Effectiveness of psychological interventions to improve quality of life in people with long-term conditions: rapid systematic review of randomised controlled trials.

PubMed

Anderson, Niall; Ozakinci, Gozde

2018-03-27

Long-term conditions may negatively impact multiple aspects of quality of life including physical functioning and mental wellbeing. The rapid systematic review aimed to examine the effectiveness of psychological interventions to improve quality of life in people with long-term conditions to inform future healthcare provision and research. EBSCOhost and OVID were used to search four databases (PsychInfo, PBSC, Medline and Embase). Relevant papers were systematically extracted by one researcher using the predefined inclusion/exclusion criteria based on titles, abstracts, and full texts. Randomized controlled trial psychological interventions conducted between 2006 and February 2016 to directly target and assess people with long-term conditions in order to improve quality of life were included. Interventions without long-term condition populations, psychological intervention and/or patient-assessed quality of life were excluded. From 2223 citations identified, 6 satisfied the inclusion/exclusion criteria. All 6 studies significantly improved at least one quality of life outcome immediately post-intervention. Significant quality of life improvements were maintained at 12-months follow-up in one out of two studies for each of the short- (0-3 months), medium- (3-12 months), and long-term (≥ 12 months) study duration categories. All 6 psychological intervention studies significantly improved at least one quality of life outcome immediately post-intervention, with three out of six studies maintaining effects up to 12-months post-intervention. Future studies should seek to assess the efficacy of tailored psychological interventions using different formats, durations and facilitators to supplement healthcare provision and practice.

CMS Nonpayment Policy, Quality Improvement, and Hospital-Acquired Conditions: An Integrative Review.

PubMed

Bae, Sung-Heui

This integrative review synthesized evidence on the consequences of the Centers for Medicare & Medicaid Services (CMS) nonpayment policy on quality improvement initiatives and hospital-acquired conditions. Fourteen articles were included. This review presents strong evidence that the CMS policy has spurred quality improvement initiatives; however, the relationships between the CMS policy and hospital-acquired conditions are inconclusive. In future research, a comprehensive model of implementation of the CMS nonpayment policy would help us understand the effectiveness of this policy.

Improve processes on healthcare: current issues and future trends.

PubMed

Chen, Jason C H; Dolan, Matt; Lin, Binshan

2004-01-01

Information Technology (IT) is a critical resource for improving today's business competitiveness. However, many healthcare providers do not proactively manage or improve the efficiency and effectiveness of their services with IT. Survival in a competitive business environment demands continuous improvements in quality and service, while rigorously maintaining core values. Electronic commerce continues its development, gaining ground as the preferred means of business transactions. Embracing e-healthcare and treating IT as a strategic tool to improve patient safety and the quality of care enables healthcare professionals to benefit from technology formerly used only for management purposes. Numerous improvement initiatives, introduced by both the federal government and the private sector, seek to better the status quo in IT. This paper examines the current IT climate using an enhanced "Built to Last" model, and comments on future IT strategies within the healthcare industry.

Continuous Quality Improvement in a University Setting: The Case of the Department of Vocational and Technical Education at the University of Minnesota.

ERIC Educational Resources Information Center

Copa, George H.

1993-01-01

Discusses the application of continuous quality improvement principles in the Department of Vocational and Technical Education at the University of Minnesota. Reviews the processes that the department incorporated to implement this program and lists future steps and categories of action. (Author)

Partnership for Continuous Improvement

NASA Technical Reports Server (NTRS)

1990-01-01

The proceedings are presented of the sixth annual conference on quality control between NASA and its contractors. The emphasis is placed on a commitment to quality and excellence that guarantees mission success. A forum is provided for representatives from government, industry, and academia to exchange ideas and experiences, encouraging total quality performance that results in high quality products and services. Key points are highlighted from the presentations and activities are described that have resulted in a broad range of improvements in products and services from government, industry, and academia. Long term commitment to quality is an essential requirement that ensures future success. That commitment reinterates the dedication to excellence in space exploration and to national quality and productivity improvement.

The theory, practice, and future of process improvement in general thoracic surgery.

PubMed

Freeman, Richard K

2014-01-01

Process improvement, in its broadest sense, is the analysis of a given set of actions with the aim of elevating quality and reducing costs. The tenets of process improvement have been applied to medicine in increasing frequency for at least the last quarter century including thoracic surgery. This review outlines the theory underlying process improvement, the currently available data sources for process improvement and possible future directions of research. Copyright © 2015 Elsevier Inc. All rights reserved.

Important technical parameters are not presented in reports of intraoral digital radiography in endodontic treatment: recommendations for future studies.

PubMed

Konishi, Masaru; Lindh, Christina; Nilsson, Mats; Tanimoto, Keiji; Rohlin, Madeleine

2012-08-01

The aims of this study were to review the literature on intraoral digital radiography in endodontic treatment with focus on technical parameters and to propose recommendations for improving the quality of reports in future publications. Two electronic databases were searched. Titles and abstracts were selected according to preestablished criteria. Data were extracted using a model of image acquisition and interpretation. The literature search yielded 233 titles and abstracts; 61 reports were read in full text. Recent reports presented technical parameters more thoroughly than older reports. Most reported important parameters for the x-ray unit, but for image interpretation only about one-half of the publications cited resolution of the display system and fewer than one-half bit depth of the graphics card. The methodologic quality of future publications must be improved to permit replication of studies and comparison of results between studies in dental digital radiography. Our recommendations can improve the quality of studies on diagnostic accuracy. Copyright © 2012 Mosby, Inc. All rights reserved.

A residency clinic chronic condition management quality improvement project.

PubMed

Halverson, Larry W; Sontheimer, Dan; Duvall, Sharon

2007-02-01

Quality improvement in chronic disease management is a major agenda for improving health and reducing health care costs. A six-component chronic disease management model can help guide this effort. Several characteristics of the "new model" of family medicine described by the Future of Family Medicine (FFM) Project Leadership Committee are promulgated to foster practice changes that improve quality. Our objective was to implement and assess a quality improvement project guided by the components of a chronic disease management model and FFM new model characteristics. Diabetes was selected as a model chronic disease focus. Multiple practice changes were implemented. A mature electronic medical record facilitated data collection and measurement of quality improvement progress. Data from the diabetes registry demonstrates that our efforts have been effective. Significant improvement occurred in five out of six quality indicators. Multidisciplinary teamwork in a model residency practice guided by chronic disease management principles and the FFM new model characteristics can produce significant management improvements in one important chronic disease.

The status of tree improvement programs for northern tree species

Treesearch

David S. Canavera

1977-01-01

Forest tree improvement research and application in the Northeast is reviewed in the perspective of past development and future needs. Control over provenance selection can provide the best quality seed for today's reforestation programs. Future supplies of seed must come from seed orchards if forest land owners are to attain the maximum production per unit area...

Robots, multi-user virtual environments and healthcare: synergies for future directions.

PubMed

Moon, Ajung; Grajales, Francisco J; Van der Loos, H F Machiel

2011-01-01

The adoption of technology in healthcare over the last twenty years has steadily increased, particularly as it relates to medical robotics and Multi-User Virtual Environments (MUVEs) such as Second Life. Both disciplines have been shown to improve the quality of care and have evolved, for the most part, in isolation from each other. In this paper, we present four synergies between medical robotics and MUVEs that have the potential to decrease resource utilization and improve the quality of healthcare delivery. We conclude with some foreseeable barriers and future research directions for researchers in these fields.

Parameters for the Design of Group Randomized Studies for Teacher Professional Development

ERIC Educational Resources Information Center

Kelcey, Ben; Phelps, Geoffrey; Jones, Nathan

2013-01-01

Teacher professional development (PD) is seen as critical to improving the quality of US schools (National Commission on Teaching and America's Future, 1997). PD is increasingly viewed as one of the primary levers for improving teaching quality and ultimately student achievement (Correnti, 2007). One factor that is driving interest in PD is…

Future riverine nitrogen export to US coastal regions: Prospects for improving water quality amid population growth.

EPA Science Inventory

Excess nitrogen (N) in the environment degrades ecosystems and adversely affects human health. Here we examine predictions of contemporary (2000) and future (2030) coastal N loading in the continental US by the Nutrient Export from WaterSheds (NEWS) model. Future scenarios were b...

International quality improvement initiatives.

PubMed

Hickey, Patricia A; Connor, Jean A; Cherian, Kotturathu M; Jenkins, Kathy; Doherty, Kaitlin; Zhang, Haibo; Gaies, Michael; Pasquali, Sara; Tabbutt, Sarah; St Louis, James D; Sarris, George E; Kurosawa, Hiromi; Jonas, Richard A; Sandoval, Nestor; Tchervenkov, Christo I; Jacobs, Jeffery P; Stellin, Giovanni; Kirklin, James K; Garg, Rajnish; Vener, David F

2017-12-01

Across the globe, the implementation of quality improvement science and collaborative learning has positively affected the care and outcomes for children born with CHD. These efforts have advanced the collective expertise and performance of inter-professional healthcare teams. In this review, we highlight selected quality improvement initiatives and strategies impacting the field of cardiovascular care and describe implications for future practice and research. The continued leveraging of technology, commitment to data transparency, focus on team-based practice, and recognition of cultural norms and preferences ensure the success of sustainable models of global collaboration.

Quality improvement in medical education: current state and future directions.

PubMed

Wong, Brian M; Levinson, Wendy; Shojania, Kaveh G

2012-01-01

During the last decade, there has been a drive to improve the quality of patient care and prevent the occurrence of avoidable errors. This review describes current efforts to teach or engage trainees in patient safety and quality improvement (QI), summarises progress to date, as well as successes and challenges, and lists our recommendations for the next steps that will shape the future of patient safety and QI in medical education. Trainees encounter patient safety and QI through three main groups of activity. First are formal curricula that teach concepts or methods intended to facilitate trainees' participation in QI activities. These curricula increase learner knowledge and may improve clinical processes, but demonstrate limited capacity to modify learner behaviours. Second are educational activities that impart specific skills related to safety or quality which are considered to represent core doctor competencies (e.g. effective patient handover). These are frequently taught effectively, but without emphasis on the general safety or quality principles that inform the relevant skills. Third are real-life QI initiatives that involve trainees as active or passive participants. These innovative approaches expose trainees to safety and quality by integrating QI activities into trainees' day-to-day work. However, this integration can be challenging and can sometimes result in tension with broader educational goals. To prepare the next generation of doctors to make meaningful contributions to the quality mission, we propose the following call to action. Firstly, a major effort to build faculty capacity, especially among teachers of QI, should be instigated. Secondly, accreditation standards and assessment methods, both during training and at end-of-training certification examinations, should explicitly target these competencies. Finally, and perhaps most importantly, we must refocus our attention at all levels of training and instil fundamental, collaborative, open-minded behaviours so that future clinicians are primed to promote a culture of safer, higher-quality care. © Blackwell Publishing Ltd 2012.

Quality engineering as a discipline of study.

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

Kolb, Rachel R.; Hoover, Marcey L.

2012-12-01

The current framework for quality scholarship in the United States ranges from the training and education of future quality engineers, managers, and professionals to focused and sustained research initiatives that, through academic institutions and other organizations, aim to improve the knowledge and application of quality across a variety of sectors. Numerous quality journals also provide a forum for professional dissemination of information.

The maturing of the quality improvement paradigm in the SEL

NASA Technical Reports Server (NTRS)

Basili, Victor R.

1993-01-01

The Software Engineering Laboratory uses a paradigm for improving the software process and product, called the quality improvement paradigm. This paradigm has evolved over the past 18 years, along with our software development processes and product. Since 1976, when we first began the SEL, we have learned a great deal about improving the software process and product, making a great many mistakes along the way. Quality improvement paradigm, as it is currently defined, can be broken up into six steps: characterize the current project and its environment with respect to the appropriate models and metrics; set the quantifiable goals for successful project performance and improvement; choose the appropriate process model and supporting methods and tools for this project; execute the processes, construct the products, and collect, validate, and analyze the data to provide real-time feedback for corrective action; analyze the data to evaluate the current practices, determine problems, record findings, and make recommendations for future project improvements; and package the experience gained in the form of updated and refined models and other forms of structured knowledge gained from this and prior projects and save it in an experience base to be reused on future projects.

American College of Cardiology (ACC)'s PINNACLE India Quality Improvement Program (PIQIP)-Inception, progress and future direction: A report from the PIQIP Investigators.

PubMed

Kalra, Ankur; Glusenkamp, Nathan; Anderson, Karen; Kalra, Ram N; Kerkar, Prafulla G; Kumar, Ganesh; Maddox, Thomas M; Oetgen, William J; Virani, Salim S

2016-12-01

Cardiovascular diseases have surpassed infectious disorders to become the leading cause of morbidity and mortality in India. 1 A national-level registry comprehensively documenting the current-day prevalence of cardiovascular risk factors and disease burden among patients seeking care in the outpatient setting in India is currently non-existent. With a burgeoning urban population, the cardiovascular disease burden in India is set to skyrocket, with an estimated 18 million productive years of life lost by 2030. 2 While there are limited quality improvement registries in India, for example, the Kerala acute coronary syndrome and Trivandrum heart failure registries, their focus is on in-patient care quality improvement, while the vast majority of patients with cardiovascular diseases worldwide, including India, interact with the health care system in the outpatient setting. 3,4 Recognizing this unmet need, the American College of Cardiology partnered with local stakeholders in India to establish India's first outpatient cardiovascular disease performance measurement initiative in 2011, the PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP). 5 This manuscript discusses the inception of the PIQIP registry, the progress it has made and challenges thus far, and its future direction and the promise it holds for cardiovascular care quality improvement in India. Copyright © 2016. Published by Elsevier B.V.

Modeling green infrastructure land use changes on future air quality in Kansas City

EPA Science Inventory

Green infrastructure can be a cost-effective approach for reducing stormwater runoff and improving water quality as a result, but it could also bring co-benefits for air quality: less impervious surfaces and more vegetation can decrease the urban heat island effect, and also resu...

Coherent scattering noise reduction method with wavelength diversity detection for holographic data storage system

NASA Astrophysics Data System (ADS)

Nakamura, Yusuke; Hoshizawa, Taku; Takashima, Yuzuru

2017-09-01

A new method, wavelength diversity detection (WDD), for improving signal quality is proposed and its effectiveness is numerically confirmed. We consider that WDD is especially effective for high-capacity systems having low hologram diffraction efficiencies. In such systems, the signal quality is primarily limited by coherent scattering noise; thus, effective improvement of the signal quality under a scattering-limited system is of great interest. WDD utilizes a new degree of freedom, the spectrum width, and scattering by molecules to improve the signal quality of the system. We found that WDD improves the quality by counterbalancing the degradation of the quality due to Bragg mismatch. With WDD, a higher-scattering-coefficient medium can improve the quality. The result provides an interesting insight into the requirements for material characteristics, especially for a large-M/# material. In general, a larger-M/# material contains more molecules; thus, the system is subject to more scattering, which actually improves the quality with WDD. We propose a pathway for a future holographic data storage system (HDSS) using WDD, which can record a larger amount of data than a conventional HDSS.

A Space Commodities Futures Trading Exchange to Grow the Lunar Economy

NASA Astrophysics Data System (ADS)

Cahan, B. B. C.

2017-10-01

This paper proposes to establish a Space Commodities Futures Trading Exchange in order to define and trade essential commodities that, when traded on an open exchange, improve availability, quality, price discovery, financeability, and equal access.

Promoting quality: the health-care organization from a management perspective.

PubMed

Glickman, Seth W; Baggett, Kelvin A; Krubert, Christopher G; Peterson, Eric D; Schulman, Kevin A

2007-12-01

Although agreement about the need for quality improvement in health care is almost universal, the means of achieving effective improvement in overall care is not well understood. Avedis Donabedian developed the structure-process-outcome framework in which to think about quality-improvement efforts. There is now a robust evidence-base in the quality-improvement literature on process and outcomes, but structure has received considerably less attention. The health-care field would benefit from expanding the current interpretation of structure to include broader perspectives on organizational attributes as primary determinants of process change and quality improvement. We highlight and discuss the following key elements of organizational attributes from a management perspective: (i) executive management, including senior leadership and board responsibilities (ii) culture, (iii) organizational design, (iv) incentive structures and (v) information management and technology. We discuss the relevant contributions from the business and medical literature for each element, and provide this framework as a roadmap for future research in an effort to develop the optimal definition of 'structure' for transforming quality-improvement initiatives.

The association of Nursing Home Compare quality measures with market competition and occupancy rates.

PubMed

Castle, Nicholas G; Liu, Darren; Engberg, John

2008-01-01

Since 2002, the Centers for Medicare and Medicaid Services have reported quality measures on the Nursing Home Compare Web site. It has been assumed that nursing homes are able to make improvements on these measures. In this study researchers examined nursing homes to see whether they have improved their quality scores, after accounting for regression to the mean. Researchers also examined whether gains varied according to market competition or market occupancy rates. They identified some regression to the mean for the quality measure scores over time; nevertheless, they also determined that some nursing homes had indeed made small improvements in their quality measure scores. As would be predicted based on the market-driven mechanism underlying quality improvements using report cards, the greatest improvements occurred in the most competitive markets and in those with the Lowest average occupancy rates. As policies to promote more competition in Long-term care proceed, further reducing occupancy rates, further, albeit small, quality gains will likely be made in the future.

Quality Improvement and Evaluation in Child and Family Services: Managing into the Next Century.

ERIC Educational Resources Information Center

Pecora, Peter J., Ed.; Seelig, William R., Ed.; Zirps, Fotena A., Ed.; Davis, Sally M., Ed.

Based on the work of the National Council on Research in Child Welfare (NCRCW), this handbook is designed to help social service agency executives cope with changing times for child welfare agencies, strengthen traditional services to meet today's needs, and analyze and plan for the future. The manual aims to demystify quality improvement theory…

Future riverine nitrogen export to US coastal regions: Prospects for improving water quality considering population growth

EPA Science Inventory

Excess nitrogen (N) in the environment degrades ecosystems and adversely affects human health. Here we examine predictions of contemporary (2000) and future (2030) coastal N loading in the continental US by the Nutrient Export from WaterSheds (NEWS) model. Future output is from s...

Stinging insect allergy: current perspectives on venom immunotherapy

PubMed Central

Ludman, Sian W; Boyle, Robert J

2015-01-01

Systemic allergic reactions to insect stings affect up to 5% of the population during their lifetime, and up to 32% of beekeepers. Such reactions can be fatal, albeit very rarely, and fear of a further systemic reaction (SR) can lead to significant anxiety and quality of life impairment. A recent Cochrane systematic review confirmed that venom immunotherapy (VIT) is an effective treatment for people who have had a systemic allergic reaction to an insect sting. VIT reduces risk of a further SR (relative risk 0.10, 95% confidence interval 0.03–0.28), but VIT also reduces risk of a future large local reaction, and significantly improves disease-specific quality of life. However, health economic analysis showed that VIT is generally not cost effective for preventing future SRs; most people are stung infrequently, most SRs resolve without long-term consequences, and a fatal outcome is extremely rare. VIT only becomes cost effective if one is stung frequently (eg, beekeepers) or if quality of life improvement is considered. Thus, for most people with insect sting allergy, anxiety and quality of life impairment should be the overriding consideration when making treatment decisions, highlighting the importance of a patient-centered approach. Areas which need to be explored in future research include efforts to improve the safety and convenience of VIT such as the use of sublingual immunotherapy; quality of life effects of venom allergy in children and adolescents as well as their parents; and the optimal duration of treatment. PMID:26229493

Emissions versus climate change

EPA Science Inventory

Climate change is likely to offset some of the improvements in air quality expected from reductions in pollutant emissions. A comprehensive analysis of future air quality over North America suggests that, on balance, the air will still be cleaner in coming decades.

49 CFR 266.19 - Environmental impact.

Code of Federal Regulations, 2010 CFR

2010-10-01

... environmental assessment concludes that the future use significantly affects the quality of human environment... improvement assistance—(1) Environmental assessment. (i) When an applicant requests substitute service... shall: (A) Prepare an environmental assessment to determine whether the future use of the property will...

Measuring and improving quality in university hospitals in Canada: The Collaborative for Excellence in Healthcare Quality.

PubMed

Backman, Chantal; Vanderloo, Saskia; Forster, Alan John

2016-09-01

Measuring and monitoring overall health system performance is complex and challenging but is crucial to improving quality of care. Today's health care organizations are increasingly being held accountable to develop and implement actions aimed at improving the quality of care, reducing costs, and achieving better patient-centered care. This paper describes the development of the Collaborative for Excellence in Healthcare Quality (CEHQ), a 5-year initiative to achieve higher quality of patient care in university hospitals across Canada. This bottom-up initiative took place between 2010 and 2015, and was successful in engaging health care leaders in the development of a common framework and set of performance measures for reporting and benchmarking, as well as working on initiatives to improve performance. Despite its successes, future efforts are needed to provide clear national leadership on standards for measuring performance. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Using health technology assessment to identify gaps in evidence and inform study design for comparative effectiveness research.

PubMed

Tunis, Sean R; Turkelson, Charles

2012-12-01

Health technology assessment (HTA) is primarily used as a tool to ensure that clinical and policy decisions are made with the benefit of a systematic analysis of all completed research. This article describes the progress and potential for HTA reports to improve the quality and relevance of future research and to better serve the information needs of patients, clinicians, payers, and other decision makers. We conducted a review of the current published literature and working papers describing past, ongoing, and future initiatives that rely on HTA reports to identify gaps in evidence and improve the design of future research. Although still in a developmental stage, significant progress is under way to improve methods for using HTA reports for the systematic identification of research gaps, prioritization of future research, and improvement of study designs. Several well-defined frameworks have been developed to assist those who produce HTA to become more effective in these additional domains of work. A recurring element of this work is the importance of meaningfully involving stakeholders in the process of defining future research needs and designing studies to address them. Patients, clinicians, and payers are important audiences for completed research and are now recognized as serving an important role in determining what future research is needed. There are substantial opportunities to improve the quality, relevance, and efficiency of clinical research. Recent efforts are beginning to demonstrate the potential to build on the work invested in developing HTA reports to provide a roadmap toward these objectives.

Improving Strategies for Low-Income Family Children's Information Literacy

ERIC Educational Resources Information Center

Zhang, Haiyan; Washington, Rodney; Yin, Jianjun

2014-01-01

This article discussed the significance of improving low-income family children's information literacy, which could improve educational quality, enhance children's self-esteem, adapt children to the future competitive world market, as well as the problems in improving low-income family children's information literacy, such as no home computer and…

Quality Leadership and the Professional School Counselor.

ERIC Educational Resources Information Center

Burgess, David G., Ed; Dedmond, Rebecca M., Ed.

Schools are not what they used to be because our society is not what it used to be. The articles appearing here discuss ways that schools can supply future societal need. The articles include: (1) "The Educational Quality Improvement Process Model" (David G. Burgess); (2) "Total Quality Management: How It Works in Schools"…

Vision for Future North American Emission Inventory Programs

EPA Science Inventory

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

PROMOTING AIR QUALITY THROUGH ENVIRONMENTAL TECHNOLOGY VERIFICATION

EPA Science Inventory

The paper discusses the promotion of improved air quality through environmental technology verifications (ETVs). In 1995, the U.S. EPA's Office of Research and Development began the ETV Program in response to President Clinton's "Bridge to a Sustainable Future" and Vice Presiden...

The future of dentistry: new challenges, new directions.

PubMed Central

Sinkford, J. C.

1990-01-01

The challenge to our profession today is to improve the quality of oral health while overcoming both extrinsic and intrinsic factors which may adversely affect our progress toward this goal. The combined efforts of dental education, dental research, and dental practice will be needed to enable us to maintain the quality of our present system and to meet the myriad changes that will chart our new directions in the future. Our unified efforts can make a difference and, thereby, ensure a meaningful and productive future for dentistry in our country and throughout the world. Let us show the world that the future of dentistry matters to us and that we look to the future with great anticipation and optimism. PMID:2352286

What's in Your Techno-Future? Vendors Share Their Views.

ERIC Educational Resources Information Center

Gerber, Carole

1995-01-01

Examines vendors' views on the future of CD-ROM technology. Topics include the library role, single point access, costs, tape backup, user-friendly library automation systems and databases, improved quality, the growth of Internet access, and perspectives on technology in schools. (AEF)

Total quality management - It works for aerospace information services

NASA Technical Reports Server (NTRS)

Erwin, James; Eberline, Carl; Colquitt, Wanda

1993-01-01

Today we are in the midst of information and 'total quality' revolutions. At the NASA STI Program's Center for AeroSpace Information (CASI), we are focused on using continuous improvements techniques to enrich today's services and products and to ensure that tomorrow's technology supports the TQM-based improvement of future STI program products and services. The Continuous Improvements Program at CASI is the foundation for Total Quality Management in products and services. The focus is customer-driven; its goal, to identify processes and procedures that can be improved and new technologies that can be integrated with the processes to gain efficiencies, provide effectiveness, and promote customer satisfaction. This Program seeks to establish quality through an iterative defect prevention approach that is based on the incorporation of standards and measurements into the processing cycle.

Practice-based learning and improvement: a curriculum in continuous quality improvement for surgery residents.

PubMed

Canal, David F; Torbeck, Laura; Djuricich, Alexander M

2007-05-01

Surgery residents can learn continuous quality improvement (CQI) principles within a structured curriculum and propose quality improvement projects. Curriculum within a surgical residency program. A university surgical residency program with multiple hospital training sites. Fifteen surgical residents during the dedicated research year. A curriculum in CQI that focuses on devising a quality improvement project. Resident self-reported attitudes about quality improvement and implementation of resident-initiated quality improvement projects. Resident survey data demonstrated an improvement in knowledge, self-efficacy, and experiences within CQI. Fifteen individual residents, within smaller teams, created 4 quality improvement projects worthy of implementation. A structured CQI curriculum can be successfully integrated into a general surgery residency program. Residents can learn the skill of constructing CQI project ideas within the framework of the plan-do-study-act cycle. Residents are eager to make improvements in their local system of residency. By giving them the tools to critically investigate systems improvement and a much needed ear to hear their concerns and suggestions for improvement, we found ways to potentially enhance patient care and developed ideas to improve the education of future surgeons. In doing so, we provided the residents with "buy-in" into their residency program, while addressing the competency of practice-based learning and improvement required by the Accreditation Council for Graduate Medical Education for resident education.

Soil agroecosystem health: current challenges and future opportunities

USDA-ARS?s Scientific Manuscript database

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

Defining Quality in Cardiovascular Imaging: A Scientific Statement From the American Heart Association.

PubMed

Shaw, Leslee J; Blankstein, Ron; Jacobs, Jill E; Leipsic, Jonathon A; Kwong, Raymond Y; Taqueti, Viviany R; Beanlands, Rob S B; Mieres, Jennifer H; Flamm, Scott D; Gerber, Thomas C; Spertus, John; Di Carli, Marcelo F

2017-12-01

The aims of the current statement are to refine the definition of quality in cardiovascular imaging and to propose novel methodological approaches to inform the demonstration of quality in imaging in future clinical trials and registries. We propose defining quality in cardiovascular imaging using an analytical framework put forth by the Institute of Medicine whereby quality was defined as testing being safe, effective, patient-centered, timely, equitable, and efficient. The implications of each of these components of quality health care are as essential for cardiovascular imaging as they are for other areas within health care. Our proposed statement may serve as the foundation for integrating these quality indicators into establishing designations of quality laboratory practices and developing standards for value-based payment reform for imaging services. We also include recommendations for future clinical research to fulfill quality aims within cardiovascular imaging, including clinical hypotheses of improving patient outcomes, the importance of health status as an end point, and deferred testing options. Future research should evolve to define novel methods optimized for the role of cardiovascular imaging for detecting disease and guiding treatment and to demonstrate the role of cardiovascular imaging in facilitating healthcare quality. © 2017 American Heart Association, Inc.

Core components of a comprehensive quality assurance program in anatomic pathology.

PubMed

Nakhleh, Raouf E

2009-11-01

In this article the core components of a comprehensive quality assurance and improvement plan are outlined. Quality anatomic pathology work comes with focus on accurate, timely, and complete reports. A commitment to continuous quality improvement and a systems approach with a persistent effort helps to achieve this end. Departments should have a quality assurance and improvement plan that includes a risk assessment of real and potential problems facing the laboratory. The plan should also list the individuals responsible for carrying out the program with adequate resources, a defined timetable, and annual assessment for progress and future directions. Quality assurance monitors should address regulatory requirements and be organized by laboratory division (surgical pathology, cytology, etc) as well as 5 segments (preanalytic, analytic, postanalytic phases of the test cycle, turn-around-time, and customer satisfaction). Quality assurance data can also be used to evaluate individual pathologists using multiple parameters with peer group comparison.

Economic Benefits of Improved Water Quality: Public Perceptions of Option and Preservation Values

NASA Astrophysics Data System (ADS)

Bouwes, Nicolaas W., Sr.

The primary objective of this book is to report the authors‧ research approach to the estimation of benefits of water quality improvements in the South Platte River of northeastern Colorado. Benefits included a “consumer surplus” from enhanced enjoyment of water-based recreation, an “option value” of assured choice of future recreation use, and a “preservation value” of the ecosystem and its bequest to future generations. Concepts such as preservation and option value benefits have been often mentioned but seldom estimated in natural resources research. The authors have met their objective by providing the reader with a detailed description of their research without being tedious.

Introducing quality improvement methods into local public health departments: structured evaluation of a statewide pilot project.

PubMed

Riley, William; Parsons, Helen; McCoy, Kim; Burns, Debra; Anderson, Donna; Lee, Suhna; Sainfort, François

2009-10-01

To test the feasibility and assess the preliminary impact of a unique statewide quality improvement (QI) training program designed for public health departments. One hundred and ninety-five public health employees/managers from 38 local health departments throughout Minnesota were selected to participate in a newly developed QI training program and 65 of those engaged in and completed eight expert-supported QI projects over a period of 10 months from June 2007 through March 2008. As part of the Minnesota Quality Improvement Initiative, a structured distance education QI training program was designed and deployed in a first large-scale pilot. To evaluate the preliminary impact of the program, a mixed-method evaluation design was used based on four dimensions: learner reaction, knowledge, intention to apply, and preliminary outcomes. Subjective ratings of three dimensions of training quality were collected from participants after each of the scheduled learning sessions. Pre- and post-QI project surveys were administered to collect participant reactions, knowledge, future intention to apply learning, and perceived outcomes. Monthly and final QI project reports were collected to further inform success and preliminary outcomes of the projects. The participants reported (1) high levels of satisfaction with the training sessions, (2) increased perception of the relevance of the QI techniques, (3) increased perceived knowledge of all specific QI methods and techniques, (4) increased confidence in applying QI techniques on future projects, (5) increased intention to apply techniques on future QI projects, and (6) high perceived success of, and satisfaction with, the projects. Finally, preliminary outcomes data show moderate to large improvements in quality and/or efficiency for six out of eight projects. QI methods and techniques can be successfully implemented in local public health agencies on a statewide basis using the collaborative model through distance training and expert facilitation. This unique training can improve both core and support processes and lead to favorable staff reactions, increased knowledge, and improved health outcomes. The program can be further improved and deployed and holds great promise to facilitate the successful dissemination of proven QI methods throughout local public health departments.

Rheumatologists' perception of systemic lupus erythematosus quality indicators: significant interest and perceived barriers.

PubMed

Casey, Carolyn; Chung, Cecilia P; Crofford, Leslie J; Barnado, April

2017-01-01

Differences in quality of care may contribute to health disparities in systemic lupus erythematosus (SLE). Studies show low physician adherence rates to the SLE quality indicators but do not assess physician perception of SLE quality indicators or quality improvement. Using a cross-sectional survey of rheumatologists in the southeastern USA, we assessed the perception and involvement of rheumatologists in quality improvement and the SLE quality indicators. Using electronic mail, an online survey of 32 questions was delivered to 568 rheumatologists. With a response rate of 19% (n = 106), the majority of participants were male, Caucasian, with over 20 years of experience, and seeing adult patients in an academic setting. Participants had a positive perception toward quality improvement (81%) with a majority responding that the SLE quality indicators would significantly impact quality of care (54%). While 66% of respondents were familiar with the SLE quality indicators, only 18% of respondents reported using them in everyday practice. The most commonly reported barrier to involvement in quality improvement and the SLE quality indicators was time. Rheumatologists had a positive perception of the SLE quality indicators and agreed that use of the quality indicators could improve quality of care in SLE; however, they identified time as a barrier to implementation. Future studies should investigate methods to increase use of the SLE quality indicators.

A repeated short educational intervention improves asthma control and quality of life.

PubMed

Plaza, Vicente; Peiró, Meritxell; Torrejón, Montserrat; Fletcher, Monica; López-Viña, Antolín; Ignacio, José María; Quintano, José Antonio; Bardagí, Santiago; Gich, Ignasi

2015-11-01

We assessed the effectiveness of an asthma educational programme based on a repeated short intervention (AEP-RSI) to improve asthma control (symptom control and future risk) and quality of life. A total of 230 adults with mild-to-moderate persistent uncontrolled asthma participated in a 1-year cluster randomised controlled multicentre study. The AEP-RSI was given in four face-to-face sessions at 3-month intervals, and included administration of a written personalised action plan and training on inhaler technique. Centres were randomised to the AEP-RSI (intervention) group or usual clinical practice group. Specialised centres using a standard educational programme were the gold standard group. A significant improvement in the Asthma Control Test score was observed in all three groups (p<0.001), but improvements were higher in the intervention and gold standard groups than in the usual clinical practice group (p=0.042), which also showed fewer exacerbations (mean±sd; 1.20±2.02 and 0.56±1.5 versus 2.04±2.72, respectively) and greater increases in the Mini Asthma Quality of Life Questionnaire scores (0.95±1.04 and 0.89±0.84 versus 0.52±0.97, respectively). The AEP-RSI was effective in improving asthma symptom control, future risk and quality of life. Copyright ©ERS 2015.

The quality case for information technology in healthcare

PubMed Central

Bates, David W

2002-01-01

Background As described in the Institute of Medicine's Crossing the Quality Chasm report, the quality of health care in the U.S. today leaves much to be desired. Discussion One major opportunity for improving quality relates to increasing the use of information technology, or IT. Health care organizations currently invest less in IT than in any other information-intensive industry, and not surprisingly current systems are relatively primitive, compared with industries such as banking or aviation. Nonetheless, a number of organizations have demonstrated that quality can be substantially improved in a variety of ways if IT use is increased in ways that improve care. Specifically, computerization of processes that are error-prone and computerized decision support may substantially improve both efficiency and quality, as well as dramatically facilitate quality measurement. This report discusses the current levels of IT and quality in health care, how quality improvement and management are currently done, the evidence that more IT might be helpful, a vision of the future, and the barriers to getting there. Summary This report suggests that there are five key policy domains that need to be addressed: standards, incentives, security and confidentiality, professional involvement, and research, with financial incentives representing the single most important lever. PMID:12396233

Economic and social structure for an ageing population.

PubMed Central

Fogel, R W

1997-01-01

The driving force behind the improvement in the quality of life, the rising standard of living, improving health, and increasing longevity, is a process called 'technophysio evolution', which began about 300 years ago, accelerated during the twentieth century, and is still in progress. Increased spending on health care and on pensions is an appropriate concomitant of technophysio evolution, and should be welcomed. Only wasteful medical services should be restricted. The resources available now and in the future can provide increasingly long and healthy lives of relative luxury for all. However, methods of financing health care and retirement need to be modernized. In the future, luxury will be defined increasingly in terms of spiritual rather than material resources. The test of well-being in the future for both young and old will be measured increasingly in terms of the quality of health and the opportunity for self-realization. PMID:9460076

Valerian for sleep: a systematic review and meta-analysis.

PubMed

Bent, Stephen; Padula, Amy; Moore, Dan; Patterson, Michael; Mehling, Wolf

2006-12-01

Insomnia affects approximately one-third of the adult population and contributes to increased rates of absenteeism, health care use, and social disability. Extracts of the roots of valerian (Valeriana officinalis) are widely used for inducing sleep and improving sleep quality. A systematic review of randomized, placebo-controlled trials of valerian for improving sleep quality is presented. An extensive literature search identified 16 eligible studies examining a total of 1093 patients. Most studies had significant methodologic problems, and the valerian doses, preparations, and length of treatment varied considerably. A dichotomous outcome of sleep quality (improved or not) was reported by 6 studies and showed a statistically significant benefit (relative risk of improved sleep = 1.8, 95% confidence interval, 1.2-2.9), but there was evidence of publication bias in this summary measure. The available evidence suggests that valerian might improve sleep quality without producing side effects. Future studies should assess a range of doses of standardized preparations of valerian and include standard measures of sleep quality and safety.

Valerian for Sleep: A Systematic Review and Meta-Analysis

PubMed Central

Bent, Stephen; Padula, Amy; Moore, Dan; Patterson, Michael; Mehling, Wolf

2014-01-01

Insomnia affects approximately one-third of the adult population and contributes to increased rates of absenteeism, health care use, and social disability. Extracts of the roots of valerian (Valeriana officinalis) are widely used for inducing sleep and improving sleep quality. A systematic review of randomized, placebo-controlled trials of valerian for improving sleep quality is presented. An extensive literature search identified 16 eligible studies examining a total of 1093 patients. Most studies had significant methodologic problems, and the valerian doses, preparations, and length of treatment varied considerably. A dichotomous outcome of sleep quality (improved or not) was reported by 6 studies and showed a statistically significant benefit (relative risk of improved sleep = 1.8, 95% confidence interval, 1.2-2.9), but there was evidence of publication bias in this summary measure. The available evidence suggests that valerian might improve sleep quality without producing side effects. Future studies should assess a range of doses of standardized preparations of valerian and include standard measures of sleep quality and safety. PMID:17145239

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.

Evaluation of quality improvement programmes

PubMed Central

Ovretveit, J; Gustafson, D

2002-01-01



 In response to increasing concerns about quality, many countries are carrying out large scale programmes which include national quality strategies, hospital programmes, and quality accreditation, assessment and review processes. Increasing amounts of resources are being devoted to these interventions, but do they ensure or improve quality of care? There is little research evidence as to their effectiveness or the conditions for maximum effectiveness. Reasons for the lack of evaluation research include the methodological challenges of measuring outcomes and attributing causality to these complex, changing, long term social interventions to organisations or health systems, which themselves are complex and changing. However, methods are available which can be used to evaluate these programmes and which can provide decision makers with research based guidance on how to plan and implement them. This paper describes the research challenges, the methods which can be used, and gives examples and guidance for future research. It emphasises the important contribution which such research can make to improving the effectiveness of these programmes and to developing the science of quality improvement. PMID:12486994

The EuPA Biobank Initiative: Meeting the future challenges of biobanking in proteomics & systems medicine.

PubMed

Wheelock, Åsa M; Paulson, Linda; Litton, Jan-Eric

2015-09-08

In this News & Reviews Discussion, the recently launched EuPA (European Proteomics Association) Biobank Initiative is introduced in the context of current and future challenges in biobanking. The purpose of the initiative is to provide a forumand knowledge platform for integrating the extensive experiences collected by the EuPA community, and link it to the European and international biobanking communities at large. The specific impact of providing a forum and easy access to this type of information to the EuPA community is the potential of improving the quality of future sample collections and biobanks, the quality of the research produced from these sample collections, as well as the output and productivity from existing biobanks. The underutilization of biobanks has recently been identified as an emerging issue of biobankingworldwide. Measures to improve our ability to locate and access appropriate sample collections for a wide range of research purposes may enhance both the scientific quality and biobank sustainability, thereby contributing to the important task of moving our research beyond basic findings and mere publications, into clinical practice. This manuscript is intended as a Discussion piece, and represents a recollection of the presentation under the “EuPA Initiative” session at HUPO/EuPA 2014 in Madrid. The launch of the EuPA (European Proteomics Association) Biobank Initiative in the context of current and future challenges in biobanking is discussed. The purpose of the initiative is to provide a forum and knowledge base for integrating the extensive experiences collected by the EuPA community, and link it to the European and international biobanking communities at large. The specific impact of providing a forumand easy access to this type of information to the EuPA community is the potential of improving the quality of future sample collections and biobanks, the quality of the research produced from these sample collections, aswell as the output and productivity fromexisting biobanks. The underutilization of biobanks has recently been identified as a challenge to the well-being and economic sustainability of biobanking worldwide. Measures to improve our ability to localize and access appropriate sample collections for validation studies and other research purposes is thus of benefit bothto scientific quality and biobank sustainability, thereby contributing to the important task of moving our research beyond basic findings and mere publications, into clinical practice. This article is part of a Special Issue entitled: HUPO 2014.

Quality, risk management and governance in mental health: an overview.

PubMed

Callaly, Tom; Arya, Dinesh; Minas, Harry

2005-03-01

To consider the origin, current emphasis and relevance of the concepts of quality, risk management and clinical governance in mental health. Increasingly, health service boards and management teams are required to give attention to clinical governance rather than corporate governance alone. Clinical governance is a unifying quality concept that aims to produce a structure and systems to assure and improve the quality of clinical services by promoting an integrated and organization-wide approach towards continuous quality improvement. Many psychiatrists will find the reduction in clinical autonomy, the need to consider the welfare of the whole population as well as the individual patient for whom they are responsible, and the requirement that they play a part in a complex systems approach to quality improvement to be a challenge. Avoiding or ignoring this challenge will potentially lead to conflict with modern management approaches and increased loss of influence on future developments in mental health services.

UCS-PROMOVE: The Engineer of the Future

ERIC Educational Resources Information Center

Villas-Boas, V.

2010-01-01

The Universidade de Caxias do Sul (UCS) elaborated the cooperative project called "The engineer of the future", with the objective of promoting science and engineering among high school teachers and students. This project aims to improve the quality of the teaching and to increase the interest of students in technological areas, leading…

Technologies of the Future.

ERIC Educational Resources Information Center

Lipson, Joseph I.; Fisher, Kathleen M.

1985-01-01

In the future, the requirements of industry will generate a wide range of hardware devices and software programs that will significantly alter and improve the quality of education. The driving forces behind the development of new technological devices include economics; emotional factors, e.g., the desire to develop aids for the handicapped;…

Implementing the patient circle. Call on patients to help improve perceptions of health care quality.

PubMed

Ostasiewski, P; Fugate, D L

1994-01-01

Adapting the quality-circle concept to a health care setting helped one hospital solve a problem and boosted its image among patients. The "patient circle" technique is one step health care providers can take toward delivering "total customer value," a quality perception that can mean the difference between surviving and thriving in the future.

Driving photomask supplier quality through automation

NASA Astrophysics Data System (ADS)

Russell, Drew; Espenscheid, Andrew

2007-10-01

In 2005, Freescale Semiconductor's newly centralized mask data prep organization (MSO) initiated a project to develop an automated global quality validation system for photomasks delivered to Freescale Semiconductor fabs. The system handles Certificate of Conformance (CofC) quality metric collection, validation, reporting and an alert system for all photomasks shipped to Freescale fabs from all qualified global suppliers. The completed system automatically collects 30+ quality metrics for each photomask shipped. Other quality metrics are generated from the collected data and quality metric conformance is automatically validated to specifications or control limits with failure alerts emailed to fab photomask and mask data prep engineering. A quality data warehouse stores the data for future analysis, which is performed quarterly. The improved access to data provided by the system has improved Freescale engineers' ability to spot trends and opportunities for improvement with our suppliers' processes. This paper will review each phase of the project, current system capabilities and quality system benefits for both our photomask suppliers and Freescale.

Preparing Future Leaders: An Integrated Quality Improvement Residency Curriculum.

PubMed

Potts, Stacy; Shields, Sara; Upshur, Carole

2016-06-01

The Accreditation Council for Graduate Medical Education (ACGME) has recognized the importance of quality improvement (QI) training and requires that accredited residencies in all specialties demonstrate that residents are "integrated and actively participate in interdisciplinary clinical quality improvement and patient safety activities." However, competing demands in residency training may make this difficult to accomplish. The study's objective is to develop and evaluate a longitudinal curriculum that meets the ACGME requirement for QI and patient safety training and links to patient-centered medical home (PCMH) practices. Residents in the Worcester Family Medicine Residency (WFMR) participated in a faculty-developed quality improvement curriculum that included web-based tutorials, quality improvement projects, and small-group sessions across all 3 years of residency. They completed self-evaluations of knowledge and use of curricular activities annually and at graduation, and comparisons were made between two graduating classes, as well as comparison of end of PGY2 to end of PGY3 for one class. Graduating residents who completed the full 3 years of the curriculum rated themselves as significantly more skilled in nine of 15 areas assessed at end of residency compared to after PGY2 and reported confidence in providing future leadership in a focus group. Five areas were also rated significantly higher than prior-year residents. Involving family medicine residents in a longitudinal curriculum with hands-on practice in implementing QI, patient safety, and chronic illness management activities that are inclusive of PCMH goals increased their self-perceived skills and leadership ability to implement these new and emerging evidence-based practices in primary care.

Data Quality Assurance for Supersonic Jet Noise Measurements

NASA Technical Reports Server (NTRS)

Brown, Clifford A.; Henderson, Brenda S.; Bridges, James E.

2010-01-01

The noise created by a supersonic aircraft is a primary concern in the design of future high-speed planes. The jet noise reduction technologies required on these aircraft will be developed using scale-models mounted to experimental jet rigs designed to simulate the exhaust gases from a full-scale jet engine. The jet noise data collected in these experiments must accurately predict the noise levels produced by the full-scale hardware in order to be a useful development tool. A methodology has been adopted at the NASA Glenn Research Center s Aero-Acoustic Propulsion Laboratory to insure the quality of the supersonic jet noise data acquired from the facility s High Flow Jet Exit Rig so that it can be used to develop future nozzle technologies that reduce supersonic jet noise. The methodology relies on mitigating extraneous noise sources, examining the impact of measurement location on the acoustic results, and investigating the facility independence of the measurements. The methodology is documented here as a basis for validating future improvements and its limitations are noted so that they do not affect the data analysis. Maintaining a high quality jet noise laboratory is an ongoing process. By carefully examining the data produced and continually following this methodology, data quality can be maintained and improved over time.

The importance of improving the quality of emergency surgery for a regional quality collaborative.

PubMed

Smith, Margaret; Hussain, Adnan; Xiao, Jane; Scheidler, William; Reddy, Haritha; Olugbade, Kola; Cummings, Dustin; Terjimanian, Michael; Krapohl, Greta; Waits, Seth A; Campbell, Darrell; Englesbe, Michael J

2013-04-01

Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan. We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance]. Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a wide variation in compliance with SCIP-1 and SCIP-2 measures and overall compliance (42.0%) was markedly lower than that for elective colon surgery (81.7%). Emergency surgical procedures are an important target for future quality improvement efforts within Michigan. Future work will identify best practices within high-performing hospitals and disseminate these practices within the collaborative.

A PRELIMINARY EVALUATION OF MODELS-3 CMAQ USING PARTICULATE MATTER DATA FROM THE IMPROVE NETWORK

EPA Science Inventory

The Clean Air Act and its Amendments require the United States Environmental Protection Agency (EPA) to establish National Ambient Air Quality Standards for Particulate Matter (PM) and to assess current and future air quality regulations designed to protect human health and wel...

The Importance of Exposure in Addressing Current and Emerging Air Quality Issues

EPA Science Inventory

The air quality issues that we face today and will face in the future are becoming increasingly more complex and require an improved understanding of human exposure to be effectively addressed. The objectives of this paper are (1) to discuss how concepts of human exposure and ex...

Quality Indicators for California Community College Job Placement Programs.

ERIC Educational Resources Information Center

Mount San Antonio Community Coll. District, Walnut, CA.

Designed to help California community colleges in assessing their job placement services, identifying strengths and needs for improvement, and establishing priorities for the future, this color-coded guide lists specific tasks and responsibilities within the four essential functional areas of job placement programs and includes quality indicators…

The Future of Higher Education in Nigeria: Global Challenges and Opportunities

ERIC Educational Resources Information Center

Oni, Adesoji A.; Alade, Ibiwumi A.

2008-01-01

Among the numerous components of development of higher education are; growth in quantity, quality, relevance and diversity of curriculum [programme and courses]; widening of access and broadening of equity, innovation in teaching methods and techniques; improvement in the quantity and quality of research activities; more and better community…

Quality in-training initiative--a solution to the need for education in quality improvement: results from a survey of program directors.

PubMed

Kelz, Rachel R; Sellers, Morgan M; Reinke, Caroline E; Medbery, Rachel L; Morris, Jon; Ko, Clifford

2013-12-01

The Next Accreditation System and the Clinical Learning Environment Review Program will emphasize practice-based learning and improvement and systems-based practice. We present the results of a survey of general surgery program directors to characterize the current state of quality improvement in graduate surgical education and introduce the Quality In-Training Initiative (QITI). In 2012, a 20-item survey was distributed to 118 surgical residency program directors from ACS NSQIP-affiliated hospitals. The survey content was developed in collaboration with the QITI to identify program director opinions regarding education in practice-based learning and improvement and systems-based practice, to investigate the status of quality improvement education in their respective programs, and to quantify the extent of resident participation in quality improvement. There was a 57% response rate. Eighty-five percent of program directors (n = 57) reported that education in quality improvement is essential to future professional work in the field of surgery. Only 28% (n = 18) of programs reported that at least 50% of their residents track and analyze their patient outcomes, compare them with norms/benchmarks/published standards, and identify opportunities to make practice improvements. Program directors recognize the importance of quality improvement efforts in surgical practice. Subpar participation in basic practice-based learning and improvement activities at the resident level reflects the need for support of these educational goals. The QITI will facilitate programmatic compliance with goals for quality improvement education. Copyright © 2013 American College of Surgeons. All rights reserved.

Building a quality culture in the Office of Space Flight: Approach, lessons learned and implications for the future

NASA Astrophysics Data System (ADS)

Roberts, C. Shannon

The purpose of this paper is to describe the approach and lessons learned by the Office of Space Flight (OSF), National Aeronautics and Space Administration (NASA), in its introduction of quality. In particular, the experience of OSF Headquarters is discussed as an example of an organization within NASA that is considering both the business and human elements of the change and the opportunities the quality focus presents to improve continuously. It is hoped that the insights shared will be of use to those embarking upon similar cultural changes. The paper is presented in the following parts: the leadership challenge; background; context of the approach to quality; initial steps; current initiatives; lessons learned; and implications for the future.

Building a quality culture in the Office of Space Flight: Approach, lessons learned and implications for the future

NASA Technical Reports Server (NTRS)

Roberts, C. Shannon

1992-01-01

The purpose of this paper is to describe the approach and lessons learned by the Office of Space Flight (OSF), National Aeronautics and Space Administration (NASA), in its introduction of quality. In particular, the experience of OSF Headquarters is discussed as an example of an organization within NASA that is considering both the business and human elements of the change and the opportunities the quality focus presents to improve continuously. It is hoped that the insights shared will be of use to those embarking upon similar cultural changes. The paper is presented in the following parts: the leadership challenge; background; context of the approach to quality; initial steps; current initiatives; lessons learned; and implications for the future.

Global quality imaging: improvement actions.

PubMed

Lau, Lawrence S; Pérez, Maria R; Applegate, Kimberly E; Rehani, Madan M; Ringertz, Hans G; George, Robert

2011-05-01

Workforce shortage, workload increase, workplace changes, and budget challenges are emerging issues around the world, which could place quality imaging at risk. It is important for imaging stakeholders to collaborate, ensure patient safety, improve the quality of care, and address these issues. There is no single panacea. A range of improvement measures, strategies, and actions are required. Examples of improvement actions supporting the 3 quality measures are described under 5 strategies: conducting research, promoting awareness, providing education and training, strengthening infrastructure, and implementing policies. The challenge is to develop long-term, cost-effective, system-based improvement actions that will bring better outcomes and underpin a sustainable future for quality imaging. In an imaging practice, these actions will result in selecting the right procedure (justification), using the right dose (optimization), and preventing errors along the patient journey. To realize this vision and implement these improvement actions, a range of expertise and adequate resources are required. Stakeholders should collaborate and work together. In today's globalized environment, collaboration is strength and provides synergy to achieve better outcomes and greater success. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Assessment of the Air Quality Improvement Potentials for Seoul Metropolitan Area using GAINS-Korea

NASA Astrophysics Data System (ADS)

Kim, Y.; Woo, J. H.; Ahn, Y. H.; Kim, J.; Bu, C.; Lee, Y.; Choi, K. C.; Amann, M.; Kim, S. K.

2016-12-01

Urban areas are very important places for climate change and air pollution because they have been emitting a significant amount of Green House Gases (GHGs) and air pollutants. Cause they have massive pollutant emissions and high population density with amount of vehicles. Korea's government has set the 2nd phase capital air quality improvement program called Seoul metropolitan area Air Quality Management Plan(SAQMP), targeting the year 2024. The air quality improvement targets are to achieve annual mean PM10 and pm2.5concentration for SMA Area 30 ug/m3 and 20 ug/m3, respectively. To achieve this target, emissions of PM10, PM2.5 are required to be decreased up to 35%, 45%, respectively, from their future baseline level. In this study, we found the emission level of some pollutants for the year 2030 will be decreased compare with the baseline level but the concentration cannot meet their target even with more stringent control measures. The more in-depth analysis of future PM concentration, estimated from Source-Receptor(S-R) relationship, were conducted for more accurate air quality improvement assessment. As the result, we found that secondary and transboundary pollution have been plying significant role in Seoul Metro air quality. Not only direct/in-region measures, therefore, but indirect measures/international cooperation have to be conducted to achieve target air quality. ** This subject is supported by Korea Ministry of Environment as "Climate Change Correspondence Program". This work was supported by a grant from the National Institute of Environment Research (NIER), funded by the Ministry of Environment (MOE) of the Republic of Korea.

Strategic planning as a focus for continuous improvement. A case study

NASA Technical Reports Server (NTRS)

Oneill, John W.; Gordon-Winkler, Lyn

1992-01-01

What do most of the successful people and organizations in our world have in common? Instead of worrying about the future, they work to create it. They have a plan, or a vision of what they want to accomplish and they focus their efforts on success. Strategic planning has been described as a disciplined, ongoing process to produce fundamental decisions and actions that shape what an organization is, what it does, and how it will respond to a changing environment. This case study discussion will evaluate the relationship between strategic planning and Total Quality Management (TQM), or continuous improvement, through the experience of the NASA Johnson Space Center in developing a strategy for the future. That experience clearly illustrates the value of strategic planning in setting the framework and establishing the overall thrust of continuous improvement initiatives. Equally significant, the fundamentals of a quality culture such as strong customer and supplier partnerships, participative involvement, open communications, and ownership were essential in overcoming the challenges inherent in the planning process. A reinforced management commitment to the quality culture was a clear, long-term benefit.

Strategic planning as a focus for continuous improvement. A case study

NASA Astrophysics Data System (ADS)

Oneill, John W.; Gordon-Winkler, Lyn

What do most of the successful people and organizations in our world have in common? Instead of worrying about the future, they work to create it. They have a plan, or a vision of what they want to accomplish and they focus their efforts on success. Strategic planning has been described as a disciplined, ongoing process to produce fundamental decisions and actions that shape what an organization is, what it does, and how it will respond to a changing environment. This case study discussion will evaluate the relationship between strategic planning and Total Quality Management (TQM), or continuous improvement, through the experience of the NASA Johnson Space Center in developing a strategy for the future. That experience clearly illustrates the value of strategic planning in setting the framework and establishing the overall thrust of continuous improvement initiatives. Equally significant, the fundamentals of a quality culture such as strong customer and supplier partnerships, participative involvement, open communications, and ownership were essential in overcoming the challenges inherent in the planning process. A reinforced management commitment to the quality culture was a clear, long-term benefit.

Tracking and sustaining improvement initiatives: leveraging quality dashboards to lead change in a neurosurgical department.

PubMed

McLaughlin, Nancy; Afsar-Manesh, Nasim; Ragland, Victoria; Buxey, Farzad; Martin, Neil A

2014-03-01

Increasingly, hospitals and physicians are becoming acquainted with business intelligence strategies and tools to improve quality of care. In 2007, the University of California Los Angeles (UCLA) Department of Neurosurgery created a quality dashboard to help manage process measures and outcomes and ultimately to enhance clinical performance and patient care. At that time, the dashboard was in a platform that required data to be entered manually. It was then reviewed monthly to allow the department to make informed decisions. In 2009, the department leadership worked with the UCLA Medical Center to align mutual quality-improvement priorities. The content of the dashboard was redesigned to include 3 areas of priorities: quality and safety, patient satisfaction, and efficiency and use. Throughout time, the neurosurgery quality dashboard has been recognized for its clarity and its success in helping management direct improvement strategies and monitor impact. We describe the creation and design of the neurosurgery quality dashboard at UCLA, summarize the evolution of its assembly process, and illustrate how it can be used as a powerful tool of improvement and change. The potential challenges and future directions of this business intelligence tool are also discussed.

Improving quality and value of future hardwoods

Treesearch

Larry R. Frye

1989-01-01

The central hardwood area is highly regarded both in this country and abroad for the high quality timber grown on both public and private lands. Buyers of standing timber and logs for lumber and veneer often look to this region first to meet their needs for raw materials. And these buyers have traditionally paid a lot more for quality timber than the usual market price...

NASA total quality management 1990 accomplishments report

NASA Technical Reports Server (NTRS)

1991-01-01

NASA's efforts in Total Quality Management are based on continuous improvement and serve as a foundation for NASA's present and future endeavors. Given here are numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. These accomplishment benefit our Agency and help to achieve our primary goal, keeping American in the forefront of the aerospace industry.

Smart information system for gachon university gil hospital.

PubMed

Park, Dong Kyun; Jung, Eun Young; Jeong, Byung Hui; Moon, Byung Chan; Kang, Hyung Wook; Tchah, Hann; Han, Gi Seong; Cheng, Woo Sung; Lee, Young Ho

2012-03-01

In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future.

Smart Information System for Gachon University Gil Hospital

PubMed Central

Jung, Eun Young; Jeong, Byung Hui; Moon, Byung Chan; Kang, Hyung Wook; Tchah, Hann; Han, Gi Seong; Cheng, Woo Sung; Lee, Young Ho

2012-01-01

Objectives In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. Methods This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. Results The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. Conclusions Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future. PMID:22509476

Pedagogical Strategies for Training Future Technicians in American Aviation Schools

ERIC Educational Resources Information Center

Pazyura, Natalia

2015-01-01

The article is devoted to the question of improvement of quality and efficiency of professional training of future technicians in aviation industry in the American educational establishments. Main attention is paid to the studies of pedagogical technologies, which are used for the sake of qualitative and efficient training of specialists of…

The Process of Pedagogical Culture Formation in the Future Social Worker

ERIC Educational Resources Information Center

Minzhanov, Nurlan A.; Ertysbaeva, Gaukhar N.

2016-01-01

The paper is aimed at studying the features of pedagogical culture formation in future social workers and developing methods to improve the professional and pedagogical preparation quality of students in the "Social work" specialty. In the study, a survey of students in the "Social work" specialty (n = 400), and a standardized…

Some Peculiarities in Training Future Masters in Technology Education in European Countries

ERIC Educational Resources Information Center

Samborska, Olena

2017-01-01

In the article, the importance of studying foreign experience in order to improve quality of future Masters' training in higher education institutions has been justified. The main peculiarities of training Masters in Technology education in European countries, namely, in Germany, Sweden and France have been outlined. It has been revealed that…

Resources for the Future. Annual Report 1970.

ERIC Educational Resources Information Center

Resources for the Future, Inc., Washington, DC.

Presented is the Annual Report for Resources For The Future, Inc. (RFF) for the year ending September 30, 1970. This organization is dedicated to advancing the development, conservation, and use of natural resources and the improvement of the quality of the environment through programs of research and education. Most of their studies are in the…

Future developments in health care performance management

PubMed Central

Crema, Maria; Verbano, Chiara

2013-01-01

This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to health care, such as lean management and risk management, can contribute to improving quality performance. Therefore, the opportunity to analyze them arises from studying their overlaps and links in order to identify possible synergies and to investigate the opportunity to develop an integrated methodology enabling improved performance. PMID:24255600

Education in Quality Improvement for Pediatric Practice: an online program to teach clinicians QI.

PubMed

Bundy, David G; Morawski, Lori F; Lazorick, Suzanne; Bradbury, Scott; Kamachi, Karen; Suresh, Gautham K

2014-01-01

Education in Quality Improvement for Pediatric Practice (EQIPP) is an online program designed to improve evidence-based care delivery by teaching front-line clinicians quality improvement (QI) skills. Our objective was to evaluate EQIPP data to characterize 1) participant enrollment, use patterns, and demographics; 2) changes in performance in clinical QI measures from baseline to follow-up measurement; and 3) participant experience. We conducted an observational study of EQIPP participants utilizing 1 of 3 modules (asthma, immunizations, gastroesophageal reflux disease) from 2009 to 2013. Enrollment and use, demographic, and quality measure data were extracted directly from the EQIPP system; participant experience was assessed via an optional online survey. Study participants (n = 3501) were diverse in their gender, age, and race; most were board certified. Significant quality gaps were observed across many of the quality measures at baseline; sizable improvements were observed across most quality measures at follow-up. Participants were generally satisfied with their experience. The most influential module elements were collecting and analyzing data, creating and implementing aim statements and improvement plans, and completing "QI Basics." Online educational programs, such as EQIPP, hold promise for front-line clinicians to learn QI. The sustainability of the observed improvements in care processes and their linkage to improvements in health outcomes are unknown and are an essential topic for future study. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

[High-quality nursing health care environment: the patient safety perspective].

PubMed

Tu, Yu-Ching; Wang, Ruey-Hsia

2011-06-01

Patient safety is regarded as an important indicator of nursing care quality, and nurses hold frontline responsibility to maintain patient safety. Many countries now face healthcare provider shortfalls, and recognize a close correlation between adequate manpower and patient safety. Many healthcare organizations work to foster positive work environments in order to improve health service quality. The active participation and "buy in" of nurses, patients and policymakers are critical to maximize healthcare environment quality and improve patient safety. This article adopts Donabedian's theoretical "Structure-Process-Outcome" model of quality (Donabedian, 1988) and presumes all high-quality healthcare environment indicators to be linked to patient safety. In addition to raising public awareness regarding the influence of healthcare environment quality on patient safety, this research suggests certain indicators for tracking and assessing healthcare environment quality. Future research may design an empirical study based on these indicators to help further enhance healthcare environment quality and the professional development of nurses.

Development of Future Scenario Emission Inventories for East Asia in Support of Multiple Modeling Studies

NASA Astrophysics Data System (ADS)

Kim, Y.; Woo, J. H.; Choi, K. C.; Lee, J. B.; Song, C. K.; Kim, S. K.; Hong, J.; Hong, S. C.; Zhang, Q.; Hong, C.; Tong, D.

2015-12-01

Future emission scenarios based on up-to-date regional socio-economic and control policy information were developed in support of climate-air quality integrated modeling research over East Asia. Two IPCC-participated Integrated Assessment Models(IAMs) were used to developed those scenario pathways. The two emission processing systems, KU-EPS and SMOKE-Asia, were used to convert these future scenario emissions to comprehensive chemical transport model-ready form. The NIER/KU-CREATE (Comprehensive Regional Emissions inventory for Atmospheric Transport Experiment) served as the regional base-year emission inventory. For anthropogenic emissions, it has 54 fuel classes, 201 sub-sectors and 13 pollutants, including CO2, CH4, N2O, SO2, NOx, CO, NMVOC, NH3, OC, BC, PM10, PM2.5, and mercury. Fast energy growth and aggressive penetration of the control measures make emissions projection very active for East Asia. Despite of more stringent air pollution control policies by the governments, however, air quality over the region seems not been improved as much - even worse in many cases. The needs of more scientific understanding of inter-relationship among emissions, transport, chemistry over the region are very high to effectively protect public health and ecosystems against ozone, fine particles, and other toxic pollutants in the air. After developing these long-term future emissions, therefore, we also tried to apply our future scenarios to develop the present emissions inventory for chemical weather forecasting and aircraft field campaign. On site, we will present; 1) the future scenario development framework and process methodologies, 2) initial development results of the future emission pathways, 3) present emission inventories from short-term projection, and 4) air quality modeling performance improvements over the region.

Boosting Quality Registries with Clinical Decision Support Functionality*. User Acceptance of a Prototype Applied to HIV/TB Drug Therapy.

PubMed

Wannheden, Carolina; Hvitfeldt-Forsberg, Helena; Eftimovska, Elena; Westling, Katarina; Ellenius, Johan

2017-08-11

The care of HIV-related tuberculosis (HIV/TB) is complex and challenging. Clinical decision support (CDS) systems can contribute to improve quality of care, but more knowledge is needed on factors determining user acceptance of CDS. To analyze physicians' and nurses' acceptance of a CDS prototype for evidence-based drug therapy recommendations for HIV/TB treatment. Physicians and nurses were involved in designing a CDS prototype intended for future integration with the Swedish national HIV quality registry. Focus group evaluation was performed with ten nurses and four physicians, respectively. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used to analyze acceptance. We identified several potential benefits with the CDS prototype as well as some concerns that could be addressed by redesign. There was also concern about dependence on physician attitudes, as well as technical, organizational, and legal issues. Acceptance evaluation at a prototype stage provided rich data to improve the future design of a CDS prototype. Apart from design and development efforts, substantial organizational efforts are needed to enable the implementation and maintenance of a future CDS system.

The High Cost of Low Educational Performance: The Long-Run Economic Impact of Improving PISA Outcomes

ERIC Educational Resources Information Center

Hanushek, Eric A.; Woessmann, Ludger

2010-01-01

While many nations express a commitment to improved educational quality, education often slips down on the policy agenda. Because the benefits of educational investments are seen only in the future, it is possible to underestimate the value and the importance of improvements. This report uses recent economic modelling to relate cognitive…

Improvements to the Noah Land Surface Model in WRF-CMAQ, and its Application to Future Changes in the Chesapeake Bay Region

EPA Science Inventory

Regional, state, and local environmental regulatory agencies often use Eulerian meteorological and air quality models to investigate the potential impacts of climate, emissions, and land use changes on nutrient loading and air quality. The Noah land surface model in WRF could be...

The Quality of Work: A People-Centred Agenda.

ERIC Educational Resources Information Center

Lowe, Graham S.

This book examines trends and problems in Canadian workplaces and advocates a people-centered agenda for improving the quality of working life. Chapters 1-9 discuss the following topics: the future of work; the crisis in work; what Canadians want from work; the "new economy"; education, skills, and the knowledge economy; youth and work;…

State of the District Address, 1982.

ERIC Educational Resources Information Center

Koltai, Leslie

This address by the Chancellor of the Los Angeles Community College District (LACCD) discusses recent and long-term changes in the district's programs, educational quality, and financial standing, and suggests means for future improvements. First, the paper highlights the district's achievements in improving transfer education and developing new…

Monitoring the delivery of cancer care: Commission on Cancer and National Cancer Data Base.

PubMed

Williams, Richelle T; Stewart, Andrew K; Winchester, David P

2012-07-01

The primary objective of the Commission on Cancer (CoC) is to ensure the delivery of comprehensive, high-quality care that improves survival while maintaining quality of life for patients with cancer. This article examines the initiatives of the CoC toward achieving this goal, utilizing data from the National Cancer Data Base (NCDB) to monitor treatment patterns and outcomes, to develop quality measures, and to benchmark hospital performance. The article also highlights how these initiatives align with the Institute of Medicine's recommendations for improving the quality of cancer care and briefly explores future projects of the CoC and NCDB. Copyright © 2012 Elsevier Inc. All rights reserved.

A systematic review of Human Factors and Ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety

PubMed Central

Xie, Anping; Carayon, Pascale

2014-01-01

Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how Human Factors and Ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified twelve projects representing 23 studies and addressing different physical, cognitive and organizational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care. Practitioner Summary Existing evidence shows that HFE-based healthcare system redesign has the potential to improve quality of care and patient safety. Healthcare organizations need to recognize the importance of HFE-based healthcare system redesign to quality of care and patient safety, and invest resources to integrate HFE in healthcare improvement activities. PMID:25323570

Exploring the Potential for Sustainable Future Bioenergy Production in the Arkansas-White-Red River Basin

NASA Astrophysics Data System (ADS)

Baskaran, L.; Jager, H.; Kreig, J.

2016-12-01

Bioenergy production in the US has been projected to increase in the next few years and this has raised concerns over environmentally sustainable production. Specifically, there are concerns that managing lands to produce bioenergy feedstocks in the Mississippi-Atchafalaya River Basin (MARB) may have impacts over the water quality in the streams draining these lands and hamper with efforts to reduce the size of the Gulf of Mexico's "Dead Zone" (hypoxic waters). However, with appropriate choice of feedstocks and good conservation practices, bioenergy production systems can be environmentally and economically sustainable. We evaluated opportunities for producing 2nd generation cellulosic feedstocks that are economically sustainable and improve water quality in the Arkansas-White-Red (AWR) river basin, which is major part of the MARB. We generated a future bioenergy landscape by downscaling county-scale projections of bioenergy crop production produced by an economic model, POLYSYS, at a market price of $60 per dry ton and a 1% annual yield increase. Our future bioenergy landscape includes perennial grasses (switchgrass and miscanthus), short-rotated woody crops (poplar and willow) and annual crops (high yield sorghum, sorghum stubble, corn stover and wheat straw). Using the Soil and Water Assessment Tool (SWAT) we analyzed changes in water quality and quantity by simulating a baseline scenario with the current landscape (2014 land cover) and a future scenario with the bioenergy landscape. Our results over the AWR indicate decreases in median nutrient and sediment loadings from the baseline scenario. We also explored methods to evaluate if conservation practices (such as reducing fertilizer applications, incorporating filter strips, planting cover crops and moving to a no-till system) can improve water quality, while maintaining biomass yield. We created a series of SWAT simulations with varying levels of conservation practices by crop and present our methods towards identifying future scenarios that may minimize water quality and maximize biomass yields.

Changes in Rice Grain Quality of Indica and Japonica Type Varieties Released in China from 2000 to 2014.

PubMed

Feng, Fan; Li, Yajun; Qin, Xiaoliang; Liao, Yuncheng; Siddique, Kadambot H M

2017-01-01

China is the first country to use heterosis successfully for commercial rice production. This study compared the main quality characteristics (head rice rate, chalky rice rate, chalkiness degree, gel consistency, amylose content, and length-to-width ratio) of 635 rice varieties (not including upland and glutinous rice) released from 2000 to 2014 to establish the quality status and offer suggestions for future rice breeding for grain quality in China. In the past 15 years, grain quality in japonica rice and indica hybrid rice has improved. In japonica rice, inbred varieties have increased head rice rates and decreased chalkiness degree over time, while hybrid rice varieties have decreased chalky rice rates and chalkiness degree. In indica hybrid rice, the chalkiness degree and amylose contents have decreased and gel consistency has increased. Improvements in grain quality in indica inbred rice have been limited, with some increases in head rice rate and decreases in chalky rice rate and amylose content. From 2010 to 2014, the percentage of indica varieties meeting the Grade III national standard of rice quality for different quality traits was low, especially for chalky rice rate and chalkiness degree. Japonica varieties have more superior grain quality than indica rice in terms of higher head rice rates and gel consistency, lower chalky rice rates and chalkiness degree, and lower amylose contents, which may explain why the Chinese prefer japonica rice. The japonica rice varieties, both hybrid and inbred, had similar grain qualities, but this varied in indica rice with the hybrid varieties having higher grain quality than inbred varieties due to significantly better head rice rates and lower chalkiness degree. For better quality rice in future, the chalky rice rate and chalkiness degree should be improved in japonica rice along with most of the quality traits in indica rice.

Improving the Yield and Nutritional Quality of Forage Crops

PubMed Central

Capstaff, Nicola M.; Miller, Anthony J.

2018-01-01

Despite being some of the most important crops globally, there has been limited research on forages when compared with cereals, fruits, and vegetables. This review summarizes the literature highlighting the significance of forage crops, the current improvements and some of future directions for improving yield and nutritional quality. We make the point that the knowledge obtained from model plant and grain crops can be applied to forage crops. The timely development of genomics and bioinformatics together with genome editing techniques offer great scope to improve forage crops. Given the social, environmental and economic importance of forage across the globe and especially in poorer countries, this opportunity has enormous potential to improve food security and political stability. PMID:29740468

Using scientific evidence to improve information practice.

PubMed

Bradley, J; Marshall, J G

1995-09-01

The recent policy statement of the Medical Library Association (MLA) takes the position that scientific evidence is the basis for improving the quality of library and information sciences now and in the future. Research activity is seen as the foundation of an evolving knowledge base for the profession--a knowledge base that will set health sciences librarians apart from others in an increasingly competitive world of information service providers. The statement represents the culmination of many years of activity by association members, during which the role of research in health information practice has been debated. Over a similar time period, the quality movement, with its increasing demand for the collection and use of data, has been growing. Developments such as total quality management (TQM) and continuous quality improvement (CQI) reinforce the centrality of research with its increasing demand for the collection and use of data, has been growing. Developments such as total quality management (TQM) and continuous quality improvement (CQI) reinforce the centrality of research and its relationship to efficient and effective information practice as envisioned in the MLA policy statement.

Monitoring quality of care at dialysis facilities: a case for regulatory parsimony--and beyond.

PubMed

Stivelman, John C

2012-10-01

With the issuance of the new Conditions for Coverage in 2008 and the implementation of the Prospective Payment System in 2011, the Centers for Medicare & Medicaid Services has fundamentally altered the regulatory landscape of quality in the ESRD program. Although these changes-largely through use of tools comparing individual facility performance to regional and national quality expectations-have increased facility accountability for the quality of patient care in many quarters, they have also complicated both substance and process of facility adherence to quality rules in that component of the program. This editorial critically assesses the main quality tools now in use for dialysis facilities and reviews the issues arising from their conjoint use. A scheme for improving the effectiveness of each quality tool is proposed, and an assessment of their future value and effectiveness in quality improvement is offered.

Ambient Assisted Living and ageing: preliminary results of RITA project.

PubMed

Aquilano, Michela; Cavallo, Filippo; Bonaccorsi, Manuele; Esposito, Raffaele; Rovini, Erika; Filippi, Massimo; Esposito, Dario; Dario, Paolo; Carrozza, Maria Chiara

2012-01-01

The ageing of population is a social phenomenon that most of worldwide countries are facing. They are, and will be even more in the future, indeed trying to find solutions for improving quality of life of their elderly citizens. The project RITA wants to demonstrate that an update of the current socio-medical services with an Ambient Assisted Living (AAL) approach could improve the service efficiency and the quality of life of both elderly and caregiver. This paper presents the preliminary results obtained in RITA.

[Scientific journals of medical students in Latin-America].

PubMed

Cabrera-Samith, Ignacio; Oróstegui-Pinilla, Diana; Angulo-Bazán, Yolanda; Mayta-Tristán, Percy; Rodríguez-Morales, Alfonso J

2010-11-01

This article deals with the history and evolution of student's scientific journals in Latin-America, their beginnings, how many still exist and which is their future projection. Relevant events show the growth of student's scientific journals in Latin-America and how are they working together to improve their quality. This article is addressed not only for Latin American readers but also to worldwide readers. Latin American medical students are consistently working together to publish scientific research, whose quality is constantly improving.

Does cultural competency training of health professionals improve patient outcomes? A systematic review and proposed algorithm for future research.

PubMed

Lie, Désirée A; Lee-Rey, Elizabeth; Gomez, Art; Bereknyei, Sylvia; Braddock, Clarence H

2011-03-01

Cultural competency training has been proposed as a way to improve patient outcomes. There is a need for evidence showing that these interventions reduce health disparities. The objective was to conduct a systematic review addressing the effects of cultural competency training on patient-centered outcomes; assess quality of studies and strength of effect; and propose a framework for future research. The authors performed electronic searches in the MEDLINE/PubMed, ERIC, PsycINFO, CINAHL and Web of Science databases for original articles published in English between 1990 and 2010, and a bibliographic hand search. Studies that reported cultural competence educational interventions for health professionals and measured impact on patients and/or health care utilization as primary or secondary outcomes were included. Four authors independently rated studies for quality using validated criteria and assessed the training effect on patient outcomes. Due to study heterogeneity, data were not pooled; instead, qualitative synthesis and analysis were conducted. Seven studies met inclusion criteria. Three involved physicians, two involved mental health professionals and two involved multiple health professionals and students. Two were quasi-randomized, two were cluster randomized, and three were pre/post field studies. Study quality was low to moderate with none of high quality; most studies did not adequately control for potentially confounding variables. Effect size ranged from no effect to moderately beneficial (unable to assess in two studies). Three studies reported positive (beneficial) effects; none demonstrated a negative (harmful) effect. There is limited research showing a positive relationship between cultural competency training and improved patient outcomes, but there remains a paucity of high quality research. Future work should address challenges limiting quality. We propose an algorithm to guide educators in designing and evaluating curricula, to rigorously demonstrate the impact on patient outcomes and health disparities.

[Implementation of the EndoCert system for certification of arthroplasty centers. Experiences from the pilot phase].

PubMed

Haas, H; Mittelmeier, W

2014-06-01

EndoCert is an initiative of the Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC, German Society for Orthopedics and Orthopedic Surgery) which has been available since October 2012 and is the first system worldwide for certification of specialized arthroplasty centers. Before implementation of this certification concept two sequential pilot phases were carried out with representative treatment institutions. The results from these pilot clinics are presented with respect to quality improvement effects. Early effects on the quality of treatment have been achieved by rectification of nonconformities determined in the audit with respect to structural and process quality. A total of 172 nonconformities found in the 23 participating pilot clinics could be rectified. Long-term effects on the quality of results will in future be analyzed in cooperation with the German endoprosthesis register (EPRD) and by accompanying evaluations. A close feedback of the collated experiences and results to the certification committee, which is responsible for the procedure together with the DGOOC, allows continuous further development of the system EndoCert represents a substantial step towards a nationwide safety and improvement of the quality in arthroplasty treatment within the preoperative, perioperative and postoperative framework and can in future represent a decisive tool together with the EPRD in quality management.

Analysis of the ecological water diversion project in Wenzhou City

NASA Astrophysics Data System (ADS)

Xu, Haibo; Fu, Lei; Lin, Tong

2018-02-01

As a developed city in China, Wenzhou City has been suffered from bad water quality for years. In order to improve the river network water quality, an ecological water diversion project was designed and executed by the regional government. In this study, an investigation and analysis of the regional ecological water diversion project is made for the purpose of examining the water quality improvements. A numerical model is also established, different water diversion flow rates and sewer interception levels are considered during the simulation. Simulation results reveal that higher flow rate and sewer interception level will greatly improve the river network water quality in Wenzhou City. The importance of the flow rate and interception level has been proved and future work will be focused on increasing the flow rate and upgrading the sewer interception level.

The Search for Perpetual Motion: Fatigue, Friction, and Drag in Quality Improvement.

PubMed

Cumbler, Ethan; Pierce, Read

Most people who have worked on continuous quality improvement (QI) with teams in the clinical microsystem have experienced "change fatigue." Application of the "Limit-to-Growth" system archetype to QI teams within health care can be used to understand negative feedback loops generated by successful QI that can limit future progress. Awareness of these factors can result in actions designed to reduce drag on forward momentum. Leaders in health care QI can anticipate and minimize negative feedback loops that accumulate to slow subsequent progress of highly functioning improvement teams within clinical microsystems.

A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety.

PubMed

Xie, Anping; Carayon, Pascale

2015-01-01

Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.

Specific Features of Social Competence Development in the Future Music Teachers Working at Universities

ERIC Educational Resources Information Center

Dzheksembekova, Menslu I.; Ibrayeva, Kamarsulu E.; Akhmetova, Aimkul K.; Urazalieva, Moldir A.; Sultangaliyeva, Elmira S.; Issametova, Klavdiya I.

2016-01-01

This paper aims at analyzing specific features of social competence of future music teachers and the development of specialized techniques in order to improve the quality of motivational and cognitive components of student social competence. The sample involved 660 undergraduate students. The authors used a number of research methods, such as…

Richard: A Blueprint for the Future of Apprenticeships?

ERIC Educational Resources Information Center

Adults Learning, 2012

2012-01-01

There is much to welcome in Doug Richard's independent report on the future of apprenticeships. The Richard review offers proposals for redefining and improving the quality of apprenticeships, and for focusing them more on the needs of employers. But will the proposals work, if adopted, and what will be the impact on adults? For this article, the…

Dynamic modeling of the Ganga river system: impacts of future climate and socio-economic change on flows and nitrogen fluxes in India and Bangladesh.

PubMed

Whitehead, P G; Sarkar, S; Jin, L; Futter, M N; Caesar, J; Barbour, E; Butterfield, D; Sinha, R; Nicholls, R; Hutton, C; Leckie, H D

2015-06-01

This study investigates the potential impacts of future climate and socio-economic change on the flow and nitrogen fluxes of the Ganga river system. This is the first basin scale water quality study for the Ganga considering climate change at 25 km resolution together with socio-economic scenarios. The revised dynamic, process-based INCA model was used to simulate hydrology and water quality within the complex multi-branched river basins. All climate realizations utilized in the study predict increases in temperature and rainfall by the 2050s with significant increase by the 2090s. These changes generate associated increases in monsoon flows and increased availability of water for groundwater recharge and irrigation, but also more frequent flooding. Decreased concentrations of nitrate and ammonia are expected due to increased dilution. Different future socio-economic scenarios were found to have a significant impact on water quality at the downstream end of the Ganga. A less sustainable future resulted in a deterioration of water quality due to the pressures from higher population growth, land use change, increased sewage treatment discharges, enhanced atmospheric nitrogen deposition, and water abstraction. However, water quality was found to improve under a more sustainable strategy as envisaged in the Ganga clean-up plan.

Dosimetric quality assurance of highly conformal external beam treatments: from 2D phantom comparisons to 4D patient dose reconstruction

NASA Astrophysics Data System (ADS)

Feygelman, V.; Nelms, B.

2013-06-01

As IMRT technology continues to evolve, so do the dosimetric QA methods. A historical review of those is presented, starting with longstanding techniques such as film and ion chamber in a phantom and progressing towards 3D and 4D dose reconstruction in the patient. Regarding patient-specific QA, we envision that the currently prevalent limited comparison of dose distributions in the phantom by γ-analysis will be eventually replaced by clinically meaningful patient dose analyses with improved sensitivity and specificity. In a larger sense, we envision a future of QA built upon lessons from the rich history of "quality" as a science and philosophy. This future will aim to improve quality (and ultimately reduce cost) via advanced commissioning processes that succeed in detecting and rooting out systematic errors upstream of patient treatment, thus reducing our reliance on, and the resource burden associated with, per-beam/per-plan inspection.

The CEOS Atmospheric Composition Constellation: Enhancing the Value of Space-Based Observations

NASA Technical Reports Server (NTRS)

Eckman, Richard; Zehner, Claus; Al-Saadi, Jay

2015-01-01

The Committee on Earth Observation Satellites (CEOS) coordinates civil space-borne observations of the Earth. Participating agencies strive to enhance international coordination and data exchange and to optimize societal benefit. In recent years, CEOS has collaborated closely with the Group on Earth Observations (GEO) in implementing the Global Earth Observing System of Systems (GEOSS) space-based objectives. The goal of the CEOS Atmospheric Composition Constellation (ACC) is to collect and deliver data to improve monitoring, assessment and predictive capabilities for changes in the ozone layer, air quality and climate forcing associated with changes in the environment through coordination of existing and future international space assets. A project to coordinate and enhance the science value of a future constellation of geostationary sensors measuring parameters relevant to air quality supports the forthcoming European Sentinel-4, Korean GEMS, and US TEMPO missions. Recommendations have been developed for harmonization to mutually improve data quality and facilitate widespread use of the data products.

Quality of Cardiac Care in Canada: Recommendations for Building a Sustainable Future.

PubMed

Young, Courtney; Lambert, Laurie; Abel, James; O'Neill, Blair J

2018-06-01

Cardiovascular (CV) disease continues to present a significant disease and economic burden in Canada. To improve the quality of care and ensure sustainability of services, a national quality improvement initiative is required. The purpose of this analysis was to review the evidence for public reporting (PR) and external benchmarking (EB) to improve patient outcomes, and to recommend a strategy to improve CV care in Canada. To incorporate recent literature, the Canadian Cardiovascular Society (CCS) commissioned the Institute of Health Economics to provide a rapid update on the literature of PR and EB. The review showed that EB is more likely to promote positive effects, such as improved mortality, morbidity, and evidence-based clinical practice, and to limit negative effects, such as access restrictions or unintended provider behaviour associated with some forms of "top-down" PR. On the basis of these findings, this we recommend the following: (1) secure funding for the provincial collection of CV quality indicators and the creation of annual National CV Quality Reports; (2) enhance the culture of using CV quality indicator data for continuous quality improvement and opportunities for national or regional EB and sharing best practices; and (3) implement ongoing evaluation and revision of CCS clinical practice guidelines incorporating key quality indicators. This is already under way to a limited extent by the CCS with its Quality Project, but intentional, sustained support needs to be secured to enhance this ongoing effort and improve the quality of CV care for all Canadians. Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Quality Improvement of Liver Ultrasound Images Using Fuzzy Techniques.

PubMed

Bayani, Azadeh; Langarizadeh, Mostafa; Radmard, Amir Reza; Nejad, Ahmadreza Farzaneh

2016-12-01

Liver ultrasound images are so common and are applied so often to diagnose diffuse liver diseases like fatty liver. However, the low quality of such images makes it difficult to analyze them and diagnose diseases. The purpose of this study, therefore, is to improve the contrast and quality of liver ultrasound images. In this study, a number of image contrast enhancement algorithms which are based on fuzzy logic were applied to liver ultrasound images - in which the view of kidney is observable - using Matlab2013b to improve the image contrast and quality which has a fuzzy definition; just like image contrast improvement algorithms using a fuzzy intensification operator, contrast improvement algorithms applying fuzzy image histogram hyperbolization, and contrast improvement algorithms by fuzzy IF-THEN rules. With the measurement of Mean Squared Error and Peak Signal to Noise Ratio obtained from different images, fuzzy methods provided better results, and their implementation - compared with histogram equalization method - led both to the improvement of contrast and visual quality of images and to the improvement of liver segmentation algorithms results in images. Comparison of the four algorithms revealed the power of fuzzy logic in improving image contrast compared with traditional image processing algorithms. Moreover, contrast improvement algorithm based on a fuzzy intensification operator was selected as the strongest algorithm considering the measured indicators. This method can also be used in future studies on other ultrasound images for quality improvement and other image processing and analysis applications.

Quality Improvement of Liver Ultrasound Images Using Fuzzy Techniques

PubMed Central

Bayani, Azadeh; Langarizadeh, Mostafa; Radmard, Amir Reza; Nejad, Ahmadreza Farzaneh

2016-01-01

Background: Liver ultrasound images are so common and are applied so often to diagnose diffuse liver diseases like fatty liver. However, the low quality of such images makes it difficult to analyze them and diagnose diseases. The purpose of this study, therefore, is to improve the contrast and quality of liver ultrasound images. Methods: In this study, a number of image contrast enhancement algorithms which are based on fuzzy logic were applied to liver ultrasound images - in which the view of kidney is observable - using Matlab2013b to improve the image contrast and quality which has a fuzzy definition; just like image contrast improvement algorithms using a fuzzy intensification operator, contrast improvement algorithms applying fuzzy image histogram hyperbolization, and contrast improvement algorithms by fuzzy IF-THEN rules. Results: With the measurement of Mean Squared Error and Peak Signal to Noise Ratio obtained from different images, fuzzy methods provided better results, and their implementation - compared with histogram equalization method - led both to the improvement of contrast and visual quality of images and to the improvement of liver segmentation algorithms results in images. Conclusion: Comparison of the four algorithms revealed the power of fuzzy logic in improving image contrast compared with traditional image processing algorithms. Moreover, contrast improvement algorithm based on a fuzzy intensification operator was selected as the strongest algorithm considering the measured indicators. This method can also be used in future studies on other ultrasound images for quality improvement and other image processing and analysis applications. PMID:28077898

The Status of the Quality Control in Acupuncture-Neuroimaging Studies

PubMed Central

Qiu, Ke; Jing, Miaomiao; Liu, Xiaoyan; Gao, Feifei; Liang, Fanrong; Zeng, Fang

2016-01-01

Using neuroimaging techniques to explore the central mechanism of acupuncture gains increasing attention, but the quality control of acupuncture-neuroimaging study remains to be improved. We searched the PubMed Database during 1995 to 2014. The original English articles with neuroimaging scan performed on human beings were included. The data involved quality control including the author, sample size, characteristics of the participant, neuroimaging technology, and acupuncture intervention were extracted and analyzed. The rigorous inclusion and exclusion criteria are important guaranty for the participants' homogeneity. The standard operation process of acupuncture and the stricter requirement for acupuncturist play significant role in quality control. More attention should be paid to the quality control in future studies to improve the reproducibility and reliability of the acupuncture-neuroimaging studies. PMID:27242911

Influenza immunizations in the elderly: a continuous quality improvement project.

PubMed

Juma, A; Evans, M F; Bloom, J

2000-08-01

As part of the continuous quality improvement program at The Toronto Hospital's Department of Family & Community Medicine (TTH-DFCM), it was considered necessary to examine the structures, processes and outcomes of influenza immunization for the elderly. The study sought to (a) document the current influenza immunization process; (b) quantify influenza immunization rates for elderly patients during two consecutive immunization seasons (1996 and 1997), and compare these rates across physician teams, attending staff vs. residents, patient gender, and patient age groups; (c) compare influenza immunization rates with other centers; and (d) identify barriers and propose solutions to improve influenza immunization rates in the elderly. Evaluation Formative Research. A computerized roster of 15,000 patients at The Toronto Hospital, Department of Family and Community Medicine, a University of Toronto academic teaching center. Active patients age 65 years and over. Influenza immunization. Physician Teams, Physician status, Patient gender, and Patient age group. Immunization rates of attendees increased from 75.4% to 78.7%; over 3% increase from 1996 to 1997. Major subgroups which benefited from increased immunization rates were patients in the Blue team, patients age 70-74 years, and female patients. This study presents a rigorous examination of the components of the influenza immunization program, and demonstrates improved immunization rates over a two-year period. Suggestions for future action have been identified. The study design can also serve as a model for future clinical quality improvement projects.

Five suggestions for future medical education in Korea.

PubMed

Yang, Eunbae B; Meng, Kwang Ho

2014-09-01

This study is to investigate the historical characteristics of medical education and healthcare environment in Korea and to suggest the desirable direction for future medical education. We draw a consensus through the literature analysis and several debates from the eight experts of medical education. There are several historical characteristics of medical education: medical education as vocational education and training, as a higher education, rapid growth of new medical schools, change to the medical education system, curriculum development, reinforcement of medical humanities, improvement of teaching and evaluation methods, validation of the national health personnel licensing examination, accreditation system for quality assurance, and establishment of specialized medical education division. The changes of health care environment in medical education are development of medical technologies, changes in the structures of the population and diseases, growth of information and communication technology, consumer-centered society, and increased intervention by the third party stakeholder. We propose five suggestions to be made to improve future medical education. They are plan for outcome and competency-based medical education, connection between the undergraduate and graduate medical education, reinforcement of continuous quality improvement of medical education, reorganization of the medical education system and construction of leadership of "academic medicine."

An Undergraduate Research Fellowship Program to Prepare Nursing Students for Future Workforce Roles

PubMed Central

Slattery, Mary Jo; Logan, Bridget; Mudge, Bridget; Secore, Karen; Von Reyn, LInda J.; Maue, Robert A.

2016-01-01

It is important for nurses today and for those joining the workforce in the future to have familiarity and training with respect to interprofessional research, evidence-based practice, and quality improvement. In an effort to address this need, we describe a 10-week summer research program that immerses undergraduate nursing students in a broad spectrum of clinical and translational research projects as part of their exposure to advanced nursing roles. In doing so, the program increases the ability of the students to participate in research, effectively interact with academic medical center researchers, and incorporate elements of evidence-based practice into future nursing interventions. Their mentors are nurses practicing in roles as nurse researcher, advanced practice nurses involved in evidence-based practice or quality improvement, and clinical trials research nurses. Each student is matched with 3 of these mentors and involved in 3 different projects. Through this exposure, the students benefit from observing multiple nursing roles, taking an active role in research-related activities participating in interdisciplinary learning experiences. Overall, the program provides benefits to the students, who demonstrate measured improvement with respect to the program objectives, and to their mentors and each of the participating organizations. PMID:27964811

Adult Education. The Quality of Life. ASPBAE Courier No. 52.

ERIC Educational Resources Information Center

ASPBAE Courier, 1991

1991-01-01

This issue of the "Courier" examines the quality of life as it can be improved by adult education, especially in the countries of Asia, Africa, and the South Pacific. It also looks at the need for women's education. The following six articles are included: (1) "The Future of the Family" (Federico Mayor); (2) "Her Words on…

"Vergara" and the Complexities of Teacher Employment Policies. ECS Education Policy Analysis

ERIC Educational Resources Information Center

Rowland, Julie

2015-01-01

Teaching quality is a crucial factor in student success, contributing to students' short- and long-term learning opportunities. High-quality teaching not only contributes to the improvement of student test scores and graduation rates but also gives students a "strong foundation from which to advance and achieve" in the future. Long term,…

How to Improve Your Impact Factor: Questioning the Quantification of Academic Quality

ERIC Educational Resources Information Center

Smeyers, Paul; Burbules, Nicholas C.

2011-01-01

A broad-scale quantification of the measure of quality for scholarship is under way. This trend has fundamental implications for the future of academic publishing and employment. In this essay we want to raise questions about these burgeoning practices, particularly how they affect philosophy of education and similar sub-disciplines. First,…

Approaches to ensuring and improving quality in the context of health system strengthening: a cross-site analysis of the five African Health Initiative Partnership programs

PubMed Central

2013-01-01

Background Integrated into the work in health systems strengthening (HSS) is a growing focus on the importance of ensuring quality of the services delivered and systems which support them. Understanding how to define and measure quality in the different key World Health Organization building blocks is critical to providing the information needed to address gaps and identify models for replication. Description of approaches We describe the approaches to defining and improving quality across the five country programs funded through the Doris Duke Charitable Foundation African Health Initiative. While each program has independently developed and implemented country-specific approaches to strengthening health systems, they all included quality of services and systems as a core principle. We describe the differences and similarities across the programs in defining and improving quality as an embedded process essential for HSS to achieve the goal of improved population health. The programs measured quality across most or all of the six WHO building blocks, with specific areas of overlap in improving quality falling into four main categories: 1) defining and measuring quality; 2) ensuring data quality, and building capacity for data use for decision making and response to quality measurements; 3) strengthened supportive supervision and/or mentoring; and 4) operational research to understand the factors associated with observed variation in quality. Conclusions Learning the value and challenges of these approaches to measuring and improving quality across the key components of HSS as the projects continue their work will help inform similar efforts both now and in the future to ensure quality across the critical components of a health system and the impact on population health. PMID:23819662

[Revision of Quality Indicators for the Endoscopy Quality Improvement Program of the National Cancer Screening Program in Korea].

PubMed

Min, Jun Ki; Cha, Jae Myung; Cho, Yu Kyung; Kim, Jie Hyun; Yoon, Soon Man; Im, Jong Pil; Jung, Yunho; Moon, Jeong Seop; Kim, Jin Oh; Jeen, Yoon Tae

2018-05-25

Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.

Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association.

PubMed

Meaney, Peter A; Bobrow, Bentley J; Mancini, Mary E; Christenson, Jim; de Caen, Allan R; Bhanji, Farhan; Abella, Benjamin S; Kleinman, Monica E; Edelson, Dana P; Berg, Robert A; Aufderheide, Tom P; Menon, Venu; Leary, Marion

2013-07-23

The "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" increased the focus on methods to ensure that high-quality cardiopulmonary resuscitation (CPR) is performed in all resuscitation attempts. There are 5 critical components of high-quality CPR: minimize interruptions in chest compressions, provide compressions of adequate rate and depth, avoid leaning between compressions, and avoid excessive ventilation. Although it is clear that high-quality CPR is the primary component in influencing survival from cardiac arrest, there is considerable variation in monitoring, implementation, and quality improvement. As such, CPR quality varies widely between systems and locations. Victims often do not receive high-quality CPR because of provider ambiguity in prioritization of resuscitative efforts during an arrest. This ambiguity also impedes the development of optimal systems of care to increase survival from cardiac arrest. This consensus statement addresses the following key areas of CPR quality for the trained rescuer: metrics of CPR performance; monitoring, feedback, and integration of the patient's response to CPR; team-level logistics to ensure performance of high-quality CPR; and continuous quality improvement on provider, team, and systems levels. Clear definitions of metrics and methods to consistently deliver and improve the quality of CPR will narrow the gap between resuscitation science and the victims, both in and out of the hospital, and lay the foundation for further improvements in the future.

Developing and Implementing a Quality Assurance Strategy for Electroconvulsive Therapy.

PubMed

Hollingsworth, Jessa; Baliko, Beverly; McKinney, Selina; Rosenquist, Peter

2018-04-17

The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care; however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT. The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy. An audit tool was developed utilizing quality criteria derived from a systematic review of ECT practice guidelines, peer review, and facility policy. All ECT procedures occurring over a 2-month period of May to June 2017 were retrospectively audited and compared against target compliance rates set for the facility's ECT program. Facility policy was adapted to reflect quality standards, and audit findings were used to inform possible practice change initiatives, were used to create benchmarks for continuous quality monitoring, and were integrated into regular hospital quality meetings. Clarification on standards of care and the use of clinical auditing in ECT was an effective starting point in the development of a quality assurance strategy. Audit findings were successfully integrated into the hospital's overall quality program, and recognition of practice compliance informed areas for future quality development and policy revision in this small community-based hospital in the southeastern United States. This project sets the foundation for a quality assurance strategy that can be used to help monitor procedural safety and guide future improvement efforts in delivering ECT. Although it is just the first step in creating meaningful quality improvement, setting clear standards and identifying areas of greatest clinical need were crucial beginning for this hospital's growing program.

Spatially explicit scenario analysis for hydrologic services in an urbanizing agricultural watershed

NASA Astrophysics Data System (ADS)

Qiu, J.; Booth, E.; Carpenter, S. R.; Turner, M.

2013-12-01

The sustainability of hydrologic services (benefits to people generated by terrestrial ecosystem effects on freshwater) is challenged by changes in climate and land use. Despite the importance of hydrologic services, few studies have investigated how the provision of ecosystem services related to freshwater quantity and quality may vary in magnitude and spatial pattern for alternative future trajectories. Such analyses may provide useful information for sustaining freshwater resources in the face of a complex and uncertain future. We analyzed the supply of multiple hydrologic services from 2010 to 2070 across a large urbanizing agricultural watershed in the Upper Midwest of the United States, and asked the following: (i) What are the potential trajectories for the supply of hydrologic services under contrasting but plausible future scenarios? (ii) Where on the landscape is the delivery of hydrologic services most vulnerable to future changes? The Nested Watershed scenario represents extreme climate change (warmer temperatures and more frequent extreme events) and a concerted response from institutions, whereas in the Investment in Innovation scenario, climate change is less severe and technological innovations play a major role. Despite more extreme climate in the Nested Watershed scenario, all hydrologic services (i.e., freshwater supply, surface water quality, flood regulation) were maintained or enhanced (~30%) compared to the 2010 baseline, by strict government interventions that prioritized freshwater resources. Despite less extreme climate in the Investment in Innovation scenario and advances in green technology, only surface water quality and flood regulation were maintained or increased (~80%); freshwater supply declined by 25%, indicating a potential future tradeoff between water quality and quantity. Spatially, the locations of greatest vulnerability (i.e., decline) differed by service and among scenarios. In the Nested Watershed scenario, although freshwater supply and surface water quality were sustained or enhanced overall, these hydrologic services declined in ~60% and 20% of the landscape, respectively. The greatest improvement for most hydrologic services corresponded to areas of restored wetland, forest and perennial crops, which were less vulnerable to future degradation. In the Investment in Innovation scenario, freshwater supply declined in almost the entire watershed; improvement of surface water quality and flood regulation occurred mainly in urban areas, where highly engineered systems made them less vulnerable. Overall, our results indicated that hydrologic services will respond differently to future climate and land-use change, and sustaining one may involve tradeoffs of another. Technological progress can conserve particular services but might not be the panacea for the future. How society reacts in the face of changes can have an important role in determining the pathways to the future and the provision and spatial patterns of ecosystem services.

Quality measurement for rhinosinusitis: a review from the Quality Improvement Committee of the American Rhinologic Society.

PubMed

Rudmik, Luke; Mattos, Jose; Schneider, John; Manes, Peter R; Stokken, Janalee K; Lee, Jivianne; Higgins, Thomas S; Schlosser, Rodney J; Reh, Douglas D; Setzen, Michael; Soler, Zachary M

2017-09-01

Measuring quality outcomes is an important prerequisite to improve quality of care. Rhinosinusitis represents a high value target to improve quality of care because it has a high prevalence of disease, large economic burden, and large practice variation. In this study we review the current state of quality measurement for management of both acute (ARS) and chronic rhinosinusitis (CRS). The major national quality metric repositories and clearinghouses were queried. Additional searches included the American Academy of Otolaryngology-Head and Neck Surgery database, PubMed, and Google to attempt to capture any additional quality metrics. Seven quality metrics for ARS and 4 quality metrics for CRS were identified. ARS metrics focused on appropriateness of diagnosis (n = 1), antibiotic prescribing (n = 4), and radiologic imaging (n = 2). CRS quality metrics focused on appropriateness of diagnosis (n = 1), radiologic imaging (n = 1), and measurement of patient quality of life (n = 2). The Physician Quality Reporting System (PQRS) currently tracks 3 ARS quality metrics and 1 CRS quality metric. There are no outcome-based rhinosinusitis quality metrics and no metrics that assess domains of safety, patient-centeredness, and timeliness of care. The current status of quality measurement for rhinosinusitis has focused primarily on the quality domain of efficiency and process measures for ARS. More work is needed to develop, validate, and track outcome-based quality metrics along with CRS-specific metrics. Although there has been excellent work done to improve quality measurement for rhinosinusitis, there remain major gaps and challenges that need to be considered during the development of future metrics. © 2017 ARS-AAOA, LLC.

High-quality cardiopulmonary resuscitation: current and future directions.

PubMed

Abella, Benjamin S

2016-06-01

Cardiopulmonary resuscitation (CPR) represents the cornerstone of cardiac arrest resuscitation care. Prompt delivery of high-quality CPR can dramatically improve survival outcomes; however, the definitions of optimal CPR have evolved over several decades. The present review will discuss the metrics of CPR delivery, and the evidence supporting the importance of CPR quality to improve clinical outcomes. The introduction of new technologies to quantify metrics of CPR delivery has yielded important insights into CPR quality. Investigations using CPR recording devices have allowed the assessment of specific CPR performance parameters and their relative importance regarding return of spontaneous circulation and survival to hospital discharge. Additional work has suggested new opportunities to measure physiologic markers during CPR and potentially tailor CPR delivery to patient requirements. Through recent laboratory and clinical investigations, a more evidence-based definition of high-quality CPR continues to emerge. Exciting opportunities now exist to study quantitative metrics of CPR and potentially guide resuscitation care in a goal-directed fashion. Concepts of high-quality CPR have also informed new approaches to training and quality improvement efforts for cardiac arrest care.

Resources for the Future. Annual Report for the Year Ending September 30, 1985.

ERIC Educational Resources Information Center

Resources for the Future, Inc., Washington, DC.

Resources for the Future, Inc. (RFF) is a nonprofit, tax exempt corporation headquartered in Washington, D.C. RFF's purpose is to advance research and education in the development, conservation, and use of natural resources, including improvement of the quality of the environment. Most of its programs are carried out by resident staff, but a few…

Resources for the Future. Annual Report for the Year Ending September 30, 1982.

ERIC Educational Resources Information Center

Resources for the Future, Inc., Washington, DC.

Resources for the Future, Inc. (RFF) is a nonprofit, tax-exempt corporation headquartered in Washington, D.C. RFF's purpose is to advance research and education in the development, conservation, and use of natural resources, including improvement of the quality of the environment. Most of its programs are carried out by resident staff, but a few…

Value-based medicine: evidence-based medicine and beyond.

PubMed

Brown, Gary C; Brown, Melissa M; Sharma, Sanjay

2003-09-01

Value-based medicine is the practice of medicine emphasizing the value received from an intervention. Value is measured by objectively quantifying: 1) the improvement in quality of life and/or 2) the improvement in length of life conferred by an intervention. Evidence-based medicine often measures the improvement gained in length of life, but generally ignores the importance of quality of life improvement or loss. Value-based medicine incorporates the best features of evidence-based medicine and takes evidence-based data to a higher level by incorporating the quality of life perceptions of patients with a disease in concerning the value of an intervention. Inherent in value-based medicine are the costs associated with an intervention. The resources expended for the value gained in value-based medicine is measured with cost-utility analysis in terms of the US dollars/QALY (money spent per quality-adjusted life-year gained). A review of the current status and the likely future of value-based medicine is addressed herein.

EMISSION REDUCTIONS AIMED AT IMPROVING AIR QUALITY: UNINTENDED CLIMATIC CONSEQUENCES AND THE EFFECT OF CLIMATE CHANGE ON THEIR SUCCESS

EPA Science Inventory

This work will provide improved understanding of the role of climate change, both in the recent past and future, on the success of pollutant control strategies, allowing for better planning and accountability of emission reductions. This work will also provide a quantitative a...

Building nurse leaders through the Institute for Healthcare Improvement Open School Student Quality Leadership Academy.

PubMed

May, Cattleya; Cutting, Katharine N

2014-01-01

The Institute for Healthcare Improvement is an independent not-for-profit organization based in Cambridge, Massachusetts. It is a leading innovator in health and health care improvement with a global following.One important part of the IHI is the development and evolution of the "Open School." Launched in September 2008, the online community currently includes hundreds of thousands of students worldwide. The goals of the Open School are consistent with the IHI initial concepts: to build will for change, seek out innovation, share expertise, and build leaders. Each year, the Open School awards scholarships to select students to attend a Leadership Academy.The Student Quality Leadership Academy allows students to network with other future nurses, physicians, and health care administrators and explores how they feel about leadership. This is important to nursing as we will need to replace many leadership positions in the future, but often new nurses are uncertain about leadership roles.

Workshop on Agricultural Air Quality: State of the science

NASA Astrophysics Data System (ADS)

Aneja, Viney P.; Blunden, Jessica; Roelle, Paul A.; Schlesinger, William H.; Knighton, Raymond; Niyogi, Dev; Gilliam, Wendell; Jennings, Greg; Duke, Clifford S.

The first Workshop on Agricultural Air Quality: State of the Science was held at the Bolger Center in Potomac, Maryland from 4 to 8 June 2006. This international conference assembled approximately 350 people representing 25 nations from 5 continents, with disciplines ranging from atmospheric chemistry to soil science. The workshop was designed as an open forum in which participants could openly exchange the most current knowledge and learn about numerous international perspectives regarding agricultural air quality. Participants represented many stakeholder groups concerned with the growing need to assess agricultural impacts on the atmosphere and to develop beneficial policies to improve air quality. The workshop focused on identifying methods to improve emissions inventories and best management practices for agriculture. Workshop participants also made recommendations for technological and methodological improvements in current emissions measurement and modeling practices. The workshop commenced with a session on agricultural emissions and was followed by international perspectives from the United States, Europe, Australia, India, and South America. This paper summarizes the findings and issues of the workshop and articulates future research needs. These needs were identified in three general areas: (1) improvement of emissions measurement; (2) development of appropriate emission factors; and (3) implementation of best management practices (BMPs) to minimize negative environmental impacts. Improvements in the appropriate measurements will inform decisions regarding US farming practices. A need was demonstrated for a national/international network to monitor atmospheric emissions from agriculture and their subsequent depositions to surrounding areas. Information collected through such a program may be used to assess model performance and could be critical for evaluating any future regulatory policies or BMPs. The workshop concluded that efforts to maximize benefits and reduce detrimental effects of agricultural production need to transcend disciplinary, geographic, and political boundaries. Also, such efforts should involve natural and social scientists, economists, engineers, business leaders, and decision makers. The workshop came to the conclusion that through these collaborative efforts improvements in air quality from agricultural practices will begin to take effect.

Impact of a future H2 transportation on atmospheric pollution in Europe

NASA Astrophysics Data System (ADS)

Popa, M. E.; Segers, A. J.; Denier van der Gon, H. A. C.; Krol, M. C.; Visschedijk, A. J. H.; Schaap, M.; Röckmann, T.

2015-07-01

Hydrogen (H2) is being explored as a fuel for passenger vehicles; it can be used in fuel cells to power electric motors or burned in internal combustion engines. In order to evaluate the potential influence of a future H2-based road transportation on the regional air quality in Europe, we implemented H2 in the atmospheric transport and chemistry model LOTOS-EUROS. We simulated the present and future (2020) air quality, using emission scenarios with different proportions of H2 vehicles and different H2 leakage rates. The reference future scenario does not include H2 vehicles, and assumes that all present and planned European regulations for emissions are fully implemented. We find that, in general, the air quality in 2020 is significantly improved compared to the current situation in all scenarios, with and without H2 cars. In the future scenario without H2 cars, the pollution is reduced due to the strict European regulations: annually averaged CO, NOx and PM2.5 over the model domain decrease by 15%, 30% and 20% respectively. The additional improvement brought by replacing 50% or 100% of traditionally-fueled vehicles by H2 vehicles is smaller in absolute terms. If 50% of vehicles are using H2, the CO, NOx and PM2.5 decrease by 1%, 10% and 1% respectively, compared to the future scenario without H2 cars. When all vehicles run on H2, then additional decreases in CO, NOx and PM2.5 are 5%, 40%, and 5% relative to the no-H2 cars future scenario. Our study shows that H2 vehicles may be an effective pathway to fulfill the strict future EU air quality regulations. O3 has a more complicated behavior - its annual average decreases in background areas, but increases in the high-NOx area in western Europe, with the decrease in NOx. A more detailed analysis shows that the population exposure to high O3 levels decreases nevertheless. In all future scenarios, traffic emissions account for only a small proportion of the total anthropogenic emissions, thus it becomes more important to better regulate emissions of non-traffic sectors. Although atmospheric H2 increases significantly in the high-leakage scenarios considered, the additional H2 added into the atmosphere does not have a significant effect on the ground level air pollution in Europe.

Improvement of water quality at Dongbin Harbor with construction of an inland canal, Korea.

PubMed

Cho, Yong-Sik

2014-01-01

The behaviors of the water body of Dongbin Harbor located at Pohang City, Gyongpook Province, in Korea were numerically simulated in this study. A canal was planned to connect the harbor and the Hyeongsan River to improve water quality inside the harbor. The current system was first simulated by using a commercial program RMA2, with respect to both tidal currents and river flow. The progress inside the harbor from a supply of fresh water from the Hyeongsan River was then predicted by using RMA4. Both the present and future conditions (before and after construction of an inland canal) were taken into consideration in numerical simulations. It is concluded that the water quality inside the harbor can be improved considerably after construction of the canal.

Month-wise variation and prediction of bulk tank somatic cell count in Brazilian dairy herds and its impact on payment based on milk quality.

PubMed

Busanello, Marcos; de Freitas, Larissa Nazareth; Winckler, João Pedro Pereira; Farias, Hiron Pereira; Dos Santos Dias, Carlos Tadeu; Cassoli, Laerte Dagher; Machado, Paulo Fernando

2017-01-01

Payment programs based on milk quality (PPBMQ) are used in several countries around the world as an incentive to improve milk quality. One of the principal milk parameters used in such programs is the bulk tank somatic cell count (BTSCC). In this study, using data from an average of 37,000 farms per month in Brazil where milk was analyzed, BTSCC data were divided into different payment classes based on milk quality. Then, descriptive and graphical analyses were performed. The probability of a change to a worse payment class was calculated, future BTSCC values were predicted using time series models, and financial losses due to the failure to reach the maximum bonus for the payment based on milk quality were simulated. In Brazil, the mean BTSCC has remained high in recent years, without a tendency to improve. The probability of changing to a worse payment class was strongly affected by both the BTSCC average and BTSCC standard deviation for classes 1 and 2 (1000-200,000 and 201,000-400,000 cells/mL, respectively) and only by the BTSCC average for classes 3 and 4 (401,000-500,000 and 501,000-800,000 cells/mL, respectively). The time series models indicated that at some point in the year, farms would not remain in their current class and would accrue financial losses due to payments based on milk quality. The BTSCC for Brazilian dairy farms has not recently improved. The probability of a class change to a worse class is a metric that can aid in decision-making and stimulate farmers to improve milk quality. A time series model can be used to predict the future value of the BTSCC, making it possible to estimate financial losses and to show, moreover, that financial losses occur in all classes of the PPBMQ because the farmers do not remain in the best payment class in all months.

Economic Analysis of Waterfront Area Services at Naval Station, Long Beach

DTIC Science & Technology

1991-06-01

the Gradall for waterfront area services, would result in improved responsiveness and timely service. Customer satisfaction and overall customer ...overall cost. Hence, both quality and efficiency will improve leading to greater customer satisfaction . 58 VII. RECOMMENDATIONS FOR ACTION RECOMMENDATION 1...prompting the need for improved efficiency. To ensure adequate future support can be provided to its customers , Naval Station Long Beach (Navsta) is

Prevention and management of "do not return" notices: a quality improvement process for supplemental staffing nursing agencies.

PubMed

Ade-Oshifogun, Jochebed Bosede; Dufelmeier, Thaddeus

2012-01-01

This article describes a quality improvement process for "do not return" (DNR) notices for healthcare supplemental staffing agencies and healthcare facilities that use them. It is imperative that supplemental staffing agencies partner with healthcare facilities in assuring the quality of supplemental staff. Although supplemental staffing agencies attempt to ensure quality staffing, supplemental staff are sometimes subjectively evaluated by healthcare facilities as "DNR." The objective of this article is to describe a quality improvement process to prevent and manage "DNR" within healthcare organizations. We developed a curriculum and accompanying evaluation tool by adapting Rampersad's problem-solving discipline approach: (a) definition of area(s) for improvement; (b) identification of all possible causes; (c) development of an action plan; (d) implementation of the action plan; (e) evaluation for program improvement; and (f) standardization of the process. Face and content validity of the evaluation tool was ascertained by input from a panel of experienced supplemental staff and nursing faculty. This curriculum and its evaluation tool will have practical implications for supplemental staffing agencies and healthcare facilities in reducing "DNR" rates and in meeting certification/accreditation requirements. Further work is needed to translate this process into future research. © 2012 Wiley Periodicals, Inc.

Enhancing the performance of brewing yeasts.

PubMed

Karabín, Marcel; Jelínek, Lukáš; Kotrba, Pavel; Cejnar, Rudolf; Dostálek, Pavel

2017-12-22

Beer production is one of the oldest known traditional biotechnological processes, but is nowadays facing increasing demands not only for enhanced product quality, but also for improved production economics. Targeted genetic modification of a yeast strain is one way to increase beer quality and to improve the economics of beer production. In this review we will present current knowledge on traditional approaches for improving brewing strains and for rational metabolic engineering. These research efforts will, in the near future, lead to the development of a wider range of industrial strains that should increase the diversity of commercial beers. Copyright © 2018 Elsevier Inc. All rights reserved.

Improving data quality in neuronal population recordings

PubMed Central

Harris, Kenneth D.; Quian Quiroga, Rodrigo; Freeman, Jeremy; Smith, Spencer

2017-01-01

Understanding how the brain operates requires understanding how large sets of neurons function together. Modern recording technology makes it possible to simultaneously record the activity of hundreds of neurons, and technological developments will soon allow recording of thousands or tens of thousands. As with all experimental techniques, these methods are subject to confounds that complicate the interpretation of such recordings, and could lead to erroneous scientific conclusions. Here, we discuss methods for assessing and improving the quality of data from these techniques, and outline likely future directions in this field. PMID:27571195

Integrated Management of Residential Indoor Air Quality: A Call for Stakeholders in a Changing Climate.

PubMed

Levasseur, Marie-Eve; Poulin, Patrick; Campagna, Céline; Leclerc, Jean-Marc

2017-11-25

A paradigm change in the management of environmental health issues has been observed in recent years: instead of managing specific risks individually, a holistic vision of environmental problems would assure sustainable solutions. However, concrete actions that could help translate these recommendations into interventions are lacking. This review presents the relevance of using an integrated indoor air quality management approach to ensure occupant health and comfort. At the nexus of three basic concepts (reducing contaminants at the source, improving ventilation, and, when relevant, purifying the indoor air), this approach can help maintain and improve indoor air quality and limit exposure to several contaminants. Its application is particularly relevant in a climate change context since the evolving outdoor conditions have to be taken into account during building construction and renovation. The measures presented through this approach target public health players, building managers, owners, occupants, and professionals involved in building design, construction, renovation, and maintenance. The findings of this review will help the various stakeholders initiate a strategic reflection on the importance of indoor air quality and climate change issues for existing and future buildings. Several new avenues and recommendations are presented to set the path for future research activities.

Integrated Management of Residential Indoor Air Quality: A Call for Stakeholders in a Changing Climate

PubMed Central

Levasseur, Marie-Eve; Poulin, Patrick; Campagna, Céline; Leclerc, Jean-Marc

2017-01-01

A paradigm change in the management of environmental health issues has been observed in recent years: instead of managing specific risks individually, a holistic vision of environmental problems would assure sustainable solutions. However, concrete actions that could help translate these recommendations into interventions are lacking. This review presents the relevance of using an integrated indoor air quality management approach to ensure occupant health and comfort. At the nexus of three basic concepts (reducing contaminants at the source, improving ventilation, and, when relevant, purifying the indoor air), this approach can help maintain and improve indoor air quality and limit exposure to several contaminants. Its application is particularly relevant in a climate change context since the evolving outdoor conditions have to be taken into account during building construction and renovation. The measures presented through this approach target public health players, building managers, owners, occupants, and professionals involved in building design, construction, renovation, and maintenance. The findings of this review will help the various stakeholders initiate a strategic reflection on the importance of indoor air quality and climate change issues for existing and future buildings. Several new avenues and recommendations are presented to set the path for future research activities. PMID:29186831

Improving the Quality of Survivorship for Older Adults with Cancer

PubMed Central

Mohile, Supriya G.; Hurria, Arti; Cohen, Harvey J.; Rowland, Julia H.; Leach, Corinne R.; Arora, Neeraj K.; Canin, Beverly; Muss, Hyman; Magnuson, Allison; Flannery, Marie; Lowenstein, Lisa; Allore, Heather; Mustian, Karen; Demark-Wahnefried, Wendy; Extermann, Martine; Ferrell, Betty; Inouye, Sharon; Studenski, Stephanie; Dale, William

2016-01-01

In May 2015, the Cancer and Aging Research Group (CARG), in collaboration with the National Cancer Institute and the National Institute on Aging through a U13 grant, convened a conference to identify research priorities to help design and implement intervention studies to improve the quality of life and survivorship of older, frailer adults with cancer. Conference attendees included researchers with multidisciplinary expertise and advocates. It was concluded that future intervention trials for older adults with cancer should: 1) rigorously test interventions to prevent decline or improve health status, especially interventions focused on optimizing physical performance, nutritional status, and cognition while undergoing cancer treatment; 2) utilize standardized care plans based on geriatric assessment findings to guide targeted interventions; and 3) incorporate the principles of geriatrics into survivorship care plans. Also highlighted was the need to integrate the expertise of interdisciplinary team members into geriatric oncology research, improve funding mechanisms to support geriatric oncology research, and disseminate high-impact results to the research and clinical community. In conjunction with the prior two U13 meetings, this conference provides the framework for future research to improve the evidence base for the clinical care of older adults with cancer. PMID:27172129

Research and Development Trend of Shape Control for Cold Rolling Strip

NASA Astrophysics Data System (ADS)

Wang, Dong-Cheng; Liu, Hong-Min; Liu, Jun

2017-09-01

Shape is an important quality index of cold rolling strip. Up to now, many problems in the shape control domain have not been solved satisfactorily, and a review on the research progress in the shape control domain can help to seek new breakthrough directions. In the past 10 years, researches and applications of shape control models, shape control means, shape detection technology, and shape control system have achieved significant progress. In the aspect of shape control models, the researches in the past improve the accuracy, speed and robustness of the models. The intelligentization of shape control models should be strengthened in the future. In the aspect of the shape control means, the researches in the past focus on the roll optimization, mill type selection, process optimization, local strip shape control, edge drop control, and so on. In the future, more attention should be paid to the coordination control of both strip shape and other quality indexes, and the refinement of control objective should be strengthened. In the aspects of shape detection technology and shape control system, some new types of shape detection meters and shape control systems are developed and have successfully industrial applications. In the future, the standardization of shape detection technology and shape control system should be promoted to solve the problem of compatibility. In general, the four expected development trends of shape control for cold rolling strip in the future are intelligentization, coordination, refinement, and standardization. The proposed research provides new breakthrough directions for improving shape quality.

The CCLM contribution to improvements in quality and patient safety.

PubMed

Plebani, Mario

2013-01-01

Clinical laboratories play an important role in improving patient care. The past decades have seen unbelievable, often unpredictable improvements in analytical performance. Although the seminal concept of the brain-to-brain laboratory loop has been described more than four decades ago, there is now a growing awareness about the importance of extra-analytical aspects in laboratory quality. According to this concept, all phases and activities of the testing cycle should be assessed, monitored and improved in order to decrease the total error rates thereby improving patients' safety. Clinical Chemistry and Laboratory Medicine (CCLM) not only has followed the shift in perception of quality in the discipline, but has been the catalyst for promoting a large debate on this topic, underlining the value of papers dealing with errors in clinical laboratories and possible remedies, as well as new approaches to the definition of quality in pre-, intra-, and post-analytical steps. The celebration of the 50th anniversary of the CCLM journal offers the opportunity to recall and mention some milestones in the approach to quality and patient safety and to inform our readers, as well as laboratory professionals, clinicians and all the stakeholders of the willingness of the journal to maintain quality issues as central to its interest even in the future.

Rural relevant quality measures for critical access hospitals.

PubMed

Casey, Michelle M; Moscovice, Ira; Klingner, Jill; Prasad, Shailendra

2013-01-01

To identify current and future relevant quality measures for Critical Access Hospitals (CAHs). Three criteria (patient volume, internal usefulness for quality improvement, and external usefulness for public reporting and payment reform) were used to analyze quality measures for their relevance for CAHs. A 6-member panel with expertise in rural hospital quality measurement and improvement provided input regarding the final measure selection. The relevant quality measures for CAHs include measures that are ready for reporting now and measures that need specifications to be finalized and/or a data reporting mechanism to be established. They include inpatient measures for specific medical conditions, global measures that address appropriate care across multiple medical conditions, and Emergency Department measures. All CAHs should publicly report on relevant quality measures. Acceptance of a single consolidated set of quality measures with common specifications for CAHs by all entities involved in regulation, accreditation, and payment; a phased process to implement the relevant measures; and the provision of technical assistance would help CAHs meet the challenge of reporting. © 2012 National Rural Health Association.

FUNDAMENTAL AREAS OF PHENOMENOLOGY(INCLUDING APPLICATIONS): Experimental Investigation of Quality of Lensless Ghost Imaging with Pseudo-Thermal Light

NASA Astrophysics Data System (ADS)

Shen, Xia; Bai, Yan-Feng; Qin, Tao; Han, Shen-Sheng

2008-11-01

Factors influencing the quality of lensless ghost imaging are investigated. According to the experimental results, we find that the imaging quality is determined by the number of independent sub light sources on the imaging plane of the reference arm. A qualitative picture based on advanced wave optics is presented to explain the physics behind the experimental phenomena. The present results will be helpful to provide a basis for improving the quality of ghost imaging systems in future works.

Young People Envision the Future of Their Local Area: An Explorative Study from the Wet Tropics, Australia

ERIC Educational Resources Information Center

Bohnet, Iris C.; Gooch, Margaret; Hickey, Ruth

2010-01-01

In this article we present the results from an exploratory study conducted in the Wet Tropics in Australia. The study was initiated as part of a larger research program to support the development of a water quality improvement plan. Seven schools were invited to participate in this study. Students were asked to develop visions for the future of…

Outcome science in practice: an overview and initial experience at the Vanderbilt Spine Center.

PubMed

McGirt, Matthew J; Speroff, Theodore; Godil, Saniya Siraj; Cheng, Joseph S; Selden, Nathan R; Asher, Anthony L

2013-01-01

In terms of policy, research, quality improvement, and practice-based learning, there are essential principles--namely, quality, effectiveness, and value of care--needed to navigate changes in the current and future US health care environment. Patient-centered outcome measurement lies at the core of all 3 principles. Multiple measures of disease-specific disability, generic health-related quality of life, and preference-based health state have been introduced to quantify disease impact and define effectiveness of care. This paper reviews the basic principles of patient outcome measurement and commonly used outcome instruments. The authors provide examples of how utilization of outcome measurement tools in everyday neurosurgical practice can facilitate practice-based learning, quality improvement, and real-world comparative effectiveness research, as well as promote the value of neurosurgical care.

A lack of standardization: the basis for the ethical issues surrounding quality and performance reports.

PubMed

Suchy, Kirsten

2010-01-01

Consumers in the United States are taking advantage of the proliferation of publicly available, internet-based performance reports and quality appraisals of health plans, healthcare organizations, hospitals, and physicians to aid in their healthcare decision making. However, these appraisal practices have given rise to controversy and debate over certain distinctive ethical issues. This article advocates a standardized ethical framework to guide current and future development and implementation of performance reports. This framework, which would resolve a number of the major issues, includes the following ethical principles to guide the practice of public reporting on the Internet and facilitate enhanced quality improvement in the healthcare industry: legitimacy, data integrity and quality, transparency, informed understanding, equity, privacy and confidentiality, collaboration, accountability, and evaluation and continuous improvement.

Source-Based Modeling Of Urban Stormwater Quality Response to the Selected Scenarios Combining Future Changes in Climate and Socio-Economic Factors

NASA Astrophysics Data System (ADS)

Borris, Matthias; Leonhardt, Günther; Marsalek, Jiri; Österlund, Heléne; Viklander, Maria

2016-08-01

The assessment of future trends in urban stormwater quality should be most helpful for ensuring the effectiveness of the existing stormwater quality infrastructure in the future and mitigating the associated impacts on receiving waters. Combined effects of expected changes in climate and socio-economic factors on stormwater quality were examined in two urban test catchments by applying a source-based computer model (WinSLAMM) for TSS and three heavy metals (copper, lead, and zinc) for various future scenarios. Generally, both catchments showed similar responses to the future scenarios and pollutant loads were generally more sensitive to changes in socio-economic factors (i.e., increasing traffic intensities, growth and intensification of the individual land-uses) than in the climate. Specifically, for the selected Intermediate socio-economic scenario and two climate change scenarios (RSP = 2.6 and 8.5), the TSS loads from both catchments increased by about 10 % on average, but when applying the Intermediate climate change scenario (RCP = 4.5) for two SSPs, the Sustainability and Security scenarios (SSP1 and SSP3), the TSS loads increased on average by 70 %. Furthermore, it was observed that well-designed and maintained stormwater treatment facilities targeting local pollution hotspots exhibited the potential to significantly improve stormwater quality, however, at potentially high costs. In fact, it was possible to reduce pollutant loads from both catchments under the future Sustainability scenario (on average, e.g., TSS were reduced by 20 %), compared to the current conditions. The methodology developed in this study was found useful for planning climate change adaptation strategies in the context of local conditions.

Source-Based Modeling Of Urban Stormwater Quality Response to the Selected Scenarios Combining Future Changes in Climate and Socio-Economic Factors.

PubMed

Borris, Matthias; Leonhardt, Günther; Marsalek, Jiri; Österlund, Heléne; Viklander, Maria

2016-08-01

The assessment of future trends in urban stormwater quality should be most helpful for ensuring the effectiveness of the existing stormwater quality infrastructure in the future and mitigating the associated impacts on receiving waters. Combined effects of expected changes in climate and socio-economic factors on stormwater quality were examined in two urban test catchments by applying a source-based computer model (WinSLAMM) for TSS and three heavy metals (copper, lead, and zinc) for various future scenarios. Generally, both catchments showed similar responses to the future scenarios and pollutant loads were generally more sensitive to changes in socio-economic factors (i.e., increasing traffic intensities, growth and intensification of the individual land-uses) than in the climate. Specifically, for the selected Intermediate socio-economic scenario and two climate change scenarios (RSP = 2.6 and 8.5), the TSS loads from both catchments increased by about 10 % on average, but when applying the Intermediate climate change scenario (RCP = 4.5) for two SSPs, the Sustainability and Security scenarios (SSP1 and SSP3), the TSS loads increased on average by 70 %. Furthermore, it was observed that well-designed and maintained stormwater treatment facilities targeting local pollution hotspots exhibited the potential to significantly improve stormwater quality, however, at potentially high costs. In fact, it was possible to reduce pollutant loads from both catchments under the future Sustainability scenario (on average, e.g., TSS were reduced by 20 %), compared to the current conditions. The methodology developed in this study was found useful for planning climate change adaptation strategies in the context of local conditions.

Design of launch systems using continuous improvement process

NASA Technical Reports Server (NTRS)

Brown, Richard W.

1995-01-01

The purpose of this paper is to identify a systematic process for improving ground operations for future launch systems. This approach is based on the Total Quality Management (TQM) continuous improvement process. While the continuous improvement process is normally identified with making incremental changes to an existing system, it can be used on new systems if they use past experience as a knowledge base. In the case of the Reusable Launch Vehicle (RLV), the Space Shuttle operations provide many lessons. The TQM methodology used for this paper will be borrowed from the United States Air Force 'Quality Air Force' Program. There is a general overview of the continuous improvement process, with concentration on the formulation phase. During this phase critical analyses are conducted to determine the strategy and goals for the remaining development process. These analyses include analyzing the mission from the customers point of view, developing an operations concept for the future, assessing current capabilities and determining the gap to be closed between current capabilities and future needs and requirements. A brief analyses of the RLV, relative to the Space Shuttle, will be used to illustrate the concept. Using the continuous improvement design concept has many advantages. These include a customer oriented process which will develop a more marketable product and a better integration of operations and systems during the design phase. But, the use of TQM techniques will require changes, including more discipline in the design process and more emphasis on data gathering for operational systems. The benefits will far outweigh the additional effort.

Applications for Freeforms Optics at NASA

NASA Technical Reports Server (NTRS)

West, Garrett J.; Howard, Joseph M.

2017-01-01

Review freeform optic applications as NASA. Describe design study results showing benefits of freeform optics to the instrument size, image quality, and field of view. Review areas of study and improvements needed to freeform manufacturing for future applications.

Erectile dysfunction in the cardiovascular patient.

PubMed

Vlachopoulos, Charalambos; Jackson, Graham; Stefanadis, Christodoulos; Montorsi, Piero

2013-07-01

Erectile dysfunction is common in the patient with cardiovascular disease. It is an important component of the quality of life and it also confers an independent risk for future cardiovascular events. The usual 3-year time period between the onset of erectile dysfunction symptoms and a cardiovascular event offers an opportunity for risk mitigation. Thus, sexual function should be incorporated into cardiovascular disease risk assessment for all men. A comprehensive approach to cardiovascular risk reduction (comprising of both lifestyle changes and pharmacological treatment) improves overall vascular health, including sexual function. Proper sexual counselling improves the quality of life and increases adherence to medication. This review explores the critical connection between erectile dysfunction and cardiovascular disease and evaluates how this relationship may influence clinical practice. Algorithms for the management of patient with erectile dysfunction according to the risk for sexual activity and future cardiovascular events are proposed.

The operating room of the future: observations and commentary.

PubMed

Satava, Richard M

2003-09-01

The Operating Room of the Future is a construct upon which to develop the next generation of operating environments for the patient, surgeon, and operating team. Analysis of the suite of visions for the Operating Room of the Future reveals a broad set of goals, with a clear overall solution to create a safe environment for high-quality healthcare. The vision, although planned for the future, is based upon iteratively improving and integrating current systems, both technology and process. This must become the Operating Room of Today, which will require the enormous efforts described. An alternative future of the operating room, based upon emergence of disruptive technologies, is also presented.

IPAD products and implications for the future

NASA Technical Reports Server (NTRS)

Miller, R. E., Jr.

1980-01-01

The betterment of productivity through the improvement of product quality and the reduction of cost is addressed. Productivity improvement is sought through (1) reduction of required resources, (2) improved ask results through the management of such saved resources, (3) reduced downstream costs through manufacturing-oriented engineering, and (4) lowered risks in the making of product design decisions. The IPAD products are both hardware architecture and software distributed over a number of heterogeneous computers in this architecture. These IPAD products are described in terms of capability and engineering usefulness. The future implications of state-of-the-art IPAD hardware and software architectures are discussed in terms of their impact on the functions and on structures of organizations concerned with creating products.

Audit and feedback interventions to improve endoscopist performance: Principles and effectiveness.

PubMed

Tinmouth, Jill; Patel, Jigisha; Hilsden, Robert J; Ivers, Noah; Llovet, Diego

2016-06-01

There is considerable variation in the quality of colonoscopy, attributable in part to endoscopist performance. Audit and feedback (A&F) provides health professionals with a summary of their performance over a period of time and is a common strategy used to improve provider performance. In this review, we discuss current understanding of the mechanism of A&F and describe specific features of effective A&F. To date, trials of A&F to improve colonoscopy performance report heterogeneous results, in part because colonoscopy is a complex procedural skill but also because the quality improvement interventions were sub-optimally implemented or inadequately evaluated. Nonetheless, evidence from a wide range of literature suggests that A&F has the potential to improve endoscopist performance. We discuss future directions for research in this area and provide guidance for providers or health system planners wishing to implement A&F to address quality of colonoscopy in their practice and/or jurisdiction. Copyright © 2016 Elsevier Ltd. All rights reserved.

The importance of continuing education for transplant coordination staff.

PubMed

Tokalak, Ibrahim; Emiroğlu, Remzi; Karakayali, Hamdi; Bilgin, Nevzat; Haberal, Mehmet

2005-06-01

Continuous quality improvement activities are necessary to achieve excellence at any institution. The Başkent University Hospitals have implemented continuous in-service training programs to improve all health services provided. Also, continuing medical education programs are being instituted in organ procurement and transplantation centers. In addition to receiving basic orientation and training upon hiring, transplant coordination staff complete forms that detail their current training status, further job training needed, and other courses of interest. The information is used to monitor skill levels, to determine the success of educational programs, and to identify further education that is needed. Our aim is to improve the quality of transplant coordination activities and increase organ donation at the hospitals in our network through effective monitoring and evaluation of continuous in-service training. These training programs enhance staff members' understanding of and participation in procedures related to transplantation and improves the total quality of the transplantation process. In the near future, this training model may be used to improve the donor hospital education program in Turkey.

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.

Validation of a Quality Management Metric

DTIC Science & Technology

2000-09-01

quality management metric (QMM) was used to measure the performance of ten software managers on Department of Defense (DoD) software development programs. Informal verification and validation of the metric compared the QMM score to an overall program success score for the entire program and yielded positive correlation. The results of applying the QMM can be used to characterize the quality of software management and can serve as a template to improve software management performance. Future work includes further refining the QMM, applying the QMM scores to provide feedback

The Ohio Gestational Diabetes Postpartum Care Learning Collaborative: Development of a Quality Improvement Initiative to Improve Systems of Care for Women.

PubMed

Shellhaas, Cynthia; Conrey, Elizabeth; Crane, Dushka; Lorenz, Allison; Wapner, Andrew; Oza-Frank, Reena; Bouchard, Jo

2016-11-01

Objectives To improve clinical practice and increase postpartum visit Type 2 diabetes mellitus (T2DM) screening rates in women with a history of gestational diabetes mellitus (GDM). Methods We recruited clinical sites with at least half of pregnant patients enrolled in Medicaid to participate in an 18-month quality improvement (QI) project. To support clinical practice changes, we developed provider and patient toolkits with educational and clinical practice resources. Clinical subject-matter experts facilitated a learning network to train sites and promote discussion and learning among sites. Sites submitted data from patient chart reviews monthly for key measures that we used to provide rapid-cycle feedback. Providers were surveyed at completion regarding toolkit usefulness and satisfaction. Results Of fifteen practices recruited, twelve remained actively engaged. We disseminated more than 70 provider and 2345 patient toolkits. Documented delivery of patient education improved for timely GDM prenatal screening, reduction of future T2DM risk, smoking cessation, and family planning. Sites reported toolkits were useful and easy to use. Of women for whom postpartum data were available, 67 % had a documented postpartum visit and 33 % had a postpartum T2DM screen. Lack of information sharing between prenatal and postpartum care providers was are barriers to provision and documentation of care. Conclusions for Practice QI and toolkit resources may improve the quality of prenatal education. However, postpartum care did not reach optimal levels. Future work should focus on strategies to support coordination of care between obstetrical and primary care providers.

An Ecological Assessment of the United States Mid-Atlantic Region: A Landscape Atlas

Treesearch

K. Bruce Jones; Kurt H. Riitters; James D. Wickham; Roger D. Tankersley; Robert V. O' Neill; Deborah J. Chaloud; Elizabeth R. Smith; Anne C. Neale

1997-01-01

Environmental quality affects our health, our quality of life, the sustainability of our economies, and the futures of our children. Yet pressures from an increasing population coupled with the need for economic development and an improved standard of living often have multiple effects on our natural resources. So just as a person with a less-than-healthy lifestyle is...

Development and participant assessment of a practical quality improvement educational initiative for surgical residents.

PubMed

Sellers, Morgan M; Hanson, Kristi; Schuller, Mary; Sherman, Karen; Kelz, Rachel R; Fryer, Jonathan; DaRosa, Debra; Bilimoria, Karl Y

2013-06-01

As patient-safety and quality efforts spread throughout health care, the need for physician involvement is critical, yet structured training programs during surgical residency are still uncommon. Our objective was to develop an extended quality-improvement curriculum for surgical residents that included formal didactics and structured practical experience. Surgical trainees completed an 8-hour didactic program in quality-improvement methodology at the start of PGY3. Small teams developed practical quality-improvement projects based on needs identified during clinical experience. With the assistance of the hospital's process-improvement team and surgical faculty, residents worked through their selected projects during the following year. Residents were anonymously surveyed after their participation to assess the experience. During the first 3 years of the program, 17 residents participated, with 100% survey completion. Seven quality-improvement projects were developed, with 57% completing all DMAIC (Define, Measure, Analyze, Improve, Control) phases. Initial projects involved issues of clinical efficiency and later projects increasingly focused on clinical care questions. Residents found the experience educationally important (65%) and believed they were well equipped to lead similar initiatives in the future (70%). Based on feedback, the timeline was expanded from 12 to 24 months and changed to start in PGY2. Developing an extended curriculum using both didactic sessions and applied projects to teach residents the theory and implementation of quality improvement is possible and effective. It addresses the ACGME competencies of practice-based improvement and learning and systems-based practice. Our iterative experience during the past 3 years can serve as a guide for other programs. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Co-benefits of air quality and climate change policies on air quality of the Mediterranean

NASA Astrophysics Data System (ADS)

Pozzoli, Luca; Mert Gokturk, Ozan; Unal, Alper; Kindap, Tayfun; Janssens-Maenhout, Greet

2015-04-01

The Mediterranean basin is one of the regions of the world where significant impacts due to climate changes are predicted to occur in the future. Observations and model simulations are used to provide to the policy makers scientifically based estimates of the necessity to adjust national emission reductions needed to achieve air quality objectives in the context of a changing climate, which is not only driven by GHGs, but also by short lived climate pollutants, such as tropospheric ozone and aerosols. There is an increasing interest and need to design cost-benefit emission reduction strategies, which could improve both regional air quality and global climate change. In this study we used the WRF-CMAQ air quality modelling system to quantify the contribution of anthropogenic emissions to ozone and particulate matter concentrations in Europe and the Eastern Mediterranean and to understand how this contribution could change in different future scenarios. We have investigated four different future scenarios for year 2050 defined during the European Project CIRCE: a "business as usual" scenario (BAU) where no or just actual measures are taken into account; an "air quality" scenario (BAP) which implements the National Emission Ceiling directive 2001/81/EC member states of the European Union (EU-27); a "climate change" scenario (CC) which implements global climate policies decoupled from air pollution policies; and an "integrated air quality and climate policy" scenario (CAP) which explores the co-benefit of global climate and EU-27 air pollution policies. The BAP scenario largely decreases summer ozone concentrations over almost the entire continent, while the CC and CAP scenarios similarly determine lower decreases in summer ozone but extending all over the Mediterranean, the Middle East countries and Russia. Similar patterns are found for winter PM concentrations; BAP scenario improves pollution levels only in the Western EU countries, and the CAP scenario determines the largest PM reductions over the entire continent and the Mediterranean basin.

Do quality improvement collaboratives' educational components match the dominant learning style preferences of the participants?

PubMed

Weggelaar-Jansen, Anne Marie; van Wijngaarden, Jeroen; Slaghuis, Sarah-Sue

2015-06-20

Quality improvement collaboratives are used to improve healthcare by various organizations. Despite their popularity literature shows mixed results on their effectiveness. A quality improvement collaborative can be seen as a temporary learning organization in which knowledge about improvement themes and methods is exchanged. In this research we studied: Does the learning approach of a quality improvement collaborative match the learning styles preferences of the individual participants and how does that affect the learning process of participants? This research used a mixed methods design combining a validated learning style questionnaire with data collected in the tradition of action research methodology to study two Dutch quality improvement collaboratives. The questionnaire is based on the learning style model of Ruijters and Simons, distinguishing five learning style preferences: Acquisition of knowledge, Apperception from others, Discovery of new insights, Exercising in fictitious situations and Participation with others. The most preferred learning styles of the participants were Discovery and Participation. The learning style Acquisition was moderately preferred and Apperception and Exercising were least preferred. The educational components of the quality improvement collaboratives studied (national conferences, half-day learning sessions, faculty site visits and use of an online tool) were predominantly associated with the learning styles Acquisition and Apperception. We observed a decrease in attendance to the learning activities and non-conformance with the standardized set goals and approaches. We conclude that the participants' satisfaction with the offered learning approach changed over time. The lacking match between these learning style preferences and the learning approach in the educational components of the quality improvement collaboratives studied might be the reason why the participants felt they did not gain new insights and therefore ceased their participation in the collaborative. This study provides guidance for future organisers and participants of quality improvement collaboratives about which learning approaches will best suit the participants and enhance improvement work.

Emergency Manuals: How Quality Improvement and Implementation Science Can Enable Better Perioperative Management During Crises.

PubMed

Goldhaber-Fiebert, Sara N; Macrae, Carl

2018-03-01

How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care. Copyright © 2017 Sara N. Goldhaber-Fiebert, Carl Macrae. Published by Elsevier Inc. All rights reserved.

An Overview of Practice Facilitation Programs in Canada: Current Perspectives and Future Directions

PubMed Central

Liddy, Clare; Laferriere, Dianne; Baskerville, Bruce; Dahrouge, Simone; Knox, Lyndee; Hogg, William

2013-01-01

Practice facilitation has proven to be effective in improving the quality of primary care. A practice facilitator is a health professional, usually external to the practice, who regularly visits the practice to provide support in change management that targets improvements in the delivery of care. Our environmental scan shows that several initiatives across Canada utilize practice facilitation as a quality improvement method; however, many are conducted in isolation as there is a lack of coordinated effort, knowledge translation and dissemination in this field across the country. We recommend that investments be made in capacity building, knowledge exchange and facilitator training, and that partnership building be considered a priority in this field. PMID:23968627

Proceedings of the First National Workshop on the Global Weather Experiment: Current Achievements and Future Directions, volume 2, part 1

NASA Technical Reports Server (NTRS)

1985-01-01

Topics covered include: data systems and quality; analysis and assimilation techniques; impacts on forecasts; tropical forecasts; analysis intercomparisons; improvements in predictability; and heat sources and sinks.

Children, Radio and Television--Now and in the Future.

ERIC Educational Resources Information Center

Von Feilitzen, Cecilia; And Others

1980-01-01

Describes aspects of television and radio broadcasting in Sweden. Particular attention is given to children's programs, children's viewing patterns, the influence of TV on children, and how to improve the quality of radio and television programs. (Author/SS)

Water quality and nutrient loading in the Klamath River between Keno, Oregon and Seiad Valley, CA from 1996-1998

USGS Publications Warehouse

Campbell, Sharon G.

2001-01-01

Implementing management strategies for reservoir operations to improve water quality and reduce nutrient concentration or loading in the Klamath River study area to benefit anadromous fisheries may be difficult and expensive. However, improving the thermal regime in spring to benefit YOY salmonids may be possible as is short-term relief in late summer for oversummering species. Decreases in nutrient concentration or loading accomplished through best management practices in the water shed may allow general protection of water resources in the Klamath Basin for future needs.

Learning leadership skills in practice through quality improvement.

PubMed

Gamble, James; Vaux, Emma

2014-02-01

The development of leadership skills in doctors in training is essential to support both their professional development and the future supply of clinical leaders the NHS so desperately needs. There is, however, limited opportunity in current training programmes for trainees to learn and develop these skills, and what opportunity there is has often focused on management rather than leadership skills. Involvement in trainee-led supported quality improvement projects can teach these skills. We summarise the current limitations in leadership training and discuss how the College's 'Learning To Make a Difference' programme, and others like it, are helping to teach leadership.

[Pay close attention to the quality of life of patients and look to the future of burn rehabilitation].

PubMed

Wu, Jun; Chen, Jian

2013-04-01

After 50 years' development, a rather comprehensive burn care system has been built up in China, and it has played key roles in wound healing and salvaging victims of burn trauma. Since survival is no longer the main priority of treatment, more efforts should be made to cut down the incidence of disabilities and to improve the quality of life of the survivors. The further progress on burn rehabilitation therapies, including functional improvement, psychological rehabilitation, aesthetic recovery, and occupational and social recuperation, would bring new perspectives to our burn care system.

Urgent Call for Nursing Big Data.

PubMed

Delaney, Connie W

2016-01-01

The purpose of this panel is to expand internationally a National Action Plan for sharable and comparable nursing data for quality improvement and big data science. There is an urgent need to assure that nursing has sharable and comparable data for quality improvement and big data science. A national collaborative - Nursing Knowledge and Big Data Science includes multi-stakeholder groups focused on a National Action Plan toward implementing and using sharable and comparable nursing big data. Panelists will share accomplishments and future plans with an eye toward international collaboration. This presentation is suitable for any audience attending the NI2016 conference.

Comparison of an enhanced versus a written feedback model on the management of Medicare inpatients with venous thrombosis.

PubMed

Hayes, R; Bratzler, D; Armour, B; Moore, L; Murray, C; Stevens, B R; Radford, M; Fitzgerald, D; Elward, K; Ballard, D J

2001-03-01

A multistate randomized study conducted under the Health Care Financing Administration's (HCFA's) Health Care Quality Improvement Program (HCQIP) offered the opportunity to compare the effect of a written feedback intervention (WFI) with that of an enhanced feedback intervention (EFI) on improving the anticoagulant management of Medicare beneficiaries who present to the hospital with venous thromboembolic disease. Twenty-nine hospitals in five states were randomly assigned to receive written hospital-specific feedback (WFI) of feedback enhanced by the participation of a trained physician, quality improvement tools, and an Anticoagulant Management of Venous Thrombosis (AMVT) project liaison (EFI). Differences in the performance of five quality indicators between baseline and remeasurement were assessed. Quality managers were interviewed to determine perceptions of project implementation. No significant differences in the change from baseline to remeasurement were found between the two intervention groups. Significant improvement in one indicator and significant decline in two indicators were found for one or both groups. Yet 59% of all quality managers perceived the AMVT project as being successful to very successful, and more EFI quality managers perceived success than did WFI managers (71% versus 40%). In the majority of EFI hospitals, physician liaisons played an important role in project implementation. Study results indicated that the addition of a physician liaison, quality improvement tools, and a project liaison did not provide incremental value to hospital-specific feedback for improving quality of care. Future studies with larger sample sizes, lengthier follow-up periods, and interventions that include more of the elements shown to affect practice behavior change are needed to identify an optimal feedback model for use by external quality management organizations.

[Designing and implementation of a web-based quality monitoring system for plasma glucose measurement in multicenter population study].

PubMed

Liu, Yong; Wang, Limin; Pang, Richard; Mo, Nanxun; Hu, Yan; Deng, Qian; Hu, Zhaohui

2015-05-01

The aim of this paper is to describe the designing and implementation of a web-based plasma glucose measurement quality monitoring system to assess the analytical quality of plasma glucose measurements in multicenter population study and provide evidence for the future studies. In the chronic non-communicable disease and related factor surveillance in China, a web based quality monitoring system for plasma glucose measurement was established to conduct evaluation on plasma glucose monitoring quality and effectiveness in 302 surveillance centers, including quality control data entry, transmission and feedback. The majority of the surveillance centers met the quality requirements and passed the evaluation of reproducibility and precision of plasma glucose measurement, only a few centers required intensive training and re-assessment. In order to ensure the completeness and reliability of plasma glucose measurement in the surveillance centers, the establishment of web-based plasma glucose measurement quality control system can facilitate the identification of the qualified surveillance centers and evaluation of plasma glucose measurement quality in different regions. Communication and training are important in ensuring plasma glucose measurement quality. It is necessary to further improve this web-based plasma glucose measurement quality monitoring system in the future to reduce the method specific plasma glucose measurement bias.

A Draft Conceptual Framework of Relevant Theories to Inform Future Rigorous Research on Student Service-Learning Outcomes

ERIC Educational Resources Information Center

Whitley, Meredith A.

2014-01-01

While the quality and quantity of research on service-learning has increased considerably over the past 20 years, researchers as well as governmental and funding agencies have called for more rigor in service-learning research. One key variable in improving rigor is using relevant existing theories to improve the research. The purpose of this…

A karate program for improving self-concept and quality of life in childhood epilepsy: results of a pilot study.

PubMed

Conant, Kerry D; Morgan, Amy K; Muzykewicz, David; Clark, Derrick C; Thiele, Elizabeth A

2008-01-01

The potential cognitive and psychosocial effects of childhood epilepsy have significant implications for a child's self-image and academic achievement. This study focuses on a 10-week karate program for children and adolescents with epilepsy aimed at increasing social confidence, self-concept, and quality of life, as well as reducing parental anxiety. Eleven children (8-16 years old) and their parents participated in this questionnaire study, and complete data were available for nine of these families. Measures consisted of the Piers-Harris Children's Self-Concept Scale, the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire, and the Parental Stress Index. By parental report, significant improvement in memory function and largely positive trends in quality of life on multiple subscales were observed. By child report, intellectual self-esteem and social confidence also improved. Parental stress decreased, although not significantly, suggesting a potential benefit and indicating a role for future interventions targeting family anxiety.

Web-Based Quality Assurance Process Drives Improvements in Obstetric Ultrasound in 5 Low- and Middle-Income Countries

PubMed Central

Swanson, Jonathan O; Plotner, David; Franklin, Holly L; Swanson, David L; Lokomba Bolamba, Victor; Lokangaka, Adrien; Sayury Pineda, Irma; Figueroa, Lester; Garces, Ana; Muyodi, David; Esamai, Fabian; Kanaiza, Nancy; Mirza, Waseem; Naqvi, Farnaz; Saleem, Sarah; Mwenechanya, Musaku; Chiwila, Melody; Hamsumonde, Dorothy; McClure, Elizabeth M; Goldenberg, Robert L; Nathan, Robert O

2016-01-01

ABSTRACT High quality is important in medical imaging, yet in many geographic areas, highly skilled sonographers are in short supply. Advances in Internet capacity along with the development of reliable portable ultrasounds have created an opportunity to provide centralized remote quality assurance (QA) for ultrasound exams performed at rural sites worldwide. We sought to harness these advances by developing a web-based tool to facilitate QA activities for newly trained sonographers who were taking part in a cluster randomized trial investigating the role of limited obstetric ultrasound to improve pregnancy outcomes in 5 low- and middle-income countries. We were challenged by connectivity issues, by country-specific needs for website usability, and by the overall need for a high-throughput system. After systematically addressing these needs, the resulting QA website helped drive ultrasound quality improvement across all 5 countries. It now offers the potential for adoption by future ultrasound- or imaging-based global health initiatives. PMID:28031304

Energy Efficient Image/Video Data Transmission on Commercial Multi-Core Processors

PubMed Central

Lee, Sungju; Kim, Heegon; Chung, Yongwha; Park, Daihee

2012-01-01

In transmitting image/video data over Video Sensor Networks (VSNs), energy consumption must be minimized while maintaining high image/video quality. Although image/video compression is well known for its efficiency and usefulness in VSNs, the excessive costs associated with encoding computation and complexity still hinder its adoption for practical use. However, it is anticipated that high-performance handheld multi-core devices will be used as VSN processing nodes in the near future. In this paper, we propose a way to improve the energy efficiency of image and video compression with multi-core processors while maintaining the image/video quality. We improve the compression efficiency at the algorithmic level or derive the optimal parameters for the combination of a machine and compression based on the tradeoff between the energy consumption and the image/video quality. Based on experimental results, we confirm that the proposed approach can improve the energy efficiency of the straightforward approach by a factor of 2∼5 without compromising image/video quality. PMID:23202181

Water quality of the Fox River and four tributaries in Green Lake County, Wisconsin, 2001-2002

USGS Publications Warehouse

Graczyk, David J.; Garn, Herbert S.

2003-01-01

The purpose of this report is to summarize the water-quality data collected on the Fox River and its tributaries in Green Lake County, Wisconsin, from November 2001 through August 2002. The goals of the project were to (1) determine the current water quality of the Fox River and selected main tributaries in Green Lake County, (2) assess the spacial variation of the water-quality conditions of the main Fox River reach, and (3) build on the quantitative data base so that future monitoring can help detect and evaluate improving or declining water-quality conditions objectively.

[Fast Detection of Camellia Sinensis Growth Process and Tea Quality Informations with Spectral Technology: A Review].

PubMed

Peng, Ji-yu; Song, Xing-lin; Liu, Fei; Bao, Yi-dan; He, Yong

2016-03-01

The research achievements and trends of spectral technology in fast detection of Camellia sinensis growth process information and tea quality information were being reviewed. Spectral technology is a kind of fast, nondestructive, efficient detection technology, which mainly contains infrared spectroscopy, fluorescence spectroscopy, Raman spectroscopy and mass spectroscopy. The rapid detection of Camellia sinensis growth process information and tea quality is helpful to realize the informatization and automation of tea production and ensure the tea quality and safety. This paper provides a review on its applications containing the detection of tea (Camellia sinensis) growing status(nitrogen, chlorophyll, diseases and insect pest), the discrimination of tea varieties, the grade discrimination of tea, the detection of tea internal quality (catechins, total polyphenols, caffeine, amino acid, pesticide residual and so on), the quality evaluation of tea beverage and tea by-product, the machinery of tea quality determination and discrimination. This paper briefly introduces the trends of the technology of the determination of tea growth process information, sensor and industrial application. In conclusion, spectral technology showed high potential to detect Camellia sinensis growth process information, to predict tea internal quality and to classify tea varieties and grades. Suitable chemometrics and preprocessing methods is helpful to improve the performance of the model and get rid of redundancy, which provides the possibility to develop the portable machinery. Future work is to develop the portable machinery and on-line detection system is recommended to improve the further application. The application and research achievement of spectral technology concerning about tea were outlined in this paper for the first time, which contained Camellia sinensis growth, tea production, the quality and safety of tea and by-produce and so on, as well as some problems to be solved and its future applicability in modern tea industrial.

Geospatial intelligence and visual classification of environmentally observed species in the Future Internet

NASA Astrophysics Data System (ADS)

Arbab-Zavar, B.; Chakravarthy, A.; Sabeur, Z. A.

2012-04-01

The rapid development of advanced smart communication tools with good quality and resolution video cameras, audio and GPS devices in the last few years shall lead to profound impacts on the way future environmental observations are conducted and accessed by communities. The resulting large scale interconnections of these "Future Internet Things" form a large environmental sensing network which will generate large volumes of quality environmental observations and at highly localised spatial scales. This enablement in environmental sensing at local scales will be of great importance to contribute in the study of fauna and flora in the near future, particularly on the effect of climate change on biodiversity in various regions of Europe and beyond. The Future Internet could also potentially become the de facto information space to provide participative real-time sensing by communities and improve our situation awarness of the effect of climate on local environments. In the ENVIROFI(2011-2013) Usage Area project in the FP7 FI-PPP programme, a set of requirements for specific (and generic) enablers is achieved with the potential establishement of participating community observatories of the future. In particular, the specific enablement of interest concerns the building of future interoperable services for the management of environmental data intelligently with tagged contextual geo-spatial information generated by multiple operators in communities (Using smart phones). The classification of observed species in the resulting images is achieved with structured data pre-processing, semantic enrichement using contextual geospatial information, and high level fusion with controlled uncertainty estimations. The returned identification of species is further improved using future ground truth corrections and learning by the specific enablers.

Post-examination interpretation of objective test data: monitoring and improving the quality of high-stakes examinations--a commentary on two AMEE Guides.

PubMed

Tavakol, Mohsen; Dennick, Reg

2012-01-01

As great emphasis is rightly placed upon the importance of assessment to judge the quality of our future healthcare professionals, it is appropriate not only to choose the most appropriate assessment method, but to continually monitor the quality of the tests themselves, in a hope that we may continually improve the process. This article stresses the importance of quality control mechanisms in the exam cycle and briefly outlines some of the key psychometric concepts including reliability measures, factor analysis, generalisability theory and item response theory. The importance of such analyses for the standard setting procedures is emphasised. This article also accompanies two new AMEE Guides in Medical Education (Tavakol M, Dennick R. Post-examination Analysis of Objective Tests: AMEE Guide No. 54 and Tavakol M, Dennick R. 2012. Post examination analysis of objective test data: Monitoring and improving the quality of high stakes examinations: AMEE Guide No. 66) which provide the reader with practical examples of analysis and interpretation, in order to help develop valid and reliable tests.

Total quality management: It works for aerospace information services

NASA Technical Reports Server (NTRS)

Erwin, James; Eberline, Carl; Colquitt, Wanda

1993-01-01

Today we are in the midst of information and 'total quality' revolutions. At the NASA STI Program's Center for AeroSpace Information (CASI), we are focused on using continuous improvements techniques to enrich today's services and products and to ensure that tomorrow's technology supports the TQM-based improvement of future STI program products and services. The Continuous Improvements Program at CASI is the foundation for Total Quality Management in products and services. The focus is customer-driven; its goal, to identify processes and procedures that can be improved and new technologies that can be integrated with the processes to gain efficiencies, provide effectiveness, and promote customer satisfaction. This Program seeks to establish quality through an iterative defect prevention approach that is based on the incorporation of standards and measurements into the processing cycle. Four projects are described that utilize cross-functional, problem-solving teams for identifying requirements and defining tasks and task standards, management participation, attention to critical processes, and measurable long-term goals. The implementation of these projects provides the customer with measurably improved access to information that is provided through several channels: the NASA STI Database, document requests for microfiche and hardcopy, and the Centralized Help Desk.

Improving the Quality of Basic Education for the Future Youth of Yemen Post Arab Spring. Global Economy & Development. Working Paper 59

ERIC Educational Resources Information Center

Yuki, Takako; Kameyama, Yuriko

2013-01-01

This paper looks at the issue of the quality of education in Yemen. It uses micro-data from TIMSS and from surveys conducted in underserved rural areas, as well as macro-level policy information from the System Assessment for Better Education Results (SABER) database. The analysis indicates that the availability of teachers and resources at…

Improving the quality of survivorship for older adults with cancer.

PubMed

Mohile, Supriya G; Hurria, Arti; Cohen, Harvey J; Rowland, Julia H; Leach, Corinne R; Arora, Neeraj K; Canin, Beverly; Muss, Hyman B; Magnuson, Allison; Flannery, Marie; Lowenstein, Lisa; Allore, Heather G; Mustian, Karen M; Demark-Wahnefried, Wendy; Extermann, Martine; Ferrell, Betty; Inouye, Sharon K; Studenski, Stephanie A; Dale, William

2016-08-15

In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging through a U13 grant, convened a conference to identify research priorities to help design and implement intervention studies to improve the quality of life and survivorship of older, frailer adults with cancer. Conference attendees included researchers with multidisciplinary expertise and advocates. It was concluded that future intervention trials for older adults with cancer should: 1) rigorously test interventions to prevent the decline of or improve health status, especially interventions focused on optimizing physical performance, nutritional status, and cognition while undergoing cancer treatment; 2) use standardized care plans based on geriatric assessment findings to guide targeted interventions; and 3) incorporate the principles of geriatrics into survivorship care plans. Also highlighted was the need to integrate the expertise of interdisciplinary team members into geriatric oncology research, improve funding mechanisms to support geriatric oncology research, and disseminate high-impact results to the research and clinical community. In conjunction with the 2 prior U13 meetings, this conference provided the framework for future research to improve the evidence base for the clinical care of older adults with cancer. Cancer 2016;122:2459-68. © 2016 American Cancer Society. © 2016 American Cancer Society.

Systematic reviews addressing microsurgical head and neck reconstruction.

PubMed

Momeni, Arash; Jacobson, Joshua Y; Lee, Gordon K

2015-01-01

Systematic reviews frequently form the basis for clinical decision making and guideline development. Yet, the quality of systematic reviews has been variable, thus raising concerns about the validity of their conclusions. In the current study, a quality analysis of systematic reviews was performed, addressing microsurgical head and neck reconstruction. A PubMed search was performed to identify all systematic reviews published up to and including December 2012 in 12 surgical journals. Two authors independently reviewed the literature and extracted data from the included reviews. Discrepancies were resolved by consensus. Quality assessment was performed using AMSTAR. The initial search retrieved 1020 articles. After screening titles and abstracts, 987 articles were excluded. Full-text review of the remaining 33 articles resulted in further exclusion of 18 articles, leaving 15 systematic reviews for final analysis. A marked increase in the number of published systematic reviews over time was noted (P = 0.07). The median AMSTAR score was 5, thus reflecting a "fair" quality. No evidence for improvement in methodological quality over time was noted. The trend to publish more systematic reviews in microsurgical head and neck reconstruction is encouraging. However, efforts are indicated to improve the methodological quality of systematic reviews. Familiarity with criteria of methodological quality is critical to ensure future improvements in the quality of systematic reviews conducted in microsurgery.

State “Technical Assistance Programs” for nursing home quality improvement: variations and potential implications

PubMed Central

Li, Yue; Spector, Williams D.; Glance, Laurent G.; Mukamel, Dana B.

2013-01-01

Context To improve nursing home quality, many states developed “Technical Assistance Programs” that provide on-site consultation and training for nursing facility staff. Methods We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. Results As of 2010, 17 states have developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. Conclusion State “Technical Assistance Programs” for nursing homes varies in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives. PMID:23216345

Mobile Apps for the Dietary Approaches to Stop Hypertension (DASH): App Quality Evaluation.

PubMed

DiFilippo, Kristen Nicole; Huang, Wen-Hao David; Chapman-Novakofski, Karen M

2018-03-08

To identify the availability and quality of apps supporting Dietary Approaches to Stop Hypertension (DASH) education. The researchers identified DASH apps over 1 month in the Apple App Store. Five registered dietitians used the App Quality Evaluation (AQEL) to evaluate app quality on 7 domains. Interrater reliability was tested using intraclass correlations. One paid and 3 free DASH apps were evaluated. Interrater reliability (n = 5) was good for 3 apps and fair for 1 app. Only the paid app scored high (>8 of 10) on most AQEL quality domains. Based on lower quality found among the included free apps, further development of free apps is warranted. Whereas the paid app may be useful in supporting DASH education, future research should determine whether improvements in clinical outcomes are found and whether this app should be improved to address AQEL domains better. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Elucidating the Mechanisms of the Tomato ovate Mutation in Regulating Fruit Quality Using Proteomics Analysis.

PubMed

Liu, Juhua; Zhang, Jing; Miao, Hongxia; Jia, Caihong; Wang, Jingyi; Xu, Biyu; Jin, Zhiqiang

2017-11-22

The ovate mutation has frequently been used to study changes in fruit shape but not fruit quality. A deterioration in fruit quality associated with the ovate mutation was discovered in this study. To elucidate how ovate influences the quality of fruit, we performed a proteomics analysis of the fruits of the ovate mutant (LA3543) and wild-type ("Ailsa Craig", LA2838A) using tandem mass tag analysis. The results indicated that the ovate mutation significantly influences fruit quality in a number of ways, including by reducing the expression of 1-aminocyclopropane-1-carboxylic acid oxidase 3 (ACO3) in ethylene biosynthesis, improving firmness by reducing the amount of pectinesterase and polygalacturonase, reducing sugar accumulation by downregulating the abundance of mannan endo-1,4-β-mannosidase 4, β-galactosidase, and β-amylase, and reducing the malic acid content by downregulating the accumulation of malic enzymes and malate synthase. These findings could inform future improvements in fruit quality.

How the national healthcare quality and disparities reports can catalyze quality improvement.

PubMed

McNeill, Dwight; Kelley, Ed

2005-03-01

The purpose of the National Reports on Healthcare Quality and Disparities is to enhance awareness of quality and health care disparities, track progress, understand variations, and catalyze improvements in health care. The objective of this paper is to propose a model that will facilitate a user's progression from knowledge to action and to show how the reports, its data warehouse, associated products, and Agency for Healthcare Research and Quality resources are integrated and focused on a comprehensive campaign to improve health care quality. The design of the paper is to present a conceptual model and to show how implementation strategies for the reports fit the model. The authors propose a quality improvement supply chain model to help elucidate the links of the process, corresponding developmental stages that potential users need to master and progress through, and "just-in-time" supply chain inputs at each of the corresponding stages, and populate the model with examples. The traditional ways of disseminating knowledge derived from science through reports and conferences are inadequate to the humbling need for vast improvements in the US health care system. Our model suggests the need for a wide variety of information, packaged in a diverse ways, and delivered just in time and on demand. It encourages the alignment of decision makers and researchers, along with information intermediaries and innovation brokers, to make the information production cycle more efficient and effective. Future iterations of the reports will improve relevance, meaning, and distribution of information to facilitate its uptake by potential users.

Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004-2012.

PubMed

Hamel, Donald J; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T; Okonkwo, Prosper; Kanki, Phyllis J

From 2004-2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President's Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings.

Appraising the methodological quality of the clinical practice guideline for diabetes mellitus using the AGREE II instrument: a methodological evaluation.

PubMed

Radwan, Mahmoud; Akbari Sari, Ali; Rashidian, Arash; Takian, Amirhossein; Abou-Dagga, Sanaa; Elsous, Aymen

2017-02-01

To evaluate the methodological quality of the Palestinian Clinical Practice Guideline for Diabetes Mellitus using the Translated Arabic Version of the AGREE II. Methodological evaluation. A cross-cultural adaptation framework was followed to translate and develop a standardised Translated Arabic Version of the AGREE II. Palestinian Primary Healthcare Centres. Sixteen appraisers independently evaluated the Clinical Practice Guideline for Diabetes Mellitus using the Translated Arabic Version of the AGREE II. Methodological quality of diabetic guideline. The Translated Arabic Version of the AGREE II showed an acceptable reliability and validity. Internal consistency ranged between 0.67 and 0.88 (Cronbach's α). Intra-class coefficient among appraisers ranged between 0.56 and 0.88. The quality of this guideline is low. Both domains 'Scope and Purpose' and 'Clarity of Presentation' had the highest quality scores (66.7% and 61.5%, respectively), whereas the scores for 'Applicability', 'Stakeholder Involvement', 'Rigour of Development' and 'Editorial Independence' were the lowest (27%, 35%, 36.5%, and 40%, respectively). The findings suggest that the quality of this Clinical Practice Guideline is disappointingly low. To improve the quality of current and future guidelines, the AGREE II instrument is extremely recommended to be incorporated as a gold standard for developing, evaluating or updating the Palestinian Clinical Practice Guidelines. Future guidelines can be improved by setting specific strategies to overcome implementation barriers with respect to economic considerations, engaging of all relevant end-users and patients, ensuring a rigorous methodology for searching, selecting and synthesising the evidences and recommendations, and addressing potential conflict of interests within the development group.

The Quality of Randomized Controlled Trials in Pediatric Orthopaedics: Are We Improving?

PubMed

Dodwell, Emily; Dua, Shiv; Dulai, Sukhdeep K; Astone, Kristina; Mulpuri, Kishore

2015-01-01

The quality of randomized controlled trials (RCTs) in orthopaedics is a topic of considerable importance, as RCTs play a major role in guiding clinical practice. The quality of RCTs published between 1995 and 2005 has previously been documented. The purpose of the current study was to assess and describe the quality of pediatric orthopaedic RCTs published from 2005 to 2012, by identifying study characteristics associated with higher quality and outlining areas for improvement. A standardized literature search was used to identify pediatric orthopaedic RCTs published in 7 well-recognized journals between September 2005 and July 2012 inclusive. The Detsky Quality Assessment Scale and the CONSORT checklist for Non-Pharmacologic Trials were used to assess the quality of the RCTs. Scores for the Detsky and CONSORT were calculated by 2 independent blinded orthopaedic surgeon reviewers with epidemiologic training. Forty RCTs were included in this analysis. The mean percentage score on the Detsky quality scale was 67%. Sixteen (40%) of the articles satisfied the threshold for a satisfactory level of methodological quality (Detsky >75%). Twenty-five (63%) of these studies were negative studies, concluding no difference between treatment arms. In 52% of the negative studies, an a priori sample size analysis was absent, and 28% were self-described as underpowered. In multiple variable regression analysis, only working with a statistician was significantly associated with higher Detsky percentage scores (P=0.01). There is a trend for improving quality in pediatric orthopaedic RCTs. Compared with past reports, the mean Detsky score improved from 53% to 67%, and the proportion meeting an acceptable level of quality improved from 19% to 40%. One of the most concerning findings of this study was the lack of attention to sample size and power analysis, and the potential for underpowered studies. Ongoing efforts are necessary to improve the conduct and reporting of clinical trials in pediatric orthopaedics. Pediatric orthopaedic surgeons, JPO, and POSNA are working toward improving levels of quality in pediatric orthopaedic research. This paper highlights progress that has been made, and addresses some high-yield areas for future improvement.

The quality encounter between purchasers and providers: what to ask and how to answer.

PubMed

Pine, M

1993-01-01

It is not easy to lay prejudices aside, to find and face the facts, and to let the chips fall where they may. There is no need to wait for improvements in technology before beginning to use outcomes monitoring to guide the business exchange between purchasers and providers. Although future technological improvements will greatly improve the capacity to use objective data to differentiate among providers and to identify strengths and weaknesses within a health care organization, reasonable methods are available today to undertake these important tasks. All that is needed is the courage and willingness to embrace them. The future belongs to purchaser and provider organizations that are willing to seek enlightenment rather than blame.

Point-of-View Recording Devices for Intraoperative Neurosurgical Video Capture.

PubMed

Porras, Jose L; Khalid, Syed; Root, Brandon K; Khan, Imad S; Singer, Robert J

2016-01-01

The ability to record and stream neurosurgery is an unprecedented opportunity to further research, medical education, and quality improvement. Here, we appraise the ease of implementation of existing point-of-view devices when capturing and sharing procedures from the neurosurgical operating room and detail their potential utility in this context. Our neurosurgical team tested and critically evaluated features of the Google Glass and Panasonic HX-A500 cameras, including ergonomics, media quality, and media sharing in both the operating theater and the angiography suite. Existing devices boast several features that facilitate live recording and streaming of neurosurgical procedures. Given that their primary application is not intended for the surgical environment, we identified a number of concrete, yet improvable, limitations. The present study suggests that neurosurgical video capture and live streaming represents an opportunity to contribute to research, education, and quality improvement. Despite this promise, shortcomings render existing devices impractical for serious consideration. We describe the features that future recording platforms should possess to improve upon existing technology.

Research and demonstration to improve air quality for the U.S. animal feeding operations in the 21st century - a critical review.

PubMed

Ni, Ji-Qin

2015-05-01

There was an increasing interest in reducing production and emission of air pollutants to improve air quality for animal feeding operations (AFOs) in the U.S. in the 21st century. Research was focused on identification, quantification, characterization, and modeling of air pollutions; effects of emissions; and methodologies and technologies for scientific research and pollution control. Mitigation effects were on pre-excretion, pre-release, pre-emission, and post-emission. More emphasis was given on reducing pollutant emissions than improving indoor air quality. Research and demonstrations were generally continuation and improvement of previous efforts. Most demonstrated technologies were still in a limited scale of application. Future efforts are needed in many fundamental and applied research areas. Advancement in instrumentation, computer technology, and biological sciences and genetic engineering is critical to bring major changes in this area. Development in research and demonstration will depend on the actual political, economic, and environmental situations. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Use of Regulatory Air Quality Models to Develop Successful Ozone Attainment Strategies

NASA Astrophysics Data System (ADS)

Canty, T. P.; Salawitch, R. J.; Dickerson, R. R.; Ring, A.; Goldberg, D. L.; He, H.; Anderson, D. C.; Vinciguerra, T.

2015-12-01

The Environmental Protection Agency (EPA) recently proposed lowering the 8-hr ozone standard to between 65-70 ppb. Not all regions of the U.S. are in attainment of the current 75 ppb standard and it is expected that many regions currently in attainment will not meet the future, lower surface ozone standard. Ozone production is a nonlinear function of emissions, biological processes, and weather. Federal and state agencies rely on regulatory air quality models such as the Community Multi-Scale Air Quality (CMAQ) model and Comprehensive Air Quality Model with Extensions (CAMx) to test ozone precursor emission reduction strategies that will bring states into compliance with the National Ambient Air Quality Standards (NAAQS). We will describe various model scenarios that simulate how future limits on emission of ozone precursors (i.e. NOx and VOCs) from sources such as power plants and vehicles will affect air quality. These scenarios are currently being developed by states required to submit a State Implementation Plan to the EPA. Projections from these future case scenarios suggest that strategies intended to control local ozone may also bring upwind states into attainment of the new NAAQS. Ground based, aircraft, and satellite observations are used to ensure that air quality models accurately represent photochemical processes within the troposphere. We will highlight some of the improvements made to the CMAQ and CAMx model framework based on our analysis of NASA observations obtained by the OMI instrument on the Aura satellite and by the DISCOVER-AQ field campaign.

Commentary: quality of care and cost containment are the hospital-based ambulatory surgery challenges for the future.

PubMed

Frezza, E E; Girnys, R P; Silich, R J; Coppa, G F

2000-01-01

Cost containment and quality of care represent the most important objectives of all health care professionals. Because of its progressive growth over the past decade, ambulatory surgery has become an area where these 2 issues need to be addressed. The goal of this paper is to discuss the economic and quality of care challenges faced by hospitals as they strive to become competitive in the 21st century. The quality of care in ambulatory surgery has been improving because of multidisciplinary activities. Hospitals tend to hire the staff on the basis of their expertise in certain areas, and those personnel do not have to cover other hospital roles. Moreover, the hospital staff is able to seek information at any time from coworkers in other areas of specialty. Ambulatory surgery in a hospital offers advantages, such as multiple operating rooms, multiple skilled health care providers, and the ability to stay overnight if needed. The consolidation of supplies makes it easier to contract for a better price. Aggressive contract negotiations and implementation of cost-effective and cost-efficient strategies are the keys to success in the future. Quality improvement (QI) initiatives and quality of care (QC) indicators need to be developed to address various problems in the ambulatory surgery setting such as unnecessary admissions, inadequate staffing, efficient operating room (OR) utilization, quality of care, and assessment outcome. These initiatives should be addressed at regular meetings where opportunities to improve the ambulatory services are discussed. The number of ambulatory surgery procedures performed each year will continue to increase, although perhaps not at the rate we experienced in the past. Procedures that once were performed in an inpatient setting can now be accomplished on an outpatient basis or even in the physician's office. We will continue to see this shift of volume as technologic advancements and anesthetic agents allow more complex procedures to be performed on an outpatient basis.

Short-Term Effect of Two Semi-Occluded Vocal Tract Training Programs on the Vocal Quality of Future Occupational Voice Users: "Resonant Voice Training Using Nasal Consonants" Versus "Straw Phonation".

PubMed

Meerschman, Iris; Van Lierde, Kristiane; Peeters, Karen; Meersman, Eline; Claeys, Sofie; D'haeseleer, Evelien

2017-09-18

The purpose of this study was to determine the short-term effect of 2 semi-occluded vocal tract training programs, "resonant voice training using nasal consonants" versus "straw phonation," on the vocal quality of vocally healthy future occupational voice users. A multigroup pretest-posttest randomized control group design was used. Thirty healthy speech-language pathology students with a mean age of 19 years (range: 17-22 years) were randomly assigned into a resonant voice training group (practicing resonant exercises across 6 weeks, n = 10), a straw phonation group (practicing straw phonation across 6 weeks, n = 10), or a control group (receiving no voice training, n = 10). A voice assessment protocol consisting of both subjective (questionnaire, participant's self-report, auditory-perceptual evaluation) and objective (maximum performance task, aerodynamic assessment, voice range profile, acoustic analysis, acoustic voice quality index, dysphonia severity index) measurements and determinations was used to evaluate the participants' voice pre- and posttraining. Groups were compared over time using linear mixed models and generalized linear mixed models. Within-group effects of time were determined using post hoc pairwise comparisons. No significant time × group interactions were found for any of the outcome measures, indicating no differences in evolution over time among the 3 groups. Within-group effects of time showed a significant improvement in dysphonia severity index in the resonant voice training group, and a significant improvement in the intensity range in the straw phonation group. Results suggest that the semi-occluded vocal tract training programs using resonant voice training and straw phonation may have a positive impact on the vocal quality and vocal capacities of future occupational voice users. The resonant voice training caused an improved dysphonia severity index, and the straw phonation training caused an expansion of the intensity range in this population.

Predictors of self-rated health: a 12-month prospective study of IT and media workers.

PubMed

Hasson, Dan; Arnetz, Bengt B; Theorell, Töres; Anderberg, Ulla Maria

2006-07-31

The aim of the present study was to determine health-related risk and salutogenic factors and to use these to construct prediction models for future self-rated health (SRH), i.e. find possible characteristics predicting individuals improving or worsening in SRH over time (0-12 months). A prospective study was conducted with measurements (physiological markers and self-ratings) at 0, 6 and 12 months, involving 303 employees (187 men and 116 women, age 23-64) from four information technology and two media companies. There were a multitude of statistically significant cross-sectional correlations (Spearman's Rho) between SRH and other self-ratings as well as physiological markers. Predictors of future SRH were baseline ratings of SRH, self-esteem and social support (logistic regression), and SRH, sleep quality and sense of coherence (linear regression). The results of the present study indicate that baseline SRH and other self-ratings are predictive of future SRH. It is cautiously implied that SRH, self-esteem, social support, sleep quality and sense of coherence might be predictors of future SRH and therefore possibly also of various future health outcomes.

Quality Measures in Stroke

PubMed Central

Poisson, Sharon N.; Josephson, S. Andrew

2011-01-01

Stroke is a major public health burden, and accounts for many hospitalizations each year. Due to gaps in practice and recommended guidelines, there has been a recent push toward implementing quality measures to be used for improving patient care, comparing institutions, as well as for rewarding or penalizing physicians through pay-for-performance. This article reviews the major organizations involved in implementing quality metrics for stroke, and the 10 major metrics currently being tracked. We also discuss possible future metrics and the implications of public reporting and using metrics for pay-for-performance. PMID:23983840

NOAA Testbed and Proving Ground Workshop 2012

Science.gov Websites

Goals: Communicate results and future directions for individual testbeds and discuss broader cross theme of "intense precipitation" Identify best practices, understand and discuss improvements . Privacy Policy | FOIA | Information Quality | Disclaimer | Commerce.gov | USA.gov | Ready.gov | Contact

Report: EPA Has Developed Guidance for Disaster Debris but Has Limited Knowledge of State Preparedness

EPA Pesticide Factsheets

Report #16-P-0219, June 29, 2016. The EPA can reduce the risk of future unsafe debris disposal practices by improving its understanding and awareness of the quality and completeness of state disaster debris management plans.

IMPROVE AND APPLY CHEMICAL MECHANISMS FOR DEVELOPING OZONE CONTROL STRATEGIES

EPA Science Inventory

Air quality models that realistically describe the formation of ozone, air toxics, and other pollutants are needed by EPA and state agencies to predict current and future concentrations of these pollutants and develop ways to decrease their concentrations below harmful levels. ...

Portal Vein Embolization: State-of-the-Art Technique and Options to Improve Liver Hypertrophy.

PubMed

Huang, Steven Y; Aloia, Thomas A

2017-12-01

Portal vein embolization (PVE) is associated with a high technical and clinical success rate for induction of future liver remnant hypertrophy prior to surgical resection. The degree of hypertrophy is variable and depends on multiple factors, including technical aspects of the procedure and underlying chronic liver disease. For patients with insufficient liver volume following PVE, adjunctive techniques, such as intra-portal administration of stem cells, dietary supplementation, transarterial embolization, and hepatic vein embolization, are available. Our purpose is to review the state-of-the-art technique associated with high-quality PVE and to discuss options to improve hypertrophy of the future liver remnant.

Quantifying the effect of air quality control measures during the 2010 Commonwealth Games at Delhi, India

NASA Astrophysics Data System (ADS)

Beig, Gufran; Chate, Dilip M.; Ghude, Sachin. D.; Mahajan, A. S.; Srinivas, R.; Ali, K.; Sahu, S. K.; Parkhi, N.; Surendran, D.; Trimbake, H. R.

2013-12-01

In 2010, the XIX Commonwealth Games (CWG-2010) were held in India for the first time at Delhi and involved 71 commonwealth nations and dependencies with more than 6000 athletes participating in 272 events. This was the largest international multi-sport event to be staged in India and strict emission controls were imposed during the games in order to ensure improved air quality for the participating athletes as a significant portion of the population in Delhi is regularly exposed to elevated levels of pollution. The air quality control measures ranged from vehicular and traffic controls to relocation of factories and reduction of power plant emissions. In order to understand the effects of these policy induced control measures, a network of air quality and weather monitoring stations was set-up across different areas in Delhi under the Government of India's System of Air quality Forecasting And Research (SAFAR) project. Simultaneous measurements of aerosols, reactive trace gases (e.g. NOx, O3, CO) and meteorological parameters were made before, during and after CWG-2010. Contrary to expectations, the emission controls implemented were not sufficient to reduce the pollutants, instead in some cases, causing an increase. The measured pollutants regularly exceeded the National Ambient Air Quality limits over the games period. The reasons for this increase are attributed to an underestimation of the required control measures, which resulted in inadequate planning. The results indicate that any future air quality control measures need to be well planned and strictly imposed in order to improve the air quality in Delhi, which affects a large population and is deteriorating rapidly. Thus, the presence of systematic high resolution data and realistic emission inventories through networks such as SAFAR will be directly useful for the future.

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.

Implementation and results of an integrated data quality assurance protocol in a randomized controlled trial in Uttar Pradesh, India.

PubMed

Gass, Jonathon D; Misra, Anamika; Yadav, Mahendra Nath Singh; Sana, Fatima; Singh, Chetna; Mankar, Anup; Neal, Brandon J; Fisher-Bowman, Jennifer; Maisonneuve, Jenny; Delaney, Megan Marx; Kumar, Krishan; Singh, Vinay Pratap; Sharma, Narender; Gawande, Atul; Semrau, Katherine; Hirschhorn, Lisa R

2017-09-07

There are few published standards or methodological guidelines for integrating Data Quality Assurance (DQA) protocols into large-scale health systems research trials, especially in resource-limited settings. The BetterBirth Trial is a matched-pair, cluster-randomized controlled trial (RCT) of the BetterBirth Program, which seeks to improve quality of facility-based deliveries and reduce 7-day maternal and neonatal mortality and maternal morbidity in Uttar Pradesh, India. In the trial, over 6300 deliveries were observed and over 153,000 mother-baby pairs across 120 study sites were followed to assess health outcomes. We designed and implemented a robust and integrated DQA system to sustain high-quality data throughout the trial. We designed the Data Quality Monitoring and Improvement System (DQMIS) to reinforce six dimensions of data quality: accuracy, reliability, timeliness, completeness, precision, and integrity. The DQMIS was comprised of five functional components: 1) a monitoring and evaluation team to support the system; 2) a DQA protocol, including data collection audits and targets, rapid data feedback, and supportive supervision; 3) training; 4) standard operating procedures for data collection; and 5) an electronic data collection and reporting system. Routine audits by supervisors included double data entry, simultaneous delivery observations, and review of recorded calls to patients. Data feedback reports identified errors automatically, facilitating supportive supervision through a continuous quality improvement model. The five functional components of the DQMIS successfully reinforced data reliability, timeliness, completeness, precision, and integrity. The DQMIS also resulted in 98.33% accuracy across all data collection activities in the trial. All data collection activities demonstrated improvement in accuracy throughout implementation. Data collectors demonstrated a statistically significant (p = 0.0004) increase in accuracy throughout consecutive audits. The DQMIS was successful, despite an increase from 20 to 130 data collectors. In the absence of widely disseminated data quality methods and standards for large RCT interventions in limited-resource settings, we developed an integrated DQA system, combining auditing, rapid data feedback, and supportive supervision, which ensured high-quality data and could serve as a model for future health systems research trials. Future efforts should focus on standardization of DQA processes for health systems research. ClinicalTrials.gov identifier, NCT02148952 . Registered on 13 February 2014.

An Ineffective Preparation? The Scarce Effect in Primary School Principals' Practices of School Leadership Preparation and Training in Seven Countries in Latin America

ERIC Educational Resources Information Center

Weinstein, José; Azar, Ariel; Flessa, Joseph

2018-01-01

Latin American educational policy has relied on the assumption that better preparation can help school leaders improve their professional performance, thus improving quality of schools. Training programs for present or future school leaders have proliferated in the region, often publicly financed, but without enough evidence of their impact. Using…

Update on Standard Operating Procedures in Preclinical Research for DMD and SMA Report of TREAT-NMD Alliance Workshop, Schiphol Airport, 26 April 2015, The Netherlands.

PubMed

van Putten, Maaike; Aartsma-Rus, Annemieke; Grounds, Miranda D; Kornegay, Joe N; Mayhew, Anna; Gillingwater, Thomas H; Takeda, Shin'ichi; Rüegg, Markus A; De Luca, Annamaria; Nagaraju, Kanneboyina; Willmann, Raffaella

A workshop took place in 2015 to follow up TREAT-NMD activities dedicated to improving quality in the preclinical phase of drug development for neuromuscular diseases. In particular, this workshop adressed necessary future steps regarding common standard experimental protocols and the issue of improving the translatability of preclinical efficacy studies.

CSTT Update: Fuel Quality Analyzer

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

Brosha, Eric L.; Lujan, Roger W.; Mukundan, Rangachary

These are slides from a presentation. The following topics are covered: project background (scope and approach), developing the prototype (timeline), update on intellectual property, analyzer comparisons (improving humidification, stabilizing the baseline, applying clean-up strategy, impact of ionomer content and improving clean-up), proposed operating mode, considerations for testing in real-world conditions (Gen 1 analyzer electronics development, testing partner identified, field trial planning), summary, and future work.

Using Classroom Management to Improve Preschoolers' Social and Emotional Skills: Final Impact and Implementation Findings from the Foundations of Learning Demonstration in Newark and Chicago

ERIC Educational Resources Information Center

Morris, Pamela; Lloyd, Chrishana M.; Millenky, Megan; Leacock, Nicole; Raver, C. Cybele; Bangser, Michael

2013-01-01

Investments in early childhood programs are widely viewed as a promising strategy to improve the future educational achievement of disadvantaged young children. However, it can be difficult for teachers to maintain program quality if children in the classroom display challenging behaviors. For example, when some children act out aggressively or…

CAD/CAM in dentistry: a historical perspective and view of the future.

PubMed

Rekow, E D

1992-04-01

What can we look forward too? Lots of fun with new CAD/CAM systems that will enhance dentistry, providing quality restorations quickly. The evolution of an array of new versions of already available systems as well as altogether new systems will provide improved quality, expanded capabilities, and increasing user friendliness. And new materials will be more esthetic, wear more nearly like enamel, and strong enough for full crowns and bridges. We can also look forward to lots of change. Because of the cost of CAD/CAM systems, many clinicians are likely to collaborate by sharing a single system. Laboratories and clinicians may collaborate as well, with data being gathered in the operatory and sent to a laboratory via modem. The fabrication would then be done by the laboratory. Other changes that we cannot even predict are likely to occur in dentistry. Exciting times are here. Automation through dental CAD/CAM systems will, most certainly, change the profession. The impact of that change will only be known in the future. But as the future approaches, the systems and materials available to us will continue to evolve, improve, and enhance dentistry.

Air leak after lung resection: pathophysiology and patients' implications.

PubMed

Pompili, Cecilia; Miserocchi, Giuseppe

2016-02-01

Protocols for the management of air leaks are critical aspects in the postoperative course of patients following lung resections. Many investigations in the last decade are focusing on the chest tube modalities or preventative measures, however, little is known about the pathophysiology of air leak and the patient perception of this common complication. This review concentrates on understanding the reasons why a pulmonary parenchyma may start to leak or an air leak may be longer than others. Experimental works support the notion that lung overdistension may favor air leak. These studies may represent the basis of future investigations. Furthermore, the standardization of nomenclature in the field of pleural space management and the creation of novel air leak scoring systems have contributed to improve the knowledge among thoracic surgeons and facilitate the organization of trials on this matter. We tried to summarize available evidences about the patient perception of a prolonged air leak and about what would be useful for them in order to prevent worsening of their quality of life. Future investigations are warranted to better understand the pathophysiologic mechanisms responsible of prolonged air leak in order to define tailored treatments and protocols. Improving the care at home with web-based telemonitoring or real time connected chest drainage may in a future improve the quality of life of the patients experience this complication and also enhance hospital finances.

Air leak after lung resection: pathophysiology and patients’ implications

PubMed Central

Miserocchi, Giuseppe

2016-01-01

Protocols for the management of air leaks are critical aspects in the postoperative course of patients following lung resections. Many investigations in the last decade are focusing on the chest tube modalities or preventative measures, however, little is known about the pathophysiology of air leak and the patient perception of this common complication. This review concentrates on understanding the reasons why a pulmonary parenchyma may start to leak or an air leak may be longer than others. Experimental works support the notion that lung overdistension may favor air leak. These studies may represent the basis of future investigations. Furthermore, the standardization of nomenclature in the field of pleural space management and the creation of novel air leak scoring systems have contributed to improve the knowledge among thoracic surgeons and facilitate the organization of trials on this matter. We tried to summarize available evidences about the patient perception of a prolonged air leak and about what would be useful for them in order to prevent worsening of their quality of life. Future investigations are warranted to better understand the pathophysiologic mechanisms responsible of prolonged air leak in order to define tailored treatments and protocols. Improving the care at home with web-based telemonitoring or real time connected chest drainage may in a future improve the quality of life of the patients experience this complication and also enhance hospital finances. PMID:26941970

Growth and performance of loblolly pine genetic planting stock through eight years

Treesearch

Randall J. Rousseau; Scott D. Roberts; Billy L. Herrin

2016-01-01

Currently, the need in the pine market is to develop higher sawtimber quality trees. The pine biomass and pulpwood market supports the low end of the product chain. However, we must improve on the quality of the southern pine for construction lumber if the southern region is expected to capture the shortfall of the sawtimber market expected in the future. Various pine...

Assessment of Service Desk Quality at an Academic Health Sciences Library.

PubMed

Blevins, Amy E; DeBerg, Jennifer; Kiscaden, Elizabeth

2016-01-01

Due to an identified need for formal assessment, a small team of librarians designed and administered a survey to gauge the quality of customer service at their academic health sciences library. Though results did not drive major changes to services, several important improvements were implemented and a process was established to serve as a foundation for future use. This article details the assessment process used and lessons learned during the project.

The Joint CEDEFOP/ETF Project on 'Scenarios and Strategies for Vocational Training and Lifelong Learning in Europe': A Contribution to the Debate on the Future of Europe.

ERIC Educational Resources Information Center

Sellin, Burkart

A project in Europe is working to improve the quality of work, promote equal opportunities, combat exclusion and poverty; promote lasting economic growth and a European Union economic policy; and promote sustainable development and quality of life. In order to achieve these goals, three main objectives for vocational education and training (VET)…

Safety considerations in providing allergen immunotherapy in the office.

PubMed

Mattos, Jose L; Lee, Stella

2016-06-01

This review highlights the risks of allergy immunotherapy, methods to improve the quality and safety of allergy treatment, the current status of allergy quality metrics, and the future of quality measurement. In the current healthcare environment, the emphasis on outcomes measurement is increasing, and providers must be better equipped in the development, measurement, and reporting of safety and quality measures. Immunotherapy offers the only potential cure for allergic disease and asthma. Although well tolerated and effective, immunotherapy can be associated with serious consequence, including anaphylaxis and death. Many predisposing factors and errors that lead to serious systemic reactions are preventable, and the evaluation and implementation of quality measures are crucial to developing a safe immunotherapy practice. Although quality metrics for immunotherapy are in their infancy, they will become increasingly sophisticated, and providers will face increased pressure to deliver safe, high-quality, patient-centered, evidence-based, and efficient allergy care. The establishment of safety in the allergy office involves recognition of potential risk factors for anaphylaxis, the development and measurement of quality metrics, and changing systems-wide practices if needed. Quality improvement is a continuous process, and although national allergy-specific quality metrics do not yet exist, they are in development.

The Medicare Health Outcomes Survey program: overview, context, and near-term prospects.

PubMed

Jones, Nathaniel; Jones, Stephanie L; Miller, Nancy A

2004-07-12

In 1996, the Centers for Medicare & Medicaid Services (CMS) initiated the Medicare Health Outcomes Survey (HOS). It is the first national survey to measure the quality of life and functional health status of Medicare beneficiaries enrolled in managed care. The program seeks to gather valid and reliable health status data in Medicare managed care for use in quality improvement activities, public reporting, plan accountability and improving health outcomes based on competition. The context that led to the development of the HOS was formed by the convergence of the following factors: 1) a recognized need to monitor the performance of managed care plans, 2) technical expertise and advancement in the areas of quality measurement and health outcomes assessment, 3) the existence of a tested functional health status assessment tool (SF-36)1, which was valid for an elderly population, 4) CMS leadership, and 5) political interest in quality improvement. Since 1998, there have been six baseline surveys and four follow up surveys. CMS, working with its partners, performs the following tasks as part of the HOS program: 1) Supports the technical/scientific development of the HOS measure, 2) Certifies survey vendors, 3) Collects Health Plan Employer Data and Information Set(HEDIS)2 HOS data, 4) Cleans, scores, and disseminates annual rounds of HOS data, public use files and reports to CMS, Quality Improvement Organizations (QIOs), Medicare+Choice Organizations (M+COs), and other stakeholders, 5) Trains M+COs and QIOs in the use of functional status measures and best practices for improving care, 6) Provides technical assistance to CMS, QIOs, M+COs and other data users, and 7) Conducts analyses using HOS data to support CMS and HHS priorities.CMS has recently sponsored an evaluation of the HOS program, which will provide the information necessary to enhance the future administration of the program. Information collected to date reveals that the HOS program is a valuable tool that provides a rich set of data that is useful for quality monitoring and improvement efforts. To enhance the future of the HOS program, many stakeholders recommend the implementation of incentives to encourage the use of the data, while others identify the need to monitor the health status of plan disenrollees.Overall, the HOS program represents an important vehicle for collecting outcomes data from Medicare beneficiaries. The new Medicare Prescription Drug, Improvement, and Modernization Act (2003) mandates the collection and use of data for outcomes measurement. Consequently, it is important to improve HOS to most effectively meet the mandate.

New Perspectives in Monitoring Drinking Water Microbial Quality

PubMed Central

Figueras, Ma José; Borrego, Juan J.

2010-01-01

The safety of drinking water is evaluated by the results obtained from faecal indicators during the stipulated controls fixed by the legislation. However, drinking-water related illness outbreaks are still occurring worldwide. The failures that lead to these outbreaks are relatively common and typically involve preceding heavy rain and inadequate disinfection processes. The role that classical faecal indicators have played in the protection of public health is reviewed and the turning points expected for the future explored. The legislation for protecting the quality of drinking water in Europe is under revision, and the planned modifications include an update of current indicators and methods as well as the introduction of Water Safety Plans (WSPs), in line with WHO recommendations. The principles of the WSP approach and the advances signified by the introduction of these preventive measures in the future improvement of dinking water quality are presented. The expected impact that climate change will have in the quality of drinking water is also critically evaluated. PMID:21318002

Clinical audit in the final year of undergraduate medical education: towards better care of future generations.

PubMed

Mak, Donna B; Miflin, Barbara

2012-01-01

In Australia, in an environment undergoing rapidly changing requirements for health services, there is an urgent need for future practitioners to be knowledgeable, skilful and self-motivated in ensuring the quality and safety of their practice. Postgraduate medical education and vocational programs have responded by incorporating training in quality improvement into continuing professional development requirements, but undergraduate medical education has been slower to respond. This article describes the clinical audit programme undertaken by all students in the final year of the medical course at the University of Notre Dame, Fremantle, Australia, and examines the educational worth of this approach. Data were obtained from curricular documents, including the clinical audit handbook, and from evaluation questionnaires administered to students and supervisors. The clinical audit programme is based on sound educational principles, including situated and participatory learning and reflective practice. It has demonstrated multi-dimensional benefits for students in terms of learning the complexities of conducting an effective audit in professional practice, and for health services in terms of facilitating quality improvement. Although this programme was developed in a medical course, the concept is readily transferable to a variety of other health professional curricula in which students undertake clinical placements.

Better big data.

PubMed

Al Kazzi, Elie S; Hutfless, Susan

2015-01-01

By 2018, Medicare payments will be tied to quality of care. The Centers for Medicare and Medicaid Services currently use quality-based metric for some reimbursements through their different programs. Existing and future quality metrics will rely on risk adjustment to avoid unfairly punishing those who see the sickest, highest-risk patients. Despite the limitations of the data used for risk adjustment, there are potential solutions to improve the accuracy of these codes by calibrating data by merging databases and compiling information collected for multiple reporting programs to improve accuracy. In addition, healthcare staff should be informed about the importance of risk adjustment for quality of care assessment and reimbursement. As the number of encounters tied to value-based reimbursements increases in inpatient and outpatient care, coupled with accurate data collection and utilization, the methods used for risk adjustment could be expanded to better account for differences in the care delivered in diverse settings.

Intensive care unit quality improvement: a "how-to" guide for the interdisciplinary team.

PubMed

Curtis, J Randall; Cook, Deborah J; Wall, Richard J; Angus, Derek C; Bion, Julian; Kacmarek, Robert; Kane-Gill, Sandra L; Kirchhoff, Karin T; Levy, Mitchell; Mitchell, Pamela H; Moreno, Rui; Pronovost, Peter; Puntillo, Kathleen

2006-01-01

Quality improvement is an important activity for all members of the interdisciplinary critical care team. Although an increasing number of resources are available to guide clinicians, quality improvement activities can be overwhelming. Therefore, the Society of Critical Care Medicine charged this Outcomes Task Force with creating a "how-to" guide that focuses on critical care, summarizes key concepts, and outlines a practical approach to the development, implementation, evaluation, and maintenance of an interdisciplinary quality improvement program in the intensive care unit. The task force met in person twice and by conference call twice to write this document. We also conducted a literature search on "quality improvement" and "critical care or intensive care" and searched online for additional resources. DATA SYNTHESIS AND OVERVIEW: We present an overview of quality improvement in the intensive care unit setting and then describe the following steps for initiating or improving an interdisciplinary critical care quality improvement program: a) identify local motivation, support teamwork, and develop strong leadership; b) prioritize potential projects and choose the first target; c) operationalize the measures, build support for the project, and develop a business plan; d) perform an environmental scan to better understand the problem, potential barriers, opportunities, and resources for the project; e) create a data collection system that accurately measures baseline performance and future improvements; f) create a data reporting system that allows clinicians and others to understand the problem; g) introduce effective strategies to change clinician behavior. In addition, we identify four steps for evaluating and maintaining this program: a) determine whether the target is changing with periodic data collection; b) modify behavior change strategies to improve or sustain improvements; c) focus on interdisciplinary collaboration; and d) develop and sustain support from the hospital leadership. We also identify a number of online resources to complement this overview. This Society of Critical Care Medicine Task Force report provides an overview for clinicians interested in developing or improving a quality improvement program using a step-wise approach. Success depends not only on committed interdisciplinary work that is incremental and continuous but also on strong leadership. Further research is needed to refine the methods and identify the most cost-effective means of improving the quality of health care received by critically ill patients and their families.

High-quality cardiopulmonary resuscitation.

PubMed

Nolan, Jerry P

2014-06-01

The quality of cardiopulmonary resuscitation (CPR) impacts on outcome after cardiac arrest. This review will explore the factors that contribute to high-quality CPR and the metrics that can be used to monitor performance. A recent consensus statement from North America defined five key components of high-quality CPR: minimizing interruptions in chest compressions, providing compressions of adequate rate and depth, avoiding leaning on the chest between compressions, and avoiding excessive ventilation. Studies have shown that real-time feedback devices improve the quality of CPR and, in one before-and-after study, outcome from out-of-hospital cardiac arrest. There is evidence for increasing survival rates following out-of-hospital cardiac arrest and this is associated with increasing rates of bystander CPR. The quality of CPR provided by healthcare professionals can be improved with real-time feedback devices. The components of high-quality CPR and the metrics that can be measured and fed back to healthcare professionals have been defined by expert consensus. In the future, real-time feedback based on the physiological responses to CPR may prove more effective.

Factors influencing health-related quality of life among Korean cancer survivors.

PubMed

Kim, KiSook; Kim, Ji-Su

2017-01-01

Early cancer detection and remarkable improvements in cancer treatment have seen the cancer survival rate grow steadily for the past 40 years. Despite expectations regarding treatment effectiveness, acceptable quality of life, and a comfortable death, patients with cancer generally have a decreased quality of life. The study aim was to examine the factors influencing health-related quality of life among South Korean cancer survivors for future development of an intervention to enhance their survivorship. Korea National Health and Nutrition Examination Survey 2008-2012 data regarding 1020 cancer survivors were used for analysis. Health-related quality of life was measured using the EuroQol 5-Dimension. The factors influencing health-related quality of life were age, educational status, employment status, income, smoking, time since diagnosis, subjective health status, stress, depression, and suicidal ideation. Individual-centered clinical interventions that consider dimensional-influencing factors, including subjective health status, are needed to improve cancer survivors' health-related quality of life. Subsequent systematic studies are needed regarding dimension-specific differences according to cancer types and time since diagnosis. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Pay for performance in thoracic surgery.

PubMed

Varela, Gonzalo

2007-08-01

In the context of improving the quality of the medical practice, PFP programs have been developed to reward best medical practice. Early studies showed little gain in quality after implementing PFP family practice programs and some unintended consequences, like excluding high-risk patients from medical services when good outcomes were linked to payment. To date, no PFP programs have been implemented in surgical practice, but it is expected that value-based purchasing philosophy will be extended to surgical specialties in the near future. Quality initiatives in surgery can be based on outcome or process measures. Outcomes-focused quality approaches rely on accurate information obtained from multiinstitutional clinical databases for calculation of risk-adjusted models. Primary outcomes such surgical mortality are uncommon in modern thoracic surgery and outcome measures should rely on more prevalent intermediate outcomes such as specific postoperative morbidities or emergency readmission. Process-based quality approaches need to be based on scientific evidence linking process to outcomes. It is our responsibility to develop practice guidelines or international practice consensus to facilitate the parameters to be evaluated in the near future.

Physicians in training as quality managers: survival strategy for academic health centers.

PubMed

Wofford, J L; Moran, W P; Cohen, S J; Simon, R C

1997-12-01

Being responsible for medical education places academic health centers at a disadvantage in competing for managed care contracts. Although many suggestions have been made for changing medical education to produce physicians who are better prepared for the managed care environment, few studies have shown how physicians in training can actually contribute to the competitiveness of an academic health center. We present three examples of engaging trainees in projects with a population-based perspective that demonstrate how quality improvement for the academic health center can be operationalized and even led by physicians in training. In addition to gaining experience in a managed care skill that is increasingly important for future employment, physicians in training can simultaneously improve the quality of care delivered through the academic health center.

GenePRIMP: Improving Microbial Gene Prediction Quality

ScienceCinema

Pati, Amrita

2018-01-24

Amrita Pati of the DOE Joint Genome Institute's Genome Biology group talks about a computational pipeline that evaluates the accuracy of gene models in genomes and metagenomes at different stages of finishing at the "Sequencing, Finishing, Analysis in the Future" meeting in Santa Fe, NM.

Environmental Education in the Galapagos: Where Do We Go From Here?

ERIC Educational Resources Information Center

Stepath, Carl M.

2009-01-01

Our future leaders' environmental understanding improves their resource management skills and decision-making capacity. Community awareness and "hands-on" involvement preserves bio-diversity and addresses human impacts. This report discusses the importance of environmental education, and effective learning programs. Quality education in…

Recruiting Teachers--Future Prospects.

ERIC Educational Resources Information Center

Schlechty, Phillip C.; Joslin, Anne W.

1984-01-01

Comprehensive reform in the ways teachers are recruited, trained, evaluated, and rewarded is required if the status of the teaching profession and the present quality of education is to be improved. A new career structure, simplification of certification, and reconceptualization of the teaching role are possible remedies. (KH)

Four Sides to Every Story: Creating Effective Multimedia Business Simulations.

ERIC Educational Resources Information Center

Graham, William; Legere, Sylvie M.

1998-01-01

Discusses the goal-based design concepts used to build a CD-ROM-based course for senior executives at Andersen Consulting. Topics include quality management; continuous improvement; problem-centered learning; video storytelling; feedback; multimedia learning environments; course organization; and possible future applications. (Author/LRW)

The Future of Principal Evaluation

ERIC Educational Resources Information Center

Clifford, Matthew; Ross, Steven

2012-01-01

The need to improve the quality of principal evaluation systems is long overdue. Although states and districts generally require principal evaluations, research and experience tell that many state and district evaluations do not reflect current standards and practices for principals, and that evaluation is not systematically administered. When…

The Future of Accreditation

ERIC Educational Resources Information Center

Eaton, Judith S.

2012-01-01

Accreditation, the primary means of assuring and improving academic quality in U.S. higher education, has endured for more than 100 years. While accommodating many changes in higher education and society, accreditation's fundamental values and practices have remained essentially intact, affirming their sturdiness. Accreditation is a form of…

Future directions for the development of virtual reality within an automotive manufacturer.

PubMed

Lawson, Glyn; Salanitri, Davide; Waterfield, Brian

2016-03-01

Virtual Reality (VR) can reduce time and costs, and lead to increases in quality, in the development of a product. Given the pressure on car companies to reduce time-to-market and to continually improve quality, the automotive industry has championed the use of VR across a number of applications, including design, manufacturing, and training. This paper describes interviews with 11 engineers and employees of allied disciplines from an automotive manufacturer about their current physical and virtual properties and processes. The results guided a review of research findings and scientific advances from the academic literature, which formed the basis of recommendations for future developments of VR technologies and applications. These include: develop a greater range of virtual contexts; use multi-sensory simulation; address perceived differences between virtual and real cars; improve motion capture capabilities; implement networked 3D technology; and use VR for market research. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Global initiatives for improving hospital care for children: state of the art and future prospects.

PubMed

Campbell, Harry; Duke, Trevor; Weber, Martin; English, Mike; Carai, Susanne; Tamburlini, Giorgio

2008-04-01

Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival, and that inequities in quality may be as important as inequities in access. There is now substantial global experience of strategies and interventions that improve the quality of care for children in hospitals with limited resources. The World Health Organization has developed a toolkit that contains adaptable instruments, including a framework for quality improvement, evidence-based clinical guidelines in the form of the Pocket Book of Hospital Care for Children, teaching material, assessment, and mortality audit tools. These tools have been field-tested by doctors, nurses, and other child health workers in many developing countries. This collective experience was brought together in a global World Health Organization meeting in Bali in 2007. This article describes how many countries are achieving improvements in quality of pediatric care, despite limited resources and other major obstacles, and how the evidence has progressed in recent years from documenting the nature and scope of the problems to describing the effectiveness of innovative interventions. The challenges remain to bring these and other strategies to scale and to support research into their use, impact, and sustainability in different environments.

Enabling nutrient security and sustainability through systems research.

PubMed

Kaput, Jim; Kussmann, Martin; Mendoza, Yery; Le Coutre, Ronit; Cooper, Karen; Roulin, Anne

2015-05-01

Human and companion animal health depends upon nutritional quality of foods. Seed varieties, seasonal and local growing conditions, transportation, food processing, and storage, and local food customs can influence the nutrient content of food. A new and intensive area of investigation is emerging that recognizes many factors in these agri-food systems that influence the maintenance of nutrient quality which is fundamental to ensure nutrient security for world populations. Modeling how these systems function requires data from different sectors including agricultural, environmental, social, and economic, but also must incorporate basic nutrition and other biomedical sciences. Improving the agri-food system through advances in pre- and post-harvest processing methods, biofortification, or fortifying processed foods will aid in targeting nutrition for populations and individuals. The challenge to maintain and improve nutrient quality is magnified by the need to produce food locally and globally in a sustainable and consumer-acceptable manner for current and future populations. An unmet requirement for assessing how to improve nutrient quality, however, is the basic knowledge of how to define health. That is, health cannot be maintained or improved by altering nutrient quality without an adequate definition of what health means for individuals and populations. Defining and measuring health therefore becomes a critical objective for basic nutritional and other biomedical sciences.

Using aircraft and satellite observations to improve regulatory air quality models

NASA Astrophysics Data System (ADS)

Canty, T. P.; Vinciguerra, T.; Anderson, D. C.; Carpenter, S. F.; Goldberg, D. L.; Hembeck, L.; Montgomery, L.; Liu, X.; Salawitch, R. J.; Dickerson, R. R.

2014-12-01

Federal and state agencies rely on EPA approved models to develop attainment strategies that will bring states into compliance with the National Ambient Air Quality Standards (NAAQS). We will describe modifications to the Community Multi-Scale Air Quality (CMAQ) model and Comprehensive Air Quality Model with Extensions (CAMx) frameworks motivated by analysis of NASA satellite and aircraft measurements. Observations of tropospheric column NO2 from OMI have already led to the identification of an important deficiency in the chemical mechanisms used by models; data collected during the DISCOVER-AQ field campaign has been instrumental in devising an improved representation of the chemistry of nitrogen species. Our recent work has focused on the use of: OMI observations of tropospheric O3 to assess and improve the representation of boundary conditions used by AQ models, OMI NO2 to derive a top down NOx emission inventory from commercial shipping vessels that affect air quality in the Eastern U.S., and OMI HCHO to assess the C5H8 emission inventories provided by bioegenic emissions models. We will describe how these OMI-driven model improvements are being incorporated into the State Implementation Plans (SIPs) being prepared for submission to EPA in summer 2015 and how future modeling efforts may be impacted by our findings.

A Narrative Review of Patient and Family Engagement: The “Foundation” of the Medical Home

PubMed Central

Cené, Crystal W.; Johnson, Beverley H.; Wells, Nora; Baker, Beverly; Davis, Renee; Turchi, Renee

2016-01-01

Background Patient and family engagement (PFE) is vital to the spirit of the medical home. This article reflects the efforts of an expert consensus panel, the Patient and Family Engagement Workgroup as part of the Society of General Internal Medicine’s 2013 Research Conference. Objective To review extant literature on PFE in pediatric and adult medicine and quality improvement, highlight emerging best practices and models, suggest questions for future research, and provide references to tools and resources to facilitate implementation of PFE strategies. Methods We conducted a narrative review of relevant articles published from 2000–2015. Additional information was retrieved from personal contact with experts and recommended sources from workgroup members. Results Despite the theoretical importance of PFE and policy recommendations that PFE occur at all levels across the health care system, evidence of effectiveness is limited, particularly for quality improvement. There is some evidence that PFE is effective, mostly related to engagement in the care of individual patients, but the evidence is mixed and few studies have assessed the effect of PFE on health outcomes. Measurement issues and the lack of a single comprehensive conceptual model pose challenges to progress in this field. Recommendations for future research and a list of practical tools and resources to facilitate PFE are provided. Conclusion Although PFE appeals to patients, families, providers, and policy-makers, research is needed to assess outcomes beyond satisfaction, address implementation barriers, and support engagement in practice redesign and quality improvement. Partnering with patients and families has great potential to support high quality health care and optimize outcomes. PMID:27111748

Improved resident physician confidence with advance care planning after an ambulatory clinic intervention.

PubMed

Tung, Ericka E; Wieland, Mark L; Verdoorn, Brandon P; Mauck, Karen F; Post, Jason A; Thomas, Matthew R; Bundrick, John B; Jaeger, Thomas M; Cha, Stephen S; Thomas, Kris G

2014-05-01

Many primary care providers feel uncomfortable discussing end-of-life care. The aim of this intervention was to assess internal medicine residents' advance care planning (ACP) practices and improve residents' ACP confidence. Residents participated in a facilitated ACP quality improvement workshop, which included an interactive presentation and chart audit of their own patients. Pre- and postintervention surveys assessed resident ACP-related confidence. Only 24% of the audited patients had an advance directive (AD), and 28% of the ACP-documentation was of no clinical utility. Terminally ill patients (odds ratio 2.8, P < .001) were more likely to have an AD. Patients requiring an interpreter were less likely to have participated in ACP. Residents reported significantly improved confidence with ACP and identified important training gaps. Future studies examining the impact on ACP quality are needed.

Forecasting land cover change impacts on drinking water treatment costs in Minneapolis, Minnesota

NASA Astrophysics Data System (ADS)

Woznicki, S. A.; Wickham, J.

2017-12-01

Source protection is a critical aspect of drinking water treatment. The benefits of protecting source water quality in reducing drinking water treatment costs are clear. However, forecasting the impacts of environmental change on source water quality and its potential to influence future treatment processes is lacking. The drinking water treatment plant in Minneapolis, MN has recognized that land cover change threatens water quality in their source watershed, the Upper Mississippi River Basin (UMRB). Over 1,000 km2 of forests, wetlands, and grasslands in the UMRB were lost to agriculture from 2008-2013. This trend, coupled with a projected population increase of one million people in Minnesota by 2030, concerns drinking water treatment plant operators in Minneapolis with respect to meeting future demand for clean water in the UMRB. The objective of this study is to relate land cover change (forest and wetland loss, agricultural expansion, urbanization) to changes in treatment costs for the Minneapolis, MN drinking water utility. To do this, we first developed a framework to determine the relationship between land cover change and water quality in the context of recent historical changes and projected future changes in land cover. Next we coupled a watershed model, the Soil and Water Assessment Tool (SWAT) to projections of land cover change from the FOREcasting SCEnarios of Land-use Change (FORE-SCE) model for the mid-21st century. Using historical Minneapolis drinking water treatment data (chemical usage and costs), source water quality in the UMRB was linked to changes in treatment requirements as a function of projected future land cover change. These analyses will quantify the value of natural landscapes in protecting drinking water quality and future treatment processes requirements. In addition, our study provides the Minneapolis drinking water utility with information critical to their planning and capital improvement process.

Design and Implementation of the Harvard Fellowship in Patient Safety and Quality.

PubMed

Gandhi, Tejal K; Abookire, Susan A; Kachalia, Allen; Sands, Kenneth; Mort, Elizabeth; Bommarito, Grace; Gagne, Jane; Sato, Luke; Weingart, Saul N

2016-01-01

The Harvard Fellowship in Patient Safety and Quality is a 2-year physician-oriented training program with a strong operational orientation, embedding trainees in the quality departments of participating hospitals. It also integrates didactic and experiential learning and offers the option of obtaining a master's degree in public health. The program focuses on methodologically rigorous improvement and measurement, with an emphasis on the development and implementation of innovative practice. The operational orientation is intended to foster the professional development of future quality and safety leaders. The purpose of this article is to describe the design and development of the fellowship. © The Author(s) 2014.

Assessing the Future Vehicle Fleet Electrification: The Impacts on Regional and Urban Air Quality.

PubMed

Ke, Wenwei; Zhang, Shaojun; Wu, Ye; Zhao, Bin; Wang, Shuxiao; Hao, Jiming

2017-01-17

There have been significant advancements in electric vehicles (EVs) in recent years. However, the different changing patterns in emissions at upstream and on-road stages and complex atmospheric chemistry of pollutants lead to uncertainty in the air quality benefits from fleet electrification. This study considers the Yangtze River Delta (YRD) region in China to investigate whether EVs can improve future air quality. The Community Multiscale Air Quality model enhanced by the two-dimensional volatility basis set module is applied to simulate the temporally, spatially, and chemically resolved changes in PM 2.5 concentrations and the changes of other pollutants from fleet electrification. A probable scenario (Scenario EV1) with 20% of private light-duty passenger vehicles and 80% of commercial passenger vehicles (e.g., taxis and buses) electrified can reduce average PM 2.5 concentrations by 0.4 to 1.1 μg m -3 during four representative months for all urban areas of YRD in 2030. The seasonal distinctions of the air quality impacts with respect to concentration reductions in key aerosol components are also identified. For example, the PM 2.5 reduction in January is mainly attributed to the nitrate reduction, whereas the secondary organic aerosol reduction is another essential contributor in August. EVs can also effectively assist in mitigating NO 2 concentrations, which would gain greater reductions for traffic-dense urban areas (e.g., Shanghai). This paper reveals that the fleet electrification in the YRD region could generally play a positive role in improving regional and urban air quality.

A review of national policies and strategies to improve quality of health care and patient safety: a case study from Lebanon and Jordan.

PubMed

El-Jardali, Fadi; Fadlallah, Racha

2017-08-16

Improving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems. We used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources. Both Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking. Importantly, incentive systems that link contractual agreement, regulations, accreditation, and performance indicators are underutilized in Lebanon and absent in Jordan. At the healthcare organizational level, there is a need to instill a culture of continuous quality improvement and promote professional training in quality improvement and patient safety. Study findings highlight the importance of aligning policies, organizations, methods, capacities and resources in order to institutionalize quality improvement and patient safety practices in health systems. Gaps and dysfunctions identified can help inform national deliberations and dialogues among key stakeholders in each study country. Findings can also inform future quality improvement efforts in the EMR and beyond, with a particular emphasis on LMICs.

How are compassion fatigue, burnout, and compassion satisfaction affected by quality of working life? Findings from a survey of mental health staff in Italy.

PubMed

Cetrano, Gaia; Tedeschi, Federico; Rabbi, Laura; Gosetti, Giorgio; Lora, Antonio; Lamonaca, Dario; Manthorpe, Jill; Amaddeo, Francesco

2017-11-21

Quality of working life includes elements such as autonomy, trust, ergonomics, participation, job complexity, and work-life balance. The overarching aim of this study was to investigate if and how quality of working life affects Compassion Fatigue, Burnout, and Compassion Satisfaction among mental health practitioners. Staff working in three Italian Mental Health Departments completed the Professional Quality of Life Scale, measuring Compassion Fatigue, Burnout, and Compassion Satisfaction, and the Quality of Working Life Questionnaire. The latter was used to collect socio-demographics, occupational characteristics and 13 indicators of quality of working life. Multiple regressions controlling for other variables were undertaken to predict Compassion Fatigue, Burnout, and Compassion Satisfaction. Four hundred questionnaires were completed. In bivariate analyses, experiencing more ergonomic problems, perceiving risks for the future, a higher impact of work on life, and lower levels of trust and of perceived quality of meetings were associated with poorer outcomes. Multivariate analysis showed that (a) ergonomic problems and impact of work on life predicted higher levels of both Compassion Fatigue and Burnout; (b) impact of life on work was associated with Compassion Fatigue and lower levels of trust and perceiving more risks for the future with Burnout only; (c) perceived quality of meetings, need of training, and perceiving no risks for the future predicted higher levels of Compassion Satisfaction. In order to provide adequate mental health services, service providers need to give their employees adequate ergonomic conditions, giving special attention to time pressures. Building trustful relationships with management and within the teams is also crucial. Training and meetings are other important targets for potential improvement. Additionally, insecurity about the future should be addressed as it can affect both Burnout and Compassion Satisfaction. Finally, strategies to reduce possible work-life conflicts need to be considered.

Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004–2012

PubMed Central

Hamel, Donald J.; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D.; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T.; Okonkwo, Prosper; Kanki, Phyllis J.

2015-01-01

Introduction From 2004–2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President’s Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Methods Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Results Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Conclusions Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings. PMID:26900573

Analysis of residents' willingness to pay to reduce air pollution to improve children's health in community and hospital settings in Shanghai, China.

PubMed

Wang, Keran; Wu, Jinyi; Wang, Rui; Yang, Yingying; Chen, Renjie; Maddock, Jay E; Lu, Yuanan

2015-11-15

Shanghai, along with many major cities in China, faces deterioration of air quality and increases in air pollution-related respiratory diseases (RDs) in children due to rapid industrialization and urbanization. The Contingent Valuation Method (CVM) was used to qualitatively and quantitatively measure the willingness to pay (WTP) for reducing children's RDs through air quality improvement. Between April and May, 2014, 975 face-to-face interviews were collected from parents in a community-based and a hospital-setting in Shanghai. Multiple imputation and the Probit model were used to determine the relationship between the WTP and the related environmental factors, child health factors and the socio-economic status. Most respondents reported being willing to make a financial contribution to improve air quality in both the community (52.6%) and hospital (70.2%) samples. Those in the hospital setting were willing to pay significantly more ¥504 (USD$80.7) compared to the community sample ¥428 ($68.5) as expected. Reasons for those not being willing to pay included lack of disposable income and believing that responsibility of the air quality was a community issue. These did not differ by sample. Annual household income and education were related to WTP. This study indicated that parents in Shanghai would be willing to pay for improved air quality. Children's health can be the incentive for the citizens' participation and support in the air quality improvement, therefore, hospital settings may present unique places to improve education about air quality and enhance advocacy efforts. This study also suggested that future environmental policies be addressed more rigorously for targeted populations. Copyright © 2015 Elsevier B.V. All rights reserved.

Improving Care And Research Electronic Data Trust Antwerp (iCAREdata): a research database of linked data on out-of-hours primary care.

PubMed

Colliers, Annelies; Bartholomeeusen, Stefaan; Remmen, Roy; Coenen, Samuel; Michiels, Barbara; Bastiaens, Hilde; Van Royen, Paul; Verhoeven, Veronique; Holmgren, Philip; De Ruyck, Bernard; Philips, Hilde

2016-05-04

Primary out-of-hours care is developing throughout Europe. High-quality databases with linked data from primary health services can help to improve research and future health services. In 2014, a central clinical research database infrastructure was established (iCAREdata: Improving Care And Research Electronic Data Trust Antwerp, www.icaredata.eu ) for primary and interdisciplinary health care at the University of Antwerp, linking data from General Practice Cooperatives, Emergency Departments and Pharmacies during out-of-hours care. Medical data are pseudonymised using the services of a Trusted Third Party, which encodes private information about patients and physicians before data is sent to iCAREdata. iCAREdata provides many new research opportunities in the fields of clinical epidemiology, health care management and quality of care. A key aspect will be to ensure the quality of data registration by all health care providers. This article describes the establishment of a research database and the possibilities of linking data from different primary out-of-hours care providers, with the potential to help to improve research and the quality of health care services.

Healthcare reform for imagers: finding a way forward now.

PubMed

Douglas, Pamela S; Picard, Michael H

2013-03-01

The changing healthcare environment presents many challenges to cardiovascular imagers. This perspective paper uses current trends to propose strategies that cardiovascular imagers can follow to lead in managing change and developing the imaging laboratory of the future. In the area of quality, imagers are encouraged to follow guidelines and standards, implement structured reporting and laboratory databases, adopt ongoing quality improvement programs, and use benchmarks to confirm imaging quality. In the area of access, imagers are encouraged to enhance availability of testing, focus on patient and referring physician value and satisfaction, collaboratively implement new technologies and uses of imaging, integrate health information technology in the laboratory, and work toward the appropriate inclusion of imaging in new healthcare delivery models. In the area of cost, imagers are encouraged to minimize laboratory operating expenses without compromising quality, and to take an active role in care redesign initiatives to ensure that imaging is utilized appropriately and at proper time intervals. Imagers are also encouraged to learn leadership and management skills, undertake strategic planning exercises, and build strong, collaborative teams. Although it is difficult to predict the future of cardiovascular imaging delivery, a reasonable sense of the likely direction of many changes and careful attention to the fundamentals of good health care (quality, access, and cost) can help imagers to thrive now and in the future. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Government employees' perception of urban air pollution and willingness to pay for improved quality: a cross-sectional survey study in Nanchang, China.

PubMed

Liu, Xiaojun; Wu, Yanyan; Hu, Yongxin; Liu, Denglai; Zhang, Jin; Chen, Cheng; Yuan, Zhaokang; Lu, Yuanan

2016-11-01

To improve the public's awareness of urban air pollution and promote establishment of more efficient policy toward urban air pollution, we investigated the government employees' perceptions of current urban air pollution and their willingness to pay (WTP) taxes for improved quality in Nanchang, China. Stratified cluster sampling strategy was used to distribute 629 questionnaires, and 608 were completed anonymously, yielding a 96.7 % response rate. Descriptive statistics frequencies and proportions were used to summarize the sample characteristics, and logistic regression models were performed to assess the associations of perception of urban air quality and WTP versus demographic variables. We found low awareness of urban air pollution (34.5 %) as well as low WTP (44.9 %), especially among the middle aged people (age 30-39 and age 40-49). Our study shows that female employees have better awareness of urban air pollution but much less willingness to pay for air quality improvement. Majority of the government employees showed their support to the government for more effective policies toward environmental protection, indicating more enhanced public education and environmental protection campaigns to improve the public's awareness of air pollution and work with every citizen to improve air quality. This study also obtained baseline information useful to the local regional and even national government in developing nations in their attempt to control urban air pollution in future.

Creativity and connections: the future of nursing education and practice: the Massachusetts Initiative.

PubMed

Sroczynski, Maureen; Gravlin, Gayle; Route, Paulette Seymour; Hoffart, Nancy; Creelman, Patricia

2011-01-01

Education and practice partnerships are key to effective academic program design and implementation in a time of decreasing supply and increasing demands on the nursing profession. An integrated education/practice competency model can positively impact patient safety, improve patient care, increase retention, and ensure a sufficient and competent nursing workforce, which is paramount to survival of the health care system. Through the contributions of nursing leaders from the broad spectrum of nursing and industry organizations within the state, the Massachusetts Nurse of the Future project developed a competency-based framework for the future design of nursing educational programs to meet current and future practice needs. The Massachusetts Nurse of the Future Nursing Core Competencies(©) expand on the Institute of Medicine's core competencies for all health care professionals and the Quality and Safety Education for Nurses competencies for quality and safety to define the expectations for all professional nurses of the future. The Massachusetts Nurse of the Future Nursing Core Competencies define the knowledge, attitude, and skills required as the minimal expectations for initial nursing practice following completion of a prelicensure professional nursing education program. These competencies are now being integrated into new models for seamless, coordinated nursing curriculum and transition into practice within the state and beyond. Copyright © 2011 Elsevier Inc. All rights reserved.

Maintenance of Certification and the Challenge of Professionalism.

PubMed

Nichols, David G

2017-05-01

Board certification has been part of the social contract in which physicians commit to maintaining up-to-date scientific knowledge and improving the quality of patient care. However, the maintenance of certification program has been controversial. This review summarizes the philosophical underpinnings, published literature, recent improvements, and future directions of the American Board of Pediatrics maintenance of certification program. Copyright © 2017 by the American Academy of Pediatrics.

Palliative care in the home: a scoping review of study quality, primary outcomes, and thematic component analysis.

PubMed

Hofmeister, Mark; Memedovich, Ally; Dowsett, Laura E; Sevick, Laura; McCarron, Tamara; Spackman, Eldon; Stafinski, Tania; Menon, Devidas; Noseworthy, Tom; Clement, Fiona

2018-03-07

The aim of palliative care is to improve the quality of life of patients and families through the prevention and relief of suffering. Frequently, patients may choose to receive palliative care in the home. The objective of this paper is to summarize the quality and primary outcomes measured within the palliative care in the home literature. This will synthesize the current state of the literature and inform future work. A scoping review was completed using PRISMA guidelines. PubMed, Embase, CINAHL, Web of Science, Cochrane Library, EconLit, PsycINFO, Centre for Reviews and Dissemination, Database of Abstracts of Reviews of Effects, and National Health Service Economic Evaluation Database were searched from inception to August 2016. Inclusion criteria included: 1) care was provided in the "home of the patient" as defined by the study, 2) outcomes were reported, and 3) reported original data. Thematic component analysis was completed to categorize interventions. Fifty-three studies formed the final data set. The literature varied extensively. Five themes were identified: accessibility of healthcare, caregiver support, individualized patient centered care, multidisciplinary care provision, and quality improvement. Primary outcomes were resource use, symptom burden, quality of life, satisfaction, caregiver distress, place of death, cost analysis, or described experiences. The majority of studies were of moderate or unclear quality. There is robust literature of varying quality, assessing different components of palliative care in the home interventions, and measuring different outcomes. To be meaningful to patients, these interventions need to be consistently evaluated with outcomes that matter to patients. Future research could focus on reaching a consensus for outcomes to evaluate palliative care in the home interventions.

[CAP quality management system in clinical laboratory and its issue].

PubMed

Tazawa, Hiromitsu

2004-03-01

The CAP (College of American Pathologists) was established in 1962 and, at present, CAP-accredited laboratories include about 6000 institutions all over the world, mainly in the U.S. The essential purpose of CAP accreditation is high quality reservation and improvement of clinical laboratory services for patient care, and is based on seven points, listed below. (1) Establishment of a laboratory management program and laboratory techniques to assure accuracy and improve overall quality of laboratory services. (2) Maintenance and improvement of accuracy objectively by centering on a CAP survey. (3) Thoroughness in safety and health administration. (4) Reservation of the performance of laboratory services by personnel and proficiency management. (5) Provision of appropriate information to physicians, and contribution to improved quality of patient care by close communication with physicians (improvement in patient care). (6) Reduction of running costs and personnel costs based on evidence by employing the above-mentioned criteria. (7) Reduction of laboratory error. In the future, accreditation and/or certification by organizations such as CAP, ISO, etc., may become a requirement for providing any clinical laboratory services in Japan. Taking the essence of the CAP and the characteristics of the new international standard, ISO151589, into consideration, it is important to choose the best suited accreditation and/or certification depending of the purpose of clinical laboratory.

Perceptional and socio-demographic factors associated with household drinking water management strategies in rural Puerto Rico.

PubMed

Jain, Meha; Lim, Yili; Arce-Nazario, Javier A; Uriarte, María

2014-01-01

Identifying which factors influence household water management can help policy makers target interventions to improve drinking water quality for communities that may not receive adequate water quality at the tap. We assessed which perceptional and socio-demographic factors are associated with household drinking water management strategies in rural Puerto Rico. Specifically, we examined which factors were associated with household decisions to boil or filter tap water before drinking, or to obtain drinking water from multiple sources. We find that households differ in their management strategies depending on the institution that distributes water (i.e. government PRASA vs community-managed non-PRASA), perceptions of institutional efficacy, and perceptions of water quality. Specifically, households in PRASA communities are more likely to boil and filter their tap water due to perceptions of low water quality. Households in non-PRASA communities are more likely to procure water from multiple sources due to perceptions of institutional inefficacy. Based on informal discussions with community members, we suggest that water quality may be improved if PRASA systems improve the taste and odor of tap water, possibly by allowing for dechlorination prior to distribution, and if non-PRASA systems reduce the turbidity of water at the tap, possibly by increasing the degree of chlorination and filtering prior to distribution. Future studies should examine objective water quality standards to identify whether current management strategies are effective at improving water quality prior to consumption.

Perceptional and Socio-Demographic Factors Associated with Household Drinking Water Management Strategies in Rural Puerto Rico

PubMed Central

Jain, Meha; Lim, Yili; Arce-Nazario, Javier A.; Uriarte, María

2014-01-01

Identifying which factors influence household water management can help policy makers target interventions to improve drinking water quality for communities that may not receive adequate water quality at the tap. We assessed which perceptional and socio-demographic factors are associated with household drinking water management strategies in rural Puerto Rico. Specifically, we examined which factors were associated with household decisions to boil or filter tap water before drinking, or to obtain drinking water from multiple sources. We find that households differ in their management strategies depending on the institution that distributes water (i.e. government PRASA vs community-managed non-PRASA), perceptions of institutional efficacy, and perceptions of water quality. Specifically, households in PRASA communities are more likely to boil and filter their tap water due to perceptions of low water quality. Households in non-PRASA communities are more likely to procure water from multiple sources due to perceptions of institutional inefficacy. Based on informal discussions with community members, we suggest that water quality may be improved if PRASA systems improve the taste and odor of tap water, possibly by allowing for dechlorination prior to distribution, and if non-PRASA systems reduce the turbidity of water at the tap, possibly by increasing the degree of chlorination and filtering prior to distribution. Future studies should examine objective water quality standards to identify whether current management strategies are effective at improving water quality prior to consumption. PMID:24586302

The Ambulatory Long-Block: An Accreditation Council for Graduate Medical Education (ACGME) Educational Innovations Project (EIP)

PubMed Central

Schauer, Daniel P.; Diers, Tiffiny; Mathis, Bradley R.; Neirouz, Yvette; Boex, James R.; Rouan, Gregory W.

2008-01-01

Introduction Historical bias toward service-oriented inpatient graduate medical education experiences has hindered both resident education and care of patients in the ambulatory setting. Aim Describe and evaluate a residency redesign intended to improve the ambulatory experience for residents and patients. Setting Categorical Internal Medicine resident ambulatory practice at the University of Cincinnati Academic Health Center. Program Description We created a year-long continuous ambulatory group-practice experience separated from traditional inpatient responsibilities called the long block as an Accreditation Council for Graduate Medical Education Educational Innovations Project. The practice adopted the Chronic Care Model and residents received extensive instruction in quality improvement and interprofessional teams. Program Evaluation The long block was associated with significant increases in resident and patient satisfaction as well as improvement in multiple quality process and outcome measures. Continuity and no-show rates also improved. Discussion An ambulatory long block can be associated with improvements in resident and patient satisfaction, quality measures, and no-show rates. Future research should be done to determine effects of the long block on education and patient care in the long term, and elucidate which aspects of the long block most contribute to improvement. PMID:18612718

Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction.

PubMed

Warner, Courtney J; Horvath, Alexander J; Powell, Richard J; Columbo, Jesse A; Walsh, Teri R; Goodney, Philip P; Walsh, Daniel B; Stone, David H

2015-08-01

Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care systems. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction

PubMed Central

Warner, Courtney J.; Horvath, Alexander J.; Powell, Richard J.; Columbo, Jesse A.; Walsh, Teri R.; Goodney, Philip P.; Walsh, Daniel B.; Stone, David H.

2017-01-01

Objective Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. Methods All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Results Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Conclusions Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care systems. PMID:25935271

Upstream factors affecting Tualatin River algae—Tracking the 2008 Anabaena algae bloom to Wapato Lake, Oregon

USGS Publications Warehouse

Rounds, Stewart A.; Carpenter, Kurt D.; Fesler, Kristel J.; Dorsey, Jessica L.

2015-12-17

The results and insights derived from this study can be used to enhance future monitoring and data collection strategies designed to improve water quality and plankton models and better predict dissolved-oxygen concentrations in the lower Tualatin River.

Sentinel site data for model improvement – Definition and characterization

USDA-ARS?s Scientific Manuscript database

Crop models are increasingly being used to assess the impacts of future climate change on production and food security. High quality site-specific data on weather, soils, management, and cultivar are needed for those model applications. Also important, is that model development, evaluation, improvem...

Trends in Schooling: Demography, Performance and Organization.

ERIC Educational Resources Information Center

Mare, Robert D.

1981-01-01

Utilizing "Social Indicators" (1979), discusses growth and distribution of schooling in the U.S., trends in student test performance, and major organizational changes in elementary/secondary education. Comments on quality of available data and suggests improvements for future reporting of educational indicators. (Reprint of article is available…

Psychological Interventions for Cancer Patients to Enhance the Quality of Life.

ERIC Educational Resources Information Center

Andersen, Barbara L.

1992-01-01

Reviews experimental and quasi-experimental studies of psychological interventions designed to help individuals diagnosed with cancer reduce emotional distress, enhance coping, and improve their adjustment to the illness. Treatment components and mechanisms are discussed. Future research directions and challenges to scientific advance are…

Should Quality School Education Be a Kaizen (Improvement) or an Innovation?

ERIC Educational Resources Information Center

Sun-Keung Pang, Nicholas

1998-01-01

Reviews Hong Kong's School Management Initiative implementation strategies (rational-empirical, power-coercive, and normative-reeducative), compares them with New South Wales, Australia's strategies, and suggests an appropriate strategy for future reforms. In Australia, changes were radical and thorough (using power-coercive strategies), whereas…

Air pollution in India and related adverse respiratory health effects: past, present, and future directions.

PubMed

Khilnani, Gopi C; Tiwari, Pawan

2018-03-01

The review describes current status of air pollution in India, summarizes recent research on adverse health effects of ambient and household air pollution, and outlines the ongoing efforts and future actions required to improve air quality and reduce morbidity and mortality because of air pollution in India. Global burden of disease data analysis reveals more than one million premature deaths attributable to ambient air pollution in 2015 in India. More than one million additional deaths can be attributed to household air pollution. Particulate matter with diameter 2.5 μm or less has been causatively linked with most premature deaths. Acute respiratory tract infections, asthma, chronic obstructive pulmonary disease, exacerbations of preexisting obstructive airway disease and lung cancer are proven adverse respiratory effects of air pollution. Targeting air quality standards laid by WHO can significantly reduce morbidity and mortality because of air pollution in India. India is currently exposed to high levels of ambient and household air pollutants. Respiratory adverse effects of air pollution are significant contributors to morbidity and premature mortality in India. Substantial efforts are being made at legislative, administrative, and community levels to improve air quality. However, much more needs to be done to change the 'status quo' and attain the target air quality standards. VIDEO ABSTRACT: http://links.lww.com/COPM/A24.

The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital.

PubMed

Goldfield, Norbert

2010-01-01

Policymakers are searching for ways to control health care costs and improve quality. Diagnosis-related groups (DRGs) are by far the most important cost control and quality improvement tool that governments and private payers have implemented. This article reviews why DRGs have had this singular success both in the hospital sector and, over the past 10 years, in ambulatory and managed care settings. Last, the author reviews current trends in the development and implementation of tools that have the key ingredients of DRG success: categorical clinical model, separation of the clinical model from payment weights, separate payment adjustments for nonclinical factors, and outlier payments. Virtually all current tools used to manage health care costs and improve quality do not have these characteristics. This failure explains a key reason for the failure, for example, of the Medicare Advantage program to control health care costs. This article concludes with a discussion of future developments for DRG-type models outside the hospital sector.

Organizing the pantry: cache management improves quality of overwinter food stores in a montane mammal

USGS Publications Warehouse

Jakopak, Rhiannon P.; Hall, L. Embere; Chalfoun, Anna D.

2017-01-01

Many mammals create food stores to enhance overwinter survival in seasonal environments. Strategic arrangement of food within caches may facilitate the physical integrity of the cache or improve access to high-quality food to ensure that cached resources meet future nutritional demands. We used the American pika (Ochotona princeps), a food-caching lagomorph, to evaluate variation in haypile (cache) structure (i.e., horizontal layering by plant functional group) in Wyoming, United States. Fifty-five percent of 62 haypiles contained at least 2 discrete layers of vegetation. Adults and juveniles layered haypiles in similar proportions. The probability of layering increased with haypile volume, but not haypile number per individual or nearby forage diversity. Vegetation cached in layered haypiles was also higher in nitrogen compared to vegetation in unlayered piles. We found that American pikas frequently structured their food caches, structured caches were larger, and the cached vegetation in structured piles was of higher nutritional quality. Improving access to stable, high-quality vegetation in haypiles, a critical overwinter food resource, may allow individuals to better persist amidst harsh conditions.

Peer mentoring for eating disorders: evaluation of a pilot program.

PubMed

Beveridge, Jennifer; Phillipou, Andrea; Edwards, Kelly; Hobday, Alice; Hilton, Krissy; Wyett, Cathy; Saw, Anna; Graham, Georgia; Castle, David; Brennan, Leah; Harrison, Philippa; de Gier, Rebecca; Warren, Narelle; Hanly, Freya; Torrens-Witherow, Benjamin; Newton, J Richard

2018-01-01

Eating disorders are serious psychiatric illnesses that are often associated with poor quality of life and low long-term recovery rates. Peer mentor programs have been found to improve psychiatric symptoms and quality of life in other mental illnesses, and a small number of studies have suggested that eating disorder patients may benefit from such programs. The aim of this study is to assess the efficacy of a peer mentor program for individuals with eating disorders in terms of improving symptomatology and quality of life. Up to 30 individuals with a past history of an eating disorder will be recruited to mentor 30 individuals with a current eating disorder. Mentoring will involve 13 sessions (held approximately every 2 weeks), of up to 3 h each, over 6 months. This pilot proof-of-concept feasibility study will inform the efficacy of a peer mentoring program on improving eating disorder symptomatology and quality of life, and will inform future randomised controlled trials. Australian and New Zealand Clinical Trials Registration Number: ACTRN12617001412325. The date of registration (retrospective): 05/10/2017.

Parental loss, trusting relationship with current caregivers, and psychosocial adjustment among children affected by AIDS in China.

PubMed

Zhao, Junfeng; Li, Xiaoming; Barnett, Douglas; Lin, Xiuyun; Fang, Xiaoyi; Zhao, Guoxiang; Naar-King, Sylvie; Stanton, Bonita

2011-08-01

The objective of this study was to examine the relationship between parental loss, trusting relationship with current caregivers, and psychosocial adjustment among children affected by AIDS in China. In this study, cross-sectional data were collected from 755 AIDS orphans (296 double orphans and 459 single orphans), 466 vulnerable children living with HIV-infected parents, and 404 comparison children in China. The trusting relationship with current caregivers was measured with a 15-item scale (Cronbach's α = 0.84) modified from the Trusting Relationship Questionnaire developed by Mustillo et al. in 2005 (Quality of relationships between youth and community service providers: Reliability and validity of the trusting relationship questionnaire. Journal of Child and Family Studies, 14, 577-590). The psychosocial measures include rule compliance/acting out, anxiety/withdrawal, peer social skills, school interest, depressive symptoms, loneliness, self-esteem, future expectation, hopefulness about future, and perceived control over the future. Group mean comparisons using analysis of variance suggested a significant association (p < 0.0001) between the trusting relationship with current caregivers and all the psychosocial measures, except anxiety and depression. These associations remained significant in General Linear Model analysis, controlling for children's gender, age, family socioeconomic status, orphan status (orphans, vulnerable children, and comparison children), and appropriate interaction terms among factor variables. The findings in the current study support the global literature on the importance of attachment relationship with caregivers in promoting children's psychosocial development. Future prevention intervention efforts to improve AIDS orphans' psychosocial well-being will need to take into consideration the quality of the child's attachment relationships with current caregivers and help their current caregivers to improve the quality of care for these children. Future study is needed to explore the possible reasons for the lack of association between a trusting relationship and some internalizing symptoms such as anxiety and depression among children affected by HIV/AIDS.

Likelihood of achieving air quality targets under model uncertainties.

PubMed

Digar, Antara; Cohan, Daniel S; Cox, Dennis D; Kim, Byeong-Uk; Boylan, James W

2011-01-01

Regulatory attainment demonstrations in the United States typically apply a bright-line test to predict whether a control strategy is sufficient to attain an air quality standard. Photochemical models are the best tools available to project future pollutant levels and are a critical part of regulatory attainment demonstrations. However, because photochemical models are uncertain and future meteorology is unknowable, future pollutant levels cannot be predicted perfectly and attainment cannot be guaranteed. This paper introduces a computationally efficient methodology for estimating the likelihood that an emission control strategy will achieve an air quality objective in light of uncertainties in photochemical model input parameters (e.g., uncertain emission and reaction rates, deposition velocities, and boundary conditions). The method incorporates Monte Carlo simulations of a reduced form model representing pollutant-precursor response under parametric uncertainty to probabilistically predict the improvement in air quality due to emission control. The method is applied to recent 8-h ozone attainment modeling for Atlanta, Georgia, to assess the likelihood that additional controls would achieve fixed (well-defined) or flexible (due to meteorological variability and uncertain emission trends) targets of air pollution reduction. The results show that in certain instances ranking of the predicted effectiveness of control strategies may differ between probabilistic and deterministic analyses.

Ground-Water Availability Assessment for the Columbia Plateau Regional Aquifer System, Washington, Oregon, and Idaho

USGS Publications Warehouse

,

2008-01-01

The U.S. Geological Survey (USGS) is assessing the availability and use of the Nation's water resources to gain a clearer understanding of the status of our water resources and the land-use, water-use, and climatic trends that affect them. The goal of the National assessment is to improve our ability to forecast water availability for future economic and environmental uses. Assessments will be completed for regional aquifer systems across the Nation to help characterize how much water we have now, how water availability is changing, and how much water we can expect to have in the future (Reilly and others, 2008). Water availability is a function of many factors, including the quantity and quality of water, and the laws, regulations, economics, and environmental factors that control its use. The focus of the Columbia Plateau regional ground-water availability assessment is to improve fundamental knowledge of the ground-water balance of the region, including the flows, storage, and ground-water use by humans. An improved quantitative understanding of the region's water balance not only provides key information about water quantity, but also can serve as a fundamental basis for many analyses of water quality and ecosystem health.

Identifying effective pathways in a successful continuous quality improvement programme: the GEDAPS study.

PubMed

Bodicoat, Danielle H; Mundet, Xavier; Gray, Laura J; Cos, Xavier; Davies, Melanie J; Khunti, Kamlesh; Cano, Juan-Franciso

2014-12-01

Continuous quality improvement programmes often target several aspects of care, some of which may be more effective meaning that resources could be focussed on these. The objective was to identify the effective and ineffective aspects of a successful continuous quality improvement programme for individuals with type 2 diabetes in primary care. Data were from a series of cross-sectional studies (GEDAPS) in primary care, Catalonia, Spain, in 55 centres (2239 participants) in 1993, and 92 centres (5819 participants) in 2002. A structural equation modelling approach was used. The intervention was associated with improved microvascular outcomes through microalbuminuria and funduscopy screening, which had a direct effect on microvascular outcomes, and through attending 2-4 nurse visits and having ≥1 blood pressure measurement, which acted through reducing systolic blood pressure. The intervention was associated with improved macrovascular outcomes through blood pressure measurement and attending 2-4 nurse visits (through systolic blood pressure) and having ≥3 education topics, ≥1 HbA1c measurement and adequate medication (through HbA1c). Cholesterol measurement, weight measurement and foot examination did not contribute towards the effectiveness of the intervention. The pathways through which a continuous quality improvement programme appeared to act to reduce microvascular and macrovascular complications were driven by reductions in systolic blood pressure and HbA1c, which were attained through changes in nurse and education visits, measurement and medication. This suggests that these factors are potential areas on which future quality improvement programmes should focus. © 2014 John Wiley & Sons, Ltd.

What makes British general practitioners take part in a quality improvement scheme?

PubMed

Spooner, A; Chapple, A; Roland, M

2001-07-01

To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care. Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) and enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness--PRICCE). Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change. When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.

Neurofeedback as a form of cognitive rehabilitation therapy following stroke: A systematic review

PubMed Central

Tibbles, Alana; Topolovec-Vranic, Jane

2017-01-01

Neurofeedback therapy (NFT) has been used within a number of populations however it has not been applied or thoroughly examined as a form of cognitive rehabilitation within a stroke population. Objectives for this systematic review included: i) identifying how NFT is utilized to treat cognitive deficits following stroke, ii) examining the strength and quality of evidence to support the use of NFT as a form of cognitive rehabilitation therapy (CRT) and iii) providing recommendations for future investigations. Searches were conducted using OVID (Medline, Health Star, Embase + Embase Classic) and PubMed databases. Additional searches were completed using the Cochrane Reviews library database, Google Scholar, the University of Toronto online library catalogue, ClinicalTrials.gov website and select journals. Searches were completed Feb/March 2015 and updated in June/July/Aug 2015. Eight studies were eligible for inclusion in this review. Studies were eligible for inclusion if they: i) were specific to a stroke population, ii) delivered CRT via a NFT protocol, iii) included participants who were affected by a cognitive deficit(s) following stroke (i.e. memory loss, loss of executive function, speech impairment etc.). NFT protocols were highly specific and varied within each study. The majority of studies identified improvements in participant cognitive deficits following the initiation of therapy. Reviewers assessed study quality using the Downs and Black Checklist for Measuring Study Quality tool; limited study quality and strength of evidence restricted generalizability of conclusions regarding the use of this therapy to the greater stroke population. Progression in this field requires further inquiry to strengthen methodology quality and study design. Future investigations should aim to standardize NFT protocols in an effort to understand the dose-response relationship between NFT and improvements in functional outcome. Future investigations should also place a large emphasis on long-term participant follow-up. PMID:28510578

Neurofeedback as a form of cognitive rehabilitation therapy following stroke: A systematic review.

PubMed

Renton, Tian; Tibbles, Alana; Topolovec-Vranic, Jane

2017-01-01

Neurofeedback therapy (NFT) has been used within a number of populations however it has not been applied or thoroughly examined as a form of cognitive rehabilitation within a stroke population. Objectives for this systematic review included: i) identifying how NFT is utilized to treat cognitive deficits following stroke, ii) examining the strength and quality of evidence to support the use of NFT as a form of cognitive rehabilitation therapy (CRT) and iii) providing recommendations for future investigations. Searches were conducted using OVID (Medline, Health Star, Embase + Embase Classic) and PubMed databases. Additional searches were completed using the Cochrane Reviews library database, Google Scholar, the University of Toronto online library catalogue, ClinicalTrials.gov website and select journals. Searches were completed Feb/March 2015 and updated in June/July/Aug 2015. Eight studies were eligible for inclusion in this review. Studies were eligible for inclusion if they: i) were specific to a stroke population, ii) delivered CRT via a NFT protocol, iii) included participants who were affected by a cognitive deficit(s) following stroke (i.e. memory loss, loss of executive function, speech impairment etc.). NFT protocols were highly specific and varied within each study. The majority of studies identified improvements in participant cognitive deficits following the initiation of therapy. Reviewers assessed study quality using the Downs and Black Checklist for Measuring Study Quality tool; limited study quality and strength of evidence restricted generalizability of conclusions regarding the use of this therapy to the greater stroke population. Progression in this field requires further inquiry to strengthen methodology quality and study design. Future investigations should aim to standardize NFT protocols in an effort to understand the dose-response relationship between NFT and improvements in functional outcome. Future investigations should also place a large emphasis on long-term participant follow-up.

Low Impact Development Master Plan

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

Loftin, Samuel R.

This project creates a Low Impact Development (LID) Master Plan to guide and prioritize future development of LID projects at Los Alamos National Laboratory (LANL or the Laboratory). The LID Master Plan applies to developed areas across the Laboratory and focuses on identifying opportunities for storm water quality and hydrological improvements in the heavily urbanized areas of Technical Areas 03, 35 and 53. The LID Master Plan is organized to allow the addition of LID projects for other technical areas as time and funds allow in the future.

Are university rankings useful to improve research? A systematic review.

PubMed

Vernon, Marlo M; Balas, E Andrew; Momani, Shaher

2018-01-01

Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and "luxury" indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance.

A framework for assessing Health Economic Evaluation (HEE) quality appraisal instruments.

PubMed

Langer, Astrid

2012-08-16

Health economic evaluations support the health care decision-making process by providing information on costs and consequences of health interventions. The quality of such studies is assessed by health economic evaluation (HEE) quality appraisal instruments. At present, there is no instrument for measuring and improving the quality of such HEE quality appraisal instruments. Therefore, the objectives of this study are to establish a framework for assessing the quality of HEE quality appraisal instruments to support and improve their quality, and to apply this framework to those HEE quality appraisal instruments which have been subject to more scrutiny than others, in order to test the framework and to demonstrate the shortcomings of existing HEE quality appraisal instruments. To develop the quality assessment framework for HEE quality appraisal instruments, the experiences of using appraisal tools for clinical guidelines are used. Based on a deductive iterative process, clinical guideline appraisal instruments identified through literature search are reviewed, consolidated, and adapted to produce the final quality assessment framework for HEE quality appraisal instruments. The final quality assessment framework for HEE quality appraisal instruments consists of 36 items organized within 7 dimensions, each of which captures a specific domain of quality. Applying the quality assessment framework to four existing HEE quality appraisal instruments, it is found that these four quality appraisal instruments are of variable quality. The framework described in this study should be regarded as a starting point for appraising the quality of HEE quality appraisal instruments. This framework can be used by HEE quality appraisal instrument producers to support and improve the quality and acceptance of existing and future HEE quality appraisal instruments. By applying this framework, users of HEE quality appraisal instruments can become aware of methodological deficiencies inherent in existing HEE quality appraisal instruments. These shortcomings of existing HEE quality appraisal instruments are illustrated by the pilot test.

A framework for assessing Health Economic Evaluation (HEE) quality appraisal instruments

PubMed Central

2012-01-01

Background Health economic evaluations support the health care decision-making process by providing information on costs and consequences of health interventions. The quality of such studies is assessed by health economic evaluation (HEE) quality appraisal instruments. At present, there is no instrument for measuring and improving the quality of such HEE quality appraisal instruments. Therefore, the objectives of this study are to establish a framework for assessing the quality of HEE quality appraisal instruments to support and improve their quality, and to apply this framework to those HEE quality appraisal instruments which have been subject to more scrutiny than others, in order to test the framework and to demonstrate the shortcomings of existing HEE quality appraisal instruments. Methods To develop the quality assessment framework for HEE quality appraisal instruments, the experiences of using appraisal tools for clinical guidelines are used. Based on a deductive iterative process, clinical guideline appraisal instruments identified through literature search are reviewed, consolidated, and adapted to produce the final quality assessment framework for HEE quality appraisal instruments. Results The final quality assessment framework for HEE quality appraisal instruments consists of 36 items organized within 7 dimensions, each of which captures a specific domain of quality. Applying the quality assessment framework to four existing HEE quality appraisal instruments, it is found that these four quality appraisal instruments are of variable quality. Conclusions The framework described in this study should be regarded as a starting point for appraising the quality of HEE quality appraisal instruments. This framework can be used by HEE quality appraisal instrument producers to support and improve the quality and acceptance of existing and future HEE quality appraisal instruments. By applying this framework, users of HEE quality appraisal instruments can become aware of methodological deficiencies inherent in existing HEE quality appraisal instruments. These shortcomings of existing HEE quality appraisal instruments are illustrated by the pilot test. PMID:22894708

Sludge reduction and water quality improvement in anaerobic lagoons through influent pre-treatment

USDA-ARS?s Scientific Manuscript database

Confined swine production generates large volumes of wastewater typically stored and treated in anaerobic lagoons. These lagoons may require cleanup and closure measures in the future. In practice, liquid and sludge need to be removed by pumping, usually at great expense of energy, and land applied ...

ESP 2.0: Improved method for projecting U.S. GHG and air pollution emissions through 2055

EPA Science Inventory

The Emission Scenario Projection (ESP) method is used to develop multi-decadal projections of U.S. Greenhouse Gas (GHG) and criteria pollutant emissions. The resulting future-year emissions can then translated into an emissions inventory and applied in climate and air quality mod...

Student Perspectives: Evaluating a Higher Education Administration Program

ERIC Educational Resources Information Center

Roberts, Jalynn; Gentry, Debra; Townsend, Amy

2011-01-01

The purpose of this mixed-method study was to evaluate a Higher Education Administration doctoral program, to understand student perceptions of program quality, to improve both student satisfaction and retention to degree completion, and to plan for the future. Findings from survey data and focus group interviews indicated program strengths to…

76 FR 36078 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-21

... type of feedback from producer and other to enhance future studies and ensure that the informational... assumptions used; (c) ways to enhance the quality, utility and clarity of the information to be collected; (d... on producer and industry support. The NAHMS Program is committed to improving the value of studies...

Pedagogy for Early Childhood Gifted Education

ERIC Educational Resources Information Center

Kaplan, Sandra; Hertzog, Nancy B.

2016-01-01

Federal attention is focused currently on investing and improving the quality of early childhood education, so that children's potential and talent development can be used as a natural resource for the future of our country. This article engages readers in transitioning their thinking about early childhood gifted education from a traditional…

Individual tree control

Treesearch

Harvey A. Holt

1989-01-01

Controlling individual unwanted trees in forest stands is a readily accepted method for improving the value of future harvests. The practice is especially important in mixed hardwood forests where species differ considerably in value and within species individual trees differ in quality. Individual stem control is a mechanical or chemical weeding operation that...

The tree BVOC index

Treesearch

J.R. Simpson; E.G. McPherson

2011-01-01

Urban trees can produce a number of benefits, among them improved air quality. Biogenic volatile organic compounds (BVOCs) emitted by some species are ozone precursors. Modifying future tree planting to favor lower-emitting species can reduce these emissions and aid air management districts in meeting federally mandated emissions reductions for these compounds. Changes...

Hanging Together To Avoid Hanging Separately: Opportunities for Academic Libraries and Consortia.

ERIC Educational Resources Information Center

Allen, Barbara McFadden; Hirshon, Arnold

1998-01-01

Discusses academic library consortia, examines types of consortia, and presents three case histories (OhioLINK, PALCI and CIC). Highlights include economic competition; changes in information access and delivery; growth of information technology; quality improvement; and future strategies, including pricing models for electronic information,…

Overview and Evaluation of Alternative Air Quality ExposureMetrics Used in Recent Air Pollution Epidemiological Studies

EPA Science Inventory

This poster presents selected results from a few of these studies conducted and provides a summary of key findings and lessons learned and recommendations, in order to improve the use of enhanced exposure metrics during future epidemiological studies of air pollution.

Some Perspectives on Lifelong Education.

ERIC Educational Resources Information Center

Charters, Alexander Nathaniel

The primary mission of adult education is to assist adults in acquiring further control of their current circumstances and future destinies, thereby enabling them to participate more intelligently and responsibly in the political, working, social, cultural, family, and religious aspects of society and to improve their quality of life. Instead of…

Assessment and improvement of sound quality in cochlear implant users

PubMed Central

Caldwell, Meredith T.; Jiam, Nicole T.

2017-01-01

Objectives Cochlear implants (CIs) have successfully provided speech perception to individuals with sensorineural hearing loss. Recent research has focused on more challenging acoustic stimuli such as music and voice emotion. The purpose of this review is to evaluate and describe sound quality in CI users with the purposes of summarizing novel findings and crucial information about how CI users experience complex sounds. Data Sources Here we review the existing literature on PubMed and Scopus to present what is known about perceptual sound quality in CI users, discuss existing measures of sound quality, explore how sound quality may be effectively studied, and examine potential strategies of improving sound quality in the CI population. Results Sound quality, defined here as the perceived richness of an auditory stimulus, is an attribute of implant‐mediated listening that remains poorly studied. Sound quality is distinct from appraisal, which is generally defined as the subjective likability or pleasantness of a sound. Existing studies suggest that sound quality perception in the CI population is limited by a range of factors, most notably pitch distortion and dynamic range compression. Although there are currently very few objective measures of sound quality, the CI‐MUSHRA has been used as a means of evaluating sound quality. There exist a number of promising strategies to improve sound quality perception in the CI population including apical cochlear stimulation, pitch tuning, and noise reduction processing strategies. Conclusions In the published literature, sound quality perception is severely limited among CI users. Future research should focus on developing systematic, objective, and quantitative sound quality metrics and designing therapies to mitigate poor sound quality perception in CI users. Level of Evidence NA PMID:28894831

Implementing and using quality measures for children's health care: perspectives on the state of the practice.

PubMed

Shaller, Dale

2004-01-01

The objective of this study was to identify issues, obstacles, and priorities related to implementing and using child health care quality measures from the perspectives of 4 groups: 1) funders of quality-measurement development and implementation; 2) developers of quality measures; 3) users of quality measures (including Medicaid and the State Children's Health Insurance Program, employer coalitions, and consumer groups); and 4) health plans and providers (in their role as both subjects and users of quality measures). A series of semistructured interviews was conducted with approximately 40 opinion leaders drawn from these 4 groups. The interviews were conducted by telephone between September and December of 2001. Major topic areas covered in the interviews were similar across the groups. Topic areas included 1) strategic vision and/or objectives for funding, developing, or using quality measures for children's health care; 2) a brief summary of the specific quality measures funded, developed, or used; 3) issues and challenges facing funders and developers of measures; 4) major successes achieved; 5) obstacles to implementation and use of measures; and 6) priority needs for future funding. Leaders from all 4 groups acknowledge the importance of developing a robust set of quality measures that can serve multiple objectives and multiple audiences. Standardization of measures is viewed as a critical feature related to all objectives. An assessment of specific quality measures funded, developed, or used by strategic objective shows a high correlation between the uses intended by funders and developers and the actual applications of the various users. The most commonly cited measures across all groups are the Consumer Assessment of Health Plans Survey and Health Plan Employer Data and Information Set, followed by the Child and Adolescent Health Measurement Initiative and special topic studies to support quality-improvement applications (eg, asthma, diabetes, etc). The major issues and challenges cited in common among funders and developers are 1) the lack of trained capacity in the field to conduct needed research and development, and 2) the difficulty in generating sustained interest and support among funders because of the complexity of quality-measurement issues, competing funding priorities in the face of limited funds available to allocate, and the lack of clear and compelling evidence that quality measurement and improvement actually result in better outcomes for children. The 3 most common successes cited across all 4 groups are 1) the growing consensus and collaboration among diverse stakeholder groups involved in measurement development and implementation; 2) the increasing collection and use of specific measures; and 3) early documentation of tangible results in terms of improved quality of care. Specific measurement tools cited as successes by funders and developers include the Medicaid Health Plan Employer Data and Information Set, Consumer Assessment of Health Plans Survey, the Child and Adolescent Health Measurement Initiative, and Rand QA Tools. The most important obstacle reported across all groups is the lack of a strong and compelling "business case" that clearly demonstrates the benefits of quality measurement relative to the costs of implementation. Strongly related to this barrier is the cost of implementing and using measures without a sustainable source of financing as well as the absence of strong public awareness and political support for children's health care quality measurement. Another major barrier cited is the lack of coordination among funders, which prevents the field from developing a unified approach to addressing the numerous technical, political, and administrative issues also cited at length by the leaders interviewed. The 5 top needs for future funding identified across all 4 groups follow directly from the major obstacles that they reported: 1) develop the business case for children's health care quality measurement and improvement based on rigorous cost-bigorous cost-benefit analysis and documentation of quantifiable successes; 2) develop new measures to fill the gaps in critical areas (including adolescent health care, behavioral health, and chronic conditions) that can be applied at the hospital and ambulatory care provider levels; 3) invest in building needed research capacity, a trained pool of users of quality measures, and the capacity among providers to understand and use quality-improvement methods and tools; 4) invest in developing an information infrastructure that will support the efficient collection and use of measures for multiple purposes, including clinical practice, quality measurement, and quality improvement; and 5) develop increased public awareness and support for quality measurement based on improved strategies for communicating with consumers, purchasers, providers, and policy makers. Several implications are suggested by these perspectives for the future direction of quality measurement in children's health care. First, to meet the funding needs identified, many funders must improve coordination to reduce the noise and fragmentation generated by numerous competing or redundant activities. Improved coordination among funders will help assure maximum impact and the efficient use of scarce resources. Second, the importance attached to standardization of measures by both users and developers may conflict at times with the need for innovation and flexibility. Child health quality leaders will need to manage this tension between standardization and innovation to maintain an appropriate balance between the benefits of both. Finally, many of the obstacles identified are not unique to children's health care. Child health quality leaders will need to determine to what extent their efforts to overcome these obstacles can be successfully undertaken independently as opposed to in concert with groups concerned about other populations and sectors in the health care system.

Clinical governance in pre-hospital care.

PubMed Central

Robertson-Steel, I; Edwards, S; Gough, M

2001-01-01

This article seeks to discover and recognize the importance of clinical governance within a new and emerging quality National Health Service (NHS) system. It evaluates the present state of prehospital care and recommends how change, via clinical governance, can ensure a paradigm shift from its currently fragmented state to a seamless ongoing patient care episode. Furthermore, it identifies the drivers of a quality revolution, examines the monitoring and supervision of quality care, and evaluates the role of evidence-based practice. A frank and open view of immediate care doctors is presented, with recommendations to improve the quality of skill delivery and reduce the disparity that exists. Finally, it reviews the current problems with pre-hospital care and projects a future course for quality and patient care excellence. PMID:11383428

Could be the future climate change an opportunity for the winegrowers? The case study of Aglianico wine in southern Italy.

NASA Astrophysics Data System (ADS)

Bonfante, Antonello; Basile, Angelo; Dragonetti, Giovanna; De Lorenzi, Francesca; De Mascellis, Roberto; Gambuti, Angelita; Giorio, Pasquale; Guida, Giampiero; Manna, Piero; Minieri, Luciana; Oliva, Marco; Orefice, Nadia; Terribile, Fabio

2015-04-01

Water deficit is a limiting factor to yield production and crop adaptation to future climate conditions. This is true for crops addressed mainly for biomass production (e.g. maize, wheat, etc.) but not for those where the quality is relevant. Specifically, in grapevine water stress (mid or limited) - occurring during specific phenological phases - is a factor to produce good quality wines. It induces for example the production of anthocyanins and aroma precursors. Therefore, the water stress, due to the future increase of temperature and the rainfall decrease, could represent an opportunity to increase winegrowers' incomes. The study was carried out in Campania region (Southern Italy), in an area vocated to high quality wines production (ZOVISA project: Viticultural zoning at farm scale) The study was realized in two different soils (calcisol and cambisol), under the same climate, on Aglianico cultivar, standard clone population on 1103 Paulsen rootstocks placed along a slope of 90 m length with 11% of gradient. The agro-hydrological model SWAP was calibrated and applied to estimate soil-plant water status at the various crop phenological phases for three vintages (2011-2013). Crop water stress index (CWSI) - estimated by the model - was related to physiological measurements (e.g leaf water potential), grape bunches measurements (e.g. sugar content) and wine quality (e.g. tannins). For both soils, the correlation between measurements and CWSI were high (e.g. -0.97** with sugar; 0.895* with anthocyanins in the skins). Then, the model was applied to future climate condition (2021-2051) obtained from statistical downscaling of GCM in order to estimate the effect of the climate on CWSI and hence on vine quality. The results show that the effects of the climate change on the vine quality is dependent by the soil, being relevant to the cambisol and less pronounced to the calcisol, with an expected improvement of wine quality in the cambisol.

Development of a course review process.

PubMed

Persky, Adam M; Joyner, Pamela U; Cox, Wendy C

2012-09-10

To describe and assess a course review process designed to enhance course quality. A course review process led by the curriculum and assessment committees was designed for all required courses in the doctor of pharmacy (PharmD) program at a school of pharmacy. A rubric was used by the review team to address 5 areas: course layout and integration, learning outcomes, assessment, resources and materials, and learner interaction. One hundred percent of targeted courses, or 97% of all required courses, were reviewed from January to August 2010 (n=30). Approximately 3.5 recommendations per course were made, resulting in improvement in course evaluation items related to learning outcomes. Ninety-five percent of reviewers and 85% of course directors agreed that the process was objective and the course review process was important. The course review process was objective and effective in improving course quality. Future work will explore the effectiveness of an integrated, continual course review process in improving the quality of pharmacy education.

Contributions of the Japanese Gynecologic Oncology Group (JGOG) in Improving the Quality of Life in Women With Gynecological Malignancies.

PubMed

Futagami, Masayuki; Yokoyama, Yoshihito; Shimada, Muneaki; Sato, Shinya; Miyagi, Etsuko; Tozawa-Ono, Akiko; Suzuki, Nao; Fujimura, Masaki; Aoki, Yoichi; Sagae, Satoru; Sugiyama, Toru

2017-04-01

The Japanese Gynecologic Oncology Group (JGOG) is leading Japan in the treatment of gynecological malignancies. The JGOG consists of three treatment committees focusing on uterine cervical cancer, endometrial cancer, and ovarian cancer. Each committee makes efforts to improve treatment and diagnosis. In addition, the Supportive and Palliative Care Committee was established in 2015. Novel studies of supportive care and palliative care have been initiated by this committee. Furthermore, surveys about not only treatment results such as overall survival rates but also quality of life (QOL) and cost-effectiveness assessments are performed by the ovarian cancer committee. Improvements of patients' QOL in the treatment of gynecological malignancies were divided into three concepts as follows: QOL associated with cancer treatment, health care after cancer therapy, and progression of cancer. In this review, we report the contributions and future plans for the improvement of QOL in patients with gynecological malignancies.

Plant Metabolomics: An Indispensable System Biology Tool for Plant Science

PubMed Central

Hong, Jun; Yang, Litao; Zhang, Dabing; Shi, Jianxin

2016-01-01

As genomes of many plant species have been sequenced, demand for functional genomics has dramatically accelerated the improvement of other omics including metabolomics. Despite a large amount of metabolites still remaining to be identified, metabolomics has contributed significantly not only to the understanding of plant physiology and biology from the view of small chemical molecules that reflect the end point of biological activities, but also in past decades to the attempts to improve plant behavior under both normal and stressed conditions. Hereby, we summarize the current knowledge on the genetic and biochemical mechanisms underlying plant growth, development, and stress responses, focusing further on the contributions of metabolomics to practical applications in crop quality improvement and food safety assessment, as well as plant metabolic engineering. We also highlight the current challenges and future perspectives in this inspiring area, with the aim to stimulate further studies leading to better crop improvement of yield and quality. PMID:27258266

Market and plan characteristics related to HMO quality and improvement.

PubMed

Scanlon, Dennis P; Swaminathan, Shailender; Chernew, Michael; Lee, Woolton

2006-12-01

Existing research on health plan performance examines whether variation in plans' scores is related to enrollee and health plan traits, primarily using cross-sectional research designs. This study extends that literature by incorporating data on market characteristics using a longitudinal framework. We estimate multivariate growth models that relate plan performance on standard measures to market and HMO characteristics using an unbalanced panel of data for 1998 to 2002. We find that HMO competition is not associated with better performance or greater rates of improvement in performance on the HEDIS chronic care measures. HMO penetration, on the other hand, is positively associated with HEDIS performance in several of the chronic care process-and-outcomes measures but not with a greater rate of improvement through time. Our analysis indicates that a significant percentage of the unexplained variation in quality improvement is because of permanent, unobserved plan-level characteristics that future research should strive to identify.

Plant Metabolomics: An Indispensable System Biology Tool for Plant Science.

PubMed

Hong, Jun; Yang, Litao; Zhang, Dabing; Shi, Jianxin

2016-06-01

As genomes of many plant species have been sequenced, demand for functional genomics has dramatically accelerated the improvement of other omics including metabolomics. Despite a large amount of metabolites still remaining to be identified, metabolomics has contributed significantly not only to the understanding of plant physiology and biology from the view of small chemical molecules that reflect the end point of biological activities, but also in past decades to the attempts to improve plant behavior under both normal and stressed conditions. Hereby, we summarize the current knowledge on the genetic and biochemical mechanisms underlying plant growth, development, and stress responses, focusing further on the contributions of metabolomics to practical applications in crop quality improvement and food safety assessment, as well as plant metabolic engineering. We also highlight the current challenges and future perspectives in this inspiring area, with the aim to stimulate further studies leading to better crop improvement of yield and quality.

Transgenics in crops

NASA Technical Reports Server (NTRS)

Li, Y.; Wu, Y. H.; McAvoy, R.; Duan, H.

2001-01-01

With rapid world population growth and declining availability of fresh water and arable land, a new technology is urgently needed to enhance agricultural productivity. Recent discoveries in the field of crop transgenics clearly demonstrate the great potential of this technology for increasing food production and improving food quality while preserving the environment for future generations. In this review, we briefly discuss some of the recent achievements in crop improvement that have been made using gene transfer technology.

Cancer Care Ontario's Systematic Symptom Screening Strategy: A Human-Centred Design Approach to Exploring System Gaps and Defining Strategies for the Future.

PubMed

Molloy, Sean; McHugh, Tom; Amernic, Heidi; Mahase, Wenonah; Kurkjian, Serena; Grossi, Robert; Pottie, Patricia; Hurwitz, Gillian; Green, Esther

2018-01-01

Cancer patients experience a high symptom burden throughout their illness. Quality cancer symptom management has been shown to improve patient quality of life and prevent emergency department use. Cancer Care Ontario introduced standardized symptom screening in Ontario, using the Edmonton Symptom Assessment System (ESAS) to facilitate patient reporting and management of symptoms. However, patient symptom information is not always sufficiently addressed. To address these gaps, patient and family advisors collaborated with clinicians, administrators and health system leaders from across the Province in a Symptom Management Summit to share perspectives and co-design context-specific solutions to improve care in their region. © 2018 Longwoods Publishing.

Improving Bread Quality with the Application of a Newly Purified Thermostable α-Amylase from Rhizopus oryzae FSIS4

PubMed Central

Ait Kaki El-Hadef El-Okki, Amel; Gagaoua, Mohammed; Bourekoua, Hayat; Hafid, Kahina; Bennamoun, Leila; Djekrif-Dakhmouche, Shahrazed; El-Hadef El-Okki, Mohamed; Meraihi, Zahia

2017-01-01

A new thermostable α-amylase from Rhizopus oryzae FSIS4 was purified for first time and recovered in a single step using a three-phase partitioning (TPP) system. The fungal α-amylase, at a concentration of 1.936 U per kg of flour, was used in bread-making and compared to the commercial enzyme. The results showed a significant effect of the recovered α-amylase in the prepared bread and allowed us to improve the quality of the bread. The study indicated clearly that the recovered α-amylase is a potential candidate for future applications in the bread-making industry and in other food biotechnology applications. PMID:28231081

Socioeconomic dynamics of water quality in the Egyptian Nile

NASA Astrophysics Data System (ADS)

Malik, Maheen; Nisar, Zainab; Karakatsanis, Georgios

2016-04-01

The Nile River remains the most important source of freshwater for Egypt as it accounts for nearly all of the country's drinking and irrigation water. About 95% of the total population is accounted to live along the Banks of the Nile(1). Therefore, water quality deterioration in addition to general natural scarcity of water in the region(2) is the main driver for carrying out this study. What further aggravates this issue is the water conflict in the Blue Nile region. The study evaluates different water quality parameters and their concentrations in the Egyptian Nile; further assessing the temporal dynamics of water quality in the area with (a) the Environmental Kuznets Curve (EKC)(3) and (b) the Jevons Paradox (JP)(4) in order to identify water quality improvements or degradations using selected socioeconomic variables(5). For this purpose various environmental indicators including BOD, COD, DO, Phosphorus and TDS were plotted against different economic variables including Population, Gross Domestic Product (GDP), Annual Fresh Water Withdrawal and Improved Water Source. Mathematically, this was expressed by 2nd and 3rd degree polynomial regressions generating the EKC and JP respectively. The basic goal of the regression analysis is to model and highlight the dynamic trend of water quality indicators in relation to their established permissible limits, which will allow the identification of optimal future water quality policies. The results clearly indicate that the dependency of water quality indicators on socioeconomic variables differs for every indicator; while COD was above the permissible limits in all the cases despite of its decreasing trend in each case, BOD and phosphate signified increasing concentrations for the future, if they continue to follow the present trend. This could be an indication of rebound effect explained by the Jevons Paradox i.e. water quality deterioration after its improvement, either due to increase of population or intensification of economic activities related to these indicators. Keywords: Water quality dynamics, Environmental Kuznets Curve (EKC), Jevons Paradox (JP), economic variables, polynomial regressions, environmental indicators, permissible limit References: (1)Evans, A. (2007). River of Life River Nile. (2)Egypt's Water Crisis - Recipe for Disaster. (2016). [Blog] EcoMENA- Echoing Sustainability. (3)Alstine, J. and Neumayer, E. (2010). The Environmental Kuznets Curve. (4)Garrett, T. (2014). Rebound, Backfire, and the Jevons Paradox. [Blog] (5)Data.worldbank.org

Evaluating the state of quality-improvement science through evidence synthesis: insights from the closing the quality gap series.

PubMed

McDonald, Kathryn M; Schultz, Ellen M; Chang, Christine

2013-01-01

The Closing the Quality Gap series from the Agency for Healthcare Research and Quality summarizes evidence for eight high-priority health care topics: outcomes used in disability research, bundled payment programs, public reporting initiatives, health care disparities, palliative care, the patient-centered medical home, prevention of health care-associated infections, and medication adherence. To distill evidence from this series and provide insight into the "state of the science" of quality improvement (QI). We provided common guidance for topic development and qualitatively synthesized evidence from the series topic reports to identify cross-topic themes, challenges, and evidence gaps as related to QI practice and science. Among topics that examined effectiveness of QI interventions, we found improvement in some outcomes but not others. Implementation context and potential harms from QI activities were not widely evaluated or reported, although market factors appeared important for incentive-based QI strategies. Patient-focused and systems-focused strategies were generally more effective than clinician-focused strategies, although the latter approach improved clinician adherence to infection prevention strategies. Audit and feedback appeared better for targeting professionals and organizations, but not patients. Topic reviewers observed heterogeneity in outcomes used for QI evaluations, weaknesses in study design, and incomplete reporting. Synthesizing evidence across topics provided insight into the state of the QI field for practitioners and researchers. To facilitate future evidence synthesis, consensus is needed around a smaller set of outcomes for use in QI evaluations and a framework and lexicon to describe QI interventions more broadly, in alignment with needs of decision makers responsible for improving quality.

Comparative assessment for future prediction of urban water environment using WEAP model: A case study of Kathmandu, Manila and Jakarta

NASA Astrophysics Data System (ADS)

Kumar, Pankaj; Yoshifumi, Masago; Ammar, Rafieiemam; Mishra, Binaya; Fukushi, Ken

2017-04-01

Uncontrolled release of pollutants, increasing extreme weather condition, rapid urbanization and poor governance posing a serious threat to sustainable water resource management in developing urban spaces. Considering half of the world's mega-cities are in the Asia and the Pacific with 1.7 billion people do not access to improved water and sanitation, water security through its proper management is both an increasing concern and an imperative critical need. This research work strives to give a brief glimpse about predicted future water environment in Bagmati, Pasig and Ciliwung rivers from three different cities viz. Manila, Kathmandu and Jakarta respectively. Hydrological model used here to foresee the collective impacts of rapid population growth because of urbanization as well as climate change on unmet demand and water quality in near future time by 2030. All three rivers are major source of water for different usage viz. domestic, industrial, agriculture and recreation but uncontrolled withdrawal and sewerage disposal causing deterioration of water environment in recent past. Water Evaluation and Planning (WEAP) model was used to model river water quality pollution future scenarios using four indicator species i.e. Dissolved Oxygen (DO), Biochemical Oxygen Demand (BOD), Chemical Oxygen Demand (COD) and Nitrate (NO3). Result for simulated water quality as well as unmet demand for year 2030 when compared with that of reference year clearly indicates that not only water quality deteriorates but also unmet demands is increasing in future course of time. This also suggests that current initiatives and policies for water resource management are not sufficient enough and hence immediate and inclusive action through transdisciplinary research.

Implications of sperm banking for health-related quality of life up to 1 year after cancer diagnosis

PubMed Central

Pacey, A; Merrick, H; Arden-Close, E; Morris, K; Rowe, R; Stark, D; Eiser, C

2013-01-01

Background: Sperm banking is recommended for all men diagnosed with cancer where treatment is associated with risk of long-term gonadatoxicity, to offer the opportunity of fatherhood and improved quality of life. However, uptake of sperm banking is lower than expected and little is known about why men refuse. Our aims were to determine: (i) demographic and medical variables associated with decisions about banking and (ii) differences in quality of life between bankers and non-bankers at diagnosis (Time 1 (T1)) and 1 year later (Time 2 (T2)). Methods: Questionnaires were completed by 91 men (response rate=86.67%) at T1 and 78 (85.71% response rate) at T2. Results: In all, 44 (56.41%) banked sperm. They were younger and less likely to have children than non-bankers. In a subset of men who were not sure if they wanted children in the future (n=36), 24 banked sperm. Among this group, those who banked were younger, more satisfied with clinic appointments and less worried about the health of future children. At T2, there were no differences in quality of life between bankers and non-bankers. Conclusion: For those who are uncertain about future reproductive plans, decisions depend on their health on diagnosis and satisfaction with clinic care. We conclude that extra care should be taken in counselling younger men who may have given little consideration to future parenting. Results support previous findings that the role of the doctor is vital in facilitating decisions, especially for those who are undecided about whether they wanted children in the future or not. PMID:23470465

Perception of synthetic speech produced automatically by rule: Intelligibility of eight text-to-speech systems.

PubMed

Greene, Beth G; Logan, John S; Pisoni, David B

1986-03-01

We present the results of studies designed to measure the segmental intelligibility of eight text-to-speech systems and a natural speech control, using the Modified Rhyme Test (MRT). Results indicated that the voices tested could be grouped into four categories: natural speech, high-quality synthetic speech, moderate-quality synthetic speech, and low-quality synthetic speech. The overall performance of the best synthesis system, DECtalk-Paul, was equivalent to natural speech only in terms of performance on initial consonants. The findings are discussed in terms of recent work investigating the perception of synthetic speech under more severe conditions. Suggestions for future research on improving the quality of synthetic speech are also considered.

Impact of peer-led quality improvement networks on quality of inpatient mental health care: study protocol for a cluster randomized controlled trial.

PubMed

Aimola, Lina; Jasim, Sarah; Tripathi, Neeraj; Tucker, Sarah; Worrall, Adrian; Quirk, Alan; Crawford, Mike J

2016-09-21

Quality improvement networks are peer-led programmes in which members of the network assess the quality of care colleagues provide according to agreed standards of practice. These networks aim to help members identify areas of service provision that could be improved and share good practice. Despite the widespread use of peer-led quality improvement networks, there is very little information about their impact. We are conducting a cluster randomized controlled trial of a quality improvement network for low-secure mental health wards to examine the impact of membership on the process and outcomes of care over a 12 month period. Standalone low secure units in England and Wales that expressed an interest in joining the quality improvement network were recruited for the study from 2012 to 2014. Thirty-eight units were randomly allocated to either the active intervention (participation in the network n = 18) or a control arm (delayed participation in the network n = 20). Using a 5 % significance level and 90 % power, it was calculated that a sample size of 60 wards was required taking into account a 10 % drop out. A total of 75 wards were assessed at baseline and 8 wards dropped out the study before the data collection at follow up. Researchers masked to the allocation status of the units assessed all study outcomes at baseline and follow-up 12 months later. The primary outcome is the quality of the physical environment and facilities on the wards. The secondary outcomes are: safety of the ward, patient-rated satisfaction with care and mental well-being, staff burnout, training and supervision. Relative to control wards, it is hypothesized that the quality of the physical environment and facilities will be higher on wards in the active arm of the trial 12 months after randomization. To our knowledge, this is the first randomized evaluation of a peer-led quality improvement network that has examined the impact of participation on both patient-level and service-level outcomes. The study has the potential to help shape future efforts to improve the quality of inpatient care. Current Controlled Trials ISRCTN79614916 . Retrospectively registered 28 March 2014].

The introduction of local air quality management in the United Kingdom: A review and theoretical framework

NASA Astrophysics Data System (ADS)

Longhurst, J. W. S.; Lindley, S. J.; Watson, A. F. R.; Conlan, D. E.

In the light of recent episodes of poor air quality in many of the U.K.'s major urban areas, concern has been expressed regarding the apparent inability of existing air quality control procedures to effectively tackle contemporary scenarios. As a result of this, a new philosophy for air quality control has been sought which can provide a solid basis for the preservation and future improvement of air quality. It is proposed that a suitable mechanism for this would be found through the adoption of an integrated and holistic local air quality management approach. This paper will present and discuss a theoretical framework for the application of local air quality management in the U.K. and investigate the potential of the Environment Act (1995) to provide such a framework.

Small cause - big effect: improvement in interface design results in improved data quality - a multicenter crossover study.

PubMed

Ahlbrandt, Janko; Henrich, Michael; Hartmann, Bernd A; Bundschuh, Bettina B; Schwarz, Julia; Klasen, Joachim; Röhrig, Rainer

2012-01-01

In Germany the core data set for anesthesia version 3.0 was recently introduced for external quality assurance, which includes five surgical tracer procedures. We found a low rate of correctly documented tracers when compared to procedure data (OPS-Codes) documented separately. Examination revealed that the graphical user interface (GUI) contravened the dialogue principles as defined in EN ISO 9241-110. We worked with the manufacturer to implement small improvements and roll out the software. A crossover study was conducted at a university hospital and a municipal hospital chain with five hospitals. All study sites and surgical tracer procedures combined, we found an improvement from 42% to 65% (p<0.001; N=34,610) correctly documented anesthesias. We also saw improvements for most of the observed surgical tracer procedures at all hospitals. Our results show the big effect small changes to the GUI can have on data quality. They also raise the question, if highly flexible and parameterized clinical documentation systems are suited to achieve high usability. Finding the right balance between GUIs designed by usability experts and the flexibility of parameterization by administrators will be a difficult task for the future and subject to further research.

A fourth-year medical school rotation in quality, patient safety, and population medicine.

PubMed

Dysinger, Wayne S; Pappas, James M

2011-10-01

Quality improvement and population medicine are skills that are increasingly important for physicians to possess. Methods to achieve foundational acquisition of these skills in medical school have not been well described in the past. The primary goal of this project is to provide hands-on, experiential learning in full-cycle population-based care. A description is given of a 4-week, team-based, rapid-cycle quality improvement project embedded in a required fourth-year medical school rotation. Over the course of 4 years a nonspecialty generic Ambulatory Care rotation was converted to a population-based learning rotation. For the last 3 years this rotation has required students to participate in teams of three to four students to assess, plan, implement, and evaluate a quality improvement project. Between 2008 and 2010 a total of 510 students completed the rotation. During this time the project component of the rotation received a 53% average rating of "excellent" or "above average." Qualitative evaluation indicates the project to be an acceptable and worthwhile educational experience for medical students, adding new insights and occasionally career-changing perspectives. Although experiential team-based quality improvement projects are a new format for learning in the medical school environment, it can be implemented in a format that is acceptable and beneficial to future physicians and healthcare systems. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Surgical process improvement tools: defining quality gaps and priority areas in gastrointestinal cancer surgery.

PubMed

Wei, A C; Devitt, K S; Wiebe, M; Bathe, O F; McLeod, R S; Urbach, D R

2014-04-01

Surgery is a cornerstone of cancer treatment, but significant differences in the quality of surgery have been reported. Surgical process improvement tools (spits) modify the processes of care as a means to quality improvement (qi). We were interested in developing spits in the area of gastrointestinal (gi) cancer surgery. We report the recommendations of an expert panel held to define quality gaps and establish priority areas that would benefit from spits. The present study used the knowledge-to-action cycle was as a framework. Canadian experts in qi and in gi cancer surgery were assembled in a nominal group workshop. Participants evaluated the merits of spits, described gaps in current knowledge, and identified and ranked processes of care that would benefit from qi. A qualitative analysis of the workshop deliberations using modified grounded theory methods identified major themes. The expert panel consisted of 22 participants. Experts confirmed that spits were an important strategy for qi. The top-rated spits included clinical pathways, electronic information technology, and patient safety tools. The preferred settings for use of spits included preoperative and intraoperative settings and multidisciplinary contexts. Outcomes of interest were cancer-related outcomes, process, and the technical quality of surgery measures. Surgical process improvement tools were confirmed as an important strategy. Expert panel recommendations will be used to guide future research efforts for spits in gi cancer surgery.

Surgical process improvement tools: defining quality gaps and priority areas in gastrointestinal cancer surgery

PubMed Central

Wei, A.C.; Devitt, K.S.; Wiebe, M.; Bathe, O.F.; McLeod, R.S.; Urbach, D.R.

2014-01-01

Background Surgery is a cornerstone of cancer treatment, but significant differences in the quality of surgery have been reported. Surgical process improvement tools (spits) modify the processes of care as a means to quality improvement (qi). We were interested in developing spits in the area of gastrointestinal (gi) cancer surgery. We report the recommendations of an expert panel held to define quality gaps and establish priority areas that would benefit from spits. Methods The present study used the knowledge-to-action cycle was as a framework. Canadian experts in qi and in gi cancer surgery were assembled in a nominal group workshop. Participants evaluated the merits of spits, described gaps in current knowledge, and identified and ranked processes of care that would benefit from qi. A qualitative analysis of the workshop deliberations using modified grounded theory methods identified major themes. Results The expert panel consisted of 22 participants. Experts confirmed that spits were an important strategy for qi. The top-rated spits included clinical pathways, electronic information technology, and patient safety tools. The preferred settings for use of spits included preoperative and intraoperative settings and multidisciplinary contexts. Outcomes of interest were cancer-related outcomes, process, and the technical quality of surgery measures. Conclusions Surgical process improvement tools were confirmed as an important strategy. Expert panel recommendations will be used to guide future research efforts for spits in gi cancer surgery. PMID:24764704

Impact of physical therapy for Parkinson's disease: a critical review of the literature.

PubMed

Kwakkel, G; de Goede, C J T; van Wegen, E E H

2007-01-01

A systematic review of the literature found 23 randomized clinical trials reflecting specific core areas of physical therapy (PT), that is, transfer, posture, balance, reaching and grasping, gait, and physical condition. All studies were of moderate methodological quality. Important limitations of the studies were: (1) insufficient statistical power (type II error); (2) poor methodological quality due to inadequate randomization and blinding procedures; (3) insufficient contrast in dosage and treatment between experimental and control groups; and (4) lack of appropriate measurement instruments able to identify clinically meaningful changes according to the International Classification of Functioning (ICF). In the last 5 years, the methodological quality of RCTs has shown substantial improvement. Most high-quality studies investigated the effects of exercise therapy, including the use of external rhythms to improve gait and gait-related activities. The results of these trials suggest that the effects of PT are task- and context-specific. This indicates that the tasks that are trained tend not to generalize to related activities that are not directly trained in the rehabilitation programme itself, and suggests that future programmes should train meaningful tasks preferably in patients' home environment. In addition, the decline in treatment effects after an intervention has ended suggests the need for permanent treatment of patients with PD, i.e. chronic treatment for this chronic disease. Future studies should aim to develop responsive measurement instruments able to monitor meaningful changes in activities, as well as better understanding of insufficiently understood symptoms such as freezing, rigidity and bradykinesia and greater insight into neurophysiological mechanisms underlying training-induced changes in activities such as improved gait performance by rhythmic cueing.

Development of risk-based air quality management strategies under impacts of climate change.

PubMed

Liao, Kuo-Jen; Amar, Praveen; Tagaris, Efthimios; Russell, Armistead G

2012-05-01

Climate change is forecast to adversely affect air quality through perturbations in meteorological conditions, photochemical reactions, and precursor emissions. To protect the environment and human health from air pollution, there is an increasing recognition of the necessity of developing effective air quality management strategies under the impacts of climate change. This paper presents a framework for developing risk-based air quality management strategies that can help policy makers improve their decision-making processes in response to current and future climate change about 30-50 years from now. Development of air quality management strategies under the impacts of climate change is fundamentally a risk assessment and risk management process involving four steps: (1) assessment of the impacts of climate change and associated uncertainties; (2) determination of air quality targets; (3) selections of potential air quality management options; and (4) identification of preferred air quality management strategies that minimize control costs, maximize benefits, or limit the adverse effects of climate change on air quality when considering the scarcity of resources. The main challenge relates to the level of uncertainties associated with climate change forecasts and advancements in future control measures, since they will significantly affect the risk assessment results and development of effective air quality management plans. The concept presented in this paper can help decision makers make appropriate responses to climate change, since it provides an integrated approach for climate risk assessment and management when developing air quality management strategies. Development of climate-responsive air quality management strategies is fundamentally a risk assessment and risk management process. The risk assessment process includes quantification of climate change impacts on air quality and associated uncertainties. Risk management for air quality under the impacts of climate change includes determination of air quality targets, selections of potential management options, and identification of effective air quality management strategies through decision-making models. The risk-based decision-making framework can also be applied to develop climate-responsive management strategies for the other environmental dimensions and assess costs and benefits of future environmental management policies.

Evaluating the effectiveness of air quality interventions.

PubMed

van Erp, Annemoon M M; O'Keefe, Robert; Cohen, Aaron J; Warren, Jane

2008-01-01

Evaluating the extent to which air quality regulations improve public health--sometimes referred to as accountability--is part of an emerging effort to assess the effectiveness of environmental regulatory policies. Air quality has improved substantially in the United States and Western Europe in recent decades, with far less visible pollution and decreasing concentrations of several major pollutants. In large part, these gains were achieved through increasingly stringent air quality regulations. The costs associated with compliance and, importantly, the need to ensure that the regulations are achieving the intended public health benefits underscore the importance of accountability research. To date, accountability research has emphasized measuring the effects of actions already taken to improve air quality. Such research may also contribute to estimating the burden of disease that might be avoided in the future if certain actions are taken. The Health Effects Institute (HEI) currently funds eight ongoing studies on accountability, which cover near-term interventions to improve air quality including (1) a ban on the sale of coal, (2) replacing old wood stoves with cleaner ones, (3) decreasing sulfur content in fuel, (4) measures to reduce traffic, and (5) longer term, wide-ranging actions or events (such as complex changes associated with the reunification of Germany). HEI is also funding the development of methods and research to assess regulations that are implemented incrementally over extended periods of time, such as Title IV of the 1990 Clean Air Act Amendments, which reduces sulfur dioxide emissions from power plants in the eastern United States.

TU-EF-BRD-04: Summing It Up: The Future of Quality and Safety Research

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

Ford, E.

Research related to quality and safety has been a staple of medical physics academic activities for a long time. From very early on, medical physicists have developed new radiation measurement equipment and analysis techniques, created ever increasingly accurate dose calculation models, and have vastly improved imaging, planning, and delivery techniques. These and other areas of interest have improved the quality and safety of radiotherapy for our patients. With the advent of TG-100, quality and safety is an area that will garner even more research interest in the future. As medical physicists pursue quality and safety research in greater numbers, itmore » is worthwhile to consider what actually constitutes research on quality and safety. For example, should the development of algorithms for real-time EPID-based in-vivo dosimetry be defined as “quality and safety” research? How about the clinical implementation of such as system? Surely the application of failure modes and effects analysis to a clinical process would be considered quality and safety research, but is this type of research that should be included in the medical physics peer-reviewed literature? The answers to such questions are of critical importance to set researchers in a direction that will provide the greatest benefit to our field and the patients we serve. The purpose of this symposium is to consider what constitutes research in the arena of quality and safety and differentiate it from other research directions. The key distinction here is developing the tool itself (e.g. algorithms for EPID dosimetry) vs. studying the impact of the tool with some quantitative metric. Only the latter would I call quality and safety research. Issues of ‘basic’ versus ‘applied’ quality and safety research will be covered as well as how the research results should be structured to provide increasing levels of support that a quality and safety intervention is effective and sustainable. Examples from existing peer-reviewed research will be used to highlight the main points. Historical, medical physicists have leveraged many areas of applied physics, engineering and biology to improve radiotherapy. Research on quality and safety is another area where physicists can have an impact. The key to further progress is to clearly define what constitutes quality and safety research for those interested in doing such research and the reviewers of that research. Learning Objectives: List several tools of quality and safety with references to peer-reviewed literature. Describe effects of mental workload on performance. Outline research in quality and safety indicators and technique analysis. Understand what quality and safety research needs to be going forward. Understand the links between cooperative group trials and quality and safety research.« less

Clinical leadership for high-quality care: developing future ward leaders.

PubMed

Enterkin, Judith; Robb, Elizabeth; McLaren, Susan

2013-03-01

This paper reports upon the development, delivery and evaluation of a leadership programme for aspiring Ward Leaders in one National Health Service Trust in England. The ward sister role is fundamental to quality patient care and clinical leadership, however the role is increasingly difficult to recruit to. A lack of formal preparation and skills development for the role has been widely acknowledged. An evaluation of a programme of education for leadership. Three cohorts (n = 60) completed the programme. Semi-structured questionnaires were completed by participants (n = 36: 60%) at the conclusion of the programme. Qualitative data from questionnaires was analysed using a thematic approach. Participants reported increased political, organizational and self-awareness, increased confidence, feelings of empowerment and the ability to empower others. Opportunities for networking with peers were valued within the action learning approach. For some participants, career intentions were clarified through reflection. The majority of participants had benefited from the leadership programme and valued this development as an empowering preparation for future careers. Investment in leadership preparation for future ward sister roles is strongly recommended as part of a strategy designed to enhance quality improvement, career path development, workforce empowerment and retention. © 2012 Blackwell Publishing Ltd.

Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria.

PubMed

Luckett, Tim; Bhattarai, Priyanka; Phillips, Jane; Agar, Meera; Currow, David; Krastev, Yordanka; Davidson, Patricia M

2015-11-01

A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia. A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Frameworkfor Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity. Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment--the Dying with Dignity Victoria Advance Healthcare Directive. More research is needed to understand how online resources can optimally elicit and record consumers' individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement.

Business coalitions on health: their activities and impact.

PubMed

Cronin, C

1994-07-01

Business coalitions on health-generally nonprofit, community-based membership organizations primarily composed of local employers-attempt to manage the cost and quality of health care delivery. They are also active in other areas, including member education, data collection, and selective contracting. With reference to projects related to public accountability for hospital quality of care, coalitions have been involved in legislative support of state public databases, efforts to develop severity-adjusted information on hospital quality, group purchasing from selected hospitals based on cost and quality-an activity conducted in more than 20 locales, and consumer education. With health care reform, coalitions will need to shift from looking solely at individual physicians and hospitals to looking at them in the context of managed care. Balancing the tension between continuous quality improvement activities and public accountability will also be an important issue for coalitions. The future of coalitions after health care reform is uncertain, with scenarios ranging from their demise to their expansion as active purchasing coalitions or their assumption of new roles and activities. Whatever the future viability and focus of health care coalitions, they have effectively served as change agents in their communities.

Key strategies to improve systems for managing patient complaints within health facilities - what can we learn from the existing literature?

PubMed

Mirzoev, Tolib; Kane, Sumit

2018-01-01

Information from patient complaints - a widely accepted measure of patient satisfaction with services - can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems. The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research. We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands. Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients' awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context. Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints.

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

PubMed Central

2018-01-01

ABSTRACT Background: Information from patient complaints – a widely accepted measure of patient satisfaction with services – can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems. Objectives: The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research. Methods: We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands. Results: Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients’ awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context. Conclusions: Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints. PMID:29658393

Microgravity

NASA Image and Video Library

2004-04-15

The manipulation of organic materials--cells, tissues, and even living organisms--offers many exciting possibilities for the future from organic computers to improved aquaculture. Commercial researchers are using the microgravity environment to produce large near perfect protein crystals Research on insulin has yielded crystals that far surpass the quality of insulin crystals grown on the ground. Using these crystals industry partners are working to develop new and improved treatments for diabetes. Other researchers are exploring the possibility of producing antibiotics using plant cell cultures which could lead to both orbital production and the improvement of ground-based antibiotic production.

Insulin

NASA Technical Reports Server (NTRS)

2004-01-01

The manipulation of organic materials--cells, tissues, and even living organisms--offers many exciting possibilities for the future from organic computers to improved aquaculture. Commercial researchers are using the microgravity environment to produce large near perfect protein crystals Research on insulin has yielded crystals that far surpass the quality of insulin crystals grown on the ground. Using these crystals industry partners are working to develop new and improved treatments for diabetes. Other researchers are exploring the possibility of producing antibiotics using plant cell cultures which could lead to both orbital production and the improvement of ground-based antibiotic production.

Mobile Applications Improve Quality of Life on Citizens with Disorientation: The 'NeverLost App' Paradigm.

PubMed

Fotiou, Sotirios; Vlamos, Panayiotis

2017-01-01

Mobile technology has been evolved as an important tool in healthcare. Mobile applications are being designed in order to assist patients in their everyday life and also to play a vital role on the improvement of their everyday activities and quality of life. Meanwhile students use advanced techniques in order to design and implement high quality applications that aim to introduce them to the advantages of the mobile technology. In this paper we present the steps for the creation of the application NeverLost that was inspired, designed, created and tested by students of the Secondary Education. NeverLost is an Android application that helps individuals (mainly children) with disabilities, as well as older patients with lack of orientation manage their day-to-day activities. A research of the general benefits that students using this app is presented, as well as their future proposals for the evolution of the app in other aspects of healthcare and quality of life of senior citizens or patients with neurodegenerative diseases.

The integration of FMEA with other problem solving tools: A review of enhancement opportunities

NASA Astrophysics Data System (ADS)

Ng, W. C.; Teh, S. Y.; Low, H. C.; Teoh, P. C.

2017-09-01

Failure Mode Effect Analysis (FMEA) is one the most effective and accepted problem solving (PS) tools for most of the companies in the world. Since FMEA was first introduced in 1949, practitioners have implemented FMEA in various industries for their quality improvement initiatives. However, studies have shown that there are drawbacks that hinder the effectiveness of FMEA for continuous quality improvement from product design to manufacturing. Therefore, FMEA is integrated with other PS tools such as inventive problem solving methodology (TRIZ), Quality Function Deployment (QFD), Root Cause Analysis (RCA) and seven basic tools of quality to address the drawbacks. This study begins by identifying the drawbacks in FMEA. A comprehensive literature review on the integration of FMEA with other tools is carried out to categorise the integrations based on the drawbacks identified. The three categories are inefficiency of failure analysis, psychological inertia and neglect of customers’ perspective. This study concludes by discussing the gaps and opportunities in the integration for future research.

Hospital accreditation: staff experiences and perceptions.

PubMed

Bogh, Søren Bie; Blom, Ane; Raben, Ditte Caroline; Braithwaite, Jeffrey; Thude, Bettina; Hollnagel, Erik; Plessen, Christian von

2018-06-11

Purpose The purpose of this paper is to understand how staff at various levels perceive and understand hospital accreditation generally and in relation to quality improvement (QI) specifically. Design/methodology/approach In a newly accredited Danish hospital, the authors conducted semi-structured interviews to capture broad ranging experiences. Medical doctors, nurses, a quality coordinator and a quality department employee participated. Interviews were audio recorded and subjected to framework analysis. Findings Staff reported that The Danish Healthcare Quality Programme affected management priorities: office time and working on documentation, which reduced time with patients and on improvement activities. Organisational structures were improved during preparation for accreditation. Staff perceived that the hospital was better prepared for new QI initiatives after accreditation; staff found disease specific requirements unnecessary. Other areas benefited from accreditation. Interviewees expected that organisational changes, owing to accreditation, would be sustained and that the QI focus would continue. Practical implications Accreditation is a critical and complete hospital review, including areas that often are neglected. Accreditation dominates hospital agendas during preparation and surveyor visits, potentially reducing patient care and other QI initiatives. Improvements are less likely to occur in areas that other QI initiatives addressed. Yet, accreditation creates organisational foundations for future QI initiatives. Originality/value The authors study contributes new insights into how hospital staff at different organisational levels perceive and understand accreditation.

Oncology drug discovery: planning a turnaround.

PubMed

Toniatti, Carlo; Jones, Philip; Graham, Hilary; Pagliara, Bruno; Draetta, Giulio

2014-04-01

We have made remarkable progress in our understanding of the pathophysiology of cancer. This improved understanding has resulted in increasingly effective targeted therapies that are better tolerated than conventional cytotoxic agents and even curative in some patients. Unfortunately, the success rate of drug approval has been limited, and therapeutic improvements have been marginal, with too few exceptions. In this article, we review the current approach to oncology drug discovery and development, identify areas in need of improvement, and propose strategies to improve patient outcomes. We also suggest future directions that may improve the quality of preclinical and early clinical drug evaluation, which could lead to higher approval rates of anticancer drugs.

Kaizen: a process improvement model for the business of health care and perioperative nursing professionals.

PubMed

Tetteh, Hassan A

2012-01-01

Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement. Published by Elsevier Inc.

Planning for Adaptation to Climate Change in the City of Chicago

NASA Astrophysics Data System (ADS)

Wuebbles, D. J.; Hayhoe, K.; Coffee, J.; McGraw, J.; Parzen, J.

2008-12-01

Under Mayor Richard M. Daley's leadership, the City of Chicago initiated the Chicago Climate Action Plan (CCAP) to better understand local implications of global climate change in both higher and lower emissions scenarios, reduce greenhouse gas emissions, and implement programs to build future climate change resilience. The City approached this work not only as a way to make Chicago more adaptable in the future, but also to improve Chicago's quality of life today. The Chicago Climate Action Plan adopted stresses the importance of both reducing greenhouse gas emissions in Chicago and preparing for climate changes that may be unavoidable. Building off of the City's significant environmental programs and projects, and based on our analyses of the climate effects and impacts that improved the scientific understanding of future climate change impacts on Chicago, the City then developed a set of climate change adaptation strategies, resulting in the City of Chicago Climate Change Adaptation Summary. This document includes prioritization of climate change adaptations based on relative risk as well as framework strategies for those tactics categorized as "must do/early action." In early 2008, The Mayor's Office asked five Commissioners from its Green Steering Committee to chair adaptation work groups including: extreme heat; extreme precipitation; buildings, infrastructure and equipment; ecosystems; and leadership, planning and communications. Working with staff from relevant departments, sister agencies and other stakeholders, these work groups developed 39 basic adaptation work plans, including plans for enhancing the City's existing projects and programs that relate to climate change adaptation. Climate change adaptation work will be on-going in City Departments under the Mayor's Office leadership. The City intends to continually monitor and improve its response to climate change, resulting in an improved quality of life for Chicago residents.

The Role of Mindfulness in Reducing the Adverse Effects of Childhood Stress and Trauma

PubMed Central

Ortiz, Robin; Sibinga, Erica M.

2017-01-01

Research suggests that many children are exposed to adverse experiences in childhood. Such adverse childhood exposures may result in stress and trauma, which are associated with increased morbidity and mortality into adulthood. In general populations and trauma-exposed adults, mindfulness interventions have demonstrated reduced depression and anxiety, reduced trauma-related symptoms, enhanced coping and mood, and improved quality of life. Studies in children and youth also demonstrate that mindfulness interventions improve mental, behavioral, and physical outcomes. Taken together, this research suggests that high-quality, structured mindfulness instruction may mitigate the negative effects of stress and trauma related to adverse childhood exposures, improving short- and long-term outcomes, and potentially reducing poor health outcomes in adulthood. Future work is needed to optimize implementation of youth-based mindfulness programs and to study long-term outcomes into adulthood. PMID:28264496

The software product assurance metrics study: JPL's software systems quality and productivity

NASA Technical Reports Server (NTRS)

Bush, Marilyn W.

1989-01-01

The findings are reported of the Jet Propulsion Laboratory (JPL)/Software Product Assurance (SPA) Metrics Study, conducted as part of a larger JPL effort to improve software quality and productivity. Until recently, no comprehensive data had been assembled on how JPL manages and develops software-intensive systems. The first objective was to collect data on software development from as many projects and for as many years as possible. Results from five projects are discussed. These results reflect 15 years of JPL software development, representing over 100 data points (systems and subsystems), over a third of a billion dollars, over four million lines of code and 28,000 person months. Analysis of this data provides a benchmark for gauging the effectiveness of past, present and future software development work. In addition, the study is meant to encourage projects to record existing metrics data and to gather future data. The SPA long term goal is to integrate the collection of historical data and ongoing project data with future project estimations.

Qualitative research in rehabilitation science: opportunities, challenges, and future directions.

PubMed

VanderKaay, Sandra; Moll, Sandra E; Gewurtz, Rebecca E; Jindal, Pranay; Loyola-Sanchez, Adalberto; Packham, Tara L; Lim, Chun Y

2018-03-01

Qualitative research has had a significant impact within rehabilitation science over time. During the past 20 years the number of qualitative studies published per year in Disability and Rehabilitation has markedly increased (from 1 to 54). In addition, during this period there have been significant changes in how qualitative research is conceptualized, conducted, and utilized to advance the field of rehabilitation. The purpose of this article is to reflect upon the progress of qualitative research within rehabilitation to date, to explicate current opportunities and challenges, and to suggest future directions to continue to strengthen the contribution of qualitative research in this field. Relevant literature searches were conducted in electronic data bases and reference lists. Pertinent literature was examined to identify current opportunities and challenges for qualitative research use in rehabilitation and to identify future directions. Six key areas of opportunity and challenge were identified: (a) paradigm shifts, (b) advancements in methodology, (c) emerging technology, (d) advances in quality evaluation, (e) increasing popularity of mixed methods approaches, and (f) evolving approaches to knowledge translation. Two important future directions for rehabilitation are posited: (1) advanced training in qualitative methods and (2) engaging qualitative communities of research. Qualitative research is well established in rehabilitation and has an important place in the continued growth of this field. Ongoing development of qualitative researchers and methods are essential. Implications for Rehabilitation Qualitative research has the potential to improve rehabilitation practice by addressing some of the most pervasive concerns in the field such as practitioner-client interaction, the subjective and lived experience of disability, and clinical reasoning and decision making. This will serve to better inform those providing rehabilitation services thereby benefiting patients that are utilizing these services. Changes over time in how qualitative research is conceptualized, conducted, and utilized to advance rehabilitation science have resulted in a number of unique opportunities and challenges in using qualitative research that must be considered within this field. Advances in methodology and increased expectations for evaluation must be considered to ensure quality and credibility of qualitative rehabilitation research within rehabilitation. Improved quality and credibility may increase likelihood of research dissemination and use by clinicians intervening within the rehabilitation process in order to improve clinical practice. In order to maximize opportunities and mitigate challenges there are two principal future directions for rehabilitation scientists to consider: (1) advancing training in qualitative methods to adequately prepare future rehabilitation scientists and (2) engaging qualitative communities of research.

Innovative Information Systems in the Intensive Care Unit, King Saud Medical City in Saudi Arabia.

PubMed

Al Saleem, Nouf; Al Harthy, Abdulrahman

2015-01-01

The purpose of this paper is to discuss the experience of implementing innovative information technology to improve the quality of services in one of the largest Intensive Care Units in Saudi Arabia. The Intensive Care Units in King Saud Medical City (ICU-KSMC) is the main ICU in the kingdom that represents the Ministry of Health. KSMC's ICU is also considered one of the largest ICU in the world as it consists of six units with 129 beds. Leaders in KSMC's ICU have introduced and integrated three information technologies to produce powerful, accurate, and timely information systems to overcome the challenges of the ICU nature and improve the quality of service to ensure patients' safety. By 2015, ICU in KSMC has noticed a remarkable improvement in: beds' occupation and utilization, staff communication, reduced medical errors, and improved departmental work flow, which created a healthy professional work environment. Yet, ICU in KSMC has ongoing improvement projects that include future plans for more innovative information technologies' implementation in the department.

Evolutionary Trajectories in School Assessment Systems: The Case of Bhutan

ERIC Educational Resources Information Center

Maxwell, Tom W.; Rinchen, Phub; Cooksey, Ray

2010-01-01

The purpose of this paper is to trace the evolution of school assessment in Bhutan, briefly, as a background to considering the present and future school assessment issues especially as they relate to quality concerns and educational improvement in Bhutan. A benchmark for Bhutan, the National Educational Assessment (NEA) programme in Bhutan was…

Urban Education: Past, Present and Future.

ERIC Educational Resources Information Center

Watson, Bernard C.

In spite of the efforts of the Ford Foundation's Great Cities School Improvement Program in ten large city school systems to provide quality education to children and youth from the ghettos of America's cities, this problem remains unsolved. Cities have never been able to do an adequate job of educating the poor, the immigrants, and the…

ARM! For the future: adaptive resource management in the wildlife profession

Treesearch

Richard A. Lancia; Clait E. Braun; Michael W. Collopy; Raymond D. Dueser; John G. Kie; Clifford J. Martinka; James D. Nichols; Thomas D. Nudds; Wayne R. Porath; Nancy G. Tilghman

1996-01-01

The authors encourage wildlife professionals to shift from a traditional, agricultural paradigm to an ecological one through adaptive resource management (ARM). The wildlife profession has a long-established tradition of examining and debating the quality and direction of wildlife research. This introspection is good, for it encourages the profession to improve and...

Faculty Beliefs and Practices about Writing Initiatives as Classroom Strategies and Institutional Objectives

ERIC Educational Resources Information Center

Kreiger, Joan

2013-01-01

Employers consistently rank "writing skills" as a desired quality of college graduates; however studies show that students' writing skills often fall short of the mark (AAC& U, 2008; Charting the Future, 2006). Writing Across the Curriculum (WAC) initiatives are one way universities attempt to improve student writing and promote…

The Future of Counseling Psychology: Improving Quality of Life for Persons with Chronic Health Issues

ERIC Educational Resources Information Center

Chwalisz, Kathleen

2008-01-01

The literature review and focus group findings that compose the Major Contribution illustrate how counseling psychologists can integrate expertise from various subdisciplines (vocational psychology, health psychology, multicultural psychology) to effectively address the needs of those living with HIV. Given changes in the nature of health problems…

78 FR 12750 - Information Collection(s) Being Reviewed by the Federal Communications Commission, Comments...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-25

... retain benefits. Statutory authority for this information collection is contained in 47 U.S.C. sections... Plan for Our Future; Establish Just and Reasonable Rates for Local Exchange Carriers; High-Cost... to file a five-year service quality improvement plan by July 1, 2013, and to file annually thereafter...

Roadmap to Afterschool for All: Examining Current Investments and Mapping Future Needs

ERIC Educational Resources Information Center

Earle, Alison

2009-01-01

Quality afterschool programs are improving and transforming the lives of children and youth across the nation. Research shows that afterschool programs keep kids safe, inspire them to learn and help working parents. They give children opportunities to see new worlds, put school lessons into practice, discover their talents and explore career…

The Future Architects' Attitude towards Innovations in the Context of Sustainable Development

ERIC Educational Resources Information Center

Artemeva, Veronika

2014-01-01

The architectural innovations are becoming more and more important in the economic and social development and in the quality improvement of people's lives. Sometimes, however, the implementation of innovative projects can lead to negative consequences. The development of any innovation should be based on a comprehensive analysis of their…

An Analysis of State Music Education Certification and Licensure Practices in the United States

ERIC Educational Resources Information Center

May, Brittany Nixon; Willie, Karen; Worthen, Cherilyn; Pehrson, Allyssa

2017-01-01

Teacher certification and licensure practices for music educators vary by state. Enhancing music teacher educator knowledge of state music education certification and licensure practices can inform music teacher preparation and improve future music teacher quality. The purpose of this study was to compile relevant information for music educators…

Multi-perspective observations of NO2 over the Denver area during DISCOVER-AQ: Insights for future monitoring

EPA Science Inventory

The final deployment in the DISCOVER-AQ1 series of air quality field campaigns focused on the Northern Front Range of Colorado including the Denver Metropolitan Area in July-August 2014. The overarching goal of these campaigns was to improve the interpretation of satellite observ...

Accreditation in Kinesiology: The Process, Criticism and Controversy, and the Future

ERIC Educational Resources Information Center

Templin, Thomas J.; Blankenship, Bonnie Tjeerdsma

2007-01-01

The question of accreditation has been quite controversial in higher education. Some consider accreditation as a necessary "evil" while others reject it outright. It is a process designed to promote quality assurance and improvement in institutions and programs, yet one mired in various issues. While accreditation is controversial in a number of…

Teaching and California's Future: California's Teaching Force, 2008. Key Issues and Trends

ERIC Educational Resources Information Center

Guha, R.; Shields, P.; Tiffany-Morales, J.; Bland, J.; Campbell, A.

2008-01-01

This year's report provides an update on California's teacher workforce and state policies that affect the teacher development system. It examines overall trends in the workforce and discusses the demand for teachers, the distribution of underprepared teachers, and the implementation of a statewide data system to improve the quality and accuracy…

Jurisdictional Control: The Regulation of Nurses' Aides.

ERIC Educational Resources Information Center

Reinhard, Susan C.

1988-01-01

The future of health care depends on a more unified nursing hierarchy. It makes sense to place the regulation of nurses' aides within the jurisdiction of the state nursing board, the agency charged with providing safe nursing care. Strengthening nursing's jurisdictional control will not only improve the quality of care, it will increase the…

[Nursing education in Taiwan: the current situation and prospects for the future].

PubMed

Lu, Meei-Shiow

2004-08-01

Two factors which have a close bearing on nursing education are social and technological change. How nursing education meets social needs and how nursing students are best equipped with professional knowledge, attitudes, and skills in a rapidly changing society have become important issues. The purposes of this paper are to describe the current state of nursing education and to identify problems that need to be solved, including the complexity of the educational system, the quality and quantity of nursing manpower, the degree of compatibility between the aims of education and future social needs, the quality of nursing educators, courses and course delivery, and the clinical competence of nursing graduates. Based on the paradigm shifts of International Medical Care and higher education described by McBride, several suggestions for future educational reform are proposed, including simplifying the educational system, improving the development of both the quality and quantity of nursing manpower, matching educational aims with future social needs, bridging the gap between theory and clinical practice, promoting both instructional and clinical skills among nursing educators and enhancing the ability of graduates to deal with a contingency strain. It is expected that in order to meet the challenges presented by a rapidly changing society, nursing educators will have to develop a mixed role including clinical proficiency, outstanding research skills, and excellent leadership skills.

Comprehensive Care Plan Development Using Resident Assessment Instrument Framework: Past, Present, and Future Practices

PubMed Central

Dellefield, Mary Ellen; Corazzini, Kirsten

2015-01-01

Development of the comprehensive care plan (CCP) is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework—the Resident Assessment Instrument (RAI). Consistent compliance with this requirement has been difficult to achieve. To improve the quality of CCP development within this framework, an increased understanding of complex factors contributing to inconsistent compliance is required. In this commentary, we examine the history of the comprehensive care plan; its development within the RAI framework; linkages between the RAI and registered nurse staffing; empirical evidence of the CCP’s efficacy; and the limitations of extant standards of practices in CCP development. Because of the registered nurse’s educational preparation, professional practice standards, and licensure obligations, the essential contributions of professional nurses in CCP development are emphasized. Recommendations for evidence-based micro and macro level practice changes with the potential to improve the quality of CCP development and regulatory compliance are presented. Suggestions for future research are given. PMID:27417811

Association between quality of care and complications after abdominal surgery.

PubMed

Bergman, Simon; Deban, Melina; Martelli, Vanessa; Monette, Michèle; Sourial, Nadia; Hamadani, Fadi; Teasdale, Debby; Holcroft, Christina; Zakrzewski, Helena; Fraser, Shannon

2014-09-01

Measuring the quality of surgical care is essential to identifying areas of weakness in the delivery of effective surgical care and to improving patient outcomes. Our objectives were to (1) assess the quality of surgical care delivered to adult patients; and (2) determine the association between quality of surgical care and postoperative complications. This retrospective, pilot, cohort study was conducted at a single university-affiliated institution. Using the institution's National Surgical Quality Improvement Program database (2009-2010), 273 consecutive patients ≥18 years of age who underwent elective major abdominal operations were selected. Adherence to 10 process-based quality indicators (QIs) was measured and quantified by calculating a patient quality score (no. of QIs passed/no. of QIs eligible). A pass rate for each individual QI was also calculated. The association between quality of surgical care and postoperative complications was assessed using an incidence rate ratio, which was estimated from a Poisson regression. The mean overall patient quality score was 67.2 ± 14.4% (range, 25-100%). The mean QI pass rate was 65.9 ± 26.1%, which varied widely from 9.6% (oral intake documentation) to 95.6% (prophylactic antibiotics). Poisson regression revealed that as the quality score increased, the incidence of postoperative complications decreased (incidence rate ratio, 0.19; P = .011). A sensitivity analysis revealed that this association was likely driven by the postoperative ambulation QI. Higher quality scores, mainly driven by early ambulation, were associated with fewer postoperative complications. QIs with unacceptably low adherence were identified as targets for future quality improvement initiatives. Copyright © 2014 Mosby, Inc. All rights reserved.

Assessment Study on Sensors and Automation in the Industries of the Future. Reports on Industrial Controls, Information Processing, Automation, and Robotics

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

Bennett, Bonnie; Boddy, Mark; Doyle, Frank

This report presents the results of an expert study to identify research opportunities for Sensors & Automation, a sub-program of the U.S. Department of Energy (DOE) Industrial Technologies Program (ITP). The research opportunities are prioritized by realizable energy savings. The study encompasses the technology areas of industrial controls, information processing, automation, and robotics. These areas have been central areas of focus of many Industries of the Future (IOF) technology roadmaps. This report identifies opportunities for energy savings as a direct result of advances in these areas and also recognizes indirect means of achieving energy savings, such as product quality improvement,more » productivity improvement, and reduction of recycle.« less

Print quality challenges for the next decade

NASA Astrophysics Data System (ADS)

Meyer, John D.

1990-07-01

The decade of the eighties has seen a remarkable transformation in the performance and capabilities of shared and personal printers. Dramatic gains have been made in four key areas: cost, throughput, reliability and most significantly, print quality. The improvements in text print quality due to algorithmic fonts and increased resolution have been pivotal in the creation of the desktop publishing market. Electronic pre-press systems now include hardware to receive Postscript files accompanied by color originals for scanning and separation. These systems have application in the commercial printing of a wide variety of material e.g. books, magazines, brochures, newspapers. The vision of the future of hardcopy now embraces the full spectrum from typeset text to full color reproduction of natural images due to the advent of grayscale and color capability in printer technology. This will place increased demands for improvements in print quality, particularly in the use of grayscale and color. This paper gives an overview of the challenges which must be met and discusses data communication standards and print quality measurement techniques as a means of meeting these challenges for both color and black and white output.

Quality assurance in the treatment of colorectal cancer: the EURECCA initiative.

PubMed

Breugom, A J; Boelens, P G; van den Broek, C B M; Cervantes, A; Van Cutsem, E; Schmoll, H J; Valentini, V; van de Velde, C J H

2014-08-01

Colorectal cancer is one of the most common cancers in Europe. Over the past few decades, important advances have been made in screening, staging and treatment of colorectal cancer. However, considerable variation between and within European countries remains, which implies that further improvements are possible. The most important remaining question now is: when are we, health care professionals, delivering the best available care to patients with colon or rectal cancer? Currently, quality assurance is a major issue in colorectal cancer care and quality assurance awareness is developing in almost all disciplines involved in the treatment of colorectal cancer patients. Quality assurance has shown to be effective in clinical trials. For example, standardisation and quality control were introduced in the Dutch TME trial and led to marked improvements of local control and survival in rectal cancer patients. Besides, audit structures can also be very effective in monitoring cancer management and national audits showed to further improve outcome in colorectal cancer patients. To reduce the differences between European countries, an international, multidisciplinary, outcome-based quality improvement programme, European Registration of Cancer Care (EURECCA), has been initiated. In the near future, the EURECCA dataset will perform research on subgroups as elderly patients or patients with comorbidities, which are often excluded from trials. For optimal colorectal cancer care, quality assurance in guideline formation and in multidisciplinary team management is also of great importance. The aim of this review was to create greater awareness and to give an overview of quality assurance in the management of colorectal cancer. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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

NASA Astrophysics Data System (ADS)

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

2017-07-01

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

Systematic Review of Radiation Therapy Toxicity Reporting in Randomized Controlled Trials of Rectal Cancer: A Comparison of Patient-Reported Outcomes and Clinician Toxicity Reporting

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

Gilbert, Alexandra, E-mail: a.gilbert@leeds.ac.uk; Ziegler, Lucy; Martland, Maisie

The use of multimodal treatments for rectal cancer has improved cancer-related outcomes but makes monitoring toxicity challenging. Optimizing future radiation therapy regimens requires collection and publication of detailed toxicity data. This review evaluated the quality of toxicity information provided in randomized controlled trials (RCTs) of radiation therapy in rectal cancer and focused on the difference between clinician-reported and patient-reported toxicity. Medline, EMBASE, and the Cochrane Library were searched (January 1995-July 2013) for RCTs reporting late toxicity in patients treated with regimens including preoperative (chemo)radiation therapy. Data on toxicity measures and information on toxicity reported were extracted using Quantitative Analyses ofmore » Normal Tissue Effects in the Clinic recommendations. International Society for Quality of Life Research standards on patient-reported outcomes (PROs) were used to evaluate the quality of patient-reported toxicity. Twenty-one RCT publications met inclusion criteria out of 4144 articles screened. All PRO studies reported higher rates of toxicity symptoms than clinician-reported studies and reported on a wider range and milder symptoms. No clinician-reported study published data on sexual dysfunction. Of the clinician-reported studies, 55% grouped toxicity data related to an organ system together (eg “Bowel”), and 45% presented data only on more-severe (grade ≥3) toxicity. In comparison, all toxicity grades were reported in 79% of PRO publications, and all studies (100%) presented individual symptom toxicity data (eg bowel urgency). However, PRO reporting quality was variable. Only 43% of PRO studies presented baseline data, 28% did not use any psychometrically validated instruments, and only 29% of studies described statistical methods for managing missing data. Analysis of these trials highlights the lack of reporting standards for adverse events and reveals the differences between clinician and patient reporting of toxicity. Recommendations for improving the quality of adverse event data collection are provided, with the aim of improving critical appraisal of outcomes for future studies.« less

Diabetes in the African-American Medicare population. Morbidity, quality of care, and resource utilization.

PubMed

Chin, M H; Zhang, J X; Merrell, K

1998-07-01

To determine whether African-American Medicare recipients with diabetes are at increased risk for morbidity, poor quality of care, and high resource utilization. We analyzed 1,376 patients with diabetes who were > or = 65 years of age and in the 1993 Medicare Current Beneficiary Survey. Morbidity measures were the Katz Index of Activities of Daily Living, Instrumental Activities of Daily Living, overall health perception, Charlson Comorbidity Index score, and diabetic complications. Quality of care standards were glycosylated hemoglobin measurements, ophthalmological visits, lipid testing, mammography, influenza vaccination, readmission within 30 days of hospital discharge, and outpatient visits within 4 weeks of hospital discharge. We stratified Medicare reimbursement by type of service and adjusted for sex, education, and age in multivariable analyses. Compared with white patients, African-American patients had worse health perception and lower quality of care. They were more likely to visit the emergency department and had fewer physician visits per year. African-Americans had higher reimbursement for home health services, but total reimbursement was similar after case-mix adjustment. Improved access to preventive care for older African-Americans with diabetes may improve health perception and use of the emergency department. The potential effect on total reimbursement is unclear. Future policy interventions to improve quality of care among Medicare patients with diabetes should especially target African-Americans.

Impact of a future H2-based road transportation sector on the composition and chemistry of the atmosphere - Part 1: Tropospheric composition and air quality

NASA Astrophysics Data System (ADS)

Wang, D.; Jia, W.; Olsen, S. C.; Wuebbles, D. J.; Dubey, M. K.; Rockett, A. A.

2013-07-01

Vehicles burning fossil fuel emit a number of substances that change the composition and chemistry of the atmosphere, and contribute to global air and water pollution and climate change. For example, nitrogen oxides and volatile organic compounds (VOCs) emitted as byproducts of fossil fuel combustion are key precursors to ground-level ozone and aerosol formation. In addition, on-road vehicles are major CO2 emitters. In order to tackle these problems, molecular hydrogen (H2) has been proposed as an energy carrier to substitute for fossil fuels in the future. However, before implementing any such strategy it is crucial to evaluate its potential impacts on air quality and climate. Here, we evaluate the impact of a future (2050) H2-based road transportation sector on tropospheric chemistry and air quality for several possible growth and technology adoption scenarios. The growth scenarios are based on the high and low emissions Intergovernmental Panel on Climate Change Special Report on Emissions Scenarios, A1FI and B1, respectively. The technological adoption scenarios include H2 fuel cell and H2 internal combustion engine options. The impacts are evaluated with the Community Atmospheric Model Chemistry global chemistry transport model (CAM-Chem). Higher resolution simulations focusing on the contiguous United States are also carried out with the Community Multiscale Air Quality Modeling System (CMAQ) regional chemistry transport model. For all scenarios future air quality improves with the adoption of a H2-based road transportation sector; however, the magnitude and type of improvement depend on the scenario. Model results show that the adoption of H2 fuel cells would decrease tropospheric burdens of ozone (7%), CO (14%), NOx (16%), soot (17%), sulfate aerosol (4%), and ammonium nitrate aerosol (12%) in the A1FI scenario, and would decrease those of ozone (5%), CO (4%), NOx (11%), soot (7%), sulfate aerosol (4%), and ammonium nitrate aerosol (9%) in the B1 scenario. The adoption of H2 internal combustion engines would decrease tropospheric burdens of ozone (1%), CO (18%), soot (17%), and sulfate aerosol (3%) in the A1FI scenario, and would decrease those of ozone (1%), CO (7%), soot (7%), and sulfate aerosol (3%) in the B1 scenario. In the future, people residing in the contiguous United States could expect to experience significantly fewer days of elevated levels of pollution if a H2 fuel cell road transportation sector were to be adopted. Health benefits of transitioning to a H2 economy for citizens in developing nations, like China and India, will be much more dramatic, particularly in megacities with severe, intensifying air-quality problems.

The impact of a future H2-based road transportation sector on the composition and chemistry of the atmosphere - Part 1: Tropospheric composition and air quality

NASA Astrophysics Data System (ADS)

Wang, D.; Jia, W.; Olsen, S. C.; Wuebbles, D. J.; Dubey, M. K.; Rockett, A. A.

2012-08-01

Vehicles burning fossil fuel emit a number of substances that change the composition and chemistry of the atmosphere, and contribute to global air and water pollution and climate change. For example, nitrogen oxides and volatile organic compounds (VOCs) emitted as byproducts of fossil fuel combustion are key precursors to ground-level ozone and aerosol formation. In addition, on-road vehicles are major CO2 emitters. In order to tackle these problems, molecular hydrogen (H2) has been proposed as an energy carrier to substitute for fossil fuel in the future. However, before implementing any such strategy it is crucial to evaluate its potential impacts on air quality and climate. Here we evaluate the impact of a future (2050) H2-based road transportation sector on tropospheric chemistry and air quality for several possible growth and technology adoption scenarios. The growth scenarios are based on the high and low emissions Intergovernmental Panel on Climate Change Special Report on Emissions Scenarios, A1FI and B1, respectively. The technological adoption scenarios include H2 fuel cell and H2 internal combustion engine options. The impacts are evaluated with the Community Atmospheric Model Chemistry global chemistry transport model (CAM-Chem). Higher resolution simulations focusing on the contiguous United States are also carried out with the Community Multiscale Air Quality Modeling System (CMAQ) regional chemistry transport model. For all scenarios future air quality improves with the adoption of a H2-based road transportation sector, however, the magnitude and type of improvement depend on the scenario. Model results show that with the adoption of H2 fuel cells decreases tropospheric burdens of ozone (7%), CO (14%), NOx (16%), soot (17%), sulfate aerosol (4%), and ammonium nitrate aerosol (12%) in the A1FI scenario, and decreases those of ozone (5%), CO (4%), NOx (11%), soot (7%), sulfate aerosol (4%), and ammonium nitrate aerosol (9 %) in the B1 scenario. The adoption of H2 internal combustion engines decreases tropospheric burdens of ozone (1%), CO (18%), soot (17%), and sulfate aerosol (3%) in the A1FI scenario, and decreases those of ozone (1%), CO (7%), soot (7%), and sulfate aerosol (3%) in the B1 scenario. In the future, people residing in the contiguous United States are expected to experience significantly fewer days of elevated levels of pollution if a H2 fuel cell road transportation sector is adopted. Health benefits of transitioning to a H2 economy for citizens in developing nations, like China and India, will be much more dramatic particularly in megacities with severe air-quality problems that are exacerbating.

GLIMPSE: a rapid decision framework for energy and environmental policy.

PubMed

Akhtar, Farhan H; Pinder, Robert W; Loughlin, Daniel H; Henze, Daven K

2013-01-01

Over the coming decades, new energy production technologies and the policies that oversee them will affect human health, the vitality of our ecosystems, and the stability of the global climate. The GLIMPSE decision model framework provides insights about the implications of technology and policy decisions on these outcomes. Using GLIMPSE, decision makers can identify alternative techno-policy futures, examining their air quality, health, and short- and long-term climate impacts. Ultimately, GLIMPSE will support the identification of cost-effective strategies for simultaneously achieving performance goals for these metrics. Here, we demonstrate the utility of GLIMPSE by analyzing several future energy scenarios under existing air quality regulations and potential CO2 emission reduction policies. We find opportunities for substantial cobenefits in setting both climate change mitigation and health-benefit based air quality improvement targets. Though current policies which prioritize public health protection increase near-term warming, establishing policies that also reduce greenhouse gas emissions may offset warming in the near-term and lead to significant reductions in long-term warming.

Nursing home administrators' opinions of pay for performance.

PubMed

Castle, Nicholas G; Engberg, John; Ferguson-Rome, Jamie C; Sonon, Kristen

2014-01-01

The research presented here provides some descriptive information of nursing home pay for performance (P4P) initiatives and an examination of the opinions of nursing home administrators (NHAs) about P4P. Opinions on three common elements of P4P were examined: the incentive format, program format, and quality format. Information came from a mail survey of 2,426 NHAs. Most of the summary scores show that few NHAs gave positive responses to P4P. Very few NHAs believed that P4P would increase their revenues. NHAs were skeptical that P4P systems were for quality improvement and instead believed they were developed for purposes of cost reduction. Relatively few NHAs believed that P4P would improve quality of care. Given that we have limited experience with setting performance goals and incentive formats for NHAs, the findings presented may prove useful in modeling future P4P systems.

Vacuum cooling of meat products: current state-of-the-art research advances.

PubMed

Feng, Chaohui; Drummond, Liana; Zhang, Zhihang; Sun, Da-Wen; Wang, Qijun

2012-01-01

Vacuum cooling (VC) is commonly applied for cooling of several foodstuffs, to provide exceptionally rapid cooling rates with low energy consumption and resulting in high-quality food products. However, for products such as meat and cooked meat products, the higher cooling loss of vacuum cooling compared with established methods still means lower yields, and important meat quality parameters can be negatively affected. Substantial efforts during the past ten years have aimed to improve the technology in order to offer the meat industry, especially the cooked meat industry, optimized production in terms of safety regulations and guidelines, as well as meat quality. This review presents and discusses recent VC developments directed to the cooked meat industry. The principles of VC, and the basis for improvements of this technology, are firstly discussed; future prospects for research and development in this area are later explored, particularly in relation to cooling of cooked meat and meat products.

Premature menopause in young breast cancer: effects on quality of life and treatment interventions

PubMed Central

Partridge, Ann H.

2013-01-01

Many young women are at increased risk for premature menopause following adjuvant treatment for breast cancer. These women must deal with consequences of menopause, including loss of fertility and physiologic symptoms such as night sweats, hot flashes, vaginal dryness, and weight gain. These symptoms can be particularly distressing for young women and can adversely affect both health-related and psychosocial quality of life (QOL). While there are a wide range of pharmacologic and non-pharmacologic interventions available to help with these symptoms and in turn, improve QOL, there is little data available about the use and efficacy of these interventions in younger women who become menopausal as a result of their breast cancer treatment. Future studies should focus on this vulnerable population, with the goal of identifying effective strategies to relieve symptoms and improve quality of life in young breast cancer survivors. PMID:23819028

[Application of traditional Chinese medicine reference standards in quality control of Chinese herbal pieces].

PubMed

Lu, Tu-Lin; Li, Jin-Ci; Yu, Jiang-Yong; Cai, Bao-Chang; Mao, Chun-Qin; Yin, Fang-Zhou

2014-01-01

Traditional Chinese medicine (TCM) reference standards plays an important role in the quality control of Chinese herbal pieces. This paper overviewed the development of TCM reference standards. By analyzing the 2010 edition of Chinese pharmacopoeia, the application of TCM reference standards in the quality control of Chinese herbal pieces was summarized, and the problems exiting in the system were put forward. In the process of improving the quality control level of Chinese herbal pieces, various kinds of advanced methods and technology should be used to research the characteristic reference standards of Chinese herbal pieces, more and more reasonable reference standards should be introduced in the quality control system of Chinese herbal pieces. This article discussed the solutions in the aspect of TCM reference standards, and future development of quality control on Chinese herbal pieces is prospected.

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda

PubMed Central

2014-01-01

Background Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. Methods In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. Discussion EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. Trial registration PACTR201311000681314 PMID:24690284

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.

PubMed

Hanson, Claudia; Waiswa, Peter; Marchant, Tanya; Marx, Michael; Manzi, Fatuma; Mbaruku, Godfrey; Rowe, Alex; Tomson, Göran; Schellenberg, Joanna; Peterson, Stefan

2014-04-02

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. PACTR201311000681314.

Patient-clinician communication about end-of-life care for Dutch and US patients with COPD.

PubMed

Janssen, D J A; Curtis, J R; Au, D H; Spruit, M A; Downey, L; Schols, J M G A; Wouters, E F M; Engelberg, R A

2011-08-01

Improving patient-clinician communication about end-of-life care is important in order to enhance quality of care for patients with chronic obstructive pulmonary disease (COPD). Our objective was to compare quality of patient-clinician communication about end-of-life care, and endorsement of barriers and facilitators to this communication in the Netherlands and the USA. The present study was an analysis of survey data from 122 Dutch and 391 US outpatients with COPD. We compared quality of patient-clinician communication about end-of-life care (Quality of Communication questionnaire) and barriers and facilitators to communication about end-of-life care (Barriers and Facilitators Questionnaire) between the Netherlands and the USA, controlling for patients' demographic and illness characteristics. Although Dutch patients in this study had worse lung function and disease-specific health status than US patients, Dutch patients reported lower quality of communication about end-of-life care (median score 0.0 (interquartile range 0.0-2.0) versus 1.4 (0.0-3.6); adjusted p<0.005). Clinicians in both countries rarely discussed life-sustaining treatment preferences, prognoses, dying processes or spiritual issues. Quality of communication about end-of-life care needs to improve in the Netherlands and the USA. Future studies to improve this communication should be designed to take into account international differences and patient-specific barriers and facilitators to communication about end-of-life care.

Statistical process management: An essential element of quality improvement

NASA Astrophysics Data System (ADS)

Buckner, M. R.

Successful quality improvement requires a balanced program involving the three elements that control quality: organization, people and technology. The focus of the SPC/SPM User's Group is to advance the technology component of Total Quality by networking within the Group and by providing an outreach within Westinghouse to foster the appropriate use of statistic techniques to achieve Total Quality. SPM encompasses the disciplines by which a process is measured against its intrinsic design capability, in the face of measurement noise and other obscuring variability. SPM tools facilitate decisions about the process that generated the data. SPM deals typically with manufacturing processes, but with some flexibility of definition and technique it accommodates many administrative processes as well. The techniques of SPM are those of Statistical Process Control, Statistical Quality Control, Measurement Control, and Experimental Design. In addition, techniques such as job and task analysis, and concurrent engineering are important elements of systematic planning and analysis that are needed early in the design process to ensure success. The SPC/SPM User's Group is endeavoring to achieve its objectives by sharing successes that have occurred within the member's own Westinghouse department as well as within other US and foreign industry. In addition, failures are reviewed to establish lessons learned in order to improve future applications. In broader terms, the Group is interested in making SPM the accepted way of doing business within Westinghouse.

Simulating climate change and socio-economic change impacts on flows and water quality in the Mahanadi River system, India.

PubMed

Jin, Li; Whitehead, Paul G; Rodda, Harvey; Macadam, Ian; Sarkar, Sananda

2018-10-01

Delta systems formed by the deposition of sediments at the mouths of large catchments are vulnerable to sea level rise and other climate change impacts. Deltas often have some of the highest population densities in the world and the Mahanadi Delta in India is one of these, with a population of 39 million. The Mahanadi River is a major river in East Central India and flows through Chattisgarh and Orissa states before discharging into the Bay of Bengal. This study uses an Integrated Catchment Model (INCA) to simulate flow dynamics and water quality (nitrogen and phosphorus) and to analyze the impacts of climate change and socio-economic drivers in the Mahanadi River system. Future flows affected by large population growth, effluent discharge increases and changes in irrigation water demand from changing land uses are assessed under shared socio-economic pathways (SSPs). Model results indicate a significant increase in monsoon flows under the future climates at 2050s (2041-2060) and 2090s (2079-2098) which greatly enhances flood potential. The water availability under low flow conditions will be worsened because of increased water demand from population growth and increased irrigation in the future. Decreased concentrations of nitrogen and phosphorus are expected due to increased flow hence dilution. Socio-economic scenarios have a significant impact on water quality but less impact on the river flow. For example, higher population growth, increased sewage treatment discharges, land use change and enhanced atmospheric deposition would result in the deterioration of water quality, while the upgrade of the sewage treatment works lead to improved water quality. In summary, socio-economic scenarios would change future water quality of the Mahanadi River and alter nutrient fluxes transported into the delta region. This study has serious implications for people's livelihoods in the deltaic area and could impact coastal and Bay of Bengal water ecology. Copyright © 2018 Elsevier B.V. All rights reserved.

A Narrative Review of High-Quality Literature on the Effects of Resident Duty Hours Reforms.

PubMed

Lin, Henry; Lin, Emery; Auditore, Stephanie; Fanning, Jon

2016-01-01

To summarize current high-quality studies evaluating the effect and efficacy of resident duty hours reforms (DHRs) on patient safety and resident education and well-being. The authors searched PubMed and Medline in August 2012 and again in May 2013 for literature (1987-2013) about the effects of DHRs. They assessed the quality of articles using the Medical Education Research Study Quality Instrument (MERSQI) scoring system. They considered randomized controlled trials (RCTs), partial RCTs, and all studies with a MERSQI score ≥ 14 to be "high-quality" methodology studies. A total of 72 high-quality studies met inclusion criteria. Most studies showed no change or slight improvement in mortality and complication rates after DHRs. Resident well-being was generally improved, but there was a perceived negative impact on education (knowledge acquisition, skills, and cognitive performance) following DHRs. Eleven high-quality studies assessed the impact of DHR interventions; all reported a neutral to positive impact. Seven high-quality studies assessed costs associated with DHRs and demonstrated an increase in hospital costs. The results of most studies that allow enough time for DHR interventions to take effect suggest a benefit to patient safety and resident well-being, but the effect on the quality of training remains unknown. Additional methodologically sound studies on the impact of DHRs are necessary. Priorities for future research include approaches to optimizing education and clinical proficiency and studies on the effect of intervention strategies on both education and patient safety. Such studies will provide additional information to help improve duty hours policies.

The Atlanta Urban Heat Island Mitigation and Air Quality Modeling Project: How High-Resoution Remote Sensing Data Can Improve Air Quality Models

NASA Technical Reports Server (NTRS)

Quattrochi, Dale A.; Estes, Maurice G., Jr.; Crosson, William L.; Khan, Maudood N.

2006-01-01

The Atlanta Urban Heat Island and Air Quality Project had its genesis in Project ATLANTA (ATlanta Land use Analysis: Temperature and Air quality) that began in 1996. Project ATLANTA examined how high-spatial resolution thermal remote sensing data could be used to derive better measurements of the Urban Heat Island effect over Atlanta. We have explored how these thermal remote sensing, as well as other imaged datasets, can be used to better characterize the urban landscape for improved air quality modeling over the Atlanta area. For the air quality modeling project, the National Land Cover Dataset and the local scale Landpro99 dataset at 30m spatial resolutions have been used to derive land use/land cover characteristics for input into the MM5 mesoscale meteorological model that is one of the foundations for the Community Multiscale Air Quality (CMAQ) model to assess how these data can improve output from CMAQ. Additionally, land use changes to 2030 have been predicted using a Spatial Growth Model (SGM). SGM simulates growth around a region using population, employment and travel demand forecasts. Air quality modeling simulations were conducted using both current and future land cover. Meteorological modeling simulations indicate a 0.5 C increase in daily maximum air temperatures by 2030. Air quality modeling simulations show substantial differences in relative contributions of individual atmospheric pollutant constituents as a result of land cover change. Enhanced boundary layer mixing over the city tends to offset the increase in ozone concentration expected due to higher surface temperatures as a result of urbanization.

Urban Landscape Characterization Using Remote Sensing Data For Input into Air Quality Modeling

NASA Technical Reports Server (NTRS)

Quattrochi, Dale A.; Estes, Maurice G., Jr.; Crosson, William; Khan, Maudood

2005-01-01

The urban landscape is inherently complex and this complexity is not adequately captured in air quality models that are used to assess whether urban areas are in attainment of EPA air quality standards, particularly for ground level ozone. This inadequacy of air quality models to sufficiently respond to the heterogeneous nature of the urban landscape can impact how well these models predict ozone pollutant levels over metropolitan areas and ultimately, whether cities exceed EPA ozone air quality standards. We are exploring the utility of high-resolution remote sensing data and urban growth projections as improved inputs to meteorological and air quality models focusing on the Atlanta, Georgia metropolitan area as a case study. The National Land Cover Dataset at 30m resolution is being used as the land use/land cover input and aggregated to the 4km scale for the MM5 mesoscale meteorological model and the Community Multiscale Air Quality (CMAQ) modeling schemes. Use of these data have been found to better characterize low density/suburban development as compared with USGS 1 km land use/land cover data that have traditionally been used in modeling. Air quality prediction for future scenarios to 2030 is being facilitated by land use projections using a spatial growth model. Land use projections were developed using the 2030 Regional Transportation Plan developed by the Atlanta Regional Commission. This allows the State Environmental Protection agency to evaluate how these transportation plans will affect future air quality.

Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea

PubMed Central

Aurora, R. Nisha; Collop, Nancy A.; Jacobowitz, Ofer; Thomas, Sherene M.; Quan, Stuart F.; Aronsky, Amy J.

2015-01-01

Obstructive sleep apnea (OSA) is a prevalent disorder associated with a multitude of adverse outcomes when left untreated. There is significant heterogeneity in the evaluation and management of OSA resulting in variation in cost and outcomes. Thus, the goal for developing these measures was to have a way to evaluate the outcomes and reliability of the processes involved with the standard care approaches used in the diagnosis and management of OSA. The OSA quality care measures presented here focus on both outcomes and processes. The AASM commissioned the Adult OSA Quality Measures Workgroup to develop quality care measures aimed at optimizing care for adult patients with OSA. These quality care measures developed by the Adult OSA Quality Measures Workgroup are an extension of the original Centers for Medicare & Medicaid Services (CMS) approved Physician Quality Reporting System (PQRS) measures group for OSA. The measures are based on the available scientific evidence, focus on public safety, and strive to improve quality of life and cardiovascular outcomes for individual OSA patients. The three outcomes that were selected were as follows: (1) improve disease detection and categorization; (2) improve quality of life; and (3) reduce cardiovascular risk. After selecting these relevant outcomes, a total of ten process measures were chosen that could be applied and assessed for the purpose of accomplishing these outcomes. In the future, the measures described in this document may be reported through the PQRS in addition to, or as a replacement for, the current OSA measures group. The overall objective for the development of these measures is that implementation of these quality measures will result in improved patient outcomes, reduce the public health burden of OSA, and provide a measurable standard for evaluating and managing OSA. Citation: Aurora RN, Collop NA, Jacobowitz O, Thomas SM, Quan SF, Aronsky AJ. Quality measures for the care of adult patients with obstructive sleep apnea. J Clin Sleep Med 2015;11(3):357–383. PMID:25700878

The quality of mental disorder information websites: a review.

PubMed

Reavley, Nicola J; Jorm, Anthony F

2011-11-01

This paper reviews studies assessing the quality of websites providing information about mental disorders. The review included 31 articles identified by searching research databases in March 2010. Topics covered included affective disorders, anxiety disorders, eating disorders, substance use disorders and schizophrenia/psychosis. The largest number of articles (13) reported studies assessing affective disorder information quality. Methodologies varied in site selection and rating methods, with some of limited validity. Most concluded that quality was poor, although quality of affective disorder sites may be improving. There is currently very little understanding of the influence of website quality on user behaviour. Future quality assessments might use the criteria informed by key behaviour change theories. A possible approach to research on websites and user behaviour might be to develop an evaluation framework incorporating strategies from behaviour change models, key mental health literacy elements and health outcomes relevant to mental health promotion. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

What is the future of 'organ transplantation' in the head and neck?

PubMed

Lott, David G

2014-10-01

To update readers on the current state and future of head and neck tissue transplantation. Many exciting advances have recently occurred in the field of head and neck transplantation and regenerative medicine. Larynx, face, and trachea transplants have all been successfully performed. Significant advancements in tissue engineering have occurred, including the ability to generate three-dimensional tissue structures. Transplantation of regenerated tissues has been successfully incorporated into airway reconstruction. These exciting advancements set the foundation to expand reconstructive options for dysfunctional tissues and to improve a patient's quality of life.

Evaluation of Simulation Models that Estimate the Effect of Dietary Strategies on Nutritional Intake: A Systematic Review.

PubMed

Grieger, Jessica A; Johnson, Brittany J; Wycherley, Thomas P; Golley, Rebecca K

2017-05-01

Background: Dietary simulation modeling can predict dietary strategies that may improve nutritional or health outcomes. Objectives: The study aims were to undertake a systematic review of simulation studies that model dietary strategies aiming to improve nutritional intake, body weight, and related chronic disease, and to assess the methodologic and reporting quality of these models. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the search strategy with studies located through electronic searches [Cochrane Library, Ovid (MEDLINE and Embase), EBSCOhost (CINAHL), and Scopus]. Study findings were described and dietary modeling methodology and reporting quality were critiqued by using a set of quality criteria adapted for dietary modeling from general modeling guidelines. Results: Forty-five studies were included and categorized as modeling moderation, substitution, reformulation, or promotion dietary strategies. Moderation and reformulation strategies targeted individual nutrients or foods to theoretically improve one particular nutrient or health outcome, estimating small to modest improvements. Substituting unhealthy foods with healthier choices was estimated to be effective across a range of nutrients, including an estimated reduction in intake of saturated fatty acids, sodium, and added sugar. Promotion of fruits and vegetables predicted marginal changes in intake. Overall, the quality of the studies was moderate to high, with certain features of the quality criteria consistently reported. Conclusions: Based on the results of reviewed simulation dietary modeling studies, targeting a variety of foods rather than individual foods or nutrients theoretically appears most effective in estimating improvements in nutritional intake, particularly reducing intake of nutrients commonly consumed in excess. A combination of strategies could theoretically be used to deliver the best improvement in outcomes. Study quality was moderate to high. However, given the lack of dietary simulation reporting guidelines, future work could refine the quality tool to harmonize consistency in the reporting of subsequent dietary modeling studies. © 2017 American Society for Nutrition.

The PIERDUB project: International Project on Education and Research in Donation at University of Barcelona: training university students about donation and transplantation.

PubMed

Manyalich, M; Paredes, D; Ballesté, C; Menjívar, A

2010-01-01

Donation and transplantation is an accepted therapeutic option when organ failure or tissue replacements are needed to save or improve the quality of life. However, in most medical schools there is no specific training for it, thus disregarding the key role of university students for the future success of the process. Knowledge diffusion about the donation procedure to clarify doubts and stimulate positive attitudes toward donation. Training university students in the donation and transplantation process. Research about the previous donation knowledge and the impact in donation indexes. Three different phases have been designed: (1) Training the University of Barcelona Health Sciences School students; (2) Training the Health Sciences School students in other faculties of Catalonia, Spain, and International; and (3) research. Since 2005, we have offered yearly an Optional Credits Course to medical students with duration of 45 hours, and two Donation days opened to health sciences students. Since 2007, promotional campaigns have been carried out in medicine and other health sciences faculties. Until now, 818 answered surveys have been collected to evaluate previous knowledge among university students. Training medical and other health sciences students in the donation process will improve quality of medical education and develop a trainer role for future professionals to help improve donation rates.

Connecting organisational culture and quality of care in the hospital: is job burnout the missing link?

PubMed

Montgomery, Anthony; Panagopoulou, Efharis; Kehoe, Ian; Valkanos, Efthymios

2011-01-01

To date, relatively little evidence has been published as to what represents an effective and efficient way to improve quality of care and safety in hospitals. In addition, the initiatives that do exist are rarely designed or developed with regard to the individual and organisational factors that determine the success or failure of such initiatives. One of the challenges in linking organisational culture to quality of care is to identify the focal point at which a deficient hospital culture and inadequate organisational resources are most evident. The accumulated evidence suggests that such a point is physician burnout. This paper sets out to examine this issue. The paper reviews the existing literature on organisational culture, burnout and quality of care in the healthcare sector. A new conceptual approach as to how organisational culture and quality of care can be more effectively linked through the physician experience of burnout is proposed. Recommendations are provided with regard to how future research can approach quality of care from a bottom-up organisational change perspective. In addition, the need to widen the debate beyond US and North European experiences is discussed. The present paper represents an attempt to link organisational culture, job burnout and quality of care in a more meaningful way. A conceptual model has been provided as a way to frame and evaluate future research.

Parental Loss, Trusting Relationship with Current Caregivers and Psychosocial Adjustment among Children Affected by AIDS in China

PubMed Central

Zhao, Junfeng; Li, Xiaoming; Barnett, Douglas; Lin, Xiuyun; Fang, Xiaoyi; Zhao, Guoxiang; Naar-King, Sylvie; Stanton, Bonita

2011-01-01

Objective to examine the relationship between parental loss, trusting relationship with current caregivers, and psychosocial adjustment among children affected by AIDS in China. Methods Cross-sectional data were collected from 755 AIDS orphans (296 double orphans and 459 single orphans), 466 vulnerable children living with HIV-infected parents, and 404 comparison children in China. The trusting relationship with current caregivers was measured with a 15-item scale (Cronbach alpha=.84) modified from the Trusting Relationship Questionnaire (TRQ) developed by Mustillo and colleagues (2005). The psychosocial measures include rule compliance/acting out, anxiety/withdrawal, peer social skills, school interest, depressive symptoms, loneliness, self-esteem, future expectation, hopefulness about future, and perceived control over the future. Results Group mean comparisons using ANOVA suggested a significant association (p<.0001) between the trusting relationship with current caregivers and all the psychosocial measures except anxiety and depression. These associations remained significant in General Linear Model analysis, controlling for children's gender, age, family SES, orphan status (orphans, vulnerable children, and comparison children), and appropriate interaction terms among factor variables. Discussion The findings in the current study support the global literature on the importance of attachment relationship with caregivers in promoting children's psychosocial development. Future prevention intervention efforts to improve AIDS orphans' psychosocial well-being will need to take into consideration the quality of the child's attachment relationships with current caregivers and help their current caregivers to improve the quality of care for these children. Future study is needed to explore the possible reasons for the lack of association between a trusting relationship and some internalizing symptoms such as anxiety and depression among children affected by HIV/AIDS. PMID:21749241

The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures.

PubMed

Rutter, Matthew D; Senore, Carlo; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Kaminski, Michal F; Spada, Cristiano; Bretthauer, Michael; Bennett, Cathy; Bellisario, Cristina; Minozzi, Silvia; Hassan, Cesare; Rees, Colin; Dinis-Ribeiro, Mário; Hucl, Tomas; Ponchon, Thierry; Aabakken, Lars; Fockens, Paul

2016-02-01

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision. ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients.

Cotton genotypes selection through artificial neural networks.

PubMed

Júnior, E G Silva; Cardoso, D B O; Reis, M C; Nascimento, A F O; Bortolin, D I; Martins, M R; Sousa, L B

2017-09-27

Breeding programs currently use statistical analysis to assist in the identification of superior genotypes at various stages of a cultivar's development. Differently from these analyses, the computational intelligence approach has been little explored in genetic improvement of cotton. Thus, this study was carried out with the objective of presenting the use of artificial neural networks as auxiliary tools in the improvement of the cotton to improve fiber quality. To demonstrate the applicability of this approach, this research was carried out using the evaluation data of 40 genotypes. In order to classify the genotypes for fiber quality, the artificial neural networks were trained with replicate data of 20 genotypes of cotton evaluated in the harvests of 2013/14 and 2014/15, regarding fiber length, uniformity of length, fiber strength, micronaire index, elongation, short fiber index, maturity index, reflectance degree, and fiber quality index. This quality index was estimated by means of a weighted average on the determined score (1 to 5) of each characteristic of the HVI evaluated, according to its industry standards. The artificial neural networks presented a high capacity of correct classification of the 20 selected genotypes based on the fiber quality index, so that when using fiber length associated with the short fiber index, fiber maturation, and micronaire index, the artificial neural networks presented better results than using only fiber length and previous associations. It was also observed that to submit data of means of new genotypes to the neural networks trained with data of repetition, provides better results of classification of the genotypes. When observing the results obtained in the present study, it was verified that the artificial neural networks present great potential to be used in the different stages of a genetic improvement program of the cotton, aiming at the improvement of the fiber quality of the future cultivars.

Evaluating the State of Quality-Improvement Science through Evidence Synthesis: Insights from the Closing the Quality Gap Series

PubMed Central

McDonald, Kathryn M; Schultz, Ellen M; Chang, Christine

2013-01-01

Context: The Closing the Quality Gap series from the Agency for Healthcare Research and Quality summarizes evidence for eight high-priority health care topics: outcomes used in disability research, bundled payment programs, public reporting initiatives, health care disparities, palliative care, the patient-centered medical home, prevention of health care-associated infections, and medication adherence. Objective: To distill evidence from this series and provide insight into the “state of the science” of quality improvement (QI). Methods: We provided common guidance for topic development and qualitatively synthesized evidence from the series topic reports to identify cross-topic themes, challenges, and evidence gaps as related to QI practice and science. Results: Among topics that examined effectiveness of QI interventions, we found improvement in some outcomes but not others. Implementation context and potential harms from QI activities were not widely evaluated or reported, although market factors appeared important for incentive-based QI strategies. Patient-focused and systems-focused strategies were generally more effective than clinician-focused strategies, although the latter approach improved clinician adherence to infection prevention strategies. Audit and feedback appeared better for targeting professionals and organizations, but not patients. Topic reviewers observed heterogeneity in outcomes used for QI evaluations, weaknesses in study design, and incomplete reporting. Conclusions: Synthesizing evidence across topics provided insight into the state of the QI field for practitioners and researchers. To facilitate future evidence synthesis, consensus is needed around a smaller set of outcomes for use in QI evaluations and a framework and lexicon to describe QI interventions more broadly, in alignment with needs of decision makers responsible for improving quality. PMID:24079357

Perception of synthetic speech produced automatically by rule: Intelligibility of eight text-to-speech systems

PubMed Central

GREENE, BETH G.; LOGAN, JOHN S.; PISONI, DAVID B.

2012-01-01

We present the results of studies designed to measure the segmental intelligibility of eight text-to-speech systems and a natural speech control, using the Modified Rhyme Test (MRT). Results indicated that the voices tested could be grouped into four categories: natural speech, high-quality synthetic speech, moderate-quality synthetic speech, and low-quality synthetic speech. The overall performance of the best synthesis system, DECtalk-Paul, was equivalent to natural speech only in terms of performance on initial consonants. The findings are discussed in terms of recent work investigating the perception of synthetic speech under more severe conditions. Suggestions for future research on improving the quality of synthetic speech are also considered. PMID:23225916

Marital Quality and Families of Children with Developmental Disabilities

PubMed Central

Hartley, Sigan L.; Seltzer, Marsha Mailick; Barker, Erin T.; Greenberg, Jan S.

2014-01-01

In the current review, we highlight recent research on marital quality in parents of children with developmental disabilities (DD) and discuss the child and family factors that account for why some marriages fare better than others. We will also discuss the need for the field of DD to broaden its perspective on marital quality and to examine the impact of marriages on child well-being and the well-being of parents. The clinical implications of recent research findings on marital quality for improving supports and interventions for families of children with DD are discussed. A theoretical framework and model of marriage and parent and child psychosocial well-being in the context of child disability is proposed and a roadmap for future research is provided. PMID:25414813

Wheelchair interventions, services and provision for disabled children: a mixed-method systematic review and conceptual framework

PubMed Central

2014-01-01

Background Wheelchairs for disabled children (≤18 years) can provide health, developmental and social benefits. World Health Organisation and United Kingdom Government reports demonstrate the need for improved access to wheelchairs both locally and internationally. The use of health economics within this field is lacking. Provision of wheelchairs based on cost-effectiveness evidence is not currently possible. We conducted the first systematic review in this field to incorporate evidence of effectiveness, service user perspectives, policy intentions and cost-effectiveness in order to develop a conceptual framework to inform future research and service development. Methods We used an adapted EPPI-Centre mixed-method systematic review design with narrative summary, thematic and narrative synthesis. 11 databases were searched. Studies were appraised for quality using one of seven appropriate tools. A conceptual framework was developed from synthesised evidence. Results 22 studies and 14 policies/guidelines were included. Powered wheelchairs appear to offer benefits in reduced need for caregiver assistance; improved communicative, personal-social and cognitive development; and improved mobility function and independent movement. From 14 months of age children can learn some degree of powered wheelchair driving competence. However, effectiveness evidence was limited and low quality. Children and parents placed emphasis on improving social skill and independence. Participation in wider society and development of meaningful relationships were key desired outcomes. Policy intentions and aspirations are in line with the perspectives of children and parents, although translation of policy recommendations into practice is lacking. Conclusions There is a distinct lack of high quality effectiveness and economic evidence in this field. Social and health needs should be seen as equally important when assessing the mobility needs of disabled children. Disabled children and parents placed highest priority on independence and psychosocial outcomes of wheelchair interventions. Translation of policy and guidelines into practice is lacking and more effective implementation strategies are required to improve services and outcomes. Future research should focus on outcome measure development, developing economic evaluation tools and incorporating these into high quality studies to address known research gaps. The novel conceptual framework maps current gaps in evidence and outlines areas for development. PMID:25034517

Comparison of Effectiveness of the Metacognition Treatment and the Mindfulness-Based Stress Reduction Treatment on Global and Specific Life Quality of Women with Breast Cancer

PubMed Central

Rahmani, Soheila; Talepasand, Siavash; Ghanbary-Motlagh, ALi

2014-01-01

Background This study is conducted to compare the metacognition treatment and the mindfulness-based stress reduction treatment on life quality of women with breast cancer. Methods In a quasi-experimental design, with pre-test, post-test and control group, 36 patients with diagnosis of breast cancer, among patients who referred to the Division of Oncology and Radiotherapy of Imam Hossein hospital in Tehran, were selected in accessible way and were assigned randomly to three experimental groups, the first group receiving meta-cognition treatment (n=12), the second one receiving mindfulness-based stress reduction program (n=12), and the other was the control group. Participants completed global life quality in cancer patient's questionnaire and specific quality of life in breast cancer patient's questionnaire in three stages: baseline, after intervention and two-month follow-up. Data were analyzed using the multivariate repeated measurement model. Results Findings showed both treatments were effective in improving global and specific quality of life in patients with breast cancer. The mindfulness -based stress reduction treatment excelled in functions and roles, fatigue, pain, future perspective and treatment side effects symptoms at the end of the treatment and follow-up in comparison to the metacognition treatment. Conclusion Results of this research showed the mindfulness-based stress reduction treatment can be effective in improving global and specific life quality of women with breast cancer and is a selective method for improving quality of life in patients. PMID:25628839

Changes in air quality and tropospheric composition due to depletion of stratospheric ozone and interactions with changing climate: implications for human and environmental health.

PubMed

Madronich, S; Shao, M; Wilson, S R; Solomon, K R; Longstreth, J D; Tang, X Y

2015-01-01

UV radiation is an essential driver for the formation of photochemical smog, which includes ground-level ozone and particulate matter (PM). Recent analyses support earlier work showing that poor outdoor air quality is a major environmental hazard as well as quantifying health effects on regional and global scales more accurately. Greater exposure to these pollutants has been linked to increased risks of cardiovascular and respiratory diseases in humans and is associated globally with several million premature deaths per year. Ozone also has adverse effects on yields of crops, leading to loss of billions of US dollars each year. These detrimental effects also may alter biological diversity and affect the function of natural ecosystems. Future air quality will depend mostly on changes in emission of pollutants and their precursors, but changes in UV radiation and climate will contribute as well. Significant reductions in emissions, mainly from the energy and transportation sectors, have already led to improved air quality in many locations. Air quality will continue to improve in those cities/states that can afford controls, and worsen where the regulatory infrastructure is not available. Future changes in UV radiation and climate will alter the rates of formation of ground-level ozone and photochemically-generated particulate matter and must be considered in predictions of air quality. The decrease in UV radiation associated with recovery of stratospheric ozone will, according to recent global atmospheric model simulations, lead to increases in ground-level ozone at most locations. If correct, this will add significantly to future ground-level ozone trends. However, the spatial resolution of these global models is insufficient to inform policy at this time, especially for urban areas. UV radiation affects the atmospheric concentration of hydroxyl radicals, ˙OH, which are responsible for the self-cleaning of the atmosphere. Recent measurements confirm that, on a local scale, ˙OH radicals respond rapidly to changes in UV radiation. However, on large (global) scales, models differ in their predictions by nearly a factor of two, with consequent uncertainties for estimating the atmospheric lifetime and concentrations of key greenhouse gases and air pollutants. Projections of future climate need to consider these uncertainties. No new negative environmental effects of substitutes for ozone depleting substances or their breakdown-products have been identified. However, some substitutes for the ozone depleting substances will continue to contribute to global climate change if concentrations rise above current levels.

Are university rankings useful to improve research? A systematic review

PubMed Central

Momani, Shaher

2018-01-01

Introduction Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. Methods A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. Results A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. Discussion No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and “luxury” indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance. PMID:29513762

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

PubMed

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

2011-10-26

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

Potential impact of a US climate policy and air quality regulations on future air quality and climate change

NASA Astrophysics Data System (ADS)

Lee, Y. H.; Shindell, D. T.; Faluvegi, G.; Pinder, R. W.

2015-11-01

We have investigated how future air quality and climate change are influenced by the US air quality regulations that existed or were proposed in 2013 and a hypothetical climate mitigation policy that reduces 2050 CO2 emissions to be 50 % below 2005 emissions. Using NASA GISS ModelE2, we look at the impacts in year 2030 and 2055. The US energy-sector emissions are from the GLIMPSE project (GEOS-Chem LIDORT Integrated with MARKAL for the Purpose of Scenario Exploration), and other US emissions and the rest of the world emissions are based on the RCP4.5 scenario. The US air quality regulations are projected to have a strong beneficial impact on US air quality and public health in the future but result in positive radiative forcing. Surface PM2.5 is reduced by ~ 2 μg m-3 on average over the US, and surface ozone by ~ 8 ppbv. The improved air quality prevents about 91 400 premature deaths in the US, mainly due to the PM2.5 reduction (~ 74 200 lives saved). The air quality regulations reduces the light-reflecting aerosols (i.e., sulfate and organic matter) more than the light-absorbing species (i.e., black carbon and ozone), leading a strong positive radiative forcing (RF) by both aerosols direct and indirect forcing: total RF is ~ 0.04 W m-2 over the globe; ~ 0.8 W m-2 over the US. Under the hypothetical climate policy, future US energy relies less on coal and thus SO2 emissions are noticeably reduced. This provides air quality co-benefits, but it leads to climate dis-benefits over the US. In 2055, the US mean total RF is +0.22 W m-2 due to positive aerosol direct and indirect forcing, while the global mean total RF is -0.06 W m-2 due to the dominant negative CO2 RF (instantaneous RF). To achieve a regional-scale climate benefit via a climate policy, it is critical (1) to have multi-national efforts to reduce GHGs emissions and (2) to target emission reduction of light-absorbing species (e.g., BC and O3) on top of long-lived species. The latter is very desirable as the resulting climate benefit occurs faster and provides co-benefits to air quality and public health.

Perceived Factors Associated with Sustained Improvement Following Participation in a Multicenter Quality Improvement Collaborative.

PubMed

Stone, Sohini; Lee, Henry C; Sharek, Paul J

2016-07-01

The California Perinatal Quality Care Collaborative led the Breastmilk Nutrition Quality Improvement Collaborative from October 2009 to September 2010 to increase the percentage of very low birth weight infants receiving breast milk at discharge in 11 collaborative neonatal ICUs (NICUs). Observed increases in breast milk feeding and decreases in necrotizing enterocolitis persisted for 6 months after the collaborative ended. Eighteen to 24 months after the end of the collaborative, some sites maintained or further increased their gains, while others trended back toward baseline. A study was conducted to assess the qualitative factors that affect sustained improvement following participation. Collaborative leaders at each of the 11 NICUs that participated in the Breastmilk Nutrition Quality Improvement Collaborative were invited to participate in a site-specific one-hour phone interview. Interviews were recorded and transcribed and then analyzed using qualitative research analysis software to identify themes associated with sustained improvement. Eight of 11 invited centers agreed to participate in the interviews. Thematic saturation was achieved by the sixth interview, so further interviews were not pursued. Factors contributing to sustainability included physician involvement within the multidisciplinary teams, continuous education, incorporation of interventions into the daily work flow, and integration of a data-driven feedback system. Early consideration by site leaders of how to integrate best-practice interventions into the daily work flow, and ensuring physician commitment and ongoing education based in continuous data review, should enhance the likelihood of sustaining improvements. To maximize sustained success, future collaborative design should consider proactively identifying and supporting these factors at participating sites.

Quality initiatives: improving patient flow for a bone densitometry practice: results from a Mayo Clinic radiology quality initiative.

PubMed

Aakre, Kenneth T; Valley, Timothy B; O'Connor, Michael K

2010-03-01

Lean Six Sigma process improvement methodologies have been used in manufacturing for some time. However, Lean Six Sigma process improvement methodologies also are applicable to radiology as a way to identify opportunities for improvement in patient care delivery settings. A multidisciplinary team of physicians and staff conducted a 100-day quality improvement project with the guidance of a quality advisor. By using the framework of DMAIC (define, measure, analyze, improve, and control), time studies were performed for all aspects of patient and technologist involvement. From these studies, value stream maps for the current state and for the future were developed, and tests of change were implemented. Comprehensive value stream maps showed that before implementation of process changes, an average time of 20.95 minutes was required for completion of a bone densitometry study. Two process changes (ie, tests of change) were undertaken. First, the location for completion of a patient assessment form was moved from inside the imaging room to the waiting area, enabling patients to complete the form while waiting for the technologist. Second, the patient was instructed to sit in a waiting area immediately outside the imaging rooms, rather than in the main reception area, which is far removed from the imaging area. Realignment of these process steps, with reduced technologist travel distances, resulted in a 3-minute average decrease in the patient cycle time. This represented a 15% reduction in the initial patient cycle time with no change in staff or costs. Radiology process improvement projects can yield positive results despite small incremental changes.

Investigating financial incentives for maternal health: an introduction.

PubMed

Stanton, Mary Ellen; Higgs, Elizabeth S; Koblinsky, Marge

2013-12-01

Projection of current trends in maternal and neonatal mortality reduction shows that many countries will fall short of the UN Millennium Development Goal 4 and 5. Underutilization of maternal health services contributes to this poor progress toward reducing maternal and neonatal morbidity and mortality. Moreover, the quality of services continues to lag in many countries, with a negative effect on the health of women and their babies, including deterring women from seeking care. To enhance the use and provision of quality maternal care, countries and donors are increasingly using financial incentives. This paper introduces the JHPN Supplement, in which each paper reviews the evidence of the effectiveness of a specific financial incentive instrument with the aim of improving the use and quality of maternal healthcare and impact. The US Agency for International Development and the US National Institutes of Health convened a US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives on 24-25 April 2012 in Washington, DC. The Summit brought together leading global experts in finance, maternal health, and health systems from governments, academia, development organizations, and foundations to assess the evidence on whether financial incentives significantly and substantially increase provision, use and quality of maternal health services, and the contextual factors that impact the effectiveness of these incentives. Evidence review teams evaluated the multidisciplinary evidence of various financial mechanisms, including supply-side incentives (e.g. performance-based financing, user fees, and various insurance mechanisms) and demand-side incentives (e.g. conditional cash transfers, vouchers, user fee exemptions, and subsidies for care-seeking). At the Summit, the teams presented a synthesis of evidence and initial recommendations on practice, policy, and research for discussion. The Summit enabled structured feedback on recommendations which the teams included in their final papers appearing in this Supplement. Papers in this Supplement review the evidence for a specific financial incentive mechanism (e.g. pay for performance, conditional cash transfer) to improve the use and quality of maternal healthcare and makes recommendations for programmes and future research. While data on programmes using financial incentives for improved use and indications of the quality of maternal health services support specific conclusions and recommendations, including those for future research, data linking the use of financial incentives with improved health outcomes are minimal.

Resident-initiated interventions to improve inpatient heart-failure management.

PubMed

Oujiri, James; Hakeem, Abdul; Pack, Quinn; Holland, Robert; Meyers, David; Hildebrand, Christopher; Bridges, Alan; Roach, Mary A; Vogelman, Bennett

2011-02-01

Third-year internal medicine residents participating in a quality improvement rotation identified gaps between the Joint Commission's ORYX quality guidelines and clinical practices for the inpatient management of heart failure (HF) at the William S. Middleton Memorial Veterans Hospital. Residents focused on the performance metrics associated with tobacco-cessation counselling documentation, ejection fraction assessment and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescriptions. After analysing data collected by the External Peer Review Program, residents reviewed the institution's admissions and discharge processes with the aim of improving quality and compliance. In redesigning these processes, residents created an admissions template and a discharge face sheet, and compared specific ORYX measure compliance rates before and after institution-wide implementation. Following implementation of the tobacco-cessation admissions template, 100% of HF patients who used tobacco received documented cessation counselling, compared with 59% prior to intervention (p<0.01, n=32). Following implementation of the mandatory discharge face sheet, 97% of HF patients (compared with 92% preintervention, p>0.05) received comprehensive discharge instruction; LV function assessment went from 98% to 100% (p>0.05); and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription for left ventricular systolic dysfunction at discharge (or documentation of a contra-indication) went from 82% to 100% (p<0.01, n=48). By implementing a standardised admissions template and a mandatory discharge face sheet, the hospital improved its processes of documentation and increased adherence to quality-performance measures. By strengthening residents' learning and commitment to quality improvement, the hospital created a foundation for future changes in the systems that affect patient care.

Meaningful Peer Review in Radiology: A Review of Current Practices and Potential Future Directions.

PubMed

Moriarity, Andrew K; Hawkins, C Matthew; Geis, J Raymond; Dreyer, Keith J; Kamer, Aaron P; Khandheria, Paras; Morey, Jose; Whitfill, James; Wiggins, Richard H; Itri, Jason N

2016-12-01

The current practice of peer review within radiology is well developed and widely implemented compared with other medical specialties. However, there are many factors that limit current peer review practices from reducing diagnostic errors and improving patient care. The development of "meaningful peer review" requires a transition away from compliance toward quality improvement, whereby the information and insights gained facilitate education and drive systematic improvements that reduce the frequency and impact of diagnostic error. The next generation of peer review requires significant improvements in IT functionality and integration, enabling features such as anonymization, adjudication by multiple specialists, categorization and analysis of errors, tracking, feedback, and easy export into teaching files and other media that require strong partnerships with vendors. In this article, the authors assess various peer review practices, with focused discussion on current limitations and future needs for meaningful peer review in radiology. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

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

Wasner, Evan; Bearden, Sean; Žutić, Igor, E-mail: zigor@buffalo.edu

Digital operation of lasers with injected spin-polarized carriers provides an improved operation over their conventional counterparts with spin-unpolarized carriers. Such spin-lasers can attain much higher bit rates, crucial for optical communication systems. The overall quality of a digital signal in these two types of lasers is compared using eye diagrams and quantified by improved Q-factors and bit-error-rates in spin-lasers. Surprisingly, an optimal performance of spin-lasers requires finite, not infinite, spin-relaxation times, giving a guidance for the design of future spin-lasers.

Opportunities for oncology in the Patient Protection and Affordable Care Act.

PubMed

Patel, Kavita K; Tran, Lisa

2013-01-01

The Patient Protection and Affordable Care Act (ACA) contains within it three significant legislative constructs: to enhance access to health care, improve quality, and decrease cost. Also known as the Triple Aim, these three simple, yet monumental, goals have been the object of actions to date as well as future implementation efforts. This article will identify sections of the legislation that would directly provide areas of opportunity to improve health and achieve the triple aim for the oncology profession.

Practical applications of space systems. [environmental quality and resources management

NASA Technical Reports Server (NTRS)

1975-01-01

The study was conducted to provide an opportunity for knowledgeable users to express their needs for information or services which might or might not be met by space systems, and to relate the present and potential capabilities of space systems to their needs. The needs, accomplishments to date, and future possibilities in the applications of space systems for providing food and energy, while at the same time improving and safeguarding the physical environment and the quality of life, are presented. Organizing the usage of these space systems capabilities is also discussed.

Electron tubes for industrial applications

NASA Astrophysics Data System (ADS)

Gellert, Bernd

1994-05-01

This report reviews research and development efforts within the last years for vacuum electron tubes, in particular power grid tubes for industrial applications. Physical and chemical effects are discussed that determine the performance of todays devices. Due to the progress made in the fundamental understanding of materials and newly developed processes the reliability and reproducibility of power grid tubes could be improved considerably. Modern computer controlled manufacturing methods ensure a high reproducibility of production and continuous quality certification according to ISO 9001 guarantees future high quality standards. Some typical applications of these tubes are given as an example.

Protecting drinking water: water quality testing and PHAST in South Africa.

PubMed

Breslin, E D

2000-01-01

The paper presents an innovative field-based programme that uses a simple total coliform test and the approach of PHAST (Participatory Hygiene And Sanitation Transformation) to help communities exploring possible water quality problems and actions that can be taken to address them. The Mvula Trust, a South African water and environmental sanitation NGO, has developed the programme. It is currently being tested throughout South Africa. The paper provides two case studies on its implementation in the field, and suggests ways in which the initiative can be improved in the future.

The Role of Lean Process Improvement in Implementation of Evidence-Based Practices in Behavioral Health Care.

PubMed

Steinfeld, Bradley; Scott, Jennifer; Vilander, Gavin; Marx, Larry; Quirk, Michael; Lindberg, Julie; Koerner, Kelly

2015-10-01

To effectively implement evidence-based practices (EBP) in behavioral health care, an organization needs to have operating structures and processes that can address core EBP implementation factors and stages. Lean, a widely used quality improvement process, can potentially address the factors crucial to successful implementation of EBP. This article provides an overview of Lean and the relationship between Lean process improvement steps, and EBP implementation models. Examples of how Lean process improvement methodologies can be used to help plan and carry out implementation of EBP in mental health delivery systems are presented along with limitations and recommendations for future research and clinical application.

Global ozone and air quality: a multi-model assessment of risks to human health and crops

NASA Astrophysics Data System (ADS)

Ellingsen, K.; Gauss, M.; van Dingenen, R.; Dentener, F. J.; Emberson, L.; Fiore, A. M.; Schultz, M. G.; Stevenson, D. S.; Ashmore, M. R.; Atherton, C. S.; Bergmann, D. J.; Bey, I.; Butler, T.; Drevet, J.; Eskes, H.; Hauglustaine, D. A.; Isaksen, I. S. A.; Horowitz, L. W.; Krol, M.; Lamarque, J. F.; Lawrence, M. G.; van Noije, T.; Pyle, J.; Rast, S.; Rodriguez, J.; Savage, N.; Strahan, S.; Sudo, K.; Szopa, S.; Wild, O.

2008-02-01

Within ACCENT, a European Network of Excellence, eighteen atmospheric models from the U.S., Europe, and Japan calculated present (2000) and future (2030) concentrations of ozone at the Earth's surface with hourly temporal resolution. Comparison of model results with surface ozone measurements in 14 world regions indicates that levels and seasonality of surface ozone in North America and Europe are characterized well by global models, with annual average biases typically within 5-10 nmol/mol. However, comparison with rather sparse observations over some regions suggest that most models overestimate annual ozone by 15-20 nmol/mol in some locations. Two scenarios from the International Institute for Applied Systems Analysis (IIASA) and one from the Intergovernmental Panel on Climate Change Special Report on Emissions Scenarios (IPCC SRES) have been implemented in the models. This study focuses on changes in near-surface ozone and their effects on human health and vegetation. Different indices and air quality standards are used to characterise air quality. We show that often the calculated changes in the different indices are closely inter-related. Indices using lower thresholds are more consistent between the models, and are recommended for global model analysis. Our analysis indicates that currently about two-thirds of the regions considered do not meet health air quality standards, whereas only 2-4 regions remain below the threshold. Calculated air quality exceedances show moderate deterioration by 2030 if current emissions legislation is followed and slight improvements if current emissions reduction technology is used optimally. For the "business as usual" scenario severe air quality problems are predicted. We show that model simulations of air quality indices are particularly sensitive to how well ozone is represented, and improved accuracy is needed for future projections. Additional measurements are needed to allow a more quantitative assessment of the risks to human health and vegetation from changing levels of surface ozone.

Influence of the Nogales International Wastewater Treatment Plant on surface water in the Santa Cruz River and local aquifers

NASA Astrophysics Data System (ADS)

LaBrie, H. M.; Brusseau, M. L.; Huth, H.

2015-12-01

As water resources become limited in Arizona due to drought and excessive use of ground water, treated wastewater effluent is becoming essential in creating natural ecosystems and recharging the decreasing groundwater supplies. Therefore, future water supplies are heavily dependent of the flow (quantity) and quality of the treated effluent. The Nogales International Wastewater Treatment Plant (NIWTP) releases treated wastewater from both Nogales, Arizona and Nogales, Sonora, Mexico into the Santa Cruz River. This released effluent not only has the potential to impact surface water, but also groundwater supplies in Southern Arizona. In the recent past, the NIWTP has had reoccurring issues with elevated levels of cadmium, in addition to other, more infrequent, releases of high amounts of other metals. The industrial demographic of the region, as well as limited water quality regulations in Mexico makes the NIWTP and its treated effluent an important area of study. In addition, outdated infrastructure can potentially lead to damaging environmental impacts, as well as human health concerns. The Santa Cruz River has been monitored and studied in the past, but in recent years, there has been a halt in research regarding the state of the river. Data from existing water quality databases and recent sampling reports are used to address research questions regarding the state of the Santa Cruz River. These questions include: 1) How will change in flow eventually impact surface water and future groundwater supplies 2) What factors influence this flow (such as extreme flooding and drought) 3) What is the impact of effluent on surface water quality 4) Can changes in surface water quality impact groundwater quality 5) How do soil characteristics and surface flow impact the transport of released contaminants Although outreach to stakeholders across the border and updated infrastructure has improved the quality of water in the river, there are many areas to improve upon as the demand for treated wastewater increases.

Recent progress in the biology of multiple myeloma and future directions in the treatment.

PubMed

Pico, J L; Castagna, L; Bourhis, J H

1998-04-01

A great amount of scientific information, accumulated over recent years on the biology of Multiple Myeloma (MM), has fuelled speculation about the origin of malignant plasma cells, about a purported critical role played by the bone marrow stroma, and further still, on cytokine interactions and in particular that of IL-6 and its relationship with the immune system. Among the growth factors secreted by stroma cells, IL-6 is a potent stimulator of myeloma cells in vitro but does not induce a malignant phenotype in normal plasma cells. Many efforts have been produced to identify the stem cell in MM and probably memory B lymphocytes are the best candidates. The demonstration of a Graft vs Myeloma effect in the allogeneic setting strongly supports the immunotherapy in MM. Recent data also suggest that a virus (Kaposi-associated herpes virus, HHV-8) may be significantly associated with the development of MM. In parallel, progress has been achieved in the treatment of this incurable disease with well defined prognostic factors, more efficient supportive care and its corollary, improved quality of life and dose-intensified chemo-radiotherapy followed by autologous hematopoietic stem cell support. Improving the quality of grafts with the selection of CD34 positive cells is another approach aimed at reducing plasma cell contamination without impairing haematological recovery. An EBMT randomized study assessing the role of CD34 selection has been initiated by our group Increasingly efficient first-line therapy, better quality autografts and improved post-remission treatment with, for example, anti-idiopathic vaccination are the most promising future directions.

Revealing driving factors of China's PM2.5 pollution

NASA Astrophysics Data System (ADS)

Zheng, Y.; Zhao, H.; Zhang, Q.; Geng, G.; Tong, D.; Peng, L.; He, K.

2017-12-01

China's rapid economic development and intensive energy consumption are deteriorating the air quality significantly. Understanding the key driving factors behind China's growing emissions of air pollutants and the accompanying PM2.5 pollution is critical for the development of China's clean air policies and also provides insight into how other emerging economies may develop a clear sky future. Here we reveal the socioeconomic drivers of the variations of China's PM2.5 concentrations during 2002-2012 by using an interdisciplinary framework that integrates an emission inventory model, an index decomposition analysis model, and a regional air quality model. The decomposition results demostrate that the improvements in emission efficiency and energy efficiency failed to offset the increased emissions of both primary PM2.5 and gaseous PM2.5 precursors (including SO2 NOx, and volatile organic compounds) triggered by the surging economic growth during 2002-2012. During the same time, the effects of energy structure, production structure and population growth were relatively less significant to all pollutants, which indicates the potential of large emission abatements through energy structure and production structure adjustment. Sensitivity simulations by the air quality model based on the provincial decomposition results also show that the economic growth have outpaced efficiency improvements in the increments of PM2.5 concentrations during the study years. As China continues to develop rapidly, future policies should promote further improvements in efficiency and accelerate the adjustments toward clean energy and production structures, which are critical for reducing China's emissions and alleviating the severe PM2.5 pollution.

Linked Analysis of East Asia Emission Reduction Pathways

NASA Astrophysics Data System (ADS)

Kim, Y.; Woo, J. H.; Bu, C.; Lee, Y.; Kim, J.; Jang, Y.; Park, M.

2017-12-01

Air pollution and its impacts over the Northeast Asia are very severe because of the massive pollutant emissions and high population. Korea has been trying to improve air quality with the enhanced environmental legislation. The air quality over Korea, however, does not entirely dependent on its local emissions. Transboundary air pollution from China highly affects Korean atmosphere. The purpose of this research is to understand role of local and transbounday efforts to improve air quality changes over Korea. In this research, we have tried to set up the multiple emission scenario pathways for Korea and China using IIASA's GAINS (Greenhouse gas - Air pollution Interactions aNd Synergies) modeling framework. More up-to-date growth factors and control policy packets were made using regional socio-economic data and control policy information from local governments and international statistics. Four major scenario pathways, 1) Base (Baseline: current legislation), 2) OTB/OTB(On the book/On the way : existing control measure/planed control measure), 3) BOTW_GHG(Beyond on the way : OTW with GHG reduction plan), 4) BOTW_NH3 (OTW with additional NH3 reduction measure) were developed to represent air quality improvement pathways in consideration of both Korean and Chinese efforts. Strict ambient PM2.5 standards from Seoul metropolitan Air quality Improvement Plan(SAIP) seems too enthusiastic without linking air quality control efforts of China. Step-by-step emission controls and following air quality, control cost, health impact from each scenario will be presented at the conference. This subject is supported by Korea Ministry of Environment as "Climate Change Correspondence Program". And This work was supported under the framework of national strategy project on fine particulate matters by Ministry of Science, ICT and Future Planning.

Applying Collaborative Learning and Quality Improvement to Public Health: Lessons from the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality.

PubMed

Ghandour, Reem M; Flaherty, Katherine; Hirai, Ashley; Lee, Vanessa; Walker, Deborah Klein; Lu, Michael C

2017-06-01

Infant mortality remains a significant public health problem in the U.S. The Collaborative Improvement & Innovation Network (CoIIN) model is an innovative approach, using the science of quality improvement and collaborative learning, which was applied across 13 Southern states in Public Health Regions IV and VI to reduce infant mortality and improve birth outcomes. We provide an in-depth discussion of the history, development, implementation, and adaptation of the model based on the experience of the original CoIIN organizers and participants. In addition to the political genesis and functional components of the initiative, 8 key lessons related to staffing, planning, and implementing future CoIINs are described in detail. This paper reports the findings from a process evaluation of the model. Data on the states' progress toward reducing infant mortality and improving birth outcomes were collected through a survey in the final months of a 24-month implementation period, as well as through ongoing team communications. The peer-to-peer exchange and platform for collaborative learning, as well as the sharing of data across the states, were major strengths and form the foundation for future CoIIN efforts. A lasting legacy of the initiative is the unique application and sharing of provisional "real time" data to inform "real time" decision-making. The CoIIN model of collaborative learning, QI, and innovation offers a promising approach to strengthening partnerships within and across states, bolstering data systems to inform and track progress more rapidly, and ultimately accelerating improvement toward healthier communities, States, and the Nation as a whole.

The Engineer of 2020: Visions of Engineering in the New Century

ERIC Educational Resources Information Center

National Academies Press, 2004

2004-01-01

To enhance the nation's economic productivity and improve the quality of life worldwide, engineering education in the United States must anticipate and adapt to the dramatic changes of engineering practice. The Engineer of 2020 urges the engineering profession to recognize what engineers can build for the future through a wide range of leadership…

Genetic analysis of some agronomic and fiber traits in Gossypium hirsutum L. grown in field conditions

USDA-ARS?s Scientific Manuscript database

Cotton production is an essential component of the economy of Pakistan, and continuing to improve the yield and fiber quality of this crop will ensure the future stability of this industry. Combining ability describes the performance of genotypes when they are crossed together, and it is a common me...

Supporting Adults with Autism Spectrum Disorders: Lessons from Six Decades of International Research

ERIC Educational Resources Information Center

Poon, Kenneth K.

2012-01-01

Research focusing on the intervention and support of children with autism spectrum disorders (ASD) has grown exponentially but this increase research has not been mirrored for adults with ASD. With the aims of informing intervention planning, improving quality of life, and areas for future research, 18 peer-reviewed research articles reporting the…

Using Biomass to Improve Site Quality and Carbon Sequestration

Treesearch

Bryce J. Stokes; Felipe G. Sanchez; Emily A. Carter

1998-01-01

The future demands on forest lands are a concern because of reduced productivity, especially on inherently poor sites, sites with long-depleted soils, or those soils that bear repeated, intensive short rotations. Forests are also an important carbon sink and, when well managed, can make even more significant contributions to sequestration and to reduction of greenhouse...

Quality Schools, Healthy Neighborhoods, and the Future of DC: Policy Report

ERIC Educational Resources Information Center

Filardo, Mary; Allen, Marni; Huvendick, Nancy; Sung, Ping; Garrison, David; Turner, Margery Austin; Comey, Jennifer; Williams, Barika; Guernsey, Elizabeth

2008-01-01

Over the last decade, the District of Columbia implemented bold steps to improve its public schools while also experiencing population growth, property value increases, and strong city fiscal health. But its child population (0-17 years old) remained essentially the same and a dwindling share of the city's children was attending the public…

Understanding the Design Context for Australian University Teachers: Implications for the Future of Learning Design

ERIC Educational Resources Information Center

Bennett, Sue; Thomas, Lisa; Agostinho, Shirley; Lockyer, Lori; Jones, Jennifer; Harper, Barry

2011-01-01

Based on the premise that providing support for university teachers in designing for their teaching will ultimately improve the quality of student learning outcomes, recent interest in the development of support tools and strategies has gained momentum. This article reports on a study that examined the context in which Australian university…

Vermont State Colleges. Futures Task Force II Report.

ERIC Educational Resources Information Center

Vermont State Commission on Higher Education.

This report presents recommendations to strengthen quality and improve programs and services in the Vermont State College (VSC) for Vermont and Vermonters for the next 10-15 years. The report notes three major changes in the VSC and in the role which education beyond high school plays: that VSC enrollments have increased by 37 percent in the past…

The Equity Challenge in China's Higher Education Finance Policy

ERIC Educational Resources Information Center

Sun, Fengshou; Barrientos, Armando

2009-01-01

Sustaining China's rapid economic growth in the future will come to depend in large part on the quantity and quality of the human resources it can mobilize. The paper considers the prospects for higher education financing, and highlights the importance of improving equity in access to higher education as a precondition for a sustainable expansion…

[Guided and computer-assisted implant surgery and prosthetic: The continuous digital workflow].

PubMed

Pascual, D; Vaysse, J

2016-02-01

New continuous digital workflow protocols of guided and computer-assisted implant surgery improve accuracy of implant positioning. The design of the future prosthesis is based on the available prosthetic space, gingival height and occlusal relationship with the opposing and adjacent teeth. The implant position and length depend on volume, density and bone quality, gingival height, tooth-implant and implant-implant distances, implant parallelism, axis and type of the future prosthesis. The crown modeled on the software will therefore serve as a guide to the future implant axis and not the reverse. The guide is made by 3D printing. The software determines surgical protocol with the drilling sequences. The unitary or plural prosthesis, modeled on the software and built before surgery, is loaded directly after implant placing, if needed. These protocols allow for a full continuity of the digital workflow. The software provides the surgeon and the dental technician a total freedom for the prosthetic-surgery guide design and the position of the implants. The prosthetic project, occlusal and aesthetic, taking the bony and surgical constraints into account, is optimized. The implant surgery is simplified and becomes less "stressful" for the patient and the surgeon. Guided and computer-assisted surgery with continuous digital workflow is becoming the technique of choice to improve the accuracy and quality of implant rehabilitation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Socio-technical and organizational challenges to wider e-Health implementation.

PubMed

Vitacca, M; Mazzù, M; Scalvini, S

2009-01-01

Recent advances in information communication technology allow contact with patients at home through e-Health services (telemedicine, in particular). We provide insights on the state of the art of e-Health and telemedicine for possible wider future clinical use. Telemedicine opportunities are summarized as i) home telenursing, ii) electronic transfer to specialists and hospitals, iii) teleconsulting between general practitioners and specialists and iv) call centres activities and online health. At present, a priority action of the EU is the Initiative on TM for chronic disease management as home health monitoring and the future Vision for Europe 2020 is based on development of Integrated Telemedicine Services. There are pros and cons in e-Health and telemedicine. Benefits can be classified as benefits for i) citizens, patients and caregivers and ii) health care provider organizations. Institutions and individuals that play key roles in the future of e-Health are doctors, patients and hospitals, while the whole system should be improved at three crucial levels: 1) organizational, 2) regulatory and 3) technological. Quality, access and efficiency are the general key issues for the success of e-Health and telemedicine implementation. The real technology is the human resource available into the organizations. For e-Health and telemedicine to grow, it will be necessary to investigate their long-term efficacy, cost effectiveness, possible improvement in quality of life and impact on public health burden.

A Methodological Critique of the ProPublica Surgeon Scorecard

PubMed Central

Friedberg, Mark W.; Pronovost, Peter J.; Shahian, David M.; Safran, Dana Gelb; Bilimoria, Karl Y.; Elliott, Marc N.; Damberg, Cheryl L.; Dimick, Justin B.; Zaslavsky, Alan M.

2016-01-01

Abstract On July 14, 2015, ProPublica published its Surgeon Scorecard, which displays “Adjusted Complication Rates” for individual, named surgeons for eight surgical procedures performed in hospitals. Public reports of provider performance have the potential to improve the quality of health care that patients receive. A valid performance report can drive quality improvement and usefully inform patients' choices of providers. However, performance reports with poor validity and reliability are potentially damaging to all involved. This article critiques the methods underlying the Scorecard and identifies opportunities for improvement. Until these opportunities are addressed, the authors advise users of the Scorecard—most notably, patients who might be choosing their surgeons—not to consider the Scorecard a valid or reliable predictor of the health outcomes any individual surgeon is likely to provide. The authors hope that this methodological critique will contribute to the development of more-valid and more-reliable performance reports in the future. PMID:28083411

Robust Decision Making to Support Water Quality Climate Adaptation: a Case Study in the Chesapeake Bay Watershed

NASA Astrophysics Data System (ADS)

Fischbach, J. R.; Lempert, R. J.; Molina-Perez, E.

2017-12-01

The U.S. Environmental Protection Agency (USEPA), together with state and local partners, develops watershed implementation plans designed to meet water quality standards. Climate uncertainty, along with uncertainty about future land use changes or the performance of water quality best management practices (BMPs), may make it difficult for these implementation plans to meet water quality goals. In this effort, we explored how decision making under deep uncertainty (DMDU) methods such as Robust Decision Making (RDM) could help USEPA and its partners develop implementation plans that are more robust to future uncertainty. The study focuses on one part of the Chesapeake Bay watershed, the Patuxent River, which is 2,479 sq km in area, highly urbanized, and has a rapidly growing population. We simulated the contribution of stormwater contaminants from the Patuxent to the overall Total Maximum Daily Load (TMDL) for the Chesapeake Bay under multiple scenarios reflecting climate and other uncertainties. Contaminants considered included nitrogen, phosphorus, and sediment loads. The assessment included a large set of scenario simulations using the USEPA Chesapeake Bay Program's Phase V watershed model. Uncertainties represented in the analysis included 18 downscaled climate projections (based on 6 general circulation models and 3 emissions pathways), 12 land use scenarios with different population projections and development patterns, and alternative assumptions about BMP performance standards and efficiencies associated with different suites of stormwater BMPs. Finally, we developed cost estimates for each of the performance standards and compared cost to TMDL performance as a key tradeoff for future water quality management decisions. In this talk, we describe how this research can help inform climate-related decision support at USEPA's Chesapeake Bay Program, and more generally how RDM and other DMDU methods can support improved water quality management under climate uncertainty.

Effects of aquatic exercise on physical function and fitness among people with spinal cord injury: A systematic review.

PubMed

Li, Chunxiao; Khoo, Selina; Adnan, Athirah

2017-03-01

The aim of this review is to synthesize the evidence on the effects of aquatic exercise interventions on physical function and fitness among people with spinal cord injury. Six major databases were searched from inception till June 2015: MEDLINE, CINAHL, EMBASE, PsychInfo, SPORTDiscus, and Cochrane Center Register of Controlled Trials. Two reviewers independently rated methodological quality using the modified Downs and Black Scale and extracted and synthesized key findings (i.e., participant characteristics, study design, physical function and fitness outcomes, and adverse events). Eight of 276 studies met the inclusion criteria, of which none showed high research quality. Four studies assessed physical function outcomes and 4 studies evaluated aerobic fitness as outcome measures. Significant improvements on these 2 outcomes were generally found. Other physical or fitness outcomes including body composition, muscular strength, and balance were rarely reported. There is weak evidence supporting aquatic exercise training to improve physical function and aerobic fitness among adults with spinal cord injury. Suggestions for future research include reporting details of exercise interventions, evaluating other physical or fitness outcomes, and improving methodological quality.

Low-Voltage Organic Single-Crystal Field-Effect Transistor with Steep Subthreshold Slope.

PubMed

Yang, Fangxu; Sun, Lingjie; Han, Jiangli; Li, Baili; Yu, Xi; Zhang, Xiaotao; Ren, Xiaochen; Hu, Wenping

2018-03-06

Anodization is a promising technique to form high- k dielectrics for low-power organic field-effect transistor (OFET) applications. However, the surface quality of the dielectric, which is mainly inherited from the metal electrode, can be improved further than other fabrication techniques, such as sol-gel. In this study, we applied the template stripping method to fabricate a low-power single-crystalline OFET based on the anodized AlO x dielectric. We found that the template stripping method largely improves the surface roughness of the deposited Al and allows for the formation of a high-quality AlO x high- k dielectric by anodization. The ultraflat AlO x /SAM dielectric combined with a single-crystal 2,6-diphenylanthracene (DPA) semiconductor produced a nearly defect-free interface with a steep subthreshold swing (SS) of 66 mV/decade. The current device is a promising candidate for future ultralow-power applications. Other than metal deposition, template stripping could provide a general approach to improve thin-film quality for many other types of materials and processes.

Integrating future scenario‐based crop expansion and crop conditions to map switchgrass biofuel potential in eastern Nebraska, USA

USGS Publications Warehouse

Gu, Yingxin; Wylie, Bruce K.

2018-01-01

Switchgrass (Panicum virgatum) has been evaluated as one potential source for cellulosic biofuel feedstocks. Planting switchgrass in marginal croplands and waterway buffers can reduce soil erosion, improve water quality, and improve regional ecosystem services (i.e. it serves as a potential carbon sink). In previous studies, we mapped high risk marginal croplands and highly erodible cropland buffers that are potentially suitable for switchgrass development, which would improve ecosystem services and minimally impact food production. In this study, we advance our previous study results and integrate future crop expansion information to develop a switchgrass biofuel potential ensemble map for current and future croplands in eastern Nebraska. The switchgrass biomass productivity and carbon benefits (i.e. NEP: net ecosystem production) for the identified biofuel potential ensemble areas were quantified. The future scenario‐based (‘A1B’) land use and land cover map for 2050, the US Geological Survey crop type and Compound Topographic Index (CTI) maps, and long‐term (1981–2010) averaged annual precipitation data were used to identify future crop expansion regions that are suitable for switchgrass development. Results show that 2528 km2 of future crop expansion regions (~3.6% of the study area) are potentially suitable for switchgrass development. The total estimated biofuel potential ensemble area (including cropland buffers, marginal croplands, and future crop expansion regions) is 4232 km2 (~6% of the study area), potentially producing 3.52 million metric tons of switchgrass biomass per year. Converting biofuel ensemble regions to switchgrass leads to potential carbon sinks (the total NEP for biofuel potential areas is 0.45 million metric tons C) and is environmentally sustainable. Results from this study improve our understanding of environmental conditions and ecosystem services of current and future cropland systems in eastern Nebraska and provide useful information to land managers to make land use decisions regarding switchgrass development.

The development and evaluation of the Australian child and adolescent recommended food score: a cross-sectional study

PubMed Central

2012-01-01

Background Diet quality tools have been developed to assess the adequacy of dietary patterns for predicting future morbidity and mortality. This study describes the development and evaluation of a brief food-based diet quality index for use with children at the individual or population level. The Australian Child and Adolescent Recommended Food Score (ACARFS) was developed to reflect adherence to the Dietary Guidelines for Children and Adolescents in Australia and modelled on the approach of the US Recommended Food Score. Methods The ACARFS has eight sub-scales and is scored from zero to 73. The diet quality score was evaluated by assessing correlation (Spearman’s correlations) and agreement (weighted κ statistics) between ACARFS scores and nutrient intakes, derived from a food frequency questionnaire in 691 children (mean age 11.0, SD 1.1) in New South Wales, Australia. Nutrient intakes for ACARFS quartiles were compared with the relevant Australian nutrient reference values. Results ACARFS showed slight to substantial agreement (κ 0.13-0.64) with nutrient intakes, with statistically significant moderate to strong positive correlations with all vitamins, minerals and energy intake (r = 0.42-0.70). ACARFS was not related to BMI.Participants who scored less than the median ACARFS were more likely to have sub-optimal intakes of fibre, folic acid and calcium. Conclusion ACARFS demonstrated sufficient accuracy for use in future studies evaluating diet quality. Future research on its utility in targeting improvements in the nutritional quality of usual eating habits of children and adolescents is warranted. PMID:23164095

Urban groundwater quality in sub-Saharan Africa: current status and implications for water security and public health

NASA Astrophysics Data System (ADS)

Lapworth, D. J.; Nkhuwa, D. C. W.; Okotto-Okotto, J.; Pedley, S.; Stuart, M. E.; Tijani, M. N.; Wright, J.

2017-06-01

Groundwater resources are important sources of drinking water in Africa, and they are hugely important in sustaining urban livelihoods and supporting a diverse range of commercial and agricultural activities. Groundwater has an important role in improving health in sub-Saharan Africa (SSA). An estimated 250 million people (40% of the total) live in urban centres across SSA. SSA has experienced a rapid expansion in urban populations since the 1950s, with increased population densities as well as expanding geographical coverage. Estimates suggest that the urban population in SSA will double between 2000 and 2030. The quality status of shallow urban groundwater resources is often very poor due to inadequate waste management and source protection, and poses a significant health risk to users, while deeper borehole sources often provide an important source of good quality drinking water. Given the growth in future demand from this finite resource, as well as potential changes in future climate in this region, a detailed understanding of both water quantity and quality is required to use this resource sustainably. This paper provides a comprehensive assessment of the water quality status, both microbial and chemical, of urban groundwater in SSA across a range of hydrogeological terrains and different groundwater point types. Lower storage basement terrains, which underlie a significant proportion of urban centres in SSA, are particularly vulnerable to contamination. The relationship between mean nitrate concentration and intrinsic aquifer pollution risk is assessed for urban centres across SSA. Current knowledge gaps are identified and future research needs highlighted.

Dietary self-efficacy predicts AHEI diet quality in women with previous gestational diabetes.

PubMed

Ferranti, Erin Poe; Narayan, K M Venkat; Reilly, Carolyn M; Foster, Jennifer; McCullough, Marjorie; Ziegler, Thomas R; Guo, Ying; Dunbar, Sandra B

2014-01-01

The purpose of this study was to examine the association of intrapersonal influences of diet quality as defined by the Health Belief Model constructs in women with recent histories of gestational diabetes. A descriptive, correlational, cross-sectional design was used to analyze relationships between diet quality and intrapersonal variables, including perceptions of threat of type 2 diabetes mellitus development, benefits and barriers of healthy eating, and dietary self-efficacy, in a convenience sample of 75 community-dwelling women (55% minority; mean age, 35.5 years; SD, 5.5 years) with previous gestational diabetes mellitus. Diet quality was defined by the Alternative Healthy Eating Index (AHEI). Multiple regression was used to identify predictors of AHEI diet quality. Women had moderate AHEI diet quality (mean score, 47.6; SD, 14.3). Only higher levels of education and self-efficacy significantly predicted better AHEI diet quality, controlling for other contributing variables. There is a significant opportunity to improve diet quality in women with previous gestational diabetes mellitus. Improving self-efficacy may be an important component to include in nutrition interventions. In addition to identifying other important individual components, future studies of diet quality in women with previous gestational diabetes mellitus are needed to investigate the scope of influence beyond the individual to potential family, social, and environmental factors. © 2014 The Author(s).

[Adherence to the Mediterranean diet of future teachers].

PubMed

Egeda Manzanera, José Manuel; Rodrigo Vega, Maximiliano

2014-08-01

The Spanish university population is vulnerable in their eating habits for various reasons. This would in many cases the abandonment of a traditional Mediterranean diet. To determine the adherence to the Mediterranean diet (adm) of a university population of future Teachers and analyze various factos that may condition its nutritional quality. Distribution Kidmed test to a sample of 212 university aged between 21 and 24. The Kidmed index (0-12) indicate whether the ADM was low (0 to 3), medium (4-7) or high (8 to 12). Each respondent was recorded age, weight, height and body mass index, and weekly physical activity. For comparison of the data was used Chi square test, the Mann Whitney test and ANOVA factor using SPSS 15. 15.1% had a low Kidmed index, 60.4% intermediate and 24.5% higher. The difference between the different levels of ADM is due to the consumption of fruits and vegetables (p < 0.05) mainly. Among the degrees of ADM and nutritional status (BMI) were not significantly different. The differences between those students who perform physical activity (66%) and no (34%) over the Kidmed index (< 0.05), were due primarily to breakfast consumed more cereals and cereal and pastries least). 75.5% of future Teachers needed improved ADM. In general, enhance a quality breakfast and minimum daily physical activity would be two core aspects in improving habits. It would be appropriate to provide nutritional education campaigns for this population and especially considering their future social role as educators. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Access to safe water in rural Artibonite, Haiti 16 months after the onset of the cholera epidemic.

PubMed

Patrick, Molly; Berendes, David; Murphy, Jennifer; Bertrand, Fabienne; Husain, Farah; Handzel, Thomas

2013-10-01

Haiti has the lowest improved water and sanitation coverage in the Western Hemisphere and is suffering from the largest cholera epidemic on record. In May of 2012, an assessment was conducted in rural areas of the Artibonite Department to describe the type and quality of water sources and determine knowledge, access, and use of household water treatment products to inform future programs. It was conducted after emergency response was scaled back but before longer-term water, sanitation, and hygiene activities were initiated. The household survey and source water quality analysis documented low access to safe water, with only 42.3% of households using an improved drinking water source. One-half (50.9%) of the improved water sources tested positive for Escherichia coli. Of households with water to test, 12.7% had positive chlorine residual. The assessment reinforces the identified need for major investments in safe water and sanitation infrastructure and the importance of household water treatment to improve access to safe water in the near term.

A multihospital medication allergy audit: a means to quality assurance.

PubMed

Hoffmann, R P; Ellerbrock, M C; Lovett, J E

1982-04-01

Seventeen community hospitals within the 16 division of the Sisters of Mercy Health Corporation cooperatively participated in a medication allergy audit program. Initial and follow-up audits were conducted at each hospital to determine whether allergy information for penicillin- or aspirin-sensitive patients was appropriately communicated to the pharmacist. A total of 483 patient records were reviewed during each audit which corresponded to 12% of each hospital's average patient census. In the initial audit, the overall acceptance rate for the combined hospitals was 62.3%. Following the first audit, each hospital undertook corrective follow-up measures in an attempt to improve its results. In the second audit, the overall acceptance rate improved significantly to 78.9%. It is concluded that this auditing process followed by corrective follow-up measures was an effective mechanism for improving the communication of patient allergy information and is a means to quality assurance. Future audits will be necessary to determine whether the beneficial effects produced will be sustained or improved.

Predictors of Sleep Quality Among Young Adults in Korea: Gender Differences.

PubMed

Chang, Ae Kyung; Choi, Jinyi

2016-12-01

This study was performed to identify the factors influencing gender differences in sleep quality between men and women. A cross-sectional survey was conducted using a convenience sample of 300 young adults from three Korean universities. Participants were 20-40 years of age, used smartphones, and took no sleep medication. Participants completed questionnaires on sleep quality, exercise, stress, depression, and smart phone addiction. The predictors of sleep quality in men were coffee consumption, napping, depression, failure to engage in light exercise at least three times per week, being overweight, being in the potential smart phone addiction group, and being employed, which explained 30.2% of the variance. The predictors of sleep quality in women were education to college level or higher, smoking, and stress, which explained 30.5% of the variance. To improve sleep quality in this population, future intervention should contain life style modification strategies containing smartphone addiction prevention.

Model-based synthesis of aircraft noise to quantify human perception of sound quality and annoyance

NASA Astrophysics Data System (ADS)

Berckmans, D.; Janssens, K.; Van der Auweraer, H.; Sas, P.; Desmet, W.

2008-04-01

This paper presents a method to synthesize aircraft noise as perceived on the ground. The developed method gives designers the opportunity to make a quick and economic evaluation concerning sound quality of different design alternatives or improvements on existing aircraft. By presenting several synthesized sounds to a jury, it is possible to evaluate the quality of different aircraft sounds and to construct a sound that can serve as a target for future aircraft designs. The combination of using a sound synthesis method that can perform changes to a recorded aircraft sound together with executing jury tests allows to quantify the human perception of aircraft noise.

Impact of shale gas development on regional water quality.

PubMed

Vidic, R D; Brantley, S L; Vandenbossche, J M; Yoxtheimer, D; Abad, J D

2013-05-17

Unconventional natural gas resources offer an opportunity to access a relatively clean fossil fuel that could potentially lead to energy independence for some countries. Horizontal drilling and hydraulic fracturing make the extraction of tightly bound natural gas from shale formations economically feasible. These technologies are not free from environmental risks, however, especially those related to regional water quality, such as gas migration, contaminant transport through induced and natural fractures, wastewater discharge, and accidental spills. We review the current understanding of environmental issues associated with unconventional gas extraction. Improved understanding of the fate and transport of contaminants of concern and increased long-term monitoring and data dissemination will help manage these water-quality risks today and in the future.

Improving critical care discharge summaries: a collaborative quality improvement project using PDSA

PubMed Central

Goulding, Lucy; Parke, Hannah; Maharaj, Ritesh; Loveridge, Robert; McLoone, Anne; Hadfield, Sophie; Helme, Eloise; Hopkins, Philip; Sandall, Jane

2015-01-01

Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called ‘iMobile’ is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work-load, with new cohorts of staff regularly passing through critical care. In addition to presenting the results of this quality improvement project, we also reflect on the lessons learned and make suggestions for future projects. PMID:26734368

A comprehensive review of the SLMTA literature part 1: Content analysis and future priorities

PubMed Central

Yao, Katy; Nkengasong, John N.

2014-01-01

Background Since its introduction in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has been implemented widely throughout Africa, as well as in the Caribbean, Central and South America, and Southeast Asia. Objective We compiled results from local, national and global studies to provide a broad view of the programme and identify directions for the future. The review consists of two companion papers; this paper focuses on content analysis, examining various thematic components of the SLMTA programme and future priorities. Methods A systematic literature search identified 28 published articles about implementing the SLMTA programme. Results for various components of the SLMTA programme were reviewed and summarised. Results Local and national studies provide substantial information on previous experiences with quality management systems; variations on SLMTA implementation; building human resource capacity for trainers, mentors and auditors; the benefits and effectiveness of various types of mentorship; the importance of management buy-in to ensure country ownership; the need to instill a culture of quality in the laboratory; success factors and challenges; and future directions for the programme. Conclusions Local, national and global results suggest that the SLMTA programme has been overwhelmingly successful in transforming laboratory quality management. There is an urgent need to move forward in four strategic directions: progression (continued improvement in SLMTA laboratories), saturation (additional laboratories within countries that have implemented SLMTA), expansion (implementation in additional countries), and extension (adapting SLMTA for implementation beyond the laboratory), to lead to transformation of overall health systems and patient care. PMID:29043200

Teaching Quality Improvement in Graduate Medical Education: An Experiential and Team-Based Approach to the Acquisition of Quality Improvement Competencies.

PubMed

Hall Barber, Karen; Schultz, Karen; Scott, Abigail; Pollock, Emily; Kotecha, Jyoti; Martin, Danyal

2015-10-01

An emerging priority in medical education is the need to facilitate learners' acquisition of quality improvement (QI) competencies. Accreditation bodies in both Canada and the United States have included QI and patient safety in their core competencies. In 2010, the Department of Family Medicine at Queen's University designed a graduate medical education curriculum to engage residents in a clinical QI program that would meet accreditation requirements. Monthly didactic sessions were combined with an experiential, team-based QI project that aligned with existing clinic priorities. The curriculum spans the first year of residency and is divided into three stages: (1) Engaging, (2) Understanding, and (3) Improving and translating. In Stage 1, teams of residents select a clinical QI topic, engage stakeholders, and collect baseline data related to their topic. In Stage 2, they focus on understanding their problem, interpreting their results, and applying QI tools. In Stage 3, they develop change ideas, translate their knowledge, and prepare to hand over their project. This QI curriculum aided residents in effectively acquiring QI competencies and allowed them to experience real-world challenges, such as securing project buy-in, negotiating with peers, and developing solutions to problems. Unlike in many QI programs, residents learned how to improve quality rather than about QI; thus, they formed the necessary foundation to carry out QI work in the future. The curriculum will be evaluated using a knowledge assessment and satisfaction tool and postproject resident interviews. Facilitators will focus more on improving faculty develop ment in QI.

Evaluation of the quality of antenatal care using electronic health record information in family medicine clinics of Mexico City.

PubMed

Doubova, Svetlana V; Pérez-Cuevas, Ricardo; Ortiz-Panozo, Eduardo; Hernández-Prado, Bernardo

2014-05-16

Evaluation of the quality of antenatal care (ANC) using indicators should be part of the efforts to improve primary care services in developing countries. The growing use of the electronic health record (EHR) has the potential of making the evaluation more efficient. The objectives of this study were: (a) to develop quality indicators for ANC and (b) to evaluate the quality of ANC using EHR information in family medicine clinics (FMCs) of Mexico City. We used a mixed methods approach including: (a) in-depth interviews with health professionals; (b) development of indicators following the RAND-UCLA method; (c) a retrospective cohort study of quality of care provided to 5342 women aged 12-49 years who had completed their pregnancy in 2009 and attended to at least one ANC visit with their family doctor. The study took place in four FMCs located in Mexico City. The source of information was the EHR. SAS statistical package served for programing and performing the descriptive statistical analysis. 14 ANC quality indicators were developed. The evaluation showed that 40.6% of women began ANC in the first trimester; 63.5% with low-risk pregnancy attended four or more ANC visits; 4.4% were referred for routine obstetric ultrasound, and 41.1% with vaginal infection were prescribed metronidazole. On average, the percentage of recommended care that women received was 32.7%. It is feasible to develop quality indicators suitable for evaluating the quality of ANC using routine EHR data. The study identified the ANC areas that require improvement; which can guide future strategies aimed at improving ANC quality.

Quality of reporting of modern randomized controlled trials in medical oncology: a systematic review.

PubMed

Péron, Julien; Pond, Gregory R; Gan, Hui K; Chen, Eric X; Almufti, Roula; Maillet, Denis; You, Benoit

2012-07-03

The Consolidated Standards of Reporting Trials (CONSORT) guidelines were developed in the mid-1990s for the explicit purpose of improving clinical trial reporting. However, there is little information regarding the adherence to CONSORT guidelines of recent publications of randomized controlled trials (RCTs) in oncology. All phase III RCTs published between 2005 and 2009 were reviewed using an 18-point overall quality score for reporting based on the 2001 CONSORT statement. Multivariable linear regression was used to identify features associated with improved reporting quality. To provide baseline data for future evaluations of reporting quality, RCTs were also assessed according to the 2010 revised CONSORT statement. All statistical tests were two-sided. A total of 357 RCTs were reviewed. The mean 2001 overall quality score was 13.4 on a scale of 0-18, whereas the mean 2010 overall quality score was 19.3 on a scale of 0-27. The overall RCT reporting quality score improved by 0.21 points per year from 2005 to 2009. Poorly reported items included method used to generate the random allocation (adequately reported in 29% of trials), whether and how blinding was applied (41%), method of allocation concealment (51%), and participant flow (59%). High impact factor (IF, P = .003), recent publication date (P = .008), and geographic origin of RCTs (P = .003) were independent factors statistically significantly associated with higher reporting quality in a multivariable regression model. Sample size, tumor type, and positivity of trial results were not associated with higher reporting quality, whereas funding source and treatment type had a borderline statistically significant impact. The results show that numerous items remained unreported for many trials. Thus, given the potential impact of poorly reported trials, oncology journals should require even stricter adherence to the CONSORT guidelines.

Magnetic resonance imaging in Alzheimer's Disease Neuroimaging Initiative 2.

PubMed

Jack, Clifford R; Barnes, Josephine; Bernstein, Matt A; Borowski, Bret J; Brewer, James; Clegg, Shona; Dale, Anders M; Carmichael, Owen; Ching, Christopher; DeCarli, Charles; Desikan, Rahul S; Fennema-Notestine, Christine; Fjell, Anders M; Fletcher, Evan; Fox, Nick C; Gunter, Jeff; Gutman, Boris A; Holland, Dominic; Hua, Xue; Insel, Philip; Kantarci, Kejal; Killiany, Ron J; Krueger, Gunnar; Leung, Kelvin K; Mackin, Scott; Maillard, Pauline; Malone, Ian B; Mattsson, Niklas; McEvoy, Linda; Modat, Marc; Mueller, Susanne; Nosheny, Rachel; Ourselin, Sebastien; Schuff, Norbert; Senjem, Matthew L; Simonson, Alix; Thompson, Paul M; Rettmann, Dan; Vemuri, Prashanthi; Walhovd, Kristine; Zhao, Yansong; Zuk, Samantha; Weiner, Michael

2015-07-01

Alzheimer's Disease Neuroimaging Initiative (ADNI) is now in its 10th year. The primary objective of the magnetic resonance imaging (MRI) core of ADNI has been to improve methods for clinical trials in Alzheimer's disease (AD) and related disorders. We review the contributions of the MRI core from present and past cycles of ADNI (ADNI-1, -Grand Opportunity and -2). We also review plans for the future-ADNI-3. Contributions of the MRI core include creating standardized acquisition protocols and quality control methods; examining the effect of technical features of image acquisition and analysis on outcome metrics; deriving sample size estimates for future trials based on those outcomes; and piloting the potential utility of MR perfusion, diffusion, and functional connectivity measures in multicenter clinical trials. Over the past decade the MRI core of ADNI has fulfilled its mandate of improving methods for clinical trials in AD and will continue to do so in the future. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Response of acid mobilization of iron-containing mineral dust to improvement of air quality projected in the future

NASA Astrophysics Data System (ADS)

Ito, A.; Xu, L.

2014-04-01

Acidification of dust aerosols may increase aerosol iron (Fe) solubility, which is linked to mineral properties. Combustion aerosols can also elevate aerosol iron solubility when aerosol loading is low. Here, we use an atmospheric chemical transport model to investigate the deposition of filterable iron and its response to changes in anthropogenic emissions of both combustion aerosols and precursor gases. By introducing three classes of iron-containing minerals into the detailed aerosol chemistry model, we provide a theoretical examination of the effects of different dissolution behaviors on the acid mobilization of iron. Comparisons of modeled Fe dissolution curves with the measured dissolution rates for African, east Asian, and Australian dust samples show overall good agreement under acidic conditions. The improved treatment of Fe in mineral dust and its dissolution scheme results in reasonable predictive capability for iron solubility over the oceans in the Northern Hemisphere. Our model results suggest that the improvement of air quality projected in the future will lead to a decrease of the filterable iron deposition from iron-containing mineral dust to the eastern North Pacific due to less acidification in Asian dust, which is mainly associated with the reduction of nitrogen oxides (NOx) emissions. These results could have important implications for iron fertilization of phytoplankton growth, and highlight the necessity of improving the process-based quantitative understanding of the response of the chemical modification in iron-containing minerals to environmental changes.

The Cascading Effects of Multiple Dimensions of Implementation on Program Outcomes: a Test of a Theoretical Model.

PubMed

Berkel, Cady; Mauricio, Anne M; Sandler, Irwin N; Wolchik, Sharlene A; Gallo, Carlos G; Brown, C Hendricks

2017-12-14

This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents' competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.

Macromolecular crystallization in microgravity generated by a superconducting magnet.

PubMed

Wakayama, N I; Yin, D C; Harata, K; Kiyoshi, T; Fujiwara, M; Tanimoto, Y

2006-09-01

About 30% of the protein crystals grown in space yield better X-ray diffraction data than the best crystals grown on the earth. The microgravity environments provided by the application of an upward magnetic force constitute excellent candidates for simulating the microgravity conditions in space. Here, we describe a method to control effective gravity and formation of protein crystals in various levels of effective gravity. Since 2002, the stable and long-time durable microgravity generated by a convenient type of superconducting magnet has been available for protein crystal growth. For the first time, protein crystals, orthorhombic lysozyme, were grown at microgravity on the earth, and it was proved that this microgravity improved the crystal quality effectively and reproducibly. The present method always accompanies a strong magnetic field, and the magnetic field itself seems to improve crystal quality. Microgravity is not always effective for improving crystal quality. When we applied this microgravity to the formation of cubic porcine insulin and tetragonal lysozyme crystals, we observed no dependence of effective gravity on crystal quality. Thus, this kind of test will be useful for selecting promising proteins prior to the space experiments. Finally, the microgravity generated by the magnet is compared with that in space, considering the cost, the quality of microgravity, experimental convenience, etc., and the future use of this microgravity for macromolecular crystal growth is discussed.

Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

PubMed

Scott, Colleen; Clarke, Kristie E N; Grevendonk, Jan; Dolan, Samantha B; Ahmed, Hussein Osman; Kamau, Peter; Ademba, Peter Aswani; Osadebe, Lynda; Bonsu, George; Opare, Joseph; Diamenu, Stanley; Amenuvegbe, Gregory; Quaye, Pamela; Osei-Sarpong, Fred; Abotsi, Francis; Ankrah, Joseph Dwomor; MacNeil, Adam

2017-11-10

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya = 50%, Ghana = 53%) and poor data concordance between child registers and facility tally sheets (Kenya = 0%, Ghana = 3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.

Employing continuous quality improvement in community-based substance abuse programs.

PubMed

Chinman, Matthew; Hunter, Sarah B; Ebener, Patricia

2012-01-01

This article aims to describe continuous quality improvement (CQI) for substance abuse prevention and treatment programs in a community-based organization setting. CQI (e.g., plan-do-study-act cycles (PDSA)) applied in healthcare and industry was adapted for substance abuse prevention and treatment programs in a community setting. The authors assessed the resources needed, acceptability and CQI feasibility for ten programs by evaluating CQI training workshops with program staff and a series of three qualitative interviews over a nine-month implementation period with program participants. The CQI activities, PDSA cycle progress, effort, enthusiasm, benefits and challenges were examined. Results indicated that CQI was feasible and acceptable for community-based substance abuse prevention and treatment programs; however, some notable resource challenges remain. Future studies should examine CQI impact on service quality and intended program outcomes. The study was conducted on a small number of programs. It did not assess CQI impact on service quality and intended program outcomes. Practical implications- This project shows that it is feasible to adapt CQI techniques and processes for community-based programs substance abuse prevention and treatment programs. These techniques may help community-based program managers to improve service quality and achieve program outcomes. This is one of the first studies to adapt traditional CQI techniques for community-based settings delivering substance abuse prevention and treatment programs.

An intervention to improve sibling relationship quality among youth in foster care: Results of a randomized clinical trial.

PubMed

Kothari, Brianne H; McBeath, Bowen; Sorenson, Paul; Bank, Lew; Waid, Jeff; Webb, Sara Jade; Steele, Joel

2017-01-01

Sibling programming is an important part of a prevention framework, particularly for youth in foster care. After children are removed from their families and placed into foster care in the aftermath of maltreatment, the sibling relationship is often the most viable ongoing relationship available to the child, and may be critical to a youth's sense of connection, emotional support, and continuity. The promise of dyadic sibling programming in particular rests on the ability of interventions to enhance the quality of sibling relationships; yet little research exists that suggests that sibling interventions can improve relationship quality among foster youth. The primary aim of the current study was to examine the effects of a specific dyadic sibling-focused intervention for older and younger siblings on sibling relationship quality. One hundred sixty four dyads (328 youth) participated in the study, with each dyad consisting of an older sibling between 11 and 15 years of age at baseline and a younger sibling separated in age by less than 4 years. Hierarchical linear models were applied to self-reported, observer-reported and observational data over the 18-month study period. Findings suggest that the sibling intervention holds promise for improving sibling relationship quality among youth in foster care. Implications and future directions for research are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Measuring school health center impact on access to and quality of primary care.

PubMed

Gibson, Erica J; Santelli, John S; Minguez, Mara; Lord, Alyssa; Schuyler, Ashley C

2013-12-01

School health centers (SHC) that provide comprehensive health care may improve access and quality of care for students; however, published impact data are limited. We evaluated access and quality of health services at an urban high school with a SHC compared with a school without a SHC, using a quasiexperimental research design. Data were collected at the beginning of the school year, using a paper and pencil classroom questionnaire (n = 2,076 students). We measured SHC impact in several ways including grade by school interaction terms. Students at the SHC school were more likely to report having a regular healthcare provider, awareness of confidential services, support for health services in their school, and willingness to utilize those services. Students in the SHC school reported higher quality of care as measured by: respect for their health concerns, adequate time with the healthcare provider, understandable provider communications, and greater provider discussion at their last visit on topics such as sexual activity, birth control, emotions, future plans, diet, and exercise. Users of the SHC were also more likely to report higher quality of care, compared with either nonusers or students in the comparison school. Access to comprehensive health services via a SHC led to improved access to health care and improved quality of care. Impact was measureable on a school-wide basis but was greater among SHC users. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Pharmacotherapy of bone metastases in breast cancer patients.

PubMed

Petrut, Bianca; Simmons, Christine; Broom, Reuben; Trinkaus, Mateya; Clemons, Mark

2008-04-01

A diagnosis of bone metastases is often a devastating occurrence in breast cancer patients. Bone metastases are associated with increased morbidity as reflected through pain, reduced quality of life and skeletal-related events. This paper reviews the role of different pharmacotherapeutic agents in the treatment of bone metastases from breast cancer. Randomised controlled trials of osteoclast-inhibiting agents, that is the bisphosphonates, have shown significant patient benefit. The aims of bisphosphonates are to prevent and delay skeletal-related events, reduce bone pain and improve quality of life. However, there are some limitations with bisphosphonate treatment. Biochemical markers of bone turnover seem to be a promising tool in guiding bisphosphonate treatment and future research directions. Hopefully, patient management will be further improved as new agents become available such as denosumab, osteoprotegerin analogues and anti-angiogenic agents.

Nutrition therapy issues in esophageal cancer.

PubMed

Miller, Keith R; Bozeman, Matthew C

2012-08-01

Esophageal cancer has traditionally been a disease with poor long term outcomes in terms of both survival and quality of life. In combination with surgical and pharmacologic therapy, nutrition support has been demonstrated to improve patient tolerance of treatment, quality of life, and longterm outcomes. An aggressive multi-disciplinary approach is warranted with nutrition support remaining a cornerstone in management. Historically, nutrition support has focused on adequate caloric provision to prevent weight loss and allow for tolerance of treatment regimens. Alterations in metabolism occur in these patients making their use of available calories inefficient and the future of nutritional support may lie in the ability to alter this deranged metabolism. The purpose of this article is to review the current literature surrounding the etiology, treatment, and role of nutrition support in improving outcomes in esophageal cancer.

The Wide-Field Imaging Interferometry Testbed: Enabling Techniques for High Angular Resolution Astronomy

NASA Technical Reports Server (NTRS)

Rinehart, S. A.; Armstrong, T.; Frey, Bradley J.; Jung, J.; Kirk, J.; Leisawitz, David T.; Leviton, Douglas B.; Lyon, R.; Maher, Stephen; Martino, Anthony J.;

Perspectives on the Role of Patient-Centered Medical Homes in HIV Care

PubMed Central

Yujiang, Jia; Seiler, Naomi; Malcarney, Mary-Beth; Horton, Katherine; Shaikh, Irshad; Freehill, Gunther; Alexander, Carla; Akhter, Mohammad N.; Hidalgo, Julia

2014-01-01

To strengthen the quality of HIV care and achieve improved clinical outcomes, payers, providers, and policymakers should encourage the use of patient-centered medical homes (PCMHs), building on the Ryan White CARE Act Program established in the 1990s. The rationale for a PCMH with HIV-specific expertise is rooted in clinical complexity, HIV’s social context, and ongoing gaps in HIV care. Existing Ryan White HIV/AIDS Program clinicians are prime candidates to serve HIV PCMHs, and HIV-experienced community-based organizations can play an important role. Increasingly, state Medicaid programs are adopting a PCMH care model to improve access and quality to care. Stakeholders should consider several important areas for future action and research with regard to development of the HIV PCMH. PMID:24832431

Building the capacity for evidence-based clinical nursing leadership: the role of executive co-coaching and group clinical supervision for quality patient services.

PubMed

Alleyne, Jo; Jumaa, Mansour Olawale

2007-03-01

The general aims of this article were to facilitate primary care nurses (District Nurse Team Leaders) to link management and leadership theories with clinical practice and to improve the quality of the service provided to their patients. The specific aim was to identify, create and evaluate effective processes for collaborative working so that the nurses' capacity for clinical decision-making could be improved. This article, part of a doctoral study on Clinical Leadership in Nursing, has wider application in the workplace of the future where professional standards based on collaboration will be more critical in a world of work that will be increasingly complex and uncertain. This article heralds the type of research and development activities that the nursing and midwifery professions should give premier attention to, particularly given the recent developments within the National Health Service in the United Kingdom. The implications of: Agenda for Change, the Knowledge and Skills Framework, 'Our Health, Our Care, Our Say' and the recent proposals from the article 'Modernising Nursing Career', to name but a few, are the key influences impacting on and demanding new ways of clinical supervision for nurses and midwives to improve the quality of patient management and services. The overall approach was based on an action research using a collaborative enquiry within a case study. This was facilitated by a process of executive co-coaching for focused group clinical supervision sessions involving six district nurses as co-researchers and two professional doctoral candidates as the main researchers. The enquiry conducted over a period of two and a half years used evidence-based management and leadership interventions to assist the participants to develop 'actionable knowledge'. Group clinical supervision was not practised in this study as a form of 'therapy' but as a focus for the development of actionable knowledge, knowledge needed for effective clinical management and leadership in the workplace. 1. Management and leadership interventions and approaches have significantly influenced the participants' capacity to improve the quality of services provided to their patients. 2. Using various techniques, tools, methods and frameworks presented at the sessions increased participants' confidence to perform. 3. A structured approach like the Clinical Nursing Leadership Learning and Action Process (CLINLAP) model makes implementing change more practical and manageable within a turbulent care environment. The process of Stakeholder Mapping and Management made getting agreement to do things differently much easier. Generally it is clear that many nurses and midwives, according to the participants, have to carry out management and leadership activities in their day-to-day practice. The traditional boundary between the private, the public and the voluntary sector management is increasingly becoming blurred. It is conclusive that the district nurses on this innovative programme demonstrated how they were making sense of patterns from the past, planning for the future and facilitating the clinical nursing leadership processes today to improve quality patient services tomorrow. Their improved capacity to manage change and lead people was demonstrated, for example, through their questioning attitudes about the dominance of general practitioners. They did this, for example, by initiating and leading case conferences with the multi-disciplinary teams. It became evident from this study that to use group clinical supervision with an executive co-coaching approach for the implementation and to sustain quality service demand that 'good nursing' is accepted as being synonymous with 'good management'. This is the future of 'new nursing'.

Looking forward: the effects of photographs on the qualities of future thinking.

PubMed

Bays, Rebecca B; Wellen, Brianna C M; Greenberg, Katherine S

2018-04-01

Future episodic thinking relies on the reconstruction of remembered experiences. Photographs provide one means of remembering, acting as a "cognitive springboard" for generating related memory qualities. We wondered whether photographs would also invite embellishment of future thought qualities, particularly in the presence (or absence) of associated memories. In two studies participants generated future events in familiar (associated memories) and novel (no associated memories) locations. Half of the participants viewed scene location photographs during event generation. All participants then imagined the events for one minute and completed a self-report measure of content qualities. Results of the current set of studies suggested that for novel locations, no differences in qualities emerged; however, for familiar locations, photographs did not enhance qualities and, in some cases, actually constrained perceptual (Experiments 1 and 2) and sensory (Experiment 1) detail ratings of future thoughts. Thus, photographs did not invite embellishment of future thought details.

Honing the accuracy of extreme-ultraviolet optical system testing: at-wavelength and visible-light measurements of the ETS Set-2 projection optic

NASA Astrophysics Data System (ADS)

Goldberg, Kenneth A.; Naulleau, Patrick P.; Bokor, Jeffrey; Chapman, Henry N.

2002-07-01

As the quality of optical systems for extreme ultraviolet lithography improves, high-accuracy wavefront metrology for alignment and qualification becomes ever more important. To enable the development of diffraction-limited EUV projection optics, visible-light and EUV interferometries must work in close collaboration. We present a detailed comparison of EUV and visible-light wavefront measurements performed across the field of view of a lithographic-quality EUV projection optical system designed for use in the Engineering Test Stand developed by the Virtual National Laboratory and the EUV Limited Liability Company. The comparisons reveal that the present level of RMS agreement lies in the 0.3-0.4-nm range. Astigmatism is the most significant aberration component for the alignment of this optical system; it is also the dominant term in the discrepancy, and the aberration with the highest measurement uncertainty. With EUV optical systems requiring total wavefront quality in the (lambda) EUV/50 range, and even higher surface-figure quality for the individual mirror elements, improved accuracy through future comparisons, and additional studies, are required.

Prospective Cohort Study Investigating Changes in Body Image, Quality of Life, and Self-Esteem Following Minimally Invasive Cosmetic Procedures.

PubMed

Sobanko, Joseph F; Dai, Julia; Gelfand, Joel M; Sarwer, David B; Percec, Ivona

2018-04-13

Minimally invasive cosmetic injectable procedures are increasingly common. However, a few studies have investigated changes in psychosocial functioning following these treatments. To assess changes in body image, quality of life, and self-esteem following cosmetic injectable treatment with soft tissue fillers and neuromodulators. Open, prospective study of 75 patients undergoing cosmetic injectable procedures for facial aging to evaluate changes in psychosocial functioning within 6 weeks of treatment. Outcome measures included the Derriford appearance scale (DAS-24), body image quality of life inventory (BIQLI), and the Rosenberg self-esteem scale. Body image dissatisfaction, as assessed by the DAS-24, improved significantly 6 weeks after the treatment. Body image quality of life, as assessed by the BIQLI, improved, but the change did not reach statistical significance. Self-esteem was unchanged after the treatment. Minimally invasive cosmetic injectable procedures were associated with reductions in body image dissatisfaction. Future research, using recently developed cosmetic surgery-specific instruments, may provide further insight into the psychosocial benefits of minimally invasive procedures.

Humanisation and soft qualities in emergency rooms.

PubMed

Buffoli, Maddalena; Bellini, Eva; Dell'Ovo, Marta; Gola, Marco; Nachiero, Dario; Rebecchi, Andrea; Capolongo, Stefano

2016-01-01

Scenario. Currently, there are few evaluation methods that analyse social aspects in healthcare issues, especially humanisation and well-being, as perceived by users in emergency departments which are places in which patients' psycho-physical well-being is decisive. For this reason, research was conducted to create a tool to improve the quality of these areas. In order to conduct the research, the work was structured in three phases: the first, based on the analysis of State-of-the-Art and the current studies on the interactions established between the physical and emotional conditions of the structure and the users; the second, through the definition of a questionnaire which explores humanisation and comfort aspects; the third, through the application of the instrument. The paper presents and analyses data collected from the application on a case study in Milan, analysing the responses and proposing design suggestions for increasing the quality of emergency environments. In anticipation of future works, the application of such a tool can provide the opportunity to improve and enhance quality and staff efficiency in emergency department spaces.

A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care.

PubMed

Ali, Syed Mustafa; Giordano, Richard; Lakhani, Saima; Walker, Dawn Marie

2016-03-01

A gap between current diabetes care practice and recommended diabetes care standards has consistently been reported in the literature. Many IT-based interventions have been developed to improve adherence to the quality of care standards for chronic illness like diabetes. The widespread implementation of electronic medical/health records has catalyzed clinical decision support systems (CDSS) which may improve the quality of diabetes care. Therefore, the objective of the review is to evaluate the effectiveness of CDSS in improving quality of type II diabetes care. Moreover, the review aims to highlight the key indicators of quality improvement to assist policy makers in development of future diabetes care policies through the integration of information technology and system. Setting inclusion criteria, a systematic literature search was conducted using Medline, Web of Science and Science Direct. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of studies. Eight randomized controlled trials (RCTs) were selected for the review. In the selected studies, seventeen clinical markers of diabetes care were discussed. Three quality of care indicators were given more importance in monitoring the progress of diabetes care, which is consistent with National Institute for Health and Care Excellence (NICE) guidelines. The presence of these indicators in the studies helped to determine which studies were selected for review. Clinical- and process-related improvements are compared between intervention group using CDSS and control group with usual care. Glycated hemoglobin (HbA1c), low density lipid cholesterol (LDL-C) and blood pressure (BP) were the quality of care indicators studied at the levels of process of care and clinical outcome. The review has found both inconsistent and variable results for quality of diabetes care measures. A significant improvement has been found in the process of care for all three measures of quality of diabetes care. However, weak to modest positive results are observed for the clinical measures of the diabetes care indicators. In addition to this, technology adoption of CDSS is found to be consistently low. The review suggests the need to conduct further empirical research using the critical diabetes care indicators (HbA1c, LDL-C and BP) to ascertain if CDSS improves the quality of diabetes care. Research designs should be improved, especially with regard to baseline characteristics, sample size and study period. With respect to implementation of CDSS, rather than a sudden change of clinical work practice, there should instead be an incremental, gradual adoption of technology that minimizes the disruption in clinical workflow. Copyright © 2016. Published by Elsevier Ireland Ltd.

Windblown Dust and Air Quality Under a Changing Climate in the Pacific Northwest

NASA Astrophysics Data System (ADS)

Sharratt, B. S.; Tatarko, J.; Abatzoglou, J. T.; Fox, F.; Huggins, D. R.

2016-12-01

Wind erosion is a concern for sustainable agriculture and societal health in the US Pacific Northwest. Indeed, wind erosion continues to cause exceedances of the National Ambient Air Quality Standard for PM10 in the region. Can we expect air quality to deteriorate or improve as climate changes? Will wind erosion escalate in the future under a warmer and drier climate as forecast for Australia, southern prairies of Canada, northern China, and United States Corn Belt and Colorado Plateau? To answer these questions, we used 18 global climate models, cropping systems simulation model (CropSyst), and the Wind Erosion Prediction System (WEPS) to simulate the complex interactions among climate, crop production, and wind erosion. These simulations were carried out in eastern Washington where wind erosion of agricultural lands contribute to poor air quality in the region. Our results suggest that an increase in temperature and CO2 concentration, coupled with nominal increases in precipitation, will enhance biomass production and reduce soil and PM10 losses by the mid-21st century. This study reveals that climate change may reduce the risk of wind erosion and improve air quality in the Inland Pacific Northwest.

CASA-Mot in mammals: an update.

PubMed

Yániz, J L; Silvestre, M A; Santolaria, P; Soler, C

2018-03-08

Sperm motility is one of the most widely used parameters of sperm quality. Computer-aided sperm motility analysis (CASA-Mot) systems were developed to reduce the subjectivity of sperm motility assessment, and have had broad scientific and practical acceptance. In this review, the sources of variation and current applications of this technology and its relationships with other sperm quality tests are described in detail. Despite remarkable advances in the technique, there is still great need for standardisation in many species, and the numerous factors that affect the results make it difficult to provide universally accepted criteria for classifying semen samples based on sperm motility characteristics. The main fields for CASA-Mot include the study of male fertility and pathologies, evaluation of the effects of physical and chemical agents, improvement of epidemiological survey studies, more precise calculation of seminal doses for farm animals, realisation of basic studies about sperm function, improvement of sperm technologies such as cryopreservation and quality control analysis. Numerous relationships have been established between CASA-Mot and other sperm quality tests, although most of these parameters are complementary. Future CASA-Mot systems will probably be able to integrate several sperm quality parameters with motility.

The increasing importance of a continence nurse specialist to improve outcomes and save costs of urinary incontinence care: an analysis of future policy scenarios.

PubMed

Franken, Margreet G; Corro Ramos, Isaac; Los, Jeanine; Al, Maiwenn J

2018-02-17

In an ageing population, it is inevitable to improve the management of care for community-dwelling elderly with incontinence. A previous study showed that implementation of the Optimum Continence Service Specification (OCSS) for urinary incontinence in community-dwelling elderly with four or more chronic diseases results in a reduction of urinary incontinence, an improved quality of life, and lower healthcare and lower societal costs. The aim of this study was to explore future consequences of the OCSS strategy of various healthcare policy scenarios in an ageing population. We adapted a previously developed decision analytical model in which the OCSS new care strategy was operationalised as the appointment of a continence nurse specialist located within the general practice in The Netherlands. We used a societal perspective including healthcare costs (healthcare providers, treatment costs, insured containment products, insured home care), and societal costs (informal caregiving, containment products paid out-of-pocket, travelling expenses, home care paid out-of-pocket). All outcomes were computed over a three-year time period using two different base years (2014 and 2030). Settings for future policy scenarios were based on desk-research and expert opinion. Our results show that implementation of the OSCC new care strategy for urinary incontinence would yield large health gains in community dwelling elderly (2030: 2592-2618 QALYs gained) and large cost-savings in The Netherlands (2030: health care perspective: €32.4 Million - €72.5 Million; societal perspective: €182.0 Million - €250.6 Million). Savings can be generated in different categories which depends on healthcare policy. The uncertainty analyses and extreme case scenarios showed the robustness of the results. Implementation of the OCSS new care strategy for urinary incontinence results in an improvement in the quality of life of community-dwelling elderly, a reduction of the costs for payers and affected elderly, and a reduction in time invested by carers. Various realistic policy scenarios even forecast larger health gains and cost-savings in the future. More importantly, the longer the implementation is postponed the larger the savings foregone. The future organisation of healthcare affects the category in which the greatest savings will be generated.

JPL's Role in Advancing Earth System Science to Meet the Challenges of Climate and Environmental Change

NASA Technical Reports Server (NTRS)

Evans, Diane

2012-01-01

Objective 2.1.1: Improve understanding of and improve the predictive capability for changes in the ozone layer, climate forcing, and air quality associated with changes in atmospheric composition. Objective 2.1.2: Enable improved predictive capability for weather and extreme weather events. Objective 2.1.3: Quantify, understand, and predict changes in Earth s ecosystems and biogeochemical cycles, including the global carbon cycle, land cover, and biodiversity. Objective 2.1.4: Quantify the key reservoirs and fluxes in the global water cycle and assess water cycle change and water quality. Objective 2.1.5: Improve understanding of the roles of the ocean, atmosphere, land and ice in the climate system and improve predictive capability for its future evolution. Objective 2.1.6: Characterize the dynamics of Earth s surface and interior and form the scientific basis for the assessment and mitigation of natural hazards and response to rare and extreme events. Objective 2.1.7: Enable the broad use of Earth system science observations and results in decision-making activities for societal benefits.

Performance improvement CME for quality: challenges inherent to the process.

PubMed

Vakani, Farhan Saeed; O'Beirne, Ronan

2015-01-01

The purpose of this paper is to discuss the perspective debates upon the real-time challenges for a three-staged Performance Improvement Continuing Medical Education (PI-CME) model, an innovative and potential approach for future CME, to inform providers to think, prepare and to act proactively. In this discussion, the challenges associated for adopting the American Medical Association's three-staged PI-CME model are reported. Not many institutions in USA are using a three-staged performance improvement model and then customizing it to their own healthcare context for the specific targeted audience. They integrate traditional CME methods with performance and quality initiatives, and linking with CME credits. Overall the US health system is interested in a structured PI-CME model with the potential to improve physicians practicing behaviors. Knowing the dearth of evidence for applying this structured performance improvement methodology into the design of CME activities, and the lack of clarity on challenges inherent to the process that learners and providers encounter. This paper establishes all-important first step to render the set of challenges for a three-staged PI-CME model.

Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement.

PubMed

Groller, Karen D; Teel, Cynthia; Stegenga, Kristin H; El Chaar, Maher

2018-02-17

Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. Participants were recruited from a university hospital-based WMC in Pennsylvania. This qualitative descriptive study used purposive sampling and inductive content analysis. A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

The future of monitoring in clinical research - a holistic approach: linking risk-based monitoring with quality management principles.

PubMed

Ansmann, Eva B; Hecht, Arthur; Henn, Doris K; Leptien, Sabine; Stelzer, Hans Günther

2013-01-01

Since several years risk-based monitoring is the new "magic bullet" for improvement in clinical research. Lots of authors in clinical research ranging from industry and academia to authorities are keen on demonstrating better monitoring-efficiency by reducing monitoring visits, monitoring time on site, monitoring costs and so on, always arguing with the use of risk-based monitoring principles. Mostly forgotten is the fact, that the use of risk-based monitoring is only adequate if all mandatory prerequisites at site and for the monitor and the sponsor are fulfilled.Based on the relevant chapter in ICH GCP (International Conference on Harmonisation of technical requirements for registration of pharmaceuticals for human use - Good Clinical Practice) this publication takes a holistic approach by identifying and describing the requirements for future monitoring and the use of risk-based monitoring. As the authors are operational managers as well as QA (Quality Assurance) experts, both aspects are represented to come up with efficient and qualitative ways of future monitoring according to ICH GCP.

The future of 2D metrology for display manufacturing

NASA Astrophysics Data System (ADS)

Sandstrom, Tor; Wahlsten, Mikael; Park, Youngjin

2016-10-01

The race to 800 PPI and higher in mobile devices and the transition to OLED displays are driving a dramatic development of mask quality: resolution, CDU, registration, and complexity. 2D metrology for large area masks is necessary and must follow the roadmap. Driving forces in the market place point to continued development of even more dense displays. State-of-the-art metrology has proven itself capable of overlay below 40 nm and registration below 65 nm for G6 masks. Future developments include incoming and recurrent measurements of pellicalized masks at the panel maker's factory site. Standardization of coordinate systems across supplier networks is feasible. This will enable better yield and production economy for both mask and panel maker. Better distortion correction methods will give better registration on the panels and relax the flatness requirements of the mask blanks. If panels are measured together with masks and the results are used to characterize the aligners, further quality and yield improvements are possible. Possible future developments include in-cell metrology and integration with other instruments in the same platform.

The Internet and medicine: past, present, and future.

PubMed

Doyle, D J; Ruskin, K J; Engel, T P

1996-01-01

The enormous growth of the Internet and the World Wide Web has made these two technologies an important potential adjunct to cost-effective health care research and delivery. This article surveys some recent developments in telecommunications, networking and artificial intelligence that are likely to have a significant impact on improving the efficiency and quality of future health care. Issues discussed include: clinical record keeping on the Internet, Internet-assisted medical diagnosis, privacy and security matters, financial transactions, digital money, bandwidth concerns, multimedia (music, audio and video) information delivery via the Internet, intellectual property, and the concept of Information Philanthropy.

The Internet and medicine: past, present, and future.

PubMed Central

Doyle, D. J.; Ruskin, K. J.; Engel, T. P.

1996-01-01

The enormous growth of the Internet and the World Wide Web has made these two technologies an important potential adjunct to cost-effective health care research and delivery. This article surveys some recent developments in telecommunications, networking and artificial intelligence that are likely to have a significant impact on improving the efficiency and quality of future health care. Issues discussed include: clinical record keeping on the Internet, Internet-assisted medical diagnosis, privacy and security matters, financial transactions, digital money, bandwidth concerns, multimedia (music, audio and video) information delivery via the Internet, intellectual property, and the concept of Information Philanthropy. PMID:9381738

Quantifying the Global Fresh Water Budget: Capabilities from Current and Future Satellite Sensors

NASA Technical Reports Server (NTRS)

Hildebrand, Peter; Zaitchik, Benjamin

2007-01-01

The global water cycle is complex and its components are difficult to measure, particularly at the global scales and with the precision needed for assessing climate impacts. Recent advances in satellite observational capabilities, however, are greatly improving our knowledge of the key terms in the fresh water flux budget. Many components of the of the global water budget, e.g. precipitation, atmospheric moisture profiles, soil moisture, snow cover, sea ice are now routinely measured globally using instruments on satellites such as TRMM, AQUA, TERRA, GRACE, and ICESat, as well as on operational satellites. New techniques, many using data assimilation approaches, are providing pathways toward measuring snow water equivalent, evapotranspiration, ground water, ice mass, as well as improving the measurement quality for other components of the global water budget. This paper evaluates these current and developing satellite capabilities to observe the global fresh water budget, then looks forward to evaluate the potential for improvements that may result from future space missions as detailed by the US Decadal Survey, and operational plans. Based on these analyses, and on the goal of improved knowledge of the global fresh water budget under the effects of climate change, we suggest some priorities for the future, based on new approaches that may provide the improved measurements and the analyses needed to understand and observe the potential speed-up of the global water cycle under the effects of climate change.

Getting Closer to School Effectiveness and School Improvement in the Czech Republic: Major Developments and Topics for the Future.

ERIC Educational Resources Information Center

Pol, Milan

This paper focuses on changes in school management, evaluation, and monitoring in Czech education. The major aim of the first reform wave involved removing the most evident dysfunctions of the earlier, closed and uniform educational system and transforming it into an open, pluralistic one. Subsequent reforms focused on enhancing the quality of…

Mind, brain, and teaching: Some directions for future research.

PubMed

Pasquinelli, Elena; Zalla, Tiziana; Gvodzic, Katarina; Potier-Watkins, Cassandra; Piazza, Manuela

2015-01-01

In line with Kline's taxonomy, highlighting teaching as an array of behaviors with different cognitive underpinnings, we advocate the expansion of a specific line of research on mind, brain, and teaching. This research program is devoted to the understanding of the neurocognitive mechanisms and the evolutionary determinants of teaching skills, with the ultimate goal of helping teachers improve teaching quality.

Education That Works: An Action Plan for the Education of Minorities. Report Summary.

ERIC Educational Resources Information Center

Massachusetts Inst. of Technology, Cambridge. Quality Education for Minorities Project.

This report summarizes the major points of a plan for improving the education of minority students in the United States. The following sections are included in this report: (1) "A Common Future"; (2) "A New Foundation"; (3) "Where We Start"; (4) "Our Goals for the Year 2000"; (5) "Recommended Strategies for Achieving Quality Education for…

Innovation Problems of the Fortification of Health Youth Facility of the Physical Culture

ERIC Educational Resources Information Center

Panachev, Valeriy; Zelenin, Leonid; Opletin, Anatoliy; Kudryshov, Evgeniy; Oborin, Aleksandr; Nohrin, Mihail; Annenkova, Svetlana; Solonitsin, Roman; Korepanova, Yulia; Fazleev, Marat

2016-01-01

In referencing the Russia President to Federal Meeting said, that one of the main problems of the future development of the social state is an increasing life's quality of the Russians, the improvement of health to nations and demographic situation in Russian Federation. Per annum 72-years Victories in Great Domestic war sharply cost the questions…

Fifteen Years after the Surgeon General's Report: Challenges, Changes, and Future Directions in Physical Education

ERIC Educational Resources Information Center

Bryan, Charity L.; Sims, Sandra K.; Hester, Donna J.; Dunaway, Donna L.

2013-01-01

Great anticipation surrounded the release of the first ever Surgeon General's report on physical activity and health in 1996. The report stated that physical activity can contribute significantly to overall levels of health and the quality of life for all Americans. However, since the report's release, little has improved in the health status of…

Gap analysis: a method to assess core competency development in the curriculum.

PubMed

Fater, Kerry H

2013-01-01

To determine the extent to which safety and quality improvement core competency development occurs in an undergraduate nursing program. Rapid change and increased complexity of health care environments demands that health care professionals are adequately prepared to provide high quality, safe care. A gap analysis compared the present state of competency development to a desirable (ideal) state. The core competencies, Nurse of the Future Nursing Core Competencies, reflect the ideal state and represent minimal expectations for entry into practice from pre-licensure programs. Findings from the gap analysis suggest significant strengths in numerous competency domains, deficiencies in two competency domains, and areas of redundancy in the curriculum. Gap analysis provides valuable data to direct curriculum revision. Opportunities for competency development were identified, and strategies were created jointly with the practice partner, thereby enhancing relevant knowledge, attitudes, and skills nurses need for clinical practice currently and in the future.

Lessons Learned from an LGBTQ Senior Center: A Bronx Tale.

PubMed

McGovern, Justine; Brown, Dwayne; Gasparro, Vita

This article describes an interdisciplinary pilot study exploring the impact of LGBTQ senior centers on the lives of center members. Many LGBTQ adults face the future having experienced stigma and bias, restricted rights, and rejection from family of origin, and are now growing older without the support of a partner and adult children. As a result, older LGBTQ adults experience higher rates of depression, loneliness and isolation, and shortened life expectancy as compared to non-LGBTQ peers. Findings from focus group and key informant interviews highlight features of LGBTQ senior center experiences that can significantly improve members' quality of life. These include providing family, acceptance and a home, which can have an impact on outlook and outcomes. Moreover, findings suggest the need for re-thinking hetero-normative definitions of "community" in the context of LGBTQ aging. Beyond sharing findings from the study, suggesting a conceptual framework for deepening understanding about LGBTQ aging, and identifying lines of future inquiry, the article articulates implications for social work research, practice and education. Ultimately, the article argues that social work is well positioned to improve quality of life for this under-served population when it adopts a cultural humility stance in research, practice and education.

JACIE accreditation for blood and marrow transplantation: past, present and future directions of an international model for healthcare quality improvement

PubMed Central

Snowden, J A; McGrath, E; Duarte, R F; Saccardi, R; Orchard, K; Worel, N; Kuball, J; Chabannon, C; Mohty, M

2017-01-01

Blood and marrow transplantation (BMT) is a complex and evolving medical speciality that makes substantial demands on healthcare resources. To meet a professional responsibility to both patients and public health services, the European Society for Blood and Marrow Transplantation (EBMT) initiated and developed the Joint Accreditation Committee of the International Society for Cellular Therapy and EBMT—better known by the acronym, JACIE. Since its inception, JACIE has performed over 530 voluntary accreditation inspections (62% first time; 38% reaccreditation) in 25 countries, representing 40% of transplant centres in Europe. As well as widespread professional acceptance, JACIE has become incorporated into the regulatory framework for delivery of BMT and other haematopoietic cellular therapies in several countries. In recent years, JACIE has been validated using the EBMT registry as an effective means of quality improvement with a substantial positive impact on survival outcomes. Future directions include development of Europe-wide risk-adjusted outcome benchmarking through the EBMT registry and further extension beyond Europe, including goals to faciliate access for BMT programmes in in low- and middle-income economies (LMIEs) via a ‘first-step’ process. PMID:28346416

PET motion correction in context of integrated PET/MR: Current techniques, limitations, and future projections.

PubMed

Gillman, Ashley; Smith, Jye; Thomas, Paul; Rose, Stephen; Dowson, Nicholas

2017-12-01

Patient motion is an important consideration in modern PET image reconstruction. Advances in PET technology mean motion has an increasingly important influence on resulting image quality. Motion-induced artifacts can have adverse effects on clinical outcomes, including missed diagnoses and oversized radiotherapy treatment volumes. This review aims to summarize the wide variety of motion correction techniques available in PET and combined PET/CT and PET/MR, with a focus on the latter. A general framework for the motion correction of PET images is presented, consisting of acquisition, modeling, and correction stages. Methods for measuring, modeling, and correcting motion and associated artifacts, both in literature and commercially available, are presented, and their relative merits are contrasted. Identified limitations of current methods include modeling of aperiodic and/or unpredictable motion, attaining adequate temporal resolution for motion correction in dynamic kinetic modeling acquisitions, and maintaining availability of the MR in PET/MR scans for diagnostic acquisitions. Finally, avenues for future investigation are discussed, with a focus on improvements that could improve PET image quality, and that are practical in the clinical environment. © 2017 American Association of Physicists in Medicine.

Extended Operation Testing of Stirling Convertors in Support of Stirling Radioisotope Power System Development

NASA Technical Reports Server (NTRS)

Lewandowski, Edward J.; Schreiber, Jeffre G.; Wilson, Scott D.; oriti, Salvatore M.; Cornell, Peggy; Schifer, Nicholas

2008-01-01

100 We class Stirling convertors began extended operation testing at NASA Glenn Research Center (GRC) in 2003 with a pair of Technology Demonstration Convertors (TDCs) operating in air. Currently, the number of convertors on extended operation test has grown to 12, including both TDCs and Advanced Stirling Convertors (ASCs) operating both in air and in thermal vacuum. Additional convertors and an electrically heated radioisotope generator will be put on test in the near future. This testing has provided data to support life and reliability estimates and the quality improvements and design changes that have been made to the convertor. The convertors operated 24/7 at the nominal amplitude and power levels. Performance data were recorded on an hourly basis. Techniques to monitor the convertors for change in internal operation included gas analysis, vibration measurements and acoustic emission measurements. This data provided a baseline for future comparison. This paper summarizes the results of over 145,000 hours of TDC testing and 40,000 hours of ASC testing and discusses trends in the data. Data shows the importance of improved materials, hermetic sealing, and quality processes in maintaining convertor performance over long life.

Lay Crowd-Sourced Expertise (LCE) and Its Influence on the New Role of Patients: Ethical and Societal Issues.

PubMed

Lamas, Eugenia; Salinas, Rodrigo; Ferrer, Marcela; Bousquet, Cedric; Vuillaume, Dominique

2016-01-01

The emergence of social media on the Internet allows patients to discuss about their chronic diseases within online communities sharing common interests. This allows patients to gather other patients' experience, and gain new knowledge that is usually not shared by healthcare professionals. In this context, further studies are required on the actual impact of the use of social networks on the quality of life of patients participating in these online communities, focusing on the evolving role and impact of Lay Crowdsourced expertise (LCE) in improving disease management and control. We present a study on a large number of posts from social networks of different online communities. This study allowed us to choose four pathologies, with distinctive characteristics relevant for our future analysis, and to define the themes that will be covered in future work by online questionnaires. The analysis of responses from patients, who volunteer to participate, will help us in exploring how interactions between patients, on these online communities, may help them to gain useful information for managing their conditions and improving their quality of life. Furthermore, we will identify new ethical issues that arise in the sharing of health data.

Extended Operation Testing of Stirling Convertors in Support of Stirling Radioisotope Power System Development

NASA Technical Reports Server (NTRS)

Lewandowski, Edward J.; Schreiber, Jeffrey G.; Wilson, Scott D.; Oriti, Salvatore M.; Cornell, Peggy; Schifer, Nicholas

2009-01-01

100 We class Stirling convertors began extended operation testing at NASA Glenn Research Center (GRC) in 2003 with a pair of Technology Demonstration Convertors (TDCs) operating in air. Currently, the number of convertors on extended operation test has grown to 12, including both TDCs and Advanced Stirling Convertors (ASCs) operating both in air and in thermal vacuum. Additional convertors and an electrically heated radioisotope generator will be put on test in the near future. This testing has provided data to support life and reliability estimates and the quality improvements and design changes that have been made to the convertor. The convertors operated 24/7 at the nominal amplitude and power levels. Performance data were recorded on an hourly basis. Techniques to monitor the convertors for change in internal operation included gas analysis, vibration measurements, and acoustic emission measurements. This data provided a baseline for future comparison. This paper summarizes the results of over 145,000 hr of TDC testing and 40,000 hr of ASC testing and discusses trends in the data. Data shows the importance of improved materials, hermetic sealing, and quality processes in maintaining convertor performance over long life.

Global Monitoring of Water Supply and Sanitation: History, Methods and Future Challenges

PubMed Central

Bartram, Jamie; Brocklehurst, Clarissa; Fisher, Michael B.; Luyendijk, Rolf; Hossain, Rifat; Wardlaw, Tessa; Gordon, Bruce

2014-01-01

International monitoring of drinking water and sanitation shapes awareness of countries’ needs and informs policy, implementation and research efforts to extend and improve services. The Millennium Development Goals established global targets for drinking water and sanitation access; progress towards these targets, facilitated by international monitoring, has contributed to reducing the global disease burden and increasing quality of life. The experiences of the MDG period generated important lessons about the strengths and limitations of current approaches to defining and monitoring access to drinking water and sanitation. The methods by which the Joint Monitoring Programme (JMP) of WHO and UNICEF tracks access and progress are based on analysis of data from household surveys and linear regression modelling of these results over time. These methods provide nationally-representative and internationally-comparable insights into the drinking water and sanitation facilities used by populations worldwide, but also have substantial limitations: current methods do not address water quality, equity of access, or extra-household services. Improved statistical methods are needed to better model temporal trends. This article describes and critically reviews JMP methods in detail for the first time. It also explores the impact of, and future directions for, international monitoring of drinking water and sanitation. PMID:25116635

The Genetics of Non-conventional Wine Yeasts: Current Knowledge and Future Challenges.

PubMed

Masneuf-Pomarede, Isabelle; Bely, Marina; Marullo, Philippe; Albertin, Warren

2015-01-01

Saccharomyces cerevisiae is by far the most widely used yeast in oenology. However, during the last decade, several other yeasts species has been purposed for winemaking as they could positively impact wine quality. Some of these non-conventional yeasts (Torulaspora delbrueckii, Metschnikowia pulcherrima, Pichia kluyveri, Lachancea thermotolerans, etc.) are now proposed as starters culture for winemakers in mixed fermentation with S. cerevisiae, and several others are the subject of various studies (Hanseniaspora uvarum, Starmerella bacillaris, etc.). Along with their biotechnological use, the knowledge of these non-conventional yeasts greatly increased these last 10 years. The aim of this review is to describe the last updates and the current state-of-art of the genetics of non-conventional yeasts (including S. uvarum, T. delbrueckii, S. bacillaris, etc.). We describe how genomics and genetics tools provide new data into the population structure and biodiversity of non-conventional yeasts in winemaking environments. Future challenges will lie on the development of selection programs and/or genetic improvement of these non-conventional species. We discuss how genetics, genomics and the advances in next-generation sequencing will help the wine industry to develop the biotechnological use of non-conventional yeasts to improve the quality and differentiation of wines.

ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence.

PubMed

Nyström, E; Sjöström, M; Stenlund, H; Samuelsson, E

2015-11-01

To determine whether changes in questionnaire scores on symptoms and condition-specific quality of life reflect clinically relevant improvements in women with stress urinary incontinence (SUI). We retrospectively analyzed questionnaires collected during a randomized controlled trial in women with SUI, that received pelvic floor muscle training (PFMT) in two different formats. We included 218 women that answered validated self-assessment questionnaires at baseline and at a 4-month follow-up. We registered changes on two questionnaires, the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol). We compared these score changes to responses from the Patient Global Impression of Improvement (PGI-I) questionnaire. Differences were analyzed with the Spearman rho and one-way-ANOVA. The minimum important difference (MID) was the mean change in score for women that experienced a small improvement. The PGI-I correlated significantly to both the ICIQ-UI SF (r = 0.547, P < 0.0001) and ICIQ-LUTSqol (r = 0.520, P < 0.0001). Thus, larger reductions in symptoms or quality of life scores were associated with greater impressions of improvement. The changes in ICIQ-UI SF and ICIQ-LUTSqol scores were significant across all PGI-I groups from "no change" to "very much improved" (P < 0.05). The MIDs were 2.52 (SD 2.56) for ICIQ-UI SF and 3.71 (SD 4.95) for ICIQ-LUTSqol. The change in ICIQ-UI SF and ICIQ-LUTSqol scores after PFMT reflected clinically relevant improvements in women with SUI. The MIDs established for this population may facilitate future research, treatment evaluations, and comparisons between studies. © 2014 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.

A quality analysis of clinical anaesthesia study protocols from the Chinese clinical trials registry according to the SPIRIT statement.

PubMed

Yang, Lei; Chen, Shouming; Yang, Di; Li, Jiajin; Wu, Taixiang; Zuo, Yunxia

2018-05-15

To learn about the overall quality of clinical anaesthesia study protocols from the Chinese Clinical Trials Registry and to discuss the way to improve study protocol quality. We defined completeness of each sub-item in SPIRIT as N/A (not applicable) or with a score of 0, 1, or 2. For each protocol, we calculated the proportion of adequately reported items (score = 2 and N/A) and unreported items (score = 0). Protocol quality was determined according to the proportion of reported items, with values >50% indicating high quality. Protocol quality was determined according to the proportion of reported items. For each sub-item in SPIRIT, we calculated the adequately reported rate (percentage of all protocols with score 2 and NA on one sub-item) as well as the unreported rate (percentage of all protocols with score 0 on one sub-item). Total 126 study protocols were available for assessment. Among these, 88.1% were assessed as being of low quality. By comparison, the percentage of low-quality protocols was 88.9% after the publication of the SPIRIT statement. Among the 51 SPIRIT sub-items, 18 sub-items had an unreported rate above 90% while 16 had a higher adequately reported rate than an unreported rate. The overall quality of clinical anaesthesia study protocols registered in the ChiCTR was poor. A mandatory protocol upload and self-check based on the SPIRIT statement during the trial registration process may improve protocol quality in the future.

Raising the quality of rheumatology management recommendations: lessons from the EULAR process 10 years after provision of standard operating procedures.

PubMed

Colebatch-Bourn, Alexandra N; Conaghan, Philip G; Arden, Nigel K; Cooper, Cyrus; Dougados, Maxime; Edwards, Christopher J

2015-08-01

To increase understanding of how to raise the quality of rheumatology guidelines by reviewing European League Against Rheumatism (EULAR) management recommendations, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, 10 years after publication of the EULAR standardized operating procedures (SOP) for the production of recommendations. It was hoped that this work could help inform improvements in guideline development by other societies and organizations. The SOP were published in 2004 to ensure the quality of EULAR-endorsed recommendations. We reviewed 27 published EULAR recommendations for management using the AGREE II tool. This provides a framework to assess the quality of guidelines across six broad domains using 23 specific questions. Overall the EULAR recommendations reviewed have been performed to a high standard. There are particular strengths in the methodology and presentation of the guidelines; however, the results indicate areas for development in future recommendations: in particular, stakeholder involvement and applicability of the recommendations. Improvements in quality were evident in recent years, with patient representation in 9 of 15 (60.0%) recommendations published 2010-14 compared with 4 of 12 (33.3%) published 2000-09. In the last 10 years the overall quality of recommendations was good, with standards improving over the decade following publication of the SOP. However, this review process has identified potential areas for improvement, especially in patient representation and provision of implementation tools. The lessons from this work can be applied to the development of rheumatology guidelines by other societies and organizations. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effects of group music therapy on quality of life, affect, and participation in people with varying levels of dementia.

PubMed

Solé, Carme; Mercadal-Brotons, Melissa; Galati, Adrián; De Castro, Mónica

2014-01-01

There is substantive literature reporting the importance and benefits of music and music therapy programs for older adults, and more specifically for those with dementia. However, few studies have focused on how these programs may contribute to quality of life. Objectives for this exploratory study were: (a) to evaluate the potential effect of group music therapy program participation on the quality of life of older people with mild, moderate, and severe dementia living in a nursing home; (b) to identify and analyze changes in affect and participation that take place during music therapy sessions; and (c) to suggest recommendations and strategies for the design of future music therapy studies with people in various stages of dementias. Sixteen participants (15 women; 1 man), with varying level of dementia participated in 12 weekly music therapy sessions. Based on Global Deterioration Scale (GDS) scores, phases of cognitive function were as follows: mild (n = 9; GDS 3-4), moderate (n = 5; GDS 5), and severe (n = 2; GDS 6-7). Data were collected using the GENCAT scale on Quality of Life. Sessions 1, 6, and 12 were also video recorded for post-hoc analysis of facial affect and participation behaviors. There was no significant difference in quality of life scores from pre to posttest (z = -0.824; p =0.410). However, there was a significant improvement in median subscale scores for Emotional Well-being (z = -2.176, p = 0.030), and significant worsening in median subscale scores for Interpersonal Relations (z =-2.074; p = 0.038) from pre to posttest. With regard to affect and participation, a sustained high level of participation was observed throughout the intervention program. Expressions of emotion remained low. Authors discuss implications of study findings to inform and improve future research in the areas of music therapy, quality of life, and individuals with dementia. © the American Music Therapy Association 2014. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.