Quality of care in reproductive health programmes: monitoring and evaluation of quality improvement.

PubMed

Kwast, B E

1998-12-01

As 200 million women become pregnant every year, at least 30 million will develop life-threatening complications requiring emergency treatment at any level of society where they live. But it is a basic human right that pregnancy be made safe for all women as complications are mostly unpredictable. This requires reproductive health programmes which are responsive to women's and their families' needs and expectations on the one hand and enhancement of community participation, high quality obstetric services, and both provider collaboration and satisfaction on the other. Monitoring and evaluation of these facets need to be an integral part of any safe motherhood programme, not only to assess progress, but also to use this information for subsequent planning and implementation cycles of national programmes. Lessons learned from ten years' implementation of Safe Motherhood programmes indicate that process and outcome indicators are more feasible for short-term evaluation purposes than impact indicators, such as maternal mortality reduction. The former are described in this paper with relevant country examples. This is the third, and last, article in a series on quality of care in reproductive health programmes. The first (Kwast 1998a) contains an overview of concepts, assessments, barriers and improvements of quality of care. The second (Kwast 1998b) addresses education issues for quality improvement.

Vantage point - Learn by reflecting.

PubMed

Maten-Speksnijder, Ada Ter

2014-10-30

EDUCATION IS described as a 'bridge to quality' ( Greiner and Knebel 2003 ) and, for this reason, teachers must be involved in putting safe patient care on students' radar. They can do this by teaching students how to meet their healthcare system's demands relating to high quality care, and how they can improve individual patient care.

Doped sesquioxide ceramic for eye-safe solid state laser materials

NASA Astrophysics Data System (ADS)

Kim, Woohong; Baker, Colin; Florea, Catalin; Frantz, Jesse; Villalobos, Guillermo; Shaw, Brandon; Bowman, Steve; O'Connor, Shawn; Sadowski, Bryan; Hunt, Michael; Aggalwar, Ishwar; Sanghera, Jasbinder

2013-03-01

In this paper, we present our recent results in the development of Ho3+ doped sesquioxides for eye-safe solid state lasers. We have synthesized optical quality Lu2O3 nanopowders doped with concentrations of 0.1, 1.0, 2.0, and 5% Ho3+. The powders were synthesized by a co-precipitation method beginning with nitrates of holmium and lutetium. The nanopowders were hot pressed into optical quality ceramic discs. The optical transmission of the ceramic discs is excellent, nearly approaching the theoretical limit. The optical, spectral and morphological properties as well as the lasing performance from highly transparent ceramics are presented.

Feeling safe during an inpatient hospitalization: a concept analysis.

PubMed

Mollon, Deene

2014-08-01

This paper aims to explore the critical attributes of the concept feeling safe. The safe delivery of care is a high priority; however; it is not really known what it means to the patient to 'feel safe' during an inpatient hospitalization. This analysis explores the topic of safety from the patient's perspective. Concept analysis. The data bases of CINAHL, Medline, PsychInfo and Google Scholar for the years 1995-2012 were searched using the terms safe and feeling safe. The eight-step concept analysis method of Walker and Avant was used to analyse the concept of feeling safe. Uses and defining attributes, as well as identified antecedents, consequences and empirical referents, are presented. Case examples are provided to assist in the understanding of defining attributes. Feeling safe is defined as an emotional state where perceptions of care contribute to a sense of security and freedom from harm. Four attributes were identified: trust, cared for, presence and knowledge. Relationship, environment and suffering are the antecedents of feeling safe, while control, hope and relaxed or calm are the consequences. Empirical referents and early development of a theory of feeling safe are explored. This analysis begins the work of synthesizing qualitative research already completed around the concept of feeling safe by defining the key attributes of the concept. Support for the importance of developing patient-centred models of care and creating positive environments where patients receive high-quality care and feel safe is provided. © 2014 John Wiley & Sons Ltd.

Random safety auditing, root cause analysis, failure mode and effects analysis.

PubMed

Ursprung, Robert; Gray, James

2010-03-01

Improving quality and safety in health care is a major concern for health care providers, the general public, and policy makers. Errors and quality issues are leading causes of morbidity and mortality across the health care industry. There is evidence that patients in the neonatal intensive care unit (NICU) are at high risk for serious medical errors. To facilitate compliance with safe practices, many institutions have established quality-assurance monitoring procedures. Three techniques that have been found useful in the health care setting are failure mode and effects analysis, root cause analysis, and random safety auditing. When used together, these techniques are effective tools for system analysis and redesign focused on providing safe delivery of care in the complex NICU system. Copyright 2010 Elsevier Inc. All rights reserved.

Engineering of small interfering RNA-loaded lipidoid-poly(DL-lactic-co-glycolic acid) hybrid nanoparticles for highly efficient and safe gene silencing: A quality by design-based approach.

PubMed

Thanki, Kaushik; Zeng, Xianghui; Justesen, Sarah; Tejlmann, Sarah; Falkenberg, Emily; Van Driessche, Elize; Mørck Nielsen, Hanne; Franzyk, Henrik; Foged, Camilla

2017-11-01

Safety and efficacy of therapeutics based on RNA interference, e.g., small interfering RNA (siRNA), are dependent on the optimal engineering of the delivery technology, which is used for intracellular delivery of siRNA to the cytosol of target cells. We investigated the hypothesis that commonly used and poorly tolerated cationic lipids might be replaced with more efficacious and safe lipidoids as the lipid component of siRNA-loaded lipid-polymer hybrid nanoparticles (LPNs) for achieving more efficient gene silencing at lower and safer doses. However, formulation design of such a complex formulation is highly challenging due to a strong interplay between several contributing factors. Hence, critical formulation variables, i.e. the lipidoid content and siRNA:lipidoid ratio, were initially identified, followed by a systematic quality-by-design approach to define the optimal operating space (OOS), eventually resulting in the identification of a robust, highly efficacious and safe formulation. A 17-run design of experiment with an I-optimal approach was performed to systematically assess the effect of selected variables on critical quality attributes (CQAs), i.e. physicochemical properties (hydrodynamic size, zeta potential, siRNA encapsulation/loading) and the biological performance (in vitro gene silencing and cell viability). Model fitting of the obtained data to construct predictive models revealed non-linear relationships for all CQAs, which can be readily overlooked in one-factor-at-a-time optimization approaches. The response surface methodology further enabled the identification of an OOS that met the desired quality target product profile. The optimized lipidoid-modified LPNs revealed more than 50-fold higher in vitro gene silencing at well-tolerated doses and approx. a twofold increase in siRNA loading as compared to reference LPNs modified with the commonly used cationic lipid dioleyltrimethylammonium propane (DOTAP). Thus, lipidoid-modified LPNs show highly promising prospects for efficient and safe intracellular delivery of siRNA. Copyright © 2017 Elsevier B.V. All rights reserved.

Worldwide Status of Fresh Fruits Irradiation and Concerns about Quality, Safety, and Consumer Acceptance.

PubMed

Shahbaz, Hafiz Muhammad; Akram, Kashif; Ahn, Jae-Jun; Kwon, Joong-Ho

2016-08-17

Development of knowledge-based food preservation techniques have been a major focus of researchers in providing safe and nutritious food. Food irradiation is one of the most thoroughly investigated food preservation techniques, which has been shown to be effective and safe through extensive research. This process involves exposing food to ionizing radiations in order to destroy microorganisms or insects that might be present on and/or in the food. In addition, the effects of irradiation on the enzymatic activity and improvement of functional properties in food have also been well established. In the present review, the potential of food irradiation technology to address major problems, such as short shelf life, high-initial microbial loads, insect pest management (quarantine treatment) in supply chain, and safe consumption of fresh fruits was described. With improved hygienic quality, other uses, such as delayed ripening and enhanced physical appearance by irradiation were also discussed. Available data showed that the irradiation of fruits at the optimum dose can be a safe and cost-effective method, resulting in enhanced shelf life and hygienic quality with the least amount of compromise on the various nutritional attributes, whereas the consumer acceptance of irradiated fruits is a matter of providing the proper scientific information.

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.

Small Drinking Water System Initiative | Drinking Water in New ...

EPA Pesticide Factsheets

2017-07-06

Reliable, safe, high quality drinking water is essential to sustaining our communities. Approximately 90% of New England's drinking water systems - about 10,000 systems - are small and most use ground water sources.

Investing in nursing research in practice settings: a blueprint for building capacity.

PubMed

Jeffs, Lianne; Smith, Orla; Beswick, Susan; Maoine, Maria; Ferris, Ella

2013-12-01

Engaging clinical nurses in practice-based research is a cornerstone of professional nursing practice and a critical element in the delivery of high-quality patient care. Practising staff nurses are well suited to identify the phenomena and issues that are clinically relevant and appropriate for research. In response to the need to invest in and build capacity in nursing research, hospitals have developed creative approaches to spark interest in nursing research and to equip clinical nurses with research competencies. This paper outlines a Canadian hospital's efforts to build research capacity as a key strategy to foster efficacious, safe and cost-effective patient care practices. Within a multi-pronged framework, several strategies are described that collectively resulted in enhanced research and knowledge translation productivity aimed at improving the delivery of safe and high-quality patient care.

Putting It All Together: Guiding Principles for Quality After-School Programs Serving Preteens

ERIC Educational Resources Information Center

Metz, Rachel A.; Goldsmith, Julie; Arbreton, Amy J. A.

2008-01-01

Successfully navigating early adolescence depends, in large part, on the availability of safe and engaging activities and supportive relationships with adults, yet many preteens have limited access to positive supports and opportunities such as high-quality after-school programs that could put them on a path to success. Funders, policymakers and…

POSNA Quality Safety Value Initiative: From Vision to Implementation to Early Results.

PubMed

Waters, Peter M; Flynn, John M

2015-01-01

The POSNA Quality, Safety and Value Initiative (QSVI) formally started with POSNA board approval in early 2011. The initial vision statement was: "To lead in defining our members' value based clinical care. To partner with hospital based and orthopedic organizational efforts to guarantee safe, high quality outcomes for our patients. To communicate our initiatives and results cooperatively with payer, credentialing, and compliance organizations to improve pediatric orthopedic care in North America."

New developments in short-pulse eye safe lasers pay the way for future LADARs and 3D mapping performances

NASA Astrophysics Data System (ADS)

Pasmanik, Guerman; Latone, Kevin; Shilov, Alex; Shklovsky, Eugeni; Spiro, Alex; Tiour, Larissa

2005-06-01

We have demonstrated that direct excitation of 3rd Stokes Raman emission in crystal can produce short (few nanosecond) eye-safe pulses. Produced beam has very high quality and the pulse energy can be as high as tens of millijoules. For pulsed diode pumped solid state lasers the demonstrated repetition rate was 250 Hz but higher repetition rates are certainly achievable. It is important that tested schemes do not have strict requirements on laser pump parameters, namely beam divergence and frequency bandwidth. The obtained results are very relevant to the development of eye-safe lasers, such as the new generation of rangefinders, target designators, and laser tracking and pin-pointing devices, as well as remote 2D and 3D imaging systems.

Initial Implementation Indicators From a Statewide Rollout of SafeCare Within a Child Welfare System

PubMed Central

Whitaker, Daniel J.; Ryan, Kerry A.; Wild, Robert C.; Self-Brown, Shannon; Lutzker, John R.; Shanley, Jenelle R.; Edwards, Anna M.; McFry, Erin A.; Moseley, Colby N.; Hodges, Amanda E.

2013-01-01

There is a strong movement toward implementation of evidence-based practices (EBP) in child welfare systems. The SafeCare parenting model is one of few parent-training models that addresses child neglect, the most common form of maltreatment. Here, the authors describe initial findings from a statewide effort to implement the EBP, SafeCare®, into a state child welfare system. A total of 50 agencies participated in training, with 295 individuals entering training to implement SafeCare. Analyses were conducted to describe the trainee sample, describe initial training and implementation indicators, and to examine correlates of initial training performance and implementation indicators. The quality of SafeCare uptake during training and implementation was high with trainees performing very well on training quizzes and role-plays, and demonstrating high fidelity when implementing SafeCare in the field (performing over 90% of expected behaviors). However, the quantity of implementation was generally low, with relatively few providers (only about 25%) implementing the model following workshop training. There were no significant predictors of training or implementation performance, once corrections for multiple comparisons were applied. The Discussion focuses on challenges to large-scale system-wide implementation of EBP. PMID:22146860

Perinatal staff perceptions of safety and quality in their service.

PubMed

Sinni, Suzanne V; Wallace, Euan M; Cross, Wendy M

2014-11-28

Ensuring safe and appropriate service delivery is central to a high quality maternity service. With this in mind, over recent years much attention has been given to the development of evidence-based clinical guidelines, staff education and risk reporting systems. Less attention has been given to assessing staff perceptions of a service's safety and quality and what factors may influence that. In this study we set out to assess staff perceptions of safety and quality of a maternity service and to explore potential influences on service safety. The study was undertaken within a new low risk metropolitan maternity service in Victoria, Australia with a staffing profile comprising midwives (including students), neonatal nurses, specialist obstetricians, junior medical staff and clerical staff. In depth open-ended interviews using a semi-structured questionnaire were conducted with 23 staff involved in the delivery of perinatal care, including doctors, midwives, nurses, nursing and midwifery students, and clerical staff. Data were analyzed using naturalistic interpretive inquiry to identify emergent themes. Staff unanimously reported that there were robust systems and processes in place to maintain safety and quality. Three major themes were apparent: (1) clinical governance, (2) dominance of midwives, (3) inter-professional relationships. Overall, there was a strong sense that, at least in this midwifery-led service, midwives had the greatest opportunity to be an influence, both positively and negatively, on the safe delivery of perinatal care. The importance of understanding team dynamics, particularly mutual respect, trust and staff cohesion, were identified as key issues for potential future service improvement. Senior staff, particularly midwives and neonatal nurses, play central roles in shaping team behaviors and attitudes that may affect the safety and quality of service delivery. We suggest that strategies targeting senior staff to enhance their performance in their roles, particularly in the training and teamwork role-modeling of the transitory junior workforce, are important for the development and maintenance of a high quality and safe maternity service.

Provision of safe domestic water for the promotion and protection of public health: a case study of the city of Beirut, Lebanon.

PubMed

Korfali, Samira Ibrahim; Jurdi, Mey

2009-04-01

Securing adequate safe drinking water and proper sanitation is a major challenge facing the developing world. The "Water for Life Decade" emphasizes the importance of upgrading national water quality and sanitation services. This study assessed the domestic water profile in the city of Beirut. Samples were collected from three types of household water sources (municipality, private wells, and vended water bottles) and assessed for their physiochemical and microbiological profile. At the same time, a cross-sectional survey assessing water consumption patterns and the prevalence of water-borne diseases was conducted. The results showed a deficient water quality profile in all three water sources. The measured physiochemical and bacteriological parameters reflected the high frequency of water-borne diseases. Action to secure a safe domestic water supply is essential. The plan should guarantee the protection of water sources, ensure sufficient treatment of domestic water and upgrade the national program for potable water quality control. Periodic quality monitoring and legislating the chaotic water-vending sector are indispensable. Additionally, the deterioration of private well sources by sea and wastewater infiltration necessitates the enforcement of legislation associated with the use and management of private wells. Consumer awareness and active contributions to promote and protect public health are important.

Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care

PubMed Central

2012-01-01

Unsafe abortion's significant contribution to maternal mortality and morbidity was a critical factor leading to liberalization of Nepal's restrictive abortion law in 2002. Careful, comprehensive planning among a range of multisectoral stakeholders, led by Nepal's Ministry of Health and Population, enabled the country subsequently to introduce and scale up safe abortion services in a remarkably short timeframe. This paper examines factors that contributed to rapid, successful implementation of legal abortion in this mountainous republic, including deliberate attention to the key areas of policy, health system capacity, equipment and supplies, and information dissemination. Important elements of this successful model of scaling up safe legal abortion include: the pre-existence of postabortion care services, through which health-care providers were already familiar with the main clinical technique for safe abortion; government leadership in coordinating complementary contributions from a wide range of public- and private-sector actors; reliance on public-health evidence in formulating policies governing abortion provision, which led to the embrace of medical abortion and authorization of midlevel providers as key strategies for decentralizing care; and integration of abortion care into existing Safe Motherhood and the broader health system. While challenges remain in ensuring that all Nepali women can readily exercise their legal right to early pregnancy termination, the national safe abortion program has already yielded strong positive results. Nepal's experience making high-quality abortion care widely accessible in a short period of time offers important lessons for other countries seeking to reduce maternal mortality and morbidity from unsafe abortion and to achieve Millennium Development Goals. PMID:22475782

Modeling, simulation, and flight characteristics of an aircraft designed to fly at 100,000 feet

NASA Technical Reports Server (NTRS)

Sim, Alex G.

1991-01-01

A manned real time simulation of a conceptual vehicle, the stratoplane, was developed to study the problems associated with the flight characteristics of a large, lightweight vehicle. Mathematical models of the aerodynamics, mass properties, and propulsion system were developed in support of the simulation and are presented. The simulation was at first conducted without control augmentation to determine the needs for a control system. The unaugmented flying qualities were dominated by lightly damped dutch roll oscillations. Constant pilot workloads were needed at high altitudes. Control augmentation was studied using basic feedbacks. For the longitudinal axis, flight path angle, and pitch rate feedback were sufficient to damp the phugoid mode and to provide good flying qualities. In the lateral directional axis, bank angle, roll rate, and yaw rate feedbacks were sufficient to provide a safe vehicle with acceptable handling qualities. Intentionally stalling the stratoplane to very high angles of attack (deep stall) was studied as a means of enable safe and rapid descent. It was concluded that the deep stall maneuver is viable for this class of vehicle.

A Case Review: Integrating Lewin’s Theory with Lean’s System Approach for Change

PubMed

Wojciechowski, Elizabeth; Pearsall, Tabitha; Murphy, Patricia; French, Eileen

2016-05-31

The complexity of healthcare calls for interprofessional collaboration to improve and sustain the best outcomes for safe and high quality patient care. Historically, rehabilitation nursing has been an area that relies heavily on interprofessional relationships. Professionals from various disciplines often subscribe to different change management theories for continuous quality improvement. Through a case review, authors describe how a large, Midwestern, rehabilitation hospital used the crosswalk methodology to facilitate interprofessional collaboration and develop an intervention model for implementing and sustaining bedside shift reporting. The authors provide project background and offer a brief overview of the two common frameworks used in this project, Lewin’s Three-Step Model for Change and the Lean Systems Approach. The description of the bedside shift report project methods demonstrates that multiple disciplines are able to utilize a common framework for leading and sustaining change to support outcomes of high quality and safe care, and capitalize on the opportunities of multiple views and discipline-specific approaches. The conclusion discusses outcomes, future initiatives, and implications for nursing practice.

Cucumber fermentation

USDA-ARS?s Scientific Manuscript database

Humans have consumed fermented cucumber products since before the dawn of civilization. Although cucumber fermentation remains largely a traditional process, it has proven to be a consistently safe process by which raw cucumbers are transformed into high quality pickles that have a long shelf-life ...

Testing the hospital value proposition: an empirical analysis of efficiency and quality.

PubMed

Huerta, Timothy R; Ford, Eric W; Peterson, Lori T; Brigham, Keith H

2008-01-01

To assess the relationship between hospitals' X-inefficiency levels and overall care quality based on the National Quality Forum's 27 safe practices score and to improve the analytic strategy for assessing X-inefficiency. The 2005 versions of the American Hospital Association and Leapfrog Group's annual surveys were the basis of the study. Additional case mix indices and market variables were drawn from the Centers for Medicare and Medicaid Services data sources and the Area Resource File. Data envelopment analysis was used to determine hospitals' X-inefficiency scores relative to their market-level competitors. Regression was used to assess the relationship between X-inefficiency and quality, controlling for organizational and market characteristics. Expenses (total and labor expenditures), case-mix-adjusted admissions, length of stay, and licensed beds defined the X-inefficiency function. The overall National Quality Forum's safe practice score, health maintenance organization penetration, market share, and teaching status served as independent control variables in the regression. The National Quality Forum's safe practice scores are significantly and positively correlated to hospital X-inefficiency levels (beta = .105, p < or = .05). The analysis of the value proposition had very good explanatory power (adjusted R(2) = .414; p < or = .001; df = 7, 265). Contrary to earlier findings, health maintenance organization penetration and being a teaching hospital were positively related to X-inefficiency. Similar with others' findings, greater market share and for-profit ownership were negatively associated with X-inefficiency. Measurement of overall hospital quality is improving but can still be made better. Nevertheless, the National Quality Forum's measure is significantly related to efficiency and could be used to create differential pay-for-performance programs. A market-segmented analytic strategy for studying hospitals' efficiency yields results with a high degree of explanatory power.

Handling qualities related to stall/spin accidents of supersonic fighter aircraft

NASA Technical Reports Server (NTRS)

Anderson, S. B.

1984-01-01

This paper reviews the handling qualities which influence the high angle of attack (AOA) behavior of supersonic fighter aircraft in order to obtain a clearer understanding of the causes of stall/spin accidents. The results show that, because modern fighters suffer more serious consequences when control is lost, good handling qualities are essential for safe operation at high AOA. Relaxed static stability used on some fighter aircraft can result in control problems at high AOA owing to inertia coupling and the difficulty of a recovery from a deep stall. Indications are that the use of departure/spin resistance and an automatic spin prevention system will greatly improve the safety record for modern supersonic fighters.

Accounting for water quality in monitoring access to safe drinking-water as part of the Millennium Development Goals: lessons from five countries.

PubMed

Bain, Rob E S; Gundry, Stephen W; Wright, Jim A; Yang, Hong; Pedley, Steve; Bartram, Jamie K

2012-03-01

To determine how data on water source quality affect assessments of progress towards the 2015 Millennium Development Goal (MDG) target on access to safe drinking-water. Data from five countries on whether drinking-water sources complied with World Health Organization water quality guidelines on contamination with thermotolerant coliform bacteria, arsenic, fluoride and nitrates in 2004 and 2005 were obtained from the Rapid Assessment of Drinking-Water Quality project. These data were used to adjust estimates of the proportion of the population with access to safe drinking-water at the MDG baseline in 1990 and in 2008 made by the Joint Monitoring Programme for Water Supply and Sanitation, which classified all improved sources as safe. Taking account of data on water source quality resulted in substantially lower estimates of the percentage of the population with access to safe drinking-water in 2008 in four of the five study countries: the absolute reduction was 11% in Ethiopia, 16% in Nicaragua, 15% in Nigeria and 7% in Tajikistan. There was only a slight reduction in Jordan. Microbial contamination was more common than chemical contamination. The criterion used by the MDG indicator to determine whether a water source is safe can lead to substantial overestimates of the population with access to safe drinking-water and, consequently, also overestimates the progress made towards the 2015 MDG target. Monitoring drinking-water supplies by recording both access to water sources and their safety would be a substantial improvement.

The Safe Yield and Climatic Variability: Implications for Groundwater Management.

PubMed

Loáiciga, Hugo A

2017-05-01

Methods for calculating the safe yield are evaluated in this paper using a high-quality and long historical data set of groundwater recharge, discharge, extraction, and precipitation in a karst aquifer. Consideration is given to the role that climatic variability has on the determination of a climatically representative period with which to evaluate the safe yield. The methods employed to estimate the safe yield are consistent with its definition as a long-term average extraction rate that avoids adverse impacts on groundwater. The safe yield is a useful baseline for groundwater planning; yet, it is herein shown that it is not an operational rule that works well under all climatic conditions. This paper shows that due to the nature of dynamic groundwater processes it may be most appropriate to use an adaptive groundwater management strategy that links groundwater extraction rates to groundwater discharge rates, thus achieving a safe yield that represents an estimated long-term sustainable yield. An example of the calculation of the safe yield of the Edwards Aquifer (Texas) demonstrates that it is about one-half of the average annual recharge. © 2016, National Ground Water Association.

Safe, High-Performance, Sustainable Precast School Design

ERIC Educational Resources Information Center

Finsen, Peter I.

2011-01-01

School design utilizing integrated architectural and structural precast and prestressed concrete components has gained greater acceptance recently for numerous reasons, including increasingly sophisticated owners and improved learning environments based on material benefits such as: sustainability, energy efficiency, indoor air quality, storm…

Consideration of rainwater quality parameters for drinking purposes: A case study in rural Vietnam.

PubMed

Lee, Minju; Kim, Mikyeong; Kim, Yonghwan; Han, Mooyoung

2017-09-15

Rainwater, which is used for drinking purposes near Hanoi, Vietnam, was analysed for water quality based on 1.5 years of monitoring data. In total, 23 samples were collected from different points within two rainwater harvesting systems (RWHSs). Most parameters met the standard except micro-organisms. Coliform and Escherichia coli (E. coli) were detected when the rainwater was not treated with ultraviolet (UV) light; however, analysis of rainwater after UV sterilisation showed no trace of micro-organisms. The RWHSs appear to provide drinking water of relatively good quality compared with surface water and groundwater. The superior quality of the rainwater suggests the necessity for new drinking rainwater standards because applying all of the drinking water quality standards to rainwater is highly inefficient. The traditionally implemented standards could cause more difficulties for developing countries using RWHSs installed decentralized as a source of drinking water, particularly in areas not well supplied with testing equipment, because such countries must bear the expense and time for these measures. This paper proposes the necessity of rainwater quality guideline, which could serve as a safe and cost-effective alternative to provide an access to safe drinking water. Copyright © 2017 Elsevier Ltd. All rights reserved.

Radiation Oncology Quality and Safety Considerations in Low-Resource Settings: A Medical Physics Perspective.

PubMed

Van Dyk, Jacob; Meghzifene, Ahmed

2017-04-01

The past few years have seen a significant growth of interest in the global radiation therapy (RT) crisis. Various organizations have quantified the need and are providing aid in support of addressing the shortfalls existing in many low-to-middle income countries. With the tremendous demand for new facilities, equipment, and personnel, it is very important to recognize the quality and safety challenges and to address them directly. An examination of publications on quality and safety in RT indicates a consistency in a number of the recommendations; however, these authoritative reports were generally based on input from high-resourced contexts. Here, we review these recommendations with a special emphasis on issues that are significant in low-to-middle income countries. Although multidimensional, training, and staffing are top priorities, any support provided to lower-resourced settings must address the numerous facets associated with quality and safety indicators. Strong partnerships between high income and other countries will enhance the development of safe and resource-appropriate strategies for advancing the radiation treatment process. The real challenge is the engagement of a strong spirit of cooperation, collaboration, and communication among the multiple organizations in support of reducing the cancer divide and improving the provision of safe and effective RT. Copyright © 2017 Elsevier Inc. All rights reserved.

2017 Guide to Nursing Certification Boards.

PubMed

Bonsall, Lisa Morris; Schnur, Myrna Buiser; Deming, Cara; Fryling-Resare, Kim; Maroldo, Robert

Nursing specialty certification is one way to enhance your professional development and to exhibit dedication to high-quality, safe patient care and a commitment of excellence to your organization. Use this resource to explore your options and contact the certifying body that meets your needs.

Effect of high pressure impact on the survival of Shiga Toxin-producing Escherichia coli ('Big Six' and 0157) in ground beef

USDA-ARS?s Scientific Manuscript database

High pressure processing (HPP) is a safe and effective technology for improving food safety while maintaining food quality attributes. Non-O157:H7 Shiga Toxin-producing Escherichia coli (STEC) have been increasingly implicated in foodborne illness outbreaks and recalls, and the USDA Food Safety Ins...

Accounting for water quality in monitoring access to safe drinking-water as part of the Millennium Development Goals: lessons from five countries

PubMed Central

Bain, Rob ES; Wright, Jim A; Yang, Hong; Pedley, Steve; Bartram, Jamie K

2012-01-01

Abstract Objective To determine how data on water source quality affect assessments of progress towards the 2015 Millennium Development Goal (MDG) target on access to safe drinking-water. Methods Data from five countries on whether drinking-water sources complied with World Health Organization water quality guidelines on contamination with thermotolerant coliform bacteria, arsenic, fluoride and nitrates in 2004 and 2005 were obtained from the Rapid Assessment of Drinking-Water Quality project. These data were used to adjust estimates of the proportion of the population with access to safe drinking-water at the MDG baseline in 1990 and in 2008 made by the Joint Monitoring Programme for Water Supply and Sanitation, which classified all improved sources as safe. Findings Taking account of data on water source quality resulted in substantially lower estimates of the percentage of the population with access to safe drinking-water in 2008 in four of the five study countries: the absolute reduction was 11% in Ethiopia, 16% in Nicaragua, 15% in Nigeria and 7% in Tajikistan. There was only a slight reduction in Jordan. Microbial contamination was more common than chemical contamination. Conclusion The criterion used by the MDG indicator to determine whether a water source is safe can lead to substantial overestimates of the population with access to safe drinking-water and, consequently, also overestimates the progress made towards the 2015 MDG target. Monitoring drinking-water supplies by recording both access to water sources and their safety would be a substantial improvement. PMID:22461718

Effects of Source- versus Household Contamination of Tubewell Water on Child Diarrhea in Rural Bangladesh: A Randomized Controlled Trial

PubMed Central

Unicomb, Leanne; Arnold, Benjamin F.; Colford Jr., John M.; Luby, Stephen P.

2015-01-01

Background Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh. Methods We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants’ source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions. Findings Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias. Conclusions Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh. Trial Registration ClinicalTrials.gov NCT01350063 PMID:25816342

A Virtual Circuits Lab

ERIC Educational Resources Information Center

Vick, Matthew E.

2010-01-01

The University of Colorado's Physics Education Technology (PhET) website offers free, high-quality simulations of many physics experiments that can be used in the classroom. The Circuit Construction Kit, for example, allows students to safely and constructively play with circuit components while learning the mathematics behind many circuit…

'It's a matter of patient safety': understanding challenges in everyday clinical practice for achieving good care on the surgical ward - a qualitative study.

PubMed

Jangland, Eva; Nyberg, Berit; Yngman-Uhlin, Pia

2017-06-01

Surgical care plays an important role in the acute hospital's delivery of safe, high-quality patient care. Although demands for effectiveness are high in surgical wards quality of care and patient safety must also be secured. It is therefore necessary to identify the challenges and barriers linked to quality of care and patient safety with a focus on this specific setting. To explore situations and processes that support or hinder good safe patient care on the surgical ward. This qualitative study was based on a strategic sample of 10 department and ward leaders in three hospitals and six surgical wards in Sweden. Repeated reflective interviews were analysed using systematic text condensation. Four themes described the leaders' view of a complex healthcare setting that demands effectiveness and efficiency in moving patients quickly through the healthcare system. Quality of care and patient safety were often hampered factors such as a shift of care level, with critically ill patients cared for without reorganisation of nurses' competencies on the surgical ward. There is a gap between what is described in written documents and what is or can be performed in clinical practice to achieve good care and safe care on the surgical ward. A shift in levels of care on the surgical ward without reallocation of the necessary competencies at the patient's bedside show consequences for quality of care and patient safety. This means that surgical wards should consider reviewing their organisation and implementing more advanced nursing roles in direct patient care on all shifts. The ethical issues and the moral stress on nurses who lack the resources and competence to deliver good care according to professional values need to be made more explicit as a part of the patient safety agenda in the surgical ward. © 2016 Nordic College of Caring Science.

Management of source and drinking-water quality in Pakistan.

PubMed

Aziz, J A

2005-01-01

Drinking-water quality in both urban and rural areas of Pakistan is not being managed properly. Results of various investigations provide evidence that most of the drinking-water supplies are faecally contaminated. At places groundwater quality is deteriorating due to the naturally occurring subsoil contaminants or to anthropogenic activities. The poor bacteriological quality of drinking-water has frequently resulted in high incidence of waterborne diseases while subsoil contaminants have caused other ailments to consumers. This paper presents a detailed review of drinking-water quality in the country and the consequent health impacts. It identifies various factors contributing to poor water quality and proposes key actions required to ensure safe drinking-water supplies to consumers.

Multispectral digital holographic microscopy with applications in water quality assessment

NASA Astrophysics Data System (ADS)

Kazemzadeh, Farnoud; Jin, Chao; Yu, Mei; Amelard, Robert; Haider, Shahid; Saini, Simarjeet; Emelko, Monica; Clausi, David A.; Wong, Alexander

2015-09-01

Safe drinking water is essential for human health, yet over a billion people worldwide do not have access to safe drinking water. Due to the presence and accumulation of biological contaminants in natural waters (e.g., pathogens and neuro-, hepato-, and cytotoxins associated with algal blooms) remain a critical challenge in the provision of safe drinking water globally. It is not financially feasible and practical to monitor and quantify water quality frequently enough to identify the potential health risk due to contamination, especially in developing countries. We propose a low-cost, small-profile multispectral (MS) system based on Digital Holographic Microscopy (DHM) and investigate methods for rapidly capturing holographic data of natural water samples. We have developed a test-bed for an MSDHM instrument to produce and capture holographic data of the sample at different wavelengths in the visible and the near Infra-red spectral region, allowing for resolution improvement in the reconstructed images. Additionally, we have developed high-speed statistical signal processing and analysis techniques to facilitate rapid reconstruction and assessment of the MS holographic data being captured by the MSDHM instrument. The proposed system is used to examine cyanobacteria as well as Cryptosporidium parvum oocysts which remain important and difficult to treat microbiological contaminants that must be addressed for the provision of safe drinking water globally.

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

PubMed

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

2006-05-01

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

Transitional Care

ERIC Educational Resources Information Center

Naylor, Mary; Keating, Stacen A.

2008-01-01

Transitional care encompasses a broad range of services and environments designed to promote the safe and timely passage of patients between levels of health care and across care settings. High-quality transitional care is especially important for older adults with multiple chronic conditions and complex therapeutic regimens, as well as for their…

75 FR 16157 - Pharmaceutical Supply Chain; Public Workshop

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-31

... supply of high quality, safe, and effective drug products and drug ingredients depends upon a series of... patients. Through a series of plenary sessions and working group breakout sessions, the workshop will... environment. Share improvements in programs and technology. Identify any barriers to securing the entire...

Quality of our groundwater resources: Arsenic and fluoride

USGS Publications Warehouse

Nordstrom, D. Kirk

2011-01-01

Groundwater often contains arsenic or fluoride concentrations too high for drinking or cooking. These constituents, often naturally occurring, are not easy to remove. The right combination of natural or manmade conditions can lead to elevated arsenic or fluoride which includes continental source rocks, high alkalinity and pH, reducing conditions for arsenic, high phosphate, high temperature and high silica. Agencies responsible for safe drinking water should be aware of these conditions, be prepared to monitor, and treat if necessary.

Human Milk-Treatment and Quality of Banked Human Milk.

PubMed

Picaud, Jean-Charles; Buffin, Rachel

2017-03-01

The aim of human milk banks is to deliver safe and high quality donor human milk. Treatment of human milk has to destroy most microorganisms while preserving immunological and nutrient components, which is obtained when using low time low temperature pasteurization. However it destroys bile-simulated lipase, reduces lactoferrin, lysozyme, immunoglobulins, and bactericidal capacity of human milk. New methods are under investigation such as high temperature short time pasteurization, high pressure processing, or ultraviolet irradiation. They have been tested in experimental conditions and there are promising results, but they have to be tested in real conditions in human milk bank. Copyright © 2016 Elsevier Inc. All rights reserved.

Optical Amplifier Based Space Solar Power

NASA Technical Reports Server (NTRS)

Fork, Richard L.

2001-01-01

The objective was to design a safe optical power beaming system for use in space. Research was focused on identification of strategies and structures that would enable achievement near diffraction limited optical beam quality, highly efficient electrical to optical conversion, and high average power in combination in a single system. Efforts centered on producing high efficiency, low mass of the overall system, low operating temperature, precision pointing and tracking capability, compatibility with useful satellite orbits, component and system reliability, and long component and system life in space. A system based on increasing the power handled by each individual module to an optimum and the number of modules in the complete structure was planned. We were concerned with identifying the most economical and rapid path to commercially viable safe space solar power.

Microbial quality of improved drinking water sources: evidence from western Kenya and southern Vietnam.

PubMed

Grady, Caitlin A; Kipkorir, Emmanuel C; Nguyen, Kien; Blatchley, E R

2015-06-01

In recent decades, more than 2 billion people have gained access to improved drinking water sources thanks to extensive effort from governments, and public and private sector entities. Despite this progress, many water sector development interventions do not provide access to safe water or fail to be sustained for long-term use. The authors examined drinking water quality of previously implemented water improvement projects in three communities in western Kenya and three communities in southern Vietnam. The cross-sectional study of 219 households included measurements of viable Escherichia coli. High rates of E. coli prevalence in these improved water sources were found in many of the samples. These findings suggest that measures above and beyond the traditional 'improved source' definition may be necessary to ensure truly safe water throughout these regions.

Microbes and Water Quality in Developed Countries

EPA Science Inventory

Safe drinking water has been a concern for mankind through out the world for centuries. In the developed world, governments consider access to safe and clean drinking water to be a basic human right. Government regulations generally address the quality of the source water, adequ...

Water Quality Monitoring in Developing Countries; Can Microbial Fuel Cells be the Answer?

PubMed Central

Chouler, Jon; Di Lorenzo, Mirella

2015-01-01

The provision of safe water and adequate sanitation in developing countries is a must. A range of chemical and biological methods are currently used to ensure the safety of water for consumption. These methods however suffer from high costs, complexity of use and inability to function onsite and in real time. The microbial fuel cell (MFC) technology has great potential for the rapid and simple testing of the quality of water sources. MFCs have the advantages of high simplicity and possibility for onsite and real time monitoring. Depending on the choice of manufacturing materials, this technology can also be highly cost effective. This review covers the state-of-the-art research on MFC sensors for water quality monitoring, and explores enabling factors for their use in developing countries. PMID:26193327

Water Quality Monitoring in Developing Countries; Can Microbial Fuel Cells be the Answer?

PubMed

Chouler, Jon; Di Lorenzo, Mirella

2015-07-16

The provision of safe water and adequate sanitation in developing countries is a must. A range of chemical and biological methods are currently used to ensure the safety of water for consumption. These methods however suffer from high costs, complexity of use and inability to function onsite and in real time. The microbial fuel cell (MFC) technology has great potential for the rapid and simple testing of the quality of water sources. MFCs have the advantages of high simplicity and possibility for onsite and real time monitoring. Depending on the choice of manufacturing materials, this technology can also be highly cost effective. This review covers the state-of-the-art research on MFC sensors for water quality monitoring, and explores enabling factors for their use in developing countries.

75 FR 28056 - Cachuma Lake Resource Management Plan, Santa Barbara County, CA

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-19

...: (1) Ensure safe storage and timely delivery of high-quality water to users while enhancing natural... provides irrigation, domestic, and municipal and industrial water supplies to the City of Santa Barbara, Goleta Water District, Montecito Water District, Carpinteria Valley Water District, and Santa Ynez River...

Modelling of beef sensory quality for a better prediction of palatability.

PubMed

Hocquette, Jean-François; Van Wezemael, Lynn; Chriki, Sghaier; Legrand, Isabelle; Verbeke, Wim; Farmer, Linda; Scollan, Nigel D; Polkinghorne, Rod; Rødbotten, Rune; Allen, Paul; Pethick, David W

2014-07-01

Despite efforts by the industry to control the eating quality of beef, there remains a high level of variability in palatability, which is one reason for consumer dissatisfaction. In Europe, there is still no reliable on-line tool to predict beef quality and deliver consistent quality beef to consumers. Beef quality traits depend in part on the physical and chemical properties of the muscles. The determination of these properties (known as muscle profiling) will allow for more informed decisions to be made in the selection of individual muscles for the production of value-added products. Therefore, scientists and professional partners of the ProSafeBeef project have brought together all the data they have accumulated over 20 years. The resulting BIF-Beef (Integrated and Functional Biology of Beef) data warehouse contains available data of animal growth, carcass composition, muscle tissue characteristics and beef quality traits. This database is useful to determine the most important muscle characteristics associated with a high tenderness, a high flavour or generally a high quality. Another more consumer driven modelling tool was developed in Australia: the Meat Standards Australia (MSA) grading scheme that predicts beef quality for each individual muscle×specific cooking method combination using various information on the corresponding animals and post-slaughter processing factors. This system has also the potential to detect variability in quality within muscles. The MSA system proved to be effective in predicting beef palatability not only in Australia but also in many other countries. The results of the work conducted in Europe within the ProSafeBeef project indicate that it would be possible to manage a grading system in Europe similar to the MSA system. The combination of the different modelling approaches (namely muscle biochemistry and a MSA-like meat grading system adapted to the European market) is a promising area of research to improve the prediction of beef quality. In both approaches, the volume of data available not only provides statistically sound correlations between various factors and beef quality traits but also a better understanding of the variability of beef quality according to various criteria (breed, age, sex, pH, marbling etc.). © 2013 The American Meat Science Association. All rights reserved.

The impact of flying qualities on helicopter operational agility

NASA Technical Reports Server (NTRS)

Padfield, Gareth D.; Lappos, Nick; Hodgkinson, John

1993-01-01

Flying qualities standards are formally set to ensure safe flight and therefore reflect minimum, rather than optimum, requirements. Agility is a flying quality but relates to operations at high, if not maximum, performance. While the quality metrics and test procedures for flying, as covered for example in ADS33C, may provide an adequate structure to encompass agility, they do not currently address flight at high performance. This is also true in the fixed-wing world and a current concern in both communities is the absence of substantiated agility criteria and possible conflicts between flying qualities and high performance. AGARD is sponsoring a working group (WG19) title 'Operational Agility' that deals with these and a range of related issues. This paper is condensed from contributions by the three authors to WG19, relating to flying qualities. Novel perspectives on the subject are presented including the agility factor, that quantifies performance margins in flying qualities terms; a new parameter, based on maneuver acceleration is introduced as a potential candidate for defining upper limits to flying qualities. Finally, a probabilistic analysis of pilot handling qualities ratings is presented that suggests a powerful relationship between inherent airframe flying qualities and operational agility.

High reliability and implications for nursing leaders.

PubMed

Riley, William

2009-03-01

To review high reliability theory and discuss its implications for the nursing leader. A high reliability organization (HRO) is considered that which has measurable near perfect performance for quality and safety. The author has reviewed the literature, discussed research findings that contribute to improving reliability in health care organizations, and makes five recommendations for how nursing leaders can create high reliability organizations. Health care is not a safe industry and unintended patient harm occurs at epidemic levels. Health care can learn from high reliability theory and practice developed in other high-risk industries. Viewed by HRO standards, unintended patient injury in health care is excessively high and quality is distressingly low. HRO theory and practice can be successfully applied in health care using advanced interdisciplinary teamwork training and deliberate process design techniques. Nursing has a primary leadership function for ensuring patient safety and achieving high quality in health care organizations. Learning HRO theory and methods for achieving high reliability is a foremost opportunity for nursing leaders.

Barriers and Facilitators to Safe Food Handling among Consumers: A Systematic Review and Thematic Synthesis of Qualitative Research Studies

PubMed Central

Young, Ian; Waddell, Lisa

2016-01-01

Foodborne illness has a substantial health and economic burden on society, and most cases are believed to be due to unsafe food handling practices at home. Several qualitative research studies have been conducted to investigate consumers’ perspectives, opinions, and experiences with safe food handling at home, and these studies provide insights into the underlying barriers and facilitators affecting their safe food handling behaviours. We conducted a systematic review of previously published qualitative studies in this area to synthesize the main across-study themes and to develop recommendations for future consumer interventions and research. The review was conducted using the following steps: comprehensive search strategy; relevance screening of abstracts; relevance confirmation of articles; study quality assessment; thematic synthesis of the results; and quality-of-evidence assessment. A total of 39 relevant articles reporting on 37 unique qualitative studies were identified. Twenty-one barriers and 10 facilitators to safe food handling were identified, grouped across six descriptive themes: confidence and perceived risk; knowledge-behaviour gap; habits and heuristics; practical and lifestyle constraints; food preferences; and societal and social influences. Our overall confidence that each barrier and facilitator represents the phenomenon of interest was rated as high (n = 11), moderate (11), and low (9). Overarching analytical themes included: 1) safe food handling behaviours occur as part of a complex interaction of everyday consumer practices and habituation; 2) most consumers are not concerned about food safety and are generally not motivated to change their behaviours based on new knowledge about food safety risks; and 3) consumers are amenable to changing their safe food handling habits through relevant social pressures. Key implications and recommendations for research, policy and practice are discussed. PMID:27907161

'High profile health facilities can add to your trouble': Women, stigma and un/safe abortion in Kenya.

PubMed

Izugbara, Chimaraoke O; Egesa, Carolyne; Okelo, Rispah

2015-09-01

Public health discourses on safe abortion assume the term to be unambiguous. However, qualitative evidence elicited from Kenyan women treated for complications of unsafe abortion contrasted sharply with public health views of abortion safety. For these women, safe abortion implied pregnancy termination procedures and services that concealed their abortions, shielded them from the law, were cheap and identified through dependable social networks. Participants contested the notion that poor quality abortion procedures and providers are inherently dangerous, asserting them as key to women's preservation of a good self, management of stigma, and protection of their reputation, respect, social relationships, and livelihoods. Greater public health attention to the social dimensions of abortion safety is urgent. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effects of combined pressure and temperature on enzymes related to quality of fruits and vegetables: from kinetic information to process engineering aspects.

PubMed

Ludikhuyze, L; Van Loey, A; Indrawati; Smout, C; Hendrickx, M

2003-01-01

Throughout the last decade, high pressure technology has been shown to offer great potential to the food processing and preservation industry in delivering safe and high quality products. Implementation of this new technology will be largely facilitated when a scientific basis to assess quantitatively the impact of high pressure processes on food safety and quality becomes available. Besides, quantitative data on the effects of pressure and temperature on safety and quality aspects of foods are indispensable for design and evaluation of optimal high pressure processes, i.e., processes resulting in maximal quality retention within the constraints of the required reduction of microbial load and enzyme activity. Indeed it has to be stressed that new technologies should deliver, apart from the promised quality improvement, an equivalent or preferably enhanced level of safety. The present paper will give an overview from a quantitative point of view of the combined effects of pressure and temperature on enzymes related to quality of fruits and vegetables. Complete kinetic characterization of the inactivation of the individual enzymes will be discussed, as well as the use of integrated kinetic information in process engineering.

Quality and Efficiency Improvement Tools for Every Radiologist.

PubMed

Kudla, Alexei U; Brook, Olga R

2018-06-01

In an era of value-based medicine, data-driven quality improvement is more important than ever to ensure safe and efficient imaging services. Familiarity with high-value tools enables all radiologists to successfully engage in quality and efficiency improvement. In this article, we review the model for improvement, strategies for measurement, and common practical tools with real-life examples that include Run chart, Control chart (Shewhart chart), Fishbone (Cause-and-Effect or Ishikawa) diagram, Pareto chart, 5 Whys, and Root Cause Analysis. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Safe haven laws as crime control theater.

PubMed

Hammond, Michelle; Miller, Monica K; Griffin, Timothy

2010-07-01

This article examines safe haven laws, which allow parents to legally abandon their infants. The main objective is to determine whether safe haven laws fit the criteria of crime control theater, a term used to describe public policies that produce the appearance, but not the effect, of crime control, and as such are essentially socially constructed "solutions" to socially constructed crime "problems." The analysis will apply the principles of crime control theater to safe haven laws. Specifically, the term crime control theater applies to laws that are reactionary responses to perceived criminal threats and are often widely supported as a way to address the crime in question. Such laws are attractive because they appeal to mythic narratives (i.e., saving an innocent child from a predator); however they are likely ineffective due to the complexity of the crime. These laws can have deleterious effects when policymakers make false claims of success and stunt public discourse (e.g., drawing attention away from more frequent and preventable crimes). This analysis applies these criteria to safe haven laws to determine whether such laws can be classified as crime control theater. Many qualities inherent to crime control theater are present in safe haven laws. For example, the laws are highly publicized, their intentions lack moral ambiguity, rare cases of success legitimize law enforcement and other agencies, and they appeal to the public sense of responsibility in preventing crime. Yet the goal of saving infant lives may be unattainable. These qualities make the effectiveness of the laws questionable and suggest they may be counterproductive. This analysis determined that safe haven laws are socially constructed solutions to the socially constructed problem of child abandonment. Safe haven laws are appropriately classified as crime control theater. It is imperative that further research be conducted to examine the effectiveness and collateral effects of safe haven laws. Longitudinal studies and a nationwide database to better determine the effectiveness of safe haven laws are suggested. It is also crucial that agencies implementing SHLs closely monitor the reasons parents abandon their children, and adopt policies that re-focus the attention safe haven laws receive to address more frequent causes of harm to infants. Copyright © 2010 Elsevier Ltd. All rights reserved.

Chitosan Dilutable and Dilactin Forte: Assessment of Their Efficiency for Safety and Quality of Foodstuff

NASA Astrophysics Data System (ADS)

Iurchikova, N.; Khlebosolova, O.

2018-01-01

The modern natural food preservatives used to process and store foodstuff allow to ensure its safety and high quality. Chitosan and dilactin-forte are among such medicines. These preservatives are not only safe, but also are beneficial to a human body in virtue of their effects onto human digestive system. The article describes the results of the research conducted to identify the impact of these natural preservatives on safety of carrot (Daucus carota subsp. sativus)

Informal Mentoring for Lesbian, Gay, Bisexual, and Transgender Students

ERIC Educational Resources Information Center

Mulcahy, Molly; Dalton, Sarah; Kolbert, Jered; Crothers, Laura

2016-01-01

The authors identified the process that 10 lesbian, gay, bisexual, and transgender (LGBT) high school students used to establish an informal adult-mentor relationship with a school personnel member. Five major themes emerged: (a) how LGBT students determined whether this person would be a safe mentor, (b) a listing of the important qualities of…

Baker: Apprenticeship Course Outline. Apprenticeship and Industry Training. 2412

ERIC Educational Resources Information Center

Alberta Advanced Education and Technology, 2012

2012-01-01

The graduate of the Baker apprenticeship program is a certified journeyperson who will be able to: (1) prepare and bake all types of high quality yeast raised products in commercial quantities; (2) produce and decorate various types of cakes, cookies and pastries commonly available in commercial bakeries; (3) use efficiently and safely all hand…

The mock trial: a collaborative interdisciplinary approach to understanding legal and ethical issues.

PubMed

March, Alice L; Ford, Cassandra D; Adams, Marsha Howell; Cheshire, Michelle; Collins, Angela S

2011-01-01

To provide high-quality, safe, patient-centered care, RNs must exhibit a strong understanding of legal and ethical issues. The authors describe an interdisciplinary teaching learning strategy, the premock, actual, and postmock trial, to augment student retention of legal and ethical concepts and enhance the development of their personal accountability.

Nonthermal processing technologies to improve the safety of raw meat and poultry products and ready-to-eat foods

USDA-ARS?s Scientific Manuscript database

Newly emerging nonthermal and advanced thermal processing technologies are now being adopted by the food processing industry for the purpose of providing safe and high quality food products to consumers. Scientists and engineers at USDA’s Eastern Regional Research Center in Wyndmoor, PA are activel...

75 FR 19990 - Lake Casitas Resource Management Plan, Ventura County, CA

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-16

... RMP would: (1) Ensure safe storage and timely delivery of high-quality water to users while enhancing..., California. The dam, which stores water for irrigation, municipal and industrial use within the Casitas Municipal Water District (CMWD), was completed in November 1958. Lake Casitas has a storage capacity of 254...

Community Commitment: How Education Institutions Can Best Use Green Strategies in their Construction Projects

ERIC Educational Resources Information Center

Erickson, Paul W.

2008-01-01

Education institutions that embrace green concepts in their construction projects are able to provide safe and healthful learning environments that are responsive to the community. Carrying out these strategies can enhance student learning, reduce health and operations costs, and enhance the quality of a school. Moreover, these high-performing…

Class Size, Pre-Kindergarten, and Educational Adequacy: Costs and Funding Options for Florida. Policy Brief.

ERIC Educational Resources Information Center

Harris, Douglas N.

2004-01-01

Since 1998, Florida voters have passed three amendments that pressure state officials to increase education spending. The 1998 amendment introduced constitutional language establishing the importance of education to the state and its citizens, requiring "adequate provision?for a uniform, efficient, safe, secure, and high quality system of free…

Funding Florida's Schools: Adequacy, Costs, and the State Constitution. Policy Brief.

ERIC Educational Resources Information Center

Harris, Douglas N.

2004-01-01

In 1998, Florida voters passed a unique amendment to the state constitution requiring the state to make "adequate provision...for a uniform, efficient, safe, secure, and high quality system of free public schools." This brief examines how Florida courts are likely to interpret this constitutional amendment and whether Florida's funding system will…

A Goal for North Carolina's Schools. First in America 2001 Progress Report.

ERIC Educational Resources Information Center

Cunningham, Elizabeth Kolb, Ed.; Thompson, Charles L., Ed.

This second annual report details North Carolina's performance and progress since 2000 in the five goal areas: high student performance; every child ready to learn; safe, orderly, and caring schools; quality teachers and administrators; and strong family, business, and community support. Over the years, North Carolina's education system has…

Guide for Developing High-Quality School Emergency Operations Plans

ERIC Educational Resources Information Center

Office of Safe and Healthy Students, US Department of Education, 2013

2013-01-01

Each school day, our nation's schools are entrusted to provide a safe and healthy learning environment for approximately 55 million elementary and secondary school students in public and nonpublic schools. In collaboration with their local government and community partners, schools can take steps to plan for these potential emergencies through the…

Active Supervision, Precorrection, and Explicit Timing: A High School Case Study on Classroom Behavior

ERIC Educational Resources Information Center

Haydon, Todd; Kroeger, Stephen D.

2016-01-01

One proactive approach to increasing student engagement in schools is implementing Positive Behavior Intervention and Support (PBIS) strategies. PBIS focuses on prevention and concentrates on quality-of-life issues that include improved academic achievement, enhanced social competence, and safe learning and teaching environments. This study is a…

Autologous fat grafting: use of closed syringe microcannula system for enhanced autologous structural grafting

PubMed Central

Alexander, Robert W; Harrell, David B

2013-01-01

Objectives Provide background for use of acquiring autologous adipose tissue as a tissue graft and source of adult progenitor cells for use in cosmetic plastic surgery. Discuss the background and mechanisms of action of closed syringe vacuum lipoaspiration, with emphasis on accessing adipose-derived mesenchymal/stromal cells and the stromal vascular fraction (SVF) for use in aesthetic, structural reconstruction and regenerative applications. Explain a proven protocol for acquiring high-quality autologous fat grafts (AFG) with use of disposable, microcannula systems. Design Explain the components and advantage of use of the patented super luer-lock and microcannulas system for use with the closed-syringe system. A sequential explanation of equipment selection for minimally traumatic lipoaspiration in small volumes is presented, including use of blunt injection cannulas to reduce risk of embolism. Results Thousands of AFG have proven safe and efficacious for lipoaspiration techniques for large and small structural fat grafting procedures. The importance and advantages of gentle harvesting of the adipose tissue complex has become very clear in the past 5 years. The closed-syringe system offers a minimally invasive, gentle system with which to mobilize subdermal fat tissues in a suspension form. Resulting total nuclear counting of undifferentiated cells of the adipose-derived -SVF suggests that the yield achieved is better than use of always-on, constant mechanical pump applied vacuum systems. Conclusion Use of a closed-syringe lipoaspiration system featuring disposable microcannulas offers a safe and effective means of harvesting small volumes of nonmanipulated adipose tissues and its accompanying progenitor cells within the SVF. Closed syringes and microcannulas are available as safe, sterile, disposable, compact systems for acquiring high-quality AFG. Presented is a detailed, step-by-step, proven protocol for performing quality autologous structural adipose transplantation. PMID:23630430

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

PubMed Central

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Burn injury models of care: A review of quality and cultural safety for care of Indigenous children.

PubMed

Fraser, Sarah; Grant, Julian; Mackean, Tamara; Hunter, Kate; Holland, Andrew J A; Clapham, Kathleen; Teague, Warwick J; Ivers, Rebecca Q

2018-05-01

Safety and quality in the systematic management of burn care is important to ensure optimal outcomes. It is not clear if or how burn injury models of care uphold these qualities, or if they provide a space for culturally safe healthcare for Indigenous peoples, especially for children. This review is a critique of publically available models of care analysing their ability to facilitate safe, high-quality burn care for Indigenous children. Models of care were identified and mapped against cultural safety principles in healthcare, and against the National Health and Medical Research Council standard for clinical practice guidelines. An initial search and appraisal of tools was conducted to assess suitability of the tools in providing a mechanism to address quality and cultural safety. From the 53 documents found, 6 were eligible for review. Aspects of cultural safety were addressed in the models, but not explicitly, and were recorded very differently across all models. There was also limited or no cultural consultation documented in the models of care reviewed. Quality in the documents against National Health and Medical Research Council guidelines was evident; however, description or application of quality measures was inconsistent and incomplete. Gaps concerning safety and quality in the documented care pathways for Indigenous peoples' who sustain a burn injury and require burn care highlight the need for investigation and reform of current practices. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

PubMed

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

The current status of diabetes professional educational standards and competencies in the UK--a position statement from the Diabetes UK Healthcare Professional Education Competency Framework Task and Finish Group.

PubMed

Walsh, N; George, S; Priest, L; Deakin, T; Vanterpool, G; Karet, B; Simmons, D

2011-12-01

Diabetes is a significant health concern, both in the UK and globally. Management can be complex, often requiring high levels of knowledge and skills in order to provide high-quality and safe care. The provision of good, safe, quality care lies within the foundations of healthcare education, continuing professional development and evidence-based practice, which are inseparable and part of a continuum during the career of any health professional. Sound education provides the launch pad for effective clinical management and positive patient experiences. This position paper reviews and discusses work undertaken by a Working Group under the auspices of Diabetes UK with the remit of considering all health professional educational issues for people delivering care to people with diabetes. This work has scoped the availability of education for those within the healthcare system who may directly or indirectly encounter people with diabetes and reviews alignment to existing competency frameworks within the UK's National Health Service. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Assessing Water Filtration and Safe Storage in Households with Young Children of HIV-Positive Mothers: A Randomized, Controlled Trial in Zambia

PubMed Central

Peletz, Rachel; Simunyama, Martin; Sarenje, Kelvin; Baisley, Kathy; Filteau, Suzanne; Kelly, Paul; Clasen, Thomas

2012-01-01

Background Unsafe drinking water presents a particular threat to people living with HIV/AIDS (PLHIV) due to the increased risk of opportunistic infections, diarrhea-associated malabsorption of essential nutrients, and increased exposure to untreated water for children of HIV-positive mothers who use replacement feeding to reduce the risk of HIV transmission. This population may particularly benefit from an intervention to improve water quality in the home. Methods and Findings We conducted a 12-month randomized, controlled field trial in Zambia among 120 households with children <2 years (100 with HIV-positive mothers and 20 with HIV-negative mothers to reduce stigma of participation) to assess a high-performance water filter and jerry cans for safe storage. Households were followed up monthly to assess use, drinking water quality (thermotolerant coliforms (TTC), an indicator of fecal contamination) and reported diarrhea (7-day recall) among children <2 years and all members of the household. Because previous attempts to blind the filter have been unsuccessful, we also assessed weight-for-age Z-scores (WAZ) as an objective measure of diarrhea impact. Filter use was high, with 96% (596/620) of household visits meeting the criteria for users. The quality of water stored in intervention households was significantly better than in control households (3 vs. 181 TTC/100 mL, respectively, p<0.001). The intervention was associated with reductions in the longitudinal prevalence of reported diarrhea of 53% among children <2 years (LPR = 0.47, 95% CI: 0.30–0.73, p = 0.001) and 54% among all household members (LPR = 0.46, 95% CI: 0.30–0.70, p<0.001). While reduced WAZ was associated with reported diarrhea (−0.26; 95% CI: −0.37 to −0.14, p<0.001), there was no difference in WAZ between intervention and control groups. Conclusion In this population living with HIV/AIDS, a water filter combined with safe storage was used correctly and consistently, was highly effective in improving drinking water quality, and was protective against diarrhea. Trial Registration Clinicaltrials.gov NCT01116908 PMID:23082124

[Quality of medicines in least developed countries].

PubMed

Videau, J Y

2006-12-01

Due to worsening economic conditions and poor enforcement of existing pharmaceutical and customs regulations, third world countries are faced with a growing threat from counterfeit and substandard medicines. With the expansion of illicit markets in urban areas, the sales of medicines of uncertain quality and origin are increasing. Most victims of this illicit trade are among the world's poorest populations that cannot afford to buy quality drugs through private-sector distribution channels. National pharmaceutical programs promoting universal access to essential generic medicines at reasonable cost are the key to curbing this problem. A system based on strict, rational pharmaceutical purchasing and distribution policies with quality assurance at every level of the supply chain is needed to guarantee that patients receive safe effective high quality healthcare products.

Safe and Sound: An Educational Leader's Guide to Evidence-Based Social and Emotional Learning (SEL) Programs

ERIC Educational Resources Information Center

Collaborative for Academic, Social, and Emotional Learning (NJ1), 2003

2003-01-01

This guide was developed to provide educators with information about nationally available programs for the classroom that promote social and emotional learning (SEL). It details the costs, the grades covered, evidence base, which most effectively teach core social and emotional skills, and which provide high-quality staff development and support.…

A spatial evaluation of global wildfire-water risks to human and natural systems

Treesearch

Francois-Nicolas Robinne; Kevin D. Bladon; Carol Miller; Marc-Andre Parisien; Jerome Mathieu; Mike D. Flannigan

2017-01-01

The large mediatic coverage of recent massive wildfires across the world has emphasized the vulnerability of freshwater resources. The extensive hydrogeomorphic effects from a wildfire can impair the ability of watersheds to provide safe drinking water to downstream communities and high-quality water to maintain riverine ecosystem health. Safeguarding water use for...

Avionics Integrity Program (AVIP). Volume 1. Procurement Phase Issues - Design, Manufacturing, and Integration

DTIC Science & Technology

1984-03-01

Engineering initiative to develop an orderly plan and procedure to assure that USAF acquire reliable, high quality, supportable avionics with a higher avail...susceptibility te~t~ (radiated and conducted), and emission of radio frequency energy tests."l6) Other electrical stresses can include over/under voltage...jo ints, poor welds, and dielectric defects. Also, instruments with components unable to endu very high temperatures can be safely tested. 1-19

A cross sectional comparison of postnatal care quality in facilities participating in a maternal health voucher program versus non-voucher facilities in Kenya.

PubMed

Warren, Charlotte E; Abuya, Timothy; Kanya, Lucy; Obare, Francis; Njuki, Rebecca; Temmerman, Marleen; Bellows, Ben

2015-07-24

Health service fees constitute substantial barriers for women seeking childbirth and postnatal care. In an effort to reduce health inequities, the government of Kenya in 2006 introduced the output-based approach (OBA), or voucher programme, to increase poor women's access to quality Safe Motherhood services including postnatal care. To help improve service quality, OBA programmes purchase services on behalf of the poor and marginalised, with provider reimbursements for verified services. Kenya's programme accredited health facilities in three districts as well as in two informal Nairobi settlements. Postnatal care quality in voucher health facilities (n = 21) accredited in 2006 and in similar non-voucher health facilities (n = 20) are compared with cross sectional data collected in 2010. Summary scores for quality were calculated as additive sums of specific aspects of each attribute (structure, process, outcome). Measures of effect were assessed in a linear regression model accounting for clustering at facility level. Data were analysed using Stata 11.0. The overall quality of postnatal care is poor in voucher and non-voucher facilities, but many facilities demonstrated 'readiness' for postnatal care (structural attributes: infrastructure, equipment, supplies, staffing, training) indicated by high scores (83/111), with public voucher facilities scoring higher than public non-voucher facilities. The two groups of facilities evinced no significant differences in postnatal care mean process scores: 14.2/55 in voucher facilities versus 16.4/55 in non-voucher facilities; coefficient: -1.70 (-4.9, 1.5), p = 0.294. Significantly more newborns were seen within 48 hours (83.5% versus 72.1%: p = 0.001) and received Bacillus Calmette-Guerin (BCG) (82.5% versus 76.5%: p < 0.001) at voucher facilities than at non-voucher facilities. Four years after facility accreditation in Kenya, scores for postnatal care quality are low in all facilities, even those with Safe Motherhood vouchers. We recommend the Kenya OBA programme review its Safe Motherhood reimbursement package and draw lessons from supply side results-based financing initiatives, to improve postnatal care quality.

Is a structured, manualized, evidence-based treatment protocol culturally competent and equivalently effective among American Indian parents in child welfare?

PubMed

Chaffin, Mark; Bard, David; Bigfoot, Dolores Subia; Maher, Erin J

2012-08-01

In a statewide implementation, the manualized SafeCare home-based model was effective in reducing child welfare recidivism and producing high client satisfaction. Concerns about the effectiveness and acceptability of structured, manualized models with American Indians have been raised in the literature, but have rarely been directly tested. This study tests recidivism reduction equivalency and acceptability among American Indian parents. A subpopulation of 354 American Indian parents was drawn from a larger trial that compared services with versus without modules of the SafeCare model. Outcomes were 6-year recidivism, pre/post/follow-up measures of depression and child abuse potential, and posttreatment consumer ratings of working alliance, service satisfaction, and cultural competency. Recidivism reduction among American Indian parents was found to be equivalent for cases falling within customary SafeCare inclusion criteria. When extended to cases outside customary inclusion boundaries, there was no apparent recidivism advantage or disadvantage. Contrary to concerns, SafeCare had higher consumer ratings of cultural competency, working alliance, service quality, and service benefit. Findings support using SafeCare with American Indians parents who meet customary SafeCare inclusion criteria. Findings do not support concerns in the literature that a manualized, structured, evidence-based model might be less effective or culturally unacceptable for American Indians.

Is a Structured, Manualized, Evidence-Based Treatment Protocol Culturally Competent and Equivalently Effective Among American Indian Parents in Child Welfare?

PubMed Central

Chaffin, Mark; Bard, David; Bigfoot, Dolores Subia; Maher, Erin J.

2015-01-01

In a statewide implementation, the manualized SafeCare home–based model was effective in reducing child welfare recidivism and producing high client satisfaction. Concerns about the effectiveness and acceptability of structured, manualized models with American Indians have been raised in the literature, but have rarely been directly tested. This study tests recidivism reduction equivalency and acceptability among American Indian parents. A subpopulation of 354 American Indian parents was drawn from a larger trial that compared services with versus without modules of the SafeCare model. Outcomes were 6-year recidivism, pre/post/follow-up measures of depression and child abuse potential, and posttreatment consumer ratings of working alliance, service satisfaction, and cultural competency. Recidivism reduction among American Indian parents was found to be equivalent for cases falling within customary SafeCare inclusion criteria. When extended to cases outside customary inclusion boundaries, there was no apparent recidivism advantage or disadvantage. Contrary to concerns, SafeCare had higher consumer ratings of cultural competency, working alliance, service quality, and service benefit. Findings support using SafeCare with American Indians parents who meet customary SafeCare inclusion criteria. Findings do not support concerns in the literature that a manualized, structured, evidence-based model might be less effective or culturally unacceptable for American Indians. PMID:22927674

Quality Assurance/Quality Control Jobs

NASA Astrophysics Data System (ADS)

Fanslau, Melody; Young, Janelle

The production of a quality and safe food product is essential to the success of any food manufacturing facility. Because of this great importance, a career in quality can be extremely rewarding. Without happy customers willing to buy a product, a company would not be able to survive. Quality issues such as foreign objects, spoiled or mislabeled product, failure to meet net weight requirements, or a recall can all turn customers away from buying a product. The food industry is a customer-driven market in which some consumers are brand loyal based on a history of high quality or in which a single bad experience with a product will turn them away for a lifetime. With this said, the main role of a quality department is to help ensure that quality issues such as these are eliminated or kept to a minimum to maintain or increase the number of customers purchasing their product.

Safe Handover : Safe Patients - The Electronic Handover System.

PubMed

Till, Alex; Sall, Hanish; Wilkinson, Jonathan

2014-01-01

Failure of effective handover is a major preventable cause of patient harm. We aimed to promote accurate recording of high-quality clinical information using an Electronic Handover System (EHS) that would contribute to a sustainable improvement in effective patient care and safety. Within our hospital the human factors associated with poor communication were compromising patient care and unnecessarily increasing the workload of staff due to the poor quality of handovers. Only half of handovers were understood by the doctors expected to complete them, and more than half of our medical staff felt it posed a risk to patient safety. We created a standardised proforma for handovers that contained specific sub-headings, re-classified patient risk assessments, and aided escalation of care by adding prompts for verbal handover. Sources of miscommunication were removed, accountability for handovers provided, and tasks were re-organised to reduce the workload of staff. Long-term, three-month data showed that each sub-heading achieved at least 80% compliance (an average improvement of approximately 40% for the overall quality of handovers). This translated into 91% of handovers being subjectively clear to junior doctors. 87% of medical staff felt we had reduced a risk to patient safety and 80% felt it increased continuity of care. Without guidance, doctors omit key information required for effective handover. All organisations should consider implementing an electronic handover system as a viable, sustainable and safe solution to handover of care that allows patient safety to remain at the heart of the NHS.

Safe Handover : Safe Patients – The Electronic Handover System

PubMed Central

Till, Alex; Sall, Hanish; Wilkinson, Jonathan

2014-01-01

Failure of effective handover is a major preventable cause of patient harm. We aimed to promote accurate recording of high-quality clinical information using an Electronic Handover System (EHS) that would contribute to a sustainable improvement in effective patient care and safety. Within our hospital the human factors associated with poor communication were compromising patient care and unnecessarily increasing the workload of staff due to the poor quality of handovers. Only half of handovers were understood by the doctors expected to complete them, and more than half of our medical staff felt it posed a risk to patient safety. We created a standardised proforma for handovers that contained specific sub-headings, re-classified patient risk assessments, and aided escalation of care by adding prompts for verbal handover. Sources of miscommunication were removed, accountability for handovers provided, and tasks were re-organised to reduce the workload of staff. Long-term, three-month data showed that each sub-heading achieved at least 80% compliance (an average improvement of approximately 40% for the overall quality of handovers). This translated into 91% of handovers being subjectively clear to junior doctors. 87% of medical staff felt we had reduced a risk to patient safety and 80% felt it increased continuity of care. Without guidance, doctors omit key information required for effective handover. All organisations should consider implementing an electronic handover system as a viable, sustainable and safe solution to handover of care that allows patient safety to remain at the heart of the NHS. PMID:26734244

Analysis of feature selection with Probabilistic Neural Network (PNN) to classify sources influencing indoor air quality

NASA Astrophysics Data System (ADS)

Saad, S. M.; Shakaff, A. Y. M.; Saad, A. R. M.; Yusof, A. M.; Andrew, A. M.; Zakaria, A.; Adom, A. H.

2017-03-01

There are various sources influencing indoor air quality (IAQ) which could emit dangerous gases such as carbon monoxide (CO), carbon dioxide (CO2), ozone (O3) and particulate matter. These gases are usually safe for us to breathe in if they are emitted in safe quantity but if the amount of these gases exceeded the safe level, they might be hazardous to human being especially children and people with asthmatic problem. Therefore, a smart indoor air quality monitoring system (IAQMS) is needed that able to tell the occupants about which sources that trigger the indoor air pollution. In this project, an IAQMS that able to classify sources influencing IAQ has been developed. This IAQMS applies a classification method based on Probabilistic Neural Network (PNN). It is used to classify the sources of indoor air pollution based on five conditions: ambient air, human activity, presence of chemical products, presence of food and beverage, and presence of fragrance. In order to get good and best classification accuracy, an analysis of several feature selection based on data pre-processing method is done to discriminate among the sources. The output from each data pre-processing method has been used as the input for the neural network. The result shows that PNN analysis with the data pre-processing method give good classification accuracy of 99.89% and able to classify the sources influencing IAQ high classification rate.

Water You Engineering? An Activity to Develop Water-Quality Awareness

ERIC Educational Resources Information Center

Riskowski, Jody; Todd, Carrie Davis

2009-01-01

Water is one of our most precious resources. However, for many in the United States, having fresh, safe drinking water is taken for granted, and due to this perceived lack of relevance, students may not fully appreciate the luxury of having safe running water--in the home. One approach to resolving water-quality issues in the United States may…

Chlorine and Solute Transport and Reactions in Drinking Water Distribution: The Role of Flow Hydrodynamics on Water Quality Changes and Multi-Criteria Compliance

EPA Science Inventory

Safe drinking water supply is one of the most notable modern engineering achievements in the 20th century. It is a centerpiece of the U.S. environmental protection effort under the federal Safe Drinking Water Act (SDWA) and its amendments. In this chapter, water quality changes a...

Food and Drug Administration: Helping pharmacists ensure that patients receive high-quality medicines.

PubMed

Kremzner, Mary

2016-01-01

Ensuring that the drugs patients take are safe and effective is critical to the Food and Drug Administration (FDA) mission and a major reason for testing an active pharmaceutical ingredient or currently marketed drug product. To address gaps in the assessment of drug quality, FDA's Center for Drug Evaluation and Research (CDER) has created the Office of Pharmaceutical Quality (OPQ). This newly formed "super-office" within CDER launched a concerted new strategy that enhances the surveillance of drug manufacturing and will bring a comprehensive approach to quality oversight. With OPQ and these new performance measures in place, FDA can sharpen its focus on issues critical to quality and can identify and respond to manufacturing issues before they become major systemic problems. Published by Elsevier Inc.

The quality of our Nation's waters: Water quality in principal aquifers of the United States, 1991-2010

USGS Publications Warehouse

DeSimone, Leslie A.; McMahon, Peter B.; Rosen, Michael R.

2015-01-01

About 130 million people in the United States rely on groundwater for drinking water, and the need for high-quality drinking-water supplies becomes more urgent as our population grows. Although groundwater is a safe, reliable source of drinking water for millions of people nationwide, high concentrations of some chemical constituents can pose potential human-health concerns. Some of these contaminants come from the rocks and sediments of the aquifers themselves, and others are chemicals that we use in agriculture, industry, and day-to-day life. When groundwater supplies are contaminated, millions of dollars can be required for treatment so that the supplies can be usable. Contaminants in groundwater can also affect the health of our streams and valuable coastal waters. By knowing where contaminants occur in groundwater, what factors control contaminant concentrations, and what kinds of changes in groundwater quality might be expected in the future, we can ensure the availability and quality of this vital natural resource in the future.

An Integrated Data-Driven Strategy for Safe-by-Design Nanoparticles: The FP7 MODERN Project.

PubMed

Brehm, Martin; Kafka, Alexander; Bamler, Markus; Kühne, Ralph; Schüürmann, Gerrit; Sikk, Lauri; Burk, Jaanus; Burk, Peeter; Tamm, Tarmo; Tämm, Kaido; Pokhrel, Suman; Mädler, Lutz; Kahru, Anne; Aruoja, Villem; Sihtmäe, Mariliis; Scott-Fordsmand, Janeck; Sorensen, Peter B; Escorihuela, Laura; Roca, Carlos P; Fernández, Alberto; Giralt, Francesc; Rallo, Robert

2017-01-01

The development and implementation of safe-by-design strategies is key for the safe development of future generations of nanotechnology enabled products. The safety testing of the huge variety of nanomaterials that can be synthetized is unfeasible due to time and cost constraints. Computational modeling facilitates the implementation of alternative testing strategies in a time and cost effective way. The development of predictive nanotoxicology models requires the use of high quality experimental data on the structure, physicochemical properties and bioactivity of nanomaterials. The FP7 Project MODERN has developed and evaluated the main components of a computational framework for the evaluation of the environmental and health impacts of nanoparticles. This chapter describes each of the elements of the framework including aspects related to data generation, management and integration; development of nanodescriptors; establishment of nanostructure-activity relationships; identification of nanoparticle categories; hazard ranking and risk assessment.

[Necessary changes for advancing nursing as caring science].

PubMed

de Pires, Denise Elvira Pires

2013-09-01

The article aimed to reflect upon the challenges involved in strengthening Nursing as a caring science. It is founded on the sociological theory, connecting three approaches: the historical-dialectic materialism perspective about the working process in health care and nursing; the sociology of professions from a critical perspective; and the philosophy of science. The discussion is organized considering the aspects of Nursing as a discipline, work and health care profession. It sustains that knowledge production should be driven both by the purpose of Nursing work which is providing care to human beings with health needs and to advocate for the indispensable work conditions to a safe and responsible practice. It concludes that to strengthening Nursing it is necessary to produce knowledge to support nursing care and the political actions defending safe work conditions, the universal right to health as well safe and high quality care.

Emerging technology: A key enabler for modernizing pharmaceutical manufacturing and advancing product quality.

PubMed

O'Connor, Thomas F; Yu, Lawrence X; Lee, Sau L

2016-07-25

Issues in product quality have produced recalls and caused drug shortages in United States (U.S.) in the past few years. These quality issues were often due to outdated manufacturing technologies and equipment as well as lack of an effective quality management system. To ensure consistent supply of safe, effective and high-quality drug products available to the patients, the U.S. Food and Drug Administration (FDA) supports modernizing pharmaceutical manufacturing for improvements in product quality. Specifically, five new initiatives are proposed here to achieve this goal. They include: (i) advancing regulatory science for pharmaceutical manufacturing; (ii) establishing a public-private institute for pharmaceutical manufacturing innovation; (iii) creating incentives for investment in the technological upgrade of manufacturing processes and facilities; (iv) leveraging external expertise for regulatory quality assessment of emerging technologies; and (v) promoting the international harmonization of approaches for expediting the global adoption of emerging technologies. Published by Elsevier B.V.

Effects of Forest and Grassland Management On Drinking Water Quality for Public Water Supplies:A Review And Synthesis of the Scientific Literature - Review Draft

Treesearch

George E. Dissmeyer

1999-01-01

The Importance of Safe Public Drinking Water The United States Congress justified passing the Safe Drinking Water Amendments (SDWA) of 1996 (P. L. 104-182) by stating "safe drinking water is essential to the protection of public health".For 50 years the basic axiom for public health protection has been safe drinking water...

Use of Individual Feedback during Human Gross Anatomy Course for Enhancing Professional Behaviors in Doctor of Physical Therapy Students

ERIC Educational Resources Information Center

Youdas, James W.; Krause, David A.; Hellyer, Nathan J.; Rindflesch, Aaron B.; Hollman, John H.

2013-01-01

Medical professionals and public consumers expect that new physical therapy graduates possess cognitive, technical, and behavioral skills required to provide safe and high-quality care to patients. The purpose of this study was to determine if a repertoire of ten professional behaviors assessed at the beginning of doctorate of physical therapy…

The Impact of a Reflective Thinking Intervention on Nursing Students in a Child and Family Nursing Course

ERIC Educational Resources Information Center

Becherer, Vicky H.

2011-01-01

With the ever-changing healthcare systems, nursing students need to think at a high level by applying their knowledge from theory to the clinical setting by prioritizing, delegating, and problem solving to provide safe, competent, quality nursing care. Using action research, nursing students participated in R.A.V.E. (Reflective Thinking Allows…

78 FR 73921 - California High-Speed Rail Authority-Construction Exemption-In Fresno, Kings, Tulare, and Kern...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-09

... of the Authorization & Issuance of Gen. Obligation Bonds to be Issued Pursuant to the Safe, Reliable... under the National Environmental Policy Act, 42 U.S.C. 4321 et seq. OEA is currently working with FRA.... 10502(b). This action will not significantly affect either the quality of the human environment or the...

Guide for Developing High-Quality Emergency Operations Plans for Institutions of Higher Education

ERIC Educational Resources Information Center

Office of Safe and Healthy Students, US Department of Education, 2013

2013-01-01

Our nation's postsecondary institutions are entrusted to provide a safe and healthy learning environment for students, faculty, and staff who live, work, and study on campus. Many of these emergencies occur with little to no warning; therefore, it is critical for institutions of higher education (IHEs) to plan ahead to help ensure the safety and…

A Preliminary Assessment of HTST Processing on Donkey Milk

PubMed Central

Antoniazzi, Sara; Gariglio, Gian Marco; Coscia, Alessandra; Bertino, Enrico; Cavallarin, Laura

2017-01-01

Due to increasing attention from consumers on non-bovine milk types, and to the increase in the number of small dairy donkey farms in Italy, farmers require more advanced and reliable processing devices, in order to guarantee a safe product of high quality. To this aim, a new small-scale High-Temperature Short-Time (HTST) pasteurizer (72 °C for 15 s), prototyped by the authors, was tested on donkey milk. The efficacy of the HTST device was tested on raw donkey milk microflora by enumeration of total aerobic bacteria, Enterobacteriaceae and Bacillus cereus. The biochemical quality was assessed by determining the protein profile by monodimensional electrophoresis and by measuring lysozyme activity. The HTST apparatus was able to reduce the total bacteria count, and to completely eradicate Enterobacteriaceae. Bacillus cereus, when present, was decreased with low efficiency. Changes in the protein profile were observed in milk pasteurized in accordance with both processes, although HTST seemed to limit casein degradation. Lysozyme activity was not substantially affected in comparison to raw donkey milk. In conclusion, a tailored small-volume HTST device could be safely applied to pasteurize donkey milk in on-farm pasteurization processes on small dairy donkey farms. PMID:29056708

A Preliminary Assessment of HTST Processing on Donkey Milk.

PubMed

Giribaldi, Marzia; Antoniazzi, Sara; Gariglio, Gian Marco; Coscia, Alessandra; Bertino, Enrico; Cavallarin, Laura

2017-10-09

Due to increasing attention from consumers on non-bovine milk types, and to the increase in the number of small dairy donkey farms in Italy, farmers require more advanced and reliable processing devices, in order to guarantee a safe product of high quality. To this aim, a new small-scale High-Temperature Short-Time (HTST) pasteurizer (72 °C for 15 s), prototyped by the authors, was tested on donkey milk. The efficacy of the HTST device was tested on raw donkey milk microflora by enumeration of total aerobic bacteria, Enterobacteriaceae and Bacillus cereus. The biochemical quality was assessed by determining the protein profile by monodimensional electrophoresis and by measuring lysozyme activity. The HTST apparatus was able to reduce the total bacteria count, and to completely eradicate Enterobacteriaceae. Bacillus cereus, when present, was decreased with low efficiency. Changes in the protein profile were observed in milk pasteurized in accordance with both processes, although HTST seemed to limit casein degradation. Lysozyme activity was not substantially affected in comparison to raw donkey milk. In conclusion, a tailored small-volume HTST device could be safely applied to pasteurize donkey milk in on-farm pasteurization processes on small dairy donkey farms.

Drug development and nonclinical to clinical translational databases: past and current efforts.

PubMed

Monticello, Thomas M

2015-01-01

The International Consortium for Innovation and Quality (IQ) in Pharmaceutical Development is a science-focused organization of pharmaceutical and biotechnology companies. The mission of the Preclinical Safety Leadership Group (DruSafe) of the IQ is to advance science-based standards for nonclinical development of pharmaceutical products and to promote high-quality and effective nonclinical safety testing that can enable human risk assessment. DruSafe is creating an industry-wide database to determine the accuracy with which the interpretation of nonclinical safety assessments in animal models correctly predicts human risk in the early clinical development of biopharmaceuticals. This initiative aligns with the 2011 Food and Drug Administration strategic plan to advance regulatory science and modernize toxicology to enhance product safety. Although similar in concept to the initial industry-wide concordance data set conducted by International Life Sciences Institute's Health and Environmental Sciences Institute (HESI/ILSI), the DruSafe database will proactively track concordance, include exposure data and large and small molecules, and will continue to expand with longer duration nonclinical and clinical study comparisons. The output from this work will help identify actual human and animal adverse event data to define both the reliability and the potential limitations of nonclinical data and testing paradigms in predicting human safety in phase 1 clinical trials. © 2014 by The Author(s).

Safe use of vaccines and vaccine compliance with food safety requirements.

PubMed

Grein, K; Papadopoulos, O; Tollis, M

2007-08-01

Advanced technologies and regulatory regimes have contributed to the availability of veterinary vaccines that have high quality and favourable safety profiles in terms of potential risks posed to the target animals, the persons who come into contact with the vaccine, the consumers of food derived from vaccinated animals and the environment. The authorisation process requires that a range of safety studies are provided to evaluate the products. The design and production of vaccines, and their safe use, are primarily assessed by using data gathered from extensive pre-marketing studies performed on target animals and specific quality tests. The current post-marketing safeguards include good manufacturing practices, batch safety testing, inspections and pharmacovigilance. In addition to hazard identification, a full benefit/risk evaluation needs to be undertaken. The outcome of that evaluation will determine options for risk management and affect regulatory decisions on the safety of the vaccine; options might, for example, include special warnings on package inserts and labels.

Safe working hours--doctors in training a best practice issue.

PubMed

Lewis, Andrew

2002-01-01

In 1995, the Australian Medical Association launched its Safe Working Hours campaign. By 1998, this had been developed into a National Code of Conduct that continues to resonate in the Australian public health system. However, and particularly in respect of Doctors in Training (DITs) who continue to work long hours, there are levels of resistance to proposals that seek to re-organise work or change prevailing professional and cultural expectations. Long working hours have substantial impacts on a DIT's capacity to consistently deliver high quality patient care, dilute the effectiveness of their training regime and have negative consequences on their health, social life and family responsibilities. While public hospitals often maintain the view that minimal budget flexibility restricts their capacity to affect change in a positive way, in fact devisable productivity and efficiency gains can be achieved by reducing working hours. Further, the medical profession needs to consider whether long hours provide an optimal environment for quality learning and performance.

The Provision of Interventional Radiology Services in Europe: CIRSE Recommendations.

PubMed

Tsetis, Dimitrios; Uberoi, Raman; Fanelli, Fabrizio; Roberston, Iain; Krokidis, Miltiadis; van Delden, Otto; Radeleff, Boris; Müller-Hülsbeck, Stefan; Szerbo-Trojanowska, Malgorzata; Lee, Michael; Morgan, Robert; Brountzos, Elias; Belli, Anna Maria

2016-04-01

Interventional Radiology (IR) is an essential part of modern medicine, delivering minimally invasive patient-focused care, which has been proven to be safe and effective in both elective and emergency settings. The aim of this document is to outline the core requirements and standards for the provision of Interventional Radiological services, including training, certification, manpower, and accreditation. The ultimate challenge will be the adoption of these recommendations by different countries and health economies around the world, in turn ensuring equal access to IR treatments for all patients, the appropriate distribution of resources for IR service provision as well as the continued development of safe and high-quality IR services in Europe and beyond.

Fireworks Information Center

MedlinePlus

... Community Outreach Resource Center Toy Recall Statistics CO Poster Contest Pool Safely Business & Manufacturing Business & Manufacturing Business ... This Fourth of July Season View the Fireworks Poster Broadcast Quality Video from CPSC's #CelebrateSafely Fireworks Safety ...

High-intensity focused ultrasound (HIFU) for pancreatic carcinoma: evaluation of feasibility, reduction of tumour volume and pain intensity.

PubMed

Marinova, Milka; Rauch, Maximilian; Mücke, Martin; Rolke, Roman; Gonzalez-Carmona, Maria A; Henseler, Jana; Cuhls, Henning; Radbruch, Lukas; Strassburg, Christian P; Zhang, Lian; Schild, Hans H; Strunk, Holger M

2016-11-01

Prognosis of patients with locally advanced pancreatic adenocarcinoma is extremely poor. They often suffer from cancer-related pain reducing their quality of life. This prospective observational study aimed to evaluate feasibility, local tumour response, and changes in quality of life and symptoms in Caucasian patients with locally advanced pancreatic cancer treated by ultrasound-guided high-intensity focused ultrasound (HIFU). Thirteen patients underwent HIFU, five with stage III, eight with stage IV UICC disease. Ten patients received simultaneous palliative chemotherapy. Postinterventional clinical assessment included evaluation of quality of life and symptom changes using standardized questionnaires. CT and MRI follow-up evaluated the local tumour response. HIFU was successfully performed in all patients. Average tumour reduction was 34.2 % at 6 weeks and 63.9 % at 3 months. Complete or partial relief of cancer-related pain was achieved in 10 patients (77 %), five of whom required less analgesics for pain control. Quality of life was improved revealing increased global health status and alleviated symptoms. HIFU treatment was well tolerated. Eight patients experienced transient abdominal pain directly after HIFU. HIFU ablation of pancreatic carcinoma is a feasible, safe and effective treatment with a crucial benefit in terms of reduction of tumour volume and pain intensity. • US-guided HIFU is feasible and safe for patients with unresectable pancreatic cancer. • HIFU can considerably reduce tumour volume and cancer-related pain. • Patients treated with HIFU experienced significant and lasting reduction of pain intensity. • HIFU has a crucial clinical benefit for patients with pancreatic cancer.

The role of internationally educated nurses in a quality, safe workforce.

PubMed

D Sherwood, Gwen; Shaffer, Franklin A

2014-01-01

Migration and globalization of the nursing workforce affect source countries and destination countries. Policies and regulations governing the movement of nurses from one country to another safeguard the public by ensuring educational comparability and competence. The global movement of nurses and other health care workers calls for quality and safety competencies that meet standards such as those defined by the Institute of Medicine. This article examines nurse migration and employment of internationally educated nurses (IENs) in the context of supporting and maintaining safe, quality patient care environments. Migration to the United States is featured as an exemplar to consider the following key factors: the impact of nurse migration on the nursing workforce; issues in determining educational comparability of nursing programs between countries; quality and safety concerns in transitioning IENs into the workforce; and strategies for helping IENs transition as safe, qualified members of the nursing workforce in the destination country. Copyright © 2014 Elsevier Inc. All rights reserved.

Quality of life and sexuality issues in aging women.

PubMed

Birkhäuser, M H

2009-01-01

Quality of life may decrease after menopause. Hormone replacement therapy remains the first-line and most effective treatment for menopausal symptoms and improvement of low quality of life due to estrogen deficiency. The decrease of health-related quality of life in women suffering from cardiovascular disease may be superimposed on the decrease of quality of life induced by menopause itself. Postmenopausal women with acute cardiovascular disease have a significantly higher probability of death than men of the same age. Quality of life predicts long-term mortality. A myocardial infarction does not automatically interdict sexual activity. The Princeton guidelines classify patients suffering from cardiovascular diseases in three categories. Most patients belong to the low-risk category. In general, these patients can be safely encouraged to initiate or resume sexual activity or to receive treatment for sexual dysfunction. Patients at intermediate (or indeterminate) levels of risk should further receive cardiologic evaluation to be classified into either the low- or high-risk group. Patients in the high-risk category have to be stabilized by specific treatment for their cardiac condition before resumption of sexual activity, or initiation of treatment for sexual dysfunction.

Constructing a consumption model of fine dining from the perspective of behavioral economics

PubMed Central

Tsai, Sang-Bing

2018-01-01

Numerous factors affect how people choose a fine dining restaurant, including food quality, service quality, food safety, and hedonic value. A conceptual framework for evaluating restaurant selection behavior has not yet been developed. This study surveyed 150 individuals with fine dining experience and proposed the use of mental accounting and axiomatic design to construct a consumer economic behavior model. Linear and logistic regressions were employed to determine model correlations and the probability of each factor affecting behavior. The most crucial factor was food quality, followed by service and dining motivation, particularly regarding family dining. Safe ingredients, high cooking standards, and menu innovation all increased the likelihood of consumers choosing fine dining restaurants. PMID:29641554

Constructing a consumption model of fine dining from the perspective of behavioral economics.

PubMed

Hsu, Sheng-Hsun; Hsiao, Cheng-Fu; Tsai, Sang-Bing

2018-01-01

Numerous factors affect how people choose a fine dining restaurant, including food quality, service quality, food safety, and hedonic value. A conceptual framework for evaluating restaurant selection behavior has not yet been developed. This study surveyed 150 individuals with fine dining experience and proposed the use of mental accounting and axiomatic design to construct a consumer economic behavior model. Linear and logistic regressions were employed to determine model correlations and the probability of each factor affecting behavior. The most crucial factor was food quality, followed by service and dining motivation, particularly regarding family dining. Safe ingredients, high cooking standards, and menu innovation all increased the likelihood of consumers choosing fine dining restaurants.

High-level disinfection of gastrointestinal endoscope reprocessing

PubMed Central

Chiu, King-Wah; Lu, Lung-Sheng; Chiou, Shue-Shian

2015-01-01

High level disinfection (HLD) of the gastrointestinal (GI) endoscope is not simply a slogan, but rather is a form of experimental monitoring-based medicine. By definition, GI endoscopy is a semicritical medical device. Hence, such medical devices require major quality assurance for disinfection. And because many of these items are temperature sensitive, low-temperature chemical methods, such as liquid chemical germicide, must be used rather than steam sterilization. In summarizing guidelines for infection prevention and control for GI endoscopy, there are three important steps that must be highlighted: manual washing, HLD with automated endoscope reprocessor, and drying. Strict adherence to current guidelines is required because compared to any other medical device, the GI endoscope is associated with more outbreaks linked to inadequate cleaning or disinfecting during HLD. Both experimental evaluation on the surveillance bacterial cultures and in-use clinical results have shown that, the monitoring of the stringent processes to prevent and control infection is an essential component of the broader strategy to ensure the delivery of safe endoscopy services, because endoscope reprocessing is a multistep procedure involving numerous factors that can interfere with its efficacy. Based on our years of experience in the surveillance of culture monitoring of endoscopic reprocessing, we aim in this study to carefully describe what details require attention in the GI endoscopy disinfection and to share our experience so that patients can be provided with high quality and safe medical practices. Quality management encompasses all aspects of pre- and post-procedural care including the efficiency of the endoscopy unit and reprocessing area, as well as the endoscopic procedure itself. PMID:25699232

When Is Safe, Safe Enough?

ERIC Educational Resources Information Center

Neil, Kirk

2002-01-01

Discusses events affecting parental school-safety concerns and what school districts can do to alleviate those concerns. Addresses post-September 11 crisis-management procedures, preventing sports-related student deaths, maintaining healthy indoor air quality. (PKP)

Quality Indicators for Safe Medication Preparation and Administration: A Systematic Review

PubMed Central

Maaskant, Jolanda M.; de Boer, Monica; Krediet, C. T. Paul; Nieveen van Dijkum, Els J. M.

2015-01-01

Background One-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used. Objectives The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration. Methods MEDLINE, EMBASE and CINAHL were searched for relevant studies published up to January 2015. Additionally, nine databases were searched to identify relevant grey literature. Two reviewers independently selected studies if (1) the method for quality indicator development combined a literature search with expert panel opinion, (2) the study contained quality indicators on medication safety, and (3) any of the quality indicators were applicable to hospital medication preparation and administration. A multidisciplinary team appraised the studies independently using the AIRE instrument, which contains four domains and 20 items. Quality indicators applicable to in-hospital medication preparation and administration were extracted using a structured form. Results The search identified 1683 studies, of which 64 were reviewed in detail and five met the inclusion criteria. Overall, according to the AIRE domains, all studies were clear on purpose; most of them applied stakeholder involvement and used evidence reasonably; usage of the indicator in practice was scarcely described. A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death). These quality indicators partially cover the 7 rights. Conclusion Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting point for further development of nursing specific quality indicators for medication safety. Especially on the right patient, right route, right time and right documentation there is room future development of quality indicators. PMID:25884623

Groundwater quality in Ghaziabad district, Uttar Pradesh, India: Multivariate and health risk assessment.

PubMed

Chabukdhara, Mayuri; Gupta, Sanjay Kumar; Kotecha, Yatharth; Nema, Arvind K

2017-07-01

This study aimed to assess the quality of groundwater and potential health risk due to ingestion of heavy metals in the peri-urban and urban-industrial clusters of Ghaziabad district, Uttar Pradesh, India. Furthermore, the study aimed to evaluate heavy metals sources and their pollution level using multivariate analysis and fuzzy comprehensive assessment (FCA), respectively. Multivariate analysis using principle component analysis (PCA) showed mixed origin for Pb, Cd, Zn, Fe, and Ni, natural source for Cu and Mn and anthropogenic source for Cr. Among all the metals, Pb, Cd, Fe and Ni were above the safe limits of Bureau of Indian Standards (BIS) and World Health Organization (WHO) except Ni. Health risk in terms of hazard quotient (HQ) showed that the HQ values for children were higher than the safe level (HQ = 1) for Pb (2.4) and Cd (2.1) in pre-monsoon while in post-monsoon the value exceeded only for Pb (HQ = 1.23). The health risks of heavy metals for the adults were well within safe limits. The finding of this study indicates potential health risks to the children due to chronic exposure to contaminated groundwater in the region. Based on FCA, groundwater pollution could be categorized as quite high in the peri-urban region, and absolutely high in the urban region of Ghaziabad district. This study showed that different approaches are required for the integrated assessment of the groundwater pollution, and provides a scientific basis for the strategic future planning and comprehensive management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Steering teens safe: a randomized trial of a parent-based intervention to improve safe teen driving.

PubMed

Peek-Asa, Corinne; Cavanaugh, Joseph E; Yang, Jingzhen; Chande, Vidya; Young, Tracy; Ramirez, Marizen

2014-07-31

Crashes are the leading cause of death for teens, and parent-based interventions are a promising approach. We assess the effectiveness of Steering Teens Safe, a parent-focused program to increase safe teen driving. Steering Teens Safe aimed to improve parental communication with teens about safe driving using motivational interviewing techniques in conjunction with 19 safe driving lessons. A randomized controlled trial involved 145 parent-teen dyads (70 intervention and 75 control). Intervention parents received a 45-minute session to learn the program with four follow-up phone sessions, a DVD, and a workbook. Control parents received a standard brochure about safe driving. Scores were developed to measure teen-reported quantity and quality of parental communication about safe driving. The main outcome measure was a previously validated Risky Driving Score reported by teens. Because the Score was highly skewed, a generalized linear model based on a gamma distribution was used for analysis. Intervention teens ranked their parent's success in talking about driving safety higher than control teens (p = 0.035) and reported that their parents talked about more topics (non-significant difference). The Risky Driving Score was 21% lower in intervention compared to control teens (85% CI = 0.60, 1.00). Interaction between communication quantity and the intervention was examined. Intervention teens who reported more successful communication had a 42% lower Risky Driving Score (95% CI = 0.37, 0.94) than control parents with less successful communication. This program had a positive although not strong effect, and it may hold the most promise in partnership with other programs, such as Driver's Education or Graduated Driver's License policies. ClinicalTrials.gov NCT01014923. Registered Nov. 16, 2009.

Shaping the Health Policy Agenda: The Case of Safe Motherhood Policy in Vietnam

PubMed Central

Ha, Bui Thi Thu; Mirzoev, Tolib; Mukhopadhyay, Maitrayee

2015-01-01

Background: Maternal health remains a central policy concern in Vietnam. With a commitment to achieving the Millennium Development Goal (MDG) 5 target of maternal mortality rate (MMR) of 70/100 000 by 2015, the Ministry of Health (MoH) issued the National Plan for Safe Motherhood (NPSM) 2003-2010. In 2008, reproductive health, including safe motherhood (SM) became a national health target program with annual government funding. Methods: A case study of how SM emerged as a political priority in Vietnam over the period 2001-2008, drawing on Kingdon’s theory of agenda-setting was conducted. A mixed method was adopted for this study of the NPSM. Results: Three related streams contributed to SM priority in Vietnam: (1) the problem of high MMR was officially recognized from high-quality research, (2) the strong roles of policy champion from MoH in advocating for the needs to reducing MMR as well as support from government and donors, and (3) the national and international events, providing favorable context for this issue to emerge on policy agenda. Conclusion: This paper draws on the theory of agenda-setting to analyze the Vietnam experience and to develop guidance for SM a political priority in other high maternal mortality communities. PMID:26673334

Ultrasound Applications in Food Processing

NASA Astrophysics Data System (ADS)

Bermúdez-Aguirre, Daniela; Mobbs, Tamara; Barbosa-Cánovas, Gustavo V.

Food scientists today are focused on the development of not only microbiologically safe products with a long storage life, but, at the same time, products that have fresh-like characteristics and a high quality in taste, flavor, and texture. This focus is based on the needs of the consumer, which is one of the main reasons for constant research in the so-called area of emerging technologies. Traditionally, thermal treatments have been used to produce safe food products. Pasteurization of juice, milk, beer, and wine is a common process in which the final product has a storage life of some weeks (generally under refrigeration). However, vitamins, taste, color, and other sensorial characteristics are decreased with this treatment. High temperature is responsible for these effects and can be observed in the loss of nutritional components and changes in flavor, taste, and texture, often creating the need for additives to improve the product.

[Product safety analysis of somatic cell cloned bovine].

PubMed

Hua, Song; Lan, Jie; Song, Yongli; Lu, Chenglong; Zhang, Yong

2010-05-01

Somatic cell cloning (nuclear transfer) is a technique through which the nucleus (DNA) of a somatic cell is transferred into an enucleated oocyte for the generation of a new individual, genetically identical to the somatic cell donor. It could be applied for the enhancement of reproduction rate and the improvement of food products involving quality, yield and nutrition. In recent years, the United States, Japan and Europe as well as other countries announced that meat and milk products made from cloned cattle are safe for human consumption. Yet, cloned animals are faced with a wide range of health problems, with a high death rate and a high incidence of disease. The precise causal mechanisms for the low efficiency of cloning remain unclear. Is it safe that any products from cloned animals were allowed into the food supply? This review focuses on the security of meat, milk and products from cloned cattle based on the available data.

Bio-analytical applications of microbial fuel cell-based biosensors for onsite water quality monitoring.

PubMed

ElMekawy, A; Hegab, H M; Pant, D; Saint, C P

2018-01-01

Globally, sustainable provision of high-quality safe water is a major challenge of the 21st century. Various chemical and biological monitoring analytics are presently utilized to guarantee the availability of high-quality water. However, these techniques still face some challenges including high costs, complex design and onsite and online limitations. The recent technology of using microbial fuel cell (MFC)-based biosensors holds outstanding potential for the rapid and real-time monitoring of water source quality. MFCs have the advantages of simplicity in design and efficiency for onsite sensing. Even though some sensing applications of MFCs were previously studied, e.g. biochemical oxygen demand sensor, recently numerous research groups around the world have presented new practical applications of this technique, which combine multidisciplinary scientific knowledge in materials science, microbiology and electrochemistry fields. This review presents the most updated research on the utilization of MFCs as potential biosensors for monitoring water quality and considers the range of potentially toxic analytes that have so far been detected using this methodology. The advantages of MFCs over established technology are also considered as well as future work required to establish their routine use. © 2017 The Society for Applied Microbiology.

Co-precipitation of protein and polyester as a method to isolate high molecular weight DNA.

PubMed

Dixson, Jamie D

2005-02-01

DNA isolation is often the limiting step in genetic analysis using PCR and automated fragment analysis due to low quality or purity of DNA, the need to determine and adjust DNA concentrations after isolation etc. Several protocols have been developed which are either safe and provide good quality DNA or hazardous and provide excellent quality DNA. In this brief communication I describe a new and rapid method of DNA isolation which employs the co-precipitation of protein and polyester, in the presence of acetone, to remove contaminating proteins from a lysed-tissue sample, thus leaving high quality pure DNA. The advantages of this method are increased safety over the phenol:chloroform and the chaotrophic salt methods and increased purity over the salting-out method. Since the concentrations of DNA isolated using this method are relatively consistent regardless of the amount of starting tissue (within limits), adjustments of the DNA concentrations before use as templates in PCR's are not necessary.

Meeting the requirements of importing countries: practice and policy for on-farm approaches to food safety.

PubMed

Dagg, P J; Butler, R J; Murray, J G; Biddle, R R

2006-08-01

In light of the increasing consumer demand for safe, high-quality food and recent public health concerns about food-borne illness, governments and agricultural industries are under pressure to provide comprehensive food safety policies and programmes consistent with international best practice. Countries that export food commodities derived from livestock must meet both the requirements of the importing country and domestic standards. It is internationally accepted that end-product quality control, and similar methods aimed at ensuring food safety, cannot adequately ensure the safety of the final product. To achieve an acceptable level of food safety, governments and the agricultural industry must work collaboratively to provide quality assurance systems, based on sound risk management principles, throughout the food supply chain. Quality assurance systems on livestock farms, as in other parts of the food supply chain, should address food safety using hazard analysis critical control point principles. These systems should target areas including biosecurity, disease monitoring and reporting, feedstuff safety, the safe use of agricultural and veterinary chemicals, the control of potential food-borne pathogens and traceability. They should also be supported by accredited training programmes, which award certification on completion, and auditing programmes to ensure that both local and internationally recognised guidelines and standards continue to be met. This paper discusses the development of policies for on-farm food safety measures and their practical implementation in the context of quality assurance programmes, using the Australian beef industry as a case study.

Dynamic stability and handling qualities tests on a highly augmented, statically unstable airplane

NASA Technical Reports Server (NTRS)

Gera, Joseph; Bosworth, John T.

1987-01-01

Initial envelope clearance and subsequent flight testing of a new, fully augmented airplane with an extremely high degree of static instability can place unusual demands on the flight test approach. Previous flight test experience with these kinds of airplanes is very limited or nonexistent. The safe and efficient flight testing may be further complicated by a multiplicity of control effectors that may be present on this class of airplanes. This paper describes some novel flight test and analysis techniques in the flight dynamics and handling qualities area. These techniques were utilized during the initial flight envelope clearance of the X-29A aircraft and were largely responsible for the completion of the flight controls clearance program without any incidents or significant delays.

Embedding quality improvement and patient safety at Liverpool Women's NHS Foundation Trust.

PubMed

Scholefield, Helen

2007-08-01

The provision of safe high-quality care in obstetrics and gynaecology is a key target in the UK National Health Service (NHS), in part because of the high cost of litigation in this area. Good risk management processes should improve safety and reduce the cost of litigation to the NHS. This chapter looks at structures and processes for improving quality and patient safety, using the stepwise approach described by the National Patient Safety Authority (NPSA). This encompasses building a safety culture, leading and supporting staff, integrating risk management activity, promoting reporting, involving and communicating with patients and the public, learning and sharing safety lessons, and implementing solutions to prevent harm. Examples from the Liverpool Women's NHS Foundation Trust are used to illustrate these steps, including how they were developed, what obstacles had to be overcome, ongoing challenges, and whether good risk management has translated into better, safer health care.

Sustainable waste management through end-of-waste criteria development.

PubMed

Zorpas, Antonis A

2016-04-01

The Waste Framework Directive 2000/98 (WFD) contains specific requirements to define end-of-waste criteria (EWC). The main goal of EWC is to remove and eliminate the administrative loads of waste legislation for safe and high-quality waste materials, thereby facilitating and assisting recycling. The target is to produce effective with high quality of recyclables materials, promoting product standardization and quality and safety assurance, and improving harmonization and legal certainty in the recyclable material markets. At the same time, those objectives aim to develop a plan in order to improve the development and wider use of environmental technologies, which reduce pressure on environment and at the same time address the three dimensions of the Lisbon strategy: growth, jobs and environment. This paper presents the importance of EWC, and the approach of setting EWC as EWC affect several management systems as well as sustainable and clean technologies.

Quality of groundwater resources in Afghanistan.

PubMed

Hayat, Ehsanullah; Baba, Alper

2017-07-01

Water is the main source of energy production and economy in Afghanistan where agriculture accounts for more than 50% of the country's gross domestic product (GDP). Access to safe drinking water is still a problem in the country, which has caused different health issues and even child mortality especially in rural areas. Groundwater is the main source of drinking water in the country. However, little knowledge is available about the quality of groundwater throughout the entire country, and its quality has not been investigated extensively yet like in other countries in the world. While most people think that consuming groundwater is a reliable and safe source of drinking water for health, the United Nations (UN) agencies report various kinds of waterborne diseases and even child mortalities due to drinking water quality in the country. In this article, significant geogenic and anthropogenic factors that play a vital role in groundwater contamination of the country are identified and explained. Different geogenic contaminations such as arsenic, fluoride, sulfate, and boron occur in several areas of Afghanistan that have a direct effect on human health. The water quality mapping for Afghanistan is completed for half of the country, which shows that groundwater is plagued by high levels of fluoride and arsenic in some areas. The water quality mapping of the other half of the country cannot be completed due to security concerns currently. Also, there are different kinds of waterborne diseases such as diarrhea, cholera, and dysentery that can be seen in different parts of the country because of anthropogenic activities which continuously deteriorate groundwater.

Lasing efficiency of Er-Yb-Cr-glass: A temperature study (Conference Presentation)

NASA Astrophysics Data System (ADS)

George, Simi A.; Hayden, Joseph S.; Davis, Mark J.

2017-03-01

Retina-safe operation in open-air is of high interest to the next generation of lasers that are being utilized for many industrial, defense and medical applications. Those wavelengths that are considered to be the best for retina safe operations (also called eye-safe) fall in the range between 1400nm and1800nm. This wavelength region also coincides with the low loss window of fused silica fibers used for optical fiber communications [1], where the S and C bands near 1500nm are heavily utilized for long range communications due to the lowest attenuation losses possible in the fiber. The trivalent Er ion can produce direct emission into the 1540 nm wavelength, thus, it is the rare-earth emitter of choice for many eye-safe applications. In recent years, the need for high beam quality under passive operation in open air applications have renewed interest in Er-doped bulk glasses as the gain material of choice for solid-state eye-safe lasers. The need for performance stability under a broad operating range from -400C to 1000C without active cooling is a challenge for amorphous gain materials. Moreover, there is very little known about how temperature may affect performance. In this study, we describe our first attempts to understand material behavior by systematically analyzing temperature driven variations exhibited in absorption and emission from the commercially available gain materials. As part of these investigations, we will also present our method for assessing quantum efficiency through measurements for critical evaluation from laser community at large.

Cadmium and lead accumulations and agronomic quality of a newly bred pollution-safe cultivar (PSC) of water spinach.

PubMed

Huang, Ying-Ying; Mu, Yang-Xiu; He, Chun-Tao; Fu, Hui-Ling; Wang, Xue-Song; Gong, Fei-Yue; Yang, Zhong-Yi

2018-04-01

Breeding for pollution-safe cultivars (PSCs) can reduce pollutant accumulation in crops. However, the PSC breeding would face the risk of nutritional quality reduction, which is usually ignored in conventional breeding programs targeting to increase crop yield or nutritional quality. Thus, the doubt whether the risk would exist has to be clarified for supporting the PSC breeding. In the present study, a newly bred Cd/Pb-PSC of water spinach (Ipomoea aquatic Forsk.) and its parents (QLQ with low-Cd/Pb accumulation ability and T308 with high yield) of water spinach were employed to clarify the above-mentioned issue. Yields, and concentrations of Cd, Pb, nitrite, and organic and inorganic nutrients in shoots of the three experimental lines were determined. There were no significant differences in Cd/Pb concentration between the new PSC and QLQ, in nitrite content between the new PSC and its two parents and in yield between the new PSC and T308. It is decisively significant that shoot concentrations of organic and inorganic nutrients in the Cd/Pb-PSC were as high as those in one of its parents. It is affirmed that the breeding operations (crossing and consequently continuous selfing) for lowering Cd/Pb accumulation capacity of water spinach would not lower the nutritional values of the obtained Cd/Pb-PSCs from the breeding, which should be a pillar that supports the feasibility to minimize Cd/Pb pollution in vegetables using PSC-breeding method.

Making good better: implementing a standardized handoff in pediatric transport.

PubMed

Weingart, Caroline; Herstich, Tracey; Baker, Pam; Garrett, M Lynne; Bird, Michael; Billock, James; Schwartz, Hamilton P; Bigham, Michael T

2013-01-01

Failures in communication lead to adverse events in healthcare. Handoffs, defined as the transfer of information, responsibility, and authority from one provider to another, have been identified as a cause of communication failure compromising patient safety. Locally, there was dissatisfaction among caregivers working on the general care and intensive care units regarding the quality of information received from the pediatric transport team for transferred patients. Using the Model for Improvement, a quality improvement team was engaged to lead this improvement effort. The team developed a standardized and scripted transport handoff process that incorporated parental input. The primary measure was provider satisfaction (reported as overall handoff score, OHS). Secondary outcomes included the use of components outlined by the Joint Commission's guidelines for safe handoff. Data were collected using a Likert-style survey and collated using Microsoft Excel. Baseline measures of OHS were 81.5 ± 19.4 (mean±SD) with an interval analysis showing no improvement (81.6±17.4, P=0.99). Further modifications were made to both education and process with an improved OHS (88.8±11.1, P<0.05). Certain specific handoff components showed the greatest improvement according to caregivers. This practical, low-cost quality-improvement project may help others improve handoff communication and provide safe, high-quality care. Copyright © 2013 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

The human factor: the critical importance of effective teamwork and communication in providing safe care.

PubMed

Leonard, M; Graham, S; Bonacum, D

2004-10-01

Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

The Provision of Interventional Radiology Services in Europe: CIRSE Recommendations

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

Tsetis, Dimitrios, E-mail: tsetis@med.uoc.gr; Uberoi, Raman, E-mail: raman.uberoi@orh.nhs.uk; Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it

2016-04-15

Interventional Radiology (IR) is an essential part of modern medicine, delivering minimally invasive patient-focused care, which has been proven to be safe and effective in both elective and emergency settings. The aim of this document is to outline the core requirements and standards for the provision of Interventional Radiological services, including training, certification, manpower, and accreditation. The ultimate challenge will be the adoption of these recommendations by different countries and health economies around the world, in turn ensuring equal access to IR treatments for all patients, the appropriate distribution of resources for IR service provision as well as the continuedmore » development of safe and high-quality IR services in Europe and beyond.« less

QUALITY ASSURANCE AND QUALITY CONTROL FOR WASTE CONTAINMENT FACILITIES. Project Summary

EPA Science Inventory

It is generally agreed that both quality assurance (QA) and quality control (QC) are essential to the proper installation and eventual performance of environmentally safe and secure waste containment systems. Even further, there are both manufacturing and construction aspects to...

Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

PubMed

Haas, Sheila A; Vlasses, Frances; Havey, Julia

2016-01-01

There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

Fix These First: How the World's Leading Companies Point the Way Toward High Reliability in the Military Health System.

PubMed

Beauvais, Brad; Richter, Jason; Brezinski, Paul

The 2014 Military Health System Review calls for healthcare system leaders to implement effective strategies used by other high-performing organizations. The authors state, " the [military health system] MHS can create an optimal healthcare environment that focuses on continuous quality improvement where every patient receives safe, high-quality care at all times" (Military Health System, 2014, p. 1). Although aspirational, the document does not specify how a highly reliable health system is developed or what systemic factors are necessary to sustain highly reliable performance. Our work seeks to address this gap and provide guidance to MHS leaders regarding how high-performing organizations develop exceptional levels of performance.The authors' expectation is that military medicine will draw on these lessons to enhance leadership, develop exceptional organizational cultures, onboard and engage employees, build customer loyalty, and improve quality of care. Leaders from other segments of the healthcare field likely will find this study valuable given the size of the military healthcare system (9.6 million beneficiaries), the United States' steady progression toward population-based health, and the increasing need for highly reliable systems and performance.

Highlighting 2004 award-winning initiatives.

PubMed

2005-02-01

This issue takes a closer look at how five award-winning healthcare organizations are finding--and continually refining--innovative ways to provide high-quality healthcare. One of those organizations is Robert Wood Johnson University Hospital Hamilton, which recently was named the fourth healthcare winner of the annual Malcolm Baldrige National Quality Award. The Joint Commission on Accreditation of Healthcare Organizations recently selected two facilities in the hospital category--Stamford Hospital and Staten Island University Hospital--as recipients of the eighth annual Codman Award for their work in using outcomes measurement to promote quality care. The Reading Hospital and Medical Center received a Cheers Award from the Institute for Safe Medication Practices for its toolkit promoting patient safety. Sentara Healthcare System, top winner of the American Hospital Association's Quest for Quality Award, has been cited for its efforts to align its quality and safety goals with its organizational goals.

The evolving landscape of quality measurement for heart failure

PubMed Central

Fitzgerald, Ashley A.; Allen, Larry A.; Masoudi, Frederick A.

2013-01-01

Heart failure (HF) is a major cause of mortality and morbidity, representing a leading cause of death and hospitalization among U.S. Medicare beneficiaries. Advances in science have generated effective interventions to reduce adverse outcomes in HF, particularly in patients with reduced left ventricular ejection fraction. Unfortunately, effective therapies for heart failure are often not utilized in an effective, safe, timely, equitable, patient-centered, and efficient manner. Further, the risk of adverse outcomes for HF remains high. The last decades have witnessed the growth of efforts to measure and improve the care and outcomes of patients with HF. This paper will review the evolution of quality measurement for HF, including a brief history of quality measurement in medicine; the measures that have been employed to characterize quality in heart failure; how the measures are obtained; how measures are employed; and present and future challenges surrounding quality measurement in heart failure. PMID:22548579

Systematic review of the quality and generalizability of studies on the effects of opioids on driving and cognitive/psychomotor performance.

PubMed

Mailis-Gagnon, Angela; Lakha, Shehnaz Fatima; Furlan, Andrea; Nicholson, Keith; Yegneswaran, Balaji; Sabatowski, Rainer

2012-07-01

The effect of opioids on driving performance has been much debated. Driving is a complex task requiring integration of psychomotor, cognitive, motor and decision-making skills, visual-spatial abilities, divided attention, and behavioral and emotional control. The objective of this systematic review was to assess the quality of studies and to revisit the concept that patients on stable opioids are safe to drive as it applies to everyday practice. We searched MEDLINE, EMBASE, PSYCinfo, CENTRAL, TRANSPORT, CINAHL, reference lists of retrieved articles and narrative reviews, for studies on chronic cancer and noncancer pain patients on opioids, tested by driving, driving simulator, or cognitive/psychomotor tests. Methodological quality was assessed with Methodological Index for Nonrandomized Studies, cognitive/psychomotor tests were appraised regarding their sensitivity and validation, and whether confounding variables potentially affecting the study conclusions were recorded. The results were analyzed both quantitatively and qualitatively. We included 35 studies (2044 patients, 1994 controls), 9% of the studies were of poor, 54% of fair, and 37% of high quality; 3 quarters of the studies used high sensitivity cognitive tests. Amount and dose of opioids varied largely in many studies. Mean number of possible but unreported confounders was 2.2 (range, 0 to 4), relating to failure of the studies to mention co-prescriptions with psychotropic effects, pain severity, sleep disorder or daytime somnolence, and/or significant depressive or anxiety-related problems. The commonly held concept that "chronic pain patients on stable opioids are safe to drive" cannot be generalized to all such patients in everyday practice, but may be applicable only to a subset who meet certain criteria.

Rethinking clinical governance: healthcare professionals' views: a Delphi study.

PubMed

Veenstra, Gepke L; Ahaus, Kees; Welker, Gera A; Heineman, Erik; van der Laan, Maarten J; Muntinghe, Friso L H

2017-01-12

Although the guiding principle of clinical governance states that healthcare professionals are the leading contributors to quality and safety in healthcare, little is known about what healthcare professionals perceive as important for clinical governance. The aim of this study is to clarify this by exploring healthcare professionals' views on clinical governance. Based on a literature search, a list of 99 elements related to clinical governance was constructed. This list was refined, extended and restricted during a three-round Delphi study. The panel of experts was formed of 24 healthcare professionals from an academic hospital that is seen as a leader in terms of its clinical governance expertise in the Netherlands. Rated importance of each element on a four-point scale. The 50 elements that the panel perceived as most important related to adopting a bottom-up approach to clinical governance, ownership, teamwork, learning from mistakes and feedback. The panel did not reach a consensus concerning elements that referred to patient involvement. Elements that referred to a managerial approach to clinical governance and standardisation of work were rejected by the panel. In the views of the panel of experts, clinical governance is a practice-based, value-driven approach that has the goal of delivering the highest possible quality care and ensuring the safety of patients. Bottom-up approaches and effective teamwork are seen as crucial for high quality and safe healthcare. Striving for high quality and safe healthcare is underpinned by continuous learning, shared responsibility and good relationships and collaboration between healthcare professionals, managers and patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The challenges of sustainable access to safe drinking water in rural areas of developing countries: case of Zawtar El-Charkieh, Southern Lebanon.

PubMed

Massoud, May A; Al-Abady, Abdolmonim; Jurdi, Mey; Nuwayhid, Iman

2010-06-01

Adequate and safe water is important for human health and well-being, economic production, and sustainable development. Failure to ensure the safety of drinking water may expose the community to the risk of outbreaks of waterborne and infectious diseases. Although drinking water is a basic human right, many people do not have access to safe and adequate drinking water or proper sanitation facilities. The authors conducted a study to assess the quantity, cost, continuity, coverage, and quality of drinking water in the village of Zawtar El-Charkieh, Lebanon. Their aim was to identify the challenges of sustainable access to safe drinking water in order to determine the short-term management actions and long-term strategies to improve water quality. Results revealed that contamination of the source, absence of any disinfection method or insufficient dose, poor maintenance operations, and aging of the networks are significant factors contributing to water contamination during the storage and distribution process. Establishing a comprehensive drinking water system that integrates water supply, quality, and management as well as associated educational programs in order to ensure the safety and sustainability of drinking water supplies is essential.

Implementation evaluation of steering teens safe: engaging parents to deliver a new parent-based teen driving intervention to their teens.

PubMed

Ramirez, Marizen; Yang, Jingzhen; Young, Tracy; Roth, Lisa; Garinger, Anne; Snetselaar, Linda; Peek-Asa, Corinne

2013-08-01

Parents play a fundamental role in teaching their children safe driving skills to reduce risk of motor vehicle crashes, the leading cause of death for teens. Steering Teens Safe is a new parent-based intervention that equips parents with communication skills to talk about, demonstrate, and practice safe driving behaviors and skills with their teens. This implementation evaluation focuses on a sample of 83 parents who delivered Steering Teens Safe to their teens. One-, 2- and 3-month follow-up assessments were conducted with intervention parents to evaluate the self-reported quantity and quality of talking about, demonstrating, and practicing safe driving goals with teens; perceived success and benefit of the program; and barriers to implementation. Over 3 months of follow-up, parents discussed driving goals with their teens for a median of 101.5 minutes. The most frequently addressed topics were general safety principles, including distracted driving, driving in bad weather, wearing a seat belt, and being a safe passenger. Parents spent a median of 30 minutes practicing safe driving skills such as changing lanes. Sixty-seven percent of parents talked to their children about rural road safety, but just 36% demonstrated and half practiced these skills with their teens. Barriers to implementation include time and opportunity barriers and resistant attitudes of their teens. However, barriers neither affected frequency of engagement nor parents' perceived benefit and comfort in delivering the program. Parents with time/opportunity barriers also had higher practice and demonstration times than parents without these barriers. Findings indicate high acceptability among parent implementers and promise for real-world delivery. Future studies are needed to assess intervention impact.

ENVIRONMENTAL AND ENERGY QUALITY TECHNOLOGIES Task Order 0005: Organic Finishing Technologies Sub Task 11: High Speed, Substrate Safe Specialty Coating Laser Stripping

DTIC Science & Technology

2015-06-22

hazardous materials and eliminating the hazardous waste streams associated with wheat starch , chemical strippers and hand sanding. Additionally, the laser...chemical attack resistance and other special characteristics while providing corrosion protection. The materials used for these purposes are designed...inspection and/or replacement. Standard coating removal methods include chemical strippers, media blasting (i.e., wheat starch , plastic

A Retrospective Analysis of Initial Posterior Root Canal Therapy on United States Air Force Personnel

DTIC Science & Technology

2016-06-01

and John Yaccino, DDS Abstract Introduction: The Air Force Dental Service (AFDS) has established evidence-based treatment standards for endodontics...and cuspal coverage restorations (4-6). With this research, the Air Force Dental Service (AFDS) established evidence-based treatment standards for...endodontics to ensure Airmen receive high-quality, safe dental care (7). These standards are taught at the two Air Force (AF) Postgraduate Endodontic

Adverse outcome pathways (AOPs) to enhance EDC ...

EPA Pesticide Factsheets

Screening and testing for endocrine active chemicals was mandated under 1996 amendments to the Safe Drinking Water Act and Food Quality Protection Act. Efficiencies can be gained in the endocrine disruptor screening program by using available biological and toxicological knowledge to facilitate greater use of high throughput screening data and other data sources to inform endocrine disruptor assessments. Likewise, existing knowledge, when properly organized, can help aid interpretation of test results. The adverse outcome pathway (AOP) framework, which organizes information concerning measureable changes that link initial biological interactions with a chemical to adverse effects that are meaningful to risk assessment and management, can aid this process. This presentation outlines the ways in which the AOP framework has already been employed to support EDSP and how it may further enhance endocrine disruptor assessments in the future. Screening and testing for endocrine active chemicals was mandated under 1996 amendments to the Safe Drinking Water Act and Food Quality Protection Act. Efficiencies can be gained in the endocrine disruptor screening program by using available biological and toxicological knowledge to facilitate greater use of high throughput screening data and other data sources to inform endocrine disruptor assessments. Likewise, existing knowledge, when properly organized, can help aid interpretation of test results. The adverse outcome pathway

Evaluating the evidence: is phrenic nerve stimulation a safe and effective tool for decreasing ventilator dependence in patients with high cervical spinal cord injuries and central hypoventilation?

PubMed

Sieg, Emily P; Payne, Russell A; Hazard, Sprague; Rizk, Elias

2016-06-01

Case reports, case series and case control studies have looked at the use of phrenic nerve stimulators in the setting of high spinal cord injuries and central hypoventilation syndromes dating back to the 1980s. We evaluated the evidence related to this topic by performing a systematic review of the published literature. Search terms "phrenic nerve stimulation," "phrenic nerve and spinal cord injury," and "phrenic nerve and central hypoventilation" were entered into standard search engines in a systematic fashion. Articles were reviewed by two study authors and graded independently for class of evidence according to published guidelines. The published evidence was reviewed, and the overall body of evidence was evaluated using the grading of recommendations, assesment, development and evaluations (GRADE) criteria Balshem et al. (J Clin Epidemiol 64:401-406, 2011). Our initial search yielded 420 articles. There were no class I, II, or III studies. There were 18 relevant class IV articles. There were no discrepancies among article ratings (i.e., kappa = 1). A meta-analysis could not be performed due to the low quality of the available evidence. The overall quality of the body of evidence was evaluated using GRADE criteria and fell within the "very poor" category. The quality of the published literature for phrenic nerve stimulation is poor. Our review of the literature suggests that phrenic nerve stimulation is a safe and effective option for decreasing ventilator dependence in high spinal cord injuries and central hypoventilation; however, we are left with critical questions that provide crucial directions for future studies.

Changing personnel behavior to promote quality care practices in an intensive care unit

PubMed Central

Cooper, Dominic; Farmery, Keith; Johnson, Martin; Harper, Christine; Clarke, Fiona L; Holton, Phillip; Wilson, Susan; Rayson, Paul; Bence, Hugh

2005-01-01

The delivery of safe high quality patient care is a major issue in clinical settings. However, the implementation of evidence-based practice and educational interventions are not always effective at improving performance. A staff-led behavioral management process was implemented in a large single-site acute (secondary and tertiary) hospital in the North of England for 26 weeks. A quasi-experimental, repeated-measures, within-groups design was used. Measurement focused on quality care behaviors (ie, documentation, charting, hand washing). The results demonstrate the efficacy of a staff-led behavioral management approach for improving quality-care practices. Significant behavioral change (F [6, 19] = 5.37, p < 0.01) was observed. Correspondingly, statistically significant (t-test [t] = 3.49, df = 25, p < 0.01) reductions in methicillin-resistant Staphylococcus aureus (MRSA) were obtained. Discussion focuses on implementation issues. PMID:18360574

Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

PubMed

Kakyo, Tracy Alexis; Xiao, Lily Dongxia

2017-06-01

Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention. © 2017 John Wiley & Sons Australia, Ltd.

Quality of drug information on the World Wide Web and strategies to improve pages with poor information quality. An intervention study on pages about sildenafil.

PubMed

Martin-Facklam, Meret; Kostrzewa, Michael; Martin, Peter; Haefeli, Walter E

2004-01-01

The generally poor quality of health information on the world wide web (WWW) has caused preventable adverse outcomes. Quality management of information on the internet is therefore critical given its widespread use. In order to develop strategies for the safe use of drugs, we scored general and content quality of pages about sildenafil and performed an intervention to improve their quality. The internet was searched with Yahoo and AltaVista for pages about sildenafil and 303 pages were included. For assessment of content quality a score based on accuracy and completeness of essential drug information was assigned. For assessment of general quality, four criteria were evaluated and their association with high content quality was determined by multivariate logistic regression analysis. The pages were randomly allocated to either control or intervention group. Evaluation took place before, as well as 7 and 22 weeks after an intervention which consisted of two letters with individualized feedback information on the respective page which were sent electronically to the address mentioned on the page. Providing references to scientific publications or prescribing information was significantly associated with high content quality (odds ratio: 8.2, 95% CI 3.2, 20.5). The intervention had no influence on general or content quality. To prevent adverse outcomes caused by misinformation on the WWW individualized feedback to the address mentioned on the page was ineffective. It is currently probably the most straight-forward approach to inform lay persons about indicators of high information quality, i.e. the provision of references.

Evaluation of safe performance secondary school driver education curriculum demonstration project

DOT National Transportation Integrated Search

1983-06-01

The primary objective of this Project was to determine the crash reduction potential of a quality, competency-based driver training program known as the Safe Performance Curriculum (SPC). The experimental design called for the random assignment of 18...

Why don't humanitarian organizations provide safe abortion services?

PubMed

McGinn, Therese; Casey, Sara E

2016-01-01

Although sexual and reproductive health services have become more available in humanitarian settings over the last decade, safe abortion services are still rarely provided. The authors' observations suggest that four reasons are typically given for this gap: 'There's no need'; 'Abortion is too complicated to provide in crises'; 'Donors don't fund abortion services'; and 'Abortion is illegal'. However, each of these reasons is based on false premises. Unsafe abortion is a major cause of maternal mortality globally, and the collapse of health systems in crises suggests it likely increases in humanitarian settings. Abortion procedures can be safely performed in health centers by mid-level providers without sophisticated equipment or supplies. Although US government aid does not fund abortion-related activities, other donors, including many European governments, do fund abortion services. In most countries, covering 99 % of the world's population, abortion is permitted under some circumstances; it is illegal without exception in only six countries. International law supports improved access to safe abortion. As none of the reasons often cited for not providing these services is valid, it is the responsibility of humanitarian NGOs to decide where they stand regarding their commitment to humanitarian standards and women's right to high quality and non-discriminatory health services. Providing safe abortion to women who become pregnant as a result of rape in war may be a more comfortable place for organizations to begin the discussion. Making safe abortion available will improve women's health and human rights and save lives.

Fuzzy Logic-based expert system for evaluating cake quality of freeze-dried formulations.

PubMed

Trnka, Hjalte; Wu, Jian X; Van De Weert, Marco; Grohganz, Holger; Rantanen, Jukka

2013-12-01

Freeze-drying of peptide and protein-based pharmaceuticals is an increasingly important field of research. The diverse nature of these compounds, limited understanding of excipient functionality, and difficult-to-analyze quality attributes together with the increasing importance of the biosimilarity concept complicate the development phase of safe and cost-effective drug products. To streamline the development phase and to make high-throughput formulation screening possible, efficient solutions for analyzing critical quality attributes such as cake quality with minimal material consumption are needed. The aim of this study was to develop a fuzzy logic system based on image analysis (IA) for analyzing cake quality. Freeze-dried samples with different visual quality attributes were prepared in well plates. Imaging solutions together with image analytical routines were developed for extracting critical visual features such as the degree of cake collapse, glassiness, and color uniformity. On the basis of the IA outputs, a fuzzy logic system for analysis of these freeze-dried cakes was constructed. After this development phase, the system was tested with a new screening well plate. The developed fuzzy logic-based system was found to give comparable quality scores with visual evaluation, making high-throughput classification of cake quality possible. © 2013 Wiley Periodicals, Inc. and the American Pharmacists Association.

Quality assurance: recommended guidelines for safe heating by capacitive-type heating technique to treat patients with metallic implants.

PubMed

Kato, Hirokazu; Kondo, Motoharu; Imada, Hajime; Kuroda, Masahiro; Kamimura, Yoshitsugu; Saito, Kazuyuki; Kuroda, Kagayaki; Ito, Koichi; Takahashi, Hideaki; Matsuki, Hidetoshi

2013-05-01

This article is a redissemination of the previous Japanese Quality Assurance Guide guidelines. Specific absorption rate and temperature distribution were investigated with respect to various aspects including metallic implant size and shape, insertion site, insertion direction, blood flow and heating power, and simulated results were compared with adverse reactions of patients treated by radio frequency capacitive-type heating. Recommended guidelines for safe heating methods for patients with metallic implants are presented based on our findings.

Report of a workshop on ensuring sustainable access to safe blood in developing countries: International Blood Safety Forum, March 24, 2017.

PubMed

Katz, Louis M; Donnelly, John J; Gresens, Christopher J; Holmberg, Jerry A; MacPherson, James; Zacharias, Peter J K; Stanley, Jean; Bales, Christine

2018-05-01

On March 24, 2017, more than 90 experts in blood safety and international development from blood centers, industry, government, and international and nongovernmental organizations gathered in Arlington, Virginia, for the Third International Blood Safety Forum, cosponsored by America's Blood Centers and Global Healing. This report summarizes presentations and major conclusions. The meeting explored ways to increase access to affordable, safe blood for low- and lower-middle-income countries (LMICs) in an era when funding from the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund has been redirected from preventing the spread of human immunodeficiency virus (HIV) to diagnosing and treating the 25 million-plus people living with HIV in LMICs. More effective management systems must be developed to improve cost recovery for blood. While blood systems become more sustainable, continued investment is required to keep them operating. The traditional model of large grants from bilateral and multilateral donors will need to be supplemented (or replaced) with public-private partnerships and nongovernmental investment. A continued emphasis on quality is fundamental. Blood systems must build quality programs, based on accepted standards, including hospitals, clinics, and rural health care providers to ensure proper and safe use of blood. Proposals to resolve health care inequities between LMICs and high-income countries (HICs) must include helping LMICs to define sustainable national policies and practices for blood availability and utilization to suit local contexts. The blood safety lexicon should be revised to include availability, accessibility, and affordability of safe blood and blood products as the goal of all blood safety initiatives. © 2018 AABB.

From Empiricism to Total Quality Management in Greek Education

NASA Astrophysics Data System (ADS)

Karavasilis, Ioannis; Samoladas, Ioannis; Nedos, Apostolos

Nowadays the education system in Greece moves towards democratization and decentralization. School unit is the cell and the base of the education system. Principal's role is highly demanding, multi-dimensional, and a critical determinant of school performance and effectiveness. The paper proposes an effective organizational plan of school units in Primary Education based on basic administration processes and Total Quality Management. Using theory of emotional intelligence and Blake-Mouton's grid it emphasizes the impact of Principal's leadership on democratizing the school unit, on creating a safe and secure environment and positive school climate and motivating teachers committee to participate in the decision making process.

Errors in clinical laboratories or errors in laboratory medicine?

PubMed

Plebani, Mario

2006-01-01

Laboratory testing is a highly complex process and, although laboratory services are relatively safe, they are not as safe as they could or should be. Clinical laboratories have long focused their attention on quality control methods and quality assessment programs dealing with analytical aspects of testing. However, a growing body of evidence accumulated in recent decades demonstrates that quality in clinical laboratories cannot be assured by merely focusing on purely analytical aspects. The more recent surveys on errors in laboratory medicine conclude that in the delivery of laboratory testing, mistakes occur more frequently before (pre-analytical) and after (post-analytical) the test has been performed. Most errors are due to pre-analytical factors (46-68.2% of total errors), while a high error rate (18.5-47% of total errors) has also been found in the post-analytical phase. Errors due to analytical problems have been significantly reduced over time, but there is evidence that, particularly for immunoassays, interference may have a serious impact on patients. A description of the most frequent and risky pre-, intra- and post-analytical errors and advice on practical steps for measuring and reducing the risk of errors is therefore given in the present paper. Many mistakes in the Total Testing Process are called "laboratory errors", although these may be due to poor communication, action taken by others involved in the testing process (e.g., physicians, nurses and phlebotomists), or poorly designed processes, all of which are beyond the laboratory's control. Likewise, there is evidence that laboratory information is only partially utilized. A recent document from the International Organization for Standardization (ISO) recommends a new, broader definition of the term "laboratory error" and a classification of errors according to different criteria. In a modern approach to total quality, centered on patients' needs and satisfaction, the risk of errors and mistakes in pre- and post-examination steps must be minimized to guarantee the total quality of laboratory services.

Rural drinking water at supply and household levels: quality and management.

PubMed

Hoque, Bilqis A; Hallman, Kelly; Levy, Jason; Bouis, Howarth; Ali, Nahid; Khan, Feroze; Khanam, Sufia; Kabir, Mamun; Hossain, Sanower; Shah Alam, Mohammad

2006-09-01

Access to safe drinking water has been an important national goal in Bangladesh and other developing countries. While Bangladesh has almost achieved accepted bacteriological drinking water standards for water supply, high rates of diarrheal disease morbidity indicate that pathogen transmission continues through water supply chain (and other modes). This paper investigates the association between water quality and selected management practices by users at both the supply and household levels in rural Bangladesh. Two hundred and seventy tube-well water samples and 300 water samples from household storage containers were tested for fecal coliform (FC) concentrations over three surveys (during different seasons). The tube-well water samples were tested for arsenic concentration during the first survey. Overall, the FC was low (the median value ranged from 0 to 4 cfu/100ml) in water at the supply point (tube-well water samples) but significantly higher in water samples stored in households. At the supply point, 61% of tube-well water samples met the Bangladesh and WHO standards of FC; however, only 37% of stored water samples met the standards during the first survey. When arsenic contamination was also taken into account, only 52% of the samples met both the minimum microbiological and arsenic content standards of safety. The contamination rate for water samples from covered household storage containers was significantly lower than that of uncovered containers. The rate of water contamination in storage containers was highest during the February-May period. It is shown that safe drinking water was achieved by a combination of a protected and high quality source at the initial point and maintaining quality from the initial supply (source) point through to final consumption. It is recommended that the government and other relevant actors in Bangladesh establish a comprehensive drinking water system that integrates water supply, quality, handling and related educational programs in order to ensure the safety of drinking water supplies.

Quality control of commercial bovine lactoferrin.

PubMed

Wakabayashi, Hiroyuki; Yamauchi, Koji; Abe, Fumiaki

2018-06-01

Herein we review commercial bovine lactoferrin quality issues by describing an example of industrial production, the current status of global quality standardization, and quality-activity concerns for further discussion. Morinaga Milk Industry has been industrially producing bovine lactoferrin in Milei GmbH, Germany, since 1989. We delineate its production and quality as an example of safe and high-quality manufacturing. Currently, global standardization in the quality of bovine lactoferrin is progressing through Novel Food and GRAS in the EU and USA, respectively. Novel Food was applied or notified to seven lactoferrin manufacturers and GRAS was notified to three manufacturers, two of which are for infant use and one is for adult use, by the end of 2017. The specifications of these regulations are relatively high, including more than 95% lactoferrin purity in protein, which means that such companies can supply relatively high-grade lactoferrin. There appear to be several concerns regarding lactoferrin quality affecting activities, including contamination of lipopolysaccharide (LPS) and angiogenin, purity, and degradation of lactoferrin sample. Although LPS is immunologically toxic when invading the body, it is distributed normally in foods and the gut. However, an industrial lactoferrin sample may contain LPS at a maximum LPS/lactoferrin molecule ratio = 1/1724, which means 99.9% of the lactoferrin molecule is LPS-free. It is difficult to speculate that LPS contained in a lactoferrin sample affects its activities. Finally in order to achieve good and reproducible results, we make proposals to researchers a use of high-grade lactoferrin, careful storage, and indication the manufacturers' names and specifications in the paper.

30 CFR 74.9 - Quality assurance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... specifications and are reliable, safe, effective, and otherwise suitable for their intended use. To establish and... registration under ISO Q9001-2000, American National Standard, Quality Management Systems-Requirements... ISO Q9001-2000, American National Standard, Quality Management Systems-Requirements. The Director of...

Microbial (Pathogen)/Recreational Water Quality Criteria

EPA Pesticide Factsheets

Documents pertaining to Recreational Human Health Ambient Water Quality Criteria for Microbial Organisms (Pathogens). These documents include safe levels for cyanotoxins microcystin and cylindrospermopsin, and Coliphage to protect human health.

Environmental and Energy Quality Technologies. Task Order 0005: Organic Finishing Technologies, Sub Task 11: High Speed, Substrate Safe Specialty Coating Laser Stripping : Project: WP 2146

DTIC Science & Technology

2015-06-22

hazardous materials and eliminating the hazardous waste streams associated with wheat starch , chemical strippers and hand sanding. Additionally, the laser...chemical attack resistance and other special characteristics while providing corrosion protection. The materials used for these purposes are designed...inspection and/or replacement. Standard coating removal methods include chemical strippers, media blasting (i.e., wheat starch , plastic

New responsibilities in purchasing and developing services.

PubMed

Jerram, Soline; Fox, Ann

2014-06-01

The role of nursing in the NHS commissioning structure in England is developing. Since April 2013 more than 200 clinical commissioning groups (CCGs), which comprise all GP practices in the locality, have taken on responsibility for health budgets in their areas. This article describes the challenges ahead and nurses' responsibilities in CCGs when working with local citizens and across the health and social care system to assure the delivery of high quality, safe services.

ESHRE's good practice guide for cross-border reproductive care for centers and practitioners.

PubMed

Shenfield, F; Pennings, G; De Mouzon, J; Ferraretti, A P; Goossens, V

2011-07-01

This paper outlines ESHRE's guidance for centers and physicians providing fertility treatment to foreign patients. This guide aims to ensure high-quality and safe assisted reproduction treatment, taking into account the patients, their future child and the interests of third-party collaborators such as gametes donors and surrogates. This is achieved by including considerations of equity, safety, efficiency, effectiveness (including evidence-based care), timeliness and patient centeredness.

Radioactive waste management in a hospital.

PubMed

Khan, Shoukat; Syed, At; Ahmad, Reyaz; Rather, Tanveer A; Ajaz, M; Jan, Fa

2010-01-01

Most of the tertiary care hospitals use radioisotopes for diagnostic and therapeutic applications. Safe disposal of the radioactive waste is a vital component of the overall management of the hospital waste. An important objective in radioactive waste management is to ensure that the radiation exposure to an individual (Public, Radiation worker, Patient) and the environment does not exceed the prescribed safe limits. Disposal of Radioactive waste in public domain is undertaken in accordance with the Atomic Energy (Safe disposal of radioactive waste) rules of 1987 promulgated by the Indian Central Government Atomic Energy Act 1962. Any prospective plan of a hospital that intends using radioisotopes for diagnostic and therapeutic procedures needs to have sufficient infrastructural and manpower resources to keep its ambient radiation levels within specified safe limits. Regular monitoring of hospital area and radiation workers is mandatory to assess the quality of radiation safety. Records should be maintained to identify the quality and quantity of radioactive waste generated and the mode of its disposal. Radiation Safety officer plays a key role in the waste disposal operations.

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.

Commentary: Sense and sensibility: the role of specialists in health care reform.

PubMed

Schwann, Nanette M; Nester, Brian A; McLoughlin, Thomas M

2012-03-01

How to redesign the incentives structure in the United States to reward effective coordinated care rather than production volume is a staggering public health policy challenge. In the mind of the public, there is a fine distinction between health care rationing and rational health care. Specialists have a vital but underappreciated role in reining in health care costs, but specific incentives to elicit behavior change with positive social outcomes remain ambiguous. It is imperative, therefore, that redesigning the incentives structure is thoughtfully considered, modeled, and tested prior to implementation, lest an inferior-quality model is inadvertently adopted and costs are only marginally contained. Quality metrics need to be universal and reflect real patient outcomes instead of the degree of investment by the institution in the reporting tools. Still, specialists should take immediate action to implement safe and efficient procedures and to assess their long-term impact on patients' quality of life. Scientific evaluations should guide both the assessment of the appropriateness and the safe delivery of care. Investment in high-quality data architecture and the science of health delivery implementation is an imperative if health care reform is to achieve its goals. Coordination and collaboration between specialists and primary care physicians is essential to this enterprise. Specialists can champion these efforts as they pertain to their areas of expertise by considering their care episodes in the context of the patient as a whole, working closely with generalists, and returning to the mindset of the specialist as a family doctor.

Bleach Gel: A Simple Agarose Gel for Analyzing RNA Quality

PubMed Central

Aranda, Patrick S.; LaJoie, Dollie M.; Jorcyk, Cheryl L.

2013-01-01

RNA-based applications requiring high quality, non-degraded RNA are a foundational element of many research studies. As such, it is paramount that the integrity of experimental RNA is validated prior to cDNA synthesis or other downstream applications. In the absence of expensive equipment such as microfluidic electrophoretic devices, and as an alternative to the costly and time-consuming standard formaldehyde gel, RNA quality can be quickly analyzed by adding small amounts of commercial bleach to TAE buffer-based agarose gels prior to electrophoresis. In the presence of low concentrations of bleach, the secondary structure of RNA is denatured and potential contaminating RNases are destroyed. Because of this, the ‘bleach gel’ is a functional approach that addresses the need for an inexpensive and safe way to evaluate RNA integrity and will improve the ability of researchers to rapidly analyze RNA quality. PMID:22222980

High arsenic groundwater: mobilization, metabolism and mitigation--an overview in the Bengal Delta Plain.

PubMed

Bhattacharyya, Rupa; Chatterjee, Debashis; Nath, Bibhash; Jana, Joydev; Jacks, Gunnar; Vahter, Marie

2003-11-01

The widespread occurrence of high inorganic arsenic in natural waters is attributed to human carcinogen and is identified as a major global public health issue. The scale of the problem in terms of population exposure (36 million) and geographical area coverage (173 x 10(3) Km2) to high arsenic contaminated groundwater (50-3200 microgL(-1)) compared to the National drinking water standard (50 microgL(-1)) and WHO recommended provisional limit (10 microgL(-1)) is greatest in the Holocene alluvium and deltaic aquifers of the Bengal Delta Plain (Bangladesh and West Bengal, India). This large-scale 'natural' high arsenic groundwater poses a great threat to human health via drinking water. Mobilization, metabolism and mitigation issues of high arsenic groundwater are complex and need holistic approach for sustainable development of the resource. Mobilization depends on the redox geochemistry of arsenic that plays a vital role in the release and subsequent transport of arsenic in groundwater. Metabolism narrates the biological response vis-à-vis clinical manifestations of arsenic due to various chemical and biological factors. Mitigation includes alternative source for safe drinking water supply. Drinking water quality regulatory standards as well as guidelines are yet to cover risk assessments for such metal toxicity. Lowering of the ingested inorganic arsenic level and introduction of newer treatment options (implementation of laterite, the natural material) to ensure safe water supply (arsenic free and/or low arsenic within permissible limit) are the urgent need to safe guard the mass arsenic poisoning and internal arsenic related health problems.

Quality of drug information on the World Wide Web and strategies to improve pages with poor information quality. An intervention study on pages about sildenafil

PubMed Central

Martin-Facklam, Meret; Kostrzewa, Michael; Martin, Peter; Haefeli, Walter E

2004-01-01

Aims The generally poor quality of health information on the world wide web (WWW) has caused preventable adverse outcomes. Quality management of information on the internet is therefore critical given its widespread use. In order to develop strategies for the safe use of drugs, we scored general and content quality of pages about sildenafil and performed an intervention to improve their quality. Methods The internet was searched with Yahoo and AltaVista for pages about sildenafil and 303 pages were included. For assessment of content quality a score based on accuracy and completeness of essential drug information was assigned. For assessment of general quality, four criteria were evaluated and their association with high content quality was determined by multivariate logistic regression analysis. The pages were randomly allocated to either control or intervention group. Evaluation took place before, as well as 7 and 22 weeks after an intervention which consisted of two letters with individualized feedback information on the respective page which were sent electronically to the address mentioned on the page. Results Providing references to scientific publications or prescribing information was significantly associated with high content quality (odds ratio: 8.2, 95% CI 3.2, 20.5). The intervention had no influence on general or content quality. Conclusions To prevent adverse outcomes caused by misinformation on the WWW individualized feedback to the address mentioned on the page was ineffective. It is currently probably the most straight-forward approach to inform lay persons about indicators of high information quality, i.e. the provision of references. PMID:14678344

Ground-based research with heavy ions for space radiation protection

NASA Astrophysics Data System (ADS)

Durante, M.; Kronenberg, A.

Human exposure to ionizing radiation is one of the acknowledged potential showstoppers for long duration manned interplanetary missions. Human exploratory missions cannot be safely performed without a substantial reduction of the uncertainties associated with different space radiation health risks, and the development of effective countermeasures. Most of our knowledge of the biological effects of heavy charged particles comes from accelerator-based experiments. During the 35th COSPAR meeting, recent ground-based experiments with high-energy iron ions were discussed, and these results are briefly summarised in this paper. High-quality accelerator-based research with heavy ions will continue to be the main source of knowledge of space radiation health effects and will lead to reductions of the uncertainties in predictions of human health risks. Efforts in materials science, nutrition and pharmaceutical sciences and their rigorous evaluation with biological model systems in ground-based accelerator experiments will lead to the development of safe and effective countermeasures to permit human exploration of the Solar System.

[Vegetarian Diets in Children? - An Assessment from Pediatrics and Nutrition Science].

PubMed

Kersting, Mathilde; Kalhoff, Hermann; Melter, Michael; Lücke, Thomas

2018-02-01

In Germany, the "Dietary Schedule for the 1st year of life" and the "Optimised Mixed Diet" for children and adolescents serve as scientifically based and generally applicable dietary concepts throughout the period of growth and development. Vegetarian diets as the lacto-ovo-vegetarian diet (exclusion of meat, fish) and the vegan diet (exclusion of all food groups of animal origin) need to be evaluated for their potential to safely meet the high and specific requirements for growth and development. In this regard, high-quality studies are needed. In individuals on lacto-ovo-vegetarian diets, the safe supply with critical nutrients should be checked by thorough dietary history, possibly additional laboratory tests in risk situations like pregnancy, infancy and toddlerhood. Children on pure vegan diet need ongoing elaborate dietary strategies and continuous supplementation at any age, similar to nutritional management in children with metabolic disorders. A vegan diet is disadvised during all periods with intense growth and development. © Georg Thieme Verlag KG Stuttgart · New York.

Building quality into medical product software design.

PubMed

Mallory, S R

1993-01-01

The software engineering and quality assurance disciplines are a requisite to the design of safe and effective software-based medical devices. It is in the areas of software methodology and process that the most beneficial application of these disciplines to software development can be made. Software is a product of complex operations and methodologies and is not amenable to the traditional electromechanical quality assurance processes. Software quality must be built in by the developers, with the software verification and validation engineers acting as the independent instruments for ensuring compliance with performance objectives and with development and maintenance standards. The implementation of a software quality assurance program is a complex process involving management support, organizational changes, and new skill sets, but the benefits are profound. Its rewards provide safe, reliable, cost-effective, maintainable, and manageable software, which may significantly speed the regulatory review process and therefore potentially shorten the overall time to market. The use of a trial project can greatly facilitate the learning process associated with the first-time application of a software quality assurance program.

MALDI-TOF MS for quality control of high protein content sport supplements.

PubMed

De Ceglie, Cristina; Calvano, Cosima D; Zambonin, Carlo G

2015-06-01

High protein content sport nutritional supplements are found as powder products containing, as ingredients, amino acids and proteins with important nutritional values as milk, soy and egg proteins. An EU Food Supplements Directive (2002) requires that supplements should be safe, both in dosages and in purity. It is important, then, to develop rapid and sensitive methods to be employed for the quality control of these substances. In this work, we apply, for the first time, matrix-assisted laser desorption ionization-mass spectrometry as a fast, reproducible and sensitive method for the quality control of sport nutritional supplements based on proteins. To this aim, several commercial egg- and/or milk-based powder products have been processed by in gel or in solution digestion and analyzed in comparison to pure standard products. This strategy allowed to assess the reliability of the indications on proteins (as caseins, whey proteins and ovalbumin) declared in the label of several sport nutritional supplements. Copyright © 2014 Elsevier Ltd. All rights reserved.

Communication and Culture in the Surgical Intensive Care Unit: Boundary Production and the Improvement of Patient Care.

PubMed

Conn, Lesley Gotlib; Haas, Barbara; Cuthbertson, Brian H; Amaral, Andre C; Coburn, Natalie; Nathens, Avery B

2016-06-01

This ethnography explores communication around critically ill surgical patients in three surgical intensive care units (ICUs) in Canada. A boundary framework is used to articulate how surgeons', intensivists', and nurses' communication practices shape and are shaped by their respective disciplinary perspectives and experiences. Through 50 hours of observations and 43 interviews, these health care providers are found to engage in seven communication behaviors that either mitigate or magnify three contested symbolic boundaries: expertise, patient ownership, and decisional authority. Where these boundaries are successfully mitigated, experiences of collaborative, high-quality patient care are produced; by contrast, boundary magnification produces conflict and perceptions of unsafe patient care. Findings reveal that high quality and safe patient care are produced through complex social and cultural interactions among surgeons, intensivists, and nurses that are also expressions of knowledge and power. This enhances our understanding of why current quality improvement efforts targeting communication may be ineffective. © The Author(s) 2015.

Contextual Challenges to Safe Surgery in a Resource-limited Setting: A Multicenter, Multiprofessional Qualitative Study.

PubMed

Scott, John W; Lin, Yihan; Ntakiyiruta, Georges; Mutabazi, Zeta A; Davis, William Austin; Morris, Megan A; Smink, Douglas S; Riviello, Robert; Yule, Steven

2018-03-01

Safe surgery should be available to all patients, no matter the setting. The purpose of this study was to explore the contextual-specific challenges to safe surgical care encountered by surgeons and surgical teams in many in low- and middle-income countries (LMICs), and to understand the ways in which surgical teams overcome them. Optimal surgical performance is highly complex and requires providers to integrate and communicate information regarding the patient, task, team, and environment to coordinate team-based care that is timely, effective, and safe. Resource limitations common to many LMICs present unique challenges to surgeons operating in these environments, but have never been formally described. Using a grounded theory approach, we interviewed 34 experienced providers (surgeons, anesthetists, and nurses) at the 4 tertiary referral centers in Rwanda, to understand the challenges to safe surgical care and strategies to overcome them. Interview transcripts were coded line-by-line and iteratively analyzed for emerging themes until thematic saturation was reached. Rwandan-described challenges related to 4 domains: physical resources, human resources, overall systems support, and communication/language. The majority of these challenges arose from significant variability in either the quantity or quality of these domains. Surgical providers exhibited examples of resilient strategies to anticipate, monitor, respond to, and learn from these challenges. Resource variability rather than lack of resources underlies many contextual challenges to safe surgical care in a LMIC setting. Understanding these challenges and resilient strategies to overcome them is critical for both LMIC surgical providers and surgeons from HICs working in similar settings.

Clinical Practice Guideline: Safe Medication Use in the ICU.

PubMed

Kane-Gill, Sandra L; Dasta, Joseph F; Buckley, Mitchell S; Devabhakthuni, Sandeep; Liu, Michael; Cohen, Henry; George, Elisabeth L; Pohlman, Anne S; Agarwal, Swati; Henneman, Elizabeth A; Bejian, Sharon M; Berenholtz, Sean M; Pepin, Jodie L; Scanlon, Mathew C; Smith, Brian S

2017-09-01

To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill. PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015. Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system. The committee collectively developed Population, Intervention, Comparator, Outcome questions and quality of evidence statements pertaining to medication errors and adverse drug events addressing the key components. A total of 34 Population, Intervention, Comparator, Outcome questions, five quality of evidence statements, and one commentary on disclosure was developed. Subcommittee members were assigned selected Population, Intervention, Comparator, Outcome questions or quality of evidence statements. Subcommittee members completed their Grading of Recommendations Assessment, Development, and Evaluation of the question with his/her quality of evidence assessment and proposed strength of recommendation, then the draft was reviewed by the relevant subcommittee. The subcommittee collectively reviewed the evidence profiles for each question they developed. After the draft was discussed and approved by the entire committee, then the document was circulated among all members for voting on the quality of evidence and strength of recommendation. The committee followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation system to determine quality of evidence and strength of recommendations. This guideline evaluates the ICU environment as a risk for medication-related events and the environmental changes that are possible to improve safe medication use. Prevention strategies for medication-related events are reviewed by medication use process node (prescribing, distribution, administration, monitoring). Detailed considerations to an active surveillance system that includes reporting, identification, and evaluation are discussed. Also, highlighted is the need for future research for safe medication practices that is specific to critically ill patients.

77 FR 60617 - Child Health Day, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-04

... parents, schools, and community leaders to address childhood obesity. A safe environment in which our... the quality health care and clean environment that will nurture their future success. My... children can attend schools that are safe, where we address bullying and end the myth that it is a simple...

75 FR 4331 - Seaway Regulations and Rules: Periodic Update, Various Categories

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-27

... section. In section 401.52, ``Limit of Approach to a Bridge'', vessels are required to proceed at a safe... inspection'', vessels will be required to provide a safe and approved means of boarding for inspectors... action significantly affecting the quality of the human environment. Federalism The Corporation has...

Assessment of arsenic, fluoride, bacteria, and other contaminants in drinking water sources for rural communities of Kasur and other districts in Punjab, Pakistan.

PubMed

Arshad, Nasima; Imran, Saiqa

2017-01-01

High levels of arsenic contamination in drinking water of two villages, Badarpur and Ibrahimabad of district Kasur, central Punjab, Pakistan is reported first time in present studies. Groundwater quality situation was found to be impaired when samples of different rural areas of district Kasur were monitored according to Pakistan Standards and Quality Control Authority (PSQCA) for all significant water quality constituents and analyzed for trace elements, physico-chemical, and microbiological parameters. Out of 35water sources, 97 % were found unsafe and only 3 % of the sources were within safe limits. High concentrations of arsenic, fluoride, and bacteria were found in 91, 74, and 77 % sources of drinking water, respectively. Very high concentrations of arsenic ranging 58-3800 μg/L were found in the water samples obtained from Badarpur and Ibrahimabad. A decrease in water contamination was observed with increase in source depth. The health issues like arsenicosis and skeletal/dental flourosis were observed in the residents of the monitored areas. Drinking water quality conditions of some rural areas of northen and southern districts of Punjab was also analyzed and compared with Kasur district. High levels of nitrates were found in the samples of Islamabad and Rawalpindi, while high levels of arsenic, iron, fluoride, and TDS were found in Bahawalpur district. Graphical abstract ᅟ.

Collaborating to implement interprofessional educational competencies through an international immersion experience.

PubMed

Bentley, Regina; Engelhardt, Joan A; Watzak, Bree

2014-01-01

Interprofessional collaborative practice is the key to safe, high-quality, accessible, patient-centered care. Achieving this requires the development of interprofessional competencies by health professions students as part of the learning process so that they enter the workforce ready to practice effective team-based care. The authors describe how the immersion process of an international short-term medical mission experience can intensify interprofessional learning by addressing selected Interprofessional Education Collaborative (IPEC), 2011, Core Interprofessional Education Competencies.

New quenching media

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

Voroshilov, V.A.; Kamenev, V.D.; Kochurkina, Yu.I.

This study investigates a wide range of substances to discover a high quality quenching medium. The medium must have the possibility of variation of cooling ability, fire resistance, and nontoxicity, and be available, simple, and safe. Surfactants, liquids, organosilicon compounds, and water soluble polymerics were surveyed and rejected. In aqueous solutions the cooling properties worsened during heating. Modified celluloses (polyethylenepolymine) and sulfite liquor were also studied. These were determined to be the most promising quenching media, and were tested and detailed.

Improving forensic mental health care for Aboriginal Australians: challenges and opportunities.

PubMed

Durey, Angela; Wynaden, Dianne; Barr, Lesley; Ali, Mohammed

2014-06-01

Mental illnesses constitute a major burden of disease in Aboriginal Australians and Torres Strait Islanders (hereafter Aboriginal Australians), who are also overrepresented in the prison system. A legacy of colonization compounds such prevalence, and is further exacerbated by the persistence of racial discrimination and insensitivity across many sectors, including health. This research completed in a Western Australian forensic mental health setting identifies non-Aboriginal health professionals' support needs to deliver high-quality, culturally-safe care to Aboriginal patients. Data were collected from health professionals using an online survey and 10 semistructured interviews. Survey and interview results found that ongoing education was needed for staff to provide culturally-safe care, where Aboriginal knowledge, beliefs, and values were respected. The findings also support previous research linking Aboriginal health providers to improved health outcomes for Aboriginal patients. In a colonized country, such as Australia, education programmes that critically reflect on power relations privileging white Anglo-Australian cultural dominance and subjugating Aboriginal knowledge, beliefs, and values are important to identify factors promoting or compromising the care of Aboriginal patients and developing a deeper understanding of 'cultural safety' and its clinical application. Organizational commitment is needed to translate the findings to support non-Aboriginal health professionals deliver high-quality care to Aboriginal patients that is respectful of cultural differences. © 2013 Australian College of Mental Health Nurses Inc.

Embracing Safe Ground Test Facility Operations and Maintenance

NASA Technical Reports Server (NTRS)

Dunn, Steven C.; Green, Donald R.

2010-01-01

Conducting integrated operations and maintenance in wind tunnel ground test facilities requires a balance of meeting due dates, efficient operation, responsiveness to the test customer, data quality, effective maintenance (relating to readiness and reliability), and personnel and facility safety. Safety is non-negotiable, so the balance must be an "and" with other requirements and needs. Pressure to deliver services faster at increasing levels of quality in under-maintained facilities is typical. A challenge for management is to balance the "need for speed" with safety and quality. It s especially important to communicate this balance across the organization - workers, with a desire to perform, can be tempted to cut corners on defined processes to increase speed. Having a lean staff can extend the time required for pre-test preparations, so providing a safe work environment for facility personnel and providing good stewardship for expensive National capabilities can be put at risk by one well-intending person using at-risk behavior. This paper documents a specific, though typical, operational environment and cites management and worker safety initiatives and tools used to provide a safe work environment. Results are presented and clearly show that the work environment is a relatively safe one, though still not good enough to keep from preventing injury. So, the journey to a zero injury work environment - both in measured reality and in the minds of each employee - continues. The intent of this paper is to provide a benchmark for others with operational environments and stimulate additional sharing and discussion on having and keeping a safe work environment.

Will the SAFE Strategy Be Sufficient to Eliminate Trachoma by 2020? Puzzlements and Possible Solutions

PubMed Central

Lavett, Diane K.; Lansingh, Van C.; Carter, Marissa J.; Eckert, Kristen A.; Silva, Juan C.

2013-01-01

Since the inception of (the Global Elimination of Blinding Trachoma) GET 2020 in 1997 and the implementation of the SAFE strategy a year later, much progress has been made toward lowering the prevalence of trachoma worldwide with elimination of the disease in some countries. However, high recurrence of trichiasis after surgery, difficulty in controlling the reemergence of infection after mass distribution of azithromycin in some communities, the incomplete understanding of environment in relation to the disease, and the difficulty in establishing the prevalence of the disease in low endemic areas are some of the issues still facing completion of the GET 2020 goals. In this narrative review, literature was searched from 1998 to January 2013 in PubMed for original studies and reviews. Reasons for these ongoing problems are discussed, and several suggestions are made as avenues for exploration in relation to improving the SAFE strategy with emphasis on improving surgical quality and management of the mass treatment with antibiotics. In addition, more research needs to be done to better understand the approach to improve sanitation, hygiene, and environment. The main conclusion of this review is that scale-up is needed for all SAFE components, and more research should be generated from communities outside of Africa and Asia. PMID:23766701

Hypergol Systems: Design, Buildup, and Operation

NASA Technical Reports Server (NTRS)

Baker, David; Rathgeber, Kurt

2006-01-01

This course was developed by personnel at the NASA JSC White Sands Test Facility in conjunction with the NASA Safety Training Center (NSTC). The NSTC was established in May 1991 by the NASA Headquarters Safety Directorate to provide up-to-date, high-quality, NASA specific safety training on location at NASA centers, or simultaneously to multiple centers over the Video Teleconferencing System (ViTS). Our desire is to establish and maintain a strong, long-lasting relationship with all NASA centers in order to fulfill your safety training needs on a cost-effective basis. Our ultimate goal is to provide a positive contribution to safe operations at NASA. NSTC Course 055 is a 2-day course discussing the safe usage of hypergols (hydrazine fuels and nitrogen tetroxide). During the course we will identify the hazards associated with hypergols including toxicity, reactivity, fire, and explosion. Management of risk is discussed in terms of the primary engineering controls design, buildup, and operation; and secondary controls personal protective equipment and detectors/monitors. The emphasis is on the design and buildup of compatible systems and the safe operation of these systems by technicians and engineers.

A comprehensive audit of nursing record keeping practice.

PubMed

Griffiths, Paul; Debbage, Samantha; Smith, Alison

Good quality record keeping is essential to safe and effective patient care. To ensure that high standards of record keeping are maintained, regular clinical audit should be undertaken. This article describes an audit and re-audit of nursing record keeping at Sheffield Teaching Hospital NHS Foundation Trust. The article demonstrates improving audit data in 2005 and 2006 and describes how audit and the resulting recommendations and action plans can result in real improvements in the quality of record keeping. The keys to success in this ongoing audit programme are identified as stakeholder involvement, support from the senior nurses in the organization and the use of the data for both local and trust-wide purposes.

30 CFR 75.803 - Fail safe ground check circuits on high-voltage resistance grounded systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Fail safe ground check circuits on high-voltage... High-Voltage Distribution § 75.803 Fail safe ground check circuits on high-voltage resistance grounded... shall include a fail safe ground check circuit to monitor continuously the grounding circuit to assure...

30 CFR 75.803 - Fail safe ground check circuits on high-voltage resistance grounded systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Fail safe ground check circuits on high-voltage... High-Voltage Distribution § 75.803 Fail safe ground check circuits on high-voltage resistance grounded... shall include a fail safe ground check circuit to monitor continuously the grounding circuit to assure...

30 CFR 75.803 - Fail safe ground check circuits on high-voltage resistance grounded systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Fail safe ground check circuits on high-voltage... High-Voltage Distribution § 75.803 Fail safe ground check circuits on high-voltage resistance grounded... shall include a fail safe ground check circuit to monitor continuously the grounding circuit to assure...

30 CFR 75.803 - Fail safe ground check circuits on high-voltage resistance grounded systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Fail safe ground check circuits on high-voltage... High-Voltage Distribution § 75.803 Fail safe ground check circuits on high-voltage resistance grounded... shall include a fail safe ground check circuit to monitor continuously the grounding circuit to assure...

Laser hardening techniques on steam turbine blade and application

NASA Astrophysics Data System (ADS)

Yao, Jianhua; Zhang, Qunli; Kong, Fanzhi; Ding, Qingming

Different laser surface hardening techniques, such as laser alloying and laser solution strengthening were adopted to perform modification treatment on the local region of inset edge for 2Cr13 and 17-4PH steam turbine blades to prolong the life of the blades. The microstructures, microhardness and anti-cavitation properties were investigated on the blades after laser treatment. The hardening mechanism and technique adaptability were researched. Large scale installation practices confirmed that the laser surface modification techniques are safe and reliable, which can improve the properties of blades greatly with advantages of high automation, high quality, little distortion and simple procedure.

A cable-driven parallel manipulator with force sensing capabilities for high-accuracy tissue endomicroscopy.

PubMed

Miyashita, Kiyoteru; Oude Vrielink, Timo; Mylonas, George

2018-05-01

Endomicroscopy (EM) provides high resolution, non-invasive histological tissue information and can be used for scanning of large areas of tissue to assess cancerous and pre-cancerous lesions and their margins. However, current robotic solutions do not provide the accuracy and force sensitivity required to perform safe and accurate tissue scanning. A new surgical instrument has been developed that uses a cable-driven parallel mechanism (CPDM) to manipulate an EM probe. End-effector forces are determined by measuring the tensions in each cable. As a result, the instrument allows to accurately apply a contact force on a tissue, while at the same time offering high resolution and highly repeatable probe movement. 0.2 and 0.6 N force sensitivities were found for 1 and 2 DoF image acquisition methods, respectively. A back-stepping technique can be used when a higher force sensitivity is required for the acquisition of high quality tissue images. This method was successful in acquiring images on ex vivo liver tissue. The proposed approach offers high force sensitivity and precise control, which is essential for robotic EM. The technical benefits of the current system can also be used for other surgical robotic applications, including safe autonomous control, haptic feedback and palpation.

Comparative analytical study of the selected wine varieties grown in Montenegro.

PubMed

Đorđević, Neda O; Novaković, Miroslav M; Pejin, Boris; Mutić, Jelena J; Vajs, Vlatka E; Pajović, Snežana B; Tešević, Vele V

2017-08-01

Samples of the selected red wine varieties grown in Montenegro (Merlot, Cabernet Sauvignon and Vranac; vintages 2010-2012) were compared according to total phenolic content, anti-DPPH radical activity, phenolic profile and elemental composition. All the samples showed profound anti-DPPH radical activity, due to high content of total phenolic compounds (R = 0.92). The most abundant phenolics were catechin and gallic acid with the highest values recorded for Merlot 2012 (43.22 and 28.65 mg/L, respectively). In addition to this, the content of essential elements including the potentially toxic ones was within healthy (safe) level for all the samples analysed. This study has actually pointed out Merlot wine variety as the best quality one, though all three varieties may be used as safe and health-promoting nutritional products.

2016 Draft Estuarine/Marine Copper Aquatic Life Ambient Water Quality Criteria

EPA Pesticide Factsheets

Documents pertain to Aquatic Life Ambient Water Quality criteria for Copper (2016 Estuarine/marine). These documents contain the safe levels of Copper in water that should protect to the majority of species.

Bottled Water Everywhere: Keeping it Safe

MedlinePlus

... that taps an aquifer—layers of porous rock, sand, and earth that contain water—which is under ... it to be labeled as “purified water.” Ensuring Quality and Safety Federal quality standards for bottled water ...

ANA position statement on privatization and for-profit conversion. American Nurses Association.

PubMed

1998-01-01

The American Nurses Association (ANA) believes that the health of communities benefits from a mix of health care facilities, including both public and nonprofit private facilities where feasible. ANA is concerned by the rate of conversion of nonprofit facilities and plans to for-profit status. Privatization of public facilities and the conversion of nonprofit facilities and health plans to for-profit status requires careful public oversight to ensure continued access to affordable, quality services, including a maintenance of uncompensated care; a fair accounting of the assets of the entity being privatized or converted; and an assurance that converted assets are used to maintain and improve access to affordable, safe and quality health care services. The rights and benefits of employees must be carefully safe-guarded in any privatization or conversion move. All hospitals, regardless of ownership or tax status, should be held accountable for the delivery of safe, quality services, and should be required to disclose data regarding staffing, patient outcomes, cost and delivery of uncompensated care. Continued data collection will be necessary to guide further development of public policy to address privatization and for-profit conversion.

In Search of a Safe Natural Sleep Aid.

PubMed

Rao, Theertham P; Ozeki, Motoko; Juneja, Lekh R

2015-01-01

Sleep deprivation is associated with an elevated risk of various diseases and leads to a poor quality of life and negative socioeconomic consequences. Sleep inducers such as drugs and herbal medicines may often lead to dependence and other side effects. L-Theanine (γ-glutamylethylamide), an amino acid naturally found abundant in tea leaves, has anxiolytic effects via the induction of α brain waves without additive and other side effects associated with conventional sleep inducers. Anxiolysis is required for the initiation of high-quality sleep. In this study, we review the mechanism(s), safety, and efficacy of L-theanine. Collectively, sleep studies based on an actigraph, the obstructive sleep apnea (OSA) sleep inventory questionnaire, wakeup after sleep onset (WASO) and automatic nervous system (ANS) assessment, sympathetic and parasympathetic nerve activities, and a pediatric sleep questionnaire (PSQ) suggest that the administration of 200 mg of L-theanine before bed may support improved sleep quality not by sedation but through anxiolysis. Because L-theanine does not induce daytime drowsiness, it may be useful at any time of the day. The no observable adverse effect level (NOAEL) for the oral administration of L-theanine was determined to be above 2000 mg/kg bw/day. KEY TEACHING POINTS: Sleep deprivation-associated morbidity is an increasing public health concern posing a substantial socioeconomic burden. Chronic sleep disorders may seriously affect quality of life and may be etiological factors in a number of chronic diseases such as depression, obesity, diabetes, and cardiovascular diseases. Most sleep inducers are sedatives and are often associated with addiction and other side effects. L-Theanine promotes relaxation without drowsiness. Unlike conventional sleep inducers, L-theanine is not a sedative but promotes good quality of sleep through anxiolysis. This review suggests that L-theanine is a safe natural sleep aid.

Vouchers for health: A demand side output-based aid approach to reproductive health services in Kenya.

PubMed

Janisch, C P; Albrecht, M; Wolfschuetz, A; Kundu, F; Klein, S

2010-01-01

Reaching the United Nation's Millennium Development Goals has been a focus for many countries and development partners. In Kenya, as in many other countries with low levels of development, access to and equity of basic quality health services is limited, especially for the very poor. Among poor populations, maternal mortality is high as access to medical care and financial means are lacking. In 2005, the Governments of Kenya and Germany in cooperation with KfW Banking Group made funds available for the Reproductive Health OBA Voucher Programme offering vouchers for Safe Motherhood, Family Planning and Gender Violence Recovery Services. This programme, herein referred to as Vouchers for Health, was launched in June of 2006 in five Kenyan districts with the aim of providing health services for safe deliveries, long-term family planning methods and victims of gender violence. The way that the programme is being implemented in Kenya demonstrates that the voucher-based approach comprises a variety of key structural elements of a national health insurance scheme: accreditation; quality assurance; reimbursement system; claims processing; integrating the private sector; client choice; provider competition; and access to and equity of services provided.

Bacteriological and physico-chemical quality of drinking water sources in a rural community of Ethiopia.

PubMed

Tsega, N; Sahile, S; Kibret, M; Abera, B

2013-12-01

Accesses to safe water is a universal need however, many of the world's population lack access to adequate and safe water. Consumption of water contaminated causes health risk to the public and the situation is serous in rural areas. To assess the bacteriological and physico-chemical quality of drinking water sources in a rural community of Ethiopia. Water samples were collected from tap, open springs, open dug wells and protected springs for bacteriological analysis of total coliforms and thermotolerant coliforms. The turbidity, pH and temperature were measured immediately after collection. Most drinking water sources were found to have coliform counts above the recommended national and international guidelines and had high sanitary risk scores. There was a statistically significant difference among water sources with respect to TC and TTC (p < 0.05) and there was a statistically significant positive correlation between coliform counts and sanitary risk scores (p < 0.01). Most water sources didn't satisfy the turbidity values recommended by WHO. The water sources were heavily contaminated which suggested poor protection and sanitation practice in the water sources. Source protection strategies as well as monitoring are recommend for this community.

Use of edible films and coatings to extend the shelf life of food products.

PubMed

Maftoonazad, Neda; Badii, Fojan

2009-06-01

The increased consumer demand for high quality, extended shelf life, ready to eat foods has initiated the development of several innovative techniques to keep their natural and fresh appearance as long as possible and at the same time render them safe. Packaging has been an important element in these preservation concepts for providing the appropriate (mechanical and functional) protection to the commodity. Since synthetic packaging materials contribute to the environmental pollution, edible coatings and packages have been proposed to replace or complement conventional packaging. Biodegradable and edible films and coatings are made from naturally occurring polymers and functional ingredients, and formed on the surface of food products. Edible films and coating have long been known to protect perishable food products from deterioration and reduce quality loss. These films should have acceptable sensory characteristics, appropriate barrier properties (CO(2), O(2), water, oil), microbial, biochemical and physicochemical stability, they should be safe, and be produced by simple technology in low cost. Also they can act as effective carrier for antioxidant, flavor, color, nutritional or anti-microbial additives. Patents on edible films and food products are also discussed in this article.

Safe Schools Overview. NSSC Resource Paper.

ERIC Educational Resources Information Center

National School Safety Center, Sacramento, CA.

U.S. schools must today address problems of crime, violence, drugs, suicide, child abuse, and lack of discipline. Academic issues have recently been in the public spotlight, but the quality of a child's education can be severely affected if the child is not in a safe environment. Crime and violence are a pervasive problem in schools, affecting…

Radioactive Waste Management in A Hospital

PubMed Central

Khan, Shoukat; Syed, AT; Ahmad, Reyaz; Rather, Tanveer A.; Ajaz, M; Jan, FA

2010-01-01

Most of the tertiary care hospitals use radioisotopes for diagnostic and therapeutic applications. Safe disposal of the radioactive waste is a vital component of the overall management of the hospital waste. An important objective in radioactive waste management is to ensure that the radiation exposure to an individual (Public, Radiation worker, Patient) and the environment does not exceed the prescribed safe limits. Disposal of Radioactive waste in public domain is undertaken in accordance with the Atomic Energy (Safe disposal of radioactive waste) rules of 1987 promulgated by the Indian Central Government Atomic Energy Act 1962. Any prospective plan of a hospital that intends using radioisotopes for diagnostic and therapeutic procedures needs to have sufficient infrastructural and manpower resources to keep its ambient radiation levels within specified safe limits. Regular monitoring of hospital area and radiation workers is mandatory to assess the quality of radiation safety. Records should be maintained to identify the quality and quantity of radioactive waste generated and the mode of its disposal. Radiation Safety officer plays a key role in the waste disposal operations. PMID:21475524

Access to Safe Water in Rural Artibonite, Haiti 16 Months after the Onset of the Cholera Epidemic

PubMed Central

Patrick, Molly; Berendes, David; Murphy, Jennifer; Bertrand, Fabienne; Husain, Farah; Handzel, Thomas

2013-01-01

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. PMID:24106191

Investigation on scalable high-power lasers with enhanced 'eye-safety' for future weapon systems

NASA Astrophysics Data System (ADS)

Bigotta, S.; Diener, K.; Eichhorn, M.; Galecki, L.; Geiss, L.; Ibach, T.; Scharf, H.; von Salisch, M.; Schöner, J.; Vincent, G.

2016-10-01

The possible use of lasers as weapons becomes more and more interesting for military forces. Besides the generation of high laser power and good beam quality, also safety considerations, e. g. concerning eye hazards, are of importance. The MELIAS (medium energy laser in the "eye-safe" spectral domain) project of ISL addresses these issues, and ISL has developed the most powerful solid-state laser in the "eye-safe" wavelength region up to now. "Eye safety" in this context means that light at a wavelength of > 1.4 μm does not penetrate the eye and thus will not be focused onto the retina. The basic principle of this technology is that a laser source needs to be scalable in power to far beyond 100 kW without a significant deterioration in beam quality. ISL has studied a very promising laser technology: the erbium heat-capacity laser. This type of laser is characterised by a compact design, a simple and robust technology and a scaling law which, in principle, allows the generation of laser power far beyond megawatts at small volumes. Previous investigations demonstrated the scalability of the SSHCL and up to 4.65 kW and 440 J in less than 800 ms have been obtained. Opticalto- optical efficiencies of over 41% and slope efficiencies of over 51% are obtained. The residual thermal gradients, due to non perfect pumping homogeneity, negatively affect the performance in terms of laser pulse energy, duration and beam quality. In the course of the next two years, ISL will be designing a 25 to 30 kW erbium heat-capacity laser.

Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis.

PubMed

Louwerens, Jan K G; Sierevelt, Inger N; van Noort, Arthur; van den Bekerom, Michel P J

2014-08-01

This meta-analysis assessed the short-term to midterm effectiveness of minimally invasive treatments in the management of calcifying tendinopathy of the shoulder cuff, a common source of chronic shoulder pain that leads to pain, a decreased active range of motion, and loss of muscular strength. When conservative therapies fail, minimally invasive treatment options can be considered before resulting to surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this review. A systematic literature search was conducted in May 2013 to identify all studies that examined the short-term to midterm effectiveness of minimally invasive treatments for chronic calcifying tendinopathy. The primary end points were identified as function, pain, and total resorption rates. Grades of Recommendation Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence. Included were 20 studies (1544 participants). Common methodological flaws were related to randomization. In general, there is moderate-quality GRADE evidence that high-energy extracorporeal shockwave therapy has a significant effect on pain relief and functional status compared with other interventions. There is variable-quality GRADE evidence on the efficiency of other interventions. High-energy extracorporeal shockwave therapy is the most thoroughly investigated minimally invasive treatment option in the short-term to midterm and has proven to be a safe and effective treatment. Ultrasound-guided needling is safe but has not been proven to be more effective than an ultrasound-guided subacromial corticosteroid injection in recent level I research, and further research will have to prove its effectiveness. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Understanding Interrater Reliability and Validity of Risk Assessment Tools Used to Predict Adverse Clinical Events.

PubMed

Siedlecki, Sandra L; Albert, Nancy M

This article will describe how to assess interrater reliability and validity of risk assessment tools, using easy-to-follow formulas, and to provide calculations that demonstrate principles discussed. Clinical nurse specialists should be able to identify risk assessment tools that provide high-quality interrater reliability and the highest validity for predicting true events of importance to clinical settings. Making best practice recommendations for assessment tool use is critical to high-quality patient care and safe practices that impact patient outcomes and nursing resources. Optimal risk assessment tool selection requires knowledge about interrater reliability and tool validity. The clinical nurse specialist will understand the reliability and validity issues associated with risk assessment tools, and be able to evaluate tools using basic calculations. Risk assessment tools are developed to objectively predict quality and safety events and ultimately reduce the risk of event occurrence through preventive interventions. To ensure high-quality tool use, clinical nurse specialists must critically assess tool properties. The better the tool's ability to predict adverse events, the more likely that event risk is mediated. Interrater reliability and validity assessment is relatively an easy skill to master and will result in better decisions when selecting or making recommendations for risk assessment tool use.

A post-implementation evaluation of ceramic water filters distributed to tsunami-affected communities in Sri Lanka.

PubMed

Casanova, Lisa M; Walters, Adam; Naghawatte, Ajith; Sobsey, Mark D

2012-06-01

Sri Lanka was devastated by the 2004 Indian Ocean tsunami. During recovery, the Red Cross distributed approximately 12,000 free ceramic water filters. This cross-sectional study was an independent post-implementation assessment of 452 households that received filters, to determine the proportion still using filters, household characteristics associated with use, and quality of household drinking water. The proportion of continued users was high (76%). The most common household water sources were taps or shallow wells. The majority (82%) of users used filtered water for drinking only. Mean filter flow rate was 1.12 L/hr (0.80 L/hr for households with taps and 0.71 for those with wells). Water quality varied by source; households using tap water had source water of high microbial quality. Filters improved water quality, reducing Escherichia coli for households (largely well users) with high levels in their source water. Households were satisfied with filters and are potentially long-term users. To promote sustained use, recovery filter distribution efforts should try to identify households at greatest long-term risk, particularly those who have not moved to safer water sources during recovery. They should be joined with long-term commitment to building supply chains and local production capacity to ensure safe water access.

Toxicological Assessment of the International Space Station Atmosphere with Emphasis on Metox Canister Regeneration

NASA Technical Reports Server (NTRS)

James, John T.; Limero, Tom; Beck, Steve; Martin, Millie; Covington, Phillip; Boyd, John; Peters, Randy

2003-01-01

Space-faring crews must have safe breathing air throughout their missions to ensure adequate performance and good health. Toxicological assessment of air quality depends on the standards that define acceptable air quality, measurements of pollutant levels during the flight, and reports from the crew on their in-flight perceptions of air quality. Air samples returned from ISS on flights 8A, UF2, 9A, and 11A were analyzed for trace pollutants. On average, the air during this period of operations was safe for human respiration. However, about 3 hours into the regeneration of 2 Metox canisters in the U.S. airlock on 20 February 2002 the crew reported an intolerable odor that caused them to stop the regeneration, take refuge in the Russian segment, and scrub air in the U.S. segment for 30 hours. Analytical data from grab samples taken during the incident showed that the pollutants released were characteristic of nominal air pollutants, but were present in much higher concentrations. The odors reported by the crew were due to relatively high concentrations of n-butanol, and possibly other pollutants in the mixture. Later data taken during regeneration of Metox canisters that had not been subject to long-term flows showed minimal effects on air quality. Long-term trending data suggest that a disruption in atmospheric mixing between the Service Module and the U.S. Laboratory has occurred and that formaldehyde concentrations are gradually increasing in the U.S. Laboratory. Trending data also show that the releases of octafluoropropane (OFP) have subsided.

Radio Frequency Identification (RFID) in healthcare: a literature review.

PubMed

Kolokathi, Aikaterini; Rallis, Panagiotis

2013-01-01

Creating and maintaining a safe and high-quality health care environment is of great importance for global community. New technologies and their applications can help us achieve this goal. Radio-Frequency Identification (RIFD) technology is considered one of those technologies and even today there are some interesting deployments in the health industry. As a result, this work aims to present the basic idea behind RFID solutions, problems that can be addressed with the adoption of RFID and the benefits of relative applications.

Food security status among grade 5 students in Nova Scotia, Canada and its association with health outcomes.

PubMed

Kirk, Sara F L; Kuhle, Stefan; McIsaac, Jessie-Lee D; Williams, Patty L; Rossiter, Melissa; Ohinmaa, Arto; Veugelers, Paul J

2015-11-01

Food security (FS) exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their needs. The present research sought to determine whether students from households experiencing moderate or severe food insecurity (FI) had poorer diet quality, higher body weights and poorer psychosocial outcomes than students from households classed as having high FS or marginal FI status. Population-based survey conducted in schools. Multiple regression analysis was used to explore associations between FS status (high FS; marginal, moderate, severe FI), dietary behaviours and intake, and health-related outcomes (body weight, quality of life, mood, peer relationships, externalizing problems). Nova Scotia, Canada. Grade 5 students (n 5853), aged 10-11 years, with complete information on FS status and student outcomes. In this sample, rates of household FS were 73·5% (high FS), 8·3% (marginal FI) 10·2% (moderate FI) and 7·1% (severe FI status). Students living in households experiencing moderate or severe FI had poorer diet quality, higher BMI and poorer psychosocial outcomes than students classed as having high FS or marginal FI. These findings provide important evidence for policy makers on the prevalence of FI among families in Nova Scotia with grade 5 children and its relationship with childhood nutrition, psychosocial and quality of life factors, and weight status.

If You Don't Know, Ask! Using Expert Knowledge to Determine What Content Is Needed in an Undergraduate Food Quality Management and Control Course

ERIC Educational Resources Information Center

Joyner, Helen S.; Stevenson, Clinton D.

2017-01-01

Quality management and quality control of food products are critical to producing food that is safe to consume and has consistent quality and sensory attributes. The extent to which undergraduate students are equipped with competencies in quality management/control, in theory, has a direct connection with their career potential to ensure food…

Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe

PubMed Central

Jennings, Larissa; Bertrand, Jane; Rech, Dino; Harvey, Steven A.; Hatzold, Karin; Samkange, Christopher A.; Omondi Aduda, Dickens S.; Fimbo, Bennett; Cherutich, Peter; Perry, Linnea; Castor, Delivette; Njeuhmeli, Emmanuel

2014-01-01

Background The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. Methods and Findings A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC. Conclusions Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention. PMID:24801073

[Monitoring evaluation system for high-specialty hospitals].

PubMed

Fajardo Dolci, Germán; Aguirre Gas, Héctor G; Robledo Galván, Héctor

2011-01-01

Hospital evaluation is a fundamental process to identify medical units' objective compliance, to analyze efficiency of resource use and allocation, institutional values and mission alignment, patient safety and quality standards, contributions to research and medical education, and the degree of coordination among medical units and the health system as a whole. We propose an evaluation system for highly specialized regional hospitals through the monitoring of performance indicators. The following are established as base thematic elements in the construction of indicators: safe facilities and equipment, financial situation, human resources management, policy management, organizational climate, clinical activity, quality and patient safety, continuity of care, patients' and providers' rights and obligations, teaching, research, social responsibility, coordination mechanisms. Monitoring refers to the planned and systematic evaluation of valid and reliable indicators, aimed at identifying problems and opportunity areas. Moreover, evaluation is a powerful tool to strengthen decision-making and accountability in medical units.

Identification, characterization, and palynology of high-valued medicinal plants.

PubMed

Fazal, Hina; Ahmad, Nisar; Haider Abbasi, Bilal

2013-01-01

High-valued medicinal plants Achillea millefolium, Acorus calamus, Arnebia nobilis, Fumaria indica, Gymnema sylvestre, Origanum vulgare, Paeonia emodi, Peganum harmala, Psoralea corylifolia, Rauwolfia serpentina, and Vetiveria zizanioides were identified with the help of taxonomical markers and investigated for characterization and palynological studies. These parameters are used to analyze their quality, safety, and standardization for their safe use. Botanical description and crude drug description is intended for their quality assurance at the time of collection, commerce stages, manufacturing, and production. For this purpose the detailed morphology was studied and compared with the Flora of Pakistan and other available literatures. Here we reported the pollen grain morphology of Origanum vulgare, Paeonia emodi, Psoralea corylifolia, and Rauwolfia serpentina for the first time. Similarly the crude drug study of Gymnema sylvestre (leaf), Origanum vulgare (aerial parts), Paeonia emodi (tubers), and Peganum harmala (seeds) was also carried out for the first time.

Identification, Characterization, and Palynology of High-Valued Medicinal Plants

PubMed Central

Fazal, Hina; Ahmad, Nisar; Haider Abbasi, Bilal

2013-01-01

High-valued medicinal plants Achillea millefolium, Acorus calamus, Arnebia nobilis, Fumaria indica, Gymnema sylvestre, Origanum vulgare, Paeonia emodi, Peganum harmala, Psoralea corylifolia, Rauwolfia serpentina, and Vetiveria zizanioides were identified with the help of taxonomical markers and investigated for characterization and palynological studies. These parameters are used to analyze their quality, safety, and standardization for their safe use. Botanical description and crude drug description is intended for their quality assurance at the time of collection, commerce stages, manufacturing, and production. For this purpose the detailed morphology was studied and compared with the Flora of Pakistan and other available literatures. Here we reported the pollen grain morphology of Origanum vulgare, Paeonia emodi, Psoralea corylifolia, and Rauwolfia serpentina for the first time. Similarly the crude drug study of Gymnema sylvestre (leaf), Origanum vulgare (aerial parts), Paeonia emodi (tubers), and Peganum harmala (seeds) was also carried out for the first time. PMID:23844389

Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline.

PubMed

Lutz, Stephen; Balboni, Tracy; Jones, Joshua; Lo, Simon; Petit, Joshua; Rich, Shayna E; Wong, Rebecca; Hahn, Carol

The purpose is to provide an update the Bone Metastases Guideline published in 2011 based on evidence complemented by expert opinion. The update will discuss new high-quality literature for the 8 key questions from the original guideline and implications for practice. A systematic PubMed search from the last date included in the original Guideline yielded 414 relevant articles. Ultimately, 20 randomized controlled trials, 32 prospective nonrandomized studies, and 4 meta-analyses/pooled analyses were selected and abstracted into evidence tables. The authors synthesized the evidence and reached consensus on the included recommendations. Available literature continues to support pain relief equivalency between single and multiple fraction regimens for bone metastases. High-quality data confirm single fraction radiation therapy may be delivered to spine lesions with acceptable late toxicity. One prospective, randomized trial confirms both peripheral and spine-based painful metastases can be successfully and safely palliated with retreatment for recurrence pain with adherence to published dosing constraints. Advanced radiation therapy techniques such as stereotactic body radiation therapy lack high-quality data, leading the panel to favor its use on a clinical trial or when results will be collected in a registry. The panel's conclusion remains that surgery, radionuclides, bisphosphonates, and kyphoplasty/vertebroplasty do not obviate the need for external beam radiation therapy. Updated data analysis confirms that radiation therapy provides excellent palliation for painful bone metastases and that retreatment is safe and effective. Although adherence to evidence-based medicine is critical, thorough expert radiation oncology physician judgment and discretion regarding number of fractions and advanced techniques are also essential to optimize outcomes when considering the patient's overall health, life expectancy, comorbidities, tumor biology, anatomy, previous treatment including prior radiation at or near current site of treatment, tumor and normal tissue response history to local and systemic therapies, and other factors related to the patient, tumor characteristics, or treatment. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Improving medical device regulation: the United States and Europe in perspective.

PubMed

Sorenson, Corinna; Drummond, Michael

2014-03-01

Recent debates and events have brought into question the effectiveness of existing regulatory frameworks for medical devices in the United States and Europe to ensure their performance, safety, and quality. This article provides a comparative analysis of medical device regulation in the two jurisdictions, explores current reforms to improve the existing systems, and discusses additional actions that should be considered to fully meet this aim. Medical device regulation must be improved to safeguard public health and ensure that high-quality and effective technologies reach patients. We explored and analyzed medical device regulatory systems in the United States and Europe in accordance with the available gray and peer-reviewed literature and legislative documents. The two regulatory systems differ in their mandate and orientation, organization, pre- and postmarket evidence requirements, and transparency of process. Despite these differences, both jurisdictions face similar challenges for ensuring that only safe and effective devices reach the market, monitoring real-world use, and exchanging pertinent information on devices with key users such as clinicians and patients. To address these issues, reforms have recently been introduced or debated in the United States and Europe that are principally focused on strengthening regulatory processes, enhancing postmarket regulation through more robust surveillance systems, and improving the traceability and monitoring of devices. Some changes in premarket requirements for devices are being considered. Although the current reforms address some of the outstanding challenges in device regulation, additional steps are needed to improve existing policy. We examine a number of actions to be considered, such as requiring high-quality evidence of benefit for medium- and high-risk devices; moving toward greater centralization and coordination of regulatory approval in Europe; creating links between device identifier systems and existing data collection tools, such as electronic health records; and fostering increased and more effective use of registries to ensure safe postmarket use of new and existing devices. © 2014 Milbank Memorial Fund.

Improving Medical Device Regulation: The United States and Europe in Perspective

PubMed Central

SORENSON, CORINNA; DRUMMOND, MICHAEL

2014-01-01

Context: Recent debates and events have brought into question the effectiveness of existing regulatory frameworks for medical devices in the United States and Europe to ensure their performance, safety, and quality. This article provides a comparative analysis of medical device regulation in the two jurisdictions, explores current reforms to improve the existing systems, and discusses additional actions that should be considered to fully meet this aim. Medical device regulation must be improved to safeguard public health and ensure that high-quality and effective technologies reach patients. Methods: We explored and analyzed medical device regulatory systems in the United States and Europe in accordance with the available gray and peer-reviewed literature and legislative documents. Findings: The two regulatory systems differ in their mandate and orientation, organization, pre-and postmarket evidence requirements, and transparency of process. Despite these differences, both jurisdictions face similar challenges for ensuring that only safe and effective devices reach the market, monitoring real-world use, and exchanging pertinent information on devices with key users such as clinicians and patients. To address these issues, reforms have recently been introduced or debated in the United States and Europe that are principally focused on strengthening regulatory processes, enhancing postmarket regulation through more robust surveillance systems, and improving the traceability and monitoring of devices. Some changes in premarket requirements for devices are being considered. Conclusions: Although the current reforms address some of the outstanding challenges in device regulation, additional steps are needed to improve existing policy. We examine a number of actions to be considered, such as requiring high-quality evidence of benefit for medium-and high-risk devices; moving toward greater centralization and coordination of regulatory approval in Europe; creating links between device identifier systems and existing data collection tools, such as electronic health records; and fostering increased and more effective use of registries to ensure safe postmarket use of new and existing devices. PMID:24597558

Facilitating the safe use of insulin pens in hospitals through a mentored quality-improvement program.

PubMed

Lutz, Mark F; Haines, Stuart T; Lesch, Christine A; Szumita, Paul M

2016-10-01

Results of the MENTORED QUALITY IMPROVEMENT IMPACT PROGRAM℠ (MQIIP) on Ensuring Insulin Pen Safety in Hospitals, which was part of an ASHP educational initiative aimed at ensuring the safe use of insulin pens in hospitals, are described. During this ASHP initiative, which also included continuing-education activities and Web-based resources, distance mentoring by pharmacists with expertise in the safe use of insulin pens was provided to interprofessional teams at 14 hospitals between September 2014 and May 2015. The results of baseline assessments of nursing staff knowledge of insulin pen use, insulin pen storage and labeling audits, and insulin pen injection observations conducted in September and October 2014 were the basis for insulin pen quality-improvement plans. Postintervention data were collected in April and May 2015. Compared with the baseline period, significant improvements in nurses' knowledge of insulin pen use, insulin pen labeling and storage, and insulin pen administration were observed in the postintervention period despite the relatively short time frame for implementation of quality-improvement plans. Program participants are committed to sustaining and building on improvements achieved during the program. The outcome measures described in this report could be adapted by other health systems to identify opportunities to improve the safety of insulin pen use. Focused attention on insulin pen safety through an interprofessional team approach during the MQIIP enabled participating sites to detect potential safety issues based on collected data, develop targeted process changes, document improvements, and identify areas requiring further intervention. A sustained organizational commitment is required to ensure the safe use of insulin pen devices in hospitals. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Creating a Highly Reliable Neonatal Intensive Care Unit Through Safer Systems of Care.

PubMed

Panagos, Patoula G; Pearlman, Stephen A

2017-09-01

Neonates requiring intensive care are at high risk for medical errors due to their unique characteristics and high acuity. Designing a safer work environment begins with safe processes. Creating a culture of safety demands the involvement of all organizational levels and an interdisciplinary approach. Adverse events can result from suboptimal communication and lack of a shared mental model. This chapter describes tools to promote better patient safety in the NICU through monitoring adverse events, improving communication and using information technology. Unplanned extubation is an example of a neonatal safety concern that can be reduced by employing quality improvement methodology. Copyright © 2017 Elsevier Inc. All rights reserved.

Power Ultrasound to Process Dairy Products

NASA Astrophysics Data System (ADS)

Bermúdez-Aguirre, Daniela; Barbosa-Cánovas, Gustavo V.

Conventional methods of pasteurizing milk involve the use of heat regardless of treatment (batch, high temperature short time - HTST or ultra high temperature - UHT sterilization), and the quality of the milk is affected because of the use of high temperatures. Consequences of thermal treatment are a decrease in nutritional properties through the destruction of vitamins or denaturation of proteins, and sometimes the flavor of milk is undesirably changed. These changes are produced at the same time that the goal of the pasteurization process is achieved, which is to have a microbiological safe product, free of pathogenic bacteria, and to reduce the load of deteriorative microorganisms and enzymes, resulting in a product with a longer storage life.

Educational background of nurses and their perceptions of the quality and safety of patient care.

PubMed

Swart, Reece P; Pretorius, Ronel; Klopper, Hester

2015-04-30

International health systems research confirms the critical role that nurses play in ensuring the delivery of high quality patient care and subsequent patient safety. It is therefore important that the education of nurses should prepare them for the provision of safe care of a high quality. The South African healthcare system is made up of public and private hospitals that employ various categories of nurses. The perceptions of the various categories of nurses with reference to quality of care and patient safety are unknown in South Africa (SA). To determine the relationship between the educational background of nurses and their perceptions of quality of care and patient safety in private surgical units in SA. A descriptive correlational design was used. A questionnaire was used for data collection, after which hierarchical linear modelling was utilised to determine the relationships amongst the variables. Both the registered- and enrolled nurses seemed satisfied with the quality of care and patient safety in the units were they work. Enrolled nurses (ENs) indicated that current efforts to prevent errors are adequate, whilst the registered nurses (RNs) obtained high scores in reporting incidents in surgical wards. From the results it was evident that perceptions of RNs and ENs related to the quality of care and patient safety differed. There seemed to be a statistically-significant difference between RNs and ENs perceptions of the prevention of errors in the unit, losing patient information between shifts and patient incidents related to medication errors, pressure ulcers and falls with injury.

OR.NET: a service-oriented architecture for safe and dynamic medical device interoperability.

PubMed

Kasparick, Martin; Schmitz, Malte; Andersen, Björn; Rockstroh, Max; Franke, Stefan; Schlichting, Stefan; Golatowski, Frank; Timmermann, Dirk

2018-02-23

Modern surgical departments are characterized by a high degree of automation supporting complex procedures. It recently became apparent that integrated operating rooms can improve the quality of care, simplify clinical workflows, and mitigate equipment-related incidents and human errors. Particularly using computer assistance based on data from integrated surgical devices is a promising opportunity. However, the lack of manufacturer-independent interoperability often prevents the deployment of collaborative assistive systems. The German flagship project OR.NET has therefore developed, implemented, validated, and standardized concepts for open medical device interoperability. This paper describes the universal OR.NET interoperability concept enabling a safe and dynamic manufacturer-independent interconnection of point-of-care (PoC) medical devices in the operating room and the whole clinic. It is based on a protocol specifically addressing the requirements of device-to-device communication, yet also provides solutions for connecting the clinical information technology (IT) infrastructure. We present the concept of a service-oriented medical device architecture (SOMDA) as well as an introduction to the technical specification implementing the SOMDA paradigm, currently being standardized within the IEEE 11073 service-oriented device connectivity (SDC) series. In addition, the Session concept is introduced as a key enabler for safe device interconnection in highly dynamic ensembles of networked medical devices; and finally, some security aspects of a SOMDA are discussed.

Experience with fluorine and its safe use as a propellant

NASA Technical Reports Server (NTRS)

Bond, D. L.; Guenther, M. E.; Stimpson, L. D.; Toth, L. R.; Young, D. L.

1979-01-01

The industrial and the propulsion experience with fluorine and its derivatives is surveyed. The hazardous qualities of fluorine and safe handling procedures for the substance are emphasized. Procedures which fulfill the safety requirements during ground operations for handling fluorinated propulsion systems are discussed. Procedures to be implemented for use onboard the Space Transportation System are included.

Dairy cow handling facilities and the perception of Beef Quality Assurance on Colorado dairies.

PubMed

Adams, A E; Olea-Popelka, F J; Grandin, T; Woerner, D R; Roman-Muniz, I N

2014-02-01

A survey was conducted on Colorado dairies to assess attitudes and practices regarding Dairy Beef Quality Assurance (DBQA). The objectives were to (1) assess the need for a new handling facility that would allow all injections to be administered via DBQA standards; (2) establish if Colorado dairy producers are concerned with DBQA; and (3) assess differences in responses between dairy owners and herdsmen. Of the 95 dairies contacted, 20 (21%) agreed to participate, with a median herd size of 1,178. When asked to rank the following 7 traits--efficiency, animal safety, human safety, ease of animal handling, ease of operation, inject per Beef Quality Assurance (BQA) procedures, and cost--in order of priority when designing a new handling facility, human and animal safety were ranked highest in priority (first or second) by the majority of participants, with ease of animal handling and efficiency ranked next. Interestingly, the administration of injections per BQA standards was ranked sixth or seventh by most participants. Respondents estimated the average annual income from the sale of cull cows to be 4.6% of all dairy income, with 50% receiving at least one carcass discount or condemnation in the past 12 mo. Although almost all of the participating dairy farmers stated that the preferred injection site for medications was the neck region, a significant number admitted to using alternate injection sites. In contrast, no difference was found between responses regarding the preferred and actual location for intravenous injections. Although most participating producers are aware of BQA injection guidelines, they perceive efficiency as more important, which could result in injections being administered in locations not promoted by BQA. Dairy owners and herdsmen disagreed in whether or not workers had been injured in the animal handling area in the last 12 mo. Handling facilities that allow for an efficient and safe way to administer drugs according to BQA guidelines and educational opportunities that highlight the effect of improved DBQA on profitability could prove useful. Dairy producers play a key role in ensuring that dairy beef is safe and high quality, and just as they are committed to producing safe and nutritious milk for their customers, they should be committed to producing the best quality beef. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Quality of intrapartum care by skilled birth attendants in a refugee clinic on the Thai-Myanmar border: a survey using WHO Safe Motherhood Needs Assessment.

PubMed

Hoogenboom, Gabie; Thwin, May Myo; Velink, Kris; Baaijens, Marijke; Charrunwatthana, Prakaykaew; Nosten, François; McGready, Rose

2015-02-05

Increasing the number of women birthing with skilled birth attendants (SBAs) as one of the strategies to reduce maternal mortality and morbidity must be partnered with a minimum standard of care. This manuscript describes the quality of intrapartum care provided by SBAs in Mae La camp, a low resource, protracted refugee context on the Thai-Myanmar border. In the obstetric department of Shoklo Malaria Research Unit (SMRU) the standardized WHO Safe Motherhood Needs Assessment tool was adapted to the setting and used: to assess the facility; interview SBAs; collect data from maternal records during a one year period (August 2007 - 2008); and observe practice during labour and childbirth. The facility assessment recorded no 'out of stock' or 'out of date' drugs and supplies, equipment was in operating order and necessary infrastructure e.g. a stand-by emergency car, was present. Syphilis testing was not available. SBA interviews established that danger signs and symptoms were recognized except for sepsis and endometritis. All SBAs acknowledged receiving theoretical and 'hands-on' training and regularly attended deliveries. Scores for the essential elements of antenatal care from maternal records were high (>90%) e.g. providing supplements, recording risk factors as well as regular and correct partogram use. Observed good clinical practice included: presence of a support person; active management of third stage; post-partum monitoring; and immediate and correct neonatal care. Observed incorrect practice included: improper controlled cord traction; inadequate hand washing; an episiotomy rate in nulliparous women 49% (34/70) and low rates 30% (6/20) of newborn monitoring in the first hours following birth. Overall observed complications during labour and birth were low with post-partum haemorrhage being the most common in which case the SBAs followed the protocol but were slow to recognize severity and take action. In the clinic of SMRU in Mae La refugee camp, SBAs were able to comply with evidence-based guidelines but support to improve quality of care in specific areas is required. The structure of the WHO Safe Motherhood Needs Assessment allowed significant insights into the quality of intrapartum care particularly through direct observation, identifying a clear pathway for quality improvement.

Quality Assurance Framework for Mini-Grids

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

Baring-Gould, Ian; Burman, Kari; Singh, Mohit

Providing clean and affordable energy services to the more than 1 billion people globally who lack access to electricity is a critical driver for poverty reduction, economic development, improved health, and social outcomes. More than 84% of populations without electricity are located in rural areas where traditional grid extension may not be cost-effective; therefore, distributed energy solutions such as mini-grids are critical. To address some of the root challenges of providing safe, quality, and financially viable mini-grid power systems to remote customers, the U.S. Department of Energy (DOE) teamed with the National Renewable Energy Laboratory (NREL) to develop a Qualitymore » Assurance Framework (QAF) for isolated mini-grids. The QAF for mini-grids aims to address some root challenges of providing safe, quality, and affordable power to remote customers via financially viable mini-grids through two key components: (1) Levels of service: Defines a standard set of tiers of end-user service and links them to technical parameters of power quality, power availability, and power reliability. These levels of service span the entire energy ladder, from basic energy service to high-quality, high-reliability, and high-availability service (often considered 'grid parity'); (2) Accountability and performance reporting framework: Provides a clear process of validating power delivery by providing trusted information to customers, funders, and/or regulators. The performance reporting protocol can also serve as a robust monitoring and evaluation tool for mini-grid operators and funding organizations. The QAF will provide a flexible alternative to rigid top-down standards for mini-grids in energy access contexts, outlining tiers of end-user service and linking them to relevant technical parameters. In addition, data generated through implementation of the QAF will provide the foundation for comparisons across projects, assessment of impacts, and greater confidence that will drive investment and scale-up in this sector. The QAF implementation process also defines a set of implementation guidelines that help the deployment of mini-grids on a regional or national scale, helping to insure successful rapid deployment of these relatively new remote energy options. Note that the QAF is technology agnostic, addressing both alternating current (AC) and direct current (DC) mini-grids, and is also applicable to renewable, fossil-fuel, and hybrid systems.« less

30 CFR 77.803 - Fail safe ground check circuits on high-voltage resistance grounded systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Fail safe ground check circuits on high-voltage... WORK AREAS OF UNDERGROUND COAL MINES Surface High-Voltage Distribution § 77.803 Fail safe ground check..., resistance grounded systems shall include a fail safe ground check circuit or other no less effective device...

30 CFR 77.803 - Fail safe ground check circuits on high-voltage resistance grounded systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Fail safe ground check circuits on high-voltage... WORK AREAS OF UNDERGROUND COAL MINES Surface High-Voltage Distribution § 77.803 Fail safe ground check..., resistance grounded systems shall include a fail safe ground check circuit or other no less effective device...

30 CFR 77.803 - Fail safe ground check circuits on high-voltage resistance grounded systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Fail safe ground check circuits on high-voltage... WORK AREAS OF UNDERGROUND COAL MINES Surface High-Voltage Distribution § 77.803 Fail safe ground check..., resistance grounded systems shall include a fail safe ground check circuit or other no less effective device...

30 CFR 77.803 - Fail safe ground check circuits on high-voltage resistance grounded systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Fail safe ground check circuits on high-voltage... WORK AREAS OF UNDERGROUND COAL MINES Surface High-Voltage Distribution § 77.803 Fail safe ground check..., resistance grounded systems shall include a fail safe ground check circuit or other no less effective device...

Combination of preservation factors applied to minimal processing of foods.

PubMed

Tapia de Daza, M S; Alzamora, S M; Chanes, J W

1996-07-01

Innovative technologies for producing minimally processed (MP) foods that apply the concept of combination of preservation factors are addressed in this article with special emphasis on a new combined approach that has been successfully applied in several Latin American countries for MP high-moisture fruit products (HMFP). HMFP can be regarded as a different approach to the commercially available and widely accepted MP concept for fruits and vegetables (even if developed for the same purpose of obtaining freshlike high-quality products with an extended shelf life) that is better adapted to Latin American countries in terms of independence of the chill chain and the use of simple and energy-efficient technologies. The continuous refrigeration hurdle associated with MP refrigerated fruits is not included in the preservation system of HMFP because a different combination of hurdles must be overcome to enhance the shelf stability of nonrespiring vegetable tissues while preserving freshlike character. Guidelines to obtain safe and high-quality MP fruit products are proposed. Other products preserved by combined factors technology are also discussed, as well as some other classical and new preservation factors whose application could enhance the quality of HMFP.

Helium ion microscopy of graphene: beam damage, image quality and edge contrast

NASA Astrophysics Data System (ADS)

Fox, D.; Zhou, Y. B.; O'Neill, A.; Kumar, S.; Wang, J. J.; Coleman, J. N.; Duesberg, G. S.; Donegan, J. F.; Zhang, H. Z.

2013-08-01

A study to analyse beam damage, image quality and edge contrast in the helium ion microscope (HIM) has been undertaken. The sample investigated was graphene. Raman spectroscopy was used to quantify the disorder that can be introduced into the graphene as a function of helium ion dose. The effects of the dose on both freestanding and supported graphene were compared. These doses were then correlated directly to image quality by imaging graphene flakes at high magnification. It was found that a high magnification image with a good signal to noise ratio will introduce very significant sample damage. A safe imaging dose of the order of 1013 He+ cm-2 was established, with both graphene samples becoming highly defective at doses over 5 × 1014 He+ cm-2. The edge contrast of a freestanding graphene flake imaged in the HIM was then compared with the contrast of the same flake observed in a scanning electron microscope and a transmission electron microscope. Very strong edge sensitivity was observed in the HIM. This enhanced edge sensitivity over the other techniques investigated makes the HIM a powerful nanoscale dimensional metrology tool, with the capability of both fabricating and imaging features with sub-nanometre resolution.

An Australian hospital-based student training ward delivering safe, client-centred care while developing students' interprofessional practice capabilities.

PubMed

Brewer, Margo L; Stewart-Wynne, Edward G

2013-11-01

Royal Perth Hospital, in partnership with Curtin University, established the first interprofessional student training ward in Australia, based on best practice from Europe. Evaluation of the student and client experience was undertaken. Feedback from all stakeholders was obtained regularly as a key element of the quality improvement process. An interprofessional practice program was established with six beds within a general medical ward. This provided the setting for 2- to 3-week clinical placements for students from medicine, nursing, physiotherapy, occupational therapy, social work, pharmacy, dietetics and medical imaging. Following an initial trial, the training ward began with 79 students completing a placement. An interprofessional capability framework focused on the delivery of high quality client care and effective teamwork underpins this learning experience. Quantitative outcome data showed not only an improvement in students' attitudes towards interprofessional collaboration but also acquisition of a high level of interprofessional practice capabilities. Qualitative outcome data from students and clients was overwhelmingly positive. Suggestions for improvement were identified. This innovative learning environment facilitated the development of the students' knowledge, skills and attitudes required for interprofessional, client centred collaborative practice. Staff reported a high level of compliance with clinical safety and quality.

High power eye-safe Er3+:YVO4 laser diode-pumped at 976 nm and emitting at 1603 nm

NASA Astrophysics Data System (ADS)

Newburgh, G. A.; Dubinskii, M.

2016-02-01

We report on the performance of an eye-safe laser based on a Er:YVO4 single crystal, diode-pumped at 976 nm (4I15/2-->4I11/2 transition) and operating at 1603 nm (4I13/2-->4I15/2 transition) with good beam quality. A 10 mm long Er3+:YVO4 slab, cut with its c-axis perpendicular to the laser cavity axis, was pumped in σ-polarization and lased in π-polarization. The laser operated in a quasi-continuous wave (Q-CW) regime with nearly 9 W output power, and with a slope efficiency of about 39% with respect to absorbed power. This is believed to be the highest efficiency and highest power achieved from an Er3+:YVO4 laser pumped in the 970-980 nm absorption band.

Introduction to ergonomics for healthcare workers.

PubMed

Waters, Thomas R

2010-01-01

Healthcare workers who handle and move patients as part of their jobs suffer a disproportionately high number of work-related musculoskeletal disorders (MSDs). The majority of reported work-related MSDs are back pain cases that result in significant numbers of lost work days. It is likely that these lost workdays have a substantial impact on the quality and cost of health care. Patient care ergonomics can reduce the risk of work-related MSDs by helping safety experts design the work so it can be safely performed by most workers. This article provides a general overview of ergonomics--what it is, how it can be used to help design safe work, and why all healthcare workers and administrators should know and understand how excessive work demands can lead to increased risk of work-related MSDs. The article will also explain technological solutions that can be implemented to reduce the risk of work-related MSDs for healthcare workers.

HACCP (Hazard Analysis and Critical Control Points) to guarantee safe water reuse and drinking water production--a case study.

PubMed

Dewettinck, T; Van Houtte, E; Geenens, D; Van Hege, K; Verstraete, W

2001-01-01

To obtain a sustainable water catchment in the dune area of the Flemish west coast, the integration of treated domestic wastewater in the existing potable water production process is planned. The hygienic hazards associated with the introduction of treated domestic wastewater into the water cycle are well recognised. Therefore, the concept of HACCP (Hazard Analysis and Critical Control Points) was used to guarantee hygienically safe drinking water production. Taking into account the literature data on the removal efficiencies of the proposed advanced treatment steps with regard to enteric viruses and protozoa and after setting high quality limits based on the recent progress in quantitative risk assessment, the critical control points (CCPs) and points of attention (POAs) were identified. Based on the HACCP analysis a specific monitoring strategy was developed which focused on the control of these CCPs and POAs.

Initial assessment of the ground-water resources in the Monterey Bay region, California

USGS Publications Warehouse

Muir, K.S.

1977-01-01

Because urban growth has placed an increasing demand on the ground-water resources of the Monterey Bay region, Calif., an assessment of the ground-water conditions was made to aid the development of local and regional plans. Ground water provides 80 percent of the water used in the region, which includes six ground-water subbasins. In several of the subbasins, pumpage exceeds safe yield. Existing water-quality degradation results from seawater intrusion, septic-tank effluent, and irrigation-return water. Potential sources of degradation include municipal sewage disposal, leachates from solid-waste disposal sites, and poor-quality connate water. High-priority items for future study include location of recharge areas, detection of seawater intrusion, and well-monitoring of landfill sites. (Woodard-USGS)

BACTERIA, BEACHES AND SWIMMABLE WATERS: INTRODUCING VIRTUAL BEACH

EPA Science Inventory

Safe beaches meet water quality standards and are valued for their aesthetics and the recreational opportunities that they afford. In the United States recreational water quality assessments and beach closure decisions are presently based on samples of enterococci or Escherichia ...

Measuring Teaching Quality in Several European Countries

ERIC Educational Resources Information Center

van de Grift, Wim J. C. M.

2014-01-01

Teaching quality has been observed in large representative samples from Flanders (Belgium), Lower Saxony (Germany), the Slovak Republic, and The Netherlands. This study reveals that measures of "creating a safe and stimulating climate", "clear and activating instruction", and "teaching learning strategies" were…

Recognition of an important water quality issue at zoos: prevalence and potential threat of toxic cyanobacteria.

PubMed

Doster, Enrique; Chislock, Michael F; Roberts, John F; Kottwitz, Jack J; Wilson, Alan E

2014-03-01

Zoo animals may be particularly vulnerable to water sources contaminated with cyanobacterial toxins given their nonvoluntary close association with this resource. However, the prevalence and potential threat of toxic cyanobacteria in this setting are unknown. Several otherwise unexplained yellow-bellied slider (Trachemys scripta scripta) deaths were documented in a zoo moat with recurring blooms of toxic Microcystis aeruginosa. Furthermore, an extremely high and potentially lethal concentration of the hepatotoxin microcystin (166 ng/g) was found in the liver of a necropsied turtle that died in this moat. A subsequent monthly survey of water quality revealed detectable concentrations of microcystin in all moats (0.0001 to 7.5 microg/L), with moats higher than 1 microg/L being significantly higher than the threshold for safe drinking water recommended by the World Health Organization. These results demonstrate that cyanobacterial blooms are an important water quality issue in zoos, and future research is necessary to identify potential associations among water quality, zoo animal health, and moat management strategies.

Non-caloric sweeteners, sweetness modulators, and sweetener enhancers.

PubMed

DuBois, Grant E; Prakash, Indra

2012-01-01

For a new sweetness technology to realize strong commercial success, it must be safe, exhibit good taste quality, be sufficiently soluble and stable in food and beverage systems, and be cost effective and patentable. Assessments of the commercial promise of eight synthetic and eight natural non-caloric sweeteners are made relevant to these metrics. High-potency (HP) non-caloric sweeteners, both synthetic and natural, are generally limited in taste quality by (a) low maximal sweetness response, (b) "off" tastes, (c) slow-onset sweet tastes that linger, and (d) sweet tastes that adapt or desensitize the gustatory system. Formulation approaches to address these limitations are discussed. Enhancement of the normal sucrose sensory response by action of a sweetener receptor positive allosteric modulator (PAM) has been achieved with very significant calorie reduction and with retention of the taste quality of sucrose. Research on PAM discovery over the past decade is summarized.

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

PubMed

Whelan, Jessica J; Willis, Karen

2007-01-01

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

[Drinking water supply in the Russian Federation: problems and ways of their solution].

PubMed

Onishchenko, G G

2007-01-01

Russia having a fifth of the worldwide drinking water resources is faced with considerable difficulties in solving the problems associated with the safe and rational attitude towards water resources, in improving the technologies of drinking water purification and conditioning, in introducing new universal forms of supplying the population with high-quality portable water. Particular emphasis has been recently placed on the setting-up of an effective legal and normative base for the sanitary protection of water sources and the upgrading of the quality of drinking water. Regional (republican, territorial) drinking water supply programs have been worked out up to the period 2010 in 47 subjects of the Russian Federation, with the participation of sanitary-and-epidemiological surveillance systems and approved in accordance with the established procedures. The majority of administrative areas have district and town programs to implement high-priority measures for improving the water supple system. Safe drinking water supply is one of the major components of Russia's national security. Under the established conditions, even in case of the favorable financial position, this cannot be achieved by only engineering decisions (construction and modernization of water-supply networks, use of new equipment and breakthrough technologies). Water service as a type of water consumption is based on the general principles of natural resource management. Its safety should be combined with the strategic objective of water resources utilization and conservation in the catchment basins in the country as a whole.

Long-term evaluation of the performance of four point-of-use water filters.

PubMed

Pérez-Vidal, Andrea; Diaz-Gómez, Jaime; Castellanos-Rozo, Jose; Usaquen-Perilla, Olga Lucía

2016-07-01

Despite technological advances water supply quality and poor access to safe water remain a major problem in developing countries, especially in rural areas. Point-of-use (POU) water treatment has been shown to be a viable option to produce safe drinking water quality. The aim of this study was to evaluate, under laboratory conditions over 14 months, the performance of four household filtration systems: membrane filter (MF), one-candle ceramic filter (1CCF), two-candle ceramic filter (2CCF) and pot ceramic filter (PCF). The evaluation was made using spiked water having the required concentrations of turbidity, Escherichia coli and Total Dissolved Solids (TDS). The results show that all systems have high removal efficiencies for turbidity (98-99%), and E. coli 4-5 Log Reduction Value (LRV). The poorest efficiency was for TDS (9-18%). The MF and the CCF displayed no significant difference in efficiencies for these parameters. The PCF had less significant differences for turbidity removal than the other systems. The average filtration rate for all systems decreased during the operation time. The CPF showed the major potential to be used in rural communities mainly for its low operational level and maintenance requirements as well as its local craftsmanship. It was observed that the efficiency of the systems is highly sensitive to cleaning and maintenance activities and therefore, the system sustainability will depend considerably on the training and education of the potential users. Copyright © 2016 Elsevier Ltd. All rights reserved.

Teamwork and patient safety in dynamic domains of healthcare: a review of the literature.

PubMed

Manser, T

2009-02-01

This review examines current research on teamwork in highly dynamic domains of healthcare such as operating rooms, intensive care, emergency medicine, or trauma and resuscitation teams with a focus on aspects relevant to the quality and safety of patient care. Evidence from three main areas of research supports the relationship between teamwork and patient safety: (1) Studies investigating the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events. (2) Research focusing on healthcare providers' perceptions of teamwork demonstrated that (a) staff's perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care and (b) perceptions of teamwork and leadership style are associated with staff well-being, which may impact clinician' ability to provide safe patient care. (3) Observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork. In recent years, research using diverse methodological approaches has led to significant progress in team research in healthcare. The challenge for future research is to further develop and validate instruments for team performance assessment and to develop sound theoretical models of team performance in dynamic medical domains integrating evidence from all three areas of team research identified in this review. This will help to improve team training efforts and aid the design of clinical work systems supporting effective teamwork and safe patient care.

Esophageal abnormalities in gastroesophageal reflux disease.

PubMed

Levine, Marc S; Carucci, Laura R

2018-06-01

Fluoroscopic esophagography is a widely available, safe, and inexpensive test for detecting gastroesophageal reflux disease. In this article, we review the technique for performing a high-quality esophagram, including upright, double-contrast views of the esophagus and cardia with high-density barium; prone, single-contrast views of the esophagus with low-density barium; and evaluation of gastroesophageal reflux. We then discuss the radiographic findings associated with gastroesophageal reflux disease, including esophageal dysmotility, reflux esophagitis, peptic strictures, and Barrett's esophagus. Finally, we consider the differential diagnosis for the various radiographic findings associated with this condition. When carefully performed and interpreted, the esophagram is a useful test for evaluating gastroesophageal reflux disease and its complications.

Design of a safe facility for the metalorganic chemical vapor deposition of high-purity GaAs and AlGaAs

NASA Astrophysics Data System (ADS)

Messham, R. L.; Tucker, W. K.

1986-09-01

A metalorganic chemical vapor deposition (MOCVD) facility designed to safely handle highly toxic and pyrophoric growth materials is described. The system concept is based on remote operation, passive flow restriction, and forced air dilution to maintain safe gas concentrations under normal running and catastrophic system failure conditions. MOCVD is a key materials technology for advanced high-frequency optical and microwave devices. At this time, the use of highly toxic arsine as an arsenic source is dictated by critical device purity, reproducibility, and doping control requirements. The handling and use of this gas is a primary feature in the design of any safe facility for MOCVD growth of high-quality GaAs/AlGaAs. After a critical review of presently available effluent treatment techniques, it was concluded that a combination of flow restriction and dilution presented the most reliable treatment. Measured flow rates through orifices from 0.002 to 0.005 inch in diameter were compared to calculated values. A 0.002 inch orifice located in the cylinder valve or CGA fitting, combined with a cylinder of pure liquid arsine (205 psi), limits the maximum gas flow to ≪1 lpm. Such a flow can then be vented through a dedicated exhaust system where an additional forced injection of diluting air reduces the gas concentration to acceptable levels. In the final Westinghouse R&D Center design, the use of low-pressure pure arsine, flow restriction, and stack air injection has reduced the maximum stack exist gas concentration to below 25% of the IDLH level for arsine under total and catastrophic MOCVD facility equipment failure conditions. The elimination of potential problems with purging behind such orifices using carefully designed purging procedures and a microprocessor-controlled purging system are described. The IDLH level is defined by the OSHA and NIOSH standards completion program and represents the maximum level from which one could escape within 30 min without any escape-impairing symptoms or irreversible health effects.

Blue light induced free radicals from riboflavin on E. coli DNA damage.

PubMed

Liang, Ji-Yuan; Yuann, Jeu-Ming P; Cheng, Chien-Wei; Jian, Hong-Lin; Lin, Chin-Chang; Chen, Liang-Yu

2013-02-05

The micronutrients in many cellular processes, riboflavin (vitamin B(2)), FMN, and FAD are photo-sensitive to UV and visible light to generate reactive oxygen species (ROS). The riboflavin photochemical treatment with UV light has been applied for the inactivation of microorganisms to serve as an effective and safe technology. Ultra-violet or high-intensity radiation is, however, considered as a highly risky practice. This study was working on the application of visible LED lights to riboflavin photochemical reactions to development an effective antimicrobial treatment. The photosensitization of bacterial genome with riboflavin was investigated in vitro and in vivo by light quality and irradiation dosage. The riboflavin photochemical treatment with blue LED light was proved to be able to inactivate E. coli by damaging nucleic acids with ROS generated. Riboflavin is capable of intercalating between the bases of bacterial DNA or RNA and absorbs lights in the visible regions. LED light illumination could be a more accessible and safe practice for riboflavin photochemical treatments to achieve hygienic requirements in vitro. Copyright © 2013 Elsevier B.V. All rights reserved.

Defining a Safe Operating Space for inland recreational fisheries

USGS Publications Warehouse

Carpenter, Stephen R.; Brock, William A.; Hansen, Gretchen J. A.; Hansen, Jonathan F.; Hennessy, Joseph M.; Isermann, Daniel A.; Pedersen, Eric J.; Perales, K. Martin; Rypel, Andrew L.; Sass, Greg G.; Tunney, Tyler D.; Vander Zanden, M. Jake

2017-01-01

The Safe Operating Space (SOS) of a recreational fishery is the multidimensional region defined by levels of harvest, angler effort, habitat, predation and other factors in which the fishery is sustainable into the future. SOS boundaries exhibit trade-offs such that decreases in harvest can compensate to some degree for losses of habitat, increases in predation and increasing value of fishing time to anglers. Conversely, high levels of harvest can be sustained if habitat is intact, predation is low, and value of fishing effort is moderate. The SOS approach recognizes limits in several dimensions: at overly high levels of harvest, habitat loss, predation, or value of fishing effort, the stock falls to a low equilibrium biomass. Recreational fisheries managers can influence harvest and perhaps predation, but they must cope with trends that are beyond their control such as changes in climate, loss of aquatic habitat or social factors that affect the value of fishing effort for anglers. The SOS illustrates opportunities to manage harvest or predation to maintain quality fisheries in the presence of trends in climate, social preferences or other factors that are not manageable.

Determinants, Health Problems, and Food Insecurity in Urban Areas of the Largest City in Cape Verde.

PubMed

Craveiro, Isabel; Alves, Daniela; Amado, Miguel; Santos, Zélia; Fortes, Argentina Tomar; Delgado, António Pedro; Correia, Artur; Gonçalves, Luzia

2016-11-22

Urbanization processes are intertwined with nutritional transition because there is easier access to food of low nutritional quality at reduced prices, changing dietary patterns and leading to an increase of non-communicable chronic diseases. This study aims to understand the perceptions for high blood pressure, obesity, and alcoholism, describing some interactions of these dimensions in the problem of food security in the city of Praia. A qualitative study was carried out under the framework of the research project "UPHI-STAT: Urban Planning and Health Inequalities-moving from macro to micro statistics". Ten focus groups were conducted in three urban areas with distinct characteristics in the city of Praia, with a total of 48 participants. Participants reported frequent consumption of foods with poor nutritional quality, understanding the potential danger in terms of food security in the city of Praia. Easy access to and high levels of alcohol consumption, and poor quality of traditional drinks were mentioned by participants in the study areas. The impact of the economic situation on the possibility of access to safe and healthy options emerged as a differentiating factor.

Towards Improving the Quality of Work Life in Education.

ERIC Educational Resources Information Center

Wood, J. M.

Addressing the need to consider ways in which the quality of educator work life can be improved, the author uses J. Walton's eight-point definition of the quality of work life as a framework for discussion. The eight points include (1) adequate and fair compensation, in which financial incentives are provided for advanced coursework; (2) safe and…

The link between leadership and safety outcomes in hospitals.

PubMed

Squires, Mae; Tourangeau, Ann; Spence Laschinger, Heather K; Doran, Diane

2010-11-01

To test and refine a model examining relationships among leadership, interactional justice, quality of the nursing work environment, safety climate and patient and nurse safety outcomes. The quality of nursing work environments may pose serious threats to patient and nurse safety. Justice is an important element in work environments that support safety initiatives yet little research has been done that looks at how leader interactional justice influences safety outcomes. A cross-sectional survey was conducted with 600 acute care registered nurses (RNs) to test and refine a model linking interactional justice, the quality of nurse leader-nurse relationships, work environment and safety climate with patient and nurse outcomes. In general the hypothesized model was supported. Resonant leadership and interactional justice influenced the quality of the leader-nurse relationship which in turn affected the quality of the work environment and safety climate. This ultimately was associated with decreased reported medication errors, intentions to leave and emotional exhaustion. Quality relationships based on fairness and empathy play a pivotal role in creating positive safety climates and work environments. To advocate for safe work environments, managers must strive to develop high-quality relationships through just leadership practices. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Quality Improvement in Pediatric Endoscopy: A Clinical Report From the NASPGHAN Endoscopy Committee.

PubMed

Kramer, Robert E; Walsh, Catharine M; Lerner, Diana G; Fishman, Douglas S

2017-07-01

The current era of healthcare reform emphasizes the provision of effective, safe, equitable, high-quality, and cost-effective care. Within the realm of gastrointestinal endoscopy in adults, renewed efforts are in place to accurately define and measure quality indicators across the spectrum of endoscopic care. In pediatrics, however, this movement has been less-defined and lacks much of the evidence-base that supports these initiatives in adult care. A need, therefore, exists to help define quality metrics tailored to pediatric practice and provide a toolbox for the development of robust quality improvement (QI) programs within pediatric endoscopy units. Use of uniform standards of quality reporting across centers will ensure that data can be compared and compiled on an international level to help guide QI initiatives and inform patients and their caregivers of the true risks and benefits of endoscopy. This report is intended to provide pediatric gastroenterologists with a framework for the development and implementation of endoscopy QI programs within their own centers, based on available evidence and expert opinion from the members of the NASPGHAN Endoscopy Committee. This clinical report will require expansion as further research pertaining to endoscopic quality in pediatrics is published.

Impact of Water Quality on Chlorine Demand of Corroding Copper

EPA Science Inventory

Copper is the most widely used material in drinking water premise plumbing systems. In buildings such as hospitals, large and complicated plumbing networks make it difficult to maintain good water quality. Sustaining safe disinfectant residuals throughout a building to protect ag...

Fact Sheet: Notice of Ambient Water Quality Criteria Document for Tributyltin (TBT) - Final

EPA Pesticide Factsheets

Information pertaining to 2004 Final Acute and Chronic Ambient Aquatic Life Water Quality Criteria for Tributyltin (TBT) for freshwater and saltwater. This fact sheet includes the safe levels of TBT that should protect the majority of species.

Food Safety and Quality. Uniform, Risk-Based Inspection System Needed to Ensure Safe Food Supply,

DTIC Science & Technology

1992-06-01

Concerned about the effectiveness of the federal food safety inspection system, the Chairman, Subcommittee on Oversight and Investigations, House...federal resources for inspection, and (3) agencies are effectively coordinating their food safety and quality inspection efforts.

42 CFR 483.15 - Quality of life.

Code of Federal Regulations, 2010 CFR

2010-10-01

... supervised social work experience in a health care setting working directly with individuals. (h) Environment. The facility must provide— (1) A safe, clean, comfortable, and homelike environment, allowing the... environment that promotes maintenance or enhancement of each resident's quality of life. (a) Dignity. The...

The safe home project.

PubMed

Arphorn, Sara; Jiraniratisai, Sopaphan; Rungtakul, Rungsri; Phutta, Nikom

2011-12-01

The Thai Health Promotion Foundation supported the Improvement of Quality of Life of Informal Workers project in Ban Luang District, Amphur Photaram, Ratchaburi Province. There were many informal workers in Ban Luang District. Sweet-crispy fish producers in Ban Luang were the largest group among the sweet-crispy fish producers in Thailand. This project was aimed at improving living and working conditions of informal workers, with a focus on the sweet-crispy fish group. Good practices of improved living and working conditions were used to help informal workers build safe, healthy and productive work environments. These informal workers often worked in substandard conditions and were exposed to various hazards in the working area. These hazards included risk of exposure to hot work environment, ergonomics-related injuries, chemical hazards, electrical hazards etc. Ergonomics problems were commonly in the sweet-crispy fish group. Unnatural postures such as prolonged sitting were performed dominantly. One hundred and fifty informal workers participated in this project. Occupational health volunteers were selected to encourage occupational health and safety in four groups of informal workers in 2009. The occupational health volunteers trained in 2008 were farmers, beauty salon workers and doll makers. The occupational health and safety knowledge is extended to a new informal worker group: sweet-crispy fish producer, in 2009. The occupational health and safety training for sweet-crispy fish group is conducted by occupational health volunteers. The occupational health volunteers increased their skills and knowledge assist in to make safe home and safe community through participatory oriented training. The improvement of living and working condition is conducted by using a modified WISH, Work Improvement for Safe Home, checklist. The plans of improvement were recorded. The informal workers showed improvement mostly on material handling and storage. The safe uses and safe storage of chemicals were introduced among farmers. The awareness of healthcare using personal protective equipments is increased in all groups especially in farmers. Safe home by local occupational health volunteer is proposed to be one effective measure for improvement of quality of life.

Thermal pasteurization of ready-to-eat foods and vegetables: Critical factors for process design and effects on quality.

PubMed

Peng, Jing; Tang, Juming; Barrett, Diane M; Sablani, Shyam S; Anderson, Nathan; Powers, Joseph R

2017-09-22

Increasing consumer desire for high quality ready-to-eat foods makes thermal pasteurization important to both food producers and researchers. To be in compliance with the Food Safety Modernization Act (FSMA), food companies seek regulatory and scientific guidelines to ensure that their products are safe. Clearly understanding the regulations for chilled or frozen foods is of fundamental importance to the design of thermal pasteurization processes for vegetables that meet food safety requirements. This article provides an overview of the current regulations and guidelines for pasteurization in the U.S. and in Europe for control of bacterial pathogens. Poorly understood viral pathogens, in terms of their survival in thermal treatments, are an increasing concern for both food safety regulators and scientists. New data on heat resistance of viruses in different foods are summarized. Food quality attributes are sensitive to thermal degradation. A review of thermal kinetics of inactivation of quality-related enzymes in vegetables and the effects of thermal pasteurization on vegetable quality is presented. The review also discusses shelf-life of thermally pasteurized vegetables.

Beyond Flint: National Trends in Drinking Water Quality Violations

NASA Astrophysics Data System (ADS)

Allaire, M.; Wu, H.; Lall, U.

2016-12-01

Ensuring safe water supply for communities across the U.S. represents an emerging challenge. Aging infrastructure, impaired source water, and strained community finances may increase vulnerability of water systems to quality violations. In the aftermath of Flint, there is a great need to assess the current state of U.S. drinking water quality. How widespread are violations? What are the spatial and temporal patterns in water quality? Which types of communities and systems are most vulnerable? This is the first national assessment of trends in drinking water quality violations across several decades. In 2015, 9% of community water systems violated health-related water quality standards. These non-compliant systems served nearly 23 million people. Thus, the challenge of providing safe drinking water extends beyond Flint and represents a nationwide concern. We use a panel dataset that includes every community water system in the United States from 1981 to 2010 to identify factors that lead to regulatory noncompliance. This study focuses on health-related violations of the Safe Drinking Water Act. Lasso regression informed selection of appropriate covariates, while logistic regressions modeled the probability of noncompliance. We find that compliance is positively associated with private ownership, purchased water supply, and greater household income. Yet, greater concentration of utility ownership and violations in prior years are associated with a higher likelihood of violation. The results suggest that purchased water contracts, which are growing among small utilities, could serve as a way to improve regulatory compliance in the future. However, persistence of violations and ownership concentration deserve attention from policymakers. Already, the EPA has begun to prioritize enforcement of persistent violators. Overall, as the revitalization of U.S. water infrastructure becomes a growing priority area, results of this study are intended to inform investment and policy.

Caffeine delays oocyte aging and maintains the quality of aged oocytes safely in mouse.

PubMed

Zhang, Xia; Liu, Xiaoyan; Chen, Li; Wu, Dan-Ya; Nie, Zheng-Wen; Gao, Ying-Ying; Miao, Yi-Liang

2017-03-28

Caffeine, as an oocyte aging inhibitor, was used in many different species to control or delay oocyte aging. However, the safety of caffeine and developmental competence of aged oocytes inhibited by caffeine has not been studied systematically. So we detected the spindle morphology, distribution of cortical granules, zona pellucida hardening and pronucleus formation to assess oocyte quality of caffeine treated oocytes. We found that aged oocytes treated by caffeine maintained weak susceptibility to activating stimuli and regained normal competent after aged further 6 hr. Caffeine maintained the spindle morphology, changed cortical granules distribution of aged oocytes and could not prevent zona pellucida hardening. Furthermore, caffeine increased pronucleus formation of aged oocytes and decreased fragmentation after fertilization. These results suggested that caffeine could maintain the quality of aged oocytes safely in mouse.

Clinical decision support systems: data quality management and governance.

PubMed

Liaw, Siaw-Teng

2013-01-01

This chapter examines data quality management (DQM) and information governance (IG) of electronic decision support (EDS) systems so that they are safe and fit for use by clinicians and patients and their carers. This is consistent with the ISO definition of data quality as being fit for purpose. The scope of DQM & IG should range from data creation and collection in clinical settings, through cleaning and, where obtained from multiple sources, linkage, storage, use by the EDS logic engine and algorithms, knowledge base and guidance provided, to curation and presentation. It must also include protocols and mechanisms to monitor the safety of EDS, which will feedback into DQM & IG activities. Ultimately, DQM & IG must be integrated across the data cycle to ensure that the EDS systems provide guidance that leads to safe and effective clinical decisions and care.

Safe and Durable High-Temperature Lithium-Sulfur Batteries via Molecular Layer Deposited Coating.

PubMed

Li, Xia; Lushington, Andrew; Sun, Qian; Xiao, Wei; Liu, Jian; Wang, Biqiong; Ye, Yifan; Nie, Kaiqi; Hu, Yongfeng; Xiao, Qunfeng; Li, Ruying; Guo, Jinghua; Sham, Tsun-Kong; Sun, Xueliang

2016-06-08

Lithium-sulfur (Li-S) battery is a promising high energy storage candidate in electric vehicles. However, the commonly employed ether based electrolyte does not enable to realize safe high-temperature Li-S batteries due to the low boiling and flash temperatures. Traditional carbonate based electrolyte obtains safe physical properties at high temperature but does not complete reversible electrochemical reaction for most Li-S batteries. Here we realize safe high temperature Li-S batteries on universal carbon-sulfur electrodes by molecular layer deposited (MLD) alucone coating. Sulfur cathodes with MLD coating complete the reversible electrochemical process in carbonate electrolyte and exhibit a safe and ultrastable cycle life at high temperature, which promise practicable Li-S batteries for electric vehicles and other large-scale energy storage systems.

Estimation of Effect Thresholds for the Development of Water Quality Criteria

EPA Science Inventory

Biological and ecological effect thresholds can be used for determining safe levels of nontraditional stressors. The U.S. EPA Framework for Developing Suspended and Bedded Sediments (SABS) Water Quality Criteria (WQC) [36] uses a risk assessment approach to estimate effect thre...

GIS ANALYSIS FOR EPIDEMIOLOGIC RECREATIONAL WATER SUTDIES

EPA Science Inventory

Introduction: The Beaches Act of 2000 requires that the Agency develop new rapid method water quality indicators (2 hours or less) that predict whether or not coastal water is safe for swimming. This new set of water quality indicators must be validated through the epidemiologi...

24 CFR 982.401 - Housing quality standards (HQS).

Code of Federal Regulations, 2010 CFR

2010-04-01

...) Elevators must be working and safe. (h) Interior air quality—(1) Performance requirement. The dwelling unit... environment; (E) Illumination and electricity; (F) Structure and materials; (G) Interior air quality; (H... dwelling unit. (e) Thermal environment—(1) Performance requirement. The dwelling unit must have and be...

MEASURING & MODELING VARIATIONS IN DISTRIBUTION WATER QUALITY

EPA Science Inventory

Until recently most interest in drinking water quality has been in the finished water as it leaves the treatment plant. he Safe Drinking Water requires that MCLs be met at the consumers tap. ecause finished water may undergo substantial changes while being transported through the...

One Solution to the Arsenic Problem: A Return to Surface (Improved Dug) Wells

PubMed Central

Joya, Sakila Afroz; Mostofa, Golam; Yousuf, Jabed; Islam, Ariful; Elahi, Altab; Mahiuddin, Golam; Rahman, Mahmuder; Quamruzzaman, Quazi

2006-01-01

Arsenic contamination in drinking-water in Bangladesh is a major catastrophe, the consequences of which exceed most other man-made disasters. The national policy encourages the use of surface water as much as possible without encountering the problems of sanitation that led to the use of groundwater in the first place. This paper describes the success of the Dhaka Community Hospital (DCH) team and the procedure in implementing sanitary, arsenic-free, dugwells. The capital cost for running water is US$ 5–6 per person. Sixty-six sanitary dugwells were installed in phases between 2000 and 2004 in Pabna district of Bangladesh where there was a great need of safe water because, in some villages, 90% of tubewells were highly contaminated with arsenic. In total, 1,549 families now have access to safe arsenic-free dugwell water. Some of them have a water-pipe up to their kitchen. All of these were implemented with active participation of community members. They also pay for water-use and are themselves responsible for the maintenance and water quality. The DCH helped the community with installation and maintenance protocol and also with monitoring water quality. The bacteria levels are low but not always zero, and studies are in progress to reduce bacteria by chlorination. PMID:17366778

Surgical treatment of obesity.

PubMed

Puzziferri, Nancy; Blankenship, Jeanne; Wolfe, Bruce M

2006-02-01

The surgical treatment of obesity has existed for over 50 yr. Surgical options have evolved from high-risk procedures infrequently performed, to safe, effective procedures increasingly performed. The operations used today provide significant durable weight loss, resolution or marked improvement of obesity-related comorbidities, and enhanced quality of life for the majority of patients. The effect of bariatric surgery on the neurohormonal regulation of energy homeostasis is not fully understood. Despite its effectiveness, less than 1% of obese patients are treated surgically. The perception that obesity surgery is unsafe remains a deterrent to care.

End-preparation assessments and tests for compounded sterile preparations.

PubMed

McElhiney, Linda F

2013-01-01

Outsourcing has become a necessity to obtain sterile products that are currently on backorder. Because of the expense of outsourcing sterile compounding, pharmacy leadership in health systems are now considering the option of insourcing and batch preparing compounded sterile preparations, which can be a viable option for a health system. It can significantly decrease drug-spending costs, and the pharmacy has a complete record of the compounding process. The key to preparing high-quality, safe, sterile preparations and meeting United States Pharmacopeia standards is end-preparation assessments and tests.

Control of infection in an international airline.

PubMed

Kelly, M

1993-05-01

The paper examines the possible sources of infection on an international aircraft, including the provision of food, the supply of drinking water, and the removal of waste. It considers aspects of control, and explains some of the steps which have to be taken by a major international carrier to ensure that the high quality expected by the customer is provided in all areas of the world, even those where natural resources and expertise may be limited. The emphasis is on providing a safe product, and removing any possible risk of infection of the passengers.

Sustainability in medicine.

PubMed

George, Ruth; Coffin, Janis; George, Sierra

2013-01-01

Given the current state of the U.S. healthcare system, with increasingly complicated regulations and paperwork and decreasing reimbursements, the question arises: Is it possible to provide safe, high-quality healthcare and reduce costs? Furthermore, is it possible to care for the health of your patients while simultaneously caring for the financial health of your practice and promoting improvement in the overall health of the planet? This article will review some steps currently being taken by various companies and hopefully stimulate ideas for changes you may want to consider for your own practice, hospital, or institution.

Implementation and implication of total quality management on client- contractor relationship in residential projects

NASA Astrophysics Data System (ADS)

Murali, Swetha; Ponmalar, V.

2017-07-01

To make innovation and continuous improvement as a norm, some traditional practices must become unlearnt. Change for growth and competitiveness are required for sustainability for any profitable business such as the construction industry. The leading companies are willing to implement Total Quality Management (TQM) principles, to realise potential advantages and improve growth and efficiency. Ironically, researches recollected quality as the most significant provider for competitive advantage in industrial leadership. The two objectives of this paper are 1) Identify TQM effectiveness in residential projects and 2) Identify the client satisfaction/dissatisfaction areas using Analytical Hierarchy Process (AHP) and suggest effective mitigate measures. Using statistical survey techniques like set of questionnaire survey, it is observed that total quality management was applied in some leading successful organization to an extent. The main attributes for quality achievement can be defined as teamwork and better communication with single agreed goal between client and contractor. Onsite safety is a paramount attribute in the identifying quality within the residential projects. It was noticed that the process based quality methods such as onsite safe working condition; safe management system and modern engineering process safety controls etc. as interlinked functions. Training and effective communication with all stakeholders on quality management principles is essential for effective quality work. Late Only through effective TQM principles companies can avoid some contract litigations with an increased client satisfaction Index.

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.

Advancing pharmaceutical quality: An overview of science and research in the U.S. FDA's Office of Pharmaceutical Quality.

PubMed

Fisher, Adam C; Lee, Sau L; Harris, Daniel P; Buhse, Lucinda; Kozlowski, Steven; Yu, Lawrence; Kopcha, Michael; Woodcock, Janet

2016-12-30

Failures surrounding pharmaceutical quality, particularly with respect to product manufacturing issues and facility remediation, account for the majority of drug shortages and product recalls in the United States. Major scientific advancements pressure established regulatory paradigms, especially in the areas of biosimilars, precision medicine, combination products, emerging manufacturing technologies, and the use of real-world data. Pharmaceutical manufacturing is increasingly globalized, prompting the need for more efficient surveillance systems for monitoring product quality. Furthermore, increasing scrutiny and accelerated approval pathways provide a driving force to be even more efficient with limited regulatory resources. To address these regulatory challenges, the Office of Pharmaceutical Quality (OPQ) in the Center for Drug Evaluation and Research (CDER) at the U.S. Food and Drug Administration (FDA) harbors a rigorous science and research program in core areas that support drug quality review, inspection, surveillance, standards, and policy development. Science and research is the foundation of risk-based quality assessment of new drugs, generic drugs, over-the-counter drugs, and biotechnology products including biosimilars. This is an overview of the science and research activities in OPQ that support the mission of ensuring that safe, effective, and high-quality drugs are available to the American public. Published by Elsevier B.V.

38 CFR 52.100 - Quality of life.

Code of Federal Regulations, 2010 CFR

2010-07-01

... management must provide— (1) A safe, clean, comfortable, and homelike environment, and support the... management must provide an environment and provide or coordinate care that supports the quality of life of... program management must promote care for participants in a manner and in an environment that maintains or...

Drinking water treatment plant costs and source water quality: An updated case study (2013-2016)

EPA Science Inventory

Watershed protection can play an important role in producing safe drinking water. However, many municipalities and drinking water treatment plants (DWTPs) lack the information on the potential benefits of watershed protection as an approach to improving source water quality. This...

The Small Aircraft Transportation System Project: An Update

NASA Technical Reports Server (NTRS)

Kemmerly, Guy T.

2006-01-01

To all peoples in all parts of the world throughout history, the ability to move about easily is a fundamental element of freedom. The American people have charged NASA to increase their freedom and that of their children knowing that their quality of life will improve as our nation s transportation systems improve. In pursuit of this safe, reliable, and affordable personalized air transportation option, in 2000 NASA established the Small Aircraft Transportation System (SATS) Project. As the name suggests personalized air transportation would be built on smaller aircraft than those used by the airlines. Of course, smaller aircraft can operate from smaller airports and 96% of the American population is within thirty miles of a high-quality, underutilized community airport as are the vast majority of their customers, family members, and favorite vacation destinations.

Modern banking, collection, compatibility testing and storage of blood and blood components.

PubMed

Green, L; Allard, S; Cardigan, R

2015-01-01

The clinical practice of blood transfusion has changed considerably over the last few decades. The potential risk of transfusion transmissible diseases has directed efforts towards the production of safe and high quality blood. All transfusion services now operate in an environment of ever-increasing regulatory controls encompassing all aspects of blood collection, processing and storage. Stringent donor selection, identification of pathogens that can be transmitted through blood, and development of technologies that can enhance the quality of blood, have all led to a substantial reduction in potential risks and complications associated with blood transfusion. In this article, we will discuss the current standards required for the manufacture of blood, starting from blood collection, through processing and on to storage. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Safe household water treatment and storage using ceramic drip filters: a randomised controlled trial in Bolivia.

PubMed

Clasen, T; Brown, J; Suntura, O; Collin, S

2004-01-01

A randomised controlled field trial was conducted to evaluate the effectiveness of ceramic drip filters to improve the microbiological quality of drinking water in a low-income community in rural Bolivia. In four rounds of water sampling over five months, 100% of the samples were free of thermotolerant (faecal) coliforms (TTC) compared to an arithmetic mean TTC count of 1517, 406, 167 and 245 among control households which continued to use their customary sources of drinking water. The filter systems produced water that consistently met WHO drinking-water standards despite levels of turbidity that presented a challenge to other low-cost POU treatment methods. The filter systems also demonstrated an ability to maintain the high quality of the treated water against subsequent re-contamination in the home.

Lactic acid bacteria as a cell factory for the delivery of functional biomolecules and ingredients in cereal-based beverages: a review.

PubMed

Waters, Deborah M; Mauch, Alexander; Coffey, Aidan; Arendt, Elke K; Zannini, Emanuele

2015-01-01

In this review, we aim to describe the mechanisms by which LAB can fulfil the novel role of efficient cell factory for the production of functional biomolecules and food ingredients to enhance the quality of cereal-based beverages. LAB fermentation is a safe, economical, and traditional method of food preservation foremost, as well as having the additional benefits of flavor, texture, and nutrition amelioration. Additionally, LAB fermentation in known to render cereal-based foods and beverages safe, in a chemical-free, consumer-friendly manner, from an antinutrient and toxigenic perspective. Huge market opportunities and potential exist for food manufacturers who can provide the ideal functional beverage fulfilling consumer needs. Newly developed fermented cereal-based beverages must address markets globally including, high-nutrition markets (developing countries), lifestyle choice consumers (vegetarian, vegan, low-fat, low-salt, low-calorie), food-related non-communicable disease sufferers (cardiovascular disease, diabetes), and green label consumers (Western countries). To fulfil these recommendations, a suitable LAB starter culture and cereal-based raw materials must be developed. These strains would be suitable for the biopreservation of cereal beverages and, ideally, would be highly antifungal, anti-mycotoxigenic, mycotoxin-binding and proteolytic (neutralize toxic peptides and release flavor-contributing amino acids) with an ability to ferment cereals, whilst synthesizing oligosaccharides, thus presenting a major opportunity for the development of safe cereal-based prebiotic functional beverages to compete with and replace the existing dairy versions.

Riverbank filtration for the treatment of highly turbid Colombian rivers

NASA Astrophysics Data System (ADS)

Gutiérrez, Juan Pablo; van Halem, Doris; Rietveld, Luuk

2017-05-01

The poor quality of many Colombian surface waters forces us to seek alternative, sustainable treatment solutions with the ability to manage peak pollution events and to guarantee the uninterrupted provision of safe drinking water to the population. This review assesses the potential of using riverbank filtration (RBF) for the highly turbid and contaminated waters in Colombia, emphasizing water quality improvement and the influence of clogging by suspended solids. The suspended sediments may be favorable for the improvement of the water quality, but they may also reduce the production yield capacity. The cake layer must be balanced by scouring in order for an RBF system to be sustainable. The infiltration rate must remain high enough throughout the river-aquifer interface to provide the water quantity needed, and the residence time of the contaminants must be sufficient to ensure adequate water quality. In general, RBF seems to be a technology appropriate for use in highly turbid and contaminated surface rivers in Colombia, where improvements are expected due to the removal of turbidity, pathogens and to a lesser extent inorganics, organic matter and micro-pollutants. RBF has the potential to mitigate shock loads, thus leading to the prevention of shutdowns of surface water treatment plants. In addition, RBF, as an alternative pretreatment step, may provide an important reduction in chemical consumption, considerably simplifying the operation of the existing treatment processes. However, clogging and self-cleansing issues must be studied deeper in the context of these highly turbid waters to evaluate the potential loss of abstraction capacity yield as well as the development of different redox zones for efficient contaminant removal.

The Challenge of Providing Safe Water with an Intermittently Supplied Piped Water Distribution System

NASA Astrophysics Data System (ADS)

Kumpel, E.; Nelson, K. L.

2012-12-01

An increasing number of urban residents in low- and middle-income countries have access to piped water; however, this water is often not available continuously. 84% of reporting utilities in low-income countries provide piped water for fewer than 24 hours per day (van den Berg and Danilenko, 2010), while no major city in India has continuous piped water supply. Intermittent water supply leaves pipes vulnerable to contamination and forces households to store water or rely on alternative unsafe sources, posing a health threat to consumers. In these systems, pipes are empty for long periods of time and experience low or negative pressure even when water is being supplied, leaving them susceptible to intrusion from sewage, soil, or groundwater. Households with a non-continuous supply must collect and store water, presenting more opportunities for recontamination. Upgrading to a continuous water supply, while an obvious solution to these challenges, is currently out of reach for many resource-constrained utilities. Despite its widespread prevalence, there are few data on the mechanisms causing contamination in an intermittent supply and the frequency with which it occurs. Understanding the impact of intermittent operation on water quality can lead to strategies to improve access to safe piped water for the millions of people currently served by these systems. We collected over 100 hours of continuous measurements of pressure and physico-chemical water quality indicators and tested over 1,000 grab samples for indicator bacteria over 14 months throughout the distribution system in Hubli-Dharwad, India. This data set is used to explore and explain the mechanisms influencing water quality when piped water is provided for a few hours every 3-5 days. These data indicate that contamination occurs along the distribution system as water travels from the treatment plant to reservoirs and through intermittently supplied pipes to household storage containers, while real-time measurements document variability in water quality throughout the 2-8 hour supply period. Our results show that piped water is not always safe water, but that safe water can be achieved in an intermittent supply under certain physical and operational conditions. Intermittent piped water supply is an important constraint on access to safe water in towns and cities in low-income countries, and strategies that improve these existing systems can help urban residents gain access to safe water. References van den Berg, C., and Danilenko, A. (2010). "The IBNET Water Supply and Sanitation Performance Blue Book: The International Benchmarking Network for Water and Sanitation Utilities Databook." World Bank Washington, DC.

A new leadership role for pharmacists: a prescription for change.

PubMed

Burgess, L Hayley; Cohen, Michael R; Denham, Charles R

2010-03-01

Pharmacists can play an important role as leaders to reduce patient safety risks, optimize the safe function of medication management systems, and align pharmacy services with national initiatives that measure and reward quality performance. The objective of this article is to determine the actions that pharmacists can take to create a visible and sustainable safe medication management structure and system in the health care environment. An evidence-based literature search was performed to determine what actions successful pharmacist leaders have taken to improve patient safety. There is a growing number of quality and patient safety standards, as well as measures that focus specifically on medication use and education. Health care organizations must be made aware of the valuable resources that pharmacists provide and of the complexity of medication management. There are steps that pharmacist leaders can take to achieve these goals. The 10 steps that pharmacist leaders can take to create a visible and sustainable safe medication management structure and system are the following: 1. Identify and mitigate medication management risks and hazards to reduce preventable patient harm. 2. Establish pharmacy leadership structures and systems to ensure organizational awareness of medication safety gaps. 3. Support an organizational culture of safe medication use. 4. Ensure evidence-based medication regimens for all patients. 5. Have daily check-in calls/meetings, with the primary focus on significant safety or quality issues. 6. Establish a medication safety committee. 7. Perform medication safety walk-rounds to evaluate medication processes, and request front-line staff ’s input about medication safe practices. 8. Ensure that pharmacy staff engage in teamwork, skill building, and communication training. 9. Engage in readiness planning for implementation of health information technology (HIT). 10. Include medication history-taking and reviews upon entry into the organization; medication counseling and training during the discharge process; and follow-up after the transition to home.

INTERNATIONAL PERSPECTIVE: U.S. EPA'S APPROACH TO SURVEILLANCE AND MANAGEMENT OF WATER QUALITY

EPA Science Inventory

For the past 35 years, the Environmental Protection Agency (EPA) has been establishing health-based standards for more than 80 contaminants and developing water quality methods and tools to monitor, assess, and report on the health of America's water resources. The Safe Drinking ...

A Growth Curve Analysis of Housing Quality among Transition-Aged Foster Youth

ERIC Educational Resources Information Center

Tyrell, Fanita A.; Yates, Tuppett M.

2017-01-01

Background: Procuring safe housing is a salient developmental task during emerging adulthood, one that is especially challenging for emancipated foster youth. Yet, little is known about factors that influence foster youths' housing experiences. Objective: This investigation documented changes in foster youth's housing quality during the first…

32 CFR 861.4 - DOD air transportation quality and safety requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... experience, and the individual's potential to perform safely. Freedom from alcohol abuse and illegal drugs is.... Freedom from alcohol abuse and illegal drugs is required. (ii) Quality assurance. A system that... certificate are expected. Safety equipment is available in hangars, shops, etc., and is serviceable. Shipping...

32 CFR 861.4 - DOD air transportation quality and safety requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... experience, and the individual's potential to perform safely. Freedom from alcohol abuse and illegal drugs is.... Freedom from alcohol abuse and illegal drugs is required. (ii) Quality assurance. A system that... certificate are expected. Safety equipment is available in hangars, shops, etc., and is serviceable. Shipping...

32 CFR 861.4 - DOD air transportation quality and safety requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... experience, and the individual's potential to perform safely. Freedom from alcohol abuse and illegal drugs is.... Freedom from alcohol abuse and illegal drugs is required. (ii) Quality assurance. A system that... certificate are expected. Safety equipment is available in hangars, shops, etc., and is serviceable. Shipping...

32 CFR 861.4 - DOD air transportation quality and safety requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... experience, and the individual's potential to perform safely. Freedom from alcohol abuse and illegal drugs is.... Freedom from alcohol abuse and illegal drugs is required. (ii) Quality assurance. A system that... certificate are expected. Safety equipment is available in hangars, shops, etc., and is serviceable. Shipping...

After-School Programs: Keeping Children Safe and Smart.

ERIC Educational Resources Information Center

Chung, An-Me

This guide provides information on the benefits of afterschool programs and the qualities of good after school programs. Afterschool programs reduce the risk of juvenile delinquency, substance use, and violent crime victimization. Children involved in quality programs decrease their chances of dropping out, earn higher grades, and develop better…

Drinking water treatment plant costs and source water quality: An updated case study (2013-2016) Abstract

EPA Science Inventory

Watershed protection can play an important role in producing safe drinking water. However, many municipalities and drinking water treatment plants (DWTPs) lack the information on the potential benefits of watershed protection as an approach to improving source water quality. This...

Safety and efficacy of a ginkgo biloba-containing dietary supplement on cognitive function, quality of life, and platelet function in healthy, cognitively intact older adults.

PubMed

Carlson, Joseph J; Farquhar, John W; DiNucci, Ellen; Ausserer, Laurie; Zehnder, James; Miller, Donald; Berra, Kathy; Hagerty, Lisa; Haskell, William L

2007-03-01

To determine if a ginkgo biloba-containing supplement improves cognitive function and quality of life, alters primary hemostasis, and is safe in healthy, cognitively intact older adults. Four-month, randomized, double-blind, placebo-controlled parallel design. Ninety men and women (age range 65 to 84 years) were recruited to a university clinic. Eligibility included those without dementia or depression, not taking psychoactive medications or medications or supplements that alter hemostasis. Ninety subjects were randomly assigned to placebo or a ginkgo biloba-based supplement containing 160 mg ginkgo biloba, 68 mg gotu kola, and 180 mg decosahexaenoic acid per day for 4 months. Assessments included: six standardized cognitive function tests, the SF-36 Quality of Life questionnaire, the Platelet Function Analyzer-100 (Dade Behring, Eschbom, Germany), and the monitoring of adverse events. Baseline characteristics and study hypotheses were tested using analysis of covariance. Tests were two-tailed with a 0.05 significance level. Seventy-eight subjects (87%) completed both baseline and 4-month testing (n=36 in placebo group, n=42 in ginkgo biloba group). At baseline, the participants' cognitive function was above average. One of six cognitive tests indicated significant protocol differences at 4 months (P=0.03), favoring the placebo. There were no significant differences in quality of life, platelet function, or adverse events. These finding do not support the use of a ginkgo biloba-containing supplement for improving cognitive function or quality of life in cognitively intact, older, healthy adults. However, high baseline scores may have contributed to the null findings. The ginkgo biloba product seems safe and did not alter platelet function, though additional studies are needed to evaluate the interaction of varying doses of ginkgo biloba and ginkgo biloba-containing supplements with medications and supplements that alter hemostasis.

Clinical audit: shining a light on good practice.

PubMed

Grainger, Angela

2010-07-01

Healthcare organisations undertake quality assurance to produce safe and effective patient care systems. Statutory quality assurance requirements are met through external reviews, monitoring and inspection processes, and each NHS trust must produce a corporate annual quality account. However, this can result in approaching audits as if they are 'tick-box activities'. This article discusses how organisations can avoid this trap by applying audit results to practice.

A Comprehensive Quality Evaluation System for Complex Herbal Medicine Using PacBio Sequencing, PCR-Denaturing Gradient Gel Electrophoresis, and Several Chemical Approaches

PubMed Central

Zheng, Xiasheng; Zhang, Peng; Liao, Baosheng; Li, Jing; Liu, Xingyun; Shi, Yuhua; Cheng, Jinle; Lai, Zhitian; Xu, Jiang; Chen, Shilin

2017-01-01

Herbal medicine is a major component of complementary and alternative medicine, contributing significantly to the health of many people and communities. Quality control of herbal medicine is crucial to ensure that it is safe and sound for use. Here, we investigated a comprehensive quality evaluation system for a classic herbal medicine, Danggui Buxue Formula, by applying genetic-based and analytical chemistry approaches to authenticate and evaluate the quality of its samples. For authenticity, we successfully applied two novel technologies, third-generation sequencing and PCR-DGGE (denaturing gradient gel electrophoresis), to analyze the ingredient composition of the tested samples. For quality evaluation, we used high performance liquid chromatography assays to determine the content of chemical markers to help estimate the dosage relationship between its two raw materials, plant roots of Huangqi and Danggui. A series of surveys were then conducted against several exogenous contaminations, aiming to further access the efficacy and safety of the samples. In conclusion, the quality evaluation system demonstrated here can potentially address the authenticity, quality, and safety of herbal medicines, thus providing novel insight for enhancing their overall quality control. Highlight: We established a comprehensive quality evaluation system for herbal medicine, by combining two genetic-based approaches third-generation sequencing and DGGE (denaturing gradient gel electrophoresis) with analytical chemistry approaches to achieve the authentication and quality connotation of the samples. PMID:28955365

A Comprehensive Quality Evaluation System for Complex Herbal Medicine Using PacBio Sequencing, PCR-Denaturing Gradient Gel Electrophoresis, and Several Chemical Approaches.

PubMed

Zheng, Xiasheng; Zhang, Peng; Liao, Baosheng; Li, Jing; Liu, Xingyun; Shi, Yuhua; Cheng, Jinle; Lai, Zhitian; Xu, Jiang; Chen, Shilin

2017-01-01

Herbal medicine is a major component of complementary and alternative medicine, contributing significantly to the health of many people and communities. Quality control of herbal medicine is crucial to ensure that it is safe and sound for use. Here, we investigated a comprehensive quality evaluation system for a classic herbal medicine, Danggui Buxue Formula, by applying genetic-based and analytical chemistry approaches to authenticate and evaluate the quality of its samples. For authenticity, we successfully applied two novel technologies, third-generation sequencing and PCR-DGGE (denaturing gradient gel electrophoresis), to analyze the ingredient composition of the tested samples. For quality evaluation, we used high performance liquid chromatography assays to determine the content of chemical markers to help estimate the dosage relationship between its two raw materials, plant roots of Huangqi and Danggui. A series of surveys were then conducted against several exogenous contaminations, aiming to further access the efficacy and safety of the samples. In conclusion, the quality evaluation system demonstrated here can potentially address the authenticity, quality, and safety of herbal medicines, thus providing novel insight for enhancing their overall quality control. Highlight : We established a comprehensive quality evaluation system for herbal medicine, by combining two genetic-based approaches third-generation sequencing and DGGE (denaturing gradient gel electrophoresis) with analytical chemistry approaches to achieve the authentication and quality connotation of the samples.

Test results of JPL LiSOCl sub 2 cells

NASA Technical Reports Server (NTRS)

Halpert, G.; Subbarao, S.; Dawson, S.; Ang, V.; Deligiannis, E.

1986-01-01

In the development of high rate Li-SO-Cl2 cells for various applications, the goal is to achieve 300 watt-hours per kilogram at the C/2 (5 amp) rate in a D cell configuration. The JPL role is to develop the understanding of the performance, life, and safety limiting characteristics in the cell and to transfer the technology to a manufacturer to produce a safe, high quality product in a reproducible manner. The approach taken to achieve the goals is divided into four subject areas: cathode processes and characteristics; chemical reactions and safety; cell design and assembly; and performance and abuse testing. The progress made in each of these areas is discussed.

Household safe water management in Kisii County, Kenya.

PubMed

Misati, A G

2016-11-01

Contaminated drinking water can lead to the risk of intestinal and other infectious diseases that lead to high morbidity. Therefore, determining household safe water management practices will benefit billions of people by ensuring there is no recontamination. A cross-sectional study design was used and a sample of 346 households was selected through systematic random sampling. A questionnaire was then used which was based on the core questions on drinking water and sanitation for household surveys and descriptive analyses were performed for the collected data using SPSS. Springs were predominantly used as the main source of water (97 %). Approximately, over half (58 %) of the sampled households never treated their drinking water to ensure that it was safe for drinking. Mostly (56 %), the households used jerricans for the storage of water with a majority of the households (95 %) covering their containers which were elevated from the reach of children in 52 % of the households. The risks included lack of water treatment, not covering the water container, risk of permitting dipping for those containers, lacking narrow neck and the risk of container being accessible to children. Basic treatment of the water at the household level by use of chemicals, filtration and boiling may have a great impact on the drinking water quality and health of the inhabitants of Kisii County. Also, creation of awareness on the possibilities of spring water being contaminated should be carried because of the assumption that spring water is safe and does not need to be treated.

Assuring fish safety and quality in international fish trade.

PubMed

Ababouch, Lahsen

2006-01-01

International trade in fishery commodities reached US 58.2 billion dollars in 2002, a 5% improvement relative to 2000 and a 45% increase over 1992 levels. Within this global trade, developing countries registered a net trade surplus of US 17.4 billion dollars in 2002 and accounted for almost 50% by value and 55% of fish exports by volume. This globalization of fish trade, coupled with technological developments in food production, handling, processing and distribution, and the increasing awareness and demand of consumers for safe and high quality food have put food safety and quality assurance high in public awareness and a priority for many governments. Consequently, many countries have tightened food safety controls, imposing additional costs and requirements on imports. As early as 1980, there was an international drive towards adopting preventative HACCP-based safety and quality systems. More recently, there has been a growing awareness of the importance of an integrated, multidisciplinary approach to food safety and quality throughout the entire food chain. Implementation of this approach requires an enabling policy and regulatory environment at national and international levels with clearly defined rules and standards, establishment of appropriate food control systems and programmes at national and local levels, and provision of appropriate training and capacity building. This paper discusses the international framework for fish safety and quality, with particular emphasis on the United Nation's Food and Agricultural Organization's (FAO) strategy to promote international harmonization and capacity building.

AN AIR QUALITY DATA ANALYSIS SYSTEM FOR INTERRELATING EFFECTS, STANDARDS, AND NEEDED SOURCE REDUCTIONS: PART 13. APPLYING THE EPA PROPOSED GUIDELINES FOR CARCINOGEN RISK ASSESSMENT TO A SET OF ASBESTOS LUNG CANCER MORTALITY DATA

EPA Science Inventory

The Clean Air Act Amendments of 1990 (CAAA-90) list 189 hazardous air pollutants (HAPs) for which "safe" ambient concentrations are to be determined. For a carcinogen, such as asbestos, the amendments specify that the safe concentration shall allow one excess cancer case per mi...

Contaminated drinking water and rural health perspectives in Rajasthan, India: an overview of recent case studies.

PubMed

Suthar, Surindra

2011-02-01

Access to safe drinking water is an important issue of health and development at national, regional, and local levels. The concept of safe drinking water assumes greater significance in countries like India where the majority of the population lives in villages with bare infrastructures and poor sanitation facilities. This review presents an overview of drinking water quality in rural habitations of northern Rajasthan, India. Although fluoride is an endemic problem to the groundwater of this region, recently, other anthropogenic chemicals has also been reported in the local groundwater. Recent case studies indicate that about 95% of sites of this region contain a higher fluoride level in groundwater than the maximum permissible limit as decided by the Bureau of Indian Standards. Nitrate (as NO3-) contamination has appeared as another anthropogenic threat to some intensively cultivable rural habitations of this region. Biological contamination has appeared as another issue of unsafe drinking water resources in rural areas of the state. Recent studies have claimed a wide variety of pathogenic bacteria including members of the family Enterobacteriaceae in local drinking water resources. Overall, the quality of drinking water in this area is not up to the safe level, and much work is still required to establish a safe drinking water supply program in this area.

Quantitative Real-Time PCR Fecal Source Identification in the ...

EPA Pesticide Factsheets

Rivers in the Tillamook Basin play a vital role in supporting a thriving dairy and cheese-making industry, as well as providing a safe water resource for local human and wildlife populations. Historical concentrations of fecal bacteria in these waters are at times too high to allow for safe use leading to economic loss, endangerment of local wildlife, and poor conditions for recreational use. In this study, we employ host-associated qPCR methods for human (HF183/BacR287 and HumM2), ruminant (Rum2Bac), cattle (CowM2 and CowM3), canine (DG3 and DG37), and avian (GFD) fecal pollution combined with high-resolution geographic information system (GIS) land use data and general indicator bacteria measurements to elucidatewater quality spatial and temporal trends. Water samples (n=584) were collected over a 1-year period at 29 sites along the Trask, Kilchis, and Tillamook rivers and tributaries (Tillamook Basin, OR). A total of 16.6% of samples (n=97) yielded E. coli levels considered impaired based on Oregon Department of Environmental Quality bacteria criteria (406 MPN/100mL). Hostassociated genetic indicators were detected at frequencies of 39.2% (HF183/BacR287), 16.3% (HumM2), 74.6% (Rum2Bac), 13.0% (CowM2), 26.7% (CowM3), 19.8% (DG3), 3.2% (DG37), and 53.4% (GFD) across all water samples (n=584). Seasonal trends in avian, cattle, and human fecal pollution sources were evident over the study area. On a sample site basis, quantitative fecal source identification and

Use of hospital data for Safe Motherhood programmes in south Kalimantan, Indonesia.

PubMed

Ronsmans, C; Achadi, E; Sutratikto, G; Zazri, A; McDermott, J

1999-07-01

The evaluation of Safe Motherhood programmes has been hampered by difficulties in measuring the preferred outcomes of maternal mortality and morbidity. The need for adequate indicators has led researchers and programme managers alike to resort to indicators of utilization and quality of health services. In this study we assess the magnitude of four indicators of use of essential obstetric care (EOC) and one indicator of quality of care in health facilities in three districts in South Kalimantan, Indonesia. The general picture which emerges for South Kalimantan is that the use of obstetric services is low. Even in the more urban district of Banjar where facility-based coverage is highest, fewer than 14% of all deliveries take place in an EOC facility, 2% of expected births are admitted to such a facility with a major obstetric intervention (MOI), and 1% of expected births have an MOI for an absolute maternal indication. The use of facility-based EOC is consistently lower in Barito Kuala compared to the other districts, and the differences persist regardless of the indicators used. In this setting with low utilization rates, general rates of utilization of EOC facilities seem to be as satisfactory an indicator of relative access to EOC as more elaborate indicators specifying the reasons for admission. The inequalities in access to care revealed by the various indicators of use of EOC services may prove to be a more powerful stimulus for change than the widely reported and highly inaccurate accounts of the high levels of maternal mortality.

Spectrally Tailored Pulsed Thulium Fiber Laser System for Broadband Lidar CO2 Sensing

NASA Technical Reports Server (NTRS)

Heaps, William S.; Georgieva, Elena M.; McComb, Timothy S.; Cheung, Eric C.; Hassell, Frank R.; Baldauf, Brian K.

2011-01-01

Thulium doped pulsed fiber lasers are capable of meeting the spectral, temporal, efficiency, size and weight demands of defense and civil applications for pulsed lasers in the eye-safe spectral regime due to inherent mechanical stability, compact "all-fiber" master oscillator power amplifier (MOPA) architectures, high beam quality and efficiency. Thulium fiber's longer operating wavelength allows use of larger fiber cores without compromising beam quality, increasing potential single aperture pulse energies. Applications of these lasers include eye-safe laser ranging, frequency conversion to longer or shorter wavelengths for IR countermeasures and sensing applications with otherwise tough to achieve wavelengths and detection of atmospheric species including CO2 and water vapor. Performance of a portable thulium fiber laser system developed for CO2 sensing via a broadband lidar technique with an etalon based sensor will be discussed. The fielded laser operates with approximately 280 J pulse energy in 90-150ns pulses over a tunable 110nm spectral range and has a uniquely tailored broadband spectral output allowing the sensing of multiple CO2 lines simultaneously, simplifying future potentially space based CO2 sensing instruments by reducing the number and complexity of lasers required to carry out high precision sensing missions. Power scaling and future "all fiber" system configurations for a number of ranging, sensing, countermeasures and other yet to be defined applications by use of flexible spectral and temporal performance master oscillators will be discussed. The compact, low mass, robust, efficient and readily power scalable nature of "all-fiber" thulium lasers makes them ideal candidates for use in future space based sensing applications.

Air Quality Inside Police Drug Safes and Drug Storage Areas.

PubMed

Doran, Gregory S; Deans, Ralph; De Filippis, Carlo; Kostakis, Chris; Howitt, Julia A

2018-06-01

Storage of drug-based evidence inside sealed safes may allow chemical vapors to accumulate, creating concerns of drug exposure by inhalation, or the possibility of cross-contamination of drug evidence. Air samples were taken from inside eight drug safes and one small storage room at nine city and country police stations, as well as a large centralized drug evidence storage vault, in New South Wales (NSW), Australia. Sorbent tubes containing charcoal were used to determine whether any drug residues could be detected in the air, and to identify the types of chemicals present. Carbon traps were extracted and analyzed by LC-MS-MS for a suite of 22 licit and illicit drug residues and 2 metabolites. Carbon traps and SPME fibers were also analyzed by GC-MS for general volatile organic compound (VOC) residues. No detectable drug residues, either as airborne dust or vapor, were found in the safes, the storage room or the large central repository vault. No drugs were detected in any of the 34 urine samples collected at 8 of the 10 sampling locations, while only one of the five hair samples was positive for cocaine (9 pg/mg) provided by police exhibit officers at 3 of the 10 sampling locations. VOC analysis identified a variety of solvents associated with drug manufacture, plasticisers, personal care products and volatiles associated with plants such as cannabis. The results indicate that strong chemical odours emanating from drug safes are unlikely to be drug residues due to low volatility of drugs, and are more likely VOCs associated with their manufacture or from plant growing operations. Consideration should be given to the quality of air flow in rooms in which safes are housed and the use of air filtering inside safes to reduce the likelihood of VOC accumulation, and therefore the risk of human exposure.

[Antiandrogen gynecomastia: an inescapable harm? Radiotherapy: a simple and efficient solution!].

PubMed

Couke, Philippe A; Jichliski, Patrice; Matzinger, Oscar; Ozsahin, Mahmut; Bulling, Shelley M; Zouhair, Abderrahim

2004-01-01

Anti-androgen induced gynecomastia, resulting from a treatment induced imbalance between oestrogens and androgens, is a frequently encountered side effect in the hormonal treatment of patients with prostatic cancer. One might expect to face an increase in the overall incidence of this side effect in the next-coming years as randomized trials clearly point to the evidence of the therapeutic benefit of anti-androgenic treatment for this prostatic cancer. Gynecomastia is often accompanied by mastodynia and does hamper quality of life. Surgery should be considered for established irreversible gynecomastia characterized by hyalinization and extensive fibrosis. However, radiotherapy is the treatment of choice for gynecomastia at it's early stage, or could eventually be considered as a prophylactic treatment in high risk patients. It is a safe and extremely well tolerated treatment resulting in a high degree of therapeutic success with a demonstrated effect on quality of life as reported in randomized trials. To date no medical treatment is proven effective nor devoid from deleterious effects and licenced for this indication.

End-of-life care in nursing homes: the high cost of staff turnover.

PubMed

Tilden, Virginia P; Thompson, Sarah A; Gajewski, Byron J; Bott, Marjorie J

2012-01-01

Nursing home staff turnover results in high cost--both economic and personal--and has a negative impact on the quality of care provided to residents at the end of life. Reducing staff turnover in nursing homes would benefit both the cost to the U.S. health care system, and, most importantly, the care residents receive in the vulnerable period leading to death. There is rising pressure on nursing homes to improve their palliative and end-of-life care practices and reduce transfers to hospital for situations and conditions that can be safely managed on site. Nursing care staff deserve an investment in the specific training necessary for them to give the highest quality care to dying residents. This training should be multifaceted and include the physiological, psychological, spiritual, interpersonal, and cultural (including ethnic) aspects of dying. Empowerment with these necessary knowledge, skills, and attitudes will not only result in better care for residents but likely also will reduce the burnout and frustration staff experience in caring for residents near death.

Exercise and Type 2 Diabetes

PubMed Central

Colberg, Sheri R.; Sigal, Ronald J.; Fernhall, Bo; Regensteiner, Judith G.; Blissmer, Bryan J.; Rubin, Richard R.; Chasan-Taber, Lisa; Albright, Ann L.; Braun, Barry

2010-01-01

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications. PMID:21115758

Sensitivity of immune response quality to influenza helix 190 antigen structure displayed on a modular virus-like particle.

PubMed

Anggraeni, Melisa R; Connors, Natalie K; Wu, Yang; Chuan, Yap P; Lua, Linda H L; Middelberg, Anton P J

2013-09-13

Biomolecular engineering enables synthesis of improved proteins through synergistic fusion of modules from unrelated biomolecules. Modularization of peptide antigen from an unrelated pathogen for presentation on a modular virus-like particle (VLP) represents a new and promising approach to synthesize safe and efficacious vaccines. Addressing a key knowledge gap in modular VLP engineering, this study investigates the underlying fundamentals affecting the ability of induced antibodies to recognize the native pathogen. Specifically, this quality of immune response is correlated to the peptide antigen module structure. We modularized a helical peptide antigen element, helix 190 (H190) from the influenza hemagglutinin (HA) receptor binding region, for presentation on murine polyomavirus VLP, using two strategies aimed to promote H190 helicity on the VLP. In the first strategy, H190 was flanked by GCN4 structure-promoting elements within the antigen module; in the second, dual H190 copies were arrayed as tandem repeats in the module. Molecular dynamics simulation predicted that tandem repeat arraying would minimize secondary structural deviation of modularized H190 from its native conformation. In vivo testing supported this finding, showing that although both modularization strategies conferred high H190-specific immunogenicity, tandem repeat arraying of H190 led to a strikingly higher immune response quality, as measured by ability to generate antibodies recognizing a recombinant HA domain and split influenza virion. These findings provide new insights into the rational engineering of VLP vaccines, and could ultimately enable safe and efficacious vaccine design as an alternative to conventional approaches necessitating pathogen cultivation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Using the Donabedian framework to examine the quality and safety of nursing service innovation.

PubMed

Gardner, Glenn; Gardner, Anne; O'Connell, Jane

2014-01-01

To evaluate the safety and quality of nurse practitioner service using the audit framework of Structure, Process and Outcome. Health service and workforce reform are on the agenda of governments and other service providers seeking to contain healthcare costs whilst providing safe and effective health care to communities. The nurse practitioner service is one health workforce innovation that has been adopted globally to improve timely access to clinical care, but there is scant literature reporting evaluation of the quality of this service innovation. A mixed-methods design within the Donabedian evaluation framework was used. The Donabedian framework was used to evaluate the Structure, Process and Outcome of nurse practitioner service. A range of data collection approaches was used, including stakeholder survey (n = 36), in-depth interviews (11 patients and 13 nurse practitioners) and health records data on service processes. The study identified that adequate and detailed preparation of Structure and Process is essential for the successful implementation of a service innovation. The multidisciplinary team was accepting of the addition of nurse practitioner service, and nurse practitioner clinical care was shown to be effective, satisfactory and safe from the perspective of the clinician stakeholders and patients. This study demonstrated that the Donabedian framework of Structure, Process and Outcome evaluation is a valuable and validated approach to examine the safety and quality of a service innovation. Furthermore, in this study, specific Structure elements were shown to influence the quality of service processes further validating the framework and the interdependence of the Structure, Process and Outcome components. Understanding the Structure and Process requirements for establishing nursing service innovation lays the foundation for safe, effective and patient-centred clinical care. © 2013 John Wiley & Sons Ltd.

Evaluation of biological stability and corrosion potential in drinking water distribution systems: a case study.

PubMed

Chien, C C; Kao, C M; Chen, C W; Dong, C D; Chien, H Y

2009-06-01

The appearance of assimilable organic carbon (AOC), microbial regrowth, disinfection by-products (DBPs), and pipe corrosion in drinking water distribution systems are among those major safe drinking water issues in many countries. The water distribution system of Cheng-Ching Lake Water Treatment Plant (CCLWTP) was selected in this study to evaluate the: (1) fate and transport of AOC, DBPs [e.g., trihalomethanes (THMs), haloacetic acids (HAAs)], and other organic carbon indicators in the selected distribution system, (2) correlations between AOC (or DBPs) and major water quality parameters [e.g. dissolved oxygen (DO), free residual chlorine, and bacteria, and (3) causes and significance of corrosion problems of the water pipes in this system. In this study, seasonal water samples were collected from 13 representative locations in the distribution system for analyses of AOC, DBPs, and other water quality indicators. Results indicate that residual free chlorine concentrations in the distribution system met the drinking water standards (0.2 to 1 mg l(-1)) established by Taiwan Environmental Protection Administration (TEPA). Results show that AOC measurements correlated positively with total organic carbon (TOC) and UV-254 (an organic indicator) values in this system. Moreover, AOC concentrations at some locations were higher than the 50 microg acetate-C l(-1) standard established by Taiwan Water Company. This indicates that the microbial regrowth might be a potential water quality problem in this system. Higher DO measurements (>5.7 mg l(-1)) might cause the aerobic biodegradation of THMs and HAAs in the system, and thus, low THMs (<0.035 mg l(-1)) and HAAs (<0.019 mg l(-1)) concentrations were observed at all sampling locations. Results from the observed negative Langelier Saturation Index (LSI) values, higher Ryznar Stability Index (RSI) values, and high Fe3+ concentrations at some pipe-end locations indicate that highly oxidative and corrosive conditions occurred. This reveals that pipe replacement should be considered at these locations. These findings would be helpful in managing the water distribution system for maintaining a safe drinking water quality.

Anesthesiology leadership rounding: identifying opportunities for improvement.

PubMed

Gravenstein, Dietrich; Ford, Susan; Enneking, F Kayser

2012-01-01

Rounding that includes participation of individuals with authority to implement changes has been advocated as important to the transformation of an institution into a high-quality and safe organization. We describe a Department of Anesthesiology's experience with leadership rounding. The Department Chair or other senior faculty designate, a quality coordinator, up to four residents, the ward charge nurse, and patient nurses participated in rounds at bedsides. During a 23-month period, 14 significant opportunities to improve care were identified. Nurses identified 5 of these opportunities, primary team physicians 2, the rounding team 4, and patients or their family members another 3. The anesthesiology service had sole or shared responsibility for 10 improvements. A variety of organizations track specific measures across all phases of the patient experience to gauge quality of care. Chart auditing tools for detecting threats to safety are often used. These measures and tools missed opportunities for improvement that were discovered only through rounding. We conclude that the introduction of leadership rounding by an anesthesiology service can identify opportunities for improving quality that are not captured by conventional efforts.

Quality and safety aspects in histopathology laboratory

PubMed Central

Adyanthaya, Soniya; Jose, Maji

2013-01-01

Histopathology is an art of analyzing and interpreting the shapes, sizes and architectural patterns of cells and tissues within a given specific clinical background and a science by which the image is placed in the context of knowledge of pathobiology, to arrive at an accurate diagnosis. To function effectively and safely, all the procedures and activities of histopathology laboratory should be evaluated and monitored accurately. In histopathology laboratory, the concept of quality control is applicable to pre-analytical, analytical and post-analytical activities. Ensuring safety of working personnel as well as environment is also highly important. Safety issues that may come up in a histopathology lab are primarily those related to potentially hazardous chemicals, biohazardous materials, accidents linked to the equipment and instrumentation employed and general risks from electrical and fire hazards. This article discusses quality management system which can ensure quality performance in histopathology laboratory. The hazards in pathology laboratories and practical safety measures aimed at controlling the dangers are also discussed with the objective of promoting safety consciousness and the practice of laboratory safety. PMID:24574660

A novel non-uniform control vector parameterization approach with time grid refinement for flight level tracking optimal control problems.

PubMed

Liu, Ping; Li, Guodong; Liu, Xinggao; Xiao, Long; Wang, Yalin; Yang, Chunhua; Gui, Weihua

2018-02-01

High quality control method is essential for the implementation of aircraft autopilot system. An optimal control problem model considering the safe aerodynamic envelop is therefore established to improve the control quality of aircraft flight level tracking. A novel non-uniform control vector parameterization (CVP) method with time grid refinement is then proposed for solving the optimal control problem. By introducing the Hilbert-Huang transform (HHT) analysis, an efficient time grid refinement approach is presented and an adaptive time grid is automatically obtained. With this refinement, the proposed method needs fewer optimization parameters to achieve better control quality when compared with uniform refinement CVP method, whereas the computational cost is lower. Two well-known flight level altitude tracking problems and one minimum time cost problem are tested as illustrations and the uniform refinement control vector parameterization method is adopted as the comparative base. Numerical results show that the proposed method achieves better performances in terms of optimization accuracy and computation cost; meanwhile, the control quality is efficiently improved. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

Sex-related knowledge, attitudes, and behaviors of U.S. medical students.

PubMed

Frank, Erica; Coughlin, Steven S; Elon, Lisa

2008-08-01

To understand the personal and clinical safe-sex-related knowledge, attitudes, and practices of U.S. medical students. Sixteen medical schools were selected to survey the class of 2003 based on their characteristics similar to the national average. Students were surveyed at freshman orientation, at entrance to wards, and during their senior year. The primary personal outcome was the response to the question, "Are you currently trying to practice safe sex when sexually involved? (no, not applicable/no, not trying/yes, low priority/yes, high priority)." The primary professional outcomes were answers to: 1) "How relevant do you think talking to patients about safe sex will be in your intended practice? (not at all/somewhat/highly)," and 2) "With a typical general medicine patient, how often do you actually talk about safe sex? (never-rarely/sometimes/usually-always)." A total of 2,316 students provided data, and the response rate was 80%. Personally practicing safe-sex habits was a high priority for 75% of the sexually active, single medical students, especially for women, African Americans, and those earlier in their medical education. Among seniors, 41% reported extensive training in discussing safe sex with patients, and 57% were highly confident about conducting such discussions. Overall, 55% of students believed it would be highly relevant to counsel patients about safe sex (59% of freshmen, 62% of those at entry to wards, and 41% of seniors); 73% answered all four true/false questions on human papillomavirus correctly. About half of U.S. medical students believed that counseling their patients about safe sex will not be highly relevant to their practice. These findings should be considered by those trying to interest a new generation of physicians in helping patients have safe-sex practices.

Beneficial effects of physical activity in an HIV-infected woman with lipodystrophy: a case report

PubMed Central

2011-01-01

Introduction Lipodystrophy is common in patients infected with human immunodeficiency virus receiving highly active antiretroviral therapy, and presents with morphologic changes and metabolic alterations that are associated with depressive behavior and reduced quality of life. We examined the effects of exercise training on morphological changes, lipid profile and quality of life in a woman with human immunodeficiency virus presenting with lipodystrophy. Case presentation A 31-year-old Latin-American Caucasian woman infected with human immunodeficiency virus participated in a 12-week progressive resistance exercise training program with an aerobic component. Her weight, height, skinfold thickness, body circumferences, femur and humerus diameter, blood lipid profile, maximal oxygen uptake volume, exercise duration, strength and quality of life were assessed pre-exercise and post-exercise training. After 12 weeks, she exhibited reductions in her total subcutaneous fat (18.5%), central subcutaneous fat (21.0%), peripheral subcutaneous fat (10.7%), waist circumference (WC) (4.5%), triglycerides (9.9%), total cholesterol (12.0%) and low-density lipoprotein cholesterol (8.6%). She had increased body mass (4.6%), body mass index (4.37%), humerus and femur diameter (3.0% and 2.3%, respectively), high-density lipoprotein cholesterol (16.7%), maximal oxygen uptake volume (33.3%), exercise duration (37.5%) and strength (65.5%). Quality of life measures improved mainly for psychological and physical measures, independence and social relationships. Conclusions These findings suggest that supervised progressive resistance exercise training is a safe and effective treatment for evolving morphologic and metabolic disorders in adults infected with HIV receiving highly active antiretroviral therapy, and improves their quality of life. PMID:21892961

Beneficial effects of physical activity in an HIV-infected woman with lipodystrophy: a case report.

PubMed

Mendes, Edmar Lacerda; Ribeiro Andaki, Alynne Christian; Brito, Ciro José; Córdova, Cláudio; Natali, Antônio José; Santos Amorim, Paulo Roberto Dos; de Oliveira, Leandro Licursi; de Paula, Sérgio Oliveira; Mutimura, Eugene

2011-09-05

Lipodystrophy is common in patients infected with human immunodeficiency virus receiving highly active antiretroviral therapy, and presents with morphologic changes and metabolic alterations that are associated with depressive behavior and reduced quality of life. We examined the effects of exercise training on morphological changes, lipid profile and quality of life in a woman with human immunodeficiency virus presenting with lipodystrophy. A 31-year-old Latin-American Caucasian woman infected with human immunodeficiency virus participated in a 12-week progressive resistance exercise training program with an aerobic component. Her weight, height, skinfold thickness, body circumferences, femur and humerus diameter, blood lipid profile, maximal oxygen uptake volume, exercise duration, strength and quality of life were assessed pre-exercise and post-exercise training. After 12 weeks, she exhibited reductions in her total subcutaneous fat (18.5%), central subcutaneous fat (21.0%), peripheral subcutaneous fat (10.7%), waist circumference (WC) (4.5%), triglycerides (9.9%), total cholesterol (12.0%) and low-density lipoprotein cholesterol (8.6%). She had increased body mass (4.6%), body mass index (4.37%), humerus and femur diameter (3.0% and 2.3%, respectively), high-density lipoprotein cholesterol (16.7%), maximal oxygen uptake volume (33.3%), exercise duration (37.5%) and strength (65.5%). Quality of life measures improved mainly for psychological and physical measures, independence and social relationships. These findings suggest that supervised progressive resistance exercise training is a safe and effective treatment for evolving morphologic and metabolic disorders in adults infected with HIV receiving highly active antiretroviral therapy, and improves their quality of life.

Air-insufflated high-definition dacryoendoscopy yields significantly better image quality than conventional dacryoendoscopy.

PubMed

Sasaki, Tsugihisa; Sounou, Tsutomu; Tsuji, Hideki; Sugiyama, Kazuhisa

2017-01-01

To facilitate the analysis of lacrimal conditions, we utilized high-definition dacryoendoscopy (HDD) and undertook observations with a pressure-controlled air-insufflation system. We report the safety and performance of HDD. In this retrospective, non-randomized clinical trial, 46 patients (14 males and 32 females; age range 39-91 years; mean age ± SD 70.3±12.0 years) who had lacrimal disorders were examined with HDD and conventional dacryoendoscopy (CD). The high-definition dacryoendoscope had 15,000 picture element image fibers and an advanced objective lens. Its outer diameter was 0.9-1.2 mm. Air insufflation was controlled at 0-20 kPa with a digital manometer-based pressure-controlled air-insufflation system to evaluate the quality of the image. The HDD had an air/saline irrigation channel between the outer sheath (outer diameter =1.2 mm) and the metal inner sheath of the endoscope. We used it and the CD in air, saline, and diluted milk saline with and without manual irrigation to quantitatively evaluate the effect of air pressure and saline irrigation on image quality. In vivo, the most significant improvement in image quality was demonstrated with air-insufflated (5-15 kPa) HDD, as compared with saline-irrigated HDD and saline-irrigated CD. No emphysema or damage was noted under observation with HDD. In vitro, no significant difference was demonstrated between air-insufflated HDD and saline-irrigated HDD. In vitro, the image quality of air-insufflated HDD was significantly improved as compared with that of saline-irrigated CD. Pressure-controlled (5-15 kPa) air-insufflated HDD is safe, and yields significantly better image quality than CD and saline-irrigated HDD.

Establishing High-Quality Prostate Brachytherapy Using a Phantom Simulator Training Program

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

Thaker, Nikhil G.; Kudchadker, Rajat J.; Swanson, David A.

2014-11-01

Purpose: To design and implement a unique training program that uses a phantom-based simulator to teach the process of prostate brachytherapy (PB) quality assurance and improve the quality of education. Methods and Materials: Trainees in our simulator program were practicing radiation oncologists, radiation oncology residents, and fellows of the American Brachytherapy Society. The program emphasized 6 core areas of quality assurance: patient selection, simulation, treatment planning, implant technique, treatment evaluation, and outcome assessment. Using the Iodine 125 ({sup 125}I) preoperative treatment planning technique, trainees implanted their ultrasound phantoms with dummy seeds (ie, seeds with no activity). Pre- and postimplant dosimetric parametersmore » were compared and correlated using regression analysis. Results: Thirty-one trainees successfully completed the simulator program during the period under study. The mean phantom prostate size, number of seeds used, and total activity were generally consistent between trainees. All trainees met the V100 >95% objective both before and after implantation. Regardless of the initial volume of the prostate phantom, trainees' ability to cover the target volume with at least 100% of the dose (V100) was not compromised (R=0.99 pre- and postimplant). However, the V150 had lower concordance (R=0.37) and may better reflect heterogeneity control of the implant process. Conclusions: Analysis of implants from this phantom-based simulator shows a high degree of consistency between trainees and uniformly high-quality implants with respect to parameters used in clinical practice. This training program provides a valuable educational opportunity that improves the quality of PB training and likely accelerates the learning curve inherent in PB. Prostate phantom implantation can be a valuable first step in the acquisition of the required skills to safely perform PB.« less

Determinants, Health Problems, and Food Insecurity in Urban Areas of the Largest City in Cape Verde

PubMed Central

Craveiro, Isabel; Alves, Daniela; Amado, Miguel; Santos, Zélia; Fortes, Argentina Tomar; Delgado, António Pedro; Correia, Artur; Gonçalves, Luzia

2016-01-01

Urbanization processes are intertwined with nutritional transition because there is easier access to food of low nutritional quality at reduced prices, changing dietary patterns and leading to an increase of non-communicable chronic diseases. This study aims to understand the perceptions for high blood pressure, obesity, and alcoholism, describing some interactions of these dimensions in the problem of food security in the city of Praia. A qualitative study was carried out under the framework of the research project “UPHI-STAT: Urban Planning and Health Inequalities—moving from macro to micro statistics”. Ten focus groups were conducted in three urban areas with distinct characteristics in the city of Praia, with a total of 48 participants. Participants reported frequent consumption of foods with poor nutritional quality, understanding the potential danger in terms of food security in the city of Praia. Easy access to and high levels of alcohol consumption, and poor quality of traditional drinks were mentioned by participants in the study areas. The impact of the economic situation on the possibility of access to safe and healthy options emerged as a differentiating factor. PMID:27879689

Analysis of Environmental Contamination resulting from ...

EPA Pesticide Factsheets

Catastrophic incidents can generate a large number of samples with analytically diverse types including forensic, clinical, environmental, food, and others. Environmental samples include water, wastewater, soil, air, urban building and infrastructure materials, and surface residue. Such samples may arise not only from contamination from the incident but also from the multitude of activities surrounding the response to the incident, including decontamination. This document summarizes a range of activities to help build laboratory capability in preparation for analysis following a catastrophic incident, including selection and development of fit-for-purpose analytical methods for chemical, biological, and radiological contaminants. Fit-for-purpose methods are those which have been selected to meet project specific data quality objectives. For example, methods could be fit for screening contamination in the early phases of investigation of contamination incidents because they are rapid and easily implemented, but those same methods may not be fit for the purpose of remediating the environment to safe levels when a more sensitive method is required. While the exact data quality objectives defining fitness-for-purpose can vary with each incident, a governing principle of the method selection and development process for environmental remediation and recovery is based on achieving high throughput while maintaining high quality analytical results. This paper illu

[Parasitic zoonoses transmitted by drinking water. Giardiasis and cryptosporidiosis].

PubMed

Exner, M; Gornik, V

2004-07-01

Nowadays, the parasitic zoonose organisms Giardia lamblia und Cryptosporidium spp. are among the most relevant pathogens of drinking water-associated disease outbreaks. These pathogens are transmitted via a fecal-oral route; in both cases the dose of infection is low. Apart from person-to-person or animal-to-person transmissions, the consumption of contaminated food and water are further modes of transmission. The disease is mainly characterized by gastrointestinal symptoms. In industrialized countries, the prevalence rate of giardiasis is 2-5 % and of cryptosporidiosis 1-3%. Throughout the world, a large number of giardiasis and cryptosporidiosis outbreaks associated with drinking water were published; in 2001 the first case in Germany was identified. Giardia and Cryptosporidium are detected in surface water and sporadically in unprotected groundwater. Use of these waters for drinking water abstraction makes high demands on the technology of the treatment process: because of the disinfectant resistance of the parasites, safe elimination methods are needed, which even at high contamination levels of source water guarantee safe drinking water. Further measures for prevention and control are implementation of the HACCP concept, which includes the whole chain of procedures of drinking water supply from catchment via treatment to tap and a quality management system.

Succession of bacterial and fungal communities within biofilms of a chlorinated drinking water distribution system.

PubMed

Douterelo, I; Fish, K E; Boxall, J B

2018-09-15

Understanding the temporal dynamics of multi-species biofilms in Drinking Water Distribution Systems (DWDS) is essential to ensure safe, high quality water reaches consumers after it passes through these high surface area reactors. This research studied the succession characteristics of fungal and bacterial communities under controlled environmental conditions fully representative of operational DWDS. Microbial communities were observed to increase in complexity after one month of biofilm development but they did not reach stability after three months. Changes in cell numbers were faster at the start of biofilm formation and tended to decrease over time, despite the continuing changes in bacterial community composition. Fungal diversity was markedly less than bacterial diversity and had a lag in responding to temporal dynamics. A core-mixed community of bacteria including Pseudomonas, Massillia and Sphingomonas and the fungi Acremonium and Neocosmopora were present constantly and consistently in the biofilms over time and conditions studied. Monitoring and managing biofilms and such ubiquitous core microbial communities are key control strategies to ensuring the delivery of safe drinking water via the current ageing DWDS infrastructure. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Safe swallowing and communicating for ventilated intensive care patients with tracheostoma: implementation of the Passy Muir speaking valve

PubMed

Fröhlich, Martin R; Boksberger, Heidi; Barfuss-Schneider, Claudia; Liem, Esther; Petry, Heidi

2017-01-01

Background: Between 4 to 45 % of intensive care patients suffer from prolonged ventilator dependence. Due to impeded weaning, verbal communication is impossible. The tracheal cannula affects breathing and swallowing. The Passy Muir speaking valve (PMV) allows patients on ventilators to speak. It counteracts pharyngeal as well as laryngeal desensitization and prevents an insufficient swallowing reflex. Aim and methods: To implement the PMV, we conducted a multiprofessional practice- and quality development project. The objective was to ensure safe swallowing and communicating for ventilated patients with tracheostoma. Results: Intensive care nurses, doctors and physiotherapists assessed patient safety as being high. In nine patients with 51 PMV applications, we observed three undesirable events in terms of dyspnea and oxygen desaturation. On one occasion, it was necessary to remove the PMV. Conclusion: A combination of mandatory training for the entire treatment team, presence of two professionals during PMV application, and a newly developed guiding document resulted in a high level of patient safety. By means of PMV, ventilated intensive care patients are able to communicate verbally and to swallow better. Complications can be identified early and solved effectively.

QUALITY CONTROL OF PHARMACEUTICALS.

PubMed

LEVI, L; WALKER, G C; PUGSLEY, L I

1964-10-10

Quality control is an essential operation of the pharmaceutical industry. Drugs must be marketed as safe and therapeutically active formulations whose performance is consistent and predictable. New and better medicinal agents are being produced at an accelerated rate. At the same time more exacting and sophisticated analytical methods are being developed for their evaluation. Requirements governing the quality control of pharmaceuticals in accordance with the Canadian Food and Drugs Act are cited and discussed.

White Sands Missile Range 2011 Drinking Water Quality Report

DTIC Science & Technology

2012-01-01

This Annual Drinking Water Quality Report, or the Consumer Confi dence Report, is required by the Safe Drinking Water Act (SDWA). The SDWA ensures...public drinking water systems meet national standards for the protection of your health. This report provides details about where your water comes...NMED). WSMR tap water meets all EPA and NMED drinking water standards. What is This Water Quality Report? Este informe contiene informacion importante

Evaluation of XV-15 tilt rotor aircraft for flying qualities research application

NASA Technical Reports Server (NTRS)

Radford, R. C.; Schelhorn, A. E.; Siracuse, R. J.; Till, R. D.; Wasserman, R.

1976-01-01

The results of a design review study and evaluation of the XV-15 Tilt Rotor Research Aircraft for flying qualities research application are presented. The objectives of the program were to determine the capability of the XV-15 aircraft and the V/STOLAND system as a safe, inflight facility to provide meaningful research data on flying qualities, flight control systems, and information display systems.

APSIC Guidelines for environmental cleaning and decontamination.

PubMed

Ling, Moi Lin; Apisarnthanarak, Anucha; Thu, Le Thi Anh; Villanueva, Victoria; Pandjaitan, Costy; Yusof, Mohamad Yasim

2015-01-01

This document is an executive summary of APSIC Guidelines for Environmental Cleaning and Decontamination. It describes best practices in routine cleaning and decontamination in healthcare facilities as well as in specific settings e.g. management of patients with isolation precautions, food preparation areas, construction and renovation, and following a flood. It recommends the implementation of environmental hygiene program to keep the environment safe for patients, staff and visitors visiting a healthcare facility. Objective assessment of cleanliness and quality is an essential component of this program as a method for identifying quality improvement opportunities. Recommendations for safe handling of linen and bedding; as well as occupational health and safety issues are included in the guidelines. A training program is vital to ensure consistent adherence to best practices.

Does the Quality of SafeTalk Motivational Interviewing Counseling Predict Sexual Behavior Outcomes among People Living with HIV?

PubMed Central

Grodensky, Catherine; Golin, Carol; Parikh, Megha A.; Ochtera, Rebecca; Kincaid, Carlye; Groves, Jennifer; Widman, Laura; Suchindran, Chirayath; McGirt, Camille; Amola, Kemi; Bradley-Bull, Steven

2017-01-01

Objective Although past research has demonstrated a link between the quality of motivational interviewing (MI) counseling and client behavior change, this relationship has not been examined in the context of sexual risk behavior among people living with HIV/AIDS. We studied MI quality and unprotected anal/vaginal intercourse (UAVI) in the context of SafeTalk, an evidence-based secondary HIV prevention intervention. Methods We used a structured instrument (the MISC 2.0 coding system) as well as a client-reported instrument to rate intervention sessions on aspects of MI quality. Then we correlated client-reported UAVI with specific counseling behaviors and the proportion of interactions that achieved MI quality benchmarks. Results/Conclusion Higher MISC-2.0 global ratings and a higher ratio of reflections to questions both significantly predicted fewer UAVI acts at 8-month follow-up. Analysis of client ratings, which was more exploratory, showed that clients who rated their sessions higher in counselor acceptance, client disclosure, and relevance reported higher numbers of UAVIs, whereas clients who selected higher ratings for perceived benefit were more likely to have fewer UAVI episodes. Practice Implications Further research is needed to determine the best methods of translating information about MI quality into dissemination of effective MI interventions with people living with HIV. PMID:27567497

Feasibility of Providing Safe Mouth Care and Collecting Oral and Fecal Microbiome Samples from Nursing Home Residents with Dysphagia: Proof of Concept Study.

PubMed

Jablonski, Rita A; Winstead, Vicki; Azuero, Andres; Ptacek, Travis; Jones-Townsend, Corteza; Byrd, Elizabeth; Geisinger, Maria L; Morrow, Casey

2017-09-01

Individuals with dysphagia who reside in nursing homes often receive inadequate mouth care and experience poor oral health. From a policy perspective, the combination of absent evidence-based mouth care protocols coupled with insufficient dental coverage create a pool of individuals at great risk for preventable infectious illnesses that contribute to high health care costs. The purpose of the current study was to determine (a) the safety of a mouth care protocol tailored for individuals with dysphagia residing in nursing homes without access to suction equipment, and (b) the feasibility of collecting oral and fecal samples for microbiota analyses. The mouth care protocol resulted in improved oral hygiene without aspiration, and oral and fecal samples were safely collected from participants. Policies supporting ongoing testing of evidence-based mouth care protocols for individuals with dysphagia are important to improve quality, demonstrate efficacy, and save health care costs. [Journal of Gerontological Nursing, 43(9), 9-15.]. Copyright 2017, SLACK Incorporated.

Conceptual design of semi-automatic wheelbarrow to overcome ergonomics problems among palm oil plantation workers

NASA Astrophysics Data System (ADS)

Nawik, N. S. M.; Deros, B. M.; Rahman, M. N. A.; Sukadarin, E. H.; Nordin, N.; Tamrin, S. B. M.; Bakar, S. A.; Norzan, M. L.

2015-12-01

An ergonomics problem is one of the main issues faced by palm oil plantation workers especially during harvesting and collecting of fresh fruit bunches (FFB). Intensive manual handling and labor activities involved have been associated with high prevalence of musculoskeletal disorders (MSDs) among palm oil plantation workers. New and safe technology on machines and equipment in palm oil plantation are very important in order to help workers reduce risks and injuries while working. The aim of this research is to improve the design of a wheelbarrow, which is suitable for workers and a small size oil palm plantation. The wheelbarrow design was drawn using CATIA ergonomic features. The characteristic of ergonomics assessment is performed by comparing the existing design of wheelbarrow. Conceptual design was developed based on the problems that have been reported by workers. From the analysis of the problem, finally have resulting concept design the ergonomic quality of semi-automatic wheelbarrow with safe and suitable used for palm oil plantation workers.

Identification and prioritization of novel anti-Wolbachia chemotypes from screening a 10,000-compound diversity library

PubMed Central

Johnston, Kelly L.; Cook, Darren A. N.; Berry, Neil G.; David Hong, W.; Clare, Rachel H.; Goddard, Megan; Ford, Louise; Nixon, Gemma L.; O’Neill, Paul M.; Ward, Stephen A.; Taylor, Mark J.

2017-01-01

Lymphatic filariasis and onchocerciasis are two important neglected tropical diseases (NTDs) that cause severe disability. Control efforts are hindered by the lack of a safe macrofilaricidal drug. Targeting the Wolbachia bacterial endosymbionts in these parasites with doxycycline leads to a macrofilaricidal outcome, but protracted treatment regimens and contraindications restrict its widespread implementation. The Anti-Wolbachia consortium aims to develop improved anti-Wolbachia drugs to overcome these barriers. We describe the first screening of a large, diverse compound library against Wolbachia. This whole-organism screen, streamlined to reduce bottlenecks, produced a hit rate of 0.5%. Chemoinformatic analysis of the top 50 hits led to the identification of six structurally diverse chemotypes, the disclosure of which could offer interesting avenues of investigation to other researchers active in this field. An example of hit-to-lead optimization is described to further demonstrate the potential of developing these high-quality hit series as safe, efficacious, and selective anti-Wolbachia macrofilaricides. PMID:28959730

Cross-contamination of foods and implications for food allergic patients.

PubMed

Taylor, Steve L; Baumert, Joseph L

2010-07-01

Cross-contamination presents a risk of unknown magnitude for food allergic consumers. Published cases likely represent the tip of a rather large iceberg. Cross-contamination can occur in homes, restaurants, food manufacturing plants, and on farms. The frequency of cross-contamination as the cause of accidental exposures to allergenic foods is unknown. Food allergic individuals can react to ingestion of trace levels of the offending food, although a highly variable range of threshold doses exist among populations of food allergic individuals. The magnitude of the risk posed to food allergic consumers by cross-contamination is characterized by the frequency of exposure to cross-contaminated foods, the dose of exposure, and the individual's threshold dose. The food and food service industry (and food preparers in homes as well) have the responsibility to provide and prepare foods that are safe for food allergic consumers, but quality of life may be improved with the recognition that safe (though very low) thresholds do exist.

Return to sport after patellar dislocation or following surgery for patellofemoral instability.

PubMed

Ménétrey, Jacques; Putman, Sophie; Gard, Suzanne

2014-10-01

Patellofemoral instability may occur in a young population as a result of injury during sporting activities. This review focuses on return to sport after one episode of dislocation treated no operatively and as well after surgery for chronic patellofemoral instability. With or without surgery, only two-thirds of patients return to sports at the same level as prior to injury. A high-quality rehabilitation programme using specific exercises is the key for a safe return to sporting activities. To achieve this goal, recovery of muscle strength and dynamic stability of the lower limbs is crucial. The focus should be directed to strengthen the quadriceps muscle and pelvic stabilizers, as well as lateral trunk muscle training. Patient education and regularly performed home exercises are other key factors that can lead to a successful return to sports. The criteria for a safe return to sports include the absence of pain, no effusion, a complete range of motion, almost symmetrical strength, and excellent dynamic stability. Level of evidence IV.

Short-Term Safety and Efficacy of Calcium Montmorillonite Clay (UPSN) in Children

PubMed Central

Mitchell, Nicole J.; Kumi, Justice; Aleser, Mildred; Elmore, Sarah E.; Rychlik, Kristal A.; Zychowski, Katherine E.; Romoser, Amelia A.; Phillips, Timothy D.; Ankrah, Nii-Ayi

2014-01-01

Recently, an association between childhood growth stunting and aflatoxin (AF) exposure has been identified. In Ghana, homemade nutritional supplements often consist of AF-prone commodities. In this study, children were enrolled in a clinical intervention trial to determine the safety and efficacy of Uniform Particle Size NovaSil (UPSN), a refined calcium montmorillonite known to be safe in adults. Participants ingested 0.75 or 1.5 g UPSN or 1.5 g calcium carbonate placebo per day for 14 days. Hematological and serum biochemistry parameters in the UPSN groups were not significantly different from the placebo-controlled group. Importantly, there were no adverse events attributable to UPSN treatment. A significant reduction in urinary metabolite (AFM1) was observed in the high-dose group compared with placebo. Results indicate that UPSN is safe for children at doses up to 1.5 g/day for a period of 2 weeks and can reduce exposure to AFs, resulting in increased quality and efficacy of contaminated foods. PMID:25135766

Optimising patient safety when using elastomeric pumps to administer outpatient parenteral antibiotic therapy.

PubMed

Oliver, Gemma

2016-10-27

Outpatient parenteral antibiotic therapy (OPAT) is a growing area of practice that has numerous benefits for both patients and the healthcare system. In order for OPAT services to be successful, strategies need to be in place to maximise efficiency while providing safe, high-quality care. The use of elastomeric pumps to deliver intravenous (IV) antibiotics can have many benefits for OPAT services; they are cost-effective, easy to use and allow the patient to be fully ambulant. However, plans need to be put in place to make sure their use is safe and effective. This article discusses the use of elastomeric pumps by a UK-based OPAT team and the governance processes the team put in place to optimise patient safety when using elastomeric pumps to deliver IV antibiotics. Furthermore, with experience of using elastomeric pumps for more than 4 years the OPAT team was asked to evaluate an elastomeric pump new to the UK market: the Accufuser pump (Vygon (UK) Limited). By collecting data on its use it was found to be safe and easy to use. The team felt that the Accufuser pump ran to time in 96% of completed evaluations and considered it to be clinically acceptable in all responses.

People with Intellectual Disabilities Talk About Sexuality: Implications for the Development of Sex Education.

PubMed

Schaafsma, D; Kok, G; Stoffelen, J M T; Curfs, L M G

2017-01-01

Existing sex education programmes have failed in involving people with intellectual disabilities in the development of these programmes. Not involving the target population decreases the likelihood that the sex education programme will be effective. This study was conducted to assess the perspectives of people with intellectual disabilities on several sexuality-related topics. Semi-structured interviews were held with 20 people with intellectual disabilities covering topics such as: sex education, relationships, sex, social media, parenthood and support. The reported frequency of sex education the participants receive is low. Their knowledge regarding sex education is mainly limited to topics such as safe sex, contraception and STI's and tends to be superficial. Additionally, knowledge on safe sex does not always translate to safe sex behaviour. Finally, relationships are important for most participants; mainly because they don't want to be alone. Findings from both this study and literature shows that there seems to be a need for high quality sex education. Topics to consider to include are: online relationships, social media and parenthood. It would also be beneficial to focus on sexuality-related skills. Finally, to increase the effectiveness of a sex education programme, it is advisable that a theory-and evidence-based framework, such as Intervention Mapping, is used for its development.

77 FR 39987 - Arapaho and Roosevelt National Forests and Pawnee National Grassland; Boulder and Gilpin County...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-06

... expectations for a safe, quality, recreational experience by providing appropriate lifts, terrain, and guest... reliability of lift and terrain offerings; (2) address skier safety concerns during prevalent wind events; (3...; (4) provide new and upgraded lift infrastructure to improve the quality of the alpine ski experience...

33 CFR 96.130 - Incorporation by reference.

Code of Federal Regulations, 2010 CFR

2010-07-01

....130 Section 96.130 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY VESSEL OPERATING REGULATIONS RULES FOR THE SAFE OPERATION OF VESSELS AND SAFETY MANAGEMENT SYSTEMS General § 96.130... (ANSI)—11 West 42nd St., New York, NY 10036. ANSI/ASQC Q9001-1994, Quality Systems—Model for Quality...

76 FR 34799 - Permanent Dam Safety Modification at Cherokee, Fort Loudoun, Tellico, and Watts Bar Dams, TN

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-14

... notice is provided in accordance with the Council on Environmental Quality's regulations (40 CFR parts... interconnected, fabric-lined, sand-filled HESCO containers in order to safely pass predicted worst-case..., but will not necessarily be limited to, the potential impacts on water quality, aquatic and...

A Numerical Study for Groundwater Flow, Heat and Solute Transport Associated with Operation of Open-loop Geothermal System in Alluvial Aquifer

NASA Astrophysics Data System (ADS)

Park, D. K.; Bae, G. O.; Lee, K. K.

2014-12-01

The open-loop geothermal system directly uses a relatively stable temperature of groundwater for cooling and heating in buildings and thus has been known as an eco-friendly, energy-saving, and cost-efficient technique. The facility for this system was installed at a site located near Paldang-dam in Han-river, Korea. Because of the well-developed alluvium, the site might be appropriate to application of this system requiring extraction and injection of a large amount of groundwater. A simple numerical experiment assuming various hydrogeologic conditions demonstrated that regional groundwater flow direction was the most important factor for efficient operation of facility in this site having a highly permeable layer. However, a comparison of river stage data and groundwater level measurements showed that the daily and seasonal controls of water level at Paldang-dam have had a critical influence on the regional groundwater flow in the site. Moreover, nitrate concentrations measured in the monitoring wells gave indication of the effect of agricultural activities around the facility on the groundwater quality. The facility operation, such as extraction and injection of groundwater, will obviously affect transport of the agricultural contaminant and, maybe, it will even cause serious problems in the normal operation. Particularly, the high-permeable layer in this aquifer must be a preferential path for quick spreadings of thermal and contaminant plumes. The objective of this study was to find an efficient, safe and stable operation plan of the open-loop geothermal system installed in this site having the complicated conditions of highly permeable layer, variable regional groundwater flow, and agricultural contamination. Numerical simulations for groundwater flow, heat and solute transport were carried out to analyze all the changes in groundwater level and flow, temperature, and quality according to the operation, respectively. Results showed that an operation plan for only the thermal efficiency of system cannot be the best in aspect of safe and stable operation related to groundwater quality. All these results concluded that it is essential to understand various and site-specific conditions of the site in a more integrated approach for the successful application of the open-loop geothermal system.

Microbiological quality of ice and ice machines used in food establishments.

PubMed

Hampikyan, Hamparsun; Bingol, Enver Baris; Cetin, Omer; Colak, Hilal

2017-06-01

The ice used in the food industry has to be safe and the water used in ice production should have the quality of drinking water. The consumption of contaminated ice directly or indirectly may be a vehicle for transmission of pathogenic bacteria to humans producing outbreaks of gastrointestinal diseases. The objective of this study was to monitor the microbiological quality of ice, the water used in producing ice and the hygienic conditions of ice making machines in various food enterprises. Escherichia coli was detected in seven (6.7%) ice and 23 (21.9%) ice chest samples whereas E. coli was negative in all examined water samples. Psychrophilic bacteria were detected in 83 (79.0%) of 105 ice chest and in 68 (64.7%) of 105 ice samples, whereas Enterococci were detected only in 13 (12.4%) ice samples. Coliforms were detected in 13 (12.4%) water, 71 (67.6%) ice chest and 54 (51.4%) ice samples. In order to improve the microbiological quality of ice, the maintenance, cleaning and disinfecting of ice machines should be carried out effectively and periodically. Also, high quality water should be used for ice production.

Climbing therapy under PK-tailored prophylaxis.

PubMed

Stemberger, M; Schmit, E; Czepa, D; Kurnik, K; Spannagl, M

2014-01-01

Climbing has a low risk of injury and strengthens the entire musculature. Due to its benefits in physical and mental health as well as its high fun factor climbing is an established way of therapy. So far, the usefulness of climbing therapy has not been shown for people with haemophilia (PWH). A crucial requirement for physical activity in PWH is regular prophylaxis. As the patient's individual pharmacokinetic (PK) response varies significantly, PK-tailored prophylaxis may decrease bleeding frequency. We describe a man (age 25 years) with severe haemophilia A who took part in an 8.5-month weekly climbing program under PK-tailored prophylaxis. Bleeding frequency, factor consumption, joint health (Haemophilia Joint Health Score, HJHS), quality of life (Haemo-QoL-A) and climbing performance (UIAA scale) were assessed before and after the training. Prior to the study, the patient was on demand treatment. The patient was started on standard prophylaxis for a 2 months period and then observed for 6.5 months under PK-tailored prophylaxis. PK-tailored prophylaxis was targeted to a trough level of 1-3%. For high-impact activities a factor activity >15%, for low-impact activities a factor activity >5% was suggested. Climbing therapy was safe. The bleeding rate decreased from 14 (2012) to 1 (during the study period of 8.5 months). The one bleeding event was due to a missed infusion and was not triggered by physical activity. The elimination half-life using Bayesian statistics was determined to be 16h. Using this half-life for PK-tailored prophylaxis reduced the factor VIII consumption in comparison to standard prophylaxis. Joint health was particularly improved in the categories range of motion and swelling. Quality of life scores stayed at a high level. Climbing performance improved by 1 grade. The combination of PK-tailored prophylaxis with therapeutic climbing improved clinical outcome in this young adult with severe haemophilia. The tailored concept for high- and low-impact activities appeared to be safe.

Gradient and shim technologies for ultra high field MRI

PubMed Central

Winkler, Simone A.; Schmitt, Franz; Landes, Hermann; DeBever, Josh; Wade, Trevor; Alejski, Andrew

2017-01-01

Ultra High Field (UHF) MRI requires improved gradient and shim performance to fully realize the promised gains (SNR as well as spatial, spectral, diffusion resolution) that higher main magnetic fields offer. Both the more challenging UHF environment by itself, as well as the higher currents used in high performance coils, require a deeper understanding combined with sophisticated engineering modeling and construction, to optimize gradient and shim hardware for safe operation and for highest image quality. This review summarizes the basics of gradient and shim technologies, and outlines a number of UHF-related challenges and solutions. In particular, Lorentz forces, vibroacoustics, eddy currents, and peripheral nerve stimulation are discussed. Several promising UHF-relevant gradient concepts are described, including insertable gradient coils aimed at higher performance neuroimaging. PMID:27915120

Approach to design space from retrospective quality data.

PubMed

Puñal Peces, Daniel; García-Montoya, Encarna; Manich, Albert; Suñé-Negre, Josep Maria; Pérez-Lozano, Pilar; Miñarro, Montse; Ticó, Josep Ramon

2016-01-01

Nowadays, the entire manufacturing process is based on the current GMPs, which emphasize the reproducibility of the process, and companies have a lot of recorded data about their processes. The establishment of the design space (DS) from retrospective data for a wet compression process. A design of experiments (DoE) with historical data from 4 years of industrial production has been carried out using the experimental factors as the results of the previous risk analysis and eight key parameters (quality specifications) that encompassed process and quality control data. Software Statgraphics 5.0 was applied, and data were processed to obtain eight DS as well as their safe and working ranges. Experience shows that it is possible to determine DS retrospectively, being the greatest difficulty in handling and processing of high amounts of data; however, the practicality of this study is very interesting as it let have the DS with minimal investment in experiments since actual production batch data are processed statistically.

Improving Quality of Care for Seriously Ill Patients: Opportunities for Hospitalists.

PubMed

Fail, Robin E; Meier, Diane E

2018-03-01

As the shift to value-based payment accelerates, hospitals are under increasing pressure to deliver high-quality, efficient services. Palliative care approaches improve quality of life and family well-being, and in doing so, reduce resource utilization and costs. Hospitalists frequently provide palliative care interventions to their patients, including pain and symptom management and engaging in conversations with patients and families about the realities of their illness and treatment plans that align with their priorities. Hospitalists are ideally positioned to identify patients who could most benefit from palliative care approaches and often refer the most complex cases to specialty palliative care teams. Though hospitalists are frequently called upon to provide palliative care, most lack formal training in these skills, which have not typically been included in medical education. Additional training in communication, safe and effective symptom management, and other palliative care knowledge and skills are available in both in-person and online formats. © 2017 Society of Hospital Medicine.

Safe and effective nursing shift handover with NURSEPASS: An interrupted time series.

PubMed

Smeulers, Marian; Dolman, Christine D; Atema, Danielle; van Dieren, Susan; Maaskant, Jolanda M; Vermeulen, Hester

2016-11-01

Implementation of a locally developed evidence based nursing shift handover blueprint with a bedside-safety-check to determine the effect size on quality of handover. A mixed methods design with: (1) an interrupted time series analysis to determine the effect on handover quality in six domains; (2) descriptive statistics to analyze the intercepted discrepancies by the bedside-safety-check; (3) evaluation sessions to gather experiences with the new handover process. We observed a continued trend of improvement in handover quality and a significant improvement in two domains of handover: organization/efficiency and contents. The bedside-safety-check successfully identified discrepancies on drains, intravenous medications, bandages or general condition and was highly appreciated. Use of the nursing shift handover blueprint showed promising results on effectiveness as well as on feasibility and acceptability. However, to enable long term measurement on effectiveness, evaluation with large scale interrupted times series or statistical process control is needed. Copyright © 2016 Elsevier Inc. All rights reserved.

Legalized abortion: a public health success story.

PubMed

Kelly, M

1999-06-01

60% of more than 2000 women surveyed by the Picker Institute who underwent induced abortion procedures rated the quality of their care as excellent. Another third reported their care as being either very good or good. The survey also found that the quality of abortion care is comparable to other outpatient surgery. However, the high quality of care women receive from abortion providers is lost in the hostile anti-abortion climate created by threatening protesters outside of clinics and the murder of 7 clinic workers and physicians who performed abortions. Abortion opponents fail to acknowledge that legal abortion is a medical procedure which protects women's health and saves their lives. Before abortion was legalized in the US, countless women were either rendered unable to reproduce or died from abortion-related complications. Efforts to outlaw abortion persist despite it being widely recognized by medical experts as one of the most safe medical procedures currently performed in the US. When state legislatures target abortion providers with unduly strict regulations, abortion becomes prohibitively expensive and difficult to obtain.

Mechanical CPR: Who? When? How?

PubMed

Poole, Kurtis; Couper, Keith; Smyth, Michael A; Yeung, Joyce; Perkins, Gavin D

2018-05-29

In cardiac arrest, high quality cardiopulmonary resuscitation (CPR) is a key determinant of patient survival. However, delivery of effective chest compressions is often inconsistent, subject to fatigue and practically challenging.Mechanical CPR devices provide an automated way to deliver high-quality CPR. However, large randomised controlled trials of the routine use of mechanical devices in the out-of-hospital setting have found no evidence of improved patient outcome in patients treated with mechanical CPR, compared with manual CPR. The limited data on use during in-hospital cardiac arrest provides preliminary data supporting use of mechanical devices, but this needs to be robustly tested in randomised controlled trials.In situations where high-quality manual chest compressions cannot be safely delivered, the use of a mechanical device may be a reasonable clinical approach. Examples of such situations include ambulance transportation, primary percutaneous coronary intervention, as a bridge to extracorporeal CPR and to facilitate uncontrolled organ donation after circulatory death.The precise time point during a cardiac arrest at which to deploy a mechanical device is uncertain, particularly in patients presenting in a shockable rhythm. The deployment process requires interruptions in chest compression, which may be harmful if the pause is prolonged. It is recommended that use of mechanical devices should occur only in systems where quality assurance mechanisms are in place to monitor and manage pauses associated with deployment.In summary, mechanical CPR devices may provide a useful adjunct to standard treatment in specific situations, but current evidence does not support their routine use.

Virological diagnosis of Ebolavirus infection.

PubMed

Smith, D W; Rawlinson, W D; Kok, J; Dwyer, D E; Catton, M

2015-08-01

Ebolaviruses, and the other viral causes of haemorrhagic fevers (VHF) have always posed special problems for diagnostic laboratories. These arise from the rarity of human infections, minimal documented experience with test delivery and interpretation, the paucity of established commercial or in-house assays, the lack of clinical material for test development and validation, the high level containment required for handling live virus, the ongoing evolution of the viruses, and the high personal and public health requirements for accurate diagnosis. This article addresses the current situation and the ongoing challenges associated with delivering timely, high quality and safe testing within Australia for people exposed as part of the current major outbreak of Ebolavirus disease (EVD) in Western Africa. The members of the Public Health Laboratory Network have developed deliverable and reliable nucleic acid detection tests, and also have the laboratory capacity to handle the live viruses if necessary. However delivering and maintaining these services necessitates high levels of experience in developing and applying tests for exotic and emerging infections, strong national and international links and collaborations, ongoing monitoring and reassessment of test design and performance, innovative approaches to generation of positive control material, and a regular quality assurance program.

Cancer and Exercise: Warburg Hypothesis, Tumour Metabolism and High-Intensity Anaerobic Exercise.

PubMed

Hofmann, Peter

2018-01-31

There is ample evidence that regular moderate to vigorous aerobic physical activity is related to a reduced risk for various forms of cancer to suggest a causal relationship. Exercise is associated with positive changes in fitness, body composition, and physical functioning as well as in patient-reported outcomes such as fatigue, sleep quality, or health-related quality of life. Emerging evidence indicates that exercise may also be directly linked to the control of tumour biology through direct effects on tumour-intrinsic factors. Beside a multitude of effects of exercise on the human body, one underscored effect of exercise training is to target the specific metabolism of tumour cells, namely the Warburg-type highly glycolytic metabolism. Tumour metabolism as well as the tumour⁻host interaction may be selectively influenced by single bouts as well as regularly applied exercise, dependent on exercise intensity, duration, frequency and mode. High-intensity anaerobic exercise was shown to inhibit glycolysis and some studies in animals showed that effects on tumour growth might be stronger compared with moderate-intensity aerobic exercise. High-intensity exercise was shown to be safe in patients; however, it has to be applied carefully with an individualized prescription of exercise.

Virological diagnosis of Ebolavirus infection

PubMed Central

Smith, D. W.; Rawlinson, W. D.; Kok, J.; Dwyer, D. E.; Catton, M.

2015-01-01

Summary Ebolaviruses, and the other viral causes of haemorrhagic fevers (VHF) have always posed special problems for diagnostic laboratories. These arise from the rarity of human infections, minimal documented experience with test delivery and interpretation, the paucity of established commercial or in-house assays, the lack of clinical material for test development and validation, the high level containment required for handling live virus, the ongoing evolution of the viruses, and the high personal and public health requirements for accurate diagnosis. This article addresses the current situation and the ongoing challenges associated with delivering timely, high quality and safe testing within Australia for people exposed as part of the current major outbreak of Ebolavirus disease (EVD) in Western Africa. The members of the Public Health Laboratory Network have developed deliverable and reliable nucleic acid detection tests, and also have the laboratory capacity to handle the live viruses if necessary. However delivering and maintaining these services necessitates high levels of experience in developing and applying tests for exotic and emerging infections, strong national and international links and collaborations, ongoing monitoring and reassessment of test design and performance, innovative approaches to generation of positive control material, and a regular quality assurance program. PMID:26126050

Pelvic Floor Rehabilitation in the Treatment of Fecal Incontinence

PubMed Central

Scott, Kelly M.

2014-01-01

Fecal incontinence (FI) is a prevalent problem that can drastically affect quality of life. Pelvic floor rehabilitation is an important first-line treatment for patients with FI, and many published case reports and a small number of randomized controlled trials (RCTs) provide limited evidence for its efficacy. Pelvic floor rehabilitation approaches to the treatment of FI include pelvic floor muscle training, biofeedback, and volumetric training with rectal balloon catheters. Various forms of external electrical stimulation have also been described and may be of added benefit. Behavioral bowel retraining is an important part of a good rehabilitative approach as well. Pelvic floor rehabilitation treatment for FI is thought to be effective and safe, with reported success rates in a majority of studies at 50 to 80%. Many more high-quality RCTs are needed to define optimal treatment protocols. PMID:25320568

Water Under Fire: A Seven Part Video Series on Canada's Water

NASA Astrophysics Data System (ADS)

Mrazek, R.; Byrne, J.; Rabe, N.; Gallant, G.

2003-12-01

Canada's water is under escalating pressure from a host of threats. Increasingly, our water is being tainted, misused and over allocated. Experts have identified a multitude of threats to water quantity and quality. Among them, climate change impacts on water supply, and the effects of pesticides, pathogens, industrial waste, urban runoff, and rising demands. These and other threats are the roots to a serious shortage of high quality, safe water sources. In the 1990s, waterborne diseases have re-emerged as one of the primary health issues on a national and global scale. This seven-part video series brings science voices together and provides a nationwide context. The first six programs in the series explore regional concerns: Rocky Mountains, Prairie Waters, Northern Waters, Great Lakes Basin, St. Lawrence and Atlantic Canada. The final program covers the national and international perspectives.

Putting the 'care' back into aged care.

PubMed

Beadnell, Cathy

2006-04-01

Aged care is well and truly back on the political agenda in Australia. While the mainstream media has recently exposed a number of horrific cases of alleged abuse in aged care facilities it has done little to highlight the failings of social policy over time or to foster debate on how to improve the care of older Australians. What are the barriers to providing safe and quality aged care to a growing number of our citizens and how do we overcome them? If you relied on the recent media coverage for your impression of aged care you could be forgiven for thinking it is all bad news. But there are facilities providing high quality care and stories of nurses working wonders in the face of adversity. Cathy Beadnell considers some of the broader cultural and workforce issues in aged care.

Process and product development in the manufacturing of molecular therapeutics.

PubMed

Atkinson, E M; Christensen, J R

1999-08-01

In the development of molecular therapies, a great deal of attention has focused on tissue targets, gene delivery vectors, and expression cassettes. In order to become an approved therapy, however, a molecular therapeutic has to pass down the same product registration pathway as any other biological product. Moving from research into industrial production requires careful attention to regulatory, manufacturing and quality concerns. Early work on developing and characterizing robust and scaleable manufacturing processes will ultimately be rewarded by ease of implementation as the product is successful in clinical trials. Regulatory agencies require solid process and product characterization studies to demonstrate control and understanding of the molecular therapeutic. As the gene therapy industry matures, standards will continue to rise, creating an industry that is capable of producing safe, high-quality and effective therapies for many of the world's most difficult disease targets.

Connected health: cancer symptom and quality-of-life assessment using a tablet computer: a pilot study.

PubMed

Aktas, Aynur; Hullihen, Barbara; Shrotriya, Shiva; Thomas, Shirley; Walsh, Declan; Estfan, Bassam

2015-03-01

Incorporation of tablet computers (TCs) into patient assessment may facilitate safe and secure data collection. We evaluated the usefulness and acceptability of a TC as an electronic self-report symptom assessment instrument. Research Electronic Data Capture Web-based application supported data capture. Information was collected and disseminated in real time and a structured format. Completed questionnaires were printed and given to the physician before the patient visit. Most participants completed the survey without assistance. Completion rate was 100%. The median global quality of life was high for all. More than half reported pain. Based on Edmonton Symptom Assessment System, the top 3 most common symptoms were tiredness, anxiety, and decreased well-being. Patient and physician acceptability for these quick and useful TC-based surveys was excellent. © The Author(s) 2013.

Biocontrol strategies for Mediterranean-style fermented sausages.

PubMed

Oliveira, Márcia; Ferreira, Vânia; Magalhães, Rui; Teixeira, Paula

2018-01-01

Naturally fermented meat sausages have a long tradition in Mediterranean countries and are one of the most important groups of traditional foods consumed throughout Europe. Despite all the advances in food science and technology and increased regulatory requirements and concerns for safety and quality during the last decades, the challenge to control important foodborne pathogens in this type of meat products still persists. Simultaneously, growing consumer interest in safe, high quality and minimal processed products, with less additives/preservatives have driven the food industry and scientists in a crusade for innovative technologies to maintain the safety of these products by natural means. Biological control (biocontrol) fits well within this tendency. This review summarizes the latest achievements on biocontrol strategies applied to Mediterranean-style fermented sausages, namely: (i) bioprotective cultures; (ii) bacteriocins; and, (iii) essential oils (EOs). Copyright © 2017 Elsevier Ltd. All rights reserved.

Opening a door to safe abortion: international perspectives on medical abortifacient use.

PubMed

Pollack, A E; Pine, R N

2000-01-01

International experience compels us to revisit how we define and assess the safety and efficacy of medical abortifacients such as misoprostol. In some countries where safe abortion is neither accessible nor legal, even unsupervised, off-protocol use of misoprostol can provide women with a means to safely terminate pregnancy. This is due primarily to misoprostol-induced uterine contractions that cause bleeding, which in turn provides access to existing reasonable quality health services that would otherwise be unavailable. Several studies have suggested that an increase in the underground use of misoprostol in Brazil has already reduced serious complications from unsafe abortion. Thus, the availability of medical abortifacients combined with strengthened postabortion care services can legitimately be considered a public health success in countries in which safe abortion services do not exist and law reform is unlikely.

Risky business: human factors in critical care.

PubMed

Laussen, Peter C; Allan, Catherine K; Larovere, Joan M

2011-07-01

Remarkable achievements have occurred in pediatric cardiac critical care over the past two decades. The specialty has become well defined and extremely resource intense. A great deal of focus has been centered on optimizing patient outcomes, particularly mortality and early morbidity, and this has been achieved through a focused and multidisciplinary approach to management. Delivering high-quality and safe care is our goal, and during the Risky Business symposium and simulation sessions at the Eighth International Conference of the Pediatric Cardiac Intensive Care Society in Miami, December 2010, human factors, systems analysis, team training, and lessons learned from malpractice claims were presented.

Clinically lean; "cutting the crap".

PubMed

Caldwell, G

2012-01-01

Proponents of Lean Philosophy believe that successful businesses must reduce waste in working time and resources to a minimum, and maximise their use in productive work. The productive work of the Acute Medical Unit is to provide effective clinical management to a daily cohort of acutely ill patients. Many Clinicians are cynical about Lean. In this article, Dr Caldwell discusses how many clinicians complain of too much crap in the workplace, which gets in the way of swift, safe high quality clinical care. He argues that "Cutting the Crap" in the Acute Medical Unit is entirely consistent with Lean approaches to management of complex systems.

Crisis? What crisis?

PubMed

Sherrat, Lou; Chambers, Derek

The fact that 50% of the 4600 hours that constitute a pre-registration nursing programme takes place in the practice setting, means that there is considerable reliance on mentors and other clinicians to support and teach students. Clinical experience is vital if student nurses are to implement the theory they have learnt in the classroom and become competent and safe practitioners (Panther, 2008). There is, therefore, a need for high-quality clinical learning environments which both provide students with the support they need and measure their clinical competence. Mentors play a vital role in both these aspects and are the fulcrum on which practice learning depends (Pellatt, 2006).

Building and Maintaining Organizational Infrastructure to Attain Clinical Excellence.

PubMed

Lebak, Kelly; Lane, Jason; Taus, Richard; Kim, Hansol; Stecker, Michael S; Hall, Michael; Lane-Fall, Meghan B; Weiss, Mark S

2017-12-01

Active maintenance of highly functional teams is critical to ensuring safe, efficient patient care in the non-operating room anesthesia (NORA) suite. In addition to developing collaborative relationships and patient care protocols, individual and team training is needed. For anesthesiologists, this training must begin during residency. The training should be supplemented with continuing education in this field for providers who find themselves working in the NORA space. As NORA continues to grow, robust NORA-specific quality assurance and improvement programs will empower anesthesiologists with the tools they need to best care for these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Safe and Affordable Drinking Water for Developing Countries

NASA Astrophysics Data System (ADS)

Gadgil, Ashok

2008-09-01

Safe drinking water remains inaccessible for about 1.2 billion people in the world, and the hourly toll from biological contamination of drinking water is 200 deaths mostly among children under five years of age. This chapter summarizes the need for safe drinking water, the scale of the global problem, and various methods tried to address it. Then it gives the history and current status of an innovation ("UV Waterworks™") developed to address this major public health challenge. It reviews water disinfection technologies applicable to achieve the desired quality of drinking water in developing countries, and specifically, the limitations overcome by one particular invention: UV Waterworks. It then briefly describes the business model and financing option than is accelerating its implementation for affordable access to safe drinking water to the unserved populations in these countries. Thus this chapter describes not only the innovation in design of a UV water disinfection system, but also innovation in the delivery model for safe drinking water, with potential for long term growth and sustainability.

21 CFR 110.80 - Processes and controls.

Code of Federal Regulations, 2011 CFR

2011-04-01

... safe and of adequate sanitary quality. (12) Batters, breading, sauces, gravies, dressings, and other...) Cooling to an adequate temperature during manufacturing. (vi) Disposing of batters at appropriate...

Numerical Simulation of Non-Thermal Food Preservation

NASA Astrophysics Data System (ADS)

Rauh, C.; Krauss, J.; Ertunc, Ö.; Delgado, a.

2010-09-01

Food preservation is an important process step in food technology regarding product safety and product quality. Novel preservation techniques are currently developed, that aim at improved sensory and nutritional value but comparable safety than in conventional thermal preservation techniques. These novel non-thermal food preservation techniques are based for example on high pressures up to one GPa or pulsed electric fields. in literature studies the high potential of high pressures (HP) and of pulsed electric fields (PEF) is shown due to their high retention of valuable food components as vitamins and flavour and selective inactivation of spoiling enzymes and microorganisms. for the design of preservation processes based on the non-thermal techniques it is crucial to predict the effect of high pressure and pulsed electric fields on the food components and on the spoiling enzymes and microorganisms locally and time-dependent in the treated product. Homogenous process conditions (especially of temperature fields in HP and PEF processing and of electric fields in PEF) are aimed at to avoid the need of over-processing and the connected quality loss and to minimize safety risks due to under-processing. the present contribution presents numerical simulations of thermofluiddynamical phenomena inside of high pressure autoclaves and pulsed electric field treatment chambers. in PEF processing additionally the electric fields are considered. Implementing kinetics of occurring (bio-) chemical reactions in the numerical simulations of the temperature, flow and electric fields enables the evaluation of the process homogeneity and efficiency connected to different process parameters of the preservation techniques. Suggestions to achieve safe and high quality products are concluded out of the numerical results.

77 FR 45471 - White House Initiative on Educational Excellence for African Americans

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-01

... safe and healthy environments, and have access to high-level, rigorous course work and support services...-rounded education in safe and healthy environments, as well as access to support services, which will... system. African Americans lack equal access to highly effective teachers and principals, safe schools...

Evaluation of bank filtration as a pretreatment method for the provision of hygienically safe drinking water in Norway: results from monitoring at two full-scale sites

NASA Astrophysics Data System (ADS)

Kvitsand, Hanne M. L.; Myrmel, Mette; Fiksdal, Liv; Østerhus, Stein W.

2017-08-01

Two case studies were carried out in central Norway in order to assess the performance of bank filtration systems in cold-climate fluvial aquifers relying on recharge from humic-rich surface waters with moderate microbial contamination. Three municipal wells and two surface-water sources at operative bank filtration systems were monitored for naturally occurring bacteriophages, fecal indicators, natural organic matter (NOM) and physico-chemical water quality parameters during a 4-month period. Aquifer passage effectively reduced the microorganism and NOM concentrations at both study sites. Bacteriophages were detected in 13 of 16 (81%) surface-water samples and in 4 of 24 (17%) well-water samples, and underwent 3 ± 0.3 log10 reduction after 50-80-m filtration and 20-30 days of subsurface passage. NOM reductions (color: 74-97%; dissolved organic carbon: 54-80%; very hydrophobic acids: 70%) were similar to those achieved by conventional water-treatment processes and no further treatment was needed. Both groundwater dilution and sediment filtration contributed to the hygienic water quality improvements, but sediment filtration appeared to be the most important process with regard to microbial and NOM reductions. A strengths-weaknesses-opportunities-threats analysis showed that bank filtration technology has a high potential as a pretreatment method for the provision of hygienically safe drinking water in Norway.

Assessment of bacteriological quality of drinking water from various sources in Amritsar district of northern India.

PubMed

Malhotra, Sita; Sidhu, Shailpreet K; Devi, Pushpa

2015-08-29

Safe water is a precondition for health and development and is a basic human right, yet it is still denied to hundreds of millions of people throughout the developing world. Water-related diseases caused by insufficient safe water supplies, coupled with poor sanitation and hygiene, cause 3.4 million deaths a year, mostly in children. The present study was conducted on 1,317 drinking water samples from various water sources in Amritsar district in northern India. All the samples were analyzed to assess bacteriological quality of water for presumptive coliform count by the multiple tube test. A total of 42.9% (565/1,317) samples from various sources were found to be unfit for human consumption. Of the total 565 unsatisfactory samples, 253 were from submersible pumps, 197 were from taps of piped supply (domestic/public), 79 were from hand pumps, and 36 were from various other sources A significantly high level of contamination was observed in samples collected from submersible pumps (47.6%) and water tanks (47.3%), as these sources of water are more exposed and liable to contamination. Despite continuous efforts by the government, civil society, and the international community, over a billion people still do not have access to improved water resources. Bacteriological assessment of all sources of drinking should be planned and conducted on regular basis to prevent waterborne dissemination of diseases.

Quality Control of Pharmaceuticals

PubMed Central

Levi, Leo; Walker, George C.; Pugsley, L. I.

1964-01-01

Quality control is an essential operation of the pharmaceutical industry. Drugs must be marketed as safe and therapeutically active formulations whose performance is consistent and predictable. New and better medicinal agents are being produced at an accelerated rate. At the same time more exacting and sophisticated analytical methods are being developed for their evaluation. Requirements governing the quality control of pharmaceuticals in accordance with the Canadian Food and Drugs Act are cited and discussed. PMID:14199105

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

2016-01-01

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. © Georg Thieme Verlag KG Stuttgart · New York.

Integrating quality and safety education into clinical nursing education through a dedicated education unit.

PubMed

Masters, Kelli

2016-03-01

The Institute of Medicine and American Association of Colleges of Nursing are calling for curriculum redesign that prepares nursing students with the requisite knowledge and skills to provide safe, high quality care. The purpose of this project was to improve nursing students' knowledge of quality and safety by integrating Quality and Safety Education for Nurses into clinical nursing education through development of a dedicated education unit. This model, which pairs nursing students with front-line nursing staff for clinical experiences, was implemented on a medical floor in an acute care hospital. Prior to implementation, nurses and students were educated about the dedicated education unit and quality and safety competencies. During each clinical rotation, students collaborated with their nurses on projects related to these competencies. Students' knowledge was assessed using questions related to quality and safety. Students who participated in the dedicated education unit had higher scores than those with traditional clinical rotations. Focus groups were held mid-semester to assess nurses' perceptions of the experience. Five themes emerged from the qualitative data including thirsting for knowledge, building teamwork and collaboration, establishing trust and decreasing anxiety, mirroring organization and time management skills, and evolving confidence in the nursing role. Copyright © 2015 Elsevier Ltd. All rights reserved.

Options of sustainable groundwater supply from safe aquifers in areas with elevated arsenic - a case study from Bangladesh

NASA Astrophysics Data System (ADS)

Jakariya, M.; Bhattacharya, P.; Bromssen, M. V.

2008-05-01

Access to safe drinking water is a basic human right. Several millions of people, mainly in developing countries are affected by arsenic in drinking water and the global impact now makes it a top priority water quality issue. A wide gap between the number of exposed people and the pace of mitigation programmes in rural areas of developing countries is the main problem in providing safe drinking water. The main challenge is to develop a sustainable mitigation option that rural and disadvantaged people can adopt and implement themselves to overcome possible public heath hazards. During the recent years, new approaches have emerged in Bangladesh, primarily emerging out of people's own initiative. The local drillers target presumed safe aquifers on the basis of colour and texture of the sediments. A recent study by our research group revealed a distinct correlation between the colour characteristics of the sediments and the groundwater redox conditions. The coupling between the colour of sediments and the redox characteristics of groundwater may thus be used as a tool to assess the risk for As mobilization from the aquifers. The study showed that it is possible to assess the relative risk of high concentrations of As in aquifers if the colour characteristics of the sediments are known and thus, local drillers may target safe aquifers. For validating the sustainability of this mitigation option geological, hydrogeological and microbiological investigations are needed. The sustainability of the aquifers needs to be assessed by combining results from various field and laboratory investigations and by running predictive models. There is also a need to raise the awareness and thereby create a platform for motivating the local drillers to be educated in installing safe tubewells. Awareness raising and community mobilisation are two top priorities for implementing a sustainable safe water project in rural village areas. Significant preparation, attention, and focus must be given to the human resource development stage of any project implementation. Local drillers need to be trained on how to handle and disseminate the invented method of installing safe tube wells. Capacity of the local level stakeholders and end users must be improved by providing training and conducting awareness campaigns. Based on the experiences and multidisciplinary research, Water Safety Plans needs to be formulated as well as adopted for long term monitoring and management of implemented mitigation options.

Endoscopic Endonasal Transclival Approach to the Ventral Brainstem: Anatomic Study of the Safe Entry Zones Combining Fiber Dissection Technique with 7 Tesla Magnetic Resonance Guided Neuronavigation.

PubMed

Weiss, Alessandro; Perrini, Paolo; De Notaris, Matteo; Soria, Guadalupe; Carlos, Alarcon; Castagna, Maura; Lutzemberger, Lodovico; Santonocito, Orazio Santo; Catapano, Giuseppe; Kassam, Amin; Galino, Alberto Prats

2018-05-10

Treatment of intrinsic lesions of the ventral brainstem is a surgical challenge that requires complex skull base antero- and posterolateral approaches. More recently, endoscopic endonasal transclival approach (EETA) has been reported in the treatment of selected ventral brainstem lesions. In this study we explored the endoscopic ventral brainstem anatomy with the aim to describe the degree of exposure of the ventral safe entry zones. In addition, we used a newly developed method combining traditional white matter dissection with high-resolution 7T magnetic resonance imaging (MRI) of the same specimen coregistered using a neuronavigation system. Eight fresh-frozen latex-injected cadaver heads underwent EETA. Additional 8 formalin-fixed brainstems were dissected using Klingler technique guided by ultra-high resolution MRI. The EETA allows a wide exposure of different safe entry zones located on the ventral brainstem: the exposure of perioculomotor zone requires pituitary transposition and can be hindered by superior cerebellar artery. The peritrigeminal zone was barely visible and its exposure required an extradural anterior petrosectomy. The anterolateral sulcus of the medulla was visible in most of specimens, although its close relationship with the corticospinal tract makes it suboptimal as an entry point for intrinsic lesions. In all cases, the use of 7T-MRI allowed the identification of tiny fiber bundles, improving the quality of the dissection. Exposure of the ventral brainstem with EETA requires mastering surgical maneuvers, including pituitary transposition and extradural petrosectomy. The correlation of fiber dissection with 7T-MRI neuronavigation significantly improves the understanding of the brainstem anatomy.

Much potential but many unanswered questions for high-intensity intermittent exercise training for patients with heart failure.

PubMed

Pinkstaff, Sherry O

2015-01-01

There is a robust trove of scientific studies that support the positive physical and mental health benefits associated with aerobic exercise for healthy individuals. These recommendations suggest that more vigorous exercise can be performed on fewer days for the same benefit. High-intensity intermittent exercise (HIIE) training has begun to show promise. HIIE seems safe and improves physiology, quality of life, and functional capacity. This review defines HIIE, discusses its physiologic benefit for patients with heart failure, outlines the studies that have been conducted to date, and places it in the context of the current clinical environment of exercise training for these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial.

PubMed

Moon, Rachel Y; Hauck, Fern R; Colson, Eve R; Kellams, Ann L; Geller, Nicole L; Heeren, Timothy; Kerr, Stephen M; Drake, Emily E; Tanabe, Kawai; McClain, Mary; Corwin, Michael J

2017-07-25

Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4% [95% CI, 9.3%-15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8% [95% CI, 8.1%-15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7% [95% CI, 3.9%-13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position. Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied. clinicaltrials.gov Identifier: NCT01713868.

40 CFR 131.8 - Requirements for Indian Tribes to administer a water quality standards program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the Tribe has previously qualified for eligibility or “treatment as a state” under a Clean Water Act or Safe Drinking Water Act program, the Tribe need only provide the required information which has... for Indian Tribes to administer a water quality standards program. (a) The Regional Administrator, as...

40 CFR 131.8 - Requirements for Indian Tribes to administer a water quality standards program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... the Tribe has previously qualified for eligibility or “treatment as a state” under a Clean Water Act or Safe Drinking Water Act program, the Tribe need only provide the required information which has... for Indian Tribes to administer a water quality standards program. (a) The Regional Administrator, as...

40 CFR 131.8 - Requirements for Indian Tribes to administer a water quality standards program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... the Tribe has previously qualified for eligibility or “treatment as a state” under a Clean Water Act or Safe Drinking Water Act program, the Tribe need only provide the required information which has... for Indian Tribes to administer a water quality standards program. (a) The Regional Administrator, as...

Aerosolized intranasal midazolam for safe and effective sedation for quality computed tomography imaging in infants and children.

PubMed

Mekitarian Filho, Eduardo; de Carvalho, Werther Brunow; Gilio, Alfredo Elias; Robinson, Fay; Mason, Keira P

2013-10-01

This pilot study introduces the aerosolized route for midazolam as an option for infant and pediatric sedation for computed tomography imaging. This technique produced predictable and effective sedation for quality computed tomography imaging studies with minimal artifact and no significant adverse events. Copyright © 2013 Mosby, Inc. All rights reserved.

Learner's Guide: Water Quality Monitoring. An Instructional Guide for the Two-Year Water Quality Monitoring Curriculum.

ERIC Educational Resources Information Center

Glazer, Richard B.; And Others

This learner's guide is designed to meet the training needs for technicians involved in monitoring activities related to the Federal Water Pollution Act and the Safe Drinking Water Act. In addition it will assist technicians in learning how to perform process control laboratory procedures for drinking water and wastewater treatment plant…

Place-Based Social Network Quality and Correlates of Substance Use among Urban Adolescents

ERIC Educational Resources Information Center

Mason, Michael J.; Valente, Thomas W.; Coatsworth, J. Douglas; Mennis, Jeremy; Lawrence, Frank; Zelenak, Patricia

2010-01-01

A sample of 301 Philadelphia adolescents were assessed for substance use and place-based social network quality, a weighted variable based upon risky and protective behaviors of alters. The network measure was anchored in routine locations identified as safe, risky, important, or favorite. Results show young females' (13-16) substance use was…

Safe and effective error rate monitors for SS7 signaling links

NASA Astrophysics Data System (ADS)

Schmidt, Douglas C.

1994-04-01

This paper describes SS7 error monitor characteristics, discusses the existing SUERM (Signal Unit Error Rate Monitor), and develops the recently proposed EIM (Error Interval Monitor) for higher speed SS7 links. A SS7 error monitor is considered safe if it ensures acceptable link quality and is considered effective if it is tolerant to short-term phenomena. Formal criteria for safe and effective error monitors are formulated in this paper. This paper develops models of changeover transients, the unstable component of queue length resulting from errors. These models are in the form of recursive digital filters. Time is divided into sequential intervals. The filter's input is the number of errors which have occurred in each interval. The output is the corresponding change in transmit queue length. Engineered EIM's are constructed by comparing an estimated changeover transient with a threshold T using a transient model modified to enforce SS7 standards. When this estimate exceeds T, a changeover will be initiated and the link will be removed from service. EIM's can be differentiated from SUERM by the fact that EIM's monitor errors over an interval while SUERM's count errored messages. EIM's offer several advantages over SUERM's, including the fact that they are safe and effective, impose uniform standards in link quality, are easily implemented, and make minimal use of real-time resources.

Separation of pigment formulations by high-performance thin-layer chromatography with automated multiple development.

PubMed

Stiefel, Constanze; Dietzel, Sylvia; Endress, Marc; Morlock, Gertrud E

2016-09-02

Food packaging is designed to provide sufficient protection for the respective filling, legally binding information for the consumers like nutritional facts or filling information, and an attractive appearance to promote the sale. For quality and safety of the package, a regular quality control of the used printing materials is necessary to get consistently good print results, to avoid migration of undesired ink components into the food and to identify potentially faulty ink batches. Analytical approaches, however, have hardly been considered for quality assurance so far due to the lack of robust, suitable methods for the analysis of rarely soluble pigment formulations. Thus, a simple and generic high-performance thin-layer chromatography (HPTLC) method for the separation of different colored pigment formulations was developed on HPTLC plates silica gel 60 by automated multiple development. The gradient system provided a sharp resolution for differently soluble pigment constituents like additives and coating materials. The results of multi-detection allowed a first assignment of the differently detectable bands to particular chemical substance classes (e.g., lipophilic components), enabled the comparison of different commercially available pigment batches and revealed substantial variations in the composition of the batches. Hyphenation of HPTLC with high resolution mass spectrometry and infrared spectroscopy allowed the characterization of single unknown pigment constituents, which may partly be responsible for known quality problems during printing. The newly developed, precise and selective HPTLC method can be used as part of routine quality control for both, incoming pigment batches and monitoring of internal pigment production processes, to secure a consistent pigment composition resulting in consistent ink quality, a faultless print image and safe products. Hyphenation of HPTLC with the A. fischeri bioassay gave first information on the bioactivity or rather on the toxicological potential of different compounds of the pigment formulations. The results of the bioassay might be helpful to choose pigment compositions that provide both, a high printing quality but at the same time guarantee a high consumer safety, especially in regard to smaller pigment components, which tend to migrate through the packaging. Copyright © 2016 Elsevier B.V. All rights reserved.

Raman Spectroscopy for In-Line Water Quality Monitoring — Instrumentation and Potential

PubMed Central

Li, Zhiyun; Deen, M. Jamal; Kumar, Shiva; Selvaganapathy, P. Ravi

2014-01-01

Worldwide, the access to safe drinking water is a huge problem. In fact, the number of persons without safe drinking water is increasing, even though it is an essential ingredient for human health and development. The enormity of the problem also makes it a critical environmental and public health issue. Therefore, there is a critical need for easy-to-use, compact and sensitive techniques for water quality monitoring. Raman spectroscopy has been a very powerful technique to characterize chemical composition and has been applied to many areas, including chemistry, food, material science or pharmaceuticals. The development of advanced Raman techniques and improvements in instrumentation, has significantly improved the performance of modern Raman spectrometers so that it can now be used for detection of low concentrations of chemicals such as in-line monitoring of chemical and pharmaceutical contaminants in water. This paper briefly introduces the fundamentals of Raman spectroscopy, reviews the development of Raman instrumentations and discusses advanced and potential Raman techniques for in-line water quality monitoring. PMID:25230309

Away-from-home drinking water consumption practices and the microbiological quality of water consumed in rural western Kenya.

PubMed

Onyango-Ouma, W; Gerba, Charles P

2011-12-01

A cross-sectional descriptive study was conducted to examine away-from-home drinking water consumption practices and the microbiological quality of water consumed in rural western Kenya. The study involved adults and schoolchildren. Data were collected using focus group discussions, questionnaire survey, observations, diaries and interviews. The findings suggest that away-from-home drinking water consumption is a common practice in the study area; however, the microbiological quality of the water consumed is poor. While some respondents perceive the water to be safe for drinking mainly because of the clear colour of the water, others are forced by circumstances to drink the water as it is owing to a lack of alternative safe sources. It is concluded that there is a need for new innovative approaches to address away-from-home drinking water consumption in resource-poor settings in order to complement and maximize the benefits of point-of-use water treatment at the household level.

Raman spectroscopy for in-line water quality monitoring--instrumentation and potential.

PubMed

Li, Zhiyun; Deen, M Jamal; Kumar, Shiva; Selvaganapathy, P Ravi

2014-09-16

Worldwide, the access to safe drinking water is a huge problem. In fact, the number of persons without safe drinking water is increasing, even though it is an essential ingredient for human health and development. The enormity of the problem also makes it a critical environmental and public health issue. Therefore, there is a critical need for easy-to-use, compact and sensitive techniques for water quality monitoring. Raman spectroscopy has been a very powerful technique to characterize chemical composition and has been applied to many areas, including chemistry, food, material science or pharmaceuticals. The development of advanced Raman techniques and improvements in instrumentation, has significantly improved the performance of modern Raman spectrometers so that it can now be used for detection of low concentrations of chemicals such as in-line monitoring of chemical and pharmaceutical contaminants in water. This paper briefly introduces the fundamentals of Raman spectroscopy, reviews the development of Raman instrumentations and discusses advanced and potential Raman techniques for in-line water quality monitoring.

High-Protein Diets: Are They Safe?

MedlinePlus

Healthy Lifestyle Nutrition and healthy eating Are high-protein diets safe for weight loss? Answers from Katherine Zeratsky, R.D., L.D. For most healthy people, a high-protein diet generally isn't ...

Synthetic Augmented Suture Anchor Reconstruction for a Complete Traumatic Distal Triceps Tendon Rupture in a Male Professional Bodybuilder with Postoperative Biomechanical Assessment

PubMed Central

Nikolaidou, Maria-Elissavet; Banke, Ingo J.; Laios, Thomas; Petsogiannis, Konstantinos; Mourikis, Anastasios

2014-01-01

Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the “off-season” and “precompetition” phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports. PMID:24711944

The Trouble with Color.

ERIC Educational Resources Information Center

Merchant, David

1999-01-01

Discusses problems with color quality in Web sites. Topics include differences in monitor settings, including contrast; amount of video RAM; user preference settings; browser-safe colors; cross-platform readability; and gamma values. (LRW)

National Weather Service

MedlinePlus

... Data SAFETY Floods Tsunami Beach Hazards Wildfire Cold Tornadoes Fog Air Quality Heat Hurricanes Lightning Safe Boating ... Winter Weather Forecasts River Flooding Latest Warnings Thunderstorm/Tornado Outlook Hurricanes Fire Weather Outlooks UV Alerts Drought ...

Annual Reports

EPA Pesticide Factsheets

tools,data, and models that are: improving air quality; helping communities become more resilient; reducing emissions of carbon and other pollutants; ushering in new generations of safer, more sustainable chemicals, advancing safe drinking water resources

Aquatic Life Criteria - Lead

EPA Pesticide Factsheets

References and documents pertaining to Acute and Chronic Ambient Aquatic Life Water Quality Criteria for Lead. These documents include the safe levels of Lead in water that should protect the majority of species.

Development and Validation of a High-Pressure Liquid Chromatography Method for the Determination of Chemical Purity and Radiochemical Purity of a [68Ga]-Labeled Glu-Urea-Lys(Ahx)-HBED-CC (Positron Emission Tomography) Tracer

PubMed Central

2017-01-01

Background: Prostate-specific membrane antigen (PSMA) has gained high attention as a useful biomarker in the imaging evaluation of prostate cancer with positron emission tomography (PET) during recent years. [68Ga]-labeled Glu-urea-Lys(Ahx)-HBED-CC ([68Ga]-PSMA-HBED-CC) is a novel PSMA inhibitor radiotracer which has demonstrated its suitability in detecting prostate cancer. Preparation conditions may influence the quality and in vivo behavior of this tracer, and no standard procedure for the quality control (QC) is available. The aim of this study was to develop a new rapid and simple high-pressure liquid chromatography method of analysis for the routine QCs of [68Ga]-PSMA-HBED-CC to guarantee the high quality of the radiopharmaceutical product before release. Methods: A stepwise approach was used based on the quality by design concept of the International Conference of Harmonisation Q2 (R1) and Q8 (Pharmaceutical Development) guidelines in accordance with the regulations and requirements of European Association of Nuclear Medicine, Society of Nuclear Medicine, International Atomic Energy Agency, World Health Organization, and Italian Association of Nuclear Medicine and Molecular Imaging. The developed analytical test method was validated because a specific monograph in the pharmacopoeia is not available for [68Ga]-PSMA-HBED-CC. Results: The purity and quality of the radiopharmaceutical obtained according to the proposed method resulted high enough to safely administrate it to patients. An excellent linearity was found between 0.8 and 5 μg/mL, with a detection limit of 0.2 μg/mL. Assay imprecision (% CV) was <2%. Conclusions: The developed method to assess the radiochemical and chemical purity of [68Ga]-PSMA-HBED-CC is rapid, accurate, and reproducible, allowing routinely the use of this PET tracer as a diagnostic tool for imaging prostate cancer and also assuring patient safety. PMID:29520394

The Effect of Aroma Hand Massage Therapy for People with Dementia.

PubMed

Yoshiyama, Kazuyo; Arita, Hideko; Suzuki, Jinichi

2015-12-01

Clinical aromatherapy is a complementary therapy that may be very helpful for elderly dementia care. Aromatherapy may reduce the behavioral and psychological symptoms of dementia (BPSD), improve quality of care, and thus improve the quality of life for people with dementia. In this pilot study, aroma hand massage therapy was used for elderly patients in a medical institution in Japan. The study assessed the effectiveness and safety of clinical aromatherapy as part of routine integrative care among people with dementia in a clinical care setting. The randomized, crossover pilot trials were performed among 14 patients with mild-to-moderate dementia older than age 65 years living in a nursing home in Nara, Japan. Participants were divided into two groups and offered, alternately, control therapy and clinical aromatherapy 3 times a week for the 4-week trials. The effects on BPSD and activities of daily living (ADLs) were evaluated quantitatively before and after the study and 4 weeks after the study ended as a follow-up. Observation records were also collected to obtain qualitative data. The quantitative data showed that neither therapy significantly improved the BPSD or ADL results. The qualitative data were classified into four main categories-mood, behavior, verbal communication, and nonverbal communication-reflecting the positive experiences of participants during both therapies. No harmful reactions or changes in medication occurred during the study. This pilot study demonstrated that clinical aromatherapy was clinically safe but did not lead to statistically significant improvements in BPSD or ADL among people with dementia. Further research on therapeutic effects is needed to develop high-quality care with clinical aromatherapy for elderly patients with dementia in Japan and to fully establish evidence for effective and safe practice in health care institutions.

Clinical Management of Staphylococcus aureus Bacteremia

PubMed Central

Holland, Thomas L.; Arnold, Christopher; Fowler, Vance G.

2014-01-01

Importance Several management strategies may improve outcomes in patients with Staphylococcus aureus bacteremia (SAB). The strength of evidence supporting these management strategies, however, varies widely. Objective To perform a systematic review of the evidence for two unresolved questions involving management strategies for SAB: 1) is transesophageal echocardiography (TEE) necessary in all cases of SAB; and 2) what is the optimal antibiotic therapy for methicillin resistant Staphylococcus aureus (MRSA) bacteremia? Evidence acquisition A PubMed search from inception through May 2014 was performed to find studies that addressed the role of TEE in SAB. A second search of PubMed, EMBASE, and The Cochrane Library from 1/1/1990 to 5/28/2014 was performed to find studies that addressed antibiotic treatment of MRSA bacteremia. Studies that reported outcomes of systemic antibiotic therapy for MRSA bacteremia were included. All searches were augmented by review of bibliographic references from included studies. The quality of evidence was assessed using the GRADE system by consensus of independent evaluations by at least two authors. Results In 9 studies with a total of 3513 patients, use of TEE was associated with higher rates of diagnosis of endocarditis (14–25%) when compared with TTE (2–14%). Five studies proposed criteria to identify patients in whom TEE might safely be avoided. Only one high-quality trial of antibiotic therapy for MRSA bacteremia was identified from the 83 studies considered. Conclusions and relevance Most contemporary management strategies for SAB are based upon low quality evidence. TEE is indicated in most patients with SAB. It may be possible to identify a subset of SAB patients for whom TEE can be safely avoided. Vancomycin and daptomycin are the first-line antibiotic choices for MRSA bacteremia. Well-designed studies to address the management of SAB are desperately needed. PMID:25268440

Exploring global recognition of quality midwifery education: Vision or fiction?

PubMed

Luyben, Ans; Barger, Mary; Avery, Melissa; Bharj, Kuldip Kaur; O'Connell, Rhona; Fleming, Valerie; Thompson, Joyce; Sherratt, Della

2017-06-01

Midwifery education is the foundation for preparing competent midwives to provide a high standard of safe, evidence-based care for women and their newborns. Global competencies and standards for midwifery education have been defined as benchmarks for establishing quality midwifery education and practice worldwide. However, wide variations in type and nature of midwifery education programs exist. To explore and discuss the opportunities and challenges of a global quality assurance process as a strategy to promote quality midwifery education. Accreditation and recognition as two examples of quality assurance processes in education are discussed. A global recognition process, with its opportunities and challenges, is explored from the perspective of four illustrative case studies from Ireland, Kosovo, Latin America and Bangladesh. The discussion highlights that the establishment of a global recognition process may assist in promoting quality of midwifery education programs world-wide, but cannot take the place of formal national accreditation. In addition, a recognition process will not be feasible for many institutions without additional resources, such as financial support or competent evaluators. In order to achieve quality midwifery education through a global recognition process the authors present 5 Essential Challenges for Quality Midwifery Education. Quality midwifery education is vital for establishing a competent workforce, and improving maternal and newborn health. Defining a global recognition process could be instrumental in moving toward this goal, but dealing with the identified challenges will be essential. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

A compact CCD-monitored atomic force microscope with optical vision and improved performances.

PubMed

Mingyue, Liu; Haijun, Zhang; Dongxian, Zhang

2013-09-01

A novel CCD-monitored atomic force microscope (AFM) with optical vision and improved performances has been developed. Compact optical paths are specifically devised for both tip-sample microscopic monitoring and cantilever's deflection detecting with minimized volume and optimal light-amplifying ratio. The ingeniously designed AFM probe with such optical paths enables quick and safe tip-sample approaching, convenient and effective tip-sample positioning, and high quality image scanning. An image stitching method is also developed to build a wider-range AFM image under monitoring. Experiments show that this AFM system can offer real-time optical vision for tip-sample monitoring with wide visual field and/or high lateral optical resolution by simply switching the objective; meanwhile, it has the elegant performances of nanometer resolution, high stability, and high scan speed. Furthermore, it is capable of conducting wider-range image measurement while keeping nanometer resolution. Copyright © 2013 Wiley Periodicals, Inc.

Methodology for analyzing environmental quality indicators in a dynamic operating room environment.

PubMed

Gormley, Thomas; Markel, Troy A; Jones, Howard W; Wagner, Jennifer; Greeley, Damon; Clarke, James H; Abkowitz, Mark; Ostojic, John

2017-04-01

Sufficient quantities of quality air and controlled, unidirectional flow are important elements in providing a safe building environment for operating rooms. To make dynamic assessments of an operating room environment, a validated method of testing the multiple factors influencing the air quality in health care settings needed to be constructed. These include the following: temperature, humidity, particle load, number of microbial contaminants, pressurization, air velocity, and air distribution. The team developed the name environmental quality indicators (EQIs) to describe the overall air quality based on the actual measurements of these properties taken during the mock surgical procedures. These indicators were measured at 3 different hospitals during mock surgical procedures to simulate actual operating room conditions. EQIs included microbial assessments at the operating table and the back instrument table and real-time analysis of particle counts at 9 different defined locations in the operating suites. Air velocities were measured at the face of the supply diffusers, at the sterile field, at the back table, and at a return grille. The testing protocol provided consistent and comparable measurements of air quality indicators between institutions. At 20 air changes per hour (ACH), and an average temperature of 66.3°F, the median of the microbial contaminants for the 3 operating room sites ranged from 3-22 colony forming units (CFU)/m 3 at the sterile field and 5-27 CFU/m 3 at the back table. At 20 ACH, the median levels of the 0.5-µm particles at the 3 sites were 85,079, 85,325, and 912,232 in particles per cubic meter, with a predictable increase in particle load in the non-high-efficiency particulate air-filtered operating room site. Using a comparison with cleanroom standards, the microbial and particle counts in all 3 operating rooms were equivalent to International Organization for Standardization classifications 7 and 8 during the mock surgical procedures. The EQI protocol was measurable and repeatable and therefore can be safely used to evaluate air quality within the health care environment to provide guidance for operational practices and regulatory requirements. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia.

PubMed

Bazant, Eva; Sarkar, Supriya; Banda, Joseph; Kanjipite, Webby; Reinhardt, Stephanie; Shasulwe, Hildah; Mulilo, Joyce Monica Chongo; Kim, Young Mi

2014-12-20

Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers' work environment and perceived quality of HIV-related care were assessed to complement data of provider performance. The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups. In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.In the multivariate analysis, the intervention group's improvement and the comparison group's decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item "provider lacks confidence in some clinical skills" declined in the intervention group but increased in the comparison group (P = -0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care. The performance and quality improvement intervention implemented at Zambian Defence Forces' health facilities was associated with improvements in providers' perceptions of work environment consistent with the intervention's focus on commodities, skills acquisition, and receipt of constructive feedback.

Parylene-coated ionic liquid-carbon nanotube actuators for user-safe haptic devices.

PubMed

Bubak, Grzegorz; Gendron, David; Ceseracciu, Luca; Ansaldo, Alberto; Ricci, Davide

2015-07-22

Simple fabrication, high power-to-weight and power-to-volume ratios, and the ability to operate in open air at low voltage make the ionic electroactive polymer actuators highly attractive for haptic applications. Whenever a direct tactile stimulation of the skin is involved, electrical and chemical insulation as well as a long-term stability of the actuator are required. Because of its inherent physicochemical properties such as high dielectric strength, resistance to solvents, and biological inactivity, Parylene C meets the requirements for making biocompatible actuators. We have studied the displacement and the generated force of Parylene-coated carbon nanotube actuators as well as the encapsulation quality. A 2 μm coating creates an effective electrical insulation of the actuators without altering the blocking force at frequencies from 50 mHz to 1 Hz. Moreover, the generated strain is preserved at higher frequencies (from 0.5 to 5 Hz). We employed a simple mechanical model to explain the relation between the key parameters-flexural stiffness, displacement, and force-for uncoated and coated actuators. In addition, we demonstrated that our Parylene-coated actuators are not damaged by rinsing in liquid media such as 2-propanol or water. In conclusion, our results indicate that Parylene C encapsulated actuators are safe to touch and can be used in contact with human skin and in biomedical applications in direct contact with tissues and physiological fluids.

Aquatic Life Criteria - Ammonia

EPA Pesticide Factsheets

Documents related to EPA's final 2013 Aquatic Life Ambient Water Quality Criteria for Ammonia (Freshwater). These documents pertain to the safe levels of Ammonia in water that should protect to the majority of species.

Aquatic Life Criteria - Copper

EPA Pesticide Factsheets

Documents pertain to Aquatic Life Ambient Water Quality criteria for Copper (2007 Freshwater, 2016 Estuarine/marine). These documents contain the safe levels of Copper in water that should protect to the majority of species.

Aquatic Life Criterion - Selenium

EPA Pesticide Factsheets

Documents pertaining to the 2016 Acute and Chronic Ambient Aquatic Life Water Quality Criteria for Selenium (Freshwater). These documents include what the safe levels of Selenium are in water for the majority of species.

78 FR 35936 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-14

... to, laboratory information systems, quality management systems and bioinformatics; (3) ensures a safe working environment in NCIRD laboratories; and (4) collaborates effectively with other centers and offices...

Nutrition support teams: how they work, are set up and maintained

PubMed Central

Nightingale, Jeremy

2010-01-01

Safe cost effective nutritional support is provided by a multidisciplinary team whose activity is overseen by a Nutrition Steering Group that reports directly to the Hospital Trust Board. When a nutrition support team (NST) is first formed, a nutrition nurse specialist enables parenteral nutrition to be given safely. An NST needs to have a clearly agreed scope of practice and needs to be able to justify its presence in terms of quality and cost savings. PMID:28839571

Setting priorities for safe motherhood interventions in resource-scarce settings.

PubMed

Prata, Ndola; Sreenivas, Amita; Greig, Fiona; Walsh, Julia; Potts, Malcolm

2010-01-01

Guide policy-makers in prioritizing safe motherhood interventions. Three models (LOW, MED, HIGH) were constructed based on 34 sub-Saharan African countries to assess the relative cost-effectiveness of available safe motherhood interventions. Cost and effectiveness data were compiled and inserted into the WHO Mother Baby Package Costing Spreadsheet. For each model we assessed the percentage in maternal mortality reduction after implementing all interventions, and optimal combinations of interventions given restricted budgets of US$ 0.50, US$ 1.00, US$ 1.50 per capital maternal health expenditures respectively for LOW, MED, and HIGH models. The most cost-effective interventions were family planning and safe abortion (fpsa), antenatal care including misoprostol distribution for postpartum hemorrhage prevention at home deliveries (anc-miso), followed by sepsis treatment (sepsis) and facility-based postpartum hemorrhage management (pph). The combination of interventions that avert the greatest number of maternal deaths should be prioritized and expanded to cover the greatest number of women at risk. Those which save the most number of lives in each model are 'fpsa, anc-miso' and 'fpsa, sepsis, safe delivery' for LOW; 'fpsa, anc-miso' and 'fpsa, sepsis, safe delivery' for MED; and 'fpsa, anc-miso, sepsis, eclampsia treatment, safe delivery' for HIGH settings. Safe motherhood interventions save a significant number of newborn lives.

Prevention of firearm injuries with gun safety devices and safe storage: an Eastern Association for the Surgery of Trauma systematic review.

PubMed

Violano, Pina; Bonne, Stephanie; Duncan, Thomas; Pappas, Peter; Christmas, A Britton; Dennis, Andrew; Goldberg, Stephanie; Greene, Wendy; Hirsh, Michael; Shillinglaw, William; Robinson, Bryce; Crandall, Marie

2018-03-08

Over 50,000 homicides and suicides occur each year. An estimated half of all U.S. households are believed to have a firearm present, making them one of the most ubiquitous consumer products. Our goal was to determine if the manner of storage of a firearm in a home could potentially make a difference in the outcomes of intentional and unintentional injuries involving a firearm; specifically addressing the use of gun safes and devices that block/disable firearm function (trigger locks, cable locks, etc.). A comprehensive review of the literature was performed. We used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology to assess the breadth and quality of the data specific to our PICO (Population, Intervention, Comparator, Outcomes) questions. A total of 176 studies were initially identified, then 120 more added after a subsequent, literature review with 97 removed as duplicates. One hundred and ninety-one case reports, case series, and reviews were removed because they did not focus on prevention or did not address our comparators of interest. This left a total of two studies which merited inclusion for PICO #1, should gun locks be used to prevent firearm injuries and six studies which merited inclusion for PICO #2, should safe storage for guns be used to prevent firearm injuries. PICO 1: We conditionally recommend that gun locks be used to prevent unintentional firearm injury.PICO 2: Because of the large effect size and the reasonable quality of available evidence with safe storage of firearms, we recommend safe storage prevent firearm-related injuries. Systematic review, level III.

Continental United States Military Housing Inspections Southeast

DTIC Science & Technology

2015-09-24

and safety, including focus on mold, asbestos , radon, lead-based paint, drinking water quality, and pest management. We conducted this inspection in...electrical system safety inspections. In addition, we inspected to EPA standards governing safe drinking water and toxic substances, radon, asbestos , and...inspections focused on mold, asbestos , radon, lead-based paint, drinking water quality, and pest management. We evaluated the associated plans and

Safe Drinking Water and Satisfaction with Environmental Quality of Life in Some Oil and Gas Industry Impacted Cities of Nigeria

ERIC Educational Resources Information Center

Ejechi, E. O.; Ejechi, B. O.

2008-01-01

The availability and safety of drinking water and the environmental quality of life was investigated in five cities located in an oil-producing area of Nigeria using questionnaire-based scales, discussion and laboratory tests. Polythene-packaged sachet water and commercial and non-commercial private boreholes largely met the drinking water…

How Safe? The Status of State Efforts To Protect Children in Child Care.

ERIC Educational Resources Information Center

Adams, Gina

Based on the view that strong state child care licensing policies can influence the quality of child care and thereby enhance children's health and development, this report examines the status of state efforts to improve the quality of child care programs. Almost all data were collected for a 1993 Parenting Magazine survey, and were verified by…

How Collaborative Governance Can Facilitate Quality Learning for Sustainability in Cities: A Comparative Case Study of Bristol, Kitakyushu and Tongyeong

ERIC Educational Resources Information Center

Ofei-Manu, Paul; Didham, Robert J.; Byun, Won Jung; Phillips, Rebecca; Dickella Gamaralalage, Premakumara Jagath; Rees, Sian

2018-01-01

Quality learning for sustainability can have a transformative effect in terms of promoting empowerment, leadership and wise investments in individual and collective lives and regenerating the local economies of cities, making them more inclusive, safe, resilient and sustainable. It can also help cities move towards achieving the United Nations…

$1.2 Billion Investment Needed in 2017 to Implement CCDBG Reauthorization

ERIC Educational Resources Information Center

Center for Law and Social Policy, Inc. (CLASP), 2016

2016-01-01

The Child Care and Development Block Grant (CCDBG) is the primary source of federal funding for child care subsidies for low-income families and to improve child care quality for all children. Quality child care enables parents to work or go to school while providing children with safe and enriching environments where they can learn and thrive.…

Climate, Clams, and a Changing Watershed: A time series analysis to quantify the impact of management and climate on water quality in the Potomac Estuary

EPA Science Inventory

The Potomac River is the largest tributary of the Chesapeake Bay and has been a key study site in water quality research, beginning with work to address public health concerns such as safe drinking water and waterborne disease during periods of population growth and urbanization ...

Drinking Water Quality Status and Contamination in Pakistan

PubMed Central

Nafees, Muhammad; Rizwan, Muhammad; Bajwa, Raees Ahmad; Shakoor, Muhammad Bilal; Arshad, Muhammad Umair; Chatha, Shahzad Ali Shahid; Deeba, Farah; Murad, Waheed; Malook, Ijaz

2017-01-01

Due to alarming increase in population and rapid industrialization, drinking water quality is being deteriorated day by day in Pakistan. This review sums up the outcomes of various research studies conducted for drinking water quality status of different areas of Pakistan by taking into account the physicochemical properties of drinking water as well as the presence of various pathogenic microorganisms. About 20% of the whole population of Pakistan has access to safe drinking water. The remaining 80% of population is forced to use unsafe drinking water due to the scarcity of safe and healthy drinking water sources. The primary source of contamination is sewerage (fecal) which is extensively discharged into drinking water system supplies. Secondary source of pollution is the disposal of toxic chemicals from industrial effluents, pesticides, and fertilizers from agriculture sources into the water bodies. Anthropogenic activities cause waterborne diseases that constitute about 80% of all diseases and are responsible for 33% of deaths. This review highlights the drinking water quality, contamination sources, sanitation situation, and effects of unsafe drinking water on humans. There is immediate need to take protective measures and treatment technologies to overcome unhygienic condition of drinking water supplies in different areas of Pakistan. PMID:28884130

Drinking Water Quality Status and Contamination in Pakistan.

PubMed

Daud, M K; Nafees, Muhammad; Ali, Shafaqat; Rizwan, Muhammad; Bajwa, Raees Ahmad; Shakoor, Muhammad Bilal; Arshad, Muhammad Umair; Chatha, Shahzad Ali Shahid; Deeba, Farah; Murad, Waheed; Malook, Ijaz; Zhu, Shui Jin

2017-01-01

Due to alarming increase in population and rapid industrialization, drinking water quality is being deteriorated day by day in Pakistan. This review sums up the outcomes of various research studies conducted for drinking water quality status of different areas of Pakistan by taking into account the physicochemical properties of drinking water as well as the presence of various pathogenic microorganisms. About 20% of the whole population of Pakistan has access to safe drinking water. The remaining 80% of population is forced to use unsafe drinking water due to the scarcity of safe and healthy drinking water sources. The primary source of contamination is sewerage (fecal) which is extensively discharged into drinking water system supplies. Secondary source of pollution is the disposal of toxic chemicals from industrial effluents, pesticides, and fertilizers from agriculture sources into the water bodies. Anthropogenic activities cause waterborne diseases that constitute about 80% of all diseases and are responsible for 33% of deaths. This review highlights the drinking water quality, contamination sources, sanitation situation, and effects of unsafe drinking water on humans. There is immediate need to take protective measures and treatment technologies to overcome unhygienic condition of drinking water supplies in different areas of Pakistan.

Association between health worker motivation and healthcare quality efforts in Ghana.

PubMed

Alhassan, Robert Kaba; Spieker, Nicole; van Ostenberg, Paul; Ogink, Alice; Nketiah-Amponsah, Edward; de Wit, Tobias F Rinke

2013-08-14

Ghana is one of the sub-Saharan African countries making significant progress towards universal access to quality healthcare. However, it remains a challenge to attain the 2015 targets for the health related Millennium Development Goals (MDGs) partly due to health sector human resource challenges including low staff motivation. This paper addresses indicators of health worker motivation and assesses associations with quality care and patient safety in Ghana. The aim is to identify interventions at the health worker level that contribute to quality improvement in healthcare facilities. The study is a baseline survey of health workers (n = 324) in 64 primary healthcare facilities in two regions in Ghana. Data collection involved quality care assessment using the SafeCare Essentials tool, the National Health Insurance Authority (NHIA) accreditation data and structured staff interviews on workplace motivating factors. The Spearman correlation test was conducted to test the hypothesis that the level of health worker motivation is associated with level of effort by primary healthcare facilities to improve quality care and patient safety. The quality care situation in health facilities was generally low, as determined by the SafeCare Essentials tool and NHIA data. The majority of facilities assessed did not have documented evidence of processes for continuous quality improvement and patient safety. Overall, staff motivation appeared low although workers in private facilities perceived better working conditions than workers in public facilities (P <0.05). Significant positive associations were found between staff satisfaction levels with working conditions and the clinic's effort towards quality improvement and patient safety (P <0.05). As part of efforts towards attainment of the health related MDGs in Ghana, more comprehensive staff motivation interventions should be integrated into quality improvement strategies especially in government-owned healthcare facilities where working conditions are perceived to be the worst.

Wildfire and the future of water supply.

PubMed

Bladon, Kevin D; Emelko, Monica B; Silins, Uldis; Stone, Micheal

2014-08-19

In many parts of the world, forests provide high quality water for domestic, agricultural, industrial, and ecological needs, with water supplies in those regions inextricably linked to forest health. Wildfires have the potential to have devastating effects on aquatic ecosystems and community drinking water supply through impacts on water quantity and quality. In recent decades, a combination of fuel load accumulation, climate change, extensive droughts, and increased human presence in forests have resulted in increases in area burned and wildfire severity-a trend predicted to continue. Thus, the implications of wildfire for many downstream water uses are increasingly concerning, particularly the provision of safe drinking water, which may require additional treatment infrastructure and increased operations and maintenance costs in communities downstream of impacted landscapes. A better understanding of the effects of wildfire on water is needed to develop effective adaptation and mitigation strategies to protect globally critical water supplies originating in forested environments.

A Review of the Poultry Meat Production Industry for Food Safety in Indonesia

NASA Astrophysics Data System (ADS)

Wahyono, N. D.; Utami, M. M. D.

2018-01-01

Poultry meat is an indispensable source of animal protein in human growth and development, so it is in great demand by people all over the world. Poultry meat has several advantages, namely the quality of nutrition is good enough, delicious taste, relatively affordable price, easy to get and accepted all levels of society with diverse backgrounds. The era of globalization requires competitive products, such as chicken meat in Indonesia, the current chicken meat industry is not only based on high production capacity and decreased production costs but also chicken products are safe to eat. As a consequence of trade liberalization, the poultry industry faces the threat of competition with cheaper products with better quality. The food safety of chicken meat starts from the farm, processing process until consumed. Food safety is a requirement of food products that must be handled by involving government, industry and consumers.

Behavioral Health Information Technology: From Chaos To Clarity.

PubMed

Ranallo, Piper A; Kilbourne, Amy M; Whatley, Angela S; Pincus, Harold Alan

2016-06-01

The use of health information technology (IT) in general health care has been shown to have significant potential to facilitate the delivery of safe, high-quality, and cost-effective care. However, its application to behavioral health care has been slow, limiting the extent to which consumers seeking care for mental health or substance use disorders can derive its benefits. The goal of this article is to provide an overview of the use of health IT in behavioral health and to describe some unique challenges experienced in that domain. We also highlight current obstacles to, and recommendations for, the use of health IT in improving the quality of behavioral health care. We conclude with recommendations for prioritizing the work that we believe will move the US health care system toward more effective, efficient, and patient-centric care in behavioral health. Project HOPE—The People-to-People Health Foundation, Inc.

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.

Modeling the improvement of ultrafiltration membrane mass transfer when using biofiltration pretreatment in surface water applications.

PubMed

Netcher, Andrea C; Duranceau, Steven J

2016-03-01

In surface water treatment, ultrafiltration (UF) membranes are widely used because of their ability to supply safe drinking water. Although UF membranes produce high-quality water, their efficiency is limited by fouling. Improving UF filtrate productivity is economically desirable and has been attempted by incorporating sustainable biofiltration processes as pretreatment to UF with varying success. The availability of models that can be applied to describe the effectiveness of biofiltration on membrane mass transfer are lacking. In this work, UF water productivity was empirically modeled as a function of biofilter feed water quality using either a quadratic or Gaussian relationship. UF membrane mass transfer variability was found to be governed by the dimensionless mass ratio between the alkalinity (ALK) and dissolved organic carbon (DOC). UF membrane productivity was optimized when the biofilter feed water ALK to DOC ratio fell between 10 and 14. Copyright © 2015 Elsevier Ltd. All rights reserved.

"Targeting to zero" in pediatric oncology: a review of central venous catheter-related bloodstream infections.

PubMed

Secola, Rita; Lewis, Mary Ann; Pike, Nancy; Needleman, Jack; Doering, Lynn

2012-01-01

Reducing or eliminating hospital acquired infections is a national quality of care priority. The majority of the 12,400 children diagnosed with cancer each year require long-term intravenous access to receive intensive and complex therapies. These children are at high risk for infection by nature of their disease and treatment, which often involves use of a central venous catheter (CVC). Throughout the nation, nurses assume frontline responsibility for safe, quality CVC care to minimize the risk of potentially life-threatening infections. Substantial financial and human costs are associated with CVC-related bloodstream infections, including prolonged hospital lengths of stay and increased care required to treat these infections. The purpose of this review of the literature is to summarize existing adult and pediatric data on CVC-related bloodstream infections and explore nursing models of CVC care that may improve pediatric oncology patient outcomes.

Effect of high pressure pasteurization on bacterial load and bioactivity of Echinacea purpurea.

PubMed

Chen, Xiu-Min; Hu, Chun; Raghubeer, Errol; Kitts, David D

2010-09-01

High hydrostatic pressure (HHP) technology was applied to organic Echinacea purpurea (E. purpurea) roots and flowers to determine the feasibility of using this technology for cold herb pasteurization, to produce microbiologically safe and shelf-stable products for the natural health products (NHPs) industry. HHP significantly (P < 0.01) reduced microbial contamination in both roots and flowers without affecting the phytochemical retention of chicoric and chlorogenic acids, and total alkamide contents. The antioxidant activity of E. purpurea methanol-derived extracts, evaluated in both chemical (2,2'-azino-bis(3-ethylbenzthiazoline-6-sulphonic acid) [ABTS] and oxygen radical absorption capacity [ORAC] assay) and in cell culture models (RAW264, 7 macrophage, H(2)O(2)-induced intracellular oxidation, and lipopolysaccharide [LPS]-induced nitric oxide production), was not adversely affected by the application of HHP at both 2 and 5 min at 600 mPa. Furthermore, HHP did not affect the capacity of E. purpurea extracts to suppress nitric oxide production in LPS-activated macrophage cells. Therefore, our results show that HHP is an effective pasteurization process treatment to reduce microbial-contamination load while not adversely altering chemical and bioactive function of active constituents present in organic E. purpurea. Our study reports for the first time, the effectiveness of using high hydrostatic pressure (HHP) technology pressure to pasteurize E. purpurea root and flower, and the comparative retention of bioactive phytochemicals. Therefore, this technique can be used in food and natural health product industries to produce high-quality, microbiologically safe, and shelf-stable products.

The quest for safe drinking water: an example from Guinea-Bissau (West Africa).

PubMed

Bordalo, Adriano A; Savva-Bordalo, Joana

2007-07-01

While humans require water for life, one-sixth of our species lives without access to safe water. In Africa, the situation is particularly acute because of global warming, the progression of the Sahara desert, civil unrest and poor governance, population growth, migration and poverty. In rural areas, the lack of adequate safe water and sanitary infrastructures leaves millions with doubtful water quality, increasing the harshness of daily life. In this paper, a pilot study was conducted during the wet season on Bolama Island (Guinea-Bissau, West Africa), a UNESCO Man and the Biosphere Reserve. Twenty-eight shallow wells, supplying water to most of the population, were sampled for microbiological, physical and chemical water quality characteristics. A ten-parameter water quality index (WQI) adapted to tropical conditions was applied to compare the different wells. About 79% of the wells showed moderate to heavy fecal contamination. From the surveyed parameters, it was found that chemical contamination was less important, although all samples were acidic, with the pH averaging 5.12+/-0.08. The WQI was 43+/-4% (0%-worst; 100%-best quality), showing that the water from the majority of wells was polluted but should be suitable for domestic use after appropriate treatment. At the onset of the wet season, diarrhea represented 11.5% of all medical cases, 92.5% of which were children aged <15. This paper suggests inexpensive steps to reduce the fecal contamination and control the pH in order to increase the potability of the well water and, concomitantly, to raise the living standards of the population in one of the poorest countries of the world.

Defining Swallowing-Related Quality of Life Profiles in Individuals with Amyotrophic Lateral Sclerosis

PubMed Central

Gaziano, Joy; Watts, Stephanie; Robison, Raele; Plowman, Emily K.

2016-01-01

Although it is known that dysphagia contributes to significant malnutrition, pneumonia, and mortality in amyotrophic lateral sclerosis (ALS), it remains unclear how swallowing impairment impacts quality of life in this vulnerable patient population. The aim of the current study was to (1) delineate swallow-related quality of life (SR-QOL) profiles in individuals with ALS and (2) evaluate relationships between SR-QOL, degree of swallowing impairment, and ALS global disease progression. Eighty-one ALS patients underwent a standardized videofluoroscopic swallow study and completed the swallowing quality of life (SWAL-QOL) instrument and ALS functional rating scale-revised (ALSFRS-R). Penetration Aspiration Scale (PAS) scores were derived by a blinded rater. Correlation analyses and a between groups ANOVA (safe vs. penetrators vs. aspirators) were performed. Mean SWAL-QOL score for this cohort was 75.94 indicating a moderate degree of SR-QOL impairment with fatigue, eating duration, and communication representing the most affected domains. Correlations were revealed between the SWAL-QOL and (1) PAS (r = −0.39, p < 0.001) and (2) ALSFRS-R (r = 0.23, p < 0.05). Mean (SD) SWAL-QOL scores for safe versus penetrator versus aspirator groups were 81.2 (2.3) versus 77 (3.4) versus 58.7 (5.9), respectively, with a main effect observed [F(2,78) = 9.71, p < 0.001]. Post hoc testing revealed lower SWAL-QOL scores for aspirators versus safe swallowers (p < 0.001) and aspirators versus penetrators (p < 0.001). Overall, SR-QOL was moderately reduced in this cohort of ALS patients and profoundly impacted in ALS aspirators and individuals with advanced disease. These findings highlight the importance of early multidisciplinary intervention to not only avoid malnutrition, weight loss, and pulmonary sequelae but also the associated reduced QOL seen in these individuals. PMID:26837611

Post-industrial river water quality-Fit for bathing again?

PubMed

Kistemann, Thomas; Schmidt, Alexandra; Flemming, Hans-Curt

2016-10-01

For the Ruhr River, bathing has been prohibited for decades. However, along with significant improvements of the hygienic water quality, there is an increasing demand of using the river for recreational purposes, in particular for bathing. In the "Safe Ruhr" interdisciplinary research project, demands, options and chances for lifting the bathing ban for the Ruhr River were investigated. As being the prominent reason for persisting recreational restrictions, microbiological water quality was in the focus of interest. Not only the faecal indicator organisms (FIOs) as required by the European Bathing Water Directive were considered, but also pathogens such as Salmonella, Pseudomonas aeruginosa, Legionella pneumophila, Campylobacter, Leptospira, enteroviruses and protozoan parasites. In this introductory paper, we firstly relate current recreational desires to historical experiences of river bathing. After recapitulating relevant microbial river contamination sources (predominantly sewage treatment plants, combined sewer overflows, and surface runoffs), we review existing knowledge about the relationships of FIOs and pathogens in rivers designated for recreational purposes, and then trace the evolution, rationale and validity of recreational freshwater quality criteria which are, despite obvious uncertainties, mostly relying on the FIO paradigm. In particular, the representativeness of FIOs is critically discussed. The working programme of Safe Ruhr, aiming at initiating and facilitating a process towards legalisation of Ruhr River bathing, is outlined. Sources of contamination can be technically handled which leaves the actual measures to political decisions. As contaminations are transient, only occasionally exceeding legal limits, a flexible bathing site management, warning bathers of non-safe situations, may amend technical interventions and offer innovative solutions. As a result, a situation-adapted system for lifting of the bathing ban for Ruhr River appears realistic. Copyright © 2016 Elsevier GmbH. All rights reserved.

A Pilot Project Demonstrating that Combat Medics Can Safely Administer Parenteral Medications in the Emergency Department.

PubMed

Schauer, Steven G; Cunningham, Cord W; Fisher, Andrew D; DeLorenzo, Robert A

2017-12-01

Introduction Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration. Project Design This was a quality assurance project that monitored training of combat medics to administer parenteral medications and to ensure patient safety. Combat medics were provided training that included direct supervision during medication administration. Once proficiency was demonstrated, combat medics would prepare the medications under direct supervision, followed by indirect supervision during administration. As part of the quality assurance and safety processes, combat medics were required to document all medication administrations, supervising provider, and unexpected adverse events. Additional quality assurance follow-up occurred via complete chart review by the project lead. Data During the project period, the combat medics administered the following medications: ketamine (n=13), morphine (n=8), ketorolac (n=7), fentanyl (n=5), ondansetron (n=4), and other (n=6). No adverse events or patient safety events were reported by the combat medics or discovered during the quality assurance process. In this limited case series, combat medics safely administered parenteral medications under indirect provider supervision. Future research is needed to further develop this training model for both the military and civilian setting. Schauer SG , Cunningham C W, Fisher AD , DeLorenzo RA . A pilot project demonstrating that combat medics can safely administer parenteral medications in the emergency department. Prehosp Disaster Med. 2017;32(6):679-681.

Supplemental Upward Lighting from Underneath to Obtain Higher Marketable Lettuce (Lactuca sativa) Leaf Fresh Weight by Retarding Senescence of Outer Leaves

PubMed Central

Zhang, Geng; Shen, Shanqi; Takagaki, Michiko; Kozai, Toyoki; Yamori, Wataru

2015-01-01

Recently, the so-called “plant factory with artificial lighting” (PFAL) approach has been developed to provide safe and steady food production. Although PFALs can produce high-yielding and high-quality plants, the high plant density in these systems accelerates leaf senescence in the bottom (or outer) leaves owing to shading by the upper (or inner) leaves and by neighboring plants. This decreases yield and increases labor costs for trimming. Thus, the establishment of cultivation methods to retard senescence of outer leaves is an important research goal to improve PFAL yield and profitability. In the present study, we developed an LED lighting apparatus that would optimize light conditions for PFAL cultivation of a leafy vegetable. Lettuce (Lactuca sativa L.) was hydroponically grown under white, red, or blue LEDs, with light provided from above (downward), with or without supplemental upward lighting from underneath the plant. White LEDs proved more appropriate for lettuce growth than red or blue LEDs, and the supplemental lighting retarded the senescence of outer leaves and decreased waste (i.e., dead or low-quality senescent leaves), leading to an improvement of the marketable leaf fresh weight. PMID:26697055

Review of NASA approach to space radiation risk assessments for Mars exploration.

PubMed

Cucinotta, Francis A

2015-02-01

Long duration space missions present unique radiation protection challenges due to the complexity of the space radiation environment, which includes high charge and energy particles and other highly ionizing radiation such as neutrons. Based on a recommendation by the National Council on Radiation Protection and Measurements, a 3% lifetime risk of exposure-induced death for cancer has been used as a basis for risk limitation by the National Aeronautics and Space Administration (NASA) for low-Earth orbit missions. NASA has developed a risk-based approach to radiation exposure limits that accounts for individual factors (age, gender, and smoking history) and assesses the uncertainties in risk estimates. New radiation quality factors with associated probability distribution functions to represent the quality factor's uncertainty have been developed based on track structure models and recent radiobiology data for high charge and energy particles. The current radiation dose limits are reviewed for spaceflight and the various qualitative and quantitative uncertainties that impact the risk of exposure-induced death estimates using the NASA Space Cancer Risk (NSCR) model. NSCR estimates of the number of "safe days" in deep space to be within exposure limits and risk estimates for a Mars exploration mission are described.

Supplemental Upward Lighting from Underneath to Obtain Higher Marketable Lettuce (Lactuca sativa) Leaf Fresh Weight by Retarding Senescence of Outer Leaves.

PubMed

Zhang, Geng; Shen, Shanqi; Takagaki, Michiko; Kozai, Toyoki; Yamori, Wataru

2015-01-01

Recently, the so-called "plant factory with artificial lighting" (PFAL) approach has been developed to provide safe and steady food production. Although PFALs can produce high-yielding and high-quality plants, the high plant density in these systems accelerates leaf senescence in the bottom (or outer) leaves owing to shading by the upper (or inner) leaves and by neighboring plants. This decreases yield and increases labor costs for trimming. Thus, the establishment of cultivation methods to retard senescence of outer leaves is an important research goal to improve PFAL yield and profitability. In the present study, we developed an LED lighting apparatus that would optimize light conditions for PFAL cultivation of a leafy vegetable. Lettuce (Lactuca sativa L.) was hydroponically grown under white, red, or blue LEDs, with light provided from above (downward), with or without supplemental upward lighting from underneath the plant. White LEDs proved more appropriate for lettuce growth than red or blue LEDs, and the supplemental lighting retarded the senescence of outer leaves and decreased waste (i.e., dead or low-quality senescent leaves), leading to an improvement of the marketable leaf fresh weight.

Aquatic Life Criterion - Selenium Documents

EPA Pesticide Factsheets

Documents pertaining to the 2016 Acute and Chronic Ambient Aquatic Life Water Quality Criteria for Selenium (Freshwater). These documents include what the safe levels of Selenium are in water for the majority of species.

Systematic review to evaluate the safety, efficacy and economical outcomes of the Vibrant Soundbridge for the treatment of sensorineural hearing loss.

PubMed

Bruchhage, Karl-Ludwig; Leichtle, Anke; Schönweiler, Rainer; Todt, Ingo; Baumgartner, Wolf-Dieter; Frenzel, Henning; Wollenberg, Barbara

2017-04-01

Introduced in the late 90s, the active middle ear implant Vibrant Soundbridge (VSB) is nowadays used for hearing rehabilitation in patients with mild to severe sensorineural hearing loss (SNHL) unable to tolerate conventional hearing aids. In experienced hands, the surgical implantation is fast done, safe and highly standardized. Here, we present a systematic review, after more than 15 years of application, to determine the efficacy/effectiveness and cost-effectiveness, as well as patient satisfaction with the VSB active middle ear implant in the treatment of mild to severe SNHL. A systematic search of electronic databases, investigating the safety and effectiveness of the VSB in SNHL plus medical condition resulted in a total of 1640 papers. After removing duplicates, unrelated articles, screening against inclusion criteria and after in-depth screening, the number decreased to 37 articles. 13 articles were further excluded due to insufficient outcome data. 24 studies remained to be systematically reviewed. Data was searched on safety, efficacy and economical outcomes with the VSB. Safety-oriented outcomes included complication/adverse event rates, damage to the middle/inner ear, revision surgery/explant rate/device failure and mortality. Efficacy outcomes were divided into audiological outcomes, including hearing thresholds, functional gain, speech perception in quiet and noise, speech recognition thresholds, real ear insertion gain and subjective outcomes determined by questionnaires and patient-oriented scales. Data related to quality of life (QALY, ICER) were considered under economical outcomes. The VSB turns out to be a highly reliable and a safe device which significantly improves perception of speech in noisy situations with a high sound quality. In addition, the subjective benefit of the VSB was found to be mostly significant in all studies. Finally, implantation with the VSB proved to be a cost-effective and justified health care intervention.

Nurse training with simulation: an innovative approach to teach complex microsurgery patient care.

PubMed

Flurry, Mitchell; Brooke, Sebastian; Micholetti, Brett; Natoli, Noel; Moyer, Kurtis; Mnich, Stephanie; Potochny, John

2012-10-01

Simulation has become an integral part of education at all levels within the medical field. The ability to allow personnel to practice and learn in a safe and controlled environment makes it a valuable tool for initial training and continued competence verification. An area of specific interest to the reconstructive microsurgeon is assurance that the nursing staff has adequate training and experience to provide optimum care for microsurgery patients. Plastic surgeons in institutions where few microsurgeries are performed face challenges teaching nurses how to care for these complex patients. Because no standard exists to educate microsurgery nurses, learning often happens by chance on-the-job encounters. Outcomes, therefore, may be affected by poor handoffs between inexperienced personnel. Our objective is to create a course that augments such random clinical experience and teaches the knowledge and skills necessary for successful microsurgery through simulated patient scenarios. Quality care reviews at our institution served as the foundation to develop an accredited nursing course providing clinical training for the care of microsurgery patients. The course combined lectures on microsurgery, pharmacology, and flap monitoring as well as simulated operating room, surgical intensive care unit, postanesthesia care unit, Trauma Bay, and Floor scenarios. Evaluation of participants included precourse examination, postcourse examination, and a 6-month follow-up. Average test scores were 72% precourse and 92% postcourse. Educational value, effectiveness of lectures and simulation, and overall course quality was rated very high or high by 86% of respondents; 0% respondents rated it as low. Six-month follow-up test score average was 88%. Learning to care for microsurgery patients should not be left to chance patient encounters on the job. Simulation provides a safe, reproducible, and controlled clinical experience. Our results show that simulation is a highly rated and effective way to teach nurses microsurgery patient care. Simulated patient care training should be considered to augment the clinical experience in hospitals where microsurgery is performed.

Assessment of secondhand smoke in international airports in Thailand, 2013.

PubMed

Kungskulniti, Nipapun; Charoenca, Naowarut; Peesing, Jintana; Trangwatana, Songwut; Hamann, Stephen; Pitayarangsarit, Siriwan; Chitanondh, Hatai

2015-11-01

To assess secondhand smoke (SHS) exposure in Thai international airports using a fine particulate indicator, particulate matter ≤2.5 μm (PM2.5), and to compare with 2012 exposure findings in international airports in the USA. Smoking rooms in the four largest international airports that serve the most travellers and with the most operating designated smoking rooms (DSRs) were monitored using PM2.5 monitoring equipment following an approved research protocol for assessing fine particle pollution from tobacco smoke. Monitoring was conducted inside and just outside DSRs and throughout the airport terminals in all four airports. Altogether 104 samples were taken to assess SHS exposure in four airports. Simultaneous samples were taken multiple times in a total of 11 DSRs available for sampling in the research period. Levels of PM2.5 in DSRs were extremely high in all four airports and were more dangerous inside DSRs than in the US airports (overall mean=532.5 vs 188.7 µg/m(3)), higher outside DSRs than in the US airports (overall mean=50.1 vs 43.7 µg/m(3)), and at comparable levels with the US airports in the terminals away from DSRs (overall mean=13.8 vs 11.5 µg/m(3). Findings show that travellers and employees in or near DSRs in the airports assessed in Thailand are being exposed to even higher levels of SHS than in US airports that still have DSRs. Extremely high levels of SHS in and adjacent to DSR show that these rooms are not providing safe air quality for employees and travellers. These high levels of exposure are above those levels reported in US airports and show the need for remedial action to ensure safe air quality in international airports in Thailand. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A review on grain and nut deterioration and design of the dryers for safe storage with special reference to Turkish hazelnuts.

PubMed

Ozilgen, M; Ozdemir, M

2001-01-01

Turkey produces about 80% of the total hazelnut crop of the world. About 75% of the production are exported. In Turkey hazelnuts are traditionally sun dried, and may be subject to mold growth and subsequent mycotoxin formation due to prolonged drying time under humid and rainy weather conditions. Drying hazelnuts in a reasonable time after harvest is necessary for mycotoxin-free, high-quality products. In general, nuts and cereals contaminated by the toxins pose a potential hazard not only to the people of the producer countries, but also to people of the importing countries, if they should be regarded as safe by inefficient sampling plans, therefore preventing toxin formation actually benefits very large populations. Deterioration and health hazards associated with toxin contaminated hazelnuts and other nuts and cereals have similar causes and consequences; therefore, deterioration of the nuts and cereals in storage has been reviewed by considering as many grains and nuts as possible, then special reference was made to hazelnuts. Proper preharvest practices followed by proper drying and safe storage reduces the hazards associated with contamination by the toxins. This article reviews the pre- and post-harvest practices, and the grain- and nut-drying systems required for toxin-free products. Because drying is the major unit operation involving this process, the drying systems and the mathematical models required for their design is also discussed.

World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia.

PubMed

Gelb, Adrian W; Morriss, Wayne W; Johnson, Walter; Merry, Alan F; Abayadeera, Anuja; Belîi, Natalia; Brull, Sorin J; Chibana, Aline; Evans, Faye; Goddia, Cyril; Haylock-Loor, Carolina; Khan, Fauzia; Leal, Sandra; Lin, Nan; Merchant, Richard; Newton, Mark W; Rowles, Jackie S; Sanusi, Arinola; Wilson, Iain; Velazquez Berumen, Adriana

2018-06-01

The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a nonprofit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document.

World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia.

PubMed

Gelb, Adrian W; Morriss, Wayne W; Johnson, Walter; Merry, Alan F

2018-05-07

The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a non-profit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document.

High Blood Pressure and Cold Remedies: Which Are Safe?

MedlinePlus

... counter cold remedies safe for people who have high blood pressure? Answers from Sheldon G. Sheps, M.D. Over- ... remedies aren't off-limits if you have high blood pressure, but it's important to make careful choices. Among ...

Coastal Fishermen as Lifesavers While Sailing at High Speed: A Crossover Study

PubMed Central

Fungueiriño-Suárez, Ramón; Martínez-Isasi, Santiago; Fernández-Méndez, Felipe; González-Salvado, Violeta; Navarro-Patón, Rubén; Rodríguez-Núñez, Antonio

2018-01-01

Purpose Starting basic cardiopulmonary resuscitation (CPR) early improves survival. Fishermen are the first bystanders while at work. Our objective was to test in a simulated scenario the CPR quality performed by fishermen while at port and while navigating at different speeds. Methods Twenty coastal fishermen were asked to perform 2 minutes of CPR (chest compressions and mouth-to-mouth ventilations) on a manikin, in three different scenarios: (A) at port on land, (B) on the boat floor sailing at 10 knots, and (C) sailing at 20 knots. Data was recorded using quality CPR software, adjusted to current CPR international guidelines. Results The quality of CPR (QCPR) was significantly higher at port (43% ± 10) than sailing at 10 knots (30% ± 15; p = 0.01) or at 20 knots (26% ± 12; p = 0.001). The percentage of ventilation that achieved some lung insufflation was also significantly higher when CPR was done at port (77% ± 14) than while sailing at 10 knots (59% ± 18) or 20 knots (57% ± 21) (p = 0.01). Conclusion In the event of drowning or cardiac arrest on a small boat, fishermen should immediately start basic CPR and navigate at a relatively high speed to the nearest port if the sea conditions are safe. PMID:29854735

Remote Sensing and GIS for Landuse/Landcover Classification and Water Quality in the Northern Ireland

NASA Astrophysics Data System (ADS)

Amer, R.; Ofterdinger, U.; Ruffell, A.; Donald, A.

2012-04-01

This study presents landuse/landcover (LULC) classifications of Northern Ireland in order to quantify land-use types driving chemical loading in the surface water bodies. The major LULC classes are agricultural land, bare land (mountainous areas), forest, urban areas, and water bodies. Three ENVISAT ASAR multi-look precision images acquired in 2011 and two Enhanced Thematic Mapper Plus (ETM+) acquired in 2003 were used for classification. The ASAR digital numbers were converted to backscattering coefficient (sigma nought) and enhanced using adaptive Gamma filter and Gaussian stretch. Supervised classifications of Maximum Likelihood, Mahalanobils Distance, Minimum Distance, Spectral Angel Mapper, Parallelepiped, and Winner Tercat were applied on ETM+ and ASAR images. A confusion matrix was used to evaluate the classification accuracy; the best results of ETM+ and ASAR were given by the winner classification (82.9 and 73.6 %), and maximum likelihood (81.7 and 72.5 %), respectively. Change detection was applied to identify the areas of significant changes in landuse/landcover over the last eight years. The Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) digital elevation model was processed to extract the drainage systems and watersheds. Water quality data of the first and second order streams were extracted from 2005 survey by Geological Survey of Northern Ireland. GIS spatially distributed modelling generated maps showing the distribution of phosphorus (P), nitrate (NO3), dissolved organic carbon (DOC), and some of the trace elements including fluoride (F), calcium (Ca), aluminium (Al), iron (Fe), copper (Cu), lead (Pb), zinc (Zn), and arsenic (As) across the watersheds of the Northern Ireland were generated. The distribution of these elements was evaluated against the LULC classes and bed rock geology. Concentration of these elements was classified into normal (safe level), moderate, high, and very high based on the World Health Organization (WHO, 2011) water quality standards. The results show that P concentration is generally high across all the watersheds. NO3 is within normal range in all watersheds. DOC is within normal range in urban areas, moderate to high in agricultural lands, and high in the forest areas and bare lands. F and Fe are within safe level in all watersheds. Al, Cu, and As are high in all watersheds around the bare land LULC class which are underlain by psammite and semipelite metamorphic rocks. Ca is within normal range in most of watersheds but it is high in the south western part of the study area because of the presence of limestone bedrock. Pb and Zn are within normal range in the urban and most of the agricultural land, and high in the mountainous areas underlain by psammite and semipelite metamorphic bed rock.

Preferences for infant delivery site among pregnant women and new mothers in Northern Karnataka, India.

PubMed

Bruce, Sharon G; Blanchard, Andrea K; Gurav, Kaveri; Roy, Anuradha; Jayanna, Krishnamurthy; Mohan, Haranahalli L; Ramesh, Banadakoppa M; Blanchard, James F; Moses, Stephen; Avery, Lisa

2015-02-27

The National Rural Health Mission (NRHM) of India aims to increase the uptake of safe and institutional delivery among rural communities to improve maternal, neonatal and child health (MNCH) outcomes. Previous studies in India have found that while there have been increasing numbers of institutional deliveries there are still considerable barriers to utilization and quality of services, particularly in rural areas, that may mitigate improvements achieved by MNCH interventions. This paper aims to explore the factors influencing preference for home, public or private hospital delivery among rural pregnant and new mothers in three northern districts of Karnataka state, South India. In-depth qualitative interviews were conducted in 2010 among 110 pregnant women, new mothers (infants born within past 3 months), their husbands and mothers-in-law. Interviews were conducted in the local language (Kannada) and then translated to English for analysis. The interviews of pregnant women and new mothers were used for analysis to ultimately develop broader themes around definitions of quality care from the perspective of service users, and the influence this had on their delivery site preferences. Geographical and financial access were important barriers to accessing institutional delivery services in all districts, and among those both above and below the poverty line. Access issues of greatest concern were high costs at private institutions, continuing fees at public hospitals and the inconsistent receipt of government incentives. However, views on quality of care that shaped delivery site preferences were deeply rooted in socio-cultural expectations for comfortable, respectful and safe care that must ultimately be addressed to change negative perceptions about institutional, and particularly public hospital, care at delivery. In the literature, quality of care beyond access has largely been overlooked in favour of support for incentives on the demand side, and more trained doctors, facilities and equipment on the supply side. Taking a comprehensive approach to quality of care in line with cultural values and community needs is imperative for improving experiences, utilization, and ultimately maternal and neonatal health outcomes at the time of delivery.

Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes.

PubMed

Colberg, Sheri R; Albright, Ann L; Blissmer, Bryan J; Braun, Barry; Chasan-Taber, Lisa; Fernhall, Bo; Regensteiner, Judith G; Rubin, Richard R; Sigal, Ronald J

2010-12-01

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes mellitus (T2DM), many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay T2DM, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower T2DM risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes, and safe and effective practices for PA with diabetes-related complications.

Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement.

PubMed

Colberg, Sheri R; Sigal, Ronald J; Fernhall, Bo; Regensteiner, Judith G; Blissmer, Bryan J; Rubin, Richard R; Chasan-Taber, Lisa; Albright, Ann L; Braun, Barry

2010-12-01

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.

SU-G-JeP3-08: Robotic System for Ultrasound Tracking in Radiation Therapy

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

Kuhlemann, I; Graduate School for Computing in Medicine and Life Sciences, University of Luebeck; Jauer, P

Purpose: For safe and accurate real-time tracking of tumors for IGRT using 4D ultrasound, it is necessary to make use of novel, high-end force-sensitive lightweight robots designed for human-machine interaction. Such a robot will be integrated into an existing robotized ultrasound system for non-invasive 4D live tracking, using a newly developed real-time control and communication framework. Methods: The new KUKA LWR iiwa robot is used for robotized ultrasound real-time tumor tracking. Besides more precise probe contact pressure detection, this robot provides an additional 7th link, enhancing the dexterity of the kinematic and the mounted transducer. Several integrated, certified safety featuresmore » create a safe environment for the patients during treatment. However, to remotely control the robot for the ultrasound application, a real-time control and communication framework has to be developed. Based on a client/server concept, client-side control commands are received and processed by a central server unit and are implemented by a client module running directly on the robot’s controller. Several special functionalities for robotized ultrasound applications are integrated and the robot can now be used for real-time control of the image quality by adjusting the transducer position, and contact pressure. The framework was evaluated looking at overall real-time capability for communication and processing of three different standard commands. Results: Due to inherent, certified safety modules, the new robot ensures a safe environment for patients during tumor tracking. Furthermore, the developed framework shows overall real-time capability with a maximum average latency of 3.6 ms (Minimum 2.5 ms; 5000 trials). Conclusion: The novel KUKA LBR iiwa robot will advance the current robotized ultrasound tracking system with important features. With the developed framework, it is now possible to remotely control this robot and use it for robotized ultrasound tracking applications, including image quality control and target tracking.« less

Drinking Water State Revolving Fund (DWSRF)

EPA Pesticide Factsheets

This website provides information on financial assistance to water systems needing capitalization grants and/or technical assistance to improve the quality of drinking water and for the delivery of safe drinking water to consumers.

Aquatic Life Criteria - Tributyltin (TBT)

EPA Pesticide Factsheets

Documents pertaining to 2004 Final Acute and Chronic Ambient Aquatic Life Water Quality Criteria for Tributyltin (TBT) for freshwater and saltwater. These documents include the safe levels of TBT that should protect the majority of species.

Aquatic Life Criteria - Cadmium

EPA Pesticide Factsheets

Documents pertaining to 2016 Acute and Chronic Aquatic Life Ambient Water Quality Criteria for Cadmium (Freshwater, Estuarine/marine). These documents contain the safe levels of Cadmium in water that should protect to the majority of species.

Aquatic Life Criteria - Atrazine

EPA Pesticide Factsheets

Documents pertaining to Acute and Chronic Ambient Water Quality Aquatic Life Criteria for Atrazine (Freshwater and Salt Water). This document contains the safe levels of Atrazine in water that should protect to the majority of species.

Aquatic Life Criteria - Cadmium Documents

EPA Pesticide Factsheets

Documents pertaining to 2016 Acute and Chronic Aquatic Life Ambient Water Quality Criteria for Cadmium (Freshwater, Estuarine/marine). These documents contain the safe levels of Cadmium in water that should protect the majority of species.

美国国家环境保护局 - 中文 (简体版)

EPA Pesticide Factsheets

Environmental information translated into Simplified Chinese includes air quality, drinking water and fish consumption, pesticides and toxic substances, women's health, diabetes, safe waste disposal, and environmental justice.

Aquatic Life Criteria - Carbaryl

EPA Pesticide Factsheets

Documents pertaining to 2012 Final National Recommended Aquatic Life Ambient Water Quality Criteria for Carbaryl (Freshwater, Estuarine/marine). These documents contain the safe levels of Carbaryl in water that should protect to the majority of species.

40 CFR 255.10 - Criteria for identifying regions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... volume of waste to support the goals and objectives of the State plan, including materials or energy... designated in accordance with the Safe Drinking Water Act, and with air quality planning agencies designated...

40 CFR 255.10 - Criteria for identifying regions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... volume of waste to support the goals and objectives of the State plan, including materials or energy... designated in accordance with the Safe Drinking Water Act, and with air quality planning agencies designated...

40 CFR 255.10 - Criteria for identifying regions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... volume of waste to support the goals and objectives of the State plan, including materials or energy... designated in accordance with the Safe Drinking Water Act, and with air quality planning agencies designated...

Efficient preparation of graphene liquid cell utilizing direct transfer with large-area well-stitched graphene

NASA Astrophysics Data System (ADS)

Sasaki, Yuki; Kitaura, Ryo; Yuk, Jong Min; Zettl, Alex; Shinohara, Hisanori

2016-04-01

By utilizing graphene-sandwiched structures recently developed in this laboratory, we are able to visualize small droplets of liquids in nanometer scale. We have found that small water droplets as small as several tens of nanometers sandwiched by two single-layer graphene are frequently observed by TEM. Due to the electron beam irradiation during the TEM observation, these sandwiched droplets are frequently moving from one place to another and are subjected to create small bubbles inside. The synthesis of a large area single-domain graphene of high-quality is essential to prepare the graphene sandwiched cell which safely encapsulates the droplets in nanometer size.

EBT Fidelity Trajectories Across Training Cohorts Using the Interagency Collaborative Team Strategy

PubMed Central

Hecht, Debra; Aarons, Greg; Fettes, Danielle; Hurlburt, Michael; Ledesma, Karla

2015-01-01

The Interdisciplinary Collaborative Team (ICT) strategy uses front-line providers as adaptation, training and quality control agents for multi-agency EBT implementation. This study tests whether an ICT transmits fidelity to subsequent provider cohorts. SafeCare was implemented by home visitors from multiple community-based agencies contracting with child welfare. Client-reported fidelity trajectories for 5,769 visits, 957 clients and 45 providers were compared using three-level growth models. Provider cohorts trained and live-coached by the ICT attained benchmark fidelity after 12 weeks, and this was sustained. Hispanic clients reported high cultural competency, supporting a cultural adaptation crafted by the ICT. PMID:25586878

EBT Fidelity Trajectories Across Training Cohorts Using the Interagency Collaborative Team Strategy.

PubMed

Chaffin, Mark; Hecht, Debra; Aarons, Greg; Fettes, Danielle; Hurlburt, Michael; Ledesma, Karla

2016-03-01

The Interdisciplinary Collaborative Team (ICT) strategy uses front-line providers as adaptation, training and quality control agents for multi-agency EBT implementation. This study tests whether an ICT transmits fidelity to subsequent provider cohorts. SafeCare was implemented by home visitors from multiple community-based agencies contracting with child welfare. Client-reported fidelity trajectories for 5,769 visits, 957 clients and 45 providers were compared using three-level growth models. Provider cohorts trained and live-coached by the ICT attained benchmark fidelity after 12 weeks, and this was sustained. Hispanic clients reported high cultural competency, supporting a cultural adaptation crafted by the ICT.

Prophylatic treatment of migraine and migraine clinical variants with topiramate: an update

PubMed Central

Carmona, Sergio; Bruera, Osvaldo

2009-01-01

Migraine and migraine variants are common, chronic and incapacitating neurovascular disorders with a high impact on health resources. There is an extensive evidence base provided by double-blind, placebo-controlled trials showing that topiramate is a safe, effective and well tolerated drug in the management of migraine and its variants, being especially promising in the management of migraine-vertigo syndrome. Models both in the US and the UK have also shown that it offers a cost benefit when direct and indirect costs are evaluated, by reducing work loss, improving quality of life and reducing the use of increasingly scarce health resources. PMID:19707282

[Healing with art?].

PubMed

Kühlmann, A Y R Rosalie; Jeekel, J Hans; Pierik, E G J M Robert

2015-01-01

Music and other forms of art are increasingly being integrated into hospitals. As well as the aesthetic value of art, more and more attention is being paid to its contribution to the healing of the patient. Scientific research indicates the possible benefits of specific art in healthcare facilities. Using this knowledge of the role and employability of surroundings and art in the healing of patients may be complementary to the high quality of care in the Netherlands. By means of proper, methodologically correct research, it is possible to investigate the use of different aspects of the patient's environment as simple, safe and low-cost measures in improving health and well-being of patients.

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.

Service Dogs in the Perioperative Setting.

PubMed

Levey, Janet A; Chappy, Sharon L

2017-04-01

Service dogs are critical for the independence of individuals with disabilities because they assist with daily living activities and help these individuals navigate society. Perioperative nurses need a working knowledge of disability laws pertaining to service dogs to provide patient-centered care for individuals using service dogs. This article provides information on the Americans With Disabilities Act regulations regarding service dogs, makes recommendations for the care of patients with service dogs across the perioperative continuum, and offers policy directives to ensure that safe, high-quality care is delivered to patients using service dogs. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Coal/rock interface detection by sensitized pick, part A

NASA Technical Reports Server (NTRS)

Wu, P. T. K.; Erkes, J. W.

1981-01-01

In order to increase the operating margins of the detector for safe, reliable operation under difficult in-mine conditions the transmitted signal strength was increased to provide additional signal margin for in-mine conditions and the transmitter section was redesigned to reduce frequency pulling of the transmitter frequency with variations in antenna load. The linearity of the pick load SCO signal with true pick load was increased, and hysteresis effects were minimized. The sensitized pick hardware was ruggedized for rough inmine use. The sensitized pick and telemetry system provided excellent, high quality signals proportional to cutting load under all conditions experienced during testing.

New technology in electrophysiology: FDA process and perspective.

PubMed

Selzman, Kimberly A; Fellman, Mark; Farb, Andrew; de Del Castillo, Sergio; Zuckerman, Bram

2016-10-01

The Food and Drug Administration (FDA) is a large regulatory agency that monitors everything from food, tobacco, and veterinary medicine to pharmaceutical drugs and medical devices. The Mission statement of the CDRH, one of the Centers of the FDA, in its most succinct form is to protect and promote public health. This is accomplished through timely and continued access to safe, effective, and high quality medical devices. This paper aims to review the overarching principles of the Agency's review process for cardiac devices as well as highlight some of the newer programs that FDA has engaged in to facilitate innovation, device development, research, and timely market approval.

"Know Your Well" A Groundwater Quality Project to Inform Students and Well-Owners

NASA Astrophysics Data System (ADS)

Olson, C.; Snow, D.; Samal, A.; Ray, C.; Kreifels, M.

2017-12-01

Over 15 million U.S. households rely on private, household wells for drinking water, and these sources are not protected under the Safe Drinking Water Act. Data on private well water quality is slowly being collected and evaluated from a number of different agencies, sources and projects. A new project is designed both for training high school students and to help assess the quality of water from rural domestic wells in Nebraska. This "crowd sourced" program engaging high school agricultural education programs, FFA chapters, and science classes with students sampling and testing water sampling from rural domestic wells from 12 districts across the state. Students and teachers from selected school were trained through multiple school visits, both in the classroom and in the field. Classroom visits were used to introduce topics such as water quality and groundwater, and testing methods for specific analytes. During the field visit, students were exposed to field techniques, the importance of accuracy in data collection, and what factors might influence the water in sampled wells. High school students learn to sample and test water independently. Leadership and initiative is developed through the program, and many experience the enlightenment that comes with citizen science. A customized mobile app was developed for ease of data entry and visualization, and data uploaded to a secure website where information was stored and compared to laboratory tests of the same measurements. General water quality parameters, including pH, electrical conductivity, major anions are tested in the field and laboratory, as well as environmental contaminants such as arsenic, uranium, pesticides, bacteria. Test kits provided to each class were used by the students to measure selected parameters, and then duplicate water samples were analyzed at a university laboratory. Five high schools are involved in the project during its first year. Nitrate, bacteria and pesticides represent major concerns for private well owners across the U.S. and preliminary results indicate that nitrate concentrations can range up to 70 mg/L, while detections of bacteria and traces of pesticide residues are consistent with other studies. This project will help both high school students and private well owner become better-informed about water quality in Nebraska.

Does improved access to water supply by rural households enhance the concept of safe water at the point of use? A case study from deep rural South Africa.

PubMed

Jagals, P

2006-01-01

The concept of safe water is defined by three principles: the health-related quality must be suitable, the supply/source must be accessible and the water must constantly be available in quantities sufficient for the intended use. If any one (or more) of these three elements is missing from a water services improvement programme, providing safe water is not successfully achieved. A study in a deep rural area in South Africa showed that providing small communities, using untreated river water as their only water source, with good quality water through a piped distribution system and accessible at communal taps did not fall within our parameters of safe water. The parameters for measuring the three principles were: absence of Escherichia coli in drinking water samples; accessibility by improving tap distances to within 200 m from each household; availability by assessing whether households have at least 25 L per person per day. Results show that although E. coli levels were reduced significantly, households were still consuming water with E. coli numbers at non-compliant levels. Access (distance) was improved from an average of 750 m from households to river source to an average of 120 m to new on-tap source points. This did not result in significant increases in household quantities, which on average remained around 18 L per person per day.

Interdisciplinary Team Huddles for Fetal Heart Rate Tracing Review.

PubMed

Thompson, Lisa; Krening, Cynthia; Parrett, Dolores

2018-06-01

To address an increase in unexpected poor outcomes in term neonates, our team developed a goal of high reliability and improved fetal safety in the culture of the Labor and Delivery nursing department. We implemented interdisciplinary reviews of fetal heart rate, along with a Category II fetal heart rate management algorithm and a fetal heart rate assessment rapid response alert to call for unscheduled reviews when needed. Enhanced communication between nurses and other clinicians supported an interdisciplinary approach to fetal safety, and we observed an improvement in health outcomes for term neonates. We share our experience with the intention of making our methods available to any labor and delivery unit team committed to safe, high-quality care and service excellence. Copyright © 2018 AWHONN. Published by Elsevier Inc. All rights reserved.

Effective drinking water collaborations are not accidental: interagency relationships in the international water utility sector.

PubMed

Jalba, D I; Cromar, N J; Pollard, S J T; Charrois, J W; Bradshaw, R; Hrudey, S E

2014-02-01

The role that deficient institutional relationships have played in aggravating drinking water incidents over the last 30 years has been identified in several inquiries of high profile drinking water safety events, peer-reviewed articles and media reports. These indicate that collaboration between water utilities and public health agencies (PHAs) during normal operations, and in emergencies, needs improvement. Here, critical elements of these interagency collaborations, that can be integrated within the corporate risk management structures of water utilities and PHAs alike, were identified using a grounded theory approach and 51 semi-structured interviews with utility and PHA staff. Core determinants of effective interagency relationships are discussed. Intentionally maintained functional relationships represent a key ingredient in assuring the delivery of safe, high quality drinking water. © 2013.

Biomanufacturing of Therapeutic Cells: State of the Art, Current Challenges, and Future Perspectives.

PubMed

Roh, Kyung-Ho; Nerem, Robert M; Roy, Krishnendu

2016-06-07

Stem cells and other functionally defined therapeutic cells (e.g., T cells) are promising to bring hope of a permanent cure for diseases and disorders that currently cannot be cured by conventional drugs or biological molecules. This paradigm shift in modern medicine of using cells as novel therapeutics can be realized only if suitable manufacturing technologies for large-scale, cost-effective, reproducible production of high-quality cells can be developed. Here we review the state of the art in therapeutic cell manufacturing, including cell purification and isolation, activation and differentiation, genetic modification, expansion, packaging, and preservation. We identify current challenges and discuss opportunities to overcome them such that cell therapies become highly effective, safe, and predictively reproducible while at the same time becoming affordable and widely available.

Combining Active Immunization with Monoclonal Antibody Therapy to Facilitate Early Initiation of a Long-acting Anti-methamphetamine Antibody Response

PubMed Central

Hambuchen, Michael D.; Carroll, F. Ivy; Rüedi-Bettschen, Daniela; Hendrickson, Howard P.; Hennings, Leah J.; Blough, Bruce E.; Brieaddy, Lawrence E.; Pidaparthi, Ramakrishna R.; Owens, S. Michael

2015-01-01

We hypothesized that an anti-METH mAb could be used in combination with a METH-conjugate vaccine (MCV) to safely improve the overall quality and magnitude of the anti-METH immune response. The benefits would include immediate onset of action (from the mAb), timely increases in the immune responses (from the combined therapy) and duration of antibody response that could last for months (from the MCV). A novel METH-like hapten (METH-SSOO9) was synthesized and then conjugated to immunocyanin monomers of Keyhole limpet hemocyanin (ICKLH) to create the MCV, ICKLH-SOO9. The vaccine, in combination with previously discovered anti-METH mAb7F9, was then tested in rats for safety and potential efficacy. The combination antibody therapy allowed safe achievement of an early high anti-METH antibody response, which persisted throughout the study. Indeed, even after four months the METH vaccine antibodies still had the capacity to significantly reduce METH brain concentrations resulting from a 0.56 mg/kg METH dose. PMID:25973614

Ionizing radiation regulations and the dental practitioner: 1. The nature of ionizing radiation and its use in dentistry.

PubMed

Rout, John; Brown, Jackie

2012-04-01

Legislation governing the use of ionizing radiation in the workplace and in medical treatment first became law in 1985 and 1988, being superseded by the Ionizing Radiations Regulations 1999 (IRR99) and the Ionizing Radiation (Medical Exposure) Regulations 2000, (IR(ME)R 2000), respectively. This legislation ensures a safe environment in which to work and receive treatment and requires that those involved in the radiographic process must be appropriately trained for the type of radiographic practice they perform. A list of the topics required is detailed in Schedule 2 of IR(ME)R 2000 and is paraphrased in Table 1, with the extent and amount of knowledge required depending on the type of radiographic practice undertaken. Virtually all dental practitioners undertake radiography as part of their clinical practice. Legislation requires that users of radiation, including dentists and members of the dental team, understand the basic principles of radiation physics, hazards and protection, and are able to undertake dental radiography safely with the production of high quality, diagnostic images.

Determination of Volatiles by Odor Activity Value and Phenolics of cv. Ayvalik Early-Harvest Olive Oil

PubMed Central

Guclu, Gamze; Sevindik, Onur; Kelebek, Hasim; Selli, Serkan

2016-01-01

Ayvalik is an important olive cultivar producing high quality oils in Turkey. In the present study, volatile and phenolic compositions of early-harvest extra virgin olive oil (cv. Ayvalik) were determined. The solvent-assisted flavor evaporation (SAFE) technique was used for the extraction of volatile components. The aromatic extract obtained by SAFE was representative of the olive oil odor. A total of 32 aroma compounds, including alcohols, aldehydes, terpenes, esters, and an acid, were identified in the olive oil. Aldehydes and alcohols were qualitatively and quantitatively the most dominant volatiles in the oil sample. Of these, six volatile components presented odor activity values (OAVs) greater than one, with (Z)-3-hexenal (green), hexanal (green-sweet) and nonanal (fatty-pungent) being those with the highest OAVs in olive oil. A total of 14 phenolic compounds were identified and quantified by liquid chromatography combined with a diode array detector and ion spray mass spectrometry. The major phenolic compounds were found as 3,4-DHPEA-EDA, 3,4-DHPEA-EA and p-HPEA-EDA. PMID:28231141

Intermittent aortic cross-clamping for isolated CABG can save lives and money: experience with 15307 patients.

PubMed

Boethig, D; Minami, K; Lueth, J-U; El-Banayosy, A; Breymann, T; Koerfer, R

2004-06-01

The ideal myocardial protection during isolated CABG is still a matter of debate. Cardioplegia versus intermittent aortic cross-clamping (IACC) are the main opponents; the following article shows that IACC can be safe, efficient and might be cheaper than cardioplegia. Demographics and co-morbidities of 15307 CABG only patients consecutively operated on between January 1993 and October 2001 in the Heart Center in Bad Oeynhausen were assessed by the German Quality Assurance data set and risk-stratified using the EuroSCORE. Outcome (30-day or in-hospital mortality) was compared to the expected EuroSCORE estimation. Expected mortality was 3.25 %, observed mortality was 1.3 %, being significantly lower in the low, medium as well as high risk patients subgroup. Complication rates increased steadily with expected mortality rates. Stroke and myocardial infarction rates for patients with peripheral vessel disease were not higher than in comparable studies. More than 1000000 EUR were saved by lower cardioplegia bills. Myocardial protection with intermittent aortic cross-clamping for isolated CABG can be safe, effective, and economically advantageous when compared to cardioplegic solutions.

Competent Psychopharmacology

PubMed Central

Gardner, David M

2014-01-01

There is little doubt that undergraduate and post-graduate training of physicians, pharmacists, and nurses is insufficient to prepare them to use psychotropics safely and effectively, especially in the context of their expanded off-label uses. Therefore, the development of competencies in psychotropic prescribing needs to be approached as a long-term, practice-based learning commitment. Proposed are the abilities and knowledge components necessary for safe and effective use of psychotropics. Typical challenges in prescribing for chronic and recurrent illnesses include highly variable responses and tolerability, drug interactions, and adverse effects that can be serious, irreversible, and even fatal. Prescribing psychotropics is further complicated by negative public and professional reports and growing patient concerns about the quality of care, and questions about the efficacy, safety, and addictive risks of psychotropics. Increased efforts are needed to enhance clinical training and knowledge in psychopharmacology among trainees and practising clinicians, with more comprehensive and sustained attention to the assessment of individual patients, and greater reliance on patient education and collaboration. Improved competence in psychotropic prescribing should lead to more informed, thoughtful, and better-targeted applications as one component of more comprehensive clinical care. PMID:25161064

Evidence-based risk assessment and recommendations for physical activity: arthritis, osteoporosis, and low back pain.

PubMed

Chilibeck, Philip D; Vatanparast, Hassanali; Cornish, Stephen M; Abeysekara, Saman; Charlesworth, Sarah

2011-07-01

We systematically reviewed the safety of physical activity (PA) for people with arthritis, osteoporosis, and low back pain. We searched PubMed, MEDLINE, Sport Discus, and the Cochrane Central Register of Controlled Trials (1966 through March 2008) for relevant articles on PA and adverse events. A total of 111 articles met our inclusion criteria. The incidence for adverse events during PA was 3.4%-11% (0.06%-2.4% serious adverse events) and included increased joint pain, fracture, and back pain for those with arthritis, osteoporosis, and low back pain, respectively. Recommendations were based on the Appraisal of Guidelines for Research and Evaluation, which applies Levels of Evidence based on type of study ranging from high-quality randomized controlled trials (Level 1) to anecdotal evidence (Level 4) and Grades from A (strong) to C (weak). Our main recommendations are that (i) arthritic patients with highly progressed forms of disease should avoid heavy load-bearing activities, but should participate in non-weight-bearing activities (Level 2, Grade A); and (ii) patients with osteoporosis should avoid trunk flexion (Level 2, Grade A) and powerful twisting of the trunk (Level 3, Grade C); (iii) patients with acute low back pain can safely do preference-based PA (i.e., PA that does not induce pain), including low back extension and flexion (Level 2, Grade B); (iv) arthritic patients with stable disease without progressive joint damage and patients with stable osteoporosis or low back pain can safely perform a variety of progressive aerobic or resistance-training PAs (Level 2, Grades A and B). Overall, the adverse event incidence from reviewed studies was low. PA can safely be done by most individuals with musculoskeletal conditions.

Report: risk factors associated with treatment of mixed municipal solid waste in the Indian context.

PubMed

Nema, Asit

2009-12-01

Across India, all small and large urban local bodies (ULB) alike are grappling with the problem of municipal solid waste (MSW), which has reached critical dimensions because of, among others, rapidly increasing quantities and complex characteristics, inadequate regulation, lack of awareness, concern and cooperation on the part of the urban residents, limited resources for collection, transport and safe disposal, and limited expertise on the part of the ULBs. A number of ULBs have attempted to address the two-fold constraint of resources and land by setting up treatment plants under the premise of generating revenue and reducing liability of safe disposal. Over the last three decades, under the paradigms of converting 'waste to energy' and 'waste to wealth' various technologies have been tried out, however time and again it is seen that irrespective of the technology, MSW treatment plants run in to difficulties and/or close down. The issues do not pertain just to technology but are systemic and encompass project development, feedstock delivery system including quality and quantity, climate, high life-cycle costs, low value realization on outputs and adverse environmental and social impacts. With such a wide range of risk factors, experience has shown that the probability of manifestation of any one of them or a combination thereof at one or the other stages of the project is quite high. Investment in a mixed MSW treatment plant therefore can not deliver positive financial returns, rather it can become a non-performing asset without even guaranteeing the desired environmental and public health benefits. This paper therefore argues for the adoption of a robust, elastic and most forgiving option of sanitary landfill as a dependable and safe disposal system for MSW.

Once-daily USL255 as adjunctive treatment of partial-onset seizures: Randomized phase III study

PubMed Central

Chung, Steve S; Fakhoury, Toufic A; Hogan, R Edward; Nagaraddi, Venkatesh N; Blatt, Ilan; Lawson, Balduin; Arnold, Stephan; Anders, Bob; Clark, Annie M; Laine, Dawn; Meadows, R Shawn; Halvorsen, Mark B

2014-01-01

Objective To evaluate the efficacy and safety of USL255, Qudexy™ XR (topiramate) extended-release capsules, as an adjunctive treatment for refractory partial-onset seizures (POS) in adults taking one to three concomitant antiepileptic drugs. Methods In this global phase III study (PREVAIL; NCT01142193), 249 adults with POS were randomized 1:1 to once-daily USL255 (200 mg/day) or placebo. The primary and key secondary efficacy endpoints were median percent reduction in weekly POS frequency and responder rate (proportion of patients with ≥50% reduction in seizure frequency). Seizure freedom was also assessed. Safety (adverse events, clinical and laboratory findings), as well as treatment effects on quality of life (QOLIE-31-P) and clinical global impression of change (CGI-C), were evaluated. Results Across the entire 11-week treatment phase, USL255 significantly reduced the median percent seizure frequency and significantly improved responder rate compared with placebo. Efficacy over placebo was observed early in treatment, in patients with highly refractory POS, and in those with the most debilitating seizure types (i.e., complex partial, partial secondarily generalized). USL255 was safe and generally well tolerated with a low incidence of neurocognitive adverse events. USL255 was associated with significant clinical improvement without adversely affecting quality of life. Significance The PREVAIL phase III clinical study demonstrated that once-daily USL255 (200 mg/day) significantly improved seizure control and was safe and generally well tolerated with few neurocognitive side effects. PMID:24902983

Environmental health in China: challenges to achieving clean air and safe water

PubMed Central

Zhang, Junfeng (Jim); Mauzerall, Denise L.; Zhu, Tong; Liang, Song; Ezzati, Majid; Remais, Justin

2014-01-01

The health effects of environmental risks, especially those of air and water pollution, remain a major source of morbidity and mortality in China. Biomass fuel and coal are routinely burned for cooking and heating in almost all rural and many urban households resulting in severe indoor air pollution that contributes greatly to the burden of disease. Many communities lack access to safe drinking water and santiation, and thus the risk of waterborne disease in many regions remains high. At the same time, China is rapidly industrializing with associated increases in energy use and industrial waste. While economic growth resulting from industrialization has improved health and quality of life indicators in China, it has also increased the incidence of environmental disasters and the release of chemical toxins into the environment, with severe impacts on health. Air quality in China's cities is among the worst in the world and industrial water pollution has become a widespread health hazard. Moreover, emissions of climate-warming greenhouse gases from energy use are rapidly increasing. Global climate change will inevitably intensify China's environmental health problems, with potentially catastrophic outcomes from major shifts in temperature and precipitation. Facing the overlap of traditional, modern, and emerging environmental problems, China has committed substantial resources to environmental improvement. China has the opportunity to both address its national environmental health challenges and to assume a central role in the international effort to improve the global environment. PMID:20346817

From unwanted pregnancy to safe abortion: Sharing information about abortion in Asia through animation.

PubMed

Krishnan, Shweta; Dalvie, Suchitra

2015-05-01

Although unsafe abortion continues to be a leading cause of maternal mortality in many countries in Asia, the right to safe abortion remains highly stigmatized across the region. The Asia Safe Abortion Partnership, a regional network advocating for safe abortion, produced an animated short film entitled From Unwanted Pregnancy to Safe Abortion to show in conferences, schools and meetings in order to share knowledge about the barriers to safe abortion in Asia and to facilitate conversations on the right to safe abortion. This paper describes the making of this film, its objectives, content, dissemination and how it has been used. Our experience highlights the advantages of using animated films in addressing highly politicized and sensitive issues like abortion. Animation helped to create powerful advocacy material that does not homogenize the experiences of women across a diverse region, and at the same time emphasize the need for joint activities that express solidarity. Copyright © 2015. Published by Elsevier Ltd.

The Social Work Role in Reducing 30-Day Readmissions: The Effectiveness of the Bridge Model of Transitional Care.

PubMed

Alvarez, Renae; Ginsburg, Jacob; Grabowski, Jessica; Post, Sharon; Rosenberg, Walter

2016-04-01

The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components-care coordination, case management, and patient engagement-which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment's emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.

Thermal Catalytic Oxidation of Airborne Contaminants by a Reactor Using Ultra-Short Channel Length, Monolithic Catalyst Substrates

NASA Technical Reports Server (NTRS)

Perry, J. L.; Tomes, K. M.; Tatara, J. D.

2005-01-01

Contaminated air, whether in a crewed spacecraft cabin or terrestrial work and living spaces, is a pervasive problem affecting human health, performance, and well being. The need for highly effective, economical air quality processes spans a wide range of terrestrial and space flight applications. Typically, air quality control processes rely on absorption-based processes. Most industrial packed-bed adsorption processes use activated carbon. Once saturated, the carbon is either dumped or regenerated. In either case, the dumped carbon and concentrated waste streams constitute a hazardous waste that must be handled safely while minimizing environmental impact. Thermal catalytic oxidation processes designed to address waste handling issues are moving to the forefront of cleaner air quality control and process gas decontamination processes. Careful consideration in designing the catalyst substrate and reactor can lead to more complete contaminant destruction and poisoning resistance. Maintenance improvements leading to reduced waste handling and process downtime can also be realized. Performance of a prototype thermal catalytic reaction based on ultra-short waste channel, monolith catalyst substrate design, under a variety of process flow and contaminant loading conditions, is discussed.

Molecular genetics external quality assessment pilot scheme for KRAS analysis in metastatic colorectal cancer.

PubMed

Deans, Zandra C; Tull, Justyna; Beighton, Gemma; Abbs, Stephen; Robinson, David O; Butler, Rachel

2011-11-01

Laboratories are increasingly required to perform molecular tests for the detection of mutations in the KRAS gene in metastatic colorectal cancers to allow better clinical management and more effective treatment for these patients. KRAS mutation status predicts a patient's likely response to the monoclonal antibody cetuximab. To provide a high standard of service, these laboratories require external quality assessment (EQA) to monitor the level of laboratory output and measure the performance of the laboratory against other service providers. National External Quality Assurance Services for Molecular Genetics provided a pilot EQA scheme for KRAS molecular analysis in metastatic colorectal cancers during 2009. Very few genotyping errors were reported by participating laboratories; however, the reporting nomenclature of the genotyping results varied considerably between laboratories. The pilot EQA scheme highlighted the need for continuing EQA in this field which will assess the laboratories' ability not only to obtain accurate, reliable results but also to interpret them safely and correctly ensuring that the referring clinician has the correct information to make the best clinical therapeutic decision for their patient.

The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices

PubMed Central

Moon, Rachel Y.; Hauck, Fern R.; Colson, Eve R.; Kellams, Ann L.; Geller, Nicole L.; Heeren, Timothy; Kerr, Stephen M.; Drake, Emily E.; Tanabe, Kawai; McClain, Mary; Corwin, Michael J.

2017-01-01

IMPORTANCE Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. OBJECTIVE To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. DESIGN, SETTING, AND PARTICIPANTS Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. INTERVENTIONS All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. MAIN OUTCOMES AND MEASURES The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. RESULTS Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%–11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4% [95% CI, 9.3%–15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8% [95% CI, 8.1%–15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7% [95% CI, 3.9%–13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position. CONCLUSIONS AND RELEVANCE Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01713868 PMID:28742913

Addressing disparities and achieving equity: cultural competence, ethics, and health-care transformation.

PubMed

Betancourt, Joseph R; Corbett, James; Bondaryk, Matthew R

2014-01-01

The passage of health-care reform and current efforts in payment reform signal the beginning of a significant transformation of the US health-care system. An entire new set of structures is being developed to facilitate increased access to care that is cost-effective and of high quality. As described in The Institute of Medicine report "Crossing the Quality Chasm," our nation is charting a path toward quality health care that aims to be safe, efficient, effective, timely, patient-centered, and equitable. As our health-care system rapidly undergoes dramatic transformation, several truths-and challenges-remain. First, racial and ethnic disparities in health care persist and are a clear sign of inequality in quality. Second, although the root causes for these disparities are complex, there exists a well-developed set of evidence-based approaches to address them; among these is improving the cultural competence of health-care providers and the health-care system. Third, as part of our care redesign, we must assure that we are prepared to meet the ethical challenges ahead and reassert the importance of equity, fairness, and caring as key building blocks of a new care delivery system. As we move ahead, it is critical to assure that our health-care system is culturally competent and has the capacity to deliver high-quality care for all, while eliminating disparities and assuring equity. Disparities are unjust, unethical, costly, and unacceptable-and integrating strategies to achieve equity as part of our health-care system's transformation will give us an incredible opportunity to comprehensively address them.

Probiotic use in at-risk populations.

PubMed

Sanders, Mary Ellen; Merenstein, Daniel J; Ouwehand, Arthur C; Reid, Gregor; Salminen, Seppo; Cabana, Michael D; Paraskevakos, George; Leyer, Gregory

To inform health care providers about quality standards for manufacture of probiotic products being recommended for at-risk patient populations. Probiotics are used in a variety of clinical settings, sometimes in at-risk populations for therapeutic endpoints. Although probiotics might not be approved as drugs, they are sometimes used for the prevention or treatment of disease. In the United States, and many regions of the world, probiotic products are marketed as dietary supplements (not drugs) and are therefore subject to different manufacturing and quality control standards than approved drugs are. Health care providers need to be assured that probiotic products used in at-risk populations are safe for this use. Pharmacists should require certificates of analysis, which document quality standards, from manufacturers of products stocked in hospital formularies or other pharmacies dispensing to at-risk people. Although responsible manufacturers use stringent quality standards on their processes and finished products, using a third party to verify compliance with manufacturing and accuracy of product labeling adds assurance to end users that the product is of high quality. It is in patients' best interest to use probiotics in the prevention and treatment of conditions when the evidence is convincing. To protect high-risk patients, probiotic products should meet stringent microbiological standards. Product testing results should be available for review before recommending probiotic products to at-risk individuals. For products used in at-risk populations, manufacturers should provide this information or participate in a third-party verification program that certifies compliance. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.