background may significantly deteriorate the installation quality and therefore the detection capability of the array. Several IMS arrays where the radio telemetry antennas are used for data delivery to the central site may benefit from the redesign of the intrasite communication system by its substitute with the fiber-optic net as less harmful engineering solution.

Physics of Limiting Phenomena in Superconducting Microwave Resonators: Vortex Dissipation, Ultimate Quench and Quality Factor Degradation Mechanisms

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

Checchin, Mattia

Superconducting niobium accelerating cavities are devices operating in radio-frequency and able to accelerate charged particles up to energy of tera-electron-volts. Such accelerating structures are though limited in terms of quality factor and accelerating gradient, that translates--in some cases--in higher capital costs of construction and operation of superconducting rf accelerators. Looking forward for a new generation of more affordable accelerators, the physical description of limiting mechanisms in superconducting microwave resonators is discussed. In particular, the physics behind the dissipation introduced by vortices in the superconductor, the ultimate quench limitations and the quality factor degradation mechanism after a quench are described inmore » detail. One of the limiting factor of the quality factor is the dissipation introduced by trapped magnetic flux vortices. The radio-frequency complex response of trapped vortices in superconductors is derived by solving the motion equation for a magnetic flux line, assuming a bi-dimensional and mean free path-dependent Lorentzian-shaped pinning potential. The resulting surface resistance shows the bell-shaped trend as a function of the mean free path, in agreement with the experimental data observed. Such bell-shaped trend of the surface resistance is described in terms of the interplay of the two limiting regimes identified as pinning and flux flow regimes, for low and large mean free path values respectively. The model predicts that the dissipation regime--pinning- or flux-flow-dominated--can be tuned either by acting on the frequency or on the electron mean free path value. The effect of different configurations of pinning sites and strength on the vortex surface resistance are also discussed. Accelerating cavities are also limited by the quench of the superconductive state, which limits the maximum accelerating gradient achievable. The accelerating field limiting factor is usually associate d to the superheating field, which is intimately correlated to the penetration of magnetic flux vortices in the material. Experimental data for N-doped cavities suggest that uniform Ginzburg-Landau parameter cavities are statistically limited by the lower critical field, in terms of accelerating gradient. By introducing a Ginzburg-Landau parameter profile at the cavity rf surface--dirty layer--the accelerating gradient of superconducting resonators can be enhanced. The description of the physics behind the accelerating gradient enhancement as a consequence of the dirty layer is carried out by solving numerically the Ginzburg-Landau equations for the layered system. The enhancement is showed to be promoted by the higher energy barrier to vortex penetration, and by the enhanced lower critical field. Another serious threat to the quality factor during the cavity operation is the extra dissipation introduced by the quench. Such quality factor degradation mechanism due to the quench, is generated by the trapping of external magnetic flux at quench spot. The purely extrinsic origin of such extra dissipation is proven by the impossibility of decrease the quality factor by quenching in a magnetic field-free environment. Also, a clear relation of the dissipation introduced by quenching to the orientation of the applied magnetic field is observed. The full recover of the quality factor by re-quenching in compensated field is possible when the trapped flux at the quench spot is modest. On the contrary, when the trapped magnetic flux is too large, the quality factor degradation may become irreversible by this technique, likely due to the outward flux migration beyond the normal zone opening during the quench.« less

Physics of limiting phenomena in superconducting microwave resonators: Vortex dissipation, ultimate quench and quality factor degradation mechanisms

NASA Astrophysics Data System (ADS)

Checchin, Mattia

Superconducting niobium accelerating cavities are devices operating in radiofrequency and able to accelerate charged particles up to energy of tera-electron-volts. Such accelerating structures are though limited in terms of quality factor and accelerating gradient, that translates--in some cases--in higher capital costs of construction and operation of superconducting rf accelerators. Looking forward for a new generation of more affordable accelerators, the physical description of limiting mechanisms in superconducting microwave resonators is discussed. In particular, the physics behind the dissipation introduced by vortices in the superconductor, the ultimate quench limitations and the quality factor degradation mechanism after a quench are described in detail. One of the limiting factor of the quality factor is the dissipation introduced by trapped magnetic flux vortices. The radio-frequency complex response of trapped vortices in superconductors is derived by solving the motion equation for a magnetic flux line, assuming a bi-dimensional and mean free path-dependent Lorentzian-shaped pinning potential. The resulting surface resistance shows the bell-shaped trend as a function of the mean free path, in agreement with the experimental data observed. Such bell-shaped trend of the surface resistance is described in terms of the interplay of the two limiting regimes identified as pinning and flux flow regimes, for low and large mean free path values respectively. The model predicts that the dissipation regime--pinning- or flux-flow-dominated--can be tuned either by acting on the frequency or on the electron mean free path value. The effect of different configurations of pinning sites and strength on the vortex surface resistance are also discussed. Accelerating cavities are also limited by the quench of the superconductive state, which limits the maximum accelerating gradient achievable. The accelerating field limiting factor is usually associated to the superheating field, which is intimately correlated to the penetration of magnetic flux vortices in the material. Experimental data for N-doped cavities suggest that uniform Ginzburg-Landau parameter cavities are statistically limited by the lower critical field, in terms of accelerating gradient. By introducing a Ginzburg-Landau parameter profile at the cavity rf surface--dirty layer--the accelerating gradient of superconducting resonators can be enhanced. The description of the physics behind the accelerating gradient enhancement as a consequence of the dirty layer is carried out by solving numerically the Ginzburg-Landau equations for the layered system. The enhancement is showed to be promoted by the higher energy barrier to vortex penetration, and by the enhanced lower critical field. Another serious threat to the quality factor during the cavity operation is the extra dissipation introduced by the quench. Such quality factor degradation mechanism due to the quench, is generated by the trapping of external magnetic flux at the quench spot. The purely extrinsic origin of such extra dissipation is proven by the impossibility of decrease the quality factor by quenching in a magnetic field-free environment. Also, a clear relation of the dissipation introduced by quenching to the orientation of the applied magnetic field is observed. The full recover of the quality factor by re-quenching in compensated field is possible when the trapped flux at the quench spot is modest. On the contrary, when the trapped magnetic flux is too large, the quality factor degradation may become irreversible by this technique, likely due to the outward flux migration beyond the normal zone opening during the quench.

Effects of environmental biomass-producing factors on Cd uptake in two Swedish ecotypes of Pinus sylvestris.

PubMed

Ekvall, Lars; Greger, Maria

2003-01-01

A factorial design was used to study direct effects of external biomass-producing factors such as light, temperature and photoperiod on cadmium (Cd) uptake and indirect effects, via change in biomass production in two ecotypes of Scots pine (Pinus silvestris). The aim was to find out if the external factors affect the Cd uptake directly or via change in biomass production, and if the effect differs between ecotypes. Seedlings were grown under 10 combinations of external factors, i.e. temperature (15 and 20 degrees C), light intensity (50 and 200 micromol photons m(-2) S(-1)), photoperiod (18 h light/8 h darkness and continuous light) and external Cd concentration (totally 1.88 and 7.50 micromol). The treatment lasted for 18 days and Cd concentrations in roots and shoots were determined by AAS. The results showed that an increased biomass production increased the total Cd uptake but had a dilution effect on the Cd concentration, especially in the root tissues. The external factors tested did not have any direct effects on the Cd untake, only in the case of Cd translocation to the shoot did the higher temperature show a direct increase, but only in the southern ecotype. The two ecotypes reacted differently in Cd uptake and translocation to the external factors studied. The relative Cd uptake creased with increasing photoperiod in the northern but not in the southern ecotype. The southern ecotype decreased the Cd concentration in the shoot with increased light intensity caused by a dilution effect due to extensive shoot growth of this ecotype. The conclusion is that the uptake in pine seedlings is mainly regulated via biomass production, and not directly by light and temperature and that resulting plant Cd contents to a certain extent depend on plant origin.

Experiment study on RC frame retrofitted by the external structure

NASA Astrophysics Data System (ADS)

Liu, Chunyang; Shi, Junji; Hiroshi, Kuramoto; Taguchi, Takashi; Kamiya, Takashi

2016-09-01

A new retrofitting method is proposed herein for reinforced concrete (RC) structures through attachment of an external structure. The external structure consists of a fiber concrete encased steel frame, connection slab and transverse beams. The external structure is connected to the existing structure through a connection slab and transverse beams. Pseudostatic experiments were carried out on one unretrofitted specimen and three retrofitted frame specimens. The characteristics, including failure mode, crack pattern, hysteresis loops behavior, relationship of strain and displacement of the concrete slab, are demonstrated. The results show that the load carrying capacity is obviously increased, and the extension length of the slab and the number of columns within the external frame are important influence factors on the working performance of the existing structure. In addition, the displacement difference between the existing structure and the outer structure was caused mainly by three factors: shear deformation of the slab, extraction of transverse beams, and drift of the conjunction part between the slab and the existing frame. Furthermore, the total deformation determined by the first two factors accounted for approximately 80% of the damage, therefore these factors should be carefully considered in engineering practice to enhance the effects of this new retrofitting method.

10 CFR 72.92 - Design basis external natural events.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 2 2013-01-01 2013-01-01 false Design basis external natural events. 72.92 Section 72.92... Evaluation Factors § 72.92 Design basis external natural events. (a) Natural phenomena that may exist or that... must be adopted for evaluating the design basis external natural events based on the characteristics of...

10 CFR 72.92 - Design basis external natural events.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 2 2014-01-01 2014-01-01 false Design basis external natural events. 72.92 Section 72.92... Evaluation Factors § 72.92 Design basis external natural events. (a) Natural phenomena that may exist or that... must be adopted for evaluating the design basis external natural events based on the characteristics of...

10 CFR 72.92 - Design basis external natural events.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 2 2012-01-01 2012-01-01 false Design basis external natural events. 72.92 Section 72.92... Evaluation Factors § 72.92 Design basis external natural events. (a) Natural phenomena that may exist or that... must be adopted for evaluating the design basis external natural events based on the characteristics of...

Family Resources as Protective Factors for Low-Income Youth Exposed to Community Violence.

PubMed

Hardaway, Cecily R; Sterrett-Hong, Emma; Larkby, Cynthia A; Cornelius, Marie D

2016-07-01

Exposure to community violence is a risk factor for internalizing and externalizing problems; however, resources within the family can decrease the likelihood that adolescents will experience internalizing and externalizing problems as a result of such exposure. This study investigates the potential moderating effects of kinship support (i.e., emotional and tangible support from extended family) and parental involvement on the relation between exposure to community violence (i.e., witnessing violence and violent victimization) and socioemotional adjustment (i.e., internalizing and externalizing problems) in low-income adolescents. The sample included 312 (50 % female; 71 % African American and 29 % White) low-income youth who participated in a longitudinal investigation when adolescents were age 14 (M age = 14.49 years) and again when they were 16 (M age = 16.49 years). Exposure to community violence at age 14 was related to more internalizing and externalizing problems at age 16. High levels of kinship support and parental involvement appeared to function as protective factors, weakening the association between exposure to violence and externalizing problems. Contrary to prediction, none of the hypothesized protective factors moderated the association between exposure to violence and internalizing problems. The results from this study suggest that both kinship support and parental involvement help buffer adolescents from externalizing problems that are associated with exposure to community violence.

Identification of Giftedness in Preschoolers: Are Parents' Perceptions Related to Home Environment Factors and Cognitive Assessments?

ERIC Educational Resources Information Center

Williams, Nina; Gonzalez, Virginia

This paper discusses the results of a study that explored the influence of two major external factors on children's potential giftedness before the identification process is initiated. The study involved 13 children (ages 4-6) and investigated parental perceptions of the influence of internal and/or external factors on their child's cognitive…